Transforming Professionalism Education in Clerkships: A Student-Driven Approach Utilizing The Hidden Curriculum

Professionalism, influenced by regional context and societal values, is essential in doctor-patient relationships, patient experiences, and clinical outcomes. However, formal education alone fails to cultivate professionalism effectively. Research highlights the hidden curriculum's detrimental impact on medical students' professionalism. Nonetheless, strategies to teach professionalism in specific curriculum areas and to counteract hidden curricula, particularly for clinical clerkships, remain underexplored. This study evaluates a structured, student-led professionalism training program in a clerkship.

Over one year, we implemented and replicated an educational intervention on professionalism in four emergency medicine clerkship groups. Grounded in constructivist and transformative learning theories, the intervention aimed to enhance students' reflective capacities by addressing the hidden curriculum. It included briefing sessions on professionalism models and student-led discussions on clinical cases encountered to uncover implicit lessons. Students' understanding was reinforced through anonymous self- and peer assessments of professionalism traits. The impact was evaluated qualitatively through inductive thematic analysis of student reflections and quantitatively through student feedback based on the Kirkpatrick model.

The training received highly positive evaluations from students. Quantitative analysis showed significant score increases in knowledge and ability (using the Wilcoxon Signed Rank Test). Students demonstrated the ability to reflect on the hidden curriculum and highlighted three key themes: professional attributes, sociocultural context, and system-level factors. Subthemes included communication, empathy, learning commitment, cultural competence, hierarchy, and family engagement.

This study presents a practical clerkship professionalism training model demonstrating that regular case-based discussions and anonymous self- and peer assessments help students identify and reflect on professional behaviors within the hidden curriculum.