The hidden curriculum of academic GP training: pressure, balance, and personal development

Over 50 Academic Clinical Fellows (ACF) undertake Integrated Academic Training in General Practice (GP) annually. A formal curriculum for this programme is in place. Underneath formal curricula lie hidden curricula, which students learn without being formally taught. Although this is well documented in undergraduate medical education, the hidden curriculum for academic trainees is relatively unexplored. We sought to discover the perceived hidden curriculum for ACFs to inform programme improvement.A questionnaire exploring experiences was sent to all 56 GP ACFs in London, Kent, Surrey, and Sussex and responses were thematically analysed. These themes informed a topic guide for a focus group held online with five (9%) participants, chosen through opportunity sampling of eligible individuals. Discussion was transcribed and thematically analysed to produce themes and subthemes.From the 18 (32%) survey responses and focus group discussion, four main themes were identified: management of time pressures, unequal valuation of clinical and academic work, personal development, and pressure and support.Overall hidden curriculum learning outcomes were mixed; the programme provided opportunity to develop personal skills, yet trainees gained a perceived belief that academic work is underappreciated, and that time management is challenging. Changes to the programme have been suggested. Whilst this exploratory study was limited to a geographic region of the UK, it is likely similar experiences are shared by all ACFs in GP. It would be useful to extend this work by studying hidden curricula of primary and secondary care ACFs across the UK.