They Don't Even Know Your Name: An Intergenerational Modeling Deficit in Patient-Centered Practice

Introduction This study explored how hidden curriculum mechanisms shape patient-centered care (PCC) attitudes among medical students in a Spanish public medical school with minimal formal PCC instruction, and how these mechanisms may be perceived to reproduce themselves when faculty PCC development is limited. Methods We conducted 11 focus groups with 93 medical students (83 third-year preclinical and 10 sixth-year clinical students; the sixth-year group was treated as exploratory). Sessions were audio- and video-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Reporting followed established qualitative research guidelines. Results Five categories were identified: (1) formal curriculum gaps despite sophisticated PCC understanding; (2) disease-centered and paternalistic teaching orientation linked to perceived defensive practice norms; (3) role modeling functioning as the dominant PCC pedagogy in the absence of structured training; (4) tension between PCC ideals and clinical adaptation, including anticipatory erosion narratives among preclinical students; and (5) protective factors (intrinsic motivation, family health experiences, and critical appraisal of the training environment) that sustained PCC commitments. Participants described what we term an intergenerational modeling deficit: faculty perceived as lacking PCC training were viewed as unable to model patient-centered practice, contributing to a self-reinforcing cycle across training generations. Conclusions The intergenerational modeling deficit is offered as a heuristic proposition that may help explain the persistence of hidden curriculum effects and highlights faculty development focused on observable modeling behaviors as a potential intervention target.