Skip to main content
SpringerLink
Log in

Confronting the Hidden Curriculum: A Four-Year Integrated Course in Ethics and Professionalism Grounded in Virtue Ethics

  • Published:
Journal of Medical Humanities Aims and scope Submit manuscript

Abstract

We describe a virtue ethics approach and its application in a four-year, integrated, longitudinal, and required undergraduate medical education course that attempts to address some of the challenges of the hidden curriculum and minimize some of its adverse effects on learners. We discuss how a curriculum grounded in virtue ethics strives to have the practical effect of allowing students to focus on their professional identity as physicians in training rather than merely on knowledge and skills acquisition. This orientation, combined with a student-generated curriculum, is designed to prepare students to identify and face challenges during their clinical years, further nurturing their professional growth. In short, a four-year integrated ethics and professionalism curriculum intentionally centered on cultivating virtuous physicians may alleviate, and even counteract, the effects of the hidden curriculum in the clinical years of medical training.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Association of American Medical Colleges. 1998. "Report I: Learning Objectives for Medical Student Education Guidelines for Medical Schools." Medical School Objectives Project, 1-10.

  • Atherley, A., D. Dolmans, W. Hu, I. Hegazi, S. Alexander, and P. W. Teunissen. 2019. "Beyond the Struggles: A Scoping Review on the Transition to Undergraduate Clinical Training." Medical Education 53: 559-70.

    Article  Google Scholar 

  • Baker, M., J. Wrubel, and M. W. Rabow. 2011. "Professional Development and the Informal Curriculum in End-of-Life Care." Journal of Cancer Education 26:444-50.

    Article  Google Scholar 

  • Beauchamp, T. L. 2001. "Internal and External Standards for Medical Morality." J Med Philos 26:601-19.

    Article  Google Scholar 

  • Benbassat, J. 2019. "Hypothesis: The Hospital Learning Environment Impedes Students' Acquisition of Reflectivity and Medical Professionalism." Adv Health Sci Educ Theory Practice 24:185-94.

    Article  Google Scholar 

  • Bloom, S. W. 1988. "Structure and Ideology in Medical Education: An Analysis of Resistance to Change." J Health Soc Behavior 29:294-306.

    Article  Google Scholar 

  • Branch, W. T., Jr., and M. George. 2017. "Reflection-Based Learning for Professional Ethical Formation." AMA J Ethics 19:349-56.

    Article  Google Scholar 

  • Brody, H., and D. Doukas. 2014. "Professionalism: A Framework to Guide Medical Education." Med Education 48:980-7.

    Article  Google Scholar 

  • Carrese, J. A., J. Malek, K. Watson, L. S. Lehmann, M. J. Green, L. B. McCullough, G. Geller, C. H. Braddock, 3rd, and D. J. Doukas. 2015. "The Essential Role of Medical Ethics Education in Achieving Professionalism: The Romanell Report." Acad Medicine 90:744-52.

    Article  Google Scholar 

  • Christakis, D. A., and C. Feudtner. 1993. "Ethics in a Short White Coat: The Ethical Dilemmas that Medical Students Confront." Acad Medicine 68:249-54.

    Article  Google Scholar 

  • Coverdale, J. H., R. Balon, and L. W. Roberts. 2011. "Cultivating the Professional Virtues in Medical Training and Practice." Acad Psychiatry 35:155-9.

    Article  Google Scholar 

  • Cruess, R. L., S. R. Cruess, and Y. Steinert. 2016. "Amending Miller's Pyramid to Include Professional Identity Formation." Acad Medicine 91:180-5.

    Article  Google Scholar 

  • Daaleman, T. P., W. A. Kinghorn, W. P. Newton, and K. G. Meador. 2011. "Rethinking Professionalism in Medical Education through Formation." Fam Medicine 43: 325-9.

    Google Scholar 

  • Hafferty, F. W., and R. Franks. 1994. "The Hidden Curriculum, Ethics Teaching, and the Structure of Medical Education." Acad Medicine 69:861-71.

    Article  Google Scholar 

  • Holden, Mark, Era Buck, Mark Clark, Karen Szauter, and Julie Trumble. 2012. "Professional Identity Formation in Medical Education: The Convergence of Multiple Domains." HEC Forum 24: 245-55.

    Article  Google Scholar 

  • Holmes, C. L., I. B. Harris, A. J. Schwartz, and G. Regehr. 2015. "Harnessing the Hidden Curriculum: A Four-step Approach to Developing and Reinforcing Reflective Competencies in Medical Clinical Clerkship." Adv Health Sci Educ Theory Practice 20:1355-70.

    Article  Google Scholar 

  • Irby, D. M., and S. J. Hamstra. 2016. "Parting the Clouds: Three Professionalism Frameworks in Medical Education." Acad Medicine 91:1606-11.

    Article  Google Scholar 

  • Joynt, G. M., W. T. Wong, L. Ling, and A. Lee. 2018. "Medical Students and Professionalism - Do the Hidden Curriculum and Current Role Models Fail our Future Doctors?" Med Teach 40:395-99.

    Article  Google Scholar 

  • Kaldjian, L. C., M. E. Rosenbaum, L. A. Shinkunas, J. C. Woodhead, L. M. Antes, J. A. Rowat, and V. L. Forman-Hoffman. 2012. "Through Students' Eyes: Ethical and Professional Issues Identified by Third-year Medical Students during Clerkships." J Med Ethics 38:130-2.

    Article  Google Scholar 

  • Lawrence, C., T. Mhlaba, K. A. Stewart, R. Moletsane, B. Gaede, and M. Moshabela. 2018. "The Hidden Curricula of Medical Education: A Scoping Review." Acad Medicine 93:648-56.

    Article  Google Scholar 

  • Lewis, N. J., C. E. Rees, J. N. Hudson, and A. Bleakley. 2005. "Emotional Intelligence Medical Education: Measuring the Unmeasurable?" Adv Health Sci Educ Theory Practice 10:339-55.

    Article  Google Scholar 

  • Madani, M., B. Larijani, E. Madani, and N. Ghasemzadeh. 2017. "Establishment of Medical Education upon Internalization of Virtue Ethics: Bridging the Gap between Theory and Practice." J Med Ethics Hist Medicine 10:3.

    Google Scholar 

  • Monrouxe, L. V., C. E. Rees, and W. Hu. 2011. "Differences in Medical Students' Explicit Discourses of Professionalism: Acting, Representing, Becoming." Med Education 45:585-602.

    Article  Google Scholar 

  • O'Sullivan, Helen, Walther van Mook, Ray Fewtrell, and Val Wass. 2012. "Integrating Professionalism into the Curriculum: AMEE Guide No. 61." Medical Teacher 34:e64-e77.

    Article  Google Scholar 

  • Pellegrino, E. D. 1981. "Being Ill and Being Healed: Some Reflections on the Grounding of Medical Morality." Bulletin of the New York Academy of Medicine 57:70-79.

    Google Scholar 

  • ———. 2002. "Professionalism, Profession and the Virtues of the Good Physician." Mt Sinai J Medicine 69:378-84.

  • ———. 2006. "Toward a Reconstruction of Medical Morality."Am J Bioethics 6:65-71.

  • ———. 2012. "Medical Ethics in an Era of Bioethics: Resetting the Medical Profession's Compass." Theor Med Bioethics 33:21-4.

  • Pellegrino, Edmund D. 2007. "Professing Medicine, Virtue based Ethics, and the Retrieval of Professionalism." In Working Virtue: Virtue Ethics and Contemporary Moral Problems, edited by Rebecca L. Walker and Philip J. Ivanhoe, 61-85. Oxford:Clarendon.

    Google Scholar 

  • Robinson, R. L. 2015. "Hospitalist Workload Influences Faculty Evaluations by Internal Medicine Clerkship Students." Adv Med Educ Practice 6:93-8.

    Article  Google Scholar 

  • Rosenthal, S., B. Howard, Y. R. Schlussel, D. Herrigel, B. G. Smolarz, B. Gable, J. Vasquez, H. Grigo, and M. Kaufman. 2011. "Humanism at Heart: Preserving Empathy in Third-year Medical Students." Acad Medicine 86:350-8.

    Article  Google Scholar 

  • Shelton, W. 1999. "Can Virtue be Taught?" Acad Medicine 74:671-4.

    Article  Google Scholar 

  • Silveira, Gabrielle L, Lia KS Campos, Marcelo Schweller, Egberto R Turato, Esther Helmich, and Marco Antonio de Carvalho-Filho. 2019. "'Speed up!' The Influences of the Hidden Curriculum on the Professional Identity Development of Medical Students." Health Professions Education 5:198-209.

    Article  Google Scholar 

  • Sturman, Nancy, Patricia Régo, and Marie-Louise Dick. 2011. "Rewards, Costs and Challenges: The General Practitioner’s Experience of Teaching Medical Students." Med Education 45:722-30.

    Article  Google Scholar 

  • Sulmasy, D. P. 2014. "Edmund Pellegrino's Philosophy and Ethics of Medicine: An Overview." Kennedy Inst Ethics Journal 24:105-12.

    Article  Google Scholar 

  • Wald, Hedy S., David Anthony, Tom A. Hutchinson, Stephen Liben, Mark Smilovitch, and Anthony A. Donato. 2015. "Professional Identity Formation in Medical Education for Humanistic, Resilient Physicians: Pedagogic Strategies for Bridging Theory to Practice." Academic Medicine 90:753-60.

    Article  Google Scholar 

  • Wasson, K., E. Bading, J. Hardt, L. Hatchett, M. G. Kuczewski, M. McCarthy, A. Michelfelder, and K. Parsi. 2015. "Physician, Know Thyself: The Role of Reflection in Bioethics and Professionalism Education." Narrat Inq Bioethics 5:77-86.

    Article  Google Scholar 

  • Williams, G. C., R. B. Saizow, and R. M. Ryan. 1999. "The Importance of Self-determination Theory for Medical Education." Acad Medicine 74:992-5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Alden March Bioethics Institute at Albany Medical College, 47 New Scotland Avenue, MC 153, Albany, NY, 12208, USA

    Wayne Shelton

  2. Institute for Bioethics & Health Humanities, University of Texas Medical Branch, Galveston, TX, USA

    Lisa Campo-Engelstein

Authors
  1. Wayne Shelton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa Campo-Engelstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wayne Shelton.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shelton, W., Campo-Engelstein, L. Confronting the Hidden Curriculum: A Four-Year Integrated Course in Ethics and Professionalism Grounded in Virtue Ethics. J Med Humanit 42, 689–703 (2021). https://doi.org/10.1007/s10912-021-09694-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10912-021-09694-2

Keywords

Search

Navigation