Medical education encompasses formal instruction alongside unspoken lessons absorbed through daily observations of clinical practice. This autoethnography explores my experiences as a UK medical student, focusing on how the hidden curriculum has influenced my emerging professional identity. Drawing on encounters with hierarchy and team dynamics, I examine tensions between taught ideals and observed realities. These reflections connect personal observations to wider themes in medical education literature, highlighting implications for empathy, belonging and future practice.
Observing Hierarchy in Clinical Settings
During early placements in a large NHS teaching hospital, I noticed how junior doctors deferred to consultants without question during ward rounds. This pattern was never addressed in lectures on teamwork or professionalism. One morning, a registrar hesitated to question a senior decision on patient management, and the atmosphere shifted noticeably. Such moments taught me that hierarchy often overrides open dialogue, even when patient safety might benefit from challenge. Literature describes this as a core element of the hidden curriculum, where power structures shape behaviour more than formal guidelines (Hafferty, 1998). Reflecting on this, I began to question my own assumptions about collaborative care, realising that professional identity formation involves navigating unspoken rules rather than simply applying textbook knowledge.
Encounters with Empathy and Emotional Expression
Another layer emerged through staff interactions with distressed patients. Formal teaching emphasises patient-centred communication and sustained empathy. Yet I observed colleagues adopting brisk, detached tones after long shifts, sometimes referring to patients by bed numbers rather than names. These behaviours appeared normalised, particularly in high-pressure environments. Hafferty and Franks (1994) note that such patterns can erode empathetic responses over time, creating dissonance between explicit curriculum aims and workplace culture. My initial discomfort prompted me to consider whether resilience training inadvertently encourages emotional distancing. This experience challenged my understanding of medicine as inherently caring, instead revealing resilience often as a performance shaped by institutional demands.
Shaping Belonging and Professional Identity
These observations influenced my sense of belonging within the profession. Informal conversations in the doctors’ mess frequently highlighted burnout and the expectation of stoicism, reinforcing a culture where admitting vulnerability feels risky. I noticed female trainees sometimes receiving different feedback styles, comments focusing more on demeanour than clinical decisions. Such subtle differences align with research on how hidden curricula perpetuate inequities around gender and diversity (Lempp and Seale, 2004). Consequently, my professional identity has developed cautiously, balancing aspiration toward patient-centred ideals with awareness of the cultural barriers that may hinder them. This process has encouraged greater self-reflection on how I might contribute to more inclusive team environments in future roles.
Implications for Future Practice
The hidden curriculum has therefore taught me lessons extending beyond clinical competence. It underscores the importance of recognising informal influences on attitudes and behaviours. While inspiring examples of compassionate leadership also appeared, the prevailing patterns suggest a need for structured opportunities to discuss these hidden messages. Such awareness supports ongoing development of a professional identity rooted in authenticity rather than conformity alone.
Conclusion
In summary, my medical education experiences illustrate how the hidden curriculum shapes values around hierarchy, empathy and belonging more powerfully than explicit instruction. These reflections demonstrate the value of autoethnographic approaches in bridging personal encounters with broader educational issues. Future doctors benefit from critically examining these influences to foster environments that align practice with stated professional standards.
References
- Hafferty, F.W. (1998) Beyond curriculum reform: confronting medicine’s hidden curriculum. Academic Medicine, 73(4), pp. 403-407.
- Hafferty, F.W. and Franks, R. (1994) The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine, 69(11), pp. 861-871.
- Lempp, H. and Seale, C. (2004) The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching. British Medical Journal, 329(7469), pp. 770-773.
