Moral injury and the hidden curriculum in medical school: comparing the experiences of students underrepresented in medicine (URMs) and non-URMs

AbstractUnderrepresented students in medicine (URM) have more negative perceptions of the medical school learning environment (LE), a phenomenon that can contribute to higher rates of burnout and attrition in these populations. The hidden curriculum (HC) —defined as a set of values informally conveyed to learners through clinical role-modeling—is a LE socialization construct that has been critically examined for its role in shaping students’ professional identities. Yet differences in how URMs and non-URMs experience the HC remain underexplore d. The study used a pragmatic approach that drew on elements of grounded theory and employed both deductive and inductive reasoning. Investigators conducted qualitative, semi-structured interviews with a purposive sample of 13 URM and 21 non-URM participants at a Bronx, NY medical school. Interviews examined student experiences and reactions to the HC. Both cohorts witnessed patient disparagement and mistreatment. However, from these encounters, URM participants expressed moremoral injury—the adverse emotional consequence of feeling pressured to accept ideologically incongruent values. URMs were also more likely to describe resisting the HC. Differences in group reactions appeared to arise from URMs’ identity resonance with patients’ lived experiences. Participants across coho rts emphasized increasing URM recruitment as one step toward mitigating these circumstances. URM participants experienced more distress and offered mo...
Source: Advances in Health Sciences Education - Category: Universities & Medical Training Source Type: research