Ethical enculturation: the informal and hidden ethics curricula at an Australian Medical School

Abstract

The formal ethics curriculum taught in medical schools is underscored by the informal and hidden curricula – that which is learned outside of the classroom or ward round, and which is often implied rather than explicit. Medical students' ethical and moral development is influenced by these curricula, although they have not been subject to the same scrutiny as the formal curriculum in previous research. The objective of this study was to explore University of Adelaide medical students' opinions of their ethical experiences, focusing on the informal and hidden curricula, and the perceived impact of these on their ethical development. Six undergraduates in their fourth year of a six-year course participated in an open-ended interview. Transcriptions were subjected to a qualitative methodology, Framework analysis, which extracts themes from the data. Seven interconnected themes were found. These were ethical development, the formal ethics curriculum, role- modelling, compromise, speaking out and keeping quiet, self-interest and guilt. Whilst the results of this study are consistent with that of previous research, a new and as yet unexplored result was the juxtaposition of 'local' students' perceptions of their ethical behaviour with their perceptions of 'international' students' ethical behaviour. From this, it is postulated that the informal and hidden curricula should not be conceptualised as homogeneous, and that further exploration on the basis of culture and sub-culture is warranted to instruct the formal ethics curriculum.