Effects of Hidden Curriculum on Medical Education and Strategies to Reshape Hidden Curriculum as a Curriculum Promotor – A Systematic Review

Himayat Ullah,1 Sarwat Huma,2 Nafisa Tahir,3 Ghulam Yasin,1 Muhammad Ashraf,1 Hossam Shabana,1,4 Basant Mostafa Gabr,5 Mohammed Yunus,6 Junaid Sarfraz Khan2 1Department of Medicine, College of Medicine at Shaqra, Shaqra University, Shaqra, Saudi Arabia; 2Department of Health Professions Education, Health Services Academy, Islamabad, Pakistan; 3Department of Medicine, NUST School of Health Science, Islamabad, Pakistan; 4Faculty of Medicine, Internal Medicine Department, Al-Azhar University, Cairo, Egypt; 5Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt; 6Department of Pathology, Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Mohammed Yunus, Kabul University of Medical Sciences, Kabul, Afghanistan, Tel +93796364077, Email [email protected]: The objective of this review is to analyze the hidden curriculum with respect to its potential as a curriculum promotor or inhibitor of medical curricula, and to review the strategies that can help make it one of the curriculum promotors.Data Sources: We searched PubMed, Cochrane Reviews, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) library, with Google Scholar for grey literature, using specified keywords with a time limit from January 2000 to December 2023. We included original articles, review articles and meta-analyses, book chapters, and books focusing on the hidden curriculum effects on curriculum.Data Extraction and Synthesis: Three different reviewers independently searched the relevant literature. The Best Evidence Medical Education (BEME) quality criteria were used to assess the quality, the Critical Appraisal Skills Program (CASP) checklists for risk of bias assessment, and the GRADE-CERQual framework for confidence of evidence in each article. Findings were synthesized by using thematic synthesis to identify promotive and inhibitory effects along with recommended strategies.Results: A total of 23 articles were selected for full review. These articles infer that the hidden curriculum can affect the medical curriculum in both negative and positive ways. A few of the curriculum-promoting effects of hidden curriculum are soft skills (interpersonal, communication, and professional behaviors often labelled as soft skills in the literature) and practical knowledge acquisition, cultural proficiency, moral growth, and professionalism. The negative or inhibitory effects include a detrimental learning environment, learning unprofessional and unethical practices, gender inequities, stress, and burnout. Strategies that should be adopted to overcome the inhibitory effects of the hidden curriculum include raising awareness among the stakeholders regarding the hidden curriculum, aligning the hidden curriculum with the intended curriculum, institutional and administrative policies, role modelling, and mentorship.Conclusion: Hidden Curriculum plays a very crucial role in medical education. By addressing its due importance, it can highly enhance the competence of future health professionals.Keywords: hidden curriculum, hidden curriculum in medical education, curriculum promotors and inhibitors, positive and negative effects of hidden curriculum