Lining up the ducks: aligning the hidden, formal and informal curricula in an immersed learning environment

Introduction: Incongruence between the formal, informal and hidden curricula of Aboriginal and Torres Strait Islander health education is a barrier to student learning and preparedness for delivering effective and culturally-safe healthcare to Aboriginal people. We investigated the impact of student and registrar immersion experiences in an urban Aboriginal and Torres Strait Islander primary healthcare service, where greater alignmentbetween the formal, informal and hidden curricula is evident. Methods: In 2014, 11 students and registrars participated in this qualitative study. At the commencement of their placement, they received a project-specific vignette describing a 46-year-old Aboriginal woman with type 2 diabetes, wrote responses to questions about her clinical care and participated in a semi-structured interview, which explored the assumptions underpinning their responses. Post-placement, participants reflected on their earlier responses and what they had learned from their placement about Aboriginal and Torres Strait Islander people and their health and healthcare.  Results: The placement negated many of the students’ and registrars’ previously held assumptions about Aboriginal people, for example, that Aboriginal people don’t care about their health and will not engage with health professionals. Participants became aware of the benefits of long-term doctor–patient relationships based on trust and respect. Participants realised that doctors have a role in addressing social determinants of health.  Conclusions: Our participants’ shifts in thinking and knowing suggest that greater alignment between the formal, informal and hidden curricula can lead to deepened and more effective learning outcomes for medical students and registrars and, critically, to improved Aboriginal health outcomes. Identification and reproduction of the key elements of Aboriginal health services may enrich medical students’ learning about culturally-safe and appropriate care for Aboriginal people.