Implemented Strategies to Address the Hidden Curriculum in Surgical Training: Opportunities for Change

Objective

To summarize and evaluate interventions addressing the hidden curriculum (HC) within surgical training, identify HC themes addressed, and to share strategies that have demonstrated efficacy so that educators may more easily adopt effective approaches.

Design

A scoping review was performed using 5 databases. Studies were included if they implemented an intervention to address the HC within surgical training and evaluated efficacy. Data extraction included the surgical specialty, HC theme, solutions, and outcomes.

Setting

This review includes research conducted within surgical education programs in academic medical centers.

Participants

An estimated 2345 trainees in surgical specialties participated in initiatives aimed at addressing the HC, including 2040 medical students, 303 residents, and 2 fellows.

Results

Nine studies met inclusion criteria. Interventions focused on the following HC themes: surgical culture, professionalism, ethics, power dynamics, medical errors, and mistreatment. The most common methods employed included group discussions, reflective writing, readings, mentorship, and skills workshops, among others. Successful programs often combined multiple teaching strategies. Most interventions increased trainees’ awareness of the HC and even single workshops increased their ability to recognize and feel empowered to address the HC. However, quality of evidence was often limited by small sample sizes, subjective outcomes, and lack of long-term follow-up.

Conclusion

Reviewed studies support that explicitly addressing the HC and combining multiple teaching methods (e.g. group discussion and reflection) can increase trainee awareness of the HC and bolster confidence in addressing it. However, despite some promising results, evidence remains limited by methodological weaknesses, such as reliance on subjective measures, and conclusions about sustained cultural change cannot yet be drawn. Future studies may consider including objective evaluation methods, sustained follow-up, and delving into both negative and positive influences of the HC to better inform the development of more effective and inclusive surgical training environments.