The Hidden Curriculum in Multicultural Medical Education: The Role of Case Examples

Turbes, Sandra MD; Krebs, Erin MD; Axtell, Sara PhD

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Explicit cross-cultural learning experiences in medical education are provided within the context of implicit experiences provided by a greater “hidden curriculum.” The authors conducted a content analysis of 983 cases presented in the 1996-1998 year one and year two curriculum at the University of Minnesota Medical School to determine in what ways they might embody elements of the hidden curriculum, i.e., how they either supported or undermined explicit messages about diverse patient populations. Cases were coded for demographic variables, potential risk factors, and diagnoses or presenting problems.

The findings revealed that cases featuring males out-numbered those featuring females; this ratio differed across courses, and appeared to differ from the actual epidemiology of the conditions. Sexual orientation was specified infrequently. When sexual orientation and behavior were specified, these appeared in the context of a risk assessment for particular diseases (e.g., HIV infection). Most cases did not provide racial or ethnic descriptions. For many of the ethnic descriptors, links to genetic, cultural, or socioeconomic factors were apparent; no such link was apparent when the racial terms “white” or “Caucasian” were used.

Analysis of the 983 cases shows that the pattern of demographics and associations of particular groups with diseases or risk factors in cases conveys messages, as does the lack of mention of sexual orientation and race or ethnicity. These messages are inconsistent with and may undermine the formal multicultural medical curriculum. The results suggest a need for formal deliberation of this aspect of the curriculum by curriculum planners.

Dr. Turbes is a family practice resident at Providence Hospital in Seattle, Washington, and Dr. Krebs is a resident in the internal medicine program at the University of Minnesota; at the time this article was written, they were medical students at the University of Minnesota Medical School (UMMS), Minneapolis, Minnesota. Dr. Axtell is research associate in the Office of Education—Educational Development and Research, UMMS.

Correspondence and requests for reprints should be addressed to Dr. Axtell, University of Minnesota Medical School—EDR, 420 Delaware Street, SE, MMC 293, Minneapolis, MN 55455; telephone: (612) 625-4489; fax: (612) 626-4200; e-mail: 〈〉.

The authors are grateful to Ilene Harris, PhD, for her insights and editorial review. They also thank Allison Stolz, Erin O'Fallon, L. T. Nguyen, Nicholas Krueger, Amy Knopke, Sarah Kesler, Christine Johnston, and Emery Chang for coding the cases; Young-Chi Sung for entering the data; and Thomas Powers for assistance with tables and figures. They thankfully acknowledge funding by the Minnesota Medical Foundation, with additional financial assistance provided by Gregory Vercellotti, MD, the senior associate dean for education at the University of Minnesota Medical School.

© 2002 Association of American Medical Colleges