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A Qualitative Exploration of How the Conflict Between the Formal and Informal Curriculum Influences Student Values and Behaviors

White, Casey B. PhD; Kumagai, Arno K. MD; Ross, Paula T. MA; Fantone, Joseph C. MD

Academic Medicine:
doi: 10.1097/ACM.0b013e31819fba36
Students' Values

Purpose: The third-year students at one medical school told the authors that values core to patient-centered care were impossible to practice in clerkships, in a culture where supervisors role modeled behaviors in direct conflict with patient-centered care. As they developed a new medical student curriculum, the authors designed the Family Centered Experience (FCE) to help students achieve developmental goals and understand the importance of and provide a foundation for patient-centered care.

Method: The authors solicited members of the first cohort to complete the FCE (the class of 2007) to participate in this focus-group-based study halfway through the third year. They explored the influence of the FCE on students’ experiences in the third-year clerkships, and how conflicts between the two learning experiences shaped these students’ values and behaviors.

Results: Students reported that during clerkships they experienced strong feelings of powerlessness and conflict between what they had learned about patient-centered care in the first two years and what they saw role modeled in the third year. Based on students’ comments, the authors categorized students into one of three groups: those whose patient-centered values were maintained, compromised, or transformed.

Conclusions: Students revealed that their conflict was connected to feelings of powerlessness, along with exacerbating factors including limited time, concerns about expectations for their behavior, and pessimism about change. Role modeling had a significant influence on consequences related to students’ patient-centered values.

Author Information

Dr. White is assistant dean and assistant professor of medical education, University of Michigan Medical School, Ann Arbor, Michigan.

Dr. Kumagai is associate professor of internal medicine and director, Family Centered Experience Program, University of Michigan Medical School, Ann Arbor, Michigan.

Ms. Ross is research associate, University of Michigan Medical School, Ann Arbor, Michigan.

Dr. Fantone is professor of pathology and associate dean for medical education, University of Michigan Medical School, Ann Arbor, Michigan.

Correspondence should be addressed to: Dr. White, University of Michigan Medical School, 1135 E. Catherine St., 3960 TML, Ann Arbor, MI 48109-5726; telephone: 734-763-6770; e-mail: (

© 2009 Association of American Medical Colleges