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The Hidden Curriculum of Compassionate Care

Can Assessment Drive Compassion?

Wright, Sarah R. MBA, PhD; Boyd, Victoria A. MPC; Ginsburg, Shiphra MD, PhD, FRCPC

doi: 10.1097/ACM.0000000000002773
Research Report: PDF Only

Purpose: Medical schools are expected to promote compassionate care among learners. Assessment is a key way to communicate values to learners but can also create a hidden curriculum. Assessing compassionate care is challenging; however, not assessing it can communicate to students that such care is not valued. The purpose of this study was to explore how current assessment strategies promote or suppress the idea that caring behaviors are valued learning objectives.

Method: Data sources were third-year course documents; interviews of 9 faculty, conducted between December 2015 and February 2016; and focus groups with 13 third-year medical students and an interview with 1 third-year medical student, conducted between February and June 2016. The stated intentions of third-year assessments were compared with the behaviors rewarded through the assessment process and the messages students received about what is valued in medical school.

Results: Syllabi did not include caring as a learning outcome. Participants recognized assessment as a key influence on student focus. Faculty perspectives varied on the role of medical schools in assessing students’ caring and compassion. Students prioritized studying for assessments but described learning about caring and compassion from interactions such as meaningful patient encounters and both positive and negative role models that were not captured in assessments.

Conclusions: Faculty members expressed concern about not assessing caring and compassion but acknowledged the difficulty in doing so. While students admitted that assessments influenced their studying, their reported experiences revealed that the idea “assessment drives learning” did not capture the complexity of their learning.

S.R. Wright is assistant professor, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, scientist, Michael Garron Hospital, Centre for Ambulatory Care Education, Women’s College Hospital and Wilson Centre for Research in Education, University Health Network, University of Toronto, Ontario, Canada; ORCID:

V.A. Boyd is a PhD student, Institute of Health Policy Management and Evaluation, University of Toronto, and research assistant, Department of Medicine, University of Toronto, Ontario, Canada; ORCID:

S. Ginsburg is professor, Department of Medicine, Faculty of Medicine, University of Toronto, scientist, Wilson Centre for Research in Education, University Health Network, University of Toronto, and staff physician, Mount Sinai Hospital, Toronto, Ontario, Canada.

Supplemental digital content for this article is available at

Acknowledgments: The authors would like to thank the AMS Phoenix Call to Caring Project for funding this research; Drs. Mahan Kulasegaram, Cynthia Whitehead, and Stella Ng for their discussions and contributions to the project; Andrew Perrella and Tal Milman for facilitating the student focus groups; and the faculty and student participants.

Funding/Support: This research was supported by the AMS Phoenix Call to Caring Project Grant (Toronto, Ontario, Canada), Michael Garron Hospital and the Toronto East Health Network (Toronto, Ontario, Canada), the Department of Medicine at the University of Toronto, Faculty of Medicine (Toronto, Ontario, Canada), and the Center for Ambulatory Care Education at Women’s College Hospital (Toronto, Ontario, Canada).

Other disclosures: None reported.

Ethical approval: This research was approved by the University of Toronto Research Ethics Board (reference #32140).

Correspondence should be addressed to Sarah R. Wright, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, ON M4C 3E7, Canada; telephone: (416) 469-6580 ext. 3280; email:

© 2019 by the Association of American Medical Colleges