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Letters to the Editor

The Hidden Curriculum: Taxonomic Dilemmas and Pattern Languages

Ellaway, Rachel H. PhD

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doi: 10.1097/ACM.0000000000002480
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To the Editor:

I write in reference to the recent scoping review and accompanying Invited Commentary on the hidden curriculum (HC).1,2 One calls for greater precision in terminology; the other advocates for a conceptual fluidity to ensure that the generative power of HC is retained. I have sympathy for both positions but do not see them as irreconcilable.

A generative conceptualization may need to be preserved in the context of exploring novel social situations; however, science also requires a degree of precision and agreement in modeling the world, lest the collective becomes irreconcilably fragmented and strange to itself. So, is there a way to afford greater precision and generative fluidity in the concepts we use?

The problem lies in the taxonomic reflex that pervades our field, which asserts that term X means this and only this. The response that term X can mean anything you want it to mean is still caught in this taxonomic discourse. The solution, I would suggest, is the use of pattern language.3 For example, taxonomically a garden pea is the seed of the plant Pisum sativum from the Fabaceae family and so on. The properties of the pea are inherited and understood in the context of its class and phylum. A pattern language, on the other hand, describes the pea in terms of its facets (round, green, small, edible, and so on). These facets are relatively simple and unambiguous constructs that can be recombined to describe a great many different things.

While the pea does have a singular genetic lineage (it is not descended from pigeons or princesses), social phenomena such as those modeled by various uses of HC are not. A pattern language approach can be particularly effective in modeling complex social phenomena without resorting to exclusionary taxonomic regulation. In the context of HC, “hidden” is a facet, as are “informal,” “perceived,” and “null.” We might agree on the meaning of the terms of the pattern language we use to describe the plurality of HCs without abandoning either precision or fluidity.

Rachel H. Ellaway, PhD
Professor, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada; ORCID:;


1. Lawrence C, Mhlaba T, Stewart KA, Moletsane R, Gaede B, Moshabela M. The hidden curricula of medical education: A scoping review. Acad Med. 2018;93:648656.
2. Hafferty FW, Martimianakis MA. A rose by other names: Some general musings on Lawrence and colleagues’ hidden curriculum scoping review. Acad Med. 2018;93:526531.
3. Ellaway RH, Bates J. Exploring patterns and pattern languages of medical education. Med Educ. 2015;49:11891196.
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