Beyond the Scope: The Hidden Curriculum in GI Fellowship and Its Implication for Change

Abstract

Background: The hidden curriculum exists beyond formal and informal curricula and impacts a learner’s experience as something learned that is not intentionally taught. It is discussed extensively in undergraduate medical education literature, but less understood in graduate medical education, especially in a procedurally focused subspecialty training such as gastroenterology (GI) fellowship. Aims: To better understand examples of the hidden curriculum in GI fellowship, from the perspective of fellows, to improve the overall educational experience. Methods: A qualitative analysis of semi-structured virtual interviews using grounded theory was performed. Results: Twelve fellows of six different programs participated and revealed four main categories of themes: Hierarchies and Training Dynamics, Endoscopic and Procedural Training, Professional Aspirations and Career Perspectives, Patient Care, and Challenges. Conclusion: This study highlights areas of the GI fellowship learning experience that can be classified as part of the hidden curriculum and informs areas for further improvement: fostering a more collaborative learning environment, improving endoscopic training through formalized curricula and instructor professional development, addressing stereotypes in career decision-making, and modeling positive patient communication behaviors.