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The residency years comprise the last period of a physician’s formaltraining. It is at this stage that trainees consolidate the clinical skills requiredfor independent practice and achieve a level of ethical development essential totheir work as physicians, a process known as professional identity formation (PIF).Ethics education is thought to contribute to ethical development and to that end theRoyal College of Physicians and Surgeons of Canada (RCPSC) requires that formalethics education be integrated within all postgraduate specialty training programs.However, a formal ethics curriculum can operate in parallel with informal and hiddenethics curricula, the latter being more subtle, pervasive, and influential inshaping learner attitudes and behavior. This paper reports on a study of the formal,informal, and hidden ethics curricula at two postgraduate psychiatry programs inCanada. Based on the analysis of data sources, we relate the divergences between theformal, informal, and hidden ethics curricula to two aspects of professionalidentity formation (PIF) during psychiatry residency training. The first is the ideaof group membership. Adherence to the hidden curriculum in certain circumstancesdetermines whether residents become part of an in-group or demonstrate a sense ofbelonging to that group. The second aspect of PIF we explore is the ambiguous roleof the resident as a student and a practitioner. In ethically challengingsituations, adherence to the messages of the hidden curriculum is influenced by andinfluences whether residents act as students, practitioners, or both. This paperdescribes the hidden curriculum in action and in interaction with PIF. Our analysisoffers a complementary, empirical perspective to the theoretical literatureconcerning PIF in medical education. This literature tends to position sound ethicaldecision-making as the end result of PIF. Our analysis points out that the mechanismworks in both directions: how residents respond to hidden curriculum in ethics canbe a driver of professional identity formation.

canadian journal of bioethics

The Hidden Curriculum in Ethics and its Relationship to Professional Identity Formation: A Qualitative Study of Two Canadian Psychiatry Residency Programs