The influence of learning environments on medical education: a qualitative research study in one Japanese medical school

Background: Japan has undergone dramatic change relating to both undergraduate and postgraduate medical education, with the influence of the hidden curriculum being largely disregarded. This study explores themes concerning what hidden factors affect undergraduate and postgraduate medical education in bedside learning in a Japanese medical school and teaching hospital.

 

Methods: The study was conducted on a one-to-one semi-structured interview basis, using qualitative methodology. Year 5 medical students and post-graduate year 2 junior residents at a teaching hospital were surveyed, with interviews being conducted over an 8-month period, each one lasting 30 to 60 minutes. The interviewees’ perceptions concerning the quality of teaching in their bedside learning and related experiences were collected and analyzed thematically.

 

Results: Twenty five medical students and twenty three junior residents consented to participate in the interview. Six main themes emerged; persistence of hierarchy and exclusivity, existence of gender issues, overestimation of medical knowledge and skills, and underestimation of attitudes, perception of education as having a low priority, prevalence of positive/negative role models, and relationships with colleagues.

 

Discussion & conclusions: There were both commonalities and differences between the results of the UK study and our study. While such differences may be due to the curriculum or educational practices, we suggest that there is a universality of the effects of a hidden curriculum that exists even if there is a significant difference between countries in their demographic backgrounds.