The Effect of Online Education on Hidden Cirriculum During the Covid-19 Pandemic in Medical Faculties

doi:10.21203/rs.3.rs-2308976/v1

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The Effect of Online Education on Hidden Cirriculum During the Covid-19 Pandemic in Medical Faculties

https://doi.org/10.21203/rs.3.rs-2308976/v1

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Phenomenon: The hidden curriculum in medical education determines what kind of physicians students will become. Although the formal program affects students to become physicians, the hidden cirriculum has a much greater effect on this issue. If a medical faculty wants to improve the quality of the physicians, it should be able to reveal and develop the hidden curriculum of the faculty.

Approach: In our study, it is aimed to reveal the hidden structure in medical faculties by applying the “Hidden Cirriculum Scale” to 344 students studying in different medical faculties in Turkey.

Findings: It has been seen that the preference of specialization of the students who adapt to hidden cirriculum is in favor of internal and surgical medical sciences, that is, their professional adaptation is more. In addition, it is observed that the students studying in the upper classes are more adaptable to the program.

Insights: Studies on hidden cirriculum education in medical faculties can provide innovative insights into medical education. It can increase the awareness of physicians in choosing their fields of science and their desire to be a good physician. In order to increase the quality of graduates of medical faculties and to train good physicians, students' awareness and adaptation of hidden cirriculum is necessary, therefore, an unwritten comprehensive medical faculty curriculum is of great importance in both online and face-to-face education.

Hidden Cirriculum

Covid-19

Online Education

Basic Medical Science

Since education and training activities must be carried out in line with a program, formally planned written training programs are implemented in all education and training institutions. However, students are affected not only by this formal, planned and written program, but also by other unplanned and unwritten programs. Because students gain many behaviors and attitudes outside the classroom. In this case, it can be said that there are two types of programs in university. The first type of program is the formal program in which the objectives, content, implementation and evaluation activities are clearly stated. The second type of program is the hidden cirriculum programs, the content of which is requested to be learned by the students, but which is not clearly expressed and unwritten. The first researcher to use the concept of the hidden cirriculum program is Philip Jackson (Philip Wesley Jackson, 1968). In his study named “Life in Classroom”, which he wrote in 1968, Philip Jackson revealed the hidden curriculum by examining the elements related to students' personalities, attitudes towards school, interest levels, intelligence and moral development (Philip W Jackson, 1990). Another researcher examining the hidden curriculum program is Michael Apple. Apple states that the hidden curriculum includes the values taught in schools, norms and the features demanded by the market, that is, the economy. According to him, schools are the same as society (Apple, 1980). According to Apple and King (1977) study named “What Do Schools Teach”, the mentality of society, namely social and economic ideologies, should be hidden under the open program taught in school. Students find these ideological ideas subconsciously. Benson Snyder tried to reveal the hidden curriculum in high school with her work titled The Hidden Curriculum in 1971 (Snyder, 1970). Snyder, while answering the question of how students who are open to creative change became alienated from education, concluded that the social and emotional structure of the program's content is important (Snyder, 1970). Because with the hidden curriculum, students learn how to behave in school. However, the hidden curriculum is not expressed by the teachers and principals at the school. This indicates that the hidden cirriculum program is semi-private. According to Vallance, hidden curriculum is a vague term describing an effect rather than a specific process or content (Vallance, 1980). Nancy Jachim's work titled "The Hidden Curriculum" argues that the hidden curriculum conveys the values and norms of the society. According to him, the characteristics of these norms and values should be: Content is more important than the message, Content must have a purpose, Internalization is more important, Education is knowing the answers to predetermined questions, The authority knows these questions (Jachim, 1987). Considering these features mentioned by Jachim (1987), every rule that is wanted to be gained has a purpose and the student should internalize it. School and authority form the content of the hidden curriculum. The content of the hidden cirriculum program is prepared in line with predetermined purposes.

In general, researchers working on the hidden curriculum have defined the curriculum in various ways according to their own perspectives. In summary, hidden cirriculum education is defined as messages that students are expected to learn but cannot be expressed clearly, unwanted or unintended learning outcomes, and behaviors exhibited by students in accordance with their teachers' expectations. Based on these, the hidden curriculum is defined as the knowledge, ideas and practices that emerge in the learning-teaching process and the qualifications that students reach, apart from the objectives and activities specified in the formal program. No matter how well the formal program is prepared, in reality, students are highly affected by the hidden curriculum.

Hidden Program In Medical Education

The hidden curriculum in medical education is determined by the unwritten rules in the institutions, the social structure of the institutions, the expectations of the students and the attitudes of the instructors. In addition to the importance of formal education in medical education, the hidden curriculum plays an important role in how students will become physicians. In universities, the formal program can be carried out by the instructor with different content and applications in order to fulfill their own expectations. Slotnick et al. (1985) did not focus on working with other healthcare professionals, communicating with patients and their relatives, by encouraging students to work individually instead of in groups, contrary to what is stated in the formal program in medical faculties. In other words, the formal program has changed in line with the hidden demands of the faculty and teaching staff during the implementation, so the hidden cirriculum program has become more effective.

Another situation in which the hidden curriculum is closely related is professional socialization. The formal program lags behind the hidden curriculum in order for students to successfully adapt to their profession as physicians (Howe, 2002). In order for their students to be successful in the professional socialization process, they should fulfill the requests within the scope of the hidden cirriculum program. However, since the demands in the hidden curriculum are not presented formally, it causes anxiety and uncertainty for students. This situation turns into fulfilling the expectations of faculty and teaching staff by getting high grades in exams and courses, instead of being a good physician with professional socialization. As a result, medical faculties should reveal and develop the hidden curriculum in order to train good physicians.

The Covid-19 pandemic, which started in our country in March 2020, has affected the education system as well as many other things. In our world, where the effectiveness, necessity and importance of the distance education system is still discussed, the closure of schools in our country, as in most countries in the world, due to the recent Covid-19 pandemic, has put this system into practice. The purpose of this study is to determine whether online education, which is compulsory during the Covid-19 pandemic, has an effect on the hidden structure in medical education.

Participants

A total of 344 students including at 3 rd,4 th,5 th and 6 th grades at Bezmialem Vakıf University, Sanko University, Fırat University, Bolu Abant İzzet Baysal University, İnönü University and Bursa Uludağ University of Medical Faculty in Turkey are included in this study. The "Medicine Faculty Hidden Cirriculum Scale " developed by Ercan et al. (2009) is applied to these students. The reason why only 3rd, 4th, 5th and 6th grade students were included in the research is because of the presence of face-to-face education and online education experiences during the pandemic.

Data Collection Tool

The Hidden Cirriculum Scale scale applied in the study is a 5-point Likert-type scale consisting of 25 items. The internal consistency coefficient of the scale is 0.895. The 7 sub-dimensions of the scale are "Scientific Thinking, Discussion and Research Skills", "The Benefit of Internships", "Physician Skills", "Physician Prestige", "Objectivity of Instructors", "Being Determined and Systematic" and " Absence of Memorization". In addition to the scale questions, a questionnaire consisting of 10 questions was created that includes information about the demographic characteristics of the participants. The scale and questionnaire form are delivered via Google forms, and the results are collected online.

Statistical Analysis

The distribution of the data is analyzed with the Shapiro-Wilk test. For numerical variables, two independent group comparisons of normally distributed data are made with the independent sample t-test, and comparisons of three or more groups are made with the One-Way ANOVA test. Two independent group comparisons of non-normally distributed data are made with the Mann Whitney U test, and comparisons of three or more groups are made with the Kruskal Wallis test. Chi-square test is used to evaluate the difference between categorical variables. Descriptive statistics of numerical data are expressed as mean ± standard deviation or median (min-max), descriptive statistics of categorical data are expressed as n(%).K-Means Clustering Analysis is used to separate students according to their achievement status. All statistical analyzes is made in the SPSS software program (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). K-Means Clustering Analysis is made Clustan Graphics program. Statistical significance level (α) is determined 0.05.

Ethical Aspect Of Research

The research was approved by the Medical and Health Sciences Research Committee. Necessary permissions are obtained from the Bezmialem Vakıf University, Sanko University, Fırat University, Bolu Abant İzzet Baysal University, İnönü University and Bursa Uludağ University Faculty of Health Sciences Dean's Office to conduct the survey.

344 medical students (3rd, 4th, 5th and 6th grade) of six diffirent universities are included in the study. 204 (59.3%) of the students are female and 140 (40.7%) are male. 10 (2.9%) of the students are 3rd grade students, 71 (20.6%) of the students are 4th grade students, 94 (27.3%) of the students are 5th grade students and 169 (49.1%) of the students 6th grade students. When the sciences of specialization that students want to choose after graduation are examined; It is observed that 18 (5.2%) people wanted to choose basic sciences, 202 (58.7%) people wanted to choose internal sciences, and 124 (36%) people wanted to choose surgical sciences. Students graduated from 148 (43%) state Anatolian High Schools, followed by 130 (37.8%) state Science High Schools. Most of the students, 198 (57.6%) live with their families. The average academic achievement of the students is determined as 77.23 ± 8.15 out of 100. Results regarding demographic data are given in Table-1.

Table-1: Distribution Of Demographic Data

	Descriptive Statistics (n = 344)
Gender
Female	204(%59.3)
Male	140(%40.7)
Grade
3	10(%2.9)
4	71(%20.6)
5	94(%27.3)
6	169(%49.1)
Desired Area of Expertise
Basic Science	18(%5.2)
Internal Science	202(%58.7)
Surgical Science	124(%36)
Graduated High School
State Vocational High School	3(%0.9)
State Anatolian High School	148(%43)
State Science High School	130(%37.8)
Private Anatolian High School	32(%9.3)
Private Science High School	31(%9)
Shelter
At Home With My Family	198(%57.6)
At Home With My Friends	56(%16.3)
At Home Alone	47(%13.7)
Government Dormitory	34(%9.9)
Private Dormitory	9(%2.6)
Academic Achievement Average	77.23 ± 8.15

Categorical data are expressed as frequency (percentage) and numerical data as mean ± standard deviation.

In our study, students are clustered according to their k-means clustering analysis according to their achievement status, considering the year of entry and the class they are in. Two clusters are formed. The created cluster dendogram is given in figure-1.

The statistical comparison results made according to the characteristics of the clusters formed are given in Table-2.

Table-2: Evaluation of the statistical difference of variables between clusters

	Cluster 1	Cluster 2	p-value
Academic Achievement Average	76(54–96)	77(63–100)	0.170^*
Hidden Cirriculum Scale
Scientific Thinking, Discussion and Research Skills	8(0–22)	12(0–24)	p < 0.001^*
The Benefit of Internships	10(0–20)	14(1–20)	p < 0.001^*
Physician Skills	8(0–12)	10(4–12)	p < 0.001^*
Physician Prestige	6(0–12)	7(0–12)	p < 0.001^*
Objectivity of Instructors	5(0–12)	7(0–12)	p < 0.001^*
Being Determined and Systematic	4(0–8)	6(0–8)	p < 0.001^*
Absence of Memorization	4(0–11)	6(0–12)	p < 0.001^*
Gender
Female	98(%59.4)	102(%60)	0.910^**
Male	67(%40.6)	68(%40)	0.910^**
Grade
3	2(%1.2)	7(%4.1)	p < 0.001^* 3–4: p = 0.003 3–5: p < 0.001 3–6: p = 1 4–5: p = 0.122 4–6: p < 0.001 5–6: p < 0.001**
4	51(%30.9)	17(%10)
5	78(%47.3)	14(%8.2)
6	34(%20.6)	132(%77.6)
Desired Area of Expertise
Basic Science (1)	16(%9.7)	1(%0.6)	p < 0.001^* 1–2: p < 0.001 1–3: p = 0.001** 2–3: p = 0.069
Internal Science(2)	83(%50.3)	111(%65.3)
Surgical Science(3)	66(%40)	58(%34.1)

*: The p-value of the Mann Whitney U test. **: The p-value of the Pearson Chi-Square test. ***: The p-value of the Fisher Freeman Halton test. Data are expressed as median (min-max) or frequency (percent).

"Scientific Thinking, Discussion and Research Skills", "The Benefit of Internships", "Physician Skills", "Psychic Prestige", "Objectivity of Instructors", "Being Determined and Systematic" and "Absence of Memorizing" scores show a statistically significant difference between the clusters (p < 0.001). According to this, it is seen that the students with higher level of compliance and awareness of the hidden curriculum are included in the cluster where the students at the graduation level are in the majority. In addition, it is seen that the majority of these students want to specialize in internal sciences (p < 0.001). Gender and academic average did not differ statistically between the clusters (respectively; p = 0.910, p = 0.170).

The results of the analysis regarding the evaluation of the sub-dimension scores of the hidden cirriculum scale applied according to the specialization field that the students think they would prefer are given in Table-3.

Table-3: Evaluation of the Sub-Dimension Scores of the Hidden Cirriculum Scale according to the desired area of expertise

	Desired Area of Expertise
	Basic Science¹	Internal Science²	Surgical Science³	p-değeri^****	Post-hoc p-value
Hidden Cirriculum Scale
Scientific Thinking, Discussion and Research Skills	4.50(0–16)	10(0–24)	10(0–24)	0.017	1–3:0.017, 1–2:0.005, 2–3:0.419
The Benefit of Internships	8.50(0–15)	12(0–20)	12(0–20)	0.011	1–3:0.005, 1–2:0.003, 2–3:0.787
Physician Skills	6.50(0–12)	9(0–12)	9(0–12)	0.043	1–3:0.027, 1–2:0.012, 2–3:0.599
Physician Prestige	4(0–12)	6(0–12)	6(0–12)	0.092	-
Objectivity of Instructors	6(0–11)	6(0–12)	6(0–12)	0.804	-
Being Determined and Systematic	6(0–8)	6(0–8)	5(0–8)	0.738	-
Absence of Memorization	3(0–10)	5.50(0–12)	5(0–12)	0.018	1–3:0.045, 1–2:0.008, 2–3:0.144

****: The p-value of the Kruskal Wallis test. Post-hoc comparisons are made with Dunn's test. Data are expressed as median (min-max).

According to Table-3, the sub-dimension scores of “scientific thinking”, “benefit of internships”, “physician skills” and “absence of memorization” of the hidden cirriculum scale according to the specializations that the students want to choose showed a statistically significant difference (respectively; p = 0.017, p = 0.011, p = 0.043, p = 0.018). According to the results of post-hoc comparisons, students who want to choose basic sciences have significantly higher sub-dimension scores of "scientific thinking", "benefit of internships", " Physician skills" and “absence of memorization” compared to students who want to choose internal and surgical sciences (p < 0.05). Thus, it has been determined that students who want to choose basic medical sciences are more worried about adapting by understanding what is demanded from them with the hidden curriculum in education than students who want to choose internal and surgical sciences. At the same time, it was concluded that students who want to specialize in surgery and internal sciences have a higher level of satisfaction compared to those who want to specialize in basic science.

The hidden curriculum in medical education is manifested by the informal rules in medical education institutions, the social structure of these institutions, the expectations of the students, and the values and attitudes of the instructors. In order for a student to be successful, the degree of adaptation to the hidden curriculum in the institution is important, as well as their mental competencies(Snyder, 1970; Bergenhenegouwen, 1987). Often attempts are made to modify and develop formal programs to improve the quality of graduates. However, it is often insufficient for faculties to change their formal programs. There are more than one hidden cirriculum in many faculties and even within the department, and it has been shown in many studies that the hidden cirriculum is more effective than the formal program (Philip Wesley Jackson, 1968; Martin, 1976; Gordon, 1982; Snyder, 1970; Yüksel, 2002; Eisner, 1994; Apple, 1979; Margolis et al., 2002). In the light of this information, in our study, the hidden cirriculum scale developed by Ercan et al. (2009) is applied to determine whether the Covid-19 pandemic and the effect of online education at the medical faculty on the hidden cirriculum of the 3rd, 4th and 6th grade students studying in 6 different medical faculties. As a result of this, it is found that students' adaptation to and awareness of hidden cirriculum according to the specialization they want to choose is significant. Students who want to choose basic medical sciences have higher awareness of hidden cirriculum and degree of adaptation than students who want to choose internal and surgical sciences, while students who want to specialize in surgery and internal sciences are similar in terms of understanding and adapting to the hidden structure. Thus, it has been concluded that students who understand the program by adapting to the hidden cirriculum have more adaptation to the profession and tend to internal and surgical sciences. In addition, the scores of the students, who are divided into two clusters according to their achievement status, showed a significant difference in the scores of the hidden cirriculum scale, and all of the sub-dimension scores of the hidden cirriculum scale examined in one cluster are found to be significantly higher than the other cluster. It is thought that upper classes have an effect on the increase in sub-dimension scores. Thus, it is concluded that the upper classes' behaviors in understanding and adapting to hidden cirriculum are better than the lower classes.

As a result; Quality graduates in universities and the studies for this have always kept their place on the agenda and have started to have a special importance in online education, which is mandatory during the Covid-19 pandemic. Since the quality of graduates of medical faculties is directly related to human life, it is more important than other faculties. Therefore, as we have revealed in our study, it is necessary to develop both formal and hidden curriculum in medical faculties, and to ensure the adaptation of the students to the developed hidden curriculum and to carry out studies in order to understand the program. Thus, the quality of graduates will increase and students' interest in their profession will increase.

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No competing interests reported.

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The Effect of Online Education on Hidden Cirriculum During the Covid-19 Pandemic in Medical Faculties

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Abstract

Figures

Introduction

Hidden Program In Medical Education

Material And Method

Participants

Data Collection Tool

Statistical Analysis

Ethical Aspect Of Research

Results

Discussion And Conclusion

References

Additional Declarations

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