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

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. To better understand examples of the hidden curriculum in GI fellowship, from the perspective of fellows, to improve the overall educational experience. A qualitative analysis of semi-structured virtual interviews using grounded theory was performed. 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. 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.