Mastering the Hidden Curriculum reveals how the unspoken rules, hidden expectations, and subtle power dynamics of medical training can shape who struggles, who advances, and who learns to succeed in medicine. What first convinced you that the “hidden curriculum” in medicine was not peripheral, but central to trainee success?

This is an excellent question, as my recognition of the hidden curriculum was not an immediate revelation. Several years ago, while conducting a literature search, I encountered the concept of the hidden curriculum, and it immediately resonated with me. It captured something I had long been interested in but had not previously been able to clearly define. At that point, however, I had not fully appreciated its significance.

As I explored the topic more deeply, including areas that have received limited attention, and reflected on my own experiences, I began to recognize that the hidden curriculum is far more expansive and influential than is typically acknowledged. This realization created a sense of responsibility to share these insights, which ultimately led me to begin writing a book. Despite recognizing its importance, I had not yet concluded that it was central to success in medical education.

What ultimately solidified that perspective was engaging in conversations with colleagues and peers about my work. Regardless of institution or setting, the themes in their experiences were strikingly consistent. I began to hear a steady stream of examples, many involving seemingly minor missteps by trainees that nonetheless had outsized consequences. In some cases, a single incident could shape a supervisor’s perception of a trainee in a lasting way, effectively becoming a label that is difficult to overcome.

How did you decide which invisible forces in medical training were most important to name for readers?

In developing a comprehensive framework for the book, I aimed to identify the forces that most meaningfully shape the training experience. Broadly, I focused on two categories. First, I highlighted foundational influences (those that are highly impactful yet often difficult to recognize) because they are so deeply embedded within the culture of medicine. Second, I emphasized more visible, surface-level forces that nonetheless have a significant and immediate effect on trainees’ experiences and trajectories.

Examples of foundational influences include medicine’s historical shift from a spirituality of transcendence to one of immanence, the role of humanism in shaping medical practice, and the lasting influence of William Halsted, who established the first U.S. surgical residency under motivations that were likely, in part, self-serving. These forces are less frequently discussed, yet they fundamentally shape how training is structured and experienced.

In contrast, surface-level influences include factors such as the impact of role modeling on professional behavior and the drivers of specialty segregation by sex. While these may be more readily observable, they carry substantial consequences for how trainees navigate their environment and make career decisions.

What do you most hope a first-generation medical student or early-career resident feels after finishing your book?​

Beyond the practical guidance such as the importance of actively seeking out strong mentorship, I hope that a first-generation medical student or early-career resident finishes the book with a genuine sense of belonging. That sense of belonging is a fundamental human need, and it can be especially elusive in environments where the hidden curriculum is not made explicit.

My hope is that, by understanding and navigating these often-unspoken dynamics, first-generation trainees feel empowered not only to find their place, but to do so as their authentic selves. With the support of meaningful mentorship and a clearer understanding of the training environment, they can begin to recognize that their unique perspectives are not liabilities, but strengths that can enhance both their own experience and the field more broadly.

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