OBJECTIVE: To describe and analyze the implicit curriculum of a general pediatrics inpatient setting and to understand how it maps onto competency-based goals and objectives in the explicit curriculum.

METHODS: We conducted a case study on a general pediatrics floor, which entailed 143 hours of direct observation during 8 months and 39 in-depth interviews with pediatric residents and General Pediatric attendings who were observed on multiple occasions as they worked on the floor. Data were derived from field notes and interview transcripts. We inductively coded the data, clustered it according to competency domains, and systematically inspected it to derive themes about the convergence of the implicit and explicit curricula.

RESULTS: The implicit curriculum, shaped by ordinary events, activities, and conversations, taught residents “how things work.” The implicit curriculum aligned well with the competency-based goals and objectives in the explicit curriculum; residents had frequent opportunities to meet >90% (29 of 32) of the written objectives. Nonetheless, no one referred to the explicit curriculum or to the competency domains throughout the study. In contrast to the neat list of goals and objectives in the explicit curriculum, the implicit curriculum was extraordinarily messy and dominated by 1 competency domain: patient care. Moreover, the implicit curriculum was not formally recognized as integral to a competency-based model of education.

CONCLUSIONS: Representing the competency domains in ways that better reflect how learning opportunities in the implicit curriculum align with the goals and objectives in the explicit curriculum may increase awareness of the full range of residents' learning experiences.

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