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The informal curriculum: what do junior doctors learn from a palliative care rotation?
  1. Poi Choo Hwee1,2,
  2. Khoo Hwee Sing3,
  3. Mervyn Koh Yong Hwang1,2 and
  4. Allyn Hum Yin Mei1,2
  1. 1 Palliative Medicine Department, Tan Tock Seng Hospital, Singapore, Singapore
  2. 2 Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
  3. 3 Health Outcomes and Medical Education Research (HOMER), National Healthcare Group, Singapore, Singapore
  1. Correspondence to Dr Poi Choo Hwee; choo_hwee_poi{at}


Objectives Junior doctors learn from the formal and informal curriculum. In a palliative care rotation, the informal curriculum may be useful in teaching attitudes like empathy and compassion. Our study aims to explore how the informal curriculum augments the formal curriculum of a palliative care rotation in shaping the professional development of a doctor.

Methods We conducted a qualitative study with seven focus group discussions involving 21 junior doctors (medical officers and residents) who spent at least 2 months in a palliative care setting in a tertiary hospital or an inpatient hospice. Data were analysed using qualitative thematic analysis to identify the themes related to the junior doctors' perceptions of how the informal curriculum impacted their humanistic and professional development, thereby augmenting the formal curriculum in a palliative care setting.

Results Three main themes illustrated how the informal curriculum influenced the doctors: (1) reconceptualisation of control: shifting perspectives as they grappled with their envisioned control versus reality while caring for dying patients; (2) emergence of professionalism: adapting perspectives as they learnt how to bridge theory and reality while developing professionalism and (3) personal growth: forming new perspectives, as doctors reflected on life, death and their calling through a renewed lens.

Conclusion This study explored how the informal curriculum influenced doctors’ perceptions about professionalism and personal growth, embodying the values of the profession. Observations and interpersonal interactions with healthcare professionals, patients and their caregivers encouraged the doctors to reflect upon their own calling into medicine.

  • palliative care education
  • informal curriculum
  • junior doctors

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  • PCH and KHS are joint first authors.

  • PCH and KHS contributed equally.

  • Correction notice This article has been corrected since it was published Online First. The first names and surnames for Poi Choo Hwee, Khoo Hwee Sing and Mervyn Koh Yong Hwang were incorrectly reverted. The 'Correspondence to' information was also therefore incorrect and has since been updated.

  • Contributors AH, PCH: designing the research study. AH, PCH, KHS, MK: qualitative analysis of results. AH, PCH, KHS: writing of manuscript. MK: reviewer of manuscript.

  • Funding This work was funded by a grant from HOMER (Health Outcome Medical Education Research) Grant, National Healthcare Group, Singapore (NHG-HOMER FY13/A02).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval for this study was obtained from the National Healthcare Group Domain Specific Review Board (NHG DSRB Ref: 2013/00235).

  • Provenance and peer review Not commissioned; internally peer reviewed.

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