From the 1068 studies identified in the search, 107 duplicates were removed. Eventually only 124 studies which referred to aspects on the hidden curriculum in medical education were included. After assessing the studies for eligibility, 71 studies were removed because although they mentioned the term “hidden curriculum,” they did not speak to the influences of the hidden curriculum. In addition, 30 studies were excluded because they did not refer to the positive influences of the hidden curriculum in medical education, leaving 23 studies for full-text review. The years of publication ranged from 2007 to 2022, with the most being in 2017, 2018, and 2020 — see Fig. 2.

Number of publications per year highlighting the positive influence of the hidden curriculum on medical students’ learning

The types of articles included in this study were 18 empirical, four reviews, and an AMEE guide. The reviews explored the teaching of professionalism in medical education, the informal curriculum in family medicine, psychological safety in medicine, and an analysis of the main components of the hidden curriculum in medical education. For the empirical studies, the population included medical students, residents, and faculty. Through the process of content analysis, the following themes were constructed relating to the positive aspects of the hidden curriculum and its influence on medical students’ learning. These themes include positive role-modelling, supportive team environments, positive institutional culture, and navigating ambiguity (see Table 3 for a breakdown of the codes, categories, and themes).

Role-modelling as part of the hidden curriculum in medical education was a dominant trend in the articles reviewed [22,23,24,25,26,27,28,29,30,31]. These studies highlighted various effects of positive role-modelling on medical students’ learning, including the acquisition of values and skills necessary for professional growth [23] and the development of compassion, empathy, and effective communication skills [22, 24, 30, 32]. Some studies also highlighted key attributes and behaviors that characterize positive role models, including the display of behaviors related to dedication and persistence [27], the ability to foster a sense of psychological safety, and demonstrating excellence, leadership qualities, and proficiency in the field [24, 26, 29]. Additional attributes extracted from both empirical and review articles included demonstrating patient and student-centered behaviors such as listening, inspiring trust, politeness, and respect [25,26,27, 33]. In addition, the way students were treated by their role models influenced the way they interacted and responded to others; for example, Bandini et al. highlighted how students who were treated with compassion and respect extended these behaviors to patients and families [34]. Positive role models also have the potential to influence student identity, where students identify mainly with doctors who demonstrate positive relationships with their patients, as suggested by O’Sullivan et al. in their AMEE guide [35].

Supportive team environments were associated with practices that fostered collaborative working relationships among members of healthcare teams with whom students interacted. In some studies, the team structure was seen as a form of support, which nurtured positive relationships with team members. Furthermore, being part of a team of different healthcare professionals provided an expanded understanding of the roles and responsibilities as a physician [27]. The learning-centeredness and supportive nature of the environments where students were placed, and the effectiveness of communication across the team were examples of factors which contributed to students’ positive learning experiences [36]. Being part of the team where members respond positively to students’ input also promotes a sense of psychological safety and develops student confidence [30]. Those students who were placed in cohesive teams seemed to have developed an increased tolerance to others [24].

In addition, it appeared that the hidden curriculum serves as an incubator for the development of relevant interpersonal skills which are critical for being a “good doctor” whose focus is on the quality of their relationship with their patients [37]. Collegial interactions between students and faculty, peers, and the healthcare team helped students to develop and acquire social interaction skills and other skills required for real-life situations [24]. Through positive interpersonal relationships, students developed innate attributes such as mutual respect, selflessness, and compassion [38]. Furthermore, while motivation is inherently intrapersonal, it appears that supportive team environments created conditions that enhanced students’ motivation to learn and fostered a growth mindset. The psychological safety experienced within cohesive teams enabled students to embrace challenges, and develop greater self-motivation, demonstrating how interpersonal dynamics can shape intrapersonal development. Studies also reported that supportive relationships promoted an increased sense of responsibility and the willingness to help fellow students [1, 24].

The hidden curriculum can be understood as an embodiment of the institution’s underlying culture and values. In the articles reviewed, a positive institutional culture represented the implicit messages, practices, and organizational culture that fosters a supportive, inclusive, and enriching learning experience for students. Some studies suggested that the hidden curriculum provides “richness” and depth in students’ learning and offers the opportunity to acquire the skills needed for lifelong learning [37]. Furthermore, placement in an environment that supports learning provides students with the confidence to seek assistance when needed as well as ways to access resources [27]. Acknowledging the role of students as learners also contributed to a positive learning experience creating a sense that teaching and learning, as well as students’ input, were valued [31]. Apart from the opportunity to develop competence, some students felt that they were being prepared to become agents of change, which created a feeling that others were willing to invest in their professional development [1].

In an attempt to create a positive institutional culture, some medical schools placed emphasis on certain attributes such as attendance and personal attire which seemed to influence students’ professional growth in a positive way [23]. In addition, positive institutional messages about the importance of certain aspects, such as unwavering duty, shaped how students valued this for their practice as healthcare professionals [1]. Linked to the institutional culture was the respect for cultural diversity demonstrated by the individuals in the institution. These practices helped students acquire the necessary social interaction skills to interact with diverse individuals and built a higher tolerance to others [24, 37]. While these studies spoke about a positive institutional culture, there were instances when the institutional culture was associated with negative learning experiences. However, it appeared that these were opportunities for students to develop an understanding of the institutional culture, and how to navigate this culture [37].

The positive influence of the hidden curriculum in medical education was also reflected in the practices and experiences that helped students develop the ability to manage uncertainty, complexity, and situations with conflicting messages. For example, Bandini et al. suggested that exposure to ethical-relational tensions helped students to navigate ambiguity present in the culture of the discipline [34]. Being exposed to ways to deal with uncertainty was also perceived as important to navigate the complexity within the clinical environment, as highlighted by Rothlind et al. (2020) in their review [39]. This complexity also provided a space for contested reflection, where students were guided through a process of reflection to explore their experiences, and the lessons learnt. This process, which is crucial for professional identity formation, also allowed students to identify the behaviors that they intended to adopt or avoid as part of their own professional conduct [40].