John Goldie is a retired GP and Medical Educator
When I first entered medical school, I thought I was there to learn how to be a doctor. Anatomy, pathology, ethics — the formal curriculum laid out a clear path. But what I didn’t realise then was that I was also being shaped by something far less visible: the hidden curriculum.1 It wasn’t in the lectures or textbooks. It was in the corridor glances, the silence after a sexist joke, the way junior doctors addressed consultants, and the way we learned to hide our uncertainty.
“I was … being shaped by something far less visible: the hidden curriculum.”
Socialisation is the word sociologists use for this lifelong, dynamic process — how we absorb the norms, values, and behaviours that help us function in society (Box 1).2 In medicine, it’s how we learn to think, act, and feel like doctors. Some of it is explicit: clinical guidelines, professional standards, ethical codes. But much of it is tacit. We learn by watching, imitating, and adapting to the culture around us. And that culture, like all cultures, is shaped by power. As Foucault reminds us, power is not merely held — it circulates, through institutional routines, language, and silences, shaping what is seen as normal, professional, or deviant.3
| Box 1. Forms of socialisation | |
| Primary socialisation | This happens in early childhood, when children learn basic language, values, and behaviours from their family or caregivers. |
| Secondary socialisation | This takes place outside the family, through schools, friends, religious organisations, and the media, teaching people how to behave in diverse groups. |
| Developmental socialisation | Is the ongoing learning and growth that happens as people take on new roles throughout life. |
| Anticipatory socialisation | Is when people prepare for future roles by practicing or learning about them in advance. |
| Resocialisation | Is when someone changes their behaviour and beliefs to adapt to a new part of life. |
Before we ever don a white coat, we’ve already been socialised — by our families, schools, media, and early encounters with health care. These influences form what’s called anticipatory socialisation. They shape our expectations of medicine and our place within it. But once inside the system, the process intensifies. We learn not just how to examine a patient, but how to present ourselves. We learn when to speak and when to stay silent. We learn what’s rewarded, what’s tolerated, and what’s quietly discouraged.
“This hidden curriculum can be a powerful teacher. It fosters resilience, competence, and a sense of belonging.”
This hidden curriculum can be a powerful teacher. It fosters resilience, competence, and a sense of belonging. But it can also erode empathy, reinforce inequality, and normalise behaviours we might once have questioned.1 I’ve seen students suppress their doubts to appear confident, laugh at jokes they found uncomfortable, or internalise the idea that showing emotion is unprofessional. Over time, these adaptations become automatic.4 That’s the danger: we stop noticing.
General practice offers a different rhythm. When I transitioned into GP training, I found myself in a space that challenged many of the assumptions I’d absorbed. The hierarchies were flatter. The work was more relational. The team was multidisciplinary. Suddenly, collaboration mattered more than deference. Patients weren’t fleeting cases on a ward — they were people I might see again next week. It was disorienting but also a form of resocialisation.
In this setting, I began to reflect more deeply on the kind of doctor I was becoming. I started to notice the small things: how I greeted patients, how I responded to uncertainty, how I navigated power dynamics with colleagues. I realised that socialisation doesn’t stop at graduation. It continues throughout our careers — especially during transitions, conflicts, and moments of doubt.
“I began to reflect more deeply on the kind of doctor I was becoming. I started to notice the small things …”
Conflict, in fact, can be a catalyst. It forces us to confront the gap between our values and our actions.2 I remember a hospital registrar’s dismissive comment about a referral. It was awkward, but I challenged it. It sparked a conversation with my peers about compassion, burnout, and the stories we tell ourselves to cope. That moment stayed with me. It reminded me that we’re not passive recipients of culture. We can question it. We can reshape it.
Reflexivity is the key.5 It’s the capacity to step back and examine our assumptions, our roles, and the systems we inhabit. Reflexivity allows us not only to critique the culture we inherit but to consciously author the professional identities we inhabit. It’s not always comfortable — but it’s essential. Without it, we risk reproducing the very inequalities we claim to oppose. We risk becoming technicians of care, rather than thoughtful practitioners.
Recent reviews5 suggest that medical schools are increasingly aware of these undercurrents and are experimenting with structural interventions. Reflective practice groups, ethics discussions, and quality improvement placements are helping students make sense of their experiences. Faculty development workshops are encouraging educators to model the values they hope to instil. Recruitment initiatives are widening access to the profession. These are hopeful signs. But they must be sustained — and extended into postgraduate training.
General practice offers a unique opportunity. Our setting invites reflection. Our relationships span time. Our teams are diverse. We can use this to foster a culture that values not just clinical competence, but ethical awareness and social consciousness. We can help trainees not just fit in—but think critically about what they’re fitting into.
Because becoming a doctor isn’t just about acquiring knowledge and skills. It’s about becoming ourselves — deliberately, ethically, and in dialogue with the world we serve.
References
1. Hafferty F.W, Franks R. The hidden curriculum, ethics teaching and the structure of medical education. Acad Med, 1994; 69(11): 861-871.
2. Guhin J, McCrory Calarco J, Miller-Idriss C. Whatever Happened to Socialization. Annu Rev Sociol, 2021; 47: 109-129.
3. Foucault, M. Power/Knowledge, ed C. Gordon, trans C Gordon, L Marshall, J, Mepham and K. Soper. Hemel Hempstead: Harvester Wheatsheaf. 1980.
4. Bourdieu, P. The Logic of Practice. Cambridge: Polity Press. 1990.
5. Goldie J. Do training and CPD foster truly reflective GPs? BJGP, 2017. https://doi.org/10.3399/bjgp17X689305
6. Larotta SP, Rincón EHH, Correa DN, et al. Effects of the hidden curriculum in medical education: a scoping review. JMIR Medical Education, 2025; 11: e68481.
Featured photo by Vitaly Gariev on Unsplash
