Asia Pacific Family Medicine Research The perception of the hidden curriculum on medical education: an exploratory study Manabu Murakami*, Hidenobu Kawabata and Masaji Maezawa BioMed Central Open Access Address: Department of Healthcare Systems Research, Graduate School of Medicine, Hokkaido University, Sapporo, Japan Email: Manabu Murakami* - mmanabu@med.hokudai.ac.jp; Hidenobu Kawabata - kawabata@med.hokudai.ac.jp; Masaji Maezawa - mamaeza@med.hokudai.ac.jp * Corresponding author Published: 15 December 2009 Asia Pacific Family Medicine 2009, 8:9 doi:10.1186/1447-056X-8-9 This article is available from: http://www.apfmj.com/content/8/1/9 Received: 8 September 2009 Accepted: 15 December 2009 © 2009 Murakami et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Major curriculum reform of undergraduate medical education occurred during the past decades in the United Kingdom (UK); however, the effects of the hidden curriculum, which influence the choice of primary care as a career, have not been sufficiently recognized. While Japan, where traditionally few institutions systematically foster primary care physicians and very few have truly embraced family medicine as their guiding discipline, has also experienced meaningful curriculum reform, the effect of the hidden curriculum is not well known. The aim of this study is to identify themes pertaining to the students' perceptions of the hidden curriculum affecting undergraduate medical education in bedside learning in Japan. Methods: Semi-structured interviews with thematic content analysis were implemented. Undergraduate year-5 students from a Japanese medical school at a Japanese teaching hospital were recruited. Interview were planned to last between 30 to 60 minutes each, over an 8-month period in 2007. The interviewees' perceptions concerning the quality of teaching in their bedside learning and related experiences were collected and analysed thematically. Results: Twenty five medical students (18 males and 7 females, mean age 25 years old) consented to participate in the interviews, and seven main themes emerged: "the perception of education as having a low priority," "the prevalence of positive/negative role models," "the persistence of hierarchy and exclusivity," "the existence of gender issues," "an overburdened medical knowledge," "human relationships with colleagues and medical team members," and "first experience from the practical wards and their patients." Conclusions: Both similarities and differences were found when comparing the results to those of previous studies in the UK. Some effects of the hidden curriculum in medical education likely exist in common between the UK and Japan, despite the differences in their demographic backgrounds, cultures and philosophies. Background In the United Kingdom (UK), significant curriculum reforms occurred, in which the UK General Medical Coun- cil emphasized reducing information overload of medical knowledge and diverging from didactic teaching [1]. Nev- ertheless, little attention was paid to the hidden curricu- lum [1], the effect of which influences students and faculty most concerned about primary care careers [2]. In Page 1 of 7 (page number not for citation purposes)