Lightning Talk

The Hidden Curriculum: Implicit Hierarchies in the Interprofessional Clinical Learning Environments

Tuesday, October 13, 2020, 1:05 pm - 2:05 pm EDT
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Lightning Talk Presentation
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Lightning Talk Live Discussion Recording

In traditional clinical learning environments (CLEs), providers work alongside one another with noted power differentials. The Boston University Community Health Alliance of Medical Professionals (BU CHAMPs) equips the next generation of providers with core interprofessional skills including communication, roles and responsibilities, and teamwork to address siloed clinical training and reduce health disparities for underserved populations experiencing chronic disease and social stressors. With funding from Health Resources and Services Administration (HRSA T0BHP30021), BU CHAMPs facilitates interprofessional experiential learning among medical, physician assistant, nutrition, and social work trainees.


In individual interviews and team-based focus groups, trainees identified learning strategies and structural elements conducive to a collaborative and patient-centered Interprofessional Care Clinic (ICC). Learning strategies included peer modeling, use of a case-based curriculum, and simulated patient interactions with standardized patients. Trainees noted the importance of team huddles, consultation with an IP preceptor team, and debrief of clinical experience.


Unidisciplinary trainee and preceptor focus groups highlighted the existence of a medical-centric hierarchy within the hidden curriculum. Preceptors often identified the medical professional as lead based on responsibilities, including primarily facilitating the curriculum and clinical care session. Trainees perceived clinic structure and preceptor team dynamics contributing to a traditional culture. In response to this feedback, BU CHAMPs conducted preceptor team development training sessions, shared facilitation of curriculum among all discipline leaders, empowered all trainees to take leadership roles, and offered transparency regarding medical-centered clinical operations in a community health center. In follow-up unidisciplinary focus groups, trainees reported feeling valued by members of their team, and noted the shared leadership, trust, and appreciation between the IP preceptor team.


Through qualitative findings and implementation of quality improvement efforts, the BU CHAMPs program elicited open conversation about the culture in an IP CLE. Addressing implicit hierarchies allowed for psychological safety and confidence among preceptor and trainee teams.

Accreditation Details

In support of improving patient care, this activity is planned and implemented by The National Center for Interprofessional Practice and Education. The National Center for Interprofessional Practice and Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

As a Jointly Accredited Provider, the National Center is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. The National Center maintains responsibility for this course. Social workers completing this course receive continuing education credits.

This activity was planned by and for the healthcare team, and learners will receive Interprofessional Continuing Education (IPCE) credit for learning and change.

  • Physicians: This activity will be designated for CME AMA PRA Category 1 Credit(s)TM through ACCME.
  • Physician Assistants: NCCPA accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by ACCME or a recognized state medical society.
  • Nurses: This activity will be designated for CNE nursing contact hours through ANCC.
  • Pharmacists and Pharmacy Technicians: This activity will be designated for CPE contact hours (CEUs) through ACPE.
  • Social Workers: This activity will be designated for social work continuing education credits through ASWB.
  • All health professionals: This activity was planned by and for the healthcare team, and learners will receive Interprofessional Continuing Education (IPCE) credit for learning and change.