The hidden curriculum in peer-assisted learning: An exploration of case discussions and journal clubs at a Thai medical school

Peer-assisted learning (PAL) is a common feature of health professions education, characterised as learning from and teaching others who are from a similar background. Evaluations of PAL identify a range of positive outcomes for peer tutors/tutees but rarely address the hidden curriculum, which is a by-product of the learners’ educational experiences, shaped by wider organisational influences and culture. The aim of this case study was to explore the hidden curriculum associated with two modes of PAL used in the final year of an undergraduate medical programme in Thailand: Case Discussions and a Journal Club. A naturalistic evaluation approach, incorporating multiple data sources, was used to explore students’ perspectives on PAL (interviews), student and faculty behaviours during PAL (observation) and the school’s formal/written curriculum (document analysis). Three themes emerged from the thematic analysis of student interviews, triangulated with the observational data (reflecting positive and negative aspects of PAL): 1) developing self as a doctor; 2) learning through dialogue and feedback; and 3) barriers to learning. New insights were gained in relation to the influence of norms and social interactions i.e. recycling materials for Case Discussions and student difficulties with English language journals. Some of the barriers to learning are inherently connected to the study context and recommendations can be made locally for PAL review, however, revealing what is being learned, in the medical habitus, intended and unintended outcomes, highlights the importance of considering the hidden curriculum as an integral part of PAL planning, implementation and evaluation.