Underrepresented students in medicine (URM) have more negative perceptions of the medical school learning environment (LE), a phenomenon that can contribute to higher rates of burnout and attrition in these populations. The hidden curriculum (HC)-defined as a set of values informally conveyed to learners through clinical role-modeling-is a LE socialization construct that has been critically examined for its role in shaping students' professional identities. Yet differences in how URMs and non-URMs experience the HC remain underexplored. The study used a pragmatic approach that drew on elements of grounded theory and employed both deductive and inductive reasoning. Investigators conducted qualitative, semi-structured interviews with a purposive sample of 13 URM and 21 non-URM participants at a Bronx, NY medical school. Interviews examined student experiences and reactions to the HC. Both cohorts witnessed patient disparagement and mistreatment. However, from these encounters, URM participants expressed more moral injury-the adverse emotional consequence of feeling pressured to accept ideologically incongruent values. URMs were also more likely to describe resisting the HC. Differences in group reactions appeared to arise from URMs' identity resonance with patients' lived experiences. Participants across cohorts emphasized increasing URM recruitment as one step toward mitigating these circumstances. URM participants experienced more distress and offered more resistance to the HC relative to non-URMs. The etiology of these differential reactions may stem from relative barriers in negotiating personal and professional identities. As such, URMs' perceptions of the LE may be adversely impacted given their more negative interactions with the HC.

中文翻译：

---

医学院的道德伤害和隐藏课程：比较医学（URM）和非URM中代表性不足的学生的经历。

医学专业学生 (URM) 代表性不足的学生对医学院学习环境 (LE) 的看法更为负面，这种现象可能导致这些人群的倦怠和自然减员率更高。隐藏课程（HC）——被定义为通过临床角色建模非正式地传达给学习者的一组价值观——是一种LE社会化结构，因其在塑造学生职业身份方面的作用而受到严格检验。然而，URM 和非 URM 体验 HC 的差异仍有待探索。该研究采用了一种实用的方法，借鉴了扎根理论的元素，并采用了演绎推理和归纳推理。研究人员对纽约州布朗克斯医学院的 13 名 URM 参与者和 21 名非 URM 参与者进行了定性、半结构化访谈。访谈调查了学生的经历和对 HC 的反应。两个队列都目睹了患者的蔑视和虐待。然而，从这些遭遇中，URM 参与者表达了更多的道德伤害——因为被迫接受意识形态上不一致的价值观而产生的不良情感后果。URM 也更有可能描述抵制 HC。群体反应的差异似乎源于 URM 与患者生活经历的认同共鸣。各个队列的参与者都强调增加 URM 招募是缓解这些情况的一个步骤。相对于非 URM 参与者，URM 参与者经历了更多的痛苦，并对 HC 表现出更多的抵抗力。这些差异反应的病因可能源于个人和职业身份谈判中的相对障碍。像这样，