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Simulation and Cultural Compression

By Eve Purdy (@purdy_eve)

Throughout medical school, students learn an inconceivable amount of new knowledge around pathophysiology and treatment of medical conditions. A parallel and powerful cultural learning process simultaneously takes place. Eventually, medical students come to understand and incorporate the values and beliefs of the profession, and even of specialist groups. This enculturation, for better or worse, usually happens incrementally. This insidious cultural learning is known as the hidden curriculum which has come to harbour negative connotations in the world of medical education but need not have this unilaterally hostile interpretation. The hidden curriculum is essential in the path to belonging. Students hear the way that senior physicians talk, watch what they do, receive signals about value from the curriculum, and work through their experiences over lunch, coffees, and beer with their colleagues. Some of these moments can be problematic, but much of this learning is positive. While incremental cultural learning occurs, there are also more intense moments when the weight of cultural learning bears down heavily on learners. Moments of “cultural compression” are times when the signalled values and beliefs of the profession are particularly strong.

As an anthropologist and an educator, I am interested in moments of cultural compression for what they tell us about 1) the culture doing the transmitting and 2) the process of that transmission. Rogers identified assessment as the quintessential moment of cultural compression in medical education (2005). Through assessment educators clearly outline to learners what they value and what is important. But there are other key moments of cultural compression in medical education too. In our recently published study, we found that a simulation exercise with undergraduate medical students acted as a moment of cultural compression. We were able to identify core values of emergency medicine and also show that these cultural teachings were transmitted to learners in the exercise.

As educators, this study might prompt us to observe and reflect not only on simulation but also on other times of cultural compression (i.e. CaRMS tour, resident retreats, grand rounds etc.). During these moments the invisible often becomes visible, and it becomes easier for us to see who we are. By being an ethnographer for an hour, or a day, we might gain valuable insights! We might also be mindful of the fact that cultural transmission may be particularly strong at these times. We can simultaneously be reverent of and capitalize on that reality in the structure, design, and delivery of educational activities.

If you have questions about our study or want to learn more I am always happy to chat.


Purdy et al. 2019. Identifying and transmitting the culture of emergency medicine through simulation. AEM Education and Training: in press.

Rajput et al. 2017. The contemporary hidden curriculum in medical education. AMEE 1; 12.

Rogers. 2005. Competency-based assessment and cultural compression in medical education: lessons from educational anthropology. Medical Education 39 (11).

Feature photo provided by author

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