Medical education is shaped by a "hidden curriculum", the implicit messages, norms, and values learned through the social community of an institution rather than through formal teaching (Hafferty, 1998; Bennett et al., 2004). Because it is rarely articulated explicitly, students from marginalised backgrounds or with limited support often fall through the cracks (Oron-Semper and Blasco, 2018), and mismatches with the formal curriculum can drive unprofessional behaviour, poorer outcomes, reduced wellbeing, and educational injustice (McNeill, Kerr and Mavor, 2014; Howick et al., 2024). Since medical students become future doctors, these dynamics can also normalise patient mistreatment, bias, and abusive or hierarchical work cultures (Samuriwo et al., 2020; Ong et al., 2025; Wolford et al., 2025). Identifying an institution's hidden curriculum is thus a critical first step toward addressing its harms, but this is difficult: the phenomenon is vague, interpersonal, and inconsistently defined , often called "fuzzy" (Lawrence et al., 2018) , and it is highly local, requiring context-specific approaches (Haidet and Teal, 2015).

One promising way to surface local hidden curricula is through playful interventions and games, which can stimulate learning and creativity, sharpen reflective and critical thinking, engage emotional intelligence around controversy, and support imagining alternatives (Gerodetti and Nixon, 2019; Werning and Vught, 2021; Heljakka, 2023); offering a shared, in-person space to reflect on one's agency within a culture. Our team at UMC Utrecht currently has limited insight into how the hidden curriculum operates in our own medical education, and little is known about the effectiveness of playful interventions for this purpose, with only one prior study applying them successfully to diversity, equity and inclusion issues (Schwabenland and Kofinas, 2023).

This project therefore aims to (1) identify the local hidden curriculum for medical students at UMC Utrecht, and (2) explore playful interventions as a tool for exposing, discussing, and building resilience around it; giving students and staff a shared vocabulary for unspoken rules.

After all, medical education can be understood like a game: before you can win, you first need to know the rules.

This study has the following two objectives, written up in two separate academic articles: 

1) To expose the hidden curriculum in medical education at the UMCU/UU for medical students.

2)  To explore whether games offer a valid and suitable intervention tool around the hidden curriculum.

These objectives give rise to the following research questions:

Objective 1:

1)  What is the hidden curriculum for medical students at the UMCU?

a.   How are hidden curriculum (norms) formed and transmitted?

2)  How does the hidden curriculum impact medical students at the UMCU?

3)   How do medical students experience and navigate the hidden curriculum?

Objective 2:

1)  Do playful interventions offer a suitable intervention tool to address the hidden curriculum, and if so, how?

a. What is the short-term impact of a playful intervention in guiding dialogue and reflection around the hidden curriculum?

b. What do students think of the playful intervention format/game?

This qualitative study adopts a two-fold research approach consisting of an evaluation intervention and case-study design.

By inviting participants to a playful intervention workshop, they engage with games to be introduced to the concept of the hidden curriculum. Thereafter, interviews are used to reflect and explore the hidden curriculum in their specific contexts, and the experience of learning about it via a playful exercise.  

In this case, the playful intervention is both an object of study (i.e. an intervention study on games), as well as a reflective tool to guide the subjects of the study (i.e. medical students and their experiences of the hidden curriculum).

This study has not started yet- stay tuned!