Ecuador hospital study links intern learning to support and hierarchy

A qualitative study of 21 medical interns at an urban private hospital in Ecuador found that everyday clinical work operated as a “third classroom,” offering learning opportunities while transmitting a hidden curriculum that shaped whether interns felt able to ask questions, acknowledge uncertainty and develop respectful professional identities. The research, involving members of the hospital’s 2024–2025 intern cohort, examined the relationships and organisational conditions that supported or constrained workplace learning. Researchers used a descriptive-interpretive design and analysed anonymous responses to an online questionnaire completed in July 2025.

The questionnaire contained 10 open-ended questions. Investigators read the responses in full, conducted open inductive coding, identified units of meaning, grouped them into themes and examined the categories through a double-entry matrix. Social pedagogy informed the interpretation, providing a lens focused on relationships, participation and ethics.

Reported institutional expectations offered documentary context, but the researchers did not separately report an analysis of those expectations. Three connected themes emerged. The hospital first appeared as a situated learning community, with learning arising during bedside participation, corridor microteaching, night-shift activity, encounters with senior clinicians and education involving patients and families.

Role modelling was part of this environment. These activities showed how learning could extend beyond university teaching and the formal internship programme into the routines, relationships and culture of clinical work. The second theme concerned the hidden curriculum and ethical climate.

Interns’ experiences suggested that the messages conveyed by workplace culture could influence their willingness to ask questions, acknowledge uncertainty and develop professional identities marked by respect and care. Accessible tutors, interprofessional rounds and humanising practices helped connect formal institutional intentions with everyday learning. In contrast, workload, rigid hierarchy, inconsistent feedback and variation between services restricted educational opportunities and limited participation.

The results therefore describe both a setting capable of supporting workplace education and organisational conditions that could constrain it. The third theme brought these elements together by examining the organisational conditions surrounding learning opportunities and the relationships governing participation. Accessible educators and reflective interprofessional activities were presented as features that could bridge intended and experienced teaching, while workload, hierarchy and uneven feedback could impede that connection.

The findings do not quantify the prevalence of particular experiences, and the study of one hospital and 21 interns cannot establish how widely the results apply to other settings. The questionnaire accounts also do not provide direct measures of clinical performance, and the supplied study summary does not report detailed sampling information or response rates. The authors conclude that protecting brief teaching moments, responding respectfully to uncertainty and encouraging interprofessional reflection on hidden messages are potential implications for clinical teachers; they emphasize that the feasibility and effects of these approaches require evaluation.

Subject of Research: Hospital workplace learning and hidden curricula among medical interns

Article Title: The hospital as a third classroom: a qualitative descriptive-interpretive study of situated learning and the hidden curriculum among medical interns

Article References: Llerena-Velastegui, J., Llerena-Velastegui, G., & Jimbo-Sotomayor, R. (2026). The hospital as a third classroom: a qualitative descriptive-interpretive study of situated learning and the hidden curriculum among medical interns. BMC Medical Education. https://doi.org/10.1186/s12909-026-10641-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10641-9

Keywords: medical education, situated learning, hidden curriculum, clinical workplace, medical interns, social pedagogy, ethical climate, interprofessional learning, hospital culture, Ecuador, hospital, third