• Dorene F Balmer, Emily Hall, MaryJo Fink, and Boyd F Richards.
• Center for Research, Innovation and Scholarship, Texas Children's Hospital, Houston, Texas, USA.
• Acad Med. 2013 Aug 1; 88 (8): 1135-41.

PurposeCurrent focus in medical education on competencies and curricular objectives draws attention to boundaries rather than the openness inherent in the learning process. This qualitative study explored the tension between boundedness (mandated curricular objectives) and openness (variability in learning experience as students traverse the explicit, implicit, and extracurriculum) in the curriculum.MethodFollowing the revision and implementation of 10 curricular objectives for Columbia University College of Physicians and Surgeons, the authors interviewed 18 fourth-year medical students in spring 2011. For each objective, students indicated the relative influence of the explicit curriculum, implicit curriculum, and extracurriculum on their learning. Students were asked to think aloud and assign points as they made these judgments. Quantitative and qualitative data were analyzed to understand students' perceptions of learning across curricula and for each curricular objective.ResultsThere was marked variability in students' learning experience. For two objectives, students perceived that learning occurred mainly in the explicit curriculum and consumed a disproportionate amount of study time. For two other objectives, students perceived that learning occurred mainly in the extracurriculum because opportunities to learn these objectives in the implicit and explicit curricula were sparse. For six objectives, students perceived that learning occurred mostly in the implicit curriculum, often through "watching" or interacting with peers.ConclusionsThe findings can inform discussions about how to balance the boundedness of curricular mandates with the inherent openness of students' learning experiences.

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