Signal versus noise on the wards: what "messages" from the hidden curriculum do medical students perceive to be importantly meaningful?

Interested in the hidden curriculum and the learning environment for professionalism at our school, a group of educators called the RIPPLE Team (Relationships in Positive Professional Learning Environments) created The Professionalism Journal for use by third-year medical students during their Internal Medicine and Psychiatry clerkships. The students are introduced to the online journal and encouraged to use it as a means to pause, reflect on the events of the day, and write about episodes or exchanges they find personally important and meaningful. They are informed that their journal entries will be de-identified and used as the triggers for a facilitated and confidential discussion among their peers at the end of the clerkship. This article will report on the themes of the journal entries made by Internal Medicine clerks during one academic year.