Who Stands at the Front of the Room: How Faculty Composition Shapes the Hidden Curriculum in Maternal Health Training

Every maternal health training program publishes a formal curriculum. Syllabi list competencies. Course catalogs describe learning objectives. Accreditation bodies verify that required content is delivered. But students absorb a second, less visible curriculum—one that is never written down, never assessed on a licensing examination, and rarely acknowledged in faculty meetings. This curriculum is transmitted through observation: through who teaches, who advances, who is deferred to in clinical settings, and whose professional experience is treated as authoritative.

The demographic and experiential composition of a program's faculty is not a neutral administrative fact. It is a pedagogical statement. And in maternal health education, where questions of equity, clinical authority, and patient trust are deeply consequential, that statement deserves far more scrutiny than it currently receives.

What Students Learn Before a Lecture Begins

Educational theorists have long recognized the concept of the hidden curriculum—the implicit messages institutions convey through their structures, routines, and social hierarchies rather than through explicit instruction. In medical and health professions education, researchers have documented how the hidden curriculum shapes students' understanding of professional norms, power relationships, and the relative value of different forms of knowledge.

In maternal health programs specifically, the hidden curriculum operates through a familiar set of signals. When a student observes that the majority of clinical faculty are white, that leadership positions are concentrated among those with hospital-based rather than community-based experience, or that faculty who practice in underserved or rural settings occupy adjunct rather than tenure-track roles, she draws conclusions. Those conclusions may not be consciously articulated, but they accumulate into a working model of what professional success looks like—and who is positioned to achieve it.

These observations do not stay in the classroom. They travel into clinical placements, into professional networks, and eventually into the birth room, where they influence how practitioners relate to patients whose backgrounds differ from their own.

The Hiring Criteria Problem

Many maternal health programs, particularly those housed within academic medical centers or university nursing schools, apply hiring criteria that systematically favor certain professional profiles. Publication records, advanced research degrees, and affiliations with major hospital systems are weighted heavily. Experience attending community births, working within federally qualified health centers, or practicing in settings that serve predominantly Black, Indigenous, or immigrant populations is frequently treated as supplementary rather than central.

This is not merely an equity concern in the abstract. It has direct implications for curriculum content and clinical modeling. Faculty who have spent careers in high-intervention tertiary care environments will, without any deliberate intent, model the assumptions and reflexes of those environments. Students who never observe instructors with deep experience in low-intervention or out-of-hospital settings may graduate with a narrowed conception of what competent maternal health practice looks like.

The inverse is also true. Programs that actively recruit faculty with diverse practice backgrounds—including certified professional midwives, community doulas who have transitioned into educational roles, nurses who have practiced in birth center or home settings, and clinicians with experience serving specific cultural communities—expand the range of clinical realities students are prepared to encounter.

Promotion Pathways and the Compounding Effect

Hiring is only the first mechanism through which faculty composition communicates professional values. Promotion criteria compound the message. When advancement within a program depends primarily on metrics that favor research productivity over clinical innovation, or when leadership positions are filled through networks that replicate existing demographic patterns, the institution signals which contributions it values most.

For students, watching which colleagues of their instructors receive recognition, which faculty members are invited to lead grand rounds or keynote symposia, and which voices are centered in curriculum revision processes provides continuous instruction in the informal hierarchy of the profession. A student who never observes a midwife of color in a position of institutional authority will graduate with a particular—and potentially distorted—understanding of where authority resides in maternal health.

This matters for patient care in concrete ways. Research consistently demonstrates that patients receive better care when they are treated by clinicians who share their cultural background or who have been trained by educators with relevant cultural competency. Programs that fail to build diverse faculty pipelines are not simply making an internal administrative choice; they are shaping the clinical workforce that will serve an increasingly diverse patient population.

The Adjunct Economy and Its Pedagogical Costs

A structural feature of many maternal health programs deserves particular attention: the reliance on adjunct or part-time clinical faculty to deliver instruction that full-time faculty do not provide. In practice, this often means that the instructors with the most direct, recent, and diverse clinical experience—those still actively attending births in community settings, those working in underserved areas, those who speak patients' primary languages—are employed on precarious, low-compensation contracts with minimal institutional voice.

Students perceive this arrangement clearly. The instructor who arrives twice a week from a busy community practice, who does not have an office, who is not present at faculty meetings, and who is not invited to contribute to curriculum development occupies a different status than the tenured professor who delivers the program's foundational courses. The knowledge that adjunct instructor carries—knowledge that may be more directly relevant to the range of patients students will eventually serve—is implicitly devalued by the institution's own organizational structure.

Addressing this dynamic requires more than good intentions. It requires examining compensation structures, converting contingent positions to sustainable ones where feasible, and creating formal mechanisms through which clinical faculty with community-based expertise contribute to curriculum governance.

Toward a More Deliberate Institutional Practice

None of this is to suggest that maternal health programs are unique in these patterns, or that the educators who work within them are individually responsible for structural conditions they did not create. The forces that shape faculty composition in health professions education—accreditation requirements, funding models, academic labor markets, historical patterns of exclusion—are systemic and deeply entrenched.

But acknowledging systemic origins does not exempt institutions from responsibility for deliberate action. Programs that take seriously their role in shaping the next generation of maternal health professionals have both the opportunity and the obligation to examine what their faculty composition communicates—and to make intentional choices about the messages they want to send.

This might begin with a straightforward audit: Who teaches in this program? What professional backgrounds do they represent? What practice settings, patient populations, and clinical philosophies are present in the room—and which are absent? Where do faculty of color, faculty with community-based experience, and faculty whose clinical formation occurred outside mainstream academic medicine appear in the institutional hierarchy?

The answers to those questions constitute a curriculum. The only question is whether programs will choose to design it deliberately or leave it to chance.

Conclusion

Maternal health education has invested considerable effort in examining what is taught. The field has been slower to examine who teaches, under what conditions, and with what institutional standing. The hidden curriculum transmitted through faculty composition, hiring criteria, and promotion pathways is not a peripheral concern—it is foundational to the professional identity students develop and the clinical culture they will carry into practice.

Building programs that reflect the full diversity of the profession, and that treat community-based and culturally grounded expertise as genuinely central rather than decorative, is not merely an equity initiative. It is a commitment to producing practitioners who are prepared to serve every patient who walks through the door.