Raising Awareness of the Hidden Curriculum in Medical Education

I want to highlight a page from a Gold Humanism in Medicine web page, Physician empathy and perspective taking protect against burnout – Humanizing Medicine. Although the title emphasizes the role of empathy in protecting against burnout, the tenor of the articles speak to a pervasive force in the culture of medical education in which all doctors are involved, though about which many are probably unaware–the hidden curriculum.

In the essay a physician recounts his own medical school experience of the hidden curriculum, and how the culture of medical education fails to reinvent itself.

The last article in the list about the hidden curriculum sends a particularly powerful message and a call to action by senior physicians, medical students, residents, and anyone else charged with guiding the next generation of doctors.

Often, medical students and residents are exposed to the old “see one, do one, teach one” rule governing how new doctors learn what the old doctors know. Trainees can bear the scars of their learning experience for the rest of their careers. And maybe trainees should not be learning everything the old doctors know.

Every day I’m on the psychiatry consult service is an opportunity for me to be a role model to medical students and residents. I’m a geezer though, and geezers can learn new things from their trainees. Life-long learning is a two-way street. Heck, maybe it’s a multi-lane cloverleaf interchange.

Liao says it better than I ever could:

“Ultimately, students, clinicians, schools, and health care organizations must take collective responsibility for culture change. Despite growing awareness of the hidden curriculum, many within the medical community understand it as something passively absorbed from the ambient behavior of others. Leaders play integral roles in creating positive organizational culture change. But culture is also actively shaped by choices of all team members, including students, residents, senior physicians, nurses, and others. Each individual decision to speak up or remain silent, or to promote unprofessional behavior or pursue nobler alternatives, is an important part of shaping the learning environment. Progress will require each of us to step forward and create a new culture—one that enables students, residents, faculty, and even patients to speak up safely.” [1].

Reference:

1. Liao, J. M., et al. (2014). “Speaking up about the dangers of the hidden curriculum.” Health Aff (Millwood) 33(1): 168-171.
A medical student’s fear of raising questions endangered a patient. Here, as a resident, he explores the dangers of this “hidden curriculum” with his advisers.

5 thoughts on “Raising Awareness of the Hidden Curriculum in Medical Education

  1. It is always shocking to see how radically different the cultures are from place to place and service to service. I can recall being ridiculed by an attending after he learned I was going into psychiatry. On the other hand, I can recall being on teams with grizzled senior physicians (kind of the way I am right now) who treated all of us like valued team members and would go out of their way to teach us. Some of those experiences were so good I never wanted to leave.

    Collegiality is a big part of it as well and working with senior staff who are so comfortable that they are way past the stage of blaming patients for failings in the system and way past the stage that they need to feel like they are competing with the residents and medical students.

    When you can do that the team is firing on all cylinders.

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