Hidden curricula — the lessons that are unintentionally taught to students based on norms and values demonstrated in a specific culture — are widespread in medicine. To combat these hidden curricula, the American College of Physicians (ACP) has published a position statement outlining strategies that can be used to uncover hidden curricula in medical education and practice.
In medicine, there is often a disconnect between what is taught in the classroom and what students observe in clinical practice. According to the ACP, hidden curricula can affect the future of primary care, an aspect of medicine in which there will soon be a substantial societal need. Leadership’s negative comments regarding primary care, as well as higher salaries paid to physicians working in subspecialities, may subconsciously influence future medical practitioners from entering primary care, creating a medical industry even more unprepared for the rising aging population.
Members of the ACP Ethics, Professionalism, and Human Rights committee developed recommendations to reduce the discrepancies inherent in hidden curricula. One recommendation is to encourage both faculty members and clinicians to display positive curriculum (ie, practices and behaviors in the workplace fueled by positive comments and outlooks) that matches formal curriculum. This could include demonstrating more empathy for patients and using reflection and discussion of behaviors during training.
The recommendations also include suggestions to develop a learning environment fostering “respect, inquiry, and honesty” that empowers “every individual, including learners, to raise concerns about ethics, professionalism, and care delivery.” Finally, the position paper suggests that a strong ethical culture should be created by “encouraging discussion of ethical concerns, making values in everyday decision making explicit, and embodying expectations of professionalism in which patient well-being is a core value.”
Uncovering and changing hidden curricula in the medical field involves being aware of one’s own thoughts, judgements, and behaviors. The ACP believes that the best approaches to the effect of hidden curricula include integrating “its positive aspects into the formal curriculum,” as well as developing “approaches to understand and mitigate its negative aspects by educators and practicing clinicians.”
Lehmann LS, Sulmasy LS, Desai S; for the Professionalism and Human Rights Committee. Hidden curricula, ethics, and professionalism: optimizing clinical learning environments in becoming and being a physician: a position paper of the American College of Physicians. Ann Intern Med. 2018;168(7):506-508.