The Hidden Curriculum in Medical Education

In medical education these days a lot has improved in the formal curriculum. The CanMeds and intensive evaluations were put into formal education programs. Moreover, courses on communication skills, ethics, professionalism etc. were introduced. Unfortunately some research show an erosion of communication skills and attitudes during clinical internship. This has been attributed to the “hidden curriculum” to which these young medical students are exposed during clinical rounds.

The hidden curriculum sometimes also called the culture in medical schools or medical departments is all about individuals sharing the same set of premises that are taken for granted. Examples of these premises can be:

• Doctors do not make mistakes
• You can know everything if you just try hard enough
• It is OK to be rude when you are doing something really important
• Communication skills are nice to have but not essential
• Leaving the hospital is a sign of weakness
• You must not question doctors more senior than you

And many more. These premises are also present in the process of teaching and learning in med school.

The culture of medicine has a profound influence on the behaviors of practicing physicians, because it shapes basic assumptions about what are ‘‘acceptable’’ and what are ‘‘unacceptable’’ medical practices

This is also known as The art of Pimping: pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. More on pimping med students.

According to a recent essay some principles should be important to the student-teacher relationship. These principles are from work on adult education. Medical students especially those in clinical rounds should be viewed as adults needing to be educated in a difficult environment.

Principles of adult education and of importance for changing the hidden curriculum to a more healthy culture are:

• The teacher student relationship should take into account the personhood of each other. Learning especially during medical training should not be a simple delivery or “downloading” a lot of information into the student. Instead of content delivery, teaching is the creating an interpersonal context that fosters learning. Identity forming of the student teacher interaction has powerful effects on students professionalism.
• Emotions are important for learning. Negative emotions such as fear and anger interferes with learning. Positive emotions improve the efficacy of learning and promotes positive learning behaviors such as asking questions, testing hypotheses.
• The learning interaction can lead to growth for both learner and teacher, reciprocal influence is important.
  

  A number of authors have suggested that ideal student-teacher relationships are characterized by qualities such as flexibility, collaboration, mutuality, emotional investment, interdependence, and support for one’s own identity

The information and extend of contribution of the hidden curriculum on medical education are still scarce. Medical teachers, which is almost any doctor, need data on the importance of the relationship between teacher and student. To what extend do positive and negative student teacher relationship mediate student’s adoption of the hidden curriculum. A lot of research on this has still to be done.

Haidet, P., & Stein, H. (2006). The Role of the Student-Teacher Relationship in the Formation of Physicians. The Hidden Curriculum as Process Journal of General Internal Medicine, 21 (S1) DOI: 10.1111/j.1525-1497.2006.00304.x