The Contemporary Hidden Curriculum in Medical Education

Abstract

There is a renewed interest in teaching and cultivating compassionate patient-centered care among trainees and faculty. Much of the erosion in medical professionalism can be attributed to what has been labeled the "Hidden Curriculum." We have identified eight archetypal areas where the Hidden Curriculum exerts influence on trainees and faculty. These include: Lack of Accountability to Patients, The Influence of Legal Phobia, Physician and Nursing Overload (how documentation and busy work detracts from patient-centered care), Negative Attitudes and Apathy from Teachers, The Influence of the Electronic Health Record (EHR) in Patient Depersonalization, The Negative Effect of "Work-Life" Balance, The Concept of the "Difficult Patient," and the Negative impact of Evidence-Based Medicine on a Patient-Centered Approach. We believe that we need to focus and assess the residents and faculty's knowledge and attitudes towards the Hidden Curriculum. We believe that reflective learning can enhance professionalism, humanism and compassionate patient-centered care. Reflective learning with specific focus on hidden curriculum can also contribute to the continuous improvement of care in our complex health care environment. In addition interprofessional seminars debating impact of Hidden Curriculum can increase awareness among health professionals on the hidden curriculum in daily practice and education.

Hidden curriculum within nutrition education in medical schools

“…In this apprenticeship model of medical training, learners are exposed to real-world situations to learn from experts in the field 26. It is increasingly recognised that as well as the explicit curriculum, medical students learn the ‘hidden curriculum’ of medicine that teaches them about the expectations of behaviour, professionalism, roles and responsibilities 27. The hidden curriculum is now recognised as a powerful driver of doctor behaviour and professional responsibility 27…”

“… 27 The hidden curriculum is now recognised as a powerful driver of doctor behaviour and professional responsibility. 27 …”

An immersive orientation programme to improve medical student integration and well‐being

“…Neither medical practice nor medical education occur in a cultural vacuum. The negative organisational context and implicit customs of the hidden curriculum shape students’ understanding of their learning environments, thus unconsciously affecting clinical decision‐making in the future . Implied contradictions reveal hypocrisies between stated values and what the students actually experience and learn.…”

The Hidden Curriculum and Integrating Cure- and Care-Based Approaches to Medicine

“…Because it is informal and culture-based, different interpretations exist on what exactly is the hidden curriculum; it is nuanced, and varies by institution, specialty or subspecialty, and of course by the individual physicians who impart it to students. Additionally, literature on the subject identifies many aspects of medical training as shaped by the hidden curriculum, including power-hierarchy issues in training and patient care, attitudes towards different specialties, patient dehumanization, emotional suppression, and burnout or work-life balance (Gaufberg et al 2010 ; Hopkins et al 2016 ; Mahood 2011 ; Mackin et al 2019 ; Rajput et al 2017 ) in essence influencing moral values and virtues of physicians rather than the primary informational content or therapeutic models of medical education. Most important in this context is that the hidden curriculum has a direct influence on students’ development with regard to their orientation towards patient-centered care (Bandini et al 2017 ; Haidet et al 2005 ).…”

“…In other cases, the hidden curriculum is not as hidden as the term may indicate: some attending behavior is callous and public (Bynum and Goodie 2014 ; Riskin et al, 2017 ). While the hidden curriculum might not dominate the transmission of scientific knowledge to students, its “day-to-day” influence in teaching values, such as the importance of holistic, patient-centered care, cannot be ignored (Mahood 2011 ; Rajput et al 2017 ).…”