The Hidden Curriculum: A Good Thing?

Abstract

Introduction The hidden curriculum is defined as a set of influences that function at the level of the organizational structure and culture to impact learning. Literature supports the significant impact of the hidden curriculum on all levels of learners in medical education. Our project aims to capture the messages being delivered to healthcare providers at our local facility. Methods Multiple one-time educational sessions on the hidden curriculum were provided over a fiveyear period to healthcare professionals. Participants were asked to share personal examples of their lived experiences with the hidden curriculum. A thematic analysis of the responses was completed and coded by two independent reviewers. Results Participants consisted of medical students, residents, faculty physicians, and allied health professionals. Their experience of the hidden curriculum emerged in six main themes: Vulnerability, Hierarchy, Privilege, Navigation & Negotiation, Positivity, and Dehumanizing. Conclusion A minority of responses demonstrated the positive impact that the hidden curriculum can have on professional development. This project highlights the importance of formally addressing the hidden curriculum to capitalize on its impact on medical trainees. The results have inspired a project focusing on residents as the population of interest in their unique role as learners and preceptors.

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

“…By undermining humanistic values, the hidden curriculum teaches students to prioritize "cure" over "care". It can also create a "cognitive dissonance with trainees' developed expectations distilled from the formal curricula" (Mackin et al 2019). Martimianakis et al (2015, S9) found that continued prevalence of the biomedical approach is related to the "denigration of 'nonscientific topics, such as medical history and the socio-cultural contexts of 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 ).…”

“…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 ). The significance of the hidden curriculum is well-substantiated, both by individual experience (Liao et al 2014 ; Mahood 2011 ) and by empirical studies (Hopkins et al 2016 ; Mackin et al 2019 ). The cure-oriented approach is often learned through subtle behaviors.…”

“…By undermining humanistic values, the hidden curriculum teaches students to prioritize “cure” over “care”. It can also create a “cognitive dissonance with trainees’ developed expectations distilled from the formal curricula” (Mackin et al 2019 ). Martimianakis et al ( 2015 , S9) found that continued prevalence of the biomedical approach is related to the “denigration of ‘nonscientific topics, such as medical history and the socio-cultural contexts of medicine.’” Since the biomedical approach is dominant, students might learn from physicians during clinical observation that medicine is about fighting disease with scientific methods, and that psychosocial factors such as mental health, caretaker availability, or socioeconomic status are not worth considering.…”

“…Current programs attempting to address the hidden curriculum are extensions of the formal medical school curriculum; we recommend that changes should be instituted through residency programs in such a way that would constitute a change in the informal instead of formal curriculum. According to Mackin et al ( 2019 ), “residents provide a unique opportunity as a population to target given their concurrent role as learner and preceptor of junior trainees,” and programs that target residents can “lead to sustainable change once they move into faculty positions with ongoing opportunities to be preceptors for trainees.” Physicians in the early stages of their career are likely more willing to question the sedimented, disease-based model, so the changes we propose would influence the way residents view and respond to the prevailing physician culture of reductionism and detachment, which contributes to an approach to medicine that is cure-oriented. By indirectly reiterating the importance of psychosocial factors in patient care through residency programs, the effect of changes in medical school formal curricula can be magnified.…”