Shifting the culture of medicine through everyday encounters

Knowledge, clinical skills, and professional development are core components of medical school curriculum and post-graduate training. The instruction and evaluation of trainees follows a formalized structure to ensure that each student, resident, and fellow achieves the necessary skills to make her or him a competent physician capable of independent practice in their respective specialty. 

As faculty, we attempt to integrate instruction on these components throughout a clinical encounter: how to interview a patient and establish rapport, how to use clinical reasoning to arrive at a diagnosis, why a certain medication may not be appropriate for a given patient, which surgical technique to use in each situation, and the potential complications that could arise during a procedure.  The list goes on. And educators are constantly evaluated by learners on how well we teach. Do trainees feel we are adequately teaching how to practice medicine safely and effectively? Are we appropriately balancing their autonomy with our oversight as an attending? Overall, we do this well. The U.S. remains among the top countries for the quality of physicians we produce through our medical education system. We should be proud of ourselves. Or should we?   

While we train students and residents to be experts in clinical knowledge, patient care, and medical research, it may be coming at the expense of another curriculum – the hidden curriculum. 

The hidden curriculum is the informal lessons we teach through the respect, language, demeanor, and attitude toward colleagues, team members, and patients. These lessons demonstrate our implicit biases and values – for better or for worse – and have a powerful impact on the values trainees will carry into their own practice.  Though many of us would like to think we manifest idealistic tendencies in our day-to-day practice, data suggests that learners think otherwise. More than half of medical school graduates in 2022 perceived disconnects between what they were taught about professional behaviors/attitudes and what they saw being demonstrated by faculty during their medical school experience¹.

The table below compares the key curricular components across medical training with characteristics of the informal, implicit lessons of the hidden curriculum. Over the coming weeks, this series will explore specific elements of the hidden curriculum and consider opportunities for how we can use the hidden curriculum as a tool to shift the culture of medical education and the medical profession for the better.

Table 1. Comparison of key curricular components of medical school and post-graduate training with characteristics of the hidden curriculum of medical training.

^{*Additionally includes continuation and/or reinforcement of medical school curricular components}

 ¹Association of American Medical Colleges. Medical School. Graduation Questionnaire: 2022 All Schools Summary Report. July 2022.