It is widely acknowledged by medical teachers that undergraduate medical training involves three curricula – the official or overt curriculum (what the university has defined as the content and methods of teaching), the taught curriculum (what and how it actually teaches) and the hidden curriculum (the set of influences that work below the surface, creating the culture of the institution, such as implicit rules that have to be followed to survive and customs and rituals).*1
The hidden curriculum has been found to have a very significant effect on how medical graduates develop. Six learning processes of the hidden curriculum of medical education have been identified: loss of idealism, adoption of a ‘ritualised’ professional identity, emotional neutralisation, change of ethical integrity, acceptance of hierarchy, and the learning of less formal aspects of ‘good doctoring’. Together they achieve the enculturation of students as they develop into both practitioners and members of the medical profession.*2 This correlates with other studies that have shown a loss of idealism and development of cynicism as students progress from new medical undergraduates to young doctors.*3
What was/is the hidden curriculum in your medical school? Were the role models to which you were exposed examples of caring, compassionate and conscientious physicians who treated you and their patients with respect and consideration? Or was there a hierarchical and competitive atmosphere in the medical school, in which haphazard instruction and teaching by humiliation occurred? Sadly, in many parts of the world, it is the second that most medical students experience.
It takes courage and determination to resist the hidden curriculum that would seek to turn us into emotionally neutral, ethically compromised, hierarchy loving ritualised professionals. Doctors of that kind are of little use to their patients except perhaps in a very narrow technical way, and will not encourage their patients towards restored wholeness (health). We need spiritual resources to enable us to consistently practise and demonstrate love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control*4 with our patients and colleagues. This curriculum must accompany that of good evidence based scientific medicine if we are truly to act as bringers of healing.
It is PRIME’s (not hidden!) curriculum to restore these spiritual, God breathed values and attitudes to the teaching and practice of medicine. Which of these curricula most influences your practice?
Dr Huw Morgan
PRIME Desk Holder, South
Asia
References:
*1. Lemp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching. BMJ 2004;329:770-773
*2. Ibid
*3. Hojat M et al. An empirical study in decline in empathy in medical school. Med Educ 2004;38 (9): 934–941
*4. Galatians 5:22-23.
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