6. The Hidden Curriculum

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affective preceptor series
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the hidden curriculum what are you
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teaching
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while the formal curriculum such as the
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aapko objectives are well recognized the
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hidden curriculum is unrealized and
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often provides ad-hoc and opportunistic
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transmission of implicit beliefs and
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behaviors it comprises those messages
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sent to the learner about culture
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customs rituals and informal rules of
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our profession it is a part of the
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socialization process of the institution
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and the faculty
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the hidden curriculum can have both a
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positive and negative influence here are
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some examples when you make comments
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about how great it is to see your
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patients improving or praise the patient
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who has quit smoking students may adopt
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this positive professional behavior if
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you leave clinic on time to watch your
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child in a play or other activity the
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importance of incorporating lifestyle in
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our profession is obvious on the other
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hand when medical students hear
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preceptors complain about the high cost
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of malpractice or the lifestyle of a
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practicing obstetrician the hidden
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message no matter what is being taught
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formally is that the student might want
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to consider a different specialty
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if a student witnesses the negative
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reaction or disapproval of a preceptor
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when faced with a patient who needs a
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blood transfusion but refuses they may
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incorporate this into their own
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professional behavior
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the hidden curriculum is not unique tubs
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tetrax and gynecology research and
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curricula ranging from mathematics to
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continuing medical education shows that
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it is pervasive
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in the medical world we often hear
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comments such as he acts like a surgeon
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or that’s how family physicians are such
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statements are generally attributed to
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behavior and attitudes that are not part
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of the formal curriculum in what ways
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does the hidden curriculum impact
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learning the hidden curriculum functions
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covertly in several aspects of
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obstetrics and gynaecology education
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professional behavior and attitudes
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assessment institutional policy and
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allocation of resources
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look at some of these individually
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professionalism while most medical
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schools offer biomedical ethics courses
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it is clear that such courses are too
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brief and too abstract
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therefore make it unlikely that
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professionalism is learned it is much
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more likely that day to day exposure in
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the clinical environment has a greater
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influence than the formal curriculum
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hidden curriculum messages from
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preceptors and faculty play a
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significant role in defining our
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profession for the medical students
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if students believe that obstetrics and
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gynecology is incompatible with a
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successful marriage and a satisfactory
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family life we need to check into the
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source of this misconception it is
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definitely not from the formal
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curriculum
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assessment
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medical education at all levels is now
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outcome-based we often find that
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assessment drives learning what we
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assess sends a message to our learners
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about our priorities however there can
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be a divergence between the formal
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curriculum and the hidden curriculum our
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formal objectives and outcome measures
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may suggest one message while what is
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emphasized in the surgical suite or
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clinic suggests another
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some preceptors it may actually point
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out this discrepancy but more often than
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not it is conveyed in other more
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insidious ways
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in addition to patient feedback and
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satisfaction surveys nurses or other
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health care providers are often involved
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in 360 degree evaluations and these can
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be affected by the hidden curriculum the
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institution policies and allocation of
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resources are two of the most visible
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components of the hidden curriculum
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while written policies demonstrating
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strong support and appreciation can
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affect staff hidden messages are much
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more likely to impact their attitudes
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and behavior
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similarly resource allocation reflects
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the institution’s values does the dean’s
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discretionary fund help support teaching
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efforts including the preceptor program
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our community-based preceptors provided
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the necessary tools to successfully meet
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their mission
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here are some positive ways we can use
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the curriculum
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satisfaction with patient encounters
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engage in a professional and friendly
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interaction with all staff show
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enthusiasm about your teaching
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assignments integrate professional and
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personal life
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demonstrate quality and collegial
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interactions with subspecialists and
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colleagues appreciate that there may be
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more than one right answer
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medicine is complex
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here’s how we can avoid injecting
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negative messages and influence into the
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hidden curriculum
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stop complaining about workload the cost
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of malpractice and the number of
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patients do not make disparaging remarks
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about patient’s health care team members
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or other students and residents remember
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to take time off for family or self care
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do not ignore patient concerns and don’t
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skip mid rotation evaluations or cancel
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scheduled meetings and lectures when
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supervising or teaching we need to
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acknowledge that we may unwittingly make
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comments or do things that cast a shadow
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on appropriate professional behavior if
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we speak disrespectfully with a
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colleague or about a colleague it sends
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an inappropriate message to students
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that this may be acceptable behavior
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these types of interactions often caused
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internal conflict in medical students
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confusing them about appropriate
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behavior and possibly teaching them
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unprofessional behaviors on the other
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hand we should embrace and utilize those
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times when we can transmit a positive
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professional message