Hidden Curricula

Hidden Curricula

On February 10th, three instructors from the Medical Sciences Program at Indiana University Bloomington presented a panel on the role of medical education in shaping students into physicians. Mark Bauman, MD, Doug Carr, MD, and Sarah Tieman, MD, encouraged the audience, which included several students interested in pursuing medical education, to share their ideas about what forces help shape the kind of doctor a person becomes.

The list included: core motivations (which vary person to person), relationships with faculty and mentors (preclinical and clinical), formative interactions with patients, financial pressures (tuition & debt), educational standards and metrics, and “pre-formation” or the values and abilities that medical students arrive with from their upbringing and primary education. Bauman opined that as much as nurturing key relationships and experiences as well as knowledge is essential, the core values and motives that students arrive with are most often persistent – what you learned in kindergarten really does make a big difference to who you become later.

Of particular interest for contemplating the future of professional ethics was the discussion of the formal curriculum (knowledge & competencies), and the hidden curriculum (workplace culture and the incentive structure of the for-profit health care system).

Stats in our last blog post showed that fewer than 60% of professionals surveyed across three sectors report an “ethical or strong ethical-leaning” workplace culture. What might the results be for health care system employees? Regardless, even in an ethically congenial working environment, the gap between education and practice demands careful moral reasoning.

The problem of deciding just how much contextual knowledge a newcomer needs to take meaningful – and ethically well-advised – initiatives seems like one that could apply to many professions beyond medicine. On the one hand, newcomers to a workplace can cause unintended harm when they try to assert their ideas before they get to know the local context in real depth – how do you gauge the amount of knowledge you need to fulfill good intentions in an unfamiliar context? On the other hand, for young professionals aware that they may be entering workplaces whose ethical culture needs continued improvement, how do you avoid uncritically assimilating to local norms that really should change?

Tieman pointed out that when students cycle through short-term internships, they often don’t have time to develop the level of either detailed knowledge or investment to try to be problem-solvers – and may walk away without much insight into the struggles of their colleagues and patients. She argued that a benefit of the longer concurrent rotations that IU School of Medicine is now testing out might be that young professionals have enough time to build relationships with patients, to comprehend and evaluate the big picture of how a unit works, and thus to make thoughtful decisions about where to invest their time and energy.

Certainly, the robust culture of reflection discussed at our third #FutureEthics Workshop at IUB would serve to help young professionals be mindful of the gap between their training in a formal curriculum and the informal but extremely powerful hidden curriculum of their profession.

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