lecture 12: the hidden curriculum in the clinical setting

demonstrated through a foundation of clinical competence, communication skills, and ethical and legal understanding, upon which is built the aspiration to, and wise application of, the principles of clinical excellence, humanism, accountability and altruism

how does one demonstrate professionalism?

informal currriculum

Teaching and learning that occurs outside of the formal curriculum in variety of settings (i.e., while conducting rounds in the hospital, teaching at the bedside, through clubs, or commonly known workarounds) that is unscripted and predominantly ad hoc. May be consistent or inconsistent with the formal curriculum, but it is known (not hidden).

hidden curriculum

The set of implicit messages about values, behavioral norms, attitudes, skills, and knowledge that learners infer from the behavior of individual role models as well as from group dynamics, processes, rituals, and structures (also known as the "culture" of the clinical workplace.

the patient

The hidden curriculum often relays that medicine is more focused on completing tasks and less focused on

•a fear of litigation from doctors where their conduct is not to diagnose or treat the patient, but to safeguard against the possibility of malpractice liability.

•This fear results in the creation of policies and practices in an attempt to avoid malpractice suits.

oNormalizes the overtreatment, overprescription, and overdiagnosing of patients

-Decreased trust in the physician-patient relationship: mistrust in physician's motivations, physicians regard pts as potential plaintiffs

how does defensive medicine worsen healthcare?

the "difficult patient"

-may result in normalization of non-empathetic behaviors

Labels or descriptions used by physicians to describe patients devalue caring for these patients and result in avoidance of such patients or dismissal of these patient's symptoms, concerns, or needs.

60%

____% of MD medical students reporting having been publicly embarrassed or publicly humiliated in the clinical setting

Cookbook" approach to medicine - one blueprint may be applied to all patients under specified circumstances, despite potentially wide variations in patient (and, notably, clinician) preferences, values, and beliefs.

the negative impact of evidence based medicine on patient-centered approach

•Develop an awareness of the hidden curriculum

•Active self-reflection

•Establish a study relationship with a partner or group where professional and ethical concerns are discussed.

how do you mitigate the impact of the hidden curriculum