Hidden Curricula, Ethics and Professionalism: Optimizing Clinical Learning Environments in Becoming and Being a Physician

Annals of Internal Medicine (02/27/18) Lehmann, Lisa Soleymani; Sulmasy, Lois Snyder; Desai, Sanjay

In this position paper, the American College of Physicians (ACP) focuses on the hidden curricula in the field of medicine, which refers to ethical and professional lessons embedded in culture that are not explicitly intended. Learners receive conflicting messages about ethics and professionalism when the actions or words of role models are not consistent with the values adopted by the profession. This position paper was developed on behalf of the ACP Ethics, Professionalism and Human Rights Committee, and it was reviewed and approved by the ACP Board of Regents. The ACP recommends aligning the hidden curriculum with the formal curriculum, and that faculty and senior clinicians should model empathy, encourage reflection, and discuss positive and negative behaviors in the training environment. Teamwork and respect for colleagues must be both taught and demonstrated to ensure a learning environment that fosters respect, inquiry, and honesty. Leaders should also encourage discussion of ethical concerns. The authors conclude, "The best solutions to the influence of the hidden curriculum will uncover it, integrate its positive aspects into the formal curriculum, and lead to development of approaches to understand and mitigate its negative aspects by educators and practicing clinicians. The hidden curriculum in medicine presents challenges but also opportunities to help reshape not only education but also the culture of medicine."

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