Module 4: Searching for the "Hidden" Curriculum

Objectives:

1. Enhance awareness of ethical and professional dilemmas in everyday practice
2. Inform participants of the pervasive influence of the "hidden curriculum"
3. Enhance participants' appreciation of their position and responsibility as role models in the academic medical center.

Learning Method:

In an interactive multi-media small group discussion, a videotape (ER) is used to facilitate discussion of the hidden curriculum of values in medical education. The tape itself helps residents realize that values are being expressed all around them, and that many informal conversations actually have a significant impact on the values learned. The exercise also points out a number of issues of gender/racial/power hierarchy (e.g. Benton makes a disparaging comment about nurses) as well as about simultaneously being a physician, a teacher, and a trainee. For example, Benton asks a nurse if there is a patient in the laceration room, and is told, "How should I know." Benton then tells his new medical student (in his most sarcastic voice) "I just LOVE the great spirit of camaraderie around here." Participants are asked to identify the values being taught (transmitted) by the resident in scenes of each of a series of video segments. Following this exercise, Dr. Stern reviews quantitative data on when, where, and how values are taught in clinical medical education. Subsequently, the group discusses three or four cases of common professional dilemmas.

Evaluation:

Pre and post survey (one page)

Prior to the start of the session, participants are provided a paper case that includes a number of moral, ethical, and professional issues, and asked to identify the salient issues in the case. Following the exercise, participants are again provided with a case, and asked to identify the values involved. Comparison of the number of values identified, and their relevance to the case, permits the formal evaluation of this exercise.