The Hidden Curriculum of Medical School

While most of medical education and training is about the nuts and bolts of clinical care — how to treat hypertension, how to manage a ventilator, how to take out a gallbladder — the process also involves learning how to be “a doctor.” As opposed to lessons covered in textbooks and classrooms, this kind of learning is done through modeling, or what medical sociologist F. W. Hafferty has called the “informal” or “hidden curriculum.”

Medical students and residents copy the lingo, manners and expressions of more established senior residents and attending physicians. The lessons from these role models, who are often tired and stressed out themselves, can be sobering. They are also often cynical, rooted in large part in the belief that a doctor’s level of compassion is fixed.

“See one, do one, teach one.”

“Trust no one.”

“Keep ’em alive until 6:05.”

Or as I once was told: “You either have ’it’ or you don’t.”

So, I remember thinking, why make any effort to change?

Obviously, one cannot teach bedside manner unless one wants to teach bedside manner.  I believe that attending physicians have a responsibility to demonstrate and discuss bedside manner each and every day.  Of course this statement implies that attending physicians have a clue and care.

The first step in teaching bedside manner is in acknowledging its importance.  When you start talking about bedside manner, then students and residents pay attention.  When you start considering your own bedside manner, you quickly realize your importance as a role model.  When you do all these things, bedside manner is no longer part of the hidden curriculum.

Too many teaching attending physicians never think about bedside manner.  Too many residents have seen too few positive role models, and too many weak role models.

We (the universe of medical educators) have a responsibility to make bedside manner part of our everyday concerns.  If we do not, then we are failing.