Recommendations for optimizing hidden curriculum in medicine

(HealthDay)—In a position paper published online Feb. 27 in the Annals of Internal Medicine, the American College of Physicians (ACP) presents recommendations for optimizing clinical learning environments by fostering a positive hidden curriculum in medicine.

Lisa Soleymani Lehmann, M.D., Ph.D., from the Veterans Health Administration in Washington, D.C., and colleagues address the hidden curriculum in medicine, which includes lessons that are embedded in culture and organizational structure and are not explicitly intended.

The ACP recommends that the hidden curriculum must become a positive curriculum, in alignment with the formal curriculum. To this end, faculty and clinicians should model empathy, encourage discussion of positive and negative behaviors in the training environment, and promote clinician wellness. Respect, inquiry, and honesty should be fostered by the learning environment, and individuals should be empowered to raise concerns about ethics, professionalism, and care delivery. Positive messages such as teamwork and respect should be taught and modeled. By encouraging discussion of ethical concerns, leaders should create and sustain a strong ethical culture.

"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 authors write.