The Significance of the Hidden Curriculum in Medical Ethics

The Significance of the Hidden Curriculum in Medical Ethics

Satendra Singh (Department of Physiology, Coordinator of Enabling Unit, University College of Medical Sciences, New Delhi, India)
Copyright: © 2013 |Pages: 4
DOI: 10.4018/ijudh.2013100110
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Abstract

This commentary discusses the paper by Annaswamy Nalini, “The Significance of the Hidden Curriculum in Medical Ethics: Literature Review with Focus on Students' Experiences”. The ethical dilemmas encountered by students may be because of early induction of students into medicine. The rigours and demands of professional education also deny our adolescents the chance to grow. It is this fledgling state when the students need the guidance from near peers and role models the most. Ethical feedback and experiential methods under Medical Humanities have been suggested as a coping mechanism to reveal and address the “hidden” emotional ethical dilemmas.
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The divorce between medicine and arts begins early in a student’s life, right from school. The studious, ‘brainy’ bookworms are segregated from their more creative, intuitive and imaginative classmates. The rigorous, rote-memory-based examination system throughout their medical education erases any creativity that they have, as they concentrate on memorising endless facts and answering non-analytical questions. When they graduate and enter the real world of clinical medicine, they are uncomfortable before the real people who come to seek their help. They forget that medicine is not just mastering facts and figures; it is an art in itself – the art of observing, recording, reflecting, and integrating the events around us. (Pauranik, 2012)

The above perspective by a resident doctor strengthens the author’s plea of giving more attention to medical students’ dilemmas for a foundation of ethics education. I agree with author that some educators wrongly believe that students have already developed the core values when they enter the school and which cannot be changed. Students are initiated into the medical education too early in life, when they should be exploring a basic grounding in the humanities. At 18, the rigours and demands of professional education deny our adolescents the chance to grow, and realize the fact that sometimes it is important to heal the mind and heart more than the body.

It has been argued by students that in their quest of passing an exam, patients are merely relegated as a ‘case’. Such habits in the foundation years ‘continue into residency and become the guiding principles of practice thereafter’ (Vira, 2012). It is this fledgling state when the students need the guidance from near peers and role models the most. Good mentors, through role modeling, can play a pivotal role in shaping medical student into a humane practitioner (Markides, 2011), perhaps even preventing burnout.

Students who have experienced empathy and care first hand from their mentors may develop into caring human beings and empathetic doctors; in this regard mentors have an important responsibility as role models (Bhatia, 2013). Role modeling and peer support can enhance the development of the affective domain in faculty and students. The process has exhibited to make the faculty mentors aware of student problems and they were able to empathize better. ‘Suddenly I realized that the student is not simply a case-record form, or a viva-voce, but a living creature with fears and aspirations’ (Bhatia, 2013)

The author review covered in depth student experiences from clinical studies however student reactions from preclinical subjects deserve special mention too. Jones (2013) advocates incorporation of professionalism into all basic science courses. He identified student specific professionalism challenges in anatomy and gave analogous examples in other para-clinical fields of pathology, microbiology, and pharmacology.

The author mentioned ethical dilemmas encountered by students as confidentiality; truth telling; patient autonomy; conflict between learning need and patient concern; medical errors and whistle blowing. As stressed by the author, medical errors certainly provide ‘teachable moments’. In a recent Korean study, higher levels of burnout were found associated with perceived medical errors among interns and residents (Kang, 2013).

Professionalism is an important part of the hidden curriculum. The untaught attributes in a hidden curriculum should not be taught in a conventional method. In a study from Pakistan (Khan, 2013), eighty percent of students believed instructional strategy to be the hindering point in developing these attributes. Thampy et al. (2012) advocates use of incorporating variety of learning opportunities.

The worrisome part was the use of derogatory humor as a coping mechanism. Experiential methods under Medical Humanities (MH) have been suggested to reveal and address the “hidden” emotions, attitudes, and values that are central to the communication dilemma. However, Singh (2012) has argued that “MH is an unfortunate term that suggests that medical humanities are different from the humanities taught in general arts colleges.” There is merit in the argument as the use of this phrase ‘propels us to find a medical angle to everything that the medical student may have to do with the humanities’. In reality, it should be the other way around.

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