The Hidden Curriculum: The Good, the Bad, and the Ugly

By Andrew Vaughan, Medical Student Trustee

In high school, as I considered becoming a physician, a local physician half-heartedly told me to reconsider that plan.  “It’s not what you think it is, times are changing,” he said. 

 

Call it cynicism, call it realism, call it whatever you wish; this is not the last doctor I have known that endorsed this sentiment, and judging from well-documented rates of physician burnout, he is far from being an outlier in modern medicine.

 

I have found that since starting my clinical work there is much more to the medical curriculum than one would expect.  While much of this curriculum is documented, planned for, and formally taught; some of this curriculum, particularly the aspects of medicine that are not quite as palatable, go largely unmentioned.  Though commonly referred to as the “hidden curriculum,” I have found the opposite to be true – it’s pretty hard to ignore.  I have come to understand this “hidden curriculum” as simply the good, the bad, and the ugly of how medicine is really practiced in day-to-day life.  

 

Luckily, I did not heed that particular physician’s advice, continued to pursue medicine, and have worked to put this hidden curriculum in the back of my mind.

 

The forefront of my mind on the other hand, has been devoted to learning a painfully apparent curriculum.  For two years now medical standards and education curriculum have dictated how I will spend my days (and nights) in the library; and rightfully so, medical schools need to have standards to ensure that every graduate understands the pathophysiology of atherosclerosis or the pharmacology of a statin drug.  The problem though, is you can’t really see what “real” medicine looks like in a library carrel.  As I moved past Step 1 of the USMLE Board Exam, I began to look toward my third year of school, and began to see medicine as it is really practiced.

 

Sure, at first glance the bad and the ugly are definitely apparent, even to a medical student - endless paperwork, sleep deprivation, constant pressure to get things right, frustrated patients with unreal expectations, the list seems endless.  It’s also hard to ignore that times are indeed quickly changing, and they are not changing in order that physicians will have easier workloads, fewer patients to see, and greater relationships with those patients. 

 

All that aside, it’s impossible to ignore, in only a matter of months, I have also seen the good through this same “hidden curriculum.”  Physicians that persevere, patients grateful to the point of tears, surgeons patiently correcting when a resident’s mistake adds 30 minutes to an operation, tearful patients at the mention of their doctor’s retirement, and the delivery of a child to eagerly expectant parents.

 

Dr. Charles Bryan, whom I recently had the pleasure of meeting when he was awarded the Order of the Palmetto, once wrote in the Journal of the SCMA that “the path of least resistance leads to indifference and cynicism.”  Sure, I know that there is more of this hidden curriculum to see this year and all my years to come; not all of it will be good, much of it will be bad and ugly.  Still though I hope to persevere to stay off of the path of least resistance, to work to keep my ideals, even at the risk of quixotism.  For thus far, I have found the hidden curriculum has done much more to encourage my pursuit of medicine than it has to deter it.