Using healthcare's hidden curriculum for good

With medical school graduates beginning residencies next month, a recent article in Slate painted a harrowing picture for physicians-in-training.

In it, Danielle Ofri, M.D., an associate professor of medicine at NYU School of Medicine, describes the "hidden" medical school curriculum that sends future doctors into the field jaded and embittered. The lessons taught include healthcare hierarchies, prioritizing efficiency over patient care and the hypocrisy of doctor-patient communication.

The article raises concerns about how the hidden curriculum can hurt empathetic care. Those unintended lessons can shape what kind of doctors medical students become, as well as the quality of care they will provide to patients, Ofri noted.

While such concerns aren't unfounded, they ignore the other side of the hidden curriculum, one that is a positive learning experience. Based on our FierceHealthcare coverage, many health systems and hospitals offer hidden curriculums that provide positive messages and effective role models.

For instance, at Virginia Mason Medical Center in Seattle, future physicians would experience a culture of respect, in which physicians, nurses and other team members demonstrate 10 respectful and considerate behaviors. Teachings would include how to listen to understand, express gratitude, connect with others and act as a team player, among others.

"If our physicians, nurses and other team members don't feel valued and respected, this will affect their ability to put the patient first in everything we do," Gary S. Kaplan, M.D., president and CEO at Virginia Mason, wrote this week in a Hospital Impact blog post. That's a competency I wouldn't mind residents and students bring to their future careers.

Lessons learned outside the classroom at Maryland's Meritus Health System would instill a commitment to charity care. Future doctors could see that when it comes to medical billing, it's not only about getting paid. Meritus and other nonprofits are acting as financial advocates for financially disadvantaged patients and giving them the tools they need to understand their bills.  

And not all hidden curriculums impart poor communication and insincerity. Take California's Bear Valley Community Healthcare District. It's culture and climate would teach future doctors about the importance of transparency and honesty, as they would experience first-hand efforts to maintain open lines of communication between a hospital and the people it serves.

Not all hospitals put efficiency ahead of patient care either. Some, like Loma Linda University Medical Center in Southern California and Hospital Sisters Health System throughout Illinois and Wisconsin, take patient experience and care integration beyond just buzzwords. These learning environments show how hospitals can create a bridge between quality and efficiency to improve care.

These facilities, through their actions and values, reassure us there can be more positive aspects to the hidden curriculum in healthcare. - Alicia (@FierceHealth)

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