The Hidden Curriculum, Structural Disconnects, and the Socialization of New Professionals

Chapter
Part of the Innovation and Change in Professional Education book series (ICPE, volume 6)

Abstract

Over the past 30 years, educators have come to understand the importance of differentiating between the formal and alternative forms of learning such as the hidden curriculum. We now recognize how necessary it is to account for the unstated, but never the less vital, curriculum that is operational in schools and in workplaces. The hidden curriculum refers to cultural mores that are transmitted, but not openly acknowledged, through formal and informal educational practices (Hafferty & Franks, 1994; Hafferty & Levinson, 2008; Hafferty, 1998; Sullivan, 2005; Sullivan, Colby, Wegner, Bond, & Schulman, 2007).

Keywords

Role Model Professional Identity Workplace Learning Hide Curriculum Formal Curriculum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. ABIM Foundation, ACP-ASIM Foundation, & European Foundation of Medicine (2002). Medical Professionalism in the New Millennium: A Physician Charter. Annals of Internal Medicine, 136(3), 243–246.Google Scholar
  2. American Society for Healthcare Risk Management (2006). An overview of the patient safety movement in healthcare. Plastic Surgical Nursing, 26(3), 116–120.Google Scholar
  3. Angell, M. (2000). Is academic medicine for sale? New England Journal of Medicine, 342(20), 1516–1518.CrossRefGoogle Scholar
  4. Angell, M. (2009). Drug companies & doctors: A story of corruption. The New York Review of Books Retrieved January 31, 2009, from http://www.nybooks.com/articles/22237?email
  5. Associated Press (2002). A Medical Journal Eases Conflict Rule. NYTimes.com, May 19 2002, A26.Google Scholar
  6. Association of American Medical Colleges, & Baylor College of Medicine, Department of Neuroscience and Computational Psychiatry Unit (2007). The scientific basis of influence and reciprocity: A symposium. Washington, DC: Association of American Medical Colleges.Google Scholar
  7. Avorn, J., Chen, M., & Hartley, R. (1982). Scientific versus commercial sources of influence on the prescribing behavior of physicians. American Journal of Medicine, 73, 4–8.CrossRefGoogle Scholar
  8. Backer, E. L., Lebsack, J. A., Van Tonder, R. J., & Crabtree, B. F. (2000). The value of pharmaceutical representative visits and medication samples in community-based family practices. Journal of Family Practice, 49, 817–819.Google Scholar
  9. Becker, H., Geer, B., Hughes, E. C., & Strauss, A. L. (1961). Boys in White: Student Culture in Medical School. Chicago: University of Chicago Press.Google Scholar
  10. Bell, S. K., Krupat, E., Fazio, S. B., Roberts, D. H., & Schwartzstein, R. M. (2008). Longitudinal pedagogy: A successful response to the fragmentation of the third-year medical student clerkship experience. Academic Medicine, 83(5), 467–475.CrossRefGoogle Scholar
  11. Berens, M. J. (2002). Investigation: Unhealthy hospitals: Lax procedures put patients at risk: Simple actions by hospital workers such as diligent hand-washing, could cut the number of fatal infections: Second of three parts. Chicago Tribune; http://www.chicagotribune.com/news/specials/chi-0207220180jul22.story
  12. Bosk, C. L. (1979). Forgive and Remember. Chicago: University of Chicago Press.Google Scholar
  13. Brainard, A. H. & Brislen, H. C. (2007). Viewpoint: Learning professionalism: A view from the trenches. Academic Medicine, 82(11), 1010–1014.CrossRefGoogle Scholar
  14. Brennan, T. A., Leape, L. L., Laird, N. M., Localio, A. R., Lawthers, A. G., Newhouse, J. P., et al. (1991). Incidence of Adverse Events and Negligence in Hospitalized Patients – Results of the Harvard Medical Practice Study. New England Journal of Medicine, 324, 370–376.CrossRefGoogle Scholar
  15. Brett, A. S., Burr, W., & Moloo, J. (2003). Are Gifts From Pharmaceutical Companies Ethically Problematic? Annals of Internal Medicine, 163(18), 2213–2218.CrossRefGoogle Scholar
  16. Caldicott, C. V. (2007). “Sweeping up after the parade”: Professional, ethical, and patient care implications of “turfing”. Perspectives in Biology and Medicine, 50(1), 136–149.CrossRefGoogle Scholar
  17. Campbell, E. G., Gruen, R. L., Mountford, J., Miller, L. G., Cleary, P. D., & Blumenthal, D. (2007a). A national survey of physician–industry relationships. New England Journal of Medicine, 356(17), 1742–1750.CrossRefGoogle Scholar
  18. Campbell, E. G., Regan, S., Gruen, R. L., Ferris, T. G., Rao, S. R., Cleary, P. D., et al. (2007b). Professionalism in Medicine: Results of a National Survey of Physicians. Annals of Internal Medicine, 147(11), 795–802.Google Scholar
  19. Campbell, E. G., Weissman, J. S., Ehringhaus, S., Rao, S. R., Moy, B., Feibelmann, S., et al. (2007c). Institutional academic–industry relationships. Journal of the American Medical Association, 298(15), 1779–1786.CrossRefGoogle Scholar
  20. Cantrell, D., Shamriz, O., Cohen, M. J., Stern, Z., Block, C., & Brezis, M. (2008). Hand hygiene compliance by physicians: Marked heterogeneity due to local culture? American Journal of Infection Control, 37(4), 301–305.CrossRefGoogle Scholar
  21. Chimonas, S., Brennan, T. A., & Rothman, D. J. (2007). Physicians and drug representatives: Exploring the dynamics of the relationship. Journal of General Internal Medicine, 22(2), 184–190.CrossRefGoogle Scholar
  22. Christakis, D. A. & Feudtner, C. (1997). Temporary Matters: The Ethical Consequences of Transient Social Relationships in Medical Training. Journal of the American Medical Association, 278(9), 739–743.CrossRefGoogle Scholar
  23. Dana, J. & Lowenstein, G. (2003). A social science perspective on gifts to physicians from industry. Journal of the American Medical Association, 290, 252–255.CrossRefGoogle Scholar
  24. Davis, B. & Appleby, J. (1999). Medical mistakes 8th top killer. USA Today, p. 1A.Google Scholar
  25. De Simone, J. (2006). Reductionist inference-based medicine, i.e. EBM. Journal of Evaluation in Clinical Practice, 12(4), 445–449.CrossRefGoogle Scholar
  26. Dilts, D. M. (2005). Practice variation: The Achilles’ heel in quality cancer care. Journal of Clinical Oncology, 23(25), 5881–5882.CrossRefGoogle Scholar
  27. Doherty, S. (2005). History of evidence-based medicine. Oranges, chloride of lime and leeches: Barriers to teaching old dogs new tricks. Emergency Medicine Australasia, 17(4), 314–321.CrossRefGoogle Scholar
  28. Ehringhaus, S. H., Weissman, J. S., Sears, J. L., Goold, S. D., Feibelmann, S., & Campbell, E. G. (2008). Responses of Medical Schools to Institutional Conflicts of Interest. Journal of the American Medical Association, 299(6), 665–671.CrossRefGoogle Scholar
  29. Evidence-based Medicine Working Group (1992). Evidence-based medicine: A new approach to teaching the practices of medicine. Journal of the American Medical Association, 268(17), 2420–2425.CrossRefGoogle Scholar
  30. Fein, E. H., Vermillion, M. L., & Uijtdehaage, S. H. J. (2007). Pre-Clinical Medical Students’ Exposure to and Attitudes Toward Pharmaceutical Industry Marketing. Medical Education Online; http://www.med-ed-online.org/pdf/Res00245.pdf
  31. Freidson, E. (1970a). Profession of Medicine: A Study of the Sociology of Applied Knowledge. New York: Harper & Row.Google Scholar
  32. Freidson, E. (1970b). Professional Dominance: The Social Structure of Medical Care. New York: Atherton Press.Google Scholar
  33. Gawande, A. (2002). Complications: A surgeon’s notes on an imperfect science. New York: Metropolitan Books.Google Scholar
  34. Gawande, A. (2004). On washing hands. New England Journal of Medicine, 350(3), 1283–1286.CrossRefGoogle Scholar
  35. Gherardi, S. (2005). Organizational knowledge: The texture of workplace learning. Malden, MA: Blackwell Publishing.Google Scholar
  36. Ginsburg, S., Regehr, G., Stern, D., & Lingard, L. (2002). The anatomy of the professional lapse: Bridging the gap between traditional frameworks and student perceptions. Academic Medicine, 77, 516–522.CrossRefGoogle Scholar
  37. Gofton, W. & Regehr, G. (2006). What We Don’t Know We Are Teaching: Unveiling the Hidden Curriculum. Clinical Orthopaedics and Related Research, 449, 20–27.Google Scholar
  38. Goitein, L. (1996). Book Review: The girl who died twice: Every patient’s nightmare: The Libby Zion case and the hidden hazards of hospitals. New England Journal of Medicine, 334, 201–202.CrossRefGoogle Scholar
  39. Green, M. L. (1999). Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine: A critical review of curricula. Academic Medicine, 74(6), 686–694.CrossRefGoogle Scholar
  40. Green, M. L. (2000). Evidence-based medicine training in graduate medical education: Past, present and future. Journal of Evaluation in Clinical Practice, 6(2), 121–138.CrossRefGoogle Scholar
  41. Groopman, J. (2007). How Doctors Think. New York: Houghton Mifflin.Google Scholar
  42. Grusec, J. E. & Hastings, P. D. (2006). Handbook of socialization: Theory and research. New York: Guilford Press.Google Scholar
  43. Hafferty, F. W. (1998). Beyond Curriculum Reform: Confronting Medicine’s Hidden Curriculum. Academic Medicine, 73(4), 403–407.CrossRefGoogle Scholar
  44. Hafferty, F. W. (2008). Professionalism and the socialization of medical students. In R. L. Cruess, S. R. Cruess, Y. Steinert (Eds.), Teaching Medical Professionalism (pp. 53–70). New York: Cambridge University Press.Google Scholar
  45. Hafferty, F. W. & Castellani, B. (2009). The hidden curriculum: A theory of medical education. In C. Brosnan, B. S. Turner (Eds.), Handbook of Medical Education (pp. 15–35). London: Routledge.Google Scholar
  46. Hafferty, F. W. & Franks, R. (1994). The Hidden Curriculum, Ethics Teaching, and the Structure of Medical Education. Academic Medicine, 69(11), 861–871.CrossRefGoogle Scholar
  47. Hafferty, F. W. & Levinson, D. (2008). Professionalism Perspective: Moving beyond nostalgia and motives towards a complexity science view of medical professionalism. Perspectives in Biology and Medicine, 51(4), 599–614.CrossRefGoogle Scholar
  48. Haidet, P. & Stein, H. F. (2006). The role of the student-teacher relationship in the formation of physicians: The hidden curriculum as process. Journal of General Internal Medicine, 21(Supplement), S16–S20.CrossRefGoogle Scholar
  49. Harvill, L. M. (1981). Anticipatory socialisation of medical students. Journal of Medical Education, 56(5), 431–433.Google Scholar
  50. Henry, S. G., Zaner, R. M., & Dittus, R. S. (2007). Viewpoint: Moving beyond evidence-based medicine. Academic Medicine, 82(3), 292–297.CrossRefGoogle Scholar
  51. Hirsh, D. A., Ogur, B., Thibault, G. E., & Cox, M. (2007). “Continuity” as an organizing principle for clinical education reform. New England Journal of Medicine, 356(8), 858–866.CrossRefGoogle Scholar
  52. Hoff, T. J., Pohl, H., & Bartfield, J. (2004). Creating a Learning Environment to Produce Competent Residents: The Roles of Culture and Context. Academic Medicine, 79(6), 532–540.CrossRefGoogle Scholar
  53. Inkeles, A. (1969). Social structure and socialization. In D. A. Goslin (Ed.), Handbook of socialization theory and research (pp. 605–632). Chicago: Rank McNally.Google Scholar
  54. Institute of Medicine (Committee on Quality of Health Care in America) (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press.Google Scholar
  55. Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To err is human: Building a safer health system: Quality of health care in America. Washington, DC: National Academy Press.Google Scholar
  56. Kushner, T. K. & Thomasma, D. C. (2001). Ward ethics: Dilemmas for medical students and doctors in training (Book ed.). Cambridge: Cambridge University Press.Google Scholar
  57. Lake, A. P. (2006). EBM for the future. Journal of Evaluation in Clinical Practice, 12(4), 433–437.CrossRefGoogle Scholar
  58. Lave, J. & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge: Cambridge University Press.Google Scholar
  59. Leape, L. L., Brennan, T. A., Laird, N., et al. (1991). The nature of adverse events in hospitalized patients: Results of the Harvard Medical Practice Study II. New England Journal of Medicine, 324, 377–384.CrossRefGoogle Scholar
  60. Lee, K. (2008). Has the hunt for conflicts of interest gone too far? No. BMJ, 336, 477.CrossRefGoogle Scholar
  61. Leo, T. & Eagen, K. (2008). Professionalism education: The medical student response. Perspectives in Biology and Medicine, 51(4), 508–516.CrossRefGoogle Scholar
  62. Liang, L. (2007). The gap between evidence and practice. Health Affairs, 26(2), 107–188.CrossRefGoogle Scholar
  63. Lopez, L. & Katz, J. T. (2009). Perspective: Creating an ethical workplace: Reverberations of resident work hours reform. Academic Medicine, 84(3), 315–319.CrossRefGoogle Scholar
  64. Ludmerer, K. M. (1999). Time to Heal: American medical education from the turn of the century to the era of managed care. New York: Oxford University Press.Google Scholar
  65. Lundberg, G. D. (1985). Medicine–A profession in trouble? Journal of the American Medical Association, 253(19), 2879–2880.CrossRefGoogle Scholar
  66. Martin, J. B. & Kasper, D. L. (2000). In Whose Best Interest? Breaching the Academic–Industrial Wall. New England Journal of Medicine, 343(22), 1646–1649.CrossRefGoogle Scholar
  67. Mathews, S. C. & Pronovost, P. J. (2008). Physician autonomy and informed decision making: Finding the balance for patient safety and quality. Journal of the American Medical Association, 300(24), 2913–2915.CrossRefGoogle Scholar
  68. McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., et al. (2003). Special Article: The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348(26), 2635–2645.CrossRefGoogle Scholar
  69. McKinney, W. P., Schiedermayer, D. L., Larie, N., Simpson, D. E., Goodman, J. L., & Rich, E. C. (1990). Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives. Journal of the American Medical Association, 264(13), 1693–1697.CrossRefGoogle Scholar
  70. Merton, R. K., Reeder, L. G., & Kendall, P. L. (1957). The Student–Physician: Introductory Studies in the Sociology of Medical Education. Cambridge, MA: Harvard University Press.Google Scholar
  71. Mommaerts, M. (2009). The European working time directive – facts and issues. Journal of Craniomaxillofacial Surgery, 37, 110–112.Google Scholar
  72. Moussa, I. D. (2008). The practice of Interventional Cardiovascular Medicine: “Evidence-based” or “Judgment-based”? Catheterization and Cardiovascular Interventions, 72(1), 134–136.CrossRefGoogle Scholar
  73. Moynihan, R. (2003). Who pays for the pizza? Redefining the relationships between doctors and drug companies. 1: Entanglement. BMJ, 326, 1189–1192.CrossRefGoogle Scholar
  74. Nuthalapaty, F. S., Carver, A. R., Nuthalapaty, E. S., & Ramsey, P. S. (2006). The perceived impact of duty hour restrictions on the residency environment: A survey of residency program directors. American Journal of Obstetrics and Gynecology, 194(6), 1556–1562.CrossRefGoogle Scholar
  75. Parker-Pope, T. (2008a). Blog: Panel calls for changes in doctor training. NYTImes.com. Retrieved May 19, 2009; http://well.blogs.nytimes.com/2008/12/02/panel-calls-for-changes-in-doctor-training/
  76. Parker-Pope, T. (2008b). Blog: What if the doctor doesn’t want to nap? NYTImes.com Google Scholar
  77. Parker-Pope, T. (2009). Scans for back pain ineffective. NYTImes.com. Retrieved May 19, 2009; http://well.blogs.nytimes.com/2009/02/06/scans-for-back-pain-ineffective/
  78. Plante, T. G. (2004). Sin against the Innocents: Sexual abuse by priests and the role of the Catholic Church. New York: Praeger Publishers.Google Scholar
  79. Reddy, S. T. (2007). Third-year medical students’ participation in and perceptions of unprofessional behaviors. Academic Medicine, 82(10 suppl.), S35–S39.CrossRefGoogle Scholar
  80. Relman, A. S. (1987). Practicing Medicine in the New Business Climate. New England Journal of Medicine, 316, 1150–1151.CrossRefGoogle Scholar
  81. Rosenberg, W. & Donald, A. (1995). Evidence based medicine: An approach to clinical problem solving. British Medical Journal, 310, 1122–1126.Google Scholar
  82. Sackett, D. L. (1995). The need for evidence-based medicine. Journal of the Royal Society of Medicine, 88, 620–624.Google Scholar
  83. Safford, M. M., Allison, J. J., & Kiefe, C. I. (2007). Patient complexity: More than comorbidity: The vector model of complexity. Journal of General Internal Medicine, 22(Suppl 3), 382–390.CrossRefGoogle Scholar
  84. Schaeffer, L. D. & McMurty, D. E. (2004). When excuses run dry: Transforming the U.S. health care system: Media attention alone is not sufficient to spark a transformation; real commitment and cultural change are necessary. Health Affairs (Suppl Web Exclusive):VAR117–120.Google Scholar
  85. Shalof, T. (2008). The Making of a Nurse. Toronto, ON: McClelland & Stewart.Google Scholar
  86. Shem, S. (1978). The House of God. New York: Dell.Google Scholar
  87. Sierles, F. S., Brodkey, A. C., Cleary, L. M., et al. (2005). Medical students’ exposure to and attitudes about drug company interactions: A national survey. Journal of the American Medical Association, 294(9), 1034–1043.CrossRefGoogle Scholar
  88. Smith, R. (1991). Where is the wisdom? The poverty of medical evidence. BMJ, 303, 789–790.Google Scholar
  89. Steinman, M. A., Shlipak, M. G., & McPhee, S. J. (2001). Of principles and pens: Attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. American Journal of Medicine, 110(7), 551–557.CrossRefGoogle Scholar
  90. Stolberg, S. G. (2002). Study says clinical guides often hide ties of doctors. New York Times (February 6, pp. A17).Google Scholar
  91. Stossel, T. P. (2008). Has the hunt for conflicts of interest gone too far? Yes. BMJ, 336, 476.CrossRefGoogle Scholar
  92. Sullivan, W. M. (2005). Work and integrity: The crisis and promise of professionalism in America (2nd ed.). San Francisco: Jossey-Bass.Google Scholar
  93. Sullivan, W. M., Colby, A., Wegner, J. W., Bond, L., & Schulman, L. S. (2007). Educating lawyers: Preparation for the profession of law. San Francisco: Wiley.Google Scholar
  94. Timmermans, S. & Mauck, A. (2005). The promises and pitfalls of evidence-based medicine. Health Affairs, 24(1), 18–28.CrossRefGoogle Scholar
  95. Traynor, M. (2008). Indeterminacy and technicality revisited: How medicine and nursing have responded to the evidence based movement. Sociology of Health & Illness, 31, 494–507.CrossRefGoogle Scholar
  96. Upshur, R. E. (2005). Looking for rules in a world of exceptions: Reflections on evidence-based practice. Perspectives in Biology and Medicine, 48(4), E477–E489.CrossRefGoogle Scholar
  97. van de Mortel, T., Bourke, R., McLoughlin, J., Nonu, M., & Reis, M. (2001). Gender influences handwashing rates in the critical care unit. American Journal of Infection Control, 29, 395–399.CrossRefGoogle Scholar
  98. Van Maanen, J. (1976). Breaking in: Socialization to work. In R. Dubin (Ed.), Handbook of Work, Organization and Society (pp. 67–130). Chicago: Rand McNally.Google Scholar
  99. Watson, R. T. (2003). Rediscovering the medical school. Academic Medicine, 78, 659–665.CrossRefGoogle Scholar
  100. Wear, D. & Kuczewski, M. G. (2004). The professionalism movement. Can we pause? American Journal of Bioethics, 4(2), 1–10.Google Scholar
  101. Weidman, J. C. (1992). Undergraduate socialization: A conceptual approach. In J. C. Smart (Ed.), Higher education: Handbook of theory and research (Vol. V, pp. 289–322). New York: Agathon Press.Google Scholar
  102. Whitcomb, M. E. (2007). Professionalism in medicine. Academic Medicine, 82(11), 1009.CrossRefGoogle Scholar
  103. Woodrow, S. I., Segouin, C., Armbruster, J., Hamstra, S. J., & Hodges, B. (2006). Duty hours reforms in the United States, France, and Canada: Is it time to refocus our attention on education? Academic Medicine, 81(12), 1045–1051.CrossRefGoogle Scholar
  104. Woolf, S. (2001). Evidence-based medicine: A historical and international overview. Proceedings of the Royal College of Physicians of Edinburgh, 31(Suppl 9), 39–41.Google Scholar
  105. Wusthoff, C. J. (2001). Medical mistakes and disclosure: The role of the medical student. Journal of the American Medical Association, 286(9), 1080–1081.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Mayo Medical SchoolRochesterUSA
  2. 2.Yale School of MedicineNew HavenUSA

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