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ACP calls on medicine to optimize learning environments by aligning positive ’hidden’ curriculum with formal curriculum of medical education

Learners should not experience disconnects between what is taught and what is practiced by faculty

Philadelphia, February 27, 2018 –The formal curriculum of medical education must be reinforced and enhanced by the hidden curriculum conveyed in medical schools, residency programs, hospitals,  clinics, and team rooms, the American College of Physicians (ACP) recommends in a new position paper published today in Annals of Internal Medicine.

Hidden curricula are cultural lessons learned that are not explicitly intended. Formal curricula are coursework and classroom lessons sanctioned by an institution.

“Medical education -- both in the classroom and at the bedside – must be consistent with medical ethics and professionalism,” said Dr. Jack Ende, MD, MACP, president, ACP. “Learners should not experience disconnects between what they are taught about ethics and professional behavior and what they see demonstrated by faculty and others.”

Seeing a primary care physician visit her hospital patient in the evening after clinic is a positive example of a hidden curriculum. Making disparaging comments about a patient who has frequent admissions is a negative example. Disrespect can also occur between clinicians, such as disparaging comments by academic physicians about nonacademic physicians or about a specialty.

ACP’s paper, “Hidden Curricula, Ethics, and Professionalism: Optimizing Clinical Learning Environments in Becoming and Being a Physician,” includes three position statements calling for the hidden curriculum to become a positive curriculum that aligns with the formal curriculum in which faculty and senior clinicians model empathy, encourage reflection and discussion of positive and negative behaviors in the training environment, and promote learner and clinician wellness.

The paper says the learning environment should foster respect, inquiry, and honesty and empower every individual, including learners, to raise concerns about ethics, professionalism, and care delivery. It is essential that teamwork and respect for colleagues be both taught and demonstrated.

The paper also encourages leaders to create and sustain a strong ethical culture by encouraging discussion of ethical concerns, making values in everyday decision-making explicit and embodying expectations of professionalism in which patient well-being is a core value.

For each position statement, ACP identifies challenges, opportunities, and strategies to identify and address discrepancies between values and actions to help align positive hidden curricula with formal curricula.

About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 152,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

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