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Ask the expert: What does the term ’’hidden curriculum mean’’?

Residency Program Connection, January 25, 2011

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A core definition of the hidden curriculum is rooted in the distinction between the formal curriculum—what a residency program says it is delivering to its students, including what the program includes in mission statements, formal operational policies, and ACGME accreditation filings—and what actually happens, including, but not limited to, what students experience when they are not being educated. In some instances, what is represented is delivered, and all parties (faculty, students, and administration) agree that this is the case. In other instances, the organization may believe it is delivering on its promises while students fail to recognize any such content.

For example, it is entirely possible for a residency program to document that it delivers materials on systems-based practice, yet when queried, students see nothing of the sort. In a third iteration, it also is possible for an organization to believe it is providing students with, for example, a viable professionalism curriculum, and for students to point to such a curriculum, yet they also note the presence of other practices and/or forces that effectively neutralize what is being delivered. In other words, students see other things being “taught” within the general learning environment that undercut, countermand, or otherwise neutralize elements in the formal curriculum.

Medical education is a complicated and complex process, and it is more than likely—in fact, it is a virtual certainty—that students will encounter instances where lessons taught in one setting, be they knowledge, skills, or values, are essentially retracted or muted within another setting.
 

The difficult task for educators is to maximize instances of concordance while minimizing discordance. This effort begins by recognizing that the formal curriculum is only one part of a much larger and more complicated process of learning. In the case of competencies, this also means not only looking within the competencies to make sure there is internal concordance, but also focusing across the competencies to make sure the interpersonal and communication skills that residents learn reinforce those within patient care.

This week's question and answer are from A Practical Guide to Teaching and Assessing the ACGME Core Competencies.

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