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Stunting professionalism: The potency and durability of the hidden curriculum within medical education

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Abstract

Despite an extensive literature within medical education touting the necessity in developing professionalism among future physicians, there is little evidence these ‘calls’ have thus far had an appreciable effect. Although various researchers have suggested that the hidden curriculum within medical education has a prominent role in stunting the development of professionalism among future physicians, there has been minimal discussion of how the content of the hidden curriculum actually function to this end. In this article, we explore: (i) how the hidden curriculum may function within medical education as a countervailing force to medicine’s push for professionalism and (ii) why the hidden curriculum continues to persist within medical training and particular aspects so difficult to dilute. We conclude by proposing mechanisms to assuage elements of the hidden curriculum, which may, in turn, allow the principles of professionalism to blossom among medical students.

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Notes

  1. Throughout this work, the authors use the term ‘Professionalism’ to refer to the individual-level traits, behaviors and attitudes similar to those described in the encompassing normative definition offered by Swick (2000). The term ‘Profession’, within this work, refers specifically to organized medicine as an occupational entity and in relation to specific qualities of any true profession (that is, authority and autonomy). Finally, within this work, the term ‘Professionalization’ refers to the processes and mechanisms by which medical students ‘learn’ to become professional health care practitioners. In turn, this work attempts to bridge the importunate cultural divide between the more sociologically oriented discourse on the Profession of medicine and the more medically oriented discourse on medical Professionalism (Hafferty and Castellani, 2010).

  2. Although there remains some considerable opposition to the claim that physicians are becoming deprofessionalized and/or subordinated to the bureaucratic controls (Pescosolido, 2006; Spalter-Roth, 2007), medical insiders remain quite convinced that physicians have suffered serious erosions of their clinical autonomy and discretionary decision making (Shanafelt et al, 2002; Zuger, 2004).

  3. Although writings on the hidden curriculum come largely from within the United States, United Kingdom and Canadian medical education literature there are the beginnings of an expanding international literature on the hidden curriculum. Similarly, although the concept is universal, particular context may differ enough so that what holds for one country in terms of specific findings about content of the hidden curriculum or the content of the space between the formal curriculum and the hidden curriculum is particular to place (specific medical education institution). Therefore, although discussions of the hidden curriculum (in the general sense) offered within this work could be applied to more than one national context, given that the authors are relating the role of the hidden curriculum to the current state of the medical profession in the United States the discussion of the hidden curriculum within in this particular work is primarily directed toward US medical education.

  4. Although the inclusion of other health professions within the WCC may have a positive impact on the internal status hierarchy among the health professions, it may do little to address (and may even exacerbate) the status and power divide between health care providers and patients (laypersons).

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Michalec, B., Hafferty, F. Stunting professionalism: The potency and durability of the hidden curriculum within medical education. Soc Theory Health 11, 388–406 (2013). https://doi.org/10.1057/sth.2013.6

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