Ryan is a medical student at the University of Edinburgh, and co-chair of JASME (Junior Association for the Study of Medical Education).
There are no bad students, only bad teachers. Whilst this quote, from the wonderful film “The Karate Kid”, does not quite acknowledge the shared responsibility for learning that teacher and student have, there is some truth underlying the quote: that regardless of our mindset, and our mentality in the waking moment, we are always learning something. Every moment, regardless of our stage in training from undergraduate to consultant, we are absorbing information, forming conclusions and inferences, and every conversation is a transaction of information. Students at all levels continue to learn, regardless of whether the teacher intends to teach. This is incredibly important for widening participation.
This month JASME has been exploring both widening participation, and medical education beyond the traditional classroom setting. One event exploring the latter theme has been our monthly JASME Chats, where any JASME member can become a panellist and join in the discussion on various topics. During this, the panellists talked insightfully about the hidden curriculum.
It is important to remember that the hidden curriculum, the unintended lessons of our education, is not merely what is omitted from core medical school teaching. It is not an overarching force guiding all within the same cohort equally, imbuing them with the same skillset, and the same mentality towards healthcare through the same experiences. The hidden curriculum is different for every individual. It is every interaction that we face: every word spoken; every gesture; every remark between peers, between students and faculty; between colleagues at work; between caregiver, student and patient. Whilst there are broader elements, such as what is decided as elective or mandatory teaching, that shape the content of the hidden curriculum, the individual’s experience will not be uniform.
So, in a world where every interaction matters, what does this mean for widening participation? Our conversations, and therefore the hidden curriculum, can shape how we perceive certain specialties, can give a lower regard to General Practice, and can shape not only who the next generation aspire to become, but how the current generation continue to perceive healthcare. So, ultimately, we must navigate our interactions and discussions with trepidation: the dictionary is a minefield of implicated meaning, and the wrong word, the wrong intonation or gesture could crush a person’s dreams, dissuade them from a path or solidify a negative culture within a workforce. This of course should not be the lesson to take away: fear of the destructive potential of conversation. Instead, we should think about the constructive power of our interactions.
Whilst we do not all have the time to contribute to widening participation through the growing number of wonderful student lead initiatives aimed at supporting aspiring students, a simple conversation is something that we can all do. We may have become a role model to a student without knowing it, our conversations and implicit behaviours formulating an informal mentorship. It is up to us, in our daily interactions, in our conversations, in the way that we regard our world, to ensure that as students from undergraduate to consultant never cease to learn, we do not remiss the opportunity to teach and to inspire. It can be a small step that contributes to changing the systemic limitations on diversity within medicine.
So, think back – what does your hidden curriculum look like? What did the last five corridor conversations, the last five important emails teach you about the world? About specialties, professions or the future? What could have been changed for the better? It was famously quoted that: “Changing a college curriculum is like moving a graveyard – you never know how many friends the dead have until you try to move them.” Who are the friends in your cemetery, whose teachings you consciously and unconsciously cling onto? Whose words echo on through you?
Whilst there are larger systemic changes that need to take place to widen opportunities for aspiring medics, there is one element of the hidden curriculum that we can all influence for the better today. It may be hidden, but it is hidden in plain sight.