The Hidden Curriculum of Medicine

At this point I have completed half a year of medical school, and my Christmas break has concluded. I should be studying for my hematology exam, but I would rather indulge in some writing. I know that interviews are coming up with invites already released for many schools, but do not worry, I have started writing interview tips and that post will come out relatively soon. Thank you all for being patient!

There is an aspect of medicine you may or may not be aware of, it is known as the hidden curriculum (HC). What is the HC? It is all the aspects of medicine that are not formally taught to you but are part of the practice. Learning the aspects of the HC are essential to becoming a successful medical student, clerk, resident and physician, but you are not explicitly taught these important aspects of medicine.

To give you an extremely simple example of the HC that most, if not all, medical students pick up on either before entering medical school or within the first few months, is the “pecking order” in the hospital.

When you are in third and fourth year of most four-year medical school programs, or alternatively, second and third year in three-year programs, you enter what is known as clerkship. This is essentially when you are working in a hospital in a specific specialty in order to gain more skills in an actual medical setting as opposed to an academic one. When you are a clerk you do work long hours and have a lot of responsibilities. You are also at the bottom of the stated pecking order. You are there to learn, so you are a burden to others, and need to try to make everyone else’s life easier in order to leave a positive impression. You report to the residents who are above you in the pecking order and above them are the fellows and staff physicians. This is a huge oversimplification, but it is an example of an aspect of the HC that they never directly teach you but is important to know to succeed in medicine. If you do not keep this pecking order in mind, as a first-year clerk, when you come upon a situation in which you are instructed by the resident to do something, and instead fail to comply and complain directly the staff physician without running it by the resident first, then you might be in for quite the interesting discussion and work environment.

Hopefully that example was sufficient to give you a brief understanding of the HC in medicine, but how do you learn these aspects of medicine if they are not covered in the classroom? This is when mentorship comes into play. A lot of the negative aspects of medicine will not be openly discussed in large group settings or lectures and might not even be that available on the internet, since for the most part professionals want to protect their own careers. In order to get the real perspective of what medicine is like, speak with some clerks, residents, and staff physicians. Do not stop at one mentor, try and get a large number of mentors who have different experiences and expertise to learn the most from it. In a one-to-one, or small group setting, professionals will be more honest with you and will give you the truth of the profession without the same fear of professional repercussions, and they want to assist you the best way they can. By reaching out to several different very successful physicians and residents, I can say that I have learned a lot about medicine I never knew about, providing me with more perspective to have a better idea of what I am getting into.

While I have learned some ugly in the field, I can also share that the HC is not all negative. There are a lot of unofficial positive aspects of medicine that were also shared with me by seniors in various fields. As physicians, you can advocate for your patient, and this advocacy can lead to tremendously improving not only their care, shift the entire system to improve the care of others. Adding on everything I have learned, I can without a hiccup say that I would choose this field ten times over. Medicine might be a very tough field, that requires a lot of sacrifice in other aspects of your life. The work you do in medicine, really is amazing. Through just half a year in medical school I have done about 50 hours of shadowing in various fields from forensic pathology, psychology and OB/GYN. I have seen many different corners of the field of medicine, and I have seen the various ways that this career rewards those that are a part of it. People are so trusting of medical professionals, even medical students who are just learning, and it honestly warms my heart to see individuals so open with me. The trust that is afforded to health care providers has to be one of the most valuable assets afforded to us that cannot be abused. Losing public trust would degrade the quality of care that we can provide to the public, and many other negative repercussions. One of the amazing aspects of the medicine that I have learned, and gained a greater appreciation for, is the value of this trust and the importance of maintaining it.

I imagine if you are reading my blog you are most likely considering medicine, and I would commend you and tell you to continue. In my opinion this has to be one of, if not the greatest career ever. In no other career will you have such a direct impact on every type of person’s life. At the end of the day, almost every single individual will be a patient of a health care system at one point in their life. Many of us are born in hospitals and die in hospitals with physicians bringing us to life and easing our way to whatever lies past death. In no other career are you afforded the ability to be as dynamic as a physician. You can practice and do research, own a start-up, work as a consultant, or one hundred other side jobs. You are constantly improving your knowledge-base and learning amongst some of the smartest minds while interacting with professionals from all fields. I cannot think of a greater field, but with such a great field, you need to be aware of the negatives and know what you are getting yourself into.

You might be lost in this post. It is not as structured as my usual posts. This is not an advice piece. This is a narrative of what I believe are some of the most important aspects of medicine I have learned in the four months I have studied so far. Sure, I have learned some clinical decision making skills, genetics, microbiology, and how to take a thorough patient history, but these are skills that can be taught by most individuals that are motivated enough. The aspects of the HC need to be sought out, and you need to choose what you decide to learn since you will never be tested on it. You can go through medical school and pretend you are there to help patients, while just seeking out the money and prestige. You can ignore the vital importance of trust. You might never get any repercussions from and might become a successful physician that never encounters any roadblocks. But I truly believe that if you are in here for the right reasons, take your training very seriously, and perform to the best of your abilities, you will provide better care than someone who is equivalent in all other ways except their motivations. Not only providing patients with better care, but representing other physicians by shaping our workplace in the future with not only our interests at heart, but of those for whom we care for.

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