The Silent Curriculum

Flinching from the silent curriculum.
[Susanna and the Elders via wikimedia]

I love "The Silent Curriculum" so, so, so much. It's powerful and true and brave. Go read it. Go!

I referenced similar issues in my "Beyond the classroom" post:

"SPs are only one tiny influence in a medical student's education. What school students pick, what attitudes they arrive with, who their mentors are, their internships, their residencies, the laws they practice under, and the insurance industry all influence the kinds of medical professionals they become. Almost all of these things are outside their control, and certainly outside of mine. So yes, to be effective, medical educators should be role models. I would feel better if I knew the skills SPs teach students were being reinforced at all levels."

I think one of the things Katherine Brooks writes that is particularly important is this: "I allowed myself to participate in the unconsented care of patients and prioritized my learning, evaluations, and reputation over my values."

I know when faced with personal self-preservation, I am not always the advocate I should be. I am sensitive to explicit vs. implicit rules; that's part of what makes me a good SP. But I feel at my most helpless when faced with bureaucracy where the culture does not match the mission and I have no safe way to express it.

It also makes me realize that while I love the traditional 15-minutes-in-a-room-with-a-student-doctor, the scenarios and schools I am really impressed with are the ones that focus on interdisciplinary & team scenarios. How medical professionals treat each other very much affects how they treat patients. Core values like power differential and consent are ten times worse when working within an institutional infrastructure. How can we expect people to treat patients better than they themselves are treated? While some may be able to do so in the short term through sheer force of empathy, it is not sustainable in the long term, and the medical profession suffers for it.

So the first time I was in a scenario which specifically requested students to challenge each other, my heart almost burst with happiness. I hope to see more of these kinds of events as time goes on. As learners are encouraged to practice challenging and accepting challenges to authority, I hope to contribute to a culture that values a spectrum of diverse voices and views.

Setting the Standard:
Create scenarios to help learners make decisions in teams in ways that encourage challenging each other or gracefully accepting criticism. Reinforce these aspects of scenarios even when they are not the primary objectives. These skills can and should be practiced in safe spaces where grades, jobs or professional relationships are not at risk.