Bandini Julia, Mitchell Christine, Epstein-Peterson Zachary D, Amobi Ada, Cahill Jonathan, Peteet John, Balboni Tracy, Balboni Michael J
1 Department of Sociology, Brandeis University, Waltham, MA, USA.
2 Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
Am J Hosp Palliat Care. 2017 Feb;34(1):57-63. doi: 10.1177/1049909115616359. Epub 2016 Jul 11.
The hidden curriculum, or the socialization process of medical training, plays a crucial role in the development of physicians, as they navigate the clinical learning environment. The purpose of this qualitative study was to examine medical faculty and students' perceptions of psychological, moral, and spiritual challenges during medical training in caring for critically ill patients. Focus groups were conducted with 25 Harvard Medical School (HMS) students, and interviews were conducted with 8 HMS faculty members. Five major themes emerged as important in shaping students' medical training experiences. First, students and faculty discussed the overall significance of the hidden curriculum in terms of the hierarchy of medicine, behavioral modeling, and the value placed on research versus clinical work. Second, respondents articulated values modeled in medicine. Third, students and faculty reflected on changes in student development during their training, particularly in terms of changes in empathy and compassion. Fourth, respondents discussed challenges faced in medical school including professional clinical education and the psychosocial aspects of medical training. Finally, students and faculty articulated a number of coping mechanisms to mitigate these challenges including reflection, prayer, repression, support systems, creative outlets, exercise, and separation from one's work. The results from this study suggest the significance of the hidden curriculum on medical students throughout their training, as they learn to navigate challenging and emotional experiences. Furthermore, these results emphasize an increased focus toward the effect of the hidden curriculum on students' development in medical school, particularly noting the ways in which self-reflection may benefit students.
隐性课程，即医学培训的社会化过程，在医生的成长过程中起着至关重要的作用，因为他们要应对临床学习环境。这项定性研究的目的是考察医学教师和学生在照顾重症患者的医学培训过程中对心理、道德和精神挑战的看法。对25名哈佛医学院（HMS）的学生进行了焦点小组访谈，并对8名HMS教师进行了访谈。在塑造学生的医学培训经历方面，出现了五个重要主题。首先，学生和教师从医学等级制度、行为示范以及对研究与临床工作的重视程度等方面讨论了隐性课程的总体重要性。其次，受访者阐述了医学中所体现的价值观。第三，学生和教师反思了学生在培训期间的发展变化，特别是在同理心和同情心方面的变化。第四，受访者讨论了医学院面临的挑战，包括专业临床教育和医学培训的社会心理方面。最后，学生和教师阐述了一些应对这些挑战的机制，包括反思、祈祷、压抑、支持系统、创造性发泄方式、锻炼以及与工作分离。这项研究的结果表明，隐性课程在医学生的整个培训过程中具有重要意义，因为他们要学会应对具有挑战性和情绪化的经历。此外，这些结果强调要更加关注隐性课程对医学院学生发展的影响，尤其要注意自我反思可能使学生受益的方式。
