Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (L.S.L.).
American College of Physicians, Philadelphia, Pennsylvania (L.S.S.).
Ann Intern Med. 2018 Apr 3;168(7):506-508. doi: 10.7326/M17-2058. Epub 2018 Feb 27.
Much of what is formally taught in medicine is about the knowledge, skills, and behaviors required of a physician, including how to express compassion and respect for patients at the bedside. What is learned, however, includes not only admirable qualities but also behaviors and qualities that are inconsistent with ethics and professionalism. Positive role models may reinforce the character and values the profession seeks to cultivate; negative ones directly contradict classroom lessons and expectations of patients, society, and medical educators. These positive and negative lessons, which are embedded in organizational structure and culture, are the hidden curricula conveyed in medical schools, residency programs, hospitals, and clinics. This position paper from the American College of Physicians focuses on ethics, professionalism, and the hidden curriculum. It provides strategies for revealing what is hidden to foster the development of reflective and resilient lifelong learners who embody professionalism and clinicians who are, and are perceived as, positive role models. Making the hidden visible and the implicit explicit helps to create a culture reflecting medicine's core values.
医学教育中正式教授的内容主要是医生所需的知识、技能和行为，包括如何在床边表达对患者的同情和尊重。然而，所学内容不仅包括令人钦佩的品质，还包括不符合伦理和专业精神的行为和品质。积极的榜样可以强化该专业所寻求培养的品格和价值观；而消极的榜样则直接违背了课堂教学内容以及患者、社会和医学教育者的期望。这些积极和消极的经验教训，嵌入在组织结构和文化中，是医学院、住院医师培训计划、医院和诊所中所传达的隐性课程。美国医师学院的这份立场文件侧重于伦理、专业精神和隐性课程。它提供了揭示隐藏内容的策略，以培养具有反思和适应能力的终身学习者，他们体现了专业精神，并且是被视为积极榜样的临床医生。使隐性变得可见，使隐含变得明确有助于创造一种反映医学核心价值观的文化。
