Hafferty F W
Department of Behavioral Sciences, University of Minnesota-Duluth School of Medicine, MN 55812-2487, USA.
Acad Med. 1998 Apr;73(4):403-7. doi: 10.1097/00001888-199804000-00013.
Throughout this century there have been many efforts to reform the medical curriculum. These efforts have largely been unsuccessful in producing fundamental changes in the training of medical students. The author challenges the traditional notion that changes to medical education are most appropriately made at the level of the curriculum, or the formal educational programs and instruction provided to students. Instead, he proposes that the medical school is best thought of as a "learning environment" and that reform initiatives must be undertaken with an eye to what students learn instead of what they are taught. This alternative framework distinguishes among three interrelated components of medical training: the formal curriculum, the informal curriculum, and the hidden curriculum. The author gives basic definitions of these concepts, and proposes that the hidden curriculum needs particular exploration. To uncover their institution's hidden curricula, he suggests that educators and administrators examine four areas: institutional policies, evaluation activities, resource-allocation decisions, and institutional "slang." He also describes how accreditation standards and processes might be reformed. He concludes with three recommendations for moving beyond curriculum reform to reconstruct the overall learning environment of medical education, including how best to move forward with the Medical School Objectives Project sponsored by the AAMC.
在整个本世纪，人们为改革医学课程做出了诸多努力。这些努力在给医学生的培训带来根本性变革方面大多未取得成功。作者对传统观念提出了质疑，即医学教育的变革最适宜在课程层面进行，也就是向学生提供的正式教育项目和教学内容。相反，他提议医学院最好被视为一个“学习环境”，并且改革举措必须着眼于学生学到了什么而非教了他们什么。这个替代框架区分了医学培训的三个相互关联的组成部分：正式课程、非正式课程和隐性课程。作者给出了这些概念的基本定义，并提议对隐性课程需要进行特别的探究。为了揭示所在机构的隐性课程，他建议教育工作者和管理人员审视四个领域：机构政策、评估活动、资源分配决策以及机构“行话”。他还描述了认证标准和流程可能如何改革。他最后提出了三项建议，以超越课程改革，重建医学教育的整体学习环境，包括如何最好地推进由美国医学协会（AAMC）发起的医学院目标项目。
