The hidden curriculum in medical school

As a first year medical student, one of our many responsibilities is to shadow a nurse once a month to gain an appreciation for their job. On one such shift, I asked my nurse-preceptor his greatest complaint about doctors. I expected to hear something about respecting nurses, or spending more time listening to the patients. Instead, I heard this:

“I wish doctors would communicate better with each other.”

Doctors are notorious for not playing well with others. Well, the root of the problem starts here in medical school. All I do as a first year student is sit in the library by myself and study countless biomedical facts.

Nothing we learn in the classroom years of medical school is complicated. For instance, biochemistry is nothing but list after list of memorization. The best way to learn this sort of first order knowledge is to make up a mnemonic, repeat it to yourself fifty times, write on a white board, anything that works. It just takes hard work and a lot of time by yourself.

Whenever my classmates ask me questions about the material I want to tell them, “You’re over-thinking this, just memorize the words.” I’d love to understand the concepts underlying cell signaling, but the list of things we need to memorize is endless. We haven’t even reached second year yet, when it gets hard. I know I won’t be learning the mechanism behind every antibiotic.

Group learning is useful for solving complex problems like say, figuring out how to fix health care. Unfortunately, we don’t have such group opportunities during medical school. In medical school there is little incentive to work together. The lone wolf studying strategy is not only the most efficient way to study, but it’s usually the only way. It’s not like they let you take exams together. And frankly, that’s what they want you to do.

Who is they? They is the hidden curriculum, all the lessons that medical school teaches that the professors don’t intend to.  It’s abstract, but they is everyone that says, “Yeah, healthcare is messed up, but it’s so big you can’t do anything to fix it. You’ll learn eventually.” Everyone that wants you to leave medical school apathetic.

They want you to study by yourself and become obsessed with how well you understanding the material. ergo – stop caring about whether anyone else understands it. It would be a great system to develop overconfident get-mine solo practice doctors, but everyone knows there’s too much paperwork to run a solo practice these days. We’re also coming upon the age of specialists when collaboration will be at a premium. A disease like diabetes is complex. You might need primary care physicians working with vascular surgeons, endocrinologists, ophthalmologists, I could list every specialty. Not to mention nutritionists, personal trainers, policy makers.

Instead of talking with my classmates about complex topics like health care policy, I’m spending every waking hour with my headphones on, noise-canceling the world, and sorting out cell biology. So I can get mine.

That’s the hidden curriculum at work.

Ken Noguchi is a medical student who blogs at sidenote.

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  • CuriousMS1

    This “hidden curriculum” is perhaps what separates doctors who have chosen medicine as a career vs. those who have followed their calling into a profession. Certainly improvements can be made, but at the end of the day, when we begin to let others decide what and how we learn, then there really isn’t anyone else to judge but ourselves.

    “…even the best of men must be content with fragments, with partial glimpses, never the full fruition. In this unsatisfied quest the attitude of mind, the desire, the thirst—a thirst that from the soul must rise!—the fervent longing, are the be-all and the end-all. What is the student but a lover courting a fickle mistress who ever eludes his grasp? In this very elusiveness is brought out his second great characteristic—steadfastness of purpose. Unless from the start the limitations incident to our frail human faculties are frankly accepted, nothing but disappointment awaits you…And, thirdly, the honest heart will keep him in touch with his fellow students, and furnish that sense of comradeship without which he travels an arid waste alone.” – W. Osler

    • http://www.sidenotelife.com/ ken noguchi

      Really great quote. Sounds complicated though, I’ll need to analyze it more. That said, being internally-motivated is a huge part of avoiding the influence of the hidden curriculum. It’s just really challenging to stay internally-motivated.

  • http://rk.md/ Rishi

    I completely hear where you’re coming from. During my sub-internship (my very last rotation in med school), I saw true teamwork between physicians… and it wasn’t at the attending level. Residents at all levels and from all specialties really showed me how multidisciplinary care can be efficiently implemented. They would set aside time early in the day to simply follow-up on patients with multiple consults as well as place new consults – all teams would be on the same page as far as what should get done during business hours that day. Often times these residents would go to each other’s offices to clarify ambiguities and keep the nursing staff in the know about their respective plans. Wish this could be a universal practice.

    • http://www.sidenotelife.com/ ken noguchi

      That’s really great to hear that the residents and nurses are taking such an active role in the multidisciplinary care. I always believe real change starts from the ground up.

  • morebuzzkills

    Oh boy…tried to resist commenting, but I just can’t! I blame my friend for sending me the link to this article. First, you are right about the fact that you have to memorize a bunch of facts, curriculum/”health care experts” (whatever that means) preach teamwork, and physicians could do a better job communicating with each other. However, there is no “hidden curriculum” in medical school. The medical school administrators do not hide behind closed doors and secretly devise ways to make the lowly medical students apathetic about everything in life. This is not to say that there are not drastic problems in medical education…but they do not stem from some occult curriculum. In fact, the origin of the problems in medical education is far sadder than if the curriculum folks had just sat behind closed doors and devised some secret plan of apathy. The problems themselves, ironically enough, stem from something that could be remedied by…you guessed it, education! The overwhelming majority of problems in medical education stem from the curriculum folks’ misunderstanding of the incentives medical students have in their lives. During the first two years, once NMSS (naive medical student syndrome) wears off, you come to understand that Step 1 is the most controllable factor that will dictate the rest of your life. As such, your goal becomes doing as well as possible on this exam. After Step 1 you enter your rotations…and your rotation grades become the most relevant factor for your future. Instead of embracing these incentives, curriculum designers downplay them, minimize them, misunderstand them, or ignore them all together. Curriculum design would be way more effective if it centered around the fact that Board exams and residency competition are factors cannot be controlled and that students respond to these incentives. Using critical thinking and examining the incentives that certain policies/ideas create is an economical way of thinking. Almost nobody in our country receives any appreciable education in economics. No, your econ 101 class in college nor your civics class from high school really count (although they’re a good start).

    As far as the memorization of facts goes, that’s not going to go away unless Step 1 goes away (and seeing as how it is the first part of the licensing exams for physician, it’s not going to). You must then ask yourself why this exam exists. Are the basic sciences just a relic of the medicine of yesteryear? In part, yes they are…but they are also your first introduction to the language of medicine. It is also your only opportunity to examine human physiology and disease from a scientific perspective. Real lives aren’t on the line, you don’t have to make decisions in real-time, and you can actually stop to think. Do schools do a great job of facilitating this? Not really. Should we have a knee-jerk reaction and put everyone into small groups and have a facilitator coaching them as they stumble through cases? Probably not…you would have to have some extremely good facilitators (aka dedicated teachers…and those are very hard to come by). What should be done? Schools should embrace the ‘lone wolf’ period in medical education. They should give you access to their resources, make nothing mandatory, use shelf tests that are put out by the NBME, and allow you the latitude to learn however you see see fit. If that’s sitting around a table with 4 of your classmates stumbling through cases, then more power to you! Do this for 1.5 years, take Step 1, then move on to greener pastures. Just realize that the basic sciences are your time to learn the language of medicine. You don’t start the study of a language by reading novels and speaking to natives…you usually start with grammar and vocabulary. That’s what the basic sciences are. Dedicate yourself to truly understanding them and you just might end up better on the flip side. You just have to figure out how to get around the massive road block that current medical school curricula impose. Also, don’t fall into the trap of thinking that the basic sciences are the time to inject the “fix-all vaccine” for the health care system. This is a bunch of garbage. Medical students in their first 2 years have never ordered a single test, diagnosed a single patient, etc. This is the foundational period for you to learn the language!

    • http://www.sidenotelife.com/ ken noguchi

      I hear what you are saying. I definitely understand the purpose of M1 and M2 – to gear towards Step 1, and pick up on the clinical thought process. I also absolutely agree that more curriculums should openly gear themselves towards Step 1. I often wonder what would happen if the writers of First Aid took over a pre-clinical curriculum at a school.

      However, I must disagree with you that the hidden curriculum does not exist. Yes, I understand that curriculum administrators are not scheming behind closed doors to “get us.” At the same time, there are societal forces much larger than med students or administrators that control the way med school operates, and thus how medical students are trained to think. I am simply asking that more students be conscious of how the subconscious decisions we are forced to make are contributing to how we think.

      We can control how we think if we pay attention to what is controlling how we think.

      • morebuzzkills

        I guess I am failing to see these societal forces you speak of…but I guess it’s just alphabet soup at this point. Some may call it
        ‘hidden curriculum,’ but I would just call it for what it is. It is naivety on the people who run medical schools. They don’t understand the incentives that exist for medical students. I would even go so far as to call it insanity (defined as doing the same thing over and over again and expecting a different result). They continue with the same curriculum, same incentives, same everything and expect to produce a class of docs that is some how magically better than the previous classes.

    • Daniel

      The “hidden curriculum” is not a conspiracy. It is a phrase that refers to the lessons taught and learned that are not intended to be a regular part of the (real) curriculum. In this case, the hidden curriculum is: To make it in medicine (or at least the first two to four years), you need a lot of alone time to cram as much as you can for exams and boards.

      • morebuzzkills

        I guess I am failing to see how that is hidden. This was pretty obvious to me from the onset.

    • http://www.facebook.com/shirie.leng Shirie Leng

      i agree. You don’t remember most of what you learn in the first two years and you might not ever directly use it, but you learn the language and you learn where to find the information you need. I’d be the first to say medical school should be modified, but somehow that vocabulary has to be acquired.

  • http://www.facebook.com/alison.broomall Alison Broomall

    Great to see this level of honesty coming from a medical professional. The lack of collaboration between doctors when it comes to patient care is such a huge problem. I don’t know that it is so much part of a hidden agenda as it is the by-product of a broken healthcare ecosystem. in my experience, most doctors don’t have the time–or sometimes the interest–in collaborating. Patients must bear the responsibility of coordinating their own care and unfortunately, many are not in a position to do so. Patient and health advocates are a huge help but again, many people just don’t have the access or the understanding.

    • http://www.sidenotelife.com/ ken noguchi

      Yes, the broken healthcare ecosystem is a huge part of the problem as well. It definitely shouldn’t fall on patients to coordinate their care. There are certainly many different factors playing into the problem, and it seems overwhelming, but ultimately patients and the quality of care is suffering. It’s a good conversation to have.

  • http://twitter.com/DavidGelberMD David Gelber MD

    Doctors who won’t talk to each other drive me crazy. Every day i get a call from a nurse telling me that Dr. X wants me to do this or Dr. Y thinks there may be a new problem with a particular patient. I am always happy when I am called directly by a doctor so that we can discuss the patient. That is what I always try to do. if am calling a specialist to consult on one of my patients I will almost always pick up the phone and call them. This way they know what surgery a patient may have had, as well as what my exact concerns and thoughts are.

    • http://www.sidenotelife.com/ ken noguchi

      That’s exactly the complaints I’ve been hearing!

    • Suzi Q 38

      I had been told that I have a serious problem with my spine by a PT. The PT was afraid to call the neuro. I had to tell the neuro what the PT said, to which he did not believe me.
      A year later, my gastro finally figured out what could be wrong with me, based on the upteenth time that I had decsribed my symptoms to various physicians. He told me to tell my doctors that the problem was in my upper spine (spinal stenosis). I was not familiar with this problem, and I was concerned that things could get lost in my translation to my doctors, so I asked HIM to call my doctors. He declined saying: “You tell them that you need an MRI of your upper spine. They have been looking in the wrong place (lumbar). You tell them I said so (He was chief of staff).”

      I hate that they can’t talk to each other.
      What is the big deal? When was I elected the unpaid negotiator?
      Plus, I am the patient. How does this all look to me?

  • Dave

    I think the clandestine curriculum you describe is mostly self-imposed. While the lone wolf approach may be working well for you, I’m sure many of your classmates are working together, working with upperclassmen, and helping one another even if doing so has no incentive so far as grades are concerned. Nobody is forcing you to study like you do, and finding that a solo, brute-force-memory approach works best for you is hardly a hidden curriculum. The ultimate communication problems between physicians have little to do with how the basic sciences were taught in med school. I would also caution you that the ‘memorizinators’ ultimately run into trouble if they don’t master the concepts. These are the people who think the Steps are all about remembering tiny details because they don’t see the concepts hidden in what appear to be detail questions.

    • http://www.sidenotelife.com/ ken noguchi

      Yeah I agree, the hidden curriculum is completely self-imposed. It just seems that there are certain parts of the curriculum that incentivize students to self-impose on themselves a curriculum that does not end up producing good doctors.

  • http://www.doctordinusha.info/ Dinusha Sirisena

    Did we have loads to study when we were medical students? Yes. Did we enjoy learning all these things? Not all the time. Is there a hidden agenda at medical schools? Unlikely.

    This dissonance between the professionals and apathy, stem from a much more deep problem in the society. Becoz doctors are “human”. Not all the doctors are the same, and they have their quirks. Some work well with others, and some don’t. Most students decide to study medicine, becoz they are willing and capable of sitting still and study devoid of human interaction.
    Most of the time doctors feel unrecognized, and under appreciated. That is becoz they are. This cause docs become more cynical in life.
    And even the bright eyed intern who come to the ward is so willing to learn, educate, help patients and talk to other doctors. Usually this sort of dies down after a couple of months, becoz of the heavy workload, the need to study, their own financial problems, their own family matters, etc. It is not only to do with medical education. it is the personality traits. (Doctors are usually having Obsessive Compulsive traits)

    • http://www.sidenotelife.com/ ken noguchi

      I agree that it is a very human characteristic to grow cynical, and certainly not one that only happens to medical school attendees. My question for you would be – do you think there is zero contribution of an education process such as med school, one that takes up lots of time for a minimum of four years, to the process of becoming cynical? If so, isn’t there something in med school that could be changed to help students maintain empathy?

  • http://www.facebook.com/shirie.leng Shirie Leng

    I think what you are seeing is the disconnect between how you get into medical school, how you excel in medical school, how you land a good residency, and what skills you need to actually DO the work of doctoring. Ace-ing physics doesn’t guarantee you can navigate the human interactions necessary to be an effective clinician.

    • http://www.sidenotelife.com/ ken noguchi

      Yes! Thank you. And that’s not right. It shouldn’t be that way.

  • Marc Friedman

    Here is a simple solution that is so sorely missing from most I run into; start reading the New York Times daily. Take it upon yourself to find a way to enrich your overall knowledge base. This is a two edged sword because you will quickly discover that you as a physician are not the only group that didn’t attend a good preschool and play group. Start engaging the other occupations around the usual medical complex especially the community hospitals… You will then really understand the profound problem with so many..the level of ignorance, superstition and sheer misinformation is a tidal wave that is upon is. So stop beating yourselfupand get back to the library and learn something that actually is fact.

  • JD

    With regards to medical education, I am afraid that you are using the term “hidden education” incorrectly. And yes, in the field of medical education, “hidden curriculum” has an academically accepted definition. In your article, you use the term to describe those things that you learn outside of your medical school lectures.

    The actual definition of “hidden curriculum” is slightly, but distinctly, different. And it is a term used in medical education research. It actually means receiving information that directly CONFLICTS with the formal, standardly accepted, way of either practicing medicine or learning concepts.

    Let me clarify with an example. We learn in medical school that a standardly accepted, recognized way of writing a daily progress note is to write a SOAP note, formatted as Subjective, Objective, Assessment and Plan. However, suppose that a senior medical student, or a resident, says to you “this SOAP note format is nonsense….I just write my notes the way I want to, and no one has ever complained”. His advice, which goes against the formal teaching, is an example of the “hidden curriculum” and in the field of medical education the hidden curriculum is considered detrimental to the student, in that it leads to conflict about the proper way to fulfill responsibilities.

    I do not mean to pick on you, but I thought you might want to be clear on this, because in the future you might be using the term “hidden curriculum” in front of someone who does research on medical education, and I did not want you to appear ignorant or misinformed. In medicine, I think that being precise with terms is important.

    • http://www.sidenotelife.com/ ken noguchi

      Thank you for the correction. That is good to know, and it is definitely necessary to be precise with terminology. I agree with you that what I described is not related to an explicitly taught curriculum. So based on that I have a question for you, rather than the hidden curriculum, what would you call the phenomenon I described?

      • JD

        Perhaps then term “unspoken curriculum”?…again, I am not trying to be too critical, I appreciate your writing efforts. It just so happens that you took a term that is already coined, and there are a lot of clinician-educators out there who would be confused by what you mean. Keep up the good work

        • http://www.sidenotelife.com/ ken noguchi

          Thanks, I appreciate the suggestion. Unspoken curriculum makes sense. There must be a good term for it somewhere.

  • John Feehan

    I understand what you say, and I would suggest you not be too hard on yourself – or your peers. I have an advanced degree in mathematics but still had to memorize the “times tables” in second grade.

    I know, mathematics is not nearly comparable with medicine but the principle is somewhat the same: sometimes, learning by rote must precede understanding, especially when knowing many specific details is important to the understanding itself.

    I wish you well -

    • http://www.sidenotelife.com/ ken noguchi

      Thanks! I will try not to be too hard on us. I understand the process is long.

  • http://twitter.com/ebenezer1954 Catherine Ebenezer

    Doesn’t problem-based learning teach medical students how to work collaboratively?

    • Sarah Langdon

      My thoughts exactly. I go to a school with a curriculum that is a lot different than traditional ones. We have PBL three times a week and then have other small group sessions (8 people) every week on topics such as ethics, cultural competency, translational research, etc. My colleagues and I have plenty of time to talk to each other about complex issues. Does that make us better team players? Who knows? Only time will tell.

      While there may infact be a “hidden curriculum” at some schools, maybe not so much at others.

      • morebuzzkills

        The effectiveness of PBL/small group learning is highly dependent on the facilitator of the exercise. As long as USMLE Step 1 functions as a “major life determinant” teaching modalities such as these will be met with resistance by students who do not have the very best facilitators. Plus, great basic science teaching is becoming an artifact of yesteryear. The PHDs and MDs who are great basic science instructors likely do not earn their living by just teaching basic medical sciences. Therefore they are incented to perform the activities that help them earn their living. As long as the current incentives created by Step 1 are in place, the most effective learning modalities will be those that most efficiently facilitate the mastery of this material. Med schools need to get their heads out of the sand and abandon these inefficient instruction techniques, especially ones that have highly variable quality (such as PBL and small group learning). We can try to inject as much “teamwork” and “communication” skills as we want into the first 2 years of medical school, but at the end of the day the majority of med students will lock themselves in a room and study like there is no tomorrow for Step 1.

    • http://www.sidenotelife.com/ ken noguchi

      I completely agree! There have to be ways to reduce the effect of the hidden curriculum, which causes an unintended decrease in med student empathy. Perhaps one way is the problem-based learning.

  • meyati

    Currently, I’m lucking out on this one. They really can’t do anything for me, but they’re reaching out to each other and reassure me they’re friends-willing to meet the new kid on the block-my dermatologist, etc. As far as the Nurse Navigators and counselors, they aren’t working out for me. I had to contact my PCP to get baseline lab work done. My Team leader didn’t order any-even though he wanted me to have radical surgery with bone removal-like half of my face. He walked out. I asked her, and she said the doctor didn’t order any and walked off. It got worse.
    The system is starting up a new oncology clinic on the other side of a sprawling city. The head clinic administrator is trying to be at both places at the same time. Her staff at my clinic seem to be rogue-doing what they want-didn’t tell that for over 6 weeks a woman was hounding them in person, on Email, and the phone about getting a new doctor, nurse navigator, the radiologists showed up for the tumor board-and found the date was changed-it already was convened. That first doctor screwed me over in so many different ways.

  • Sathyadeepak Ramesh

    “Whenever my classmates ask me questions about the material I want to tell them, “You’re over-thinking this, just memorize the words.” … I know I won’t be learning the mechanism behind every antibiotic.”

    Then why not just be a mid-level practitioner? Our job is to know and understand. You’re doing it wrong…

  • M2 about to take Step 1

    If you’re memorizing lists endless without conceptual understanding, you’re doing it wrong. Very wrong. There’s a lot of memorization in med school, yes. But there’s also a good amount of conceptual understanding required. If you don’t understand the concepts behind what you’re learning and how to fit everything together, you’re in for a rude awakening when M2 year comes around, especially around Step 1 time. Even more importantly, you’re putting yourself at a disadvantage when it comes to the wards.

    After spending a solid amount of time on the wards (my school is one of the weird ones where we do a lot of clinical stuff before taking boards), the people who memorized lists, like yourself, are the ones struggling immensely. It’s the ones who have worked through the concepts and have a solid understanding of physiology and pathophysiology (both of which are extremely conceptual subjects) are the ones absolutely shining. It’s very difficult to just memorize lists of differentials, but if you know the concepts, you can reason your way through patient problems and generate strong differentials and plans.

    So, to repeat again, you’re doing yourself a great disservice if all you’re doing is memorizing without thoroughly understanding concepts. You’re also doing your classmates a great disservice if you’re encouraging them to memorize rather than understand. Even classes like biochemistry are extremely conceptual — just understanding the metabolic state of the body and what hormone is dominant in that state allows you explain how nearly every single important metabolic pathway will be functioning.

    • Dan

      As another M2 about to take the boards, I agree completely. My step studying hasn’t been near as bad as I thought it would be because I learned the concepts.

    • http://www.sidenotelife.com/ ken noguchi

      That’s great to hear! I believe it’s important to learn concepts as well. My question would be – then why don’t med schools incentivize learning the concepts rather than memorizing obscure facts tucked away in the syllabus?

  • Shalena Garza

    Dear Ken, I found the best way to learn in medical school was in groups. I loved medical school. I hate memorizing so we would get together and make up stories with buzz words and jokes and I could always remember things better when there was a joke about it. We did crazy things, like memorizing pathways in anatomy, for example… Imagine the room and write the structures on separate large papers and place them around the room and tell a story going from one thing to the next… Later if you can remember the room and how you laid out the story you can see how that might work. Pin lists of memorizable information in your bathroom for example, above the toilet so you see it everytime you use it, lol. For the conceptual stuff like physiology, find someone who is good at teaching and catches on quickly and buddy up. People who like to teach find it helps them learn when they teach others. This is the most important thing, the physiology, and you cannot memorize it, you must figure it out and know how to manipulate the variables. Have fun in medical school, it should be hard but with each success, it should also be rewarding. If you find a particular subject challenging, tackle that first.

  • http://www.facebook.com/merrian.bianculli Merrian Antonini Bianculli

    What I notice is that you still did not hear the answer to the question you posed to the nurse. Doctors need to communicate does not mean when you study. It means when you care for patients. What the nurse was talking about is how Surgery does not talk to Anesthesiology, or Medicine does not communicate effectively with Surgery. Nurses are put in the middle of this non-communication loop when we are trying to just keep up with our workload. We do not have anymore time than the Doctors to call 2-3 people to get a response, let alone an answer. We really hate it when you finally respond and ask “why did you call me?”.

  • Bruce Ramshaw

    Great observations, Ken. It does seem overwhelming, but what has helped me understand potential solutions for our healthcare problem is learning complexity (complex adaptive systems) science. Appendix B in Crossing the Quality Chasm (by the Institute of medicine) has a nice overview. It will take time and it will be messy, but healthcare transformation has started (not by the new law, but by patients, entrepreneurs from outside of traditional healthcare and disruptive innovators). It will take a complete system structural change in how we care for patients. I’m glad you had time to spend with a nurse and I encourage you to spend time with and get to know patients who have gone through the system- their perspective is incredibly valuable. I recognized the flaws of the current med school model after my first month (although I had no clue about the science behind why our system is failing at the time). I stopped going to class, except to take exams, and got a job at a bar as a doorman. I learned much more about being a good physician working at that bar for four years than I ever would have in med school, even if I went to class. Good luck and thanks for your article.

    • http://www.sidenotelife.com/ ken noguchi

      Bruce,

      That’s amazing, and incredibly bold to get a job working at a bar. I’m sure that must’ve brought you a multitude of experiences that help you as a physician. Any particularly good learning experiences you had?

      from ken

      • Bruce Ramshaw

        Hi Ken,
        I was fairly shy and it really helped me learn to interact with people in a variety of situations- when they were angry, drunk, etc. I learned to just talk with them and interact as one human to another- not try to force them out of the bar or fight with them. As we start a new model for academic medicine, I am drawing on that experience to try to interact with patients and family member and others on our care team that way. Here is a TEDx talk I gave about it last year:
        http://www.youtube.com/watch?v=QPeLIbh0BAw

        Take care,
        Bruce

        • http://www.sidenotelife.com/ ken noguchi

          Thanks for the video – I love ‘this is water.’

  • Felicity

    Perhaps your medical school needs a bit of a ‘refreshed’ approach. Most of the work in medical schools in Australia is around collaboration and group work for the very reason you mention. Best wishes with your profession.

  • http://twitter.com/RDBowman Rachel Bowman

    Oh my dear Ken!

    “They” do not WANT you to study alone. “They” WANT you to learn. However you learn best is up to you. Many people learn in groups, by talking it out. I know I did. I NEVER studied alone, and I can still tell you the mechanism of action of most of the antibiotics I prescribe every day. I hate to say it, but you WILL need to know the mechanism of those antibiotics- it may not seem that way now, but it will all fit together. The microbiology and the pharmacology will have cross-links. A certain type of bacteria may have a specific defense mechanism, and a class of antibiotics may target that mechanism. That’s not memorizing, that’s making connections.

    As for the lack of empathy in medical students. That didn’t happen to me. But then again, I wasn’t a lone wolf. I struggle with empathy now that I slog away my days fending off drug seekers, disability seekers and the like. But I made it through med school with lots of altruism and positive attitude, perhaps b/c I was surrounded by a good group of friends and we supported each other. I cared deeply if my friends passed their exams. That’s why we would spend hours doing flash cards…

    I do not think your statement about the lone wolf method of studying being the most efficient is true at all. Of course you can’t take exams together, but you can certainly study together. I’m not saying you should study another way if it doesn’t work for you. You should learn your own way, and then go “get yours.” Just don’t think that anyone is forcing that type of studying on you.

    • http://www.sidenotelife.com/ ken noguchi

      Rachel,

      That is great to hear that you were able to survive med school without losing your empathy! I would love to hear more about how you were able to do that. Studying groups sounds like a good way to accomplish that. Unfortunately, the research shows that on the whole, med students decrease in empathy, especially during third year, as they progress through med school. I think it’s harsh to think that everyone can survive as you did, there are many who do not, or cannot. My goal is to help those who cannot.

      from ken

      • http://twitter.com/RDBowman Rachel Bowman

        Well Ken, I ended up in Family Medicine… have you ever seen that little nomogram that predicts what specialty you will end up in? it’s pretty funny, but it does put “nice” people into Family Medicine. I ended up in a residency surrounded by 7 other really “nice” people and I think we were all pretty tanked up with empathy.

        I think you’re really on to something though, if studies show that med students really do lack empathy, then something needs to be done to fix it. I honestly can’t imagine being a doctor without empathy. I can’t imagine
        surviving through 3 years (or more!) of residency, getting up in the middle of the night to treat drug addicts, or take the 3rd call from a primip who is NOT in labor, without empathy. That would make for some pretty lousy doctors who I would not want caring for me in the middle of the night if I were sick and in need of help.

        But honestly, I don’t think it’s all that bad. Most of the docs I know are great people. (surgeons and specialists included!)

        Whatever happens in third year probably self corrects… people end up in their chosen specialties for a reason.

  • Joshua

    It’s interesting that you use the phrase “hidden curriculum,” because this is used elsewhere in medicine as well:

    Coulehan, J. Today’s Professionalism: engaging the mind but not the heart. 2005. Academic Medicine. 80(10):892-898.

    There’s a small body of literature that discusses it, but that’s a good intro paper. Suffice it to say, this concept of the hidden curriculum doesn’t stop with MS1 – in fact, it plays a larger role as you progress in your training.

    • http://www.sidenotelife.com/ ken noguchi

      That is a great article – gave me lots to think about. Thanks!

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