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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