Uncovering the Hidden Curriculum
Medical schools revolve around curricula, syllabi and course objectives—all designed to make sure future doctors have extensive knowledge of the human body and the clinical skills to diagnose and treat patients. But there’s also the underlying
lessons students absorb, ones that aren’t necessarily overt: the hidden curriculum. Feldman describes this as an “acculturation,” based in part on the subtle messages sent via the behavior of faculty and trainees.
it’s largely unspoken, the hidden curriculum can have an outsized impact. Students are less inclined to question what they’re learning, even if the dynamics they observe are unhealthy. For example, if a student sees a physician treating
a nurse or a resident with disrespect, they may internalize the example being set. They may “question whether they belong,” says Feldman, or decide that they just “need to toughen up.” Feldman and colleagues across the College,
including the Office of Diversity and Inclusion and the Learning Environment and Professionalism Committee (LEAP), want to create the space for students to talk about what they’re witnessing— the good and the bad.
learning environment efforts are really about dialogue across divides, whatever the divides might be,” she says. A new, confidential, online reporting system streamlines how students communicate about learner mistreatment and offers various
options for intervention, from anonymously reporting a concern, to meeting with Feldman or another faculty member to decide how to proceed, to, in the most serious cases, filing a report of harassment or discrimination directly with UVM’s Affirmative
Action and Equal Opportunity Office. It’s important that the available options be easily accessible and as transparent as possible, Feldman says, so that students know where and how they can receive support.
The online system also
includes a call for accolades. Students can write in praise for individuals who have “upheld the highest standards of professionalism.” Testimonials are shared anonymously with the recipient and their direct supervisor.
students reflect on professionalism through two new questions on course and clerkship evaluations. One offers students an opportunity to identify faculty members, residents or staff who are “exemplars of professionalism.” Feldman says
the response rate continues to astound her—the large number of accolades is a testament to the impact of these positive role models on students.
The second new question asks students to address any instances of potential mistreatment
or unprofessional behavior they may have witnessed or experienced. Students explore how they perceived the action and receive support if desired. Through this system, trends and themes can be identified, empowering the College to provide education
and professional development to improve the learning environment.
“Giving voice to our students provides an opportunity for them to engage in the process of improvement,” says Feldman.
Ongoing research seeks to quantify
the effect of the College’s emphasis on reflection and gratitude, with Abigail Belser ’22 at the front lines of this work. She spent the summer of 2019 as the learning environment intern, leading a study to measure the impact of the new
accolade reporting system. She found strong student participation: Of the 851 clerkship evaluations received in the 2018-19 academic year, 67 percent contained one or more accolades. Belser and co-investigators analyzed themes in what students wrote
and collected responses from faculty who received accolades.
“Just adding this simple question to the course evaluations actually has a positive impact on a lot of people, which I think is pretty exciting,” she says.
The study, which was presented at the 2019 Association of American Medical Colleges (AAMC) annual meeting, invites further research. Leigh Ann Holterman, Ph.D., director of curricular evaluation and assessment and a co-investigator on the project,
says the next step will be looking at the accolade reporting system’s effect on burnout. Structured interviews with faculty and students should help dig deeper into how encouraging gratitude changes the status quo.
to see what impact it has on students,” says Holterman. “Does it change anything for them that they can identify? Then for the faculty, does it impact their desire to teach? Does it allow them to feel more invested?”
is hopeful her peers will benefit from identifying role models early in their education, setting them up for a lifelong focus on positive change.
“Many studies have shown that gratitude—either taking a minute yourself to be
grateful or also receiving thanks and appreciation—can have protective effects against burnout,” she says. “So, we think potentially doing something as simple as asking students to write a positive review about a faculty member could
be beneficial to both students and faculty.”