Blinded by belonging: revealing the hidden curriculum

The role of weight bias and role-modeling in medical students' patient-centered communication with higher weight standardized patients

OBJECTIVE

Patients with obesity may experience less patient-centered care. We assessed whether medical students' implicit/explicit weight-related attitudes and perceptions of normative attitudes are associated with patient-centered care for patients with obesity.

METHODS

Third and fourth year medical students (N = 111) at one medical school completed a survey and participated in a patient care scenario with a standardized patient with obesity. Encounters were coded for patient-centered behavior. Predictors of patient-centered behaviors were assessed.

RESULTS

Student perceptions that negative attitudes about patients with obesity are normative in medical school were significantly associated with poorer patient-centered behaviors, including lower attentiveness (b=-0.19, p = 0.01), friendliness (b=-0.28, p < 0.001), responsiveness (b=-0.21, p = 0.002), respectfulness (b=-0.17, p = 0.003), interactivity (b=-0.22, p = 0.003), likelihood of being recommended by observers (b=-0.34, p < 0.001), and patient-centeredness index scores (b=-0.16, p = 0.002). Student reported faculty role-modeling of discrimination against patients with obesity predicted lower friendliness (b=-0.16, p = 0.03), recommendation likelihood (b=-0.22, p = 0.04), and patient-centeredness index score (b=-0.12, p = 0.03).

CONCLUSIONS

Negative normative attitudes and behaviors regarding obesity in the medical school environment may adversely influence the quality of patient-centered behaviors provided to patients with obesity.

PRACTICE IMPLICATIONS

Efforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.

Twelve tips for integrating leadership development into undergraduate medical education

Healthcare systems need effective leadership. All healthcare professionals can and should "learn to lead" and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership. Drawing from the existing evidence base, the authors' expertise and the latest "thought leadership", these 12 tips provide practical guidance to universities and associated provider organizations, and to academic and clinical faculty, on how to integrate leadership development into their undergraduate medical programs. These 12 tips will help educators provide medical education that incorporates leadership as a core part of a professional's identity, and help students gain a deeper understanding of themselves and the teams, organizations and system they work within.

The hidden curriculum in near-peer learning: An exploratory qualitative study

BACKGROUND

Near-peer learning involving students from the same course, but at different levels, has gained prominence in health professional education over recent years. At the authors' university, nursing and paramedic students engage in near-peer learning in clinical skills laboratories where junior students learn specific skills from senior students. Our observations indicated that beyond the skills teaching, unintended learning occurred repeatedly.

OBJECTIVES

The aim of this study was to examine near-peer learner and teacher experiences of participating in near-peer learning and to explore students' engagement beyond the skill being learnt.

METHODS

Separate focus group interviews were conducted with groups of peer learners and peer teachers from nursing and paramedics following near-peer teaching and learning sessions. In total, 26 students participated in one of four audio-recorded focus groups.

RESULTS

Data were analysed thematically. A range of unintended learning experiences became evident, indicating the operation of hidden curriculum additional to that intended within the formal curriculum. Four main areas emerged and were focussed on junior students: identifying with their peers, the course and related expectations, clinical placements and managing difficult situations.

CONCLUSIONS

Near-peer learning and teaching has been reported as having a range of positive outcomes, particularly for those engaged in the teaching. However, this study has highlighted that can also provide a range of benefits unique to junior students. More research is warranted to further examine this phenomena and ways to harness and extend such learning opportunities, as well as the nature of social and cognitive congruence.

Life imitating art: depictions of the hidden curriculum in medical television programs

BACKGROUND

The hidden curriculum represents influences occurring within the culture of medicine that indirectly alter medical professionals' interactions, beliefs and clinical practices throughout their training. One approach to increase medical student awareness of the hidden curriculum is to provide them with readily available examples of how it is enacted in medicine; as such the purpose of this study was to examine depictions of the hidden curriculum in popular medical television programs.

METHODS

One full season of ER, Grey's Anatomy and Scrubs were selected for review. A summative content analysis was performed to ascertain the presence of depictions of the hidden curriculum, as well as to record the type, frequency and quality of examples. A second reviewer also viewed a random selection of episodes from each series to establish coding reliability.

RESULTS

The most prevalent themes across all television programs were: the hierarchical nature of medicine; challenges during transitional stages in medicine; the importance of role modeling; patient dehumanization; faking or overstating one's capabilities; unprofessionalism; the loss of idealism; and difficulties with work-life balance.

CONCLUSIONS

The hidden curriculum is frequently depicted in popular medical television shows. These examples of the hidden curriculum could serve as a valuable teaching resource in undergraduate medical programs.

The temporal decline of idealism in two cohorts of medical students at one institution

BACKGROUND

A number of studies have indicated that students lose idealistic motivations over the course of medical education, with some identifying the initiation of this decline as occurring as early as the second year of the traditional US curricula. This study builds on prior work testing the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school.

METHODS

The original study sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning and end of academic year 2010, on three proxies for idealism. The current study extends that work by administering the same survey items to the same student cohorts at the end of their third and fourth years (MS3 and MS4), respectively. Survey topics included questions on: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions. Linear regression was then used to test the effect of the six cohort/time-points on each composite variable, controlling for demographic characteristics.

RESULTS

Idealism in medicine decreased (β = -.113, p < .001) while emphasis on employment and job security increased (β = .146, p < .001) as motivators of pursuing a career in medicine at each medical school stage and time period. Students were more likely to be motivated by student debt over interest in content in specialty choice (β = .077, p = .004) across medical school stages. Negative attitudes towards primary care were most sensitive to MS group and time effects. Both negative/antagonistic views (β = .142, p < .001) and negative/sympathetic views (β = .091, p < .001) of primary care increased over each stage.

CONCLUSIONS

Our results provide further evidence that declines in medical student idealism may occur as early as the second year of medical education. Additionally, as students make choices in their medical careers, such as specialty choice or consideration of primary care, the influences of job security, student debt and social status increasingly outweigh idealistic motivations.

Survey of college climates at all 28 US colleges and schools of veterinary medicine: preliminary findings

In April 2011, a nationwide survey of all 28 US veterinary schools was conducted to determine the comfort level (college climate) of veterinary medical students with people from whom they are different. The original hypothesis was that some historically underrepresented students, especially those who may exhibit differences from the predominant race, ethnicity, religion, gender, or sexual orientation, experience a less welcoming college climate. Nearly half of all US students responded to the survey, allowing investigators to make conclusions from the resulting data at a 99% CI with an error rate of less than 2% using Fowler's sample-size formula. Valuable information was captured despite a few study limitations, such as occasional spurious data reporting and little ability to respond in an open-ended manner (most questions had a finite number of allowed responses). The data suggest that while overall the majority of the student population is comfortable in American colleges, some individuals who are underrepresented in veterinary medicine (URVM) may not feel the same level of acceptance or inclusivity on veterinary school campuses. Further examination of these data sets may explain some of the unacceptably lower retention rates of some of these URVM students on campuses.