HIDDEN CURRICULUM

Most nurses will have encountered a sense of bewilderment when they arrive on a ward that they have not worked on before.

Each new ward has different ways of doing things.

Welcome to “Hidden Curriculum”.

Because the new ward does things differently does not mean that the new ward’s approach is wrong.

It is just different.

How does the nurse know what are the unwritten and unspoken and unofficial norms and values that guide this new work environment?

The Atlantic has published an article about our medical colleagues and their hidden curriculum using the comics drawn by medical students.

You will find it resonates with the behaviours that nurses encounter in their working life.

The writers identified five common lessons that are never really taught. 

But that medical students are expected to know.

They are

  1. Medicine has a strict hierarchy and students are constantly reminded that they are at the bottom of it.
  2. Medical students are not individuals, but rather interchangeable generic units.
  3. Surviving medical school requires reading the mind of the attending physician.
  4. To get ahead, students should sacrifice their well-being.
  5. Medicine is supposed to be patient-centered. In practice, it isn’t.

Sounds kinda familiar, doesn’t it?

The article writers are spot on with this observation.

A core message of contemporary medical education, perhaps especially in medical-humanities courses, is that each patient should be treated with respect regardless of disease process, socioeconomic status, or belief system. Students find this message easy to understand, and most are able to practice it remarkably well, even with the most challenging patients. What often comes as a surprise, however, is the way they find themselves treated by members of their own profession.

And this observation.

Another paradox students face is that while they’re told medicine is supposed to be about putting patients’ needs above everything else, in practice other considerations can get in the way. The comics reveal that students find themselves disappointed and frustrated with a system that makes it difficult for them to practice the lessons they’ve been taught. Even for the most compassionate students and doctors, the lack of time, piles of paperwork, and emphasis on rapid hospital discharge conspire against them. The students lament becoming participants and contributors to this process, yearning to maintain their ideals as they struggle with medicine’s realities.

An article about supernumerary students on a ward identifies a similar range of norms and values that the student nurse must navigate. 

Students are expected to be competent to work while they learn.

And when registered, they expect and are expected to be competent to work immediately as registered nurses.

It reflects a large gap and contradictions that are around education and practice.

The writers wrote that

Sadly, it seemed as if students learned despite the structures rather than because of them.

As we all know, the “hidden curriculum” is everywhere.

To learn more about hidden curriculum:

The Comics Revealing Medical School’s Hidden Flaws and Hard Lessons

https://www.theatlantic.com/health/archive/2017/03/medical-humanities/520623/

Experiences of supernumerary status and the hidden curriculum in nursing a new twist in the theory-practice gap? http://epubs.surrey.ac.uk/7327/6/GNCnegotiationpaperfinal.pdf