Public Release: 

Tackling medical schools' informal curriculum

A unique change of culture underway

Indiana University

No one would dispute the importance of courses, laboratories, syllabi, and textbooks - the formal curriculum on the education of doctors. This month, medical educators report on their efforts to change the informal curriculum of a medical school--the affect that students' interactions with peers, faculty, and others in the academic medical center, has on their qualities as future physicians, their values, and how they interact with others. Their research findings appear in the May issue of the Journal of General Internal Medicine.

The Indiana University School of Medicine has been a national leader in the refinement of the formal curriculum. Over the past four years, the School has designed and implemented a competency-based curriculum assuring that each graduating student has a sound foundation of knowledge and skills for their future careers in practice. Now the school's faculty is tackling the more difficult challenge - improving the informal curriculum, the 'lessons' they teach by their actions daily. In doing this work, the school's goal is to use the social environment of the academic medical center to improve the practice of medicine, to enhance the expression of professionalism, and to teach by example. They are learning to pay closer attention to the interactions between physicians and students, physicians and patients, and students and patients.

"Competence is the buzz word in medical education today, but few medical schools actually do anything to teach or assess it in the full sense. At our school we are hoping to make our competency-based curriculum (the formal curriculum) such an integral part of our culture that it will mirror the hidden curriculum. We need to make them indistinguishable," says Stephen Leapman, M.D., the IU School of Medicine executive associate dean for educational affairs.

"The IU School of Medicine is an ideal laboratory for this process because it has an outstanding formal curriculum that teaches students how best to care for their patients," says Anthony Suchman, M.D., an internist and consultant from Rochester, New York, who is the first author of the Journal of General Internal Medicine paper. What's most significant about the project, according to Dr. Suchman, is that this is the first time any medical school has tried to transform its entire culture in the service of improving medical education.

"The organizational culture behind the scenes [in the classroom and on the wards] has to mirror what's happening between the patient and the doctor in the office or at the bedside," says Dr. Suchman. "Medical schools have been working for decades to teach technical skills to medical students and residents, but unlike most Fortune 500 companies, they haven't spent time training students about the 'customer's experience' of care - the organizational and social context of their actions."

Traditional approaches to medical education taught physicians in training to focus on the liver, blood chemistries or X-rays, which are objective, rather impersonal things. The competency-based curriculum at the IU School of Medicine strives to teach students the science while also paying attention to the social context and the quality of relationships. But it's not enough to do that in the formal curriculum alone, according to Dr. Suchman. The whole culture of the medical school - the way people treat the students and treat each other - has to consistently demonstrate collaborative, respectful relationships. To have a whole school attempting to make this culture change is truly unique, he says.


This study was funded by The Fetzer Institute of Kalamazoo, Michigan.

The IU School of Medicine is the nation's second largest medical school with approximately 280 physicians graduating annually and nearly 1000 residents and fellows.

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