ACP urges doctors to focus on ‘hidden curriculum’

Among other recommendations, faculty and senior clinicians should model empathy, encourage reflection and discussion of positive and negative behaviors in the training environment, and promote clinician wellness.


Ethics and professionalism are part of the “hidden curriculum” in medical school, and physicians must remember to model appropriate behavior for their students, a new position paper from ACP states.

The position paper was developed on behalf of the ACP Ethics, Professionalism and Human Rights Committee and proposes strategies to identify and address discrepancies between values and actions. The recommendations are as follows:

  1. 1. The hidden curriculum must become a positive curriculum that aligns with the formal curriculum. Faculty and senior clinicians should model empathy, encourage reflection and discussion of positive and negative behaviors in the training environment, and promote clinician wellness. What is taught in the classroom must be reinforced and enhanced by what is practiced at the bedside.
  2. 2. The learning environment should foster respect, inquiry, and honesty and empower every individual, including learners, to raise concerns about ethics, professionalism, and care delivery. Teamwork and respect for colleagues must be both taught and demonstrated.
  3. 3. Leaders should create and sustain a strong ethical culture by encouraging discussion of ethical concerns, making values in everyday decision making explicit, and embodying expectations of professionalism in which patient well-being is a core value.

“The educational and social milieu of medical learning environments is a complex system of influences. Role models across peer relationships and the hierarchy of medicine contribute to the formation of professional identity, behaviors, and attitudes of future physicians,” the authors wrote. “The best solutions to the influence of the hidden curriculum will uncover it, integrate its positive aspects into the formal curriculum, and lead to development of approaches to understand and mitigate its negative aspects by educators and practicing clinicians.”

The position paper was published by Annals of Internal Medicine on Feb. 27.