Monday, April 4, 2011

The Hidden Curriculum

When we speak of the curriculum in a health care setting such as chiropractic education, we typically mean this to refer to what is more properly called the formal curriculum. This is the actual course of study offered by a chiropractic college, including its planned content, teaching, evaluation methods, syllabi, exercises, textbooks and other teaching aids, as used in classroom, laboratory or clinical settings (1). We might also add here our formal policy statements, competencies and so on.

But educators also understand that there is an informal curriculum as well; this refers to the teaching opportunities that come up over the course of the day that are unplanned but involve instruction. This can occur in a clinical setting (perhaps from a chance encounter with an unusual patient), but may also occur in faculty offices or hallway interactions where a teacher has a chance to interact with a student. And again, this informal curriculum supports what teachers feel students should be learning through the formal program, as well as in terms of appropriate skills and values.

Finally, there is the hidden curriculum, which includes “the ideological and subliminal messages of both the formal and informal curricula. The hidden curriculum can be both human and structural; that is, it can be transmitted through human behaviors and through the structures and practices of institutions” (2). The hidden curriculum was first defined by Philip Jackson, who did an ethnographic study on classroom teaching in 1968 (3). We can look at this as a “vast network of unwritten social and cultural values, rules, assumptions, and expectations.” And many feel this is as important as the formal curriculum in the process of educating students.

I find this example of the power of the hidden curriculum telling. Anderson notes this story concerning a colleague, that when he went to kindergarten he learned a whole set of facts he had not known before. He learned that he was fat, which he had not known before. He learned he was slower than his friends at almost everything he did. And he learned he was poor. And this is what he remembered many years later about this time in kindergarten (4).

It is important to note that everyone in our institution participates in the hidden curriculum- we all influence our students in ways we cannot know or predict; for example, in how we respond to a challenging question in class, or how we interact with a student who visits us in our office, or how we comment on a new initiative that the college has just advanced. Students will learn by observing us; this is also a part of professionalizing them to life as a physician. Let me ask: what are the unspoken messages within each of our academic departments, between administration and faculty, between faculty and students, and between clinic and academic teachers? Are we seen as treating everyone with respect? Whose voices are heard more than others, and why? As Alexander notes, the hidden curriculum supersedes the lecture series, and it starts long before classes start while not ending when classes end.

What is important for all of us to realize is that the hidden curriculum should be harmonious with the formal curriculum; one way of looking at this is from the perspective of “walking the walk and talking the talk.” What does it say for one of us to ask that we treat people with courtesy in the classroom but then have no time or patience for a student who seeks us in the office? We all come into contact with people, and we need to think about how our behavior, our words and our actions influence those around us. This is more powerful than we might realize.

1. Pinar W. Understanding curriculum. New York, NY; Peter Lang 1995
2. Wear D, Skillicom J. Hidden in plain sight: the formal, informal, and hidden curriculum of a psychiatry clerkship. Acad Med 2009;84:451-457
3. Jackson P. Life in classrooms. New York, NY; Holt, Rinehart and Winston, 1974
4. Anderson DJ. The hidden curriculum. Am J Roentgenol 1992;159:21-22

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