martedì, ottobre 19, 2004
:: The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching ::I read an interesting article on the BMJ and here's an extract of what some of the 36 students in the study said:
Personal encouragement:
Most of the role models mentioned were male doctors (27/46), who were seen particularly valued in relation to their knowledge, professional power, and authority. The female medical role models (19/46) were said to convey more "human" attributes: tolerance, integrity, respectfulness, and support towards students.
Haphazard teaching:
"I mean we've had so many days where we've had, sort of, five different sessions scheduled—and no one turns up! You just think, you know, why bother coming in? So that's irritating. It does happen a lot to everyone. I mean, obviously the people who are teaching have another job—it's not their only job to teach you—but it's when you turn up and they don't get somebody else to do it, or they don't even let you know that they haven't turned up. " --- Year 3 student
Importance of hierarchy:
"I've found my first rotation was very stressful, humiliating, I worked and read because of fear, because of being targeted—and that was just miserable... One time, the consultant came in when I was examining the patient—his registrar was there, his SHO was there and just started asking me questions... I just went blank and didn't know the answers to his questions—and then he got angrier... after things like that... you don't even have the confidence to take blood or anything. " --- Year 3 student
Getting ahead by being competitive:
Half of the students (18/36) reported that competition rather than cooperation is the defining characteristic of medicine...
"You notice that students during the clinical years try to stand out, stabbing each other. " --- Year 3 student
and something else, from one of those 'rapid responders'... which helped me understand what is the said 'hidden curriculum' - "the set of influences that function at the level of organisational structure and culture including, for example, implicit rules to survive the institution such as customs, rituals, and taken for granted aspects..." There are six learning processes of the hidden curriculum of medical education have been identified: loss of idealism, adoption of a "ritualised" professional identity, emotional neutralisation, change of ethical integrity, acceptance of hierarchy, and the learning of less formal aspects of "good doctoring." (as defined by Lempp, and Seale)
anyway, i thought this study was a bit weird... taking only the views of 36 students?!?! i thought the BMJ would receive studies of a better quality.
anyway... the hidden agenda sounds quite scary! loss of idealism? setting everything into a ritual? washing off our emotions? makes it sound like they are making us into robots... lol... and i suspect COFM is simply trying to make us into smiley robots... hmmm as for humiliation... in my short 4mths posting, i can already recount at least 10 such incidents... but 4 stand out most to me...
1. hs and i humiliated by poon, and even 'sent back to year one'! i shall forever ridicule him behind his back... until i'm more 'senior' then him Ha... then i'll do it to the face. muahaha...
2. hs humiliated by nambiar... ok that's one scary one! actually i think he might be trying to be mean to us just to make us have a stronger impression of his teachings... however, this is just creating yet another obstacle to our learning. if a student is so demoralised, he simply will not dare to utter another word in the future. how's learning going to take place like this?
3. the nurse with the russian-sounding name in ward 13 AH. dunno what has made her so bitter about medical students? she even bullies the HOs... wonder if she does it to the MOs as well? this hardly creates an encouraging atmosphere...
4. the weird nurse in SGH who stops medical students from going to the wards, claiming that her 'superior' said we werent' supposed to go to the wards? huh? and then claiming that there were exams when it wasn't even time for any end-of-postings test, any MBBS or any MRCP/MMed or watever... ha... subjecting us to cross-examination of this nature without a good reason, and worse, even having such ridiculous reasons?!?!
regarding competitivenes, i myself was guilty of this in year one. however, after some time i realised that there's really no use... i don't see why i need to get ahead of other people, i just see that what's most important is to do my best and challenge myself. competitiveness generates quite an ugly feeling within people. i know some people who are really competitive and they suck. big time. maybe someone can tell me why they like to be so competitive? and get ahead of others? think abt it... if u had backstabbed others in order to get to the top... you're not going to be staying there long enough to warm your seat cuz no one can lead without followers!
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francesca chiu
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