Monday, 27 April 2015

The hidden curriculum: a matter of clinical safety

Lown Institute, one of the organizations leading the movement "Right Care", is the author of this tweet that leads us to an article in the Health Affairs Journal, signed by Joshua M. Liao, a resident physician at Brigham and Boston Women's Hospital. Dr. Liao’s article speaks of the hidden curriculum concept described more than a decade ago by Frederic Hafferty, encompassing those masked values ​​conveyed through vocabulary, practices and habits, which end up having a powerful influence on the development of the trainees and, as such, even more than the diplomas contained in the formal curriculum.

The paper begins with an anecdote that Dr. Liao lived as a student. In a delivery room, a resident physician asked him to proceed to removing a placenta after a moderately complicated childbirth. In doing so, the student, being inexperienced, caused a laceration of the cord, resulting haemorrhage forced the attending physician in charge to intervene in the case. In the hectic climate, the resident was reproached, while the one causing the problem was invited to leave the room. The student carried on for a couple more weeks around Obstetrics, but never heard anyone talking about that incident.

Dr. Liao now reflects: "That day I felt the weight of the hierarchy for the first time and I saw that the lack of open communication between team members can cause, in itself, poor quality and proneness to commit even more errors". Clinical safety experts warn that it’s very difficult to improve performance without changing the hierarchical rigors into a true culture of teamwork, where a continuous improvement process is established by simply talking about the errors and analyzing its causes.

Medical schools and training programs, such as the MIR should move towards more attention to the students and young doctors’ hidden curriculum because that is where the secret of changing professional attitude and real progress in quality care lies.

Jordi Varela

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