The “Hidden Curriculum” Strikes Again

Hidden Curriculum: Authors of this small but concerning qualitative study interviewed 15 surgical residents at one program in Canada regarding “impression management” – how individuals strive to actively manage their external image.  These trainees “described being immersed in an environment where they felt pressures to perform a set a strongly normative – but tacit – expectations to be ‘all-knowing’, ‘quick’, ‘decisive’, and ‘confident’.”  They described trying to give “an impression of competence to improve evaluations and afford learning opportunities” as well as to avoid getting a potentially irreversible negative reputation in their program.  There were some positive benefits of impression management such as “building confidence in oneself and building patients’ trust,” but there were many reported negative consequences.  These included:  inaccurate reporting (e.g. that a lab was normal when it was not checked); avoiding asking questions when uncertain; avoiding asking for help; worsened  psychological strain on the resident; and a focus on image or shame as opposed to learning.  Several reported vignettes included behaviors that could impair patient safety and/or resident learning.  The authors urge the creation of “a culture that truly encourages residents to admit knowledge gaps and ask for help when needed.” — Laura Willett, MD

Link To Article

Patel P, Martimianakis MA, Zilbert NR, Mui C, Mobilio MH, Kitto S, Moulton CA., Fake It ‘Til You Make It: Pressures to Measure Up in Surgical Training. Acad Med. 2017 Dec.