Lisa Soleymani Lehmann, MD, PhD; Lois Snyder Sulmasy, JD; Sanjay Desai, MD; for the ACP Ethics, Professionalism and Human Rights Committee
Acknowledgment: The authors and the ACP Ethics, Professionalism and Human Rights Committee thank peer reviewers Mark A. Levine, MD; John M. Spandorfer, MD; and Colin P. West, MD, PhD, and the many leadership and journal reviewers of the paper for helpful comments on drafts, along with Daniel Kim for research assistance and Kathy Wynkoop for editorial assistance.
Financial Support: Financial support for the development of this paper comes exclusively from the ACP operating budget.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2058.
Requests for Single Reprints: Lois Snyder Sulmasy, JD, Director, ACP Center for Ethics and Professionalism, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, email@example.com.
Current Author Addresses: Dr. Lehmann: 27 Trinity Terrace, Newton, MA 02459.
Ms. Snyder Sulmasy: Director, ACP Center for Ethics and Professionalism, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Desai: Johns Hopkins University, 1830 East Monument Street, Room 9029, Baltimore, MD 21287.
Author Contributions: Conception and design: L.S. Lehmann, S. Desai.
Analysis and interpretation of the data: L.S. Lehmann, L. Snyder Sulmasy.
Drafting of the article: L.S. Lehmann, L. Snyder Sulmasy, S. Desai.
Critical revision of the article for important intellectual content: L.S. Lehmann, L. Snyder Sulmasy, S. Desai.
Final approval of the article: L.S. Lehmann, L. Snyder Sulmasy, S. Desai.
Administrative, technical, or logistic support: L. Snyder Sulmasy.
Collection and assembly of data: L.S. Lehmann, L. Snyder Sulmasy.
Much of what is formally taught in medicine is about the knowledge, skills, and behaviors required of a physician, including how to express compassion and respect for patients at the bedside. What is learned, however, includes not only admirable qualities but also behaviors and qualities that are inconsistent with ethics and professionalism. Positive role models may reinforce the character and values the profession seeks to cultivate; negative ones directly contradict classroom lessons and expectations of patients, society, and medical educators. These positive and negative lessons, which are embedded in organizational structure and culture, are the hidden curricula conveyed in medical schools, residency programs, hospitals, and clinics. This position paper from the American College of Physicians focuses on ethics, professionalism, and the hidden curriculum. It provides strategies for revealing what is hidden to foster the development of reflective and resilient lifelong learners who embody professionalism and clinicians who are, and are perceived as, positive role models. Making the hidden visible and the implicit explicit helps to create a culture reflecting medicine's core values.
Table. Types of Curricula*
Appendix Table 1. Vignettes
Appendix Table 2. Strategies for Revealing the Hidden Curriculum
Appendix Table 3. Strategies for Mitigating the Risks of the Hidden Curriculum
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Lehmann LS, Sulmasy LS, Desai S, . Hidden Curricula, Ethics, and Professionalism: Optimizing Clinical Learning Environments in Becoming and Being a Physician: A Position Paper of the American College of Physicians. Ann Intern Med. [Epub ahead of print 27 February 2018]:. doi: 10.7326/M17-2058
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Published: Ann Intern Med. 2018.
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