Fighting bias against family medicine in the hidden curriculum
For some time now, those of us who work in medical education have been speaking about the “hidden curriculum.” The hidden curriculum refers to the many different things – ideas, behaviours, norms, values, and so on – that students learn informally while they are in medical school. These are the lessons that faculty members do not set out to explicitly teach students but that we pass on nonetheless.
Unfortunately, the hidden curriculum often weighs in with stereotypes of certain specialties. And I’m guessing that it is probably true that the hidden curriculum frequently portrays family medicine in a negative light more often than it does areas in specialty medicine.
Lately, we are seeing this bias having an especially strong impact on the decisions medical students are making as they enter the CaRMS process. This year, in the first iteration of the CaRMS match, there were 209 unfilled positions across Canada, and 138 of these positions were in family medicine. Also, notably, Queen’s medical school graduates choose family medicine as a career less frequently than graduates of other medical schools in Canada.
Many factors, of course, contribute to this problem. But I don’t think there is any denying that the hidden curriculum plays a part and that, inadvertently, medical education is steering students toward specialty medicine rather than family medicine.
I am writing this blog to say that I want to start taking action to correct this undesired effect of the hidden curriculum at Queen’s.
As a first step, Drs. Anthony Sanfilippo (Associate Dean, Undergraduate Medical Education), Ross Walker (Associate Dean, Postgraduate Medical Education) and Michael Green (Head, Department of Family Medicine) will be forming a working group to consider how best we can address this problem.
While this working group goes about its important undertaking, I would also like to ask all of you in the medical faculty to think about how you teach or mentor our undergraduate medical students. I think we all need to reflect on anything we do – or don’t do – that might indirectly make a student think less of family medicine. I know that none of our faculty who have backgrounds in specialty medicine would ever intentionally steer a student away from family medicine. However, we would all do well to keep a heightened awareness of the unintended consequences our words and actions can have.
It has never made sense that the hidden curriculum would be biased against a field as important as family medicine, but it makes even less sense now than ever. Currently, there are concerted efforts by the Ontario government to create “Ontario Health Teams” and there is no question that primary care will be a backbone to an integrated system of care. Now, then, is a moment in which we as medical educators need to make sure we’re finding ways to make our students passionate about family medicine, as it will only be growing in its centrality to the health system in the coming years.
If you have any thoughts about how we as a medical school can address this issue, please share them in the comments below. Or better yet, please stop by the Macklem House – my door is always open.