Education, Formation, and Malformation: On the Hidden Curriculum

This presentation thinks critically about the interpersonal relations and institutional contexts that contribute to the education, formation, and malformation of medical trainees. Consider the official ways in which trainees are educated and formed. On one understanding, academic medical centers exist to produce and disseminate knowledge: to do research, teach and treat patients. Whether in the clinic, conference, or lab, medical trainees are educated and formed in intellectual virtue.

But education and formation do not only happen officially; nor do they only promote virtue. Education and formation also happen unofficially, specifically through the so-called hidden curriculum. These unofficial behaviors, norms, and practices normalize values that either alienate existing and prospective trainees or forces them to participate in (and later perpetuate) practices that trade on these values. The hidden curriculum malforms trainees, leading them away from virtue and toward vice.

In response, some clinicians argue that the academic medical center itself and the university more generally exist to shape trainees ethically and spiritually, for example, through prayer, liturgy, and service. But such formation in ethical-spiritual virtue isn’t immune to malformation itself, which is increasingly problematic in our present context of increasing diversity and growing inequalities.

The aim of this presentation is primarily diagnostic: what are the practices that characterize the hidden curriculum, clinically and ethically? How does formation that attempts to address the hidden curriculum present its own problems? And how does the hidden curriculum undermine the intellectual and ethical-spiritual goals of medicine?