During the school’s annual “Power Day” medical students “define and analyze power dynamics within the medical hierarchy and hidden curriculum, using literature, guest speakers, and small groups.” As a result, some units at select hospitals hold weekly meetings, called “Power Hours,” in which staff and students discussed power within their departments. Instead of simply talking to students about power, the physicians (those in the position of power) were frequently reminded of their power in the hierarchical structure of medical practice—and of the consequences of their day-to-day actions. It's unclear whether these sessions have led to structural change so far, but the aim is to positively reshape the hidden curriculum for future healthcare professionals.
Appropriate disobedience
In order to support the development of physicians who value altruism, integrity, and accountability above the hierarchy of authority, we must stop regarding conformity as professional behavior.
Medical history should be incorporated into all medical schools’ curricula, with special attention to mechanisms that lead physicians to become subservient and numb to ethical responsibility. The values of critical pedagogy, which aim to awaken a critical consciousness, would be a welcome addition to the curriculum.
Furthermore, students should be encouraged to be critical of institutions and to think regularly about their ethical responsibilities. When students are disobedient in order to remain true to their moral standards, they should be applauded, not punished.
Recent articles have urged physicians to speak out against social injustice and unethical policies. But how will students ever become physicians who meet these demands when they’re taught to be obedient, compromise their values, and quietly do what is expected of them? A critical examination and an open discussion of the power structures embedded in the hidden curriculum is urgent and essential to make future physicians morally conscious, courageous and—when necessary—
disobedient.
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Sarah van der Lely was a 2019 FASPE Medical Fellow. She is currently a pediatric resident at Amsterdam University Medical Center.
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