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Hidden Curriculum

Curbside with Dr. D: The Hidden Curriculum

The Hidden Curriculum

by Neel Desai, M.D.

I have the pleasure of teaching 1st and 2nd-year medical students and their introduction to clinical medicine in primary care. One of my students, let’s call him Kayden, asked me an interesting question yesterday, and it led to an enlightening conversation for both of us, and tied into what we are doing with The Happy Doc. Kayden asked me,

“Dr. Desai, what do you think of medical education today?”

It got me thinking about how outdated it is in a rapidly evolving healthcare landscape. We are living in a Super Information Age, with information at our fingertips. Yet, paradoxically, so many medical students, interns, residents, fellows, and physicians are uninformed on basic medical economic issues like how they get paid. What’s up with that?!
Obviously, our first years of medical school are essential for building up a database of scientific knowledge, body systems, normal physiology, and how to treat disease when those systems go awry. But modern day training does not give students, interns, residents, fellows, and newer docs tools on how to succeed in the 21st Century. Why is that? It’s because while they may master the technical skills of medicine, it does not teach the business skills to have a successful practice and the humanistic elements of the art of medicine (as one of our podcast guests and Medical Influencers Dr. Pamela Wible talks about often). Dr. Gus W. Krucke, another recent podcast guest and Medical Influencer also echoed these sentiments.  Let’s tease that apart.
Kayden told me they don’t teach anything in medical school about the business of medicine, understanding how physicians get compensated in different practice models/specialties, billing, coding, and consequently, throws them out into the real world pool without a lifejacket and susceptible to many sharks to eat them alive. (Don’t you just love my colorful metaphors? I’m full of them. Although my wife would tell you I’m full of something else. Whatever. Hater. But I digress…).
The other thing is the humanistic elements of medicine that has been lost over the last 40+ years. Medicine has lost its’ roots of focusing on the human connection: the human connection between patients and physicians, the human connection between physician mentors and student mentees, and the human connection between physicians of all specialties. Medicine has always been an apprenticeship. We learn by watching our mentors and how they model interacting with patients, staff, colleagues, friends, and their family. We are seeing more and more disillusioned students and docs who have had their joy and passion for learning and teaching medicine beaten out of them. They end up taking out their frustrations on staff, patients, colleagues, residents, students, families, and unfortunately, even themselves. Something has got to give.
Back to Kayden. Kayden’s eyes widened when I told him about something we had during my training, Radiology rounds, and how interns and residents would gather with films of their patients in the radiologist’s office.  Each intern/resident would present their patients with a brief relevant clinical history to the attending radiologist and team, learn to read films, come up with a differential diagnosis and an appropriate treatment plan. It was a collaborative effort to understand the context of a patient’s narrative and how best to individualize that patient’s treatment plan (This reminded me of one of our podcast episodes this past summer and the 10 C’s of Medicine). He told me with EHRs now, they don’t do that anymore and as a result, medical training is diluted (This was something one of our Medical Influencers, Dr. Robert Wachter, wrote about with the history of EHR)
To me, this was just one example of the lost hidden curriculum of medicine. What do I mean by that? By the hidden curriculum, I am referring to those moments in medicine when you are alone with a mentor and you talk about your deepest thoughts, insights, fears, triumphs, experiences, and wisdom. Most of us in medicine have at least one great mentor who took us under their wing and inspired us, because they believed in us. And this comes at every level, whether it was a student, intern, resident, fellow, or attending physician with 40 years of experience ahead of us. It comes in those moments while on call, in between patients and hanging outside the hospital by the rails. It comes in those moments when grabbing a cup of coffee with a colleague to discuss challenging cases for some direction. It comes in those moments when you are asking your seniors for advice on boards, medical school interviews, residency interviews, job interviews and your personal relationships. It comes in those moments when fellow residents share some humor in the irony of certain circumstances and just blowing off some steam by being goofy. Those priceless moments are what truly make us who we are as healers. Our hidden curriculum.
So how do we find that lost hidden curriculum that is so lacking today? This is where The Happy Doc comes in. We at The Happy Doc have found a way to bring the hidden curriculum back using 21st-century communication and connection platforms. If the problem is a disconnection, our purpose is to connect. If there is a lack of fulfilled mentors, our job is to find fulfilled mentors, and share their secrets with younger docs and students who are motivated to learn (check out our YouTube Hidden Curriculum Playlist). If there is a problem with a lack of practical skills for how to learn and practice medicine successfully in the 21st Century, our job is to educate students, interns, residents, fellows, and attending docs by bringing those successful physician entrepreneurs, to everyone in a modern way, and on modern day communication platforms.
And it starts from the bottom up. From that high school student who is interested in becoming a doctor (plans are underway to develop a Happy Doc Jr. for this very purpose), to the attending physician who has been in practice for over 30+ years. We do this by forming connection networks of mentors and mentees. Having groups for different levels of training, specialty, and region. Connecting motivated mentors and mentees in one to one situations, small groups, or whatever feels right for a mentor and mentee, as it can be personalized. A virtual “apprenticeship”, if you will, but one that can also blossom into one on one sessions, or local groups in real life. Think of it as a Big Brother/Big Sister for medicine. And the best part? No third party interference. A service for the medical community, by the medical community, to give our medical community the autonomy it deserves, lift up fellow students, interns, residents, fellows, attending physicians, and bring back the joy and fulfillment of being a healer.
We have already had some pilot groups, and the response has been overwhelmingly positive. I mentioned this to Kayden, and you could just see the light go on. It made me think, with all these docs getting their lights dimmed or put out permanently, what if we had something to shine everyone’s light brighter? It is our hope that we at The Happy Doc can be that recharger to collect those lights and make them shine brighter for a new path and a new day in medicine. There he goes again with the metaphors, sheesh. Wrap it up Desai!
So what’s the takeaway and call to action here? The takeaway and call to action is to connect with us on social media, listen to a podcast, check out our Hidden Curriculum YouTube playlist, our Medical Influencer page, and join a group as a mentor, mentee, or both for whatever floats your boat.
If we could have more conversations like the one I had with Kayden yesterday, we could create a new generation of physicians, fellows, residents, interns, and students who refuse to accept the status quo and will truly change the dysfunctional healthcare system culture from the bottom up to work better for us all (and before they get “burned out”). No more feeling they are victims of systemic abuse. No more loss of autonomy. No more being unappreciated. No more feeling unprepared to practice successful medicine in the modern day landscape. No more having the creativity and humanity beaten out of us.
This is our time. Right now. Join us. Take that first step. Let’s grab a new future, together!
Dr. Desai is a family physician, active staff contributor, and medical talent agent for The Happy Doc. He thinks he is funnier than he really he is, and can be followed on Twitter at @drneel1973. To learn more about our groups e-mail, tweet Neel, or comment below. 

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