Beyond curriculum reform

TLDR

Efforts to reform medical curricula over the past century have largely failed to produce fundamental changes in student training. The author argues that reform should target the medical school as a learning environment, focusing on what students actually learn rather than what is formally taught, and emphasizes the need to explore the hidden curriculum. To uncover hidden curricula, he recommends examining institutional policies, evaluation activities, resource‑allocation decisions, and institutional slang, and suggests reforms to accreditation standards and processes. He ends with three recommendations for reconstructing the learning environment, including guidance on advancing the AAMC‑sponsored Medical School Objectives Project.

Abstract

Throughout this century there have been many efforts to reform the medical curriculum. These efforts have largely been unsuccessful in producing fundamental changes in the training of medical students. The author challenges the traditional notion that changes to medical education are most appropriately made at the level of the curriculum, or the formal educational programs and instruction provided to students. Instead, he proposes that the medical school is best thought of as a "learning environment" and that reform initiatives must be undertaken with an eye to what students learn instead of what they are taught. This alternative framework distinguishes among three interrelated components of medical training: the formal curriculum, the informal curriculum, and the hidden curriculum. The author gives basic definitions of these concepts, and proposes that the hidden curriculum needs particular exploration. To uncover their institution's hidden curricula, he suggests that educators and administrators examine four areas: institutional policies, evaluation activities, resource-allocation decisions, and institutional "slang." He also describes how accreditation standards and processes might be reformed. He concludes with three recommendations for moving beyond curriculum reform to reconstruct the overall learning environment of medical education, including how best to move forward with the Medical School Objectives Project sponsored by the AAMC.