The hidden curriculum of medical education

On the surface, medical education appears to be a fairly simple venture: with deductive reasoning, apply a heap of basic/clinical science in the venture of diagnosing and treating disease. Sounds easy enough once you have 6 years of post-secondary education under your belt, and have been selected from the heap of bright people throwing their applications at American medical schools, right???

Like so many things in life, numerous other things get in the way of that plan. Like chief residents who are too busy to acknowledge your existence because they are busy holding the hospital together. Like interns who disappear half way through the day because they're post call and have to attend to the human weakness of sleep. Like clerkship coordinators who are too disorganized to schedule a doctor to run a mandatory lecture and leave you sitting around for 45 minutes while they "work on it". Like having to break scrub in the middle of closing a patient for a BS preceptor meeting that you skipped the day before and having the resident you were assisting give you crap because of it for the second day in a row. Like having to make 3 different people aware of the intimate comings and goings of your every second of every day with the reprisal of a dirty look and sarcastic comment during a 10 minute lunch break before having to wait for the mandatory conference.

There is a hidden curriculum within third year medical education, where you are the lowest
person on the totem pole. Where you are wrong, almost no matter what you do. Where happenings that are beyond your control are assumed to be your fault. Where you must ask to ask a question, and then ask your question. Where you have no true goals defined for you, no defined schedule, no defined role, but have a series of unwritten expectations that are being continuously evaluated silently by your superiors...to be placed in your record and follow you around for the remainder of your life.

If you couldn't guess from my sunny disposition, I had a rough day where I stood around for too long, probably made some bad impressions with my actions and have fucked my evals up. Nothing bad happened, no one said anything to me, but I just feel like I'm making an ass out of myself while I stand around in the hospital and do nothing for hours on end. But when I'm busy and have a required activity, I get crap for having to go to it. Firmly planting my foot into my mouth at least twice this week with one of the chief residents didn't help...so when he informs everyone in the program that I'm an ass, that's probably not going to be good for my grades either. Working around miserable, tired people without a lick of positive feedback has sapped my energy and made me more critical of myself...but guess who gets to spend another 13 hours in the hospital again tomorrow with a smile on his face and a positive attitude? Yours truely.

Board scores came out today...I was at the national average, which is what I expected. It would be nice to make myself stand out this year, but it's probably not going to happen.

PM&R in Alabama is looking like a true possibility... here I come!


Dragonfly said...

Hope tomorrow goes better.

Resident Anesthesiologist Guy (RAG) said...

I'm sure your doing better than you think. Just like the new interns, July is well known for incoming 3rd years who get a dose of what it's like outside classes. Residents should understand that you have educational goals that are beyond getting scut done or retracting, but as often residents and surgeons are wont to do - they think only of the then and now.

Focus on understanding what is being asked of the students, do what you can, get to your preceptor and class meetings, and understand that you're not a surgery resident. They are. You're there to learn more than anything else.

Albinoblackbear said...

Hey thanks for your condolences...I responded on my post rather than leave long rambling non-sequitur comment here. Oops. Too late.

M said...

Hope surgery hasn't been treating you too badly. Heads up! This, too, will pass.