Downloaded from www.ajronline.org by 178.77.146.177 on 11/16/15 from IP address 178.77.146.177. Copyright ARRS. For personal use only; all rights reserved
21
The Hidden Dixie
Curriculum
J. Anderson1
I
.
Continuing the theater analogy, this second component would be the script, the play itself. The curriculum, especially in a dynamic field like radiology, requires an ever-changing knowledge base. As new information, new technologies, and new procedures develop, we must make all of that easily accessible to learners. Fundamental knowledge is transferred in many ways, often dictated by the physical structure and, in the case of the diagnostic radiology residency, through a balanced mix of didactics, case discussion conferences, hands-on experience, and the stacks and stacks of studies interpreted over the 4 years of the residency. The third facet, probably the most important of the three, is what I have chosen to call the hidden curriculum, and it is this component that I wish to emphasize, for it is the part of education that every member of an academic department will participate in and contribute to. The hidden curriculum can be defined as the indelible message, often nonverbal, that a person takes from an event or an experience. It is the essence, the soul, that which is remembered after the source is forgotten. In the theater, this component would be the production, the acting, how the lines are delivered, humorously or seriously, and the costumes. I first started thinking about the power of the hidden curriculum when a friend related a story about her college professor. The professor said that when he went to kindergarten he learned a whole set of facts he had not known before, but these revelations were not part of the intended kindergarten curriculum. He learned that he was fat. He had not known that before. He learned that he was slower than his peers at almost everything they did. He also learned that he was poor. These ideas became more deeply ingrained than any other thing he learned that year. In fact, it took him many years to deal with those cumbersome, limiting messages, though he finally did and became a very effective, productive adult. Well, you say to yourself, we don’t deliver such self-defeating messages. But the idea that we may teach things that we do not necessarily intend to teach, just by the way things are done, by the issues we avoid confronting, by the way we cover certain topics, and by the priorities we give certain aspects of our operation, deserves broader recognition and discussion.
Education, t strengths one of the of anmost ac-
mic radiology department, tends to be taken for ranted. The newest hightechnology equipment and he basic and clinical renot our educational command our atI tention and seem to define -I academics. In addition to taking education for granted, we assume that our educational programs will always be there and will be even better than when we were the students. While it seems intuitive that effective transfer of knowledge requires constant attention to maintain quality and examination to define the most important specific methods, the science of education is often considered to be secondary to other types of research and the provision of clinical service. How does it happen that with a minimum of focused attention .
.
.:
we continue
..
search,
I programs,
to find quality educational
programs
in our aca-
demic centers? I believe it is because of our “hidden cumculum.” The educational experience may be divided into three facets: the physical structure, the fundamental knowledge, and the hidden curriculum. Successful education results from the seemingly effortless integration of these three components into the daily conduct of a radiology department. Physical structure includes not just the facility and its equipment, but the schedule, the logistics, the structure of the day, and the frequency and number of conferences. This physical structure is the time, space, and resources that allow for a variety of learning opportunities. It is the scaffolding that supports protected time for asking questions and finding answers; time for education to occur. If we were discussing theater, the physical structure would be the set, the setting, and other elements like the length and form of the play. Fundamental knowledge, the traditional curriculum, is the second facet. This is the part of education on which we all tend to focus, taking the first component, the physical structure, for granted and ignoring the third, the hidden curriculum.
Mallinckrodt
Institute
of Radiology,
Washington
University
School
of Medicine,
510S.
to D. J. Anderson. AJR 159:21-22,
July 1992
0361-803X/92/1591-0021
© American
Roentgen
Ray Society
Kingshighway
Blvd.,
St. Louis,
MO 63110-1076.
Address
reprint
requests
22
ANDERSON
Radiology is one of the most favored specialties today, and part of the reason for its positive profile is the mostly unstated message
that medical
students
learn from clinical faculty-a
Downloaded from www.ajronline.org by 178.77.146.177 on 11/16/15 from IP address 178.77.146.177. Copyright ARRS. For personal use only; all rights reserved
message of respect for the radiologist, a message that there remains a great deal of satisfaction to be had in radiology at a time when
satisfaction
within
other
medical
specialties
is
diminishing. Though unspoken, the reviews concerning our specialty are very powerful. What are the unstated messages within our academic radiology departments, what do they say about education, and, more importantly, to what extent do each of us have some control over them? Think back to your first impression of your institution. Recall that feeling you had as you were introduced, your impression of the size of the place, the people who greeted you, the security, the way the place was dressed. And what were the first words you heard? Were they about money? Or did they convey a concern for patient care? Did they show disdain or respect
for colleagues
in other
specialties? Was there an excitement concerning the experience? One of my most memorable and formative early experiences was working with and being taught by two superb technologists who were not afraid to challenge the system when it was in the best interest of the patient. And when they had a question about the practical need for doing a particularly long or arduous procedure, I was impressed with how often their opinions were heard and were influential. That was an unintentional message: all members of the team are important and are treated
with respect.
The hidden curriculum supercedes the lecture series. In fact, it begins long before the lecture starts and does not stop when the lights come on and the slides flick off. We are each
a part of an educational change
information
with
process each
all the time. How we exother
and
our
clinical
col-
leagues, the language we use, our intellectual honesty, and the respect we have for one another are important. Each of these things influences our teaching, our learning, and our effectiveness. When the chief of the department makes teaching medical students a high priority or takes the time to sit with residents to discuss their concerns, it is a message of caring. When the person in charge of medical student education insists that we include students in our daily conferences, we have sent a strong signal of respect for our own beginnings and our own teachers. When one of my colleagues volunteers to help get the work done so that we all may attend a conference, that is a hidden curriculum-a message of support for education. How we deal with uncertainty and with our mistakes is also very important. When we verbalize our uncertainties and
AJR:159,
July 1992
when we search for and learn from our errors we announce our conscientious participation in patient care. To be most effective, the hidden curriculum and the conventional curriculum should be concordant. Certainly the hidden curriculum can overpower the intended curriculum. For example, when your family physician claims to be concerned about your health and well-being, but does not take the time to listen to your story, the message is at odds with the words, belying a lack of real concern, although unintended. What is the basis for success in education, particularly in promoting a strong, supportive hidden curriculum? Our success is based on individuals, role models who contribute to one or more of the three components of the educational process. These people are exemplified by chairpersons who make sure the physical structure is in place: state-of-the-art equipment, faculty, support staff, as well as time set aside for learning; and by many radiology faculty who embody fundamental knowledge, people who have dedicated themselves to becoming “walking textbooks of radiologic acumen”; and by those who contribute daily to the hidden curriculum. In my personal experience, the latter are perhaps best exemplified by two radiologists and teachers who are no longer with us. One was the late Hy Senturia, whom I knew as the chief of radiology at Jewish Hospital in St. Louis and who had an unparalleled work ethic, the highest standards, and a strong sense of what it meant to be a whole person as well as a competent, caring radiologist. The other was Dan Biello, first a resident at the Mallinckrodt Institute and then a member of the Mallinckrodt nuclear medicine staff. Dan was an absolutely exemplary role model who taught us, even while he was dying of Hodgkin’s disease, how to live. He was dedicated to the service of caring for patients, but at the same time he was able to take care of himself and give support to colleagues, friends, and family gathered around him. The dignity and integrity he portrayed will always be with me. The apprenticeship format of our teaching programs allows a powerful personal statement illustrating the integration of a demanding career within a fulfilling life. People are the strength of our hidden curriculum, the main source of the hidden messages. Life is a contact sport. Each of us is constantly coming into contact with people, constantly having opportunities to make a difference in the lives of others. What we teach is not limited to what we say, but includes how we say it. Our teachings reflect our attitudes, prejudices, honesty, and humility. It is our example that will be remembered long after the differential diagnoses are forgotten. Our example, our hidden curriculum, must be considered, guarded, and used wisely.
21
The Hidden Dixie
Curriculum
J. Anderson1
I
.
Continuing the theater analogy, this second component would be the script, the play itself. The curriculum, especially in a dynamic field like radiology, requires an ever-changing knowledge base. As new information, new technologies, and new procedures develop, we must make all of that easily accessible to learners. Fundamental knowledge is transferred in many ways, often dictated by the physical structure and, in the case of the diagnostic radiology residency, through a balanced mix of didactics, case discussion conferences, hands-on experience, and the stacks and stacks of studies interpreted over the 4 years of the residency. The third facet, probably the most important of the three, is what I have chosen to call the hidden curriculum, and it is this component that I wish to emphasize, for it is the part of education that every member of an academic department will participate in and contribute to. The hidden curriculum can be defined as the indelible message, often nonverbal, that a person takes from an event or an experience. It is the essence, the soul, that which is remembered after the source is forgotten. In the theater, this component would be the production, the acting, how the lines are delivered, humorously or seriously, and the costumes. I first started thinking about the power of the hidden curriculum when a friend related a story about her college professor. The professor said that when he went to kindergarten he learned a whole set of facts he had not known before, but these revelations were not part of the intended kindergarten curriculum. He learned that he was fat. He had not known that before. He learned that he was slower than his peers at almost everything they did. He also learned that he was poor. These ideas became more deeply ingrained than any other thing he learned that year. In fact, it took him many years to deal with those cumbersome, limiting messages, though he finally did and became a very effective, productive adult. Well, you say to yourself, we don’t deliver such self-defeating messages. But the idea that we may teach things that we do not necessarily intend to teach, just by the way things are done, by the issues we avoid confronting, by the way we cover certain topics, and by the priorities we give certain aspects of our operation, deserves broader recognition and discussion.
Education, t strengths one of the of anmost ac-
mic radiology department, tends to be taken for ranted. The newest hightechnology equipment and he basic and clinical renot our educational command our atI tention and seem to define -I academics. In addition to taking education for granted, we assume that our educational programs will always be there and will be even better than when we were the students. While it seems intuitive that effective transfer of knowledge requires constant attention to maintain quality and examination to define the most important specific methods, the science of education is often considered to be secondary to other types of research and the provision of clinical service. How does it happen that with a minimum of focused attention .
.
.:
we continue
..
search,
I programs,
to find quality educational
programs
in our aca-
demic centers? I believe it is because of our “hidden cumculum.” The educational experience may be divided into three facets: the physical structure, the fundamental knowledge, and the hidden curriculum. Successful education results from the seemingly effortless integration of these three components into the daily conduct of a radiology department. Physical structure includes not just the facility and its equipment, but the schedule, the logistics, the structure of the day, and the frequency and number of conferences. This physical structure is the time, space, and resources that allow for a variety of learning opportunities. It is the scaffolding that supports protected time for asking questions and finding answers; time for education to occur. If we were discussing theater, the physical structure would be the set, the setting, and other elements like the length and form of the play. Fundamental knowledge, the traditional curriculum, is the second facet. This is the part of education on which we all tend to focus, taking the first component, the physical structure, for granted and ignoring the third, the hidden curriculum.
Mallinckrodt
Institute
of Radiology,
Washington
University
School
of Medicine,
510S.
to D. J. Anderson. AJR 159:21-22,
July 1992
0361-803X/92/1591-0021
© American
Roentgen
Ray Society
Kingshighway
Blvd.,
St. Louis,
MO 63110-1076.
Address
reprint
requests
22
ANDERSON
Radiology is one of the most favored specialties today, and part of the reason for its positive profile is the mostly unstated message
that medical
students
learn from clinical faculty-a
Downloaded from www.ajronline.org by 178.77.146.177 on 11/16/15 from IP address 178.77.146.177. Copyright ARRS. For personal use only; all rights reserved
message of respect for the radiologist, a message that there remains a great deal of satisfaction to be had in radiology at a time when
satisfaction
within
other
medical
specialties
is
diminishing. Though unspoken, the reviews concerning our specialty are very powerful. What are the unstated messages within our academic radiology departments, what do they say about education, and, more importantly, to what extent do each of us have some control over them? Think back to your first impression of your institution. Recall that feeling you had as you were introduced, your impression of the size of the place, the people who greeted you, the security, the way the place was dressed. And what were the first words you heard? Were they about money? Or did they convey a concern for patient care? Did they show disdain or respect
for colleagues
in other
specialties? Was there an excitement concerning the experience? One of my most memorable and formative early experiences was working with and being taught by two superb technologists who were not afraid to challenge the system when it was in the best interest of the patient. And when they had a question about the practical need for doing a particularly long or arduous procedure, I was impressed with how often their opinions were heard and were influential. That was an unintentional message: all members of the team are important and are treated
with respect.
The hidden curriculum supercedes the lecture series. In fact, it begins long before the lecture starts and does not stop when the lights come on and the slides flick off. We are each
a part of an educational change
information
with
process each
all the time. How we exother
and
our
clinical
col-
leagues, the language we use, our intellectual honesty, and the respect we have for one another are important. Each of these things influences our teaching, our learning, and our effectiveness. When the chief of the department makes teaching medical students a high priority or takes the time to sit with residents to discuss their concerns, it is a message of caring. When the person in charge of medical student education insists that we include students in our daily conferences, we have sent a strong signal of respect for our own beginnings and our own teachers. When one of my colleagues volunteers to help get the work done so that we all may attend a conference, that is a hidden curriculum-a message of support for education. How we deal with uncertainty and with our mistakes is also very important. When we verbalize our uncertainties and
AJR:159,
July 1992
when we search for and learn from our errors we announce our conscientious participation in patient care. To be most effective, the hidden curriculum and the conventional curriculum should be concordant. Certainly the hidden curriculum can overpower the intended curriculum. For example, when your family physician claims to be concerned about your health and well-being, but does not take the time to listen to your story, the message is at odds with the words, belying a lack of real concern, although unintended. What is the basis for success in education, particularly in promoting a strong, supportive hidden curriculum? Our success is based on individuals, role models who contribute to one or more of the three components of the educational process. These people are exemplified by chairpersons who make sure the physical structure is in place: state-of-the-art equipment, faculty, support staff, as well as time set aside for learning; and by many radiology faculty who embody fundamental knowledge, people who have dedicated themselves to becoming “walking textbooks of radiologic acumen”; and by those who contribute daily to the hidden curriculum. In my personal experience, the latter are perhaps best exemplified by two radiologists and teachers who are no longer with us. One was the late Hy Senturia, whom I knew as the chief of radiology at Jewish Hospital in St. Louis and who had an unparalleled work ethic, the highest standards, and a strong sense of what it meant to be a whole person as well as a competent, caring radiologist. The other was Dan Biello, first a resident at the Mallinckrodt Institute and then a member of the Mallinckrodt nuclear medicine staff. Dan was an absolutely exemplary role model who taught us, even while he was dying of Hodgkin’s disease, how to live. He was dedicated to the service of caring for patients, but at the same time he was able to take care of himself and give support to colleagues, friends, and family gathered around him. The dignity and integrity he portrayed will always be with me. The apprenticeship format of our teaching programs allows a powerful personal statement illustrating the integration of a demanding career within a fulfilling life. People are the strength of our hidden curriculum, the main source of the hidden messages. Life is a contact sport. Each of us is constantly coming into contact with people, constantly having opportunities to make a difference in the lives of others. What we teach is not limited to what we say, but includes how we say it. Our teachings reflect our attitudes, prejudices, honesty, and humility. It is our example that will be remembered long after the differential diagnoses are forgotten. Our example, our hidden curriculum, must be considered, guarded, and used wisely.
