Writing the hidden curriculum.

curriculum. The hidden curriculum is the set of values that students learn from, no matter what we have decided to teach them. As our trainees go through medical school and then postgraduate training, they watch and learn from a whole range of doctors, something often denied to us later in our careers. This exerts a powerful influence over what behaviour is acceptable as a doctor, usually more powerful than the written curriculum. Sometimes it just takes one small act of compassion, or one example of truly patient-centred care for a learner to realise that those sort of events are allowable in medicine. Just as things seen in clinic are never described in textbooks or lectures, there are some things routinely taught in medicine but almost never seen in real-life clinics. These would form the basis for my written hidden curriculum. What my patients teach me It is a little strange that we get to decide what being patient-centred means, often without any input from patients. Some medical students can be quite disparaging of non-medical teachers. 1 Part of my hidden curriculum will routinely ask patients for advice for myself and the student or registrar: 'What do you think when we say you're non-compliant?' 'What's the best way something's ever been explained to you?' 'What's the best bit of advice you have for us right now? ' Even just asking those questions invites a sharing of expertise. At the end of each week, my curriculum would say, document and discuss what was learnt from the patients that week. hidden curriculum, hidden solutions Sometimes we see people with problems that don't have a medical diagnosis or a medical solution. But never do we see case-scenarios without a diagnosis or solution. Every problem we have ever been taught about has an answer that is correct, and there will be an authority somewhere to tell us what the answer is. It may be the teacher at the end of the room, the answer sheet to an exam, or the carefully contrived Medline search to find the recent Cochrane review on just that problem you were given. How many times will you see a rash, not know what it is and it goes away? How many times do you see a cluster of symptoms which, despite investigation, remain biologically elusive but frustratingly present? What's your plan now, doctor? That wasn't in your finals exam, was …