Car Keys, House Keys, Easter Eggs, and Curricula

The hidden curriculum has become a topic of high concern within our colleges of pharmacy. Despite our efforts to map the curriculum to competency statements and our painstaking development of lectures and syllabi, students probably learn more about becoming a pharmacist from the unplanned, hidden curriculum than from our carefully designed formal presentations. It has been said that “The hidden curriculum is not simply found, one must go looking for it.”1 My efforts to go “looking for it,” lead me to conclude that our hidden curriculum is found in ways similar to how we find everyday things. Portions of the hidden curriculum might be compared to a misplaced set of car keys. Undoubtedly we have all spent time searching for car keys. In our hurry through our daily routine, we unconsciously drop our keys in unlikely places. In our curricula the “car keys” are passing conversations and nonverbal cues. Often our interactions with each other and our nonverbal communication are inconsistent with our more formal messages. Students receive didactic lectures espousing the importance of interprofessional teamwork. When they hear pharmacists belittle the efforts of other team members, they are unlikely to retain the right “take away” message. White coat ceremonies focused on the importance of core values, including respect for others and empathy, are unlikely to have the lasting impact we desire, if followed by an introductory pharmacy practice experience (IPPE) during which students hear health care professionals make derogatory remarks about a patient. Role modeling plays a critical part in developing future practitioners. Students learn by example. They not only learn specific skills, but also “cultural norms.” Faculty members who support each other, show empathy for patients, and create an inviting learning environment are likely to foster the development of future colleagues who are supportive, empathetic, and lifelong learners. On a different note, the hidden curriculum might be compared to house keys hidden under the doormat. The house keys are purposefully hidden, but their location may be more obvious than intended. The house keys in our curriculum are the powerful messages sent by our institutional policies and the allocation of our resources. Policies that allow students to attend professional meetings and funds that support their travel send messages that the institution values their participation in professional organizations. Promotion and tenure guidelines that reward excellence in teaching imply that the organization values teaching. Flexible work schedules for faculty and staff members may send the message that the organization is family friendly. These “keys” may not be in plain view, but their effect is evident. Finally, the hidden curriculum might be compared to an Easter egg hunt. Some messages we send in our curricula are expertly hidden, disguised in ways that one might never find without continually hunting. These are messages about our own shortcomings that we hide from our students, hoping that they will not be discovered. Perhaps we do not want students to realize that we do not have all the answers or that we make mistakes. We may worry that our students will recognize that transformation from resident or postdoctoral fellow one day to faculty member the next does not make us expert teachers overnight. We may avoid discussions that make us uncomfortable. After all, how do we teach a student how to deal with the death of a patient for whom he/she cared? How do we explain that the profession can evolve in the setting of health care reform legislation that we do not completely understand? Indeed, these Easter eggs in our curricula may pose the greatest challenges. It would be a productive exercise for faculty members within all of our colleges to examine their own personal curricula for hidden messages. Are we effective role models? What messages do our institutional policies convey? Does our allocation of resources reflect our values? And finally, what messages lurk in our silences?