Absorbing bad practice
The hidden curriculum
The transition from medical student to doctor happens during the clinical years of training, and these three years also shape the behaviour and attitudes that form the way medical students will practise in the future. Beforehand, some formal teaching on paternalistic medicine versus patient centred medicine usually takes place, but medical students are only properly exposed to these phenomena in clinics.
So, the doctors from whom they learn their clinical skills are the ones that students emulate in their own practices. A survey of six medical schools concluded that “Physicians . . . teach medical ethics as role models even when ethics is not on the schedule.”1
Students need to be able to recognise what is good or poor practice to avoid the danger of copying unethical, unprofessional, or even illegal practices from the “hidden curriculum” (box 1).
At first glance, it is not obvious there is anything wrong in