The Unwritten Curriculum in Med School
- Aug 05, 2020
“It’s all contained there in your syllabus.”
We get this reassurance from our professors and leaders throughout our education. A few sheets of paper that lay out everything you need to learn, when to expect the information, and a notification of important dates and exams along the way. All that you have to do is show up, read the chapters indicated, and you will succeed. A good grade is almost assured if you keep up, work hard, and do what you’re told.
By the end of said course or experience, you have newfound knowledge, and you have pulled all that you could from the assigned curriculum.
But what about the “unwritten curriculum?”
I was unfamiliar with the term when I heard it last week, but when given some contextual examples, it became quite clear. I realized it existed, but never took the time to stop and ensure I was getting high marks there as well.
In my cardiothoracic anesthesia fellowship, I was told that the unwritten curriculum was learning how to function as part of a busy cardiac anesthesia practice. It held lessons on showing face, having a seat at the table of the health system, being proactive about throughput, and learning to become a leader.
While none of these were listed on our outline for the year, and were not included as part of our ACGME requirements, these were really the determinants of how successful we could become. Surely every one of us would figure out the technical aspects of safely administering ideal anesthetics and learning to become excellent intra-operative instructors, but the truly great would identify the unwritten curriculum, excel there as well, and be better off in the long-run for it.
So how does this apply to your current situation?
You must take some time to consciously and deliberately ascertain what constitutes your own personal unwritten curriculum.
Let’s say you are at the beginning of your medical school journey. New environment, new classmates, new challenges, new life! The beginning of MS-1 year brings with it overarching change that you must assimilate. That’s number one on your curriculum – dealing with extreme change, while at the same time, learning medicine and passing exams.
Now that you’re in medical school, you will be afforded some more control of your own daily schedule and study habits. Go to class or stay home and watch the lecture? Eschew both and use online resources instead? Study before class at the library or after class at home? With others or alone? With less hand-holding, you will have to get the pieces in place to become a self guided learner. It’s right there on your unwritten curriculum.
Now, your school will attempt to afford you opportunities to learn about most specialties in medicine, and you’ll have to complete your core clerkships, but what about the esoteric like radiation oncology or dermatology?
How will you learn about fields that aren’t spoon-fed to you? There’s no choice but to develop a proactivity for exploring on your own, organizing volunteering and shadowing experiences with other departments and professors.
Maybe you’re an MS-4 starting your sub-internship. You’ve done the book reading, have built a strong foundation in the subject, and are ready to shine on rounds. But what about the finer points? Have you thought about what it takes to show genuine interest on rounds without turning off others by being too eager? Have you crafted your approach to obtaining a letter of recommendation? Are you analyzing your teaching ability and thinking what you can do better to instruct your underclassmen during the day? Have you thought about how you will balance call shifts with completing your ERAS personal statement?
A resident’s unwritten curriculum would include topics like getting the work done with a smile, even if the 25th hour of the shift. You’ll find leadership development, the ability to both give and accept feedback in an artful and constructive way. There is much more on the path to excellence than simply teaching while learning and working.
This is without even mentioning the unwritten curriculum of life, balancing these rigorous academic workplace demands with physical fitness, interpersonal relationships, finances, families, and so on.
What I ask of you is this: stop for some time. Even if only 5 minutes.
Tear yourself away from the spiral of the work that needs to get done. And think about what are going to learn this rotation/year/phase that’s not written on the content outline for your boards exam, nor on your evaluation.
Figure out the other lessons that you are supposed to learn along the way, and devote some explicit attention towards them. Identifying and excelling at whatever is contained within your own unwritten curriculum is equally as important to the content you already knew about.