Recognizing the Role of Language in the Hidden Curriculum of Undergraduate Medical Education: Implications for Equity in Medical Training

Bonnie O Wong; Jacob A Blythe; Jason N Batten; Brandon E Turner; James N Lau; Poonam Hosamani; William F Hanks; David Magnus

doi:10.1097/ACM.0000000000003657

Recognizing the Role of Language in the Hidden Curriculum of Undergraduate Medical Education: Implications for Equity in Medical Training

Acad Med. 2021 Jun 1;96(6):842-847. doi: 10.1097/ACM.0000000000003657.

Authors

Bonnie O Wong¹, Jacob A Blythe², Jason N Batten³, Brandon E Turner⁴, James N Lau⁵, Poonam Hosamani⁶, William F Hanks⁷, David Magnus⁸

Affiliations

¹ B.O. Wong is a medical student, Stanford University School of Medicine, researcher, Stanford Center for Biomedical Ethics, Stanford, California, and PhD candidate, Department of Anthropology, University of California, Berkeley, Berkeley, California.
² J.A. Blythe is a medical student, Stanford University School of Medicine, and researcher, Stanford Center for Biomedical Ethics, Stanford, California.
³ J.N. Batten is resident physician, Internal Medicine and Anesthesia Combined Program, Stanford University, and researcher, Stanford Center for Biomedical Ethics, Stanford, California.
⁴ B.E. Turner is resident physician, Harvard Radiation Oncology Residency Program, Boston, Massachusetts.
⁵ J.N. Lau is clinical professor of surgery and assistant dean for clerkship education, Stanford University School of Medicine, and director, Stanford Surgery ACS Education Institute, Surgical Education Fellowship, and core clerkship in surgery, Stanford University, Stanford, California.
⁶ P. Hosamani is clinical assistant professor of medicine, director, Practice of Medicine course, and codirector, Transition to Clerkships, Stanford University School of Medicine, Stanford, California.
⁷ W.F. Hanks is distinguished chair of linguistic anthropology, professor of anthropology, affiliated professor of linguistics, and founding director, Social Science Matrix, University of California, Berkeley, Berkeley, California.
⁸ D. Magnus is Thomas A. Raffin Professor of Medicine and Biomedical Ethics, and professor, Pediatrics and Medicine, Stanford University School of Medicine, and director, Stanford Center for Biomedical Ethics, Stanford, California.

PMID: 32769473
DOI: 10.1097/ACM.0000000000003657

Abstract

Medical education involves a transition from "outsider" to "insider" status, which entails both rigorous formal training and an inculturation of values and norms via a hidden curriculum. Within this transition, the ability to "talk the talk" designates an individual as an insider, and learning to talk this talk is a key component of professional socialization. This Article uses the framework of "patterns of medical language" to explore the role of language in the hidden curriculum of medical education, exploring how students must learn to recognize and participate fluently within patterns of medical language to be acknowledged and evaluated as competent trainees. The authors illustrate this by reframing the Association of American Medical Colleges' Core Entrustable Professional Activities for Entering Residency as a series of overlapping patterns of medical language that students are expected to master before residency. The authors propose that many of these patterns of medical language are learned through trial and error, taught via a hidden curriculum rather than through explicit instruction. Medical students come from increasingly diverse backgrounds and therefore begin medical training further from or closer to insider status. Thus, evaluative practices based on patterns of medical language, which are not explicitly taught, may exacerbate and perpetuate existing inequities in medical education. This Article aims to bring awareness to the importance of medical language within the hidden curriculum of medical education, to the role of medical language as a marker of insider status, and to the centrality of medical language in evaluative practices. The authors conclude by offering possible approaches to ameliorate the inequities that may exist due to current evaluative practices.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Communication Barriers
Cultural Characteristics
Curriculum*
Education, Medical, Undergraduate*
Humans
Language*
Professional Practice
Socialization