The Hidden Curriculum of Medicine Portrayed in Popular Television Medical Shows

Abstract

Background: In addition to the purposeful teaching of knowledge and skills to medical students, the ‘hidden curriculum’ (HC) refers to the inadvertent – and often unrecognized – transmission of implicit ideas, attitudes, and behaviors. One way to raise student and teacher understanding of the HC is to provide them concrete examples of how and when it occurs during medical school. The goal of this study was to investigate how the HC is depicted in popular medical television (TV) shows. Methods: A systematic content analysis of successive episodes of eight prime-time TV shows was completed using a standardized classification scheme. A complete season of each TV program was analyzed to identify and classify depictions of the HC as it pertains to medical students. Our classification scheme used four dominant themes: what students discovered about medicine, what students learned about becoming a physician, what students experienced, and what students realized about themselves. After coding, all incidents were classified as ‘negative’ if a rule or normal procedure was broken or ‘positive’ if they followed established professional values or provided patient-centered care. Results: A total of 137 episodes were viewed with 1,160 depictions of the HC portrayed. The TV shows with the most depictions were Code Black and Scrubs. Within the four dominant themes, 45 subthemes were identified. Most depictions (66.7%) were described as positive and included conflict resolution, sensitivity, respect, empathy, accountability, and role modeling. However, 33.3% (386/1,160) were negative and included unrealistic patient expectations, working in a chaotic environment, haphazard learning interactions, emotional detachment, loss of idealism, complex social situations, and dealing with uncertainty. Conclusions: Television dramas contain many positive and negative examples of the HC during undergraduate medical training. Short snippets from these incidents could be used in an educational setting to teach related issues including professionalism, ethics, role modeling, communication skills, and coping techniques.