Practicing What We Preach? An Analysis of the Curriculum of Values in Medical Education

doi:10.1016/S0002-9343(98)00109-0

The American Journal of Medicine

Volume 104, Issue 6, June 1998, Pages 569-575

Presented at the 1997 Annual Meeting of the American Education Research Association, and the 1997 Annual Meeting of the Society of General Internal Medicine.

https://doi.org/10.1016/S0002-9343(98)00109-0 Get rights and content

Abstract

Purpose: Although medical students are expected to adopt and practice the ideals stated in the Hippocratic Oath, little is known about whether these values are actually taught during clinical training. The purpose of this study was to examine the “recommended curriculum” of medical values and compare it with values that are actually taught.

Subjects and Methods: The recommended curriculum was identified through content analysis of curriculum documents and interviews with individuals responsible for teaching. The taught curriculum of values was identified through naturalistic observations and audio taping of inpatient internal medicine teams at an academic medical center.

Results: The values most consistently recommended in the medical curriculum are honesty, accountability, compassion, the importance of public health, and self-policing. While accountability and caring were found frequently in the taught curriculum, self-policing and the importance of public health were emphasized less. Interprofessional respect and the importance of service were present in the recommended curriculum, but were taught as interprofessional disrespect and as the burden of service. The importance of industry (working hard) was not found in the recommended curriculum, but frequently identified in the taught curriculum.

Conclusion: This study indicates that one reason medical students are not learning the intended norms of the profession may be that the teachers are not consistently teaching the recommended values of the profession. Future research should concentrate on confirming these findings in other settings and on understanding why these values are not consistently taught.

Section snippets

Site selection

For reasons of access and convenience, this study was limited to a single institution’s teaching of values, and more specifically, the teaching of values in clinical medical education. Due to potential differences in values between specialties, the site of study was restricted to the values recommended and taught in internal medicine, during the clinical years of medical school and three years of residency training. The site was further limited to the inpatient general medicine services, since

The recommended curriculum: global

Each document was read and analyzed for references to the values expected of physicians. A tabulation of the global recommended curriculum can be found in Table 1. The first three columns represent three commonly used templates for the oath given to medical students upon graduation (23). The following example, from the Oath of Hippocrates, is interpreted as promoting confidentiality:

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of

Discussion

This textual analysis provides new insights into the teaching of values in medical education. Among the values most frequently recommended or taught, accountability and compassion are consistently present across the curriculum. Other values are recommended but not taught (honesty, public health, self-policing), taught without recommendation (industry), or recommended and taught as the reverse (interprofessional disrespect and the burden, rather than the duty, of service). For curriculum

Acknowledgements

The author thanks the members of the Department of Internal Medicine, and the housestaff at the University of Michigan for their willingness and enthusiasm to participate in this research. Thanks also to Larry Cuban, Elliot Eisner, Kelley Skeff, Lee Shulman, Deb Odom Stern, and Jim Woolliscroft for their guidance and critique throughout this research effort.

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^☆: Supported in part by the Lyle C. Roll Fund for the Study of Humane Medicine.

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Special ArticlesPracticing What We Preach? An Analysis of the Curriculum of Values in Medical Education☆

Abstract

Section snippets

Site selection

The recommended curriculum: global

Discussion

Acknowledgements

The oath, the art, the caring

Conn Med

Physicians for the Twenty-first CenturyThe GPEP Report

Prescription for Change

Medical Education in Transition

Clinical education and the doctor of tomorrowan agenda for action

Code of Ethics

House of God

Gentle VengeanceAn Account of the First Year at Harvard Medical School

Becoming a doctora journey of initiation in medical school

Boys in WhiteStudent Culture in Medical School

The Student PhysicianIntroductory Studies of the Sociology of Medical Education

Learning to doctorreflections on recent accounts of the medical school years

J Health Soc Behav

Training in caring competencethe perennial problem in North American medical education

The impact of the educational system on the development of the modern Hippocrates

Special Articles
Practicing What We Preach? An Analysis of the Curriculum of Values in Medical Education☆