Rewriting the hidden curriculum: Keeping empathy alive

Medical educators say Indiana University School of Medicine is changing the academic climate at the institution and could be creating more sensitive physicians.

By Myrle Croasdale, AMNews staff. April 24, 2006.

Southern Illinois University School of Medicine's dean, J. Kevin Dorsey, MD, PhD, remembers teaching freshmen medical students -- they seemed so idealistic, altruistic and "fresh as the driven snow."

"Then I'd go back to my practice with physicians who'd been working for 25 years, and say, 'Whoa, what happened?' " Dr. Dorsey recalls. "We come in with a full bucket of empathy, then we go through the process of acculturation, the rigors of training, and our bucket gets holes in it. When you're ready to become a doctor ... There's not much empathy left."

Dr. Dorsey is one of several medical school leaders looking for ways to keep medical students' empathy alive. And he, like a number of other deans, is looking to Indiana University School of Medicine for guidance.

Medical educators say Indiana has hit on a model of organizational change that is successfully revising its hidden curriculum from one that chews up idealistic students and spits out cynical doctors to one that produces physicians who care. The effort is being led by a cadre of IUSM faculty with the help of outside consultants, the support of the school's dean and a $2 million, three-year grant from the Fetzer Institute in Kalamazoo, Mich.

Tom Inui, MD, president and CEO of Regenstrief Institute at IUSM, is leading the effort.

"Why should we be doing this?" Dr. Inui asks. "We're accountable to have teaching done in humane environments, and it turns out that the operating room where the surgeon is swearing and throwing instruments is not a safe place for patients."