Sharp Scratch: shining a light on the hidden medical curriculumBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2223 (Published 17 May 2019) Cite this as: BMJ 2019;365:l2223
“Sharp scratch.” It’s what we’re taught to say to patients just before we push the needle under the skin to take blood or insert a cannula. But does venepuncture actually feel like a sharp scratch? Not in my experience. It’s good to warn patients that they may feel something, although it may not prepare them for the pain that follows.
Similarly, medical school attempts to prepare students for what is coming by teaching a broad range of topics. But just as “sharp scratch” falls just short of the real thing, so lectures, seminars, role playing, and exams can’t fully prepare students for what being a newly qualified doctor will be like.
The BMJ’s new student podcast fills this gap. Sharp Scratch (https://www.bmj.com/sharpscratch) is a podcast where medical students, newly qualified doctors, The BMJ’s multimedia team, and experts from around the world get to grips with the topics that really matter but medical schools don’t teach you.
Many aspects of being a new doctor we absorb from peers and role models while on clinical placements. How to cope, how to succeed, how to fit into your role in the bigger world of healthcare—skills that are hard to teach in a classroom or test in exams. Instead, they are part of what is known as the “hidden curriculum” —the customs, rituals, and other aspects of working life that experienced doctors take for granted.1 This curriculum is at the heart of the Sharp Scratch podcast.
The hidden curriculum includes administrative skills. The General Medical Council (GMC) lists practical skills for medical students in the UK, and medical schools integrate them into formal curriculums.2 But essential skills such as writing a discharge letter, ordering a test, and navigating patients’ notes are rarely formally taught. Although the GMC’s Outcomes for Graduates alludes to such skills under the requirements for working effectively with colleagues in ways that best serve the interests of patients,3 newly qualified doctors are often left to learn these and other important skills on the job, under pressure.
The hidden curriculum includes tips for success and wellbeing. In the camaraderie of hard work, we glean ideas for surviving, even thriving: how to pick a good supervisor for a project, how to get clinical skills signed off by the deadline, and how to leave a ward round when we’ve learnt all we can take that day. From doctors already on the shop floor we learn how to cope with a night shift, a death, a mistake, a complaint, or a bully.
The hidden curriculum includes healthcare culture. We follow the lead of the doctors and students around us. Should I avoid going to the ward because I have a cold? Should I tell my personal tutor about my mental illness? Should I share my revision notes with peers? Should I take my time with a patient when my supervising doctor wants me to speed up? Should I consider quitting medicine before it gets too hard? Such unspoken questions affect our professional relationships and clinical practice. They deserve open and honest discussion and resolution.
The hidden curriculum is unwritten and unregulated. It can teach us unsafe shortcuts, poor ways to deal with stress or uncertainty, and harmful cultural practices. But it can also be a force for good. After all, we learn essential skills and coping mechanisms from talking to people who have gone ahead of us.
Sharp Scratch brings the hidden medical curriculum out into the open. Each episode is an opportunity to tackle our unanswered questions about daily life as a medical student or new doctor. As the first of The BMJ’s editorial scholars, I’ve hosted episodes about the night shift, patient referrals, medical student projects, and the reality of cardiopulmonary resuscitation, with expert guests including doctors, nurses, and a NASA researcher. All episodes are available on Apple podcasts and other podcast apps, and you can learn more at www.bmj.com/sharpscratch.
With each episode, we edge closer to the doctors we want to become: safe, patient centred, and healthy. And when the sharp scratch of new doctorhood comes to us, we will be ready.
A new episode of Sharp Scratch goes live every second Friday on Apple podcasts and other podcast apps. Follow Student BMJ on Twitter, Facebook, and Instagram for Sharp Scratch updates and behind the scenes details.
Competing interests: I have read and understood BMJ policy on declaration of interests and declare I am enrolled as a medical student at the University of Cambridge (2014-21).
Provenance and peer review: Commissioned; not externally peer reviewed.