مقالات پذیرفته شده در سومین کنگره بین المللی زیست پزشکی
A Review of the Impact of Hidden Curriculum on Breaking Bad News
A Review of the Impact of Hidden Curriculum on Breaking Bad News
Reza Khedri,1,*Reza Abouali,2Hosein Bahrami Moqadam,3Hamid Yazdaninejad,4
1. Medical Student, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 2. B.S Student in Medical Laboratory Science, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 3. Medical Student, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 4. B.S Student in Anesthesiology, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Introduction: The formal curriculum as a guide for formal training in universities and higher education centers of the medical sciences and will be evaluated after implementation in these centers. In the meantime, there are fewer experiences besides the formal curriculum that is called the hidden curriculum. The personal, unwanted, hidden curriculum incorporates values and beliefs that are part of the classroom process that is closely linked to medical professional ethics training. Medical students receive plenty of medical professionals during their studies, especially in the clinical setting, which one of the most important is breaking bad news for patients. Patients have a right to information about their health status, especially bad news. Today, reporting bad news to patients and their relatives is one of the challenges of the medical profession due to the patient's and his / her surroundings' unreasonable expectations of treatment and demonstrating violent behavior. So, given the importance of a hidden curriculum on professionalism, we decided to address the impact of the hidden curriculum on breaking bad news to patients.
Methods: Pubmed, Scopus, Cochrane library, Medline, Embase, and Web of Science were searched with the keywords "breaking bad news" and "medical student." A comprehensive analysis of all levels-of-evidence was done. Twenty-seven articles discussing breaking bad news were selected.
Results: According to the findings, there are other factors outside the formal curriculum, and it is hidden from the authorities' viewpoints in the education system, which in most cases, are more effective than the curriculum and affect the thinking, emotions, and professional behavior of medical students. Variables affecting the professionalism of students, such as giving bad news to patients, can be attributed to the physical environment, behavioral and personality characteristics of faculty and senior students, which have the highest negative consequences on students' professional behavior in such a way that Medical professional ethics impacts students against predetermined goals. Difficulty in breaking bad news due to inadequate experience while studying and inconsistent and unprofessional modeling of senior teachers and students may remove bad news management from a physician's control and lead to loss of confidence of the patient and his / her staff. Consequently, the rest of the next steps will be disrupted and disorganized, causing a cycle of adverse events.
Conclusion: It is necessary to modify the physical environment, characteristics of professors 'professional behavior, as well as their evaluation methods in order to prevent adverse effects on students' modeling in order to convey bad news to patients. It is also suggested that professors become more aware of professionalism and the role of the hidden curriculum and the incorporation of professionalism criteria in forms of evaluation of student and faculty performance to improve how bad news is delivered. Cultural differences in the attitudes of physicians and people affect how bad news is delivered. It is usually best to deliver bad news to patients, including the benefits of it: strengthening trust between physicians and patients, reducing legal action against physicians, preventing harm to patients, and increasing their satisfaction unless they lead to severe psychological injury that in such cases it varies depending on the situation of each patient.