예술은 삶의 모방이다: TV 드라마에 담긴 Hidden Curriculum (BMC Med Educ, 2015)
Life imitating art: Depictions of the hidden curriculum in medical television programs
Agatha Stanek1, Chantalle Clarkin2, M Dylan Bould2, Hilary Writer2 and Asif Doja2*
잠재적 교육과정(hidden curriculum, HC)란 다음과 같다.
The hidden curriculum is a
- set of influences that function at the level of organizational structure and culture [1–6].
- It is comprised of processes, pressures and constraints which fall outside the formal curriculum, and are often unarticulated or unexplored [2].
요약하자면, 한 교육기관이 스스로 가르치고 있다고 생각하지도 않는 새에 가르치고 있는 것
In essence, the hidden curriculum represents what an institution tea- ches without intending or being aware it is taught.
This differs from the infor- mal curriculum, which takes place in interpersonal forms of teaching, such as among medical faculty and students. Such teaching is typically unscripted and ad hoc in nature [1–6]. Both the hidden curriculum and in- formal curriculum however, suggest the existence of a discrepancy between traditional forms of teaching and what the student retains.
늘 의과대학생과 전공의 사이에 존재해왔으며, 공식 교육과정보다 더 영향을 줄 수도 있다.
The hidden curriculum can be considered to be ever present among medical students and residents [7] and, as argued by Hafferty, the hidden curriculum may im- pact medical trainees more than the formal curriculum itself, [8, 9].
문화, 절차, 구조에 담겨있다.
The hidden curriculum can be observed in the cul- tures, processes and structures inherent in the practice of medicine.
- An example of cultures in medicine would be the unspoken hierarchy regarding the manner in which trainees are quizzed on inpatient rounds. In North America, usually the easier questions are targeted to- wards junior trainees, whereas more difficult questions are addressed towards more senior trainees. In North America, the “rule” which must be learnt is that it is considered improper for a more junior trainee to answer a question directed at a more senior trainee. 문화의 사례로는 위계가 있고, 북미에서는 암묵적으로 아래 연차 전공의가 윗 연차 전공의에게 한 질문에 대답하는 것은 부적절하다고 여겨진다.
- Processes refer the manner in which the daily practice of medicine is carried out. For example, medical students are often told to spend significant amounts of time with patients to obtain not only the medical history, but to pursue the patient’s perceptions of illness and the impact disease has had on their lives. However, when they get to the clinical setting, trainees sometimes find they are told they are taking too long, and need to improve their effi- ciency in a busy outpatient clinic or the emergency room. 의대생들은 병력청취 뿐 아니라 질병에 대한 환자의 인식과 삶에 미친 영향까지 청취해야 한다고 배우나, 실제로 진료실에서는 너무 시간이 오래걸린다며 바쁜 외래에서는 효율성을 높여야 한다는 이야기를 듣는다.
- Structures can be thought of as the way in which larger organizations govern medical practice. An ex- ample of these would be the physical layout of some emergency rooms, which is often dictated by hospital budgets. Students are often surprised to find that while patient privacy is stressed in medical school, often the only thing separating two patients in the emergency room is a thin curtain, which significantly limits how “private” a physician-patient conversation can be in that environment. 응급실의 구조를 살펴보면 환자의 사생활이 의과대학에서 아무리 강조되더라도, 응급실에서 두 환자 사이를 구분해놓는 것은 커튼 한 장에 불과하다는 것을 보게된다.
사회적 수준에서 TV 프로그램이 교육에 영향을 줄 수 있고, 환자-의사 의사소통에 영향을 준다는 것이 보여진 바 있다. 그 외에도 다음 것들에 영향을 줌.
At a societal level, medical television programs can act as educational agents, and have demonstrated the ability to shape patient-physician communication [15]. They can also influence patient expectations of their physicians and resulting satisfaction [16, 17]. Literature attests to the po- tential of medical television dramas and reality programs to provide health information regarding medical diseases for its viewers [18]. More recently, studies suggest medical television may also serve as a tool in educating physicians in training [19]. Hirt and colleagues formulated a guide that summarizes eight popular television dramas and their specific potential for implementation in medical education [19].
TV프로그램 선택
Selection of television programs
Three television programs were chosen for the study: the highest-rated medical drama from the 1990’s(ER), the highest-rated medical drama fromthe 2000’s(Grey’s Anat- omy) and the highest-rated medical comedy from the 2000’s(Scrubs) (http://tviv.org/Nielsen_Ratings/Historic/ Network_Television_by_Season/2000s) [20–22].
시청 원칙
Viewing protocol
All episodes of each respective season for the three med- ical dramas were viewed by one investigator (AS). 22 episodes of ER, 24 episodes of Grey’s Anatomy, and 24 episodes of Scrubs were watched, for a total of 70 epi- sodes. Notes were taken at 10-min time intervals to en- sure a minimum consistent amount of note taking.
데이터 수집과 분석
Data collection and analysis
We conducted a summative content analysis that was both inductive and deductive in nature, to identify depic- tions of the hidden and informal curriculum in the tele- vision medical programs [23].
A preliminary inductive glossary of terms relating to the hidden curriculum was developed by content experts based on the literature, and served as the initial coding scheme for data abstraction (Additional file 1) [1, 4, 13, 14, 19]. Throughout data collection, the coding scheme was revised to reflect emergent themes derived from the medical dramas. Specific examples of the hidden and informal curriculum were abstracted, documented and described in detail in a spreadsheet. For each occurrence of the hidden curriculum, the following data were recorded: episode number, scene length and timing, and major themes or conflicts being demonstrated in the scene (Additional file 1). This process allowed us to systematically condense a large volume of raw television data into categories and latent themes based on interpretation [24].
To enhance the trustworthiness of the findings, a second re- viewer (CC) independently reviewed a subsample of epi- sodes selected at random from each series (n = 6). These episodes were reviewed using the established coding scheme and procedures. The two reviewers then met to discuss their initial interpretations and coding, and areas of divergent interpretation were discussed at length until agreement was reached.
Results
사례는 세 가지 종류로 분류하였다.
Exemplars of the hidden curriculum were tabulated and subjectively rated as poor, moderate, or excellent to re- flect the quality of the depiction of the hidden curricu- lum. These ratings were developed by the authors in terms of their ability to serve as teaching tool vignettes.
- Excellent exemplars demonstrated key aspects of the hidden curriculum and did not require an understanding of character or plotline.
- Moderate exemplars required some additional context for understanding.
- Poor exemplars featured nuanced enactments of the hidden cur- riculum that were character or plot driven.
The Hierarchical nature of medicine
The hierarchical nature of medicine was the most fre- quent depiction of the hidden curriculum; the concept of a pyramidal system of superiority was common to all of the medical dramas.
Unprofessionalism
Unprofessionalism was the second-most frequent example of the hidden curriculum among the three viewed medical television dramas. Unprofessionalism was noted in scenes that promoted a sense of complacency regard- ing professional standards and behaviors, and during times of personal and professional conflicts.
Patient dehumanization
Patient dehumanization encompasses impersonal med- ical routines surrounding patient care that lack dignity, empathy, or privacy. Patient dehumanization is commonly noted at times when patients are vulnerable, in cases of sedation, confusion, or awaiting an invasive procedure. When multiple members of a health teamare discussing a patient’s case without acknowledging that patient’sverbal or nonverbal behavior, this theme also comes to light.
Work-life balance
Issues relating to difficulties establishing and maintain- ing a sense of work-life balance are readily depicted in both Grey’s Anatomy and ER, but are not featured in the viewed season of Scrubs. The challenge experienced by medical personnel to find a balance between personal commitments and their professional responsibilities is highlighted during times of promotion or transitional stages in careers. The tensions between professional and personal commitments are also emphasized during spe- cial moments in personal lives or times of increased family responsibilities, for example, the care of young children.
Role modeling
Role modeling can be portrayed both positively and negatively.
드라마의 묘사와 실제의 차이
Fictional depictions of the hidden curriculum vs reality
현실을 반영한다.
Fictional depictions of the hidden curriculum identified in television programs reflect real-life examples of the hidden curriculum.
기존 연구와 많은 부분 중첩된다.
All themes established in this study overlap with those in pre- vious literature examining real-life examples of the hidden curriculum among medical trainees. The themes of hier- archy, personal versus professional life balance, ‘faking it’, staging, the competitive nature of medicine,androle mod- eling were readily identified in many studies [12, 13, 25].
이름만 다르게 붙은 것도 있다.
Interestingly, there were certain themes described in other studies of the hidden curriculum that overlapped with those in our study; we labeled these themes differ- ently than the other studies, but the themes reflected similar content.
Differing semantics, which may reflect the subjective process of identifying themes of the hidden curriculum, may account for such discrepan- cies. Despite these differences, there is substantial overlap of content of the hidden curriculum among tele- vision programs and actual medical trainee experiences.
의료에서 나타나는 잠재적 교육과정
Differing depictions of the hidden curriculum in medicine
There are several themes of the hidden curriculum discussed in the literature, which were not identified among television programs in this study. These themes included: positive experiences of human connection; haphazard teaching; the power differential and a delega- tion of patient’s emotional needs to nurses [12, 13, 25].
TV 프로그램에서만 나타나는 잠재적 교육과정
Unique depictions of the hidden curriculum in medical television programs
We identified several unique themes of the hidden curriculum particular to television programs, which have not been well documented in studies on real life examples of the hidden curriculum.
다양한 프로그램에서 나타나는 교육적 가치의 비교
Comparing and contrasting educational values of various programs
위계, 비-전문직업성, 환자의 비인간화 등에서 차이가 주로 드러난다.
Depictions of the hidden curriculum were common to medical dramas, most notably representations of hier- archy, unprofessionalism, and patient dehumanization.
Previous literature has supported the use of televi- sion programs to enrich medical education. Hirt and colleagues, systematically analyzed 177 episodes from eight popular medical programs, three of which included Grey’sAnatomy, Scrubs,andER for their po- tential use in medical education in academic settings [19]. Grey’sAnatomywas shown to have numerous ap- plications in areas related to “hospital environments, communication skills, teaching and learning, ethics, professionalism, and interpersonal conflict” (p. 238, [19]). Interestingly, the authors stated that this televi- sion show in particular includes numerous interac- tions among health professionals of various levels, with a “learn-by-humiliation approach” (p. 240, [19]). Our findings regarding hierarchy, unprofessionalism, and issues of life balance support this previous work, and reveal its applicability for teaching purposes spe- cific to the hidden curriculum as well.
Our findings expand upon another study which exam- ined the frequency of professionalism issues portrayed in the television dramas Grey’s Anatomy and House M.D. [1]. Czarny and colleagues found a deficiency in the number of commendable portrayals of professionalism, in contrast to a much higher incidence of professional- ism breaches, among the two studied medical dramas [1]. Our research uncovered several examples of unpro- fessionalism regarding truth disclosure, ethical concerns in practice and quality of life issues. In contrast, it was rare for us to find positive examples of professionalism and professional conduct. This may be due in part to the nature of the television shows themselves and dramatic techniques employed to enhance viewer interest.
교육 관련
Relevance to education
Ornelas and Parikh [26] have argued that because of negative portrayals of physicians in medical dramas – spe- cifically unethical and unprofessional behaviors – televi- sion shows should not be used for educational purposes. We would argue, however, that the fact that the programs depict fictional characters engaging in these behaviors makes them a perfect tool for education. The fact that they are fictional representations allows for trainees to reflect and have open discussions on the behaviors related to the hidden curriculum that are observed, without the “passing judgment” worry that they are on actual individuals.
Additional file 1: Emergent coding scheme and hidden curriculum examples by series, episode and time. (DOC 94 kb)
23. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.
Life imitating art: Depictions of the hidden curriculum in medical television programs.
Author information
- 1Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada. Astan095@uottawa.ca.
- 2Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada. cclarkin@cheo.on.ca.
- 3Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada. dbould@cheo.on.ca.
- 4Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada. hwriter@cheo.on.ca.
- 5Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada. adoja@cheo.on.ca.
Abstract
BACKGROUND:
METHODS:
RESULTS:
CONCLUSIONS:
- PMID:
- 26410693
- [PubMed - in process]
- PMCID:
- PMC4583760
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