Prioritizing Clinical Teaching Excellence: A Hidden Curriculum Problem.

Abstract

Abstract: There have been many initiatives to improve the conditions of clinical teachers to enable them to achieve clinical teaching excellence in Academic Medical Centres (AMC). However, the success of such efforts has been limited due to unsupportive institutional cultures and the low value assigned to clinical teaching in comparison to clinical service and research. This forum article characterizes the low value and support for clinical teaching excellence as an expression of a hidden curriculum that is central to the cultural and structural etiology of the inequities clinical teachers experience in their pursuit of clinical teaching excellence. These elements include inequity in relation to time for participation in faculty development and recognition for clinical teaching excellence that exist within AMCs. To further compound these issues, AMCs often engage in the deployment of poor criteria and communication strategies concerning local standards of teaching excellence. Such inequities and poor governance can threaten the clinical teaching workforce's engagement, satisfaction and retention, and ultimately, can create negative downstream effects on the quality of patient care. While there are no clear normative solutions, we suggest that the examination of local policy documents, generation of stakeholder buy-in, and a culturally sensitive, localized needs assessment and integrated knowledge translation approach can develop a deeper understanding of the localized nature of this problem. The findings from local interrogations of structural, cultural and process problems can help to inform more tailored efforts to reform and improve the epistemic value of clinical teaching excellence. In conclusion, we outline a local needs assessment plan and research study that may serve as a conceptually generalizable foundation that could be applied to multiple institutional contexts.