Practicing what we preach? An analysis of the curriculum of values in medical education

PURPOSE: Although medical students are expected to adopt and practice the ideals stated in the Hippocratic Oath, little is known about whether these values are actually taught during clinical training. The purpose of this study was to examine the "recommended curriculum" of medical values and compare it with values that are actually taught. SUBJECTS AND METHODS: The recommended curriculum was identified through content analysis of curriculum documents and interviews with individuals responsible for teaching. The taught curriculum of values was identified through naturalistic observations and audio taping of inpatient internal medicine teams at an academic medical center. RESULTS: The values most consistently recommended in the medical curriculum are honesty, accountability, compassion, the importance of public health, and self-policing. While accountability and caring were found frequently in the taught curriculum, self-policing and the importance of public health were emphasized less. Interprofessional respect and the importance of Service were present in the recommended curriculum, bur were taught as interprofessional disrespect and as the burden of service. The importance of industry (working hard) was not found in the recommended curriculum, but frequently identified in the taught curriculum. CONCLUSION: This study indicates that one reason medical students are not learning the intended norms of the profession may be that the teachers are not consistently teaching the recommended values of the profession. Future research should concentrate on confirming these findings in other settings and on understanding why these values are not consistently taught. (C) 1998 by Excerpta Medica, Inc.