Caucusing Activity

Activity

• Read “caucusing guidelines” to the group

  • If you have a group that includes multiple levels of medical hierarchy (medical students, residents, attendings, nurses, MAs…) consider explicitly pointing out that expertise in medicine does not equate to expertise on issues of race and equity. One example, “For this exercise, experience and expertise may flip from how they are in clinic or on the wards. The attendings in the room may be the learners today and an MA may be the expert. Let’s recognize that we are all here to learn, share, and challenge each other.”

• Introduction

  • Despite the work of most institutions to promote cultural humility, many small unconscious behaviors and curricular examples can undermine those larger efforts. This 2002 study looked at what identifying features were portrayed in case presentations and how they were portrayed. Their findings can help promote discussion around what other places “hidden curriculum” can be found and what its impact can be.

• Break into small groups.

  • Group size may depend on the size of your large group. We have found that groups of 3-4 work well. Breaking into small groups allows people to be more vulnerable than they might be in a large group. It also makes it challenging to not participate.

  • Consider the make up of your group and how you might do this. Do you want mixed groups that include all levels (ex. student, intern, attending) or would it be helpful to break into groups that might be more comfortable for challenging discussions (ex. group attendings, students, residents separately)? Are the groups assigned in advance or do you have your group “count off” and then group by number (all the “1s” together, “2s” together, etc.)?

• Discuss

  • What stood out for you in reading this article?

  • Have you noticed the patterns described in the article?

  • Did you find anything surprising?

  • What emotional reaction did you have to reading this article? Surprise? Defensiveness? Anger?

    • Why do you think you had this reaction?

  • Can you think of examples of this “hidden curriculum” outside of medical school lectures? (Board & Step exams, patient presentations on rounds…)

  • How do you think the findings of this paper might subtly impact lessons taken away by medical students?

  • How might medical students feel when facing the portrayals noted in this study? Do you remember having a reaction to something similar in your life?

  • What are concrete ways that your institution might work to highlight and change any hidden curriculums?

  • How can you as an individual work to highlight and change hidden curriculums?

• Report back

  • Ask each group to share some highlights of what they discussed with the large group.