Collaboration required to fix “hidden curriculum”

We read the commentary “Just family doctors. Hidden curriculum against family medicine in medical schools”¹ in the January 2025 issue of Canadian Family Physician with great interest. While we cannot deny the existence of a hidden curriculum, many educational leaders across Canada are actively working to counter this narrative. These efforts are led not only by family physicians in our medical schools, but also by specialist colleagues, including senior leadership, representing collaborative efforts to promote generalism as a core component of undergraduate medical education.²

According to our research,³ all medical schools provide exposure to family medicine during preclerkship, often within weeks of starting, and much of it is mandatory. Typically, this involves clinical placements where students work alongside family physicians. These opportunities are frequently organized as half-days or repeated visits, allowing students to experience relational continuity with their preceptors and patients.

In most institutions, family physicians deliver classroom instruction not only in the traditional domain of communication skills, but also in clinical reasoning. Outside the formal curriculum, most schools feature generalist career panels and mentoring opportunities, supplemented by generalist boot camps, rural weeks, and family medicine podcasts as extra options. At the time of our data collection, 4 medical programs were actively revising their curricula to integrate generalism principles.

However, goodwill and supportive leadership are insufficient to address the challenges of promoting family medicine and generalist education more broadly. These challenges include structural barriers, particularly support for clinical coverage and income protection for family physician preceptors. Placing learners in rural communities offers the ideal exposure to family medicine but necessitates housing and infrastructural support. As Helen Jingshu Jin correctly points out, the system for applying to postgraduate training features prominently in students’ lives from early in their clerkship, sometimes before exposure to family medicine.

Perhaps, however, the biggest barrier to supporting generalist careers is the need for medical educators across all disciplines to reframe the mindset of medical practice from viewing it as broken into separate body system parts to adopting more holistic and integrative approaches. While body system approaches certainly assist learners in navigating the overwhelming amount of material to be absorbed, as a profession we have been less attentive on how to put it together again. We believe this work is relevant to all physicians as we collectively strive to counter fragmentary health care and acknowledge its increasing complexity. Only in collaboration can we drive the health care change so urgently needed to graduate generalist physicians.

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