Facilitators and barriers of the integration of spirituality into medical education: A situation analysis
Abstract
Background & Objective: Spirituality is regarded as an essential aspect of health, and therefore, it should be incorporated into medical education to foster a holistic understanding of health and to develop fully competent medical professionals. Despite the significance of incorporating spiritual issues into medical education, there has been limited research conducted on this topic in Iran. Various barriers have hindered the implementation of spiritually enriched medical education; however, there are also some factors that facilitate this process. This study attempted to explore the facilitators and barriers of integrating spirituality in medical education through a qualitative content analysis. Materials & Methods: This was a situation analysis designed and conducted as a directed content analysis study. The data collected from interviews with medical education experts and the review of upstream documents were analyzed, revealing findings categorized as internal and external factors. Internal factors were categorized using the McKinsey 7S framework, which includes structure, systems, strategies, skills, staff, style, and shared values. Meanwhile, external factors were classified according to the PEST model, encompassing political, economic, socio-cultural, and technological aspects. Results: The facilitators and barriers identified in this study encompassed a total of 100 concepts. We identified 27 internal and 16 external facilitators, while there were found 41 internal and 16 external barriers. Conclusion: The findings of this study clarify the steps needed to uphold the goals and missions of medical education in the area of spiritual health. Overcoming the barriers while leveraging existing facilitators will be crucial for successfully incorporating spiritual health into Iranian medical education.
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Facili a o s and ba ie s o he in eg a ion o spi i uali y in o
medical educa ion: A si ua ion analysis
Ak am Heida i1, Sadegh Yoose ee1,2 , Seyed Hasan Adeli1, Hoda Ahma iTeh an1, Ma yam
A debili1, Mo eza Heida i3,1*
1Spi i ual Heal h Resea ch Cen e , Qom Uni e si y o Medical Sciences, Qom, I an
2Neu oscience Resea ch Cen e , Qom Uni e si y o Medical Sciences, Qom, I an.
3School o Heal h and Religion, Qom Uni e si y o Medical Sciences, Qom, I an.
A icle in o Abs ac
In oduc ion
The ul ima e objec i e o medicine, along wi h he
ad ancemen o medical educa ion and heal h sciences,
is o p omo e he op imal well-being o indi iduals.
Heal h, in i s ue and comple e sense, encompasses
a ious aspec s o humani y h ough a holis ic app oach
and canno be ully a ained unless he humanis ic
elemen s, including spi i uali y and he spi i ual
dimension o heal h, a e aken in o accoun [1].
Consequen ly, spi i ual heal h has expe ienced a ebi h
du ing he las hal -cen u y. Along wi h he eme gence
o spi i uali y in mul iple social a eas in he pos -mode n
wo ld and he pa icula a en ion o i in heal h, he
spi i ual dimension has been conside ed as he ou h o
he physical, men al, and social dimensions decla ed in
he Wo ld Heal h O ganiza ion's de ini ion o heal h [2].
The signi icance o spi i uali y and spi i ual heal h and
i s in luence on he o he dimensions is p o essed no
only in eligious ou looks bu in secula pa adigms as
well [3]. Spi i uali y is in e p e ed in a ious ways wi hin
bo h eligious and secula communi ies, and he e is
signi ican a ia ion in how i is unde s ood ac oss
di e en eligious pe spec i es. Thus, e e yone's
spi i uali y is shaped o in luenced by eligious,
sociocul u al, his o ical, and pe sonal backg ounds and
A icle his o y:
Recei ed 1 No . 2024
Accep ed 5 Feb. 2025
Published 14 Ap . 2025
Heida i e al. J Med Edu De . 2025; 18(1): 54-64 Jou nal o Medical Educa ion De elopmen
Backg ound & Objec i e: Spi i uali y is ega ded as an essen ial aspec o heal h, and
he e o e, i should be inco po a ed in o medical educa ion o os e a holis ic unde s anding o
heal h and o de elop ully compe en medical p o essionals. Despi e he signi icance o
inco po a ing spi i ual issues in o medical educa ion, he e has been limi ed esea ch conduc ed
on his opic in I an. Va ious ba ie s ha e hinde ed he implemen a ion o spi i ually en iched
medical educa ion; howe e , he e a e also some ac o s ha acili a e his p ocess. This s udy
a emp ed o explo e he acili a o s and ba ie s o in eg a ing spi i uali y in medical educa ion
h ough a quali a i e con en analysis.
Ma e ials & Me hods: This was a si ua ion analysis designed and conduc ed as a di ec ed
con en analysis s udy. The da a collec ed om in e iews wi h medical educa ion expe s and
he e iew o ups eam documen s we e analyzed, e ealing indings ca ego ized as in e nal and
ex e nal ac o s. In e nal ac o s we e ca ego ized using he McKinsey 7S amewo k, which
includes s uc u e, sys ems, s a egies, skills, s a , s yle, and sha ed alues. Meanwhile,
ex e nal ac o s we e classi ied acco ding o he PEST model, encompassing poli ical,
economic, socio-cul u al, and echnological aspec s.
Resul s: The acili a o s and ba ie s iden i ied in his s udy encompassed a o al o 100
concep s. We iden i ied 27 in e nal and 16 ex e nal acili a o s, while he e we e ound 41
in e nal and 16 ex e nal ba ie s.
Conclusion: The indings o his s udy cla i y he s eps needed o uphold he goals and missions
o medical educa ion in he a ea o spi i ual heal h. O e coming he ba ie s while le e aging
exis ing acili a o s will be c ucial o success ully inco po a ing spi i ual heal h in o I anian
medical educa ion.
Keywo ds: medical educa ion, spi i ual heal h, acili a o s, ba ie s, I an
*Co esponding au ho :
Mo eza Heida i, School o Heal h
and Religion, Qom Uni e si y o
Medical Sciences, Qom, I an
Email: mo ezaheida [email protected]
O iginal A icle
How o ci e his a icle:
Heida i A, Yoose ee S, Adeli S H,
Ahma i Teh an H, A debili M,
Heida i M. Facili a o s and ba ie s o
he in eg a ion o spi i uali y in o
medical educa ion: A si ua ion
analysis. J Med Edu De . 2025; 18(1):
54-64.
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expe iences [4]. While spi i uali y may mani es in
di e se ways, i appea s o con e ge in i s co e meaning
and p ima y componen s, which include aspec s o
humani y such as he sea ch o meaning and pu pose in
li e, anscendence, connec ion wi h communi ies, and
he inne alue sys em in ela ion o onesel , o he s
( amily, communi y, socie y), na u e, and he signi ican
o sac ed [5, 6]. Despi e he di e si y o pe spec i es on
spi i uali y ac oss a ious cul u es and heal hca e
sys ems, in luenced by global a iances in eligious and
spi i ual belie s, he e appea s o be a g owing consensus
on he impo ance o inco po a ing spi i uali y in o
heal hca e [7-9]. The signi icance o spi i uali y in heal h
lies in he ac ha i exe s i s e ec s on he o e all well-
being o human beings in di e en ways [10]. Spi i ual
heal h is closely ela ed o men al heal h indica o s like
sel -e icacy, sel -es eem, quali y o li e, li e sa is ac ion,
and success ul coping and adap a ion [11]. On he o he
hand, insu icien spi i ual heal h leads o emo ional and
beha io al diso de s. Rega ding he de e mining ole o
spi i ual heal h on o e all heal h, plen y o s udies ha e
been conduc ed and he issue is being accep ed as an
in eg al pa o heal h esea ch. Pa ien s and hei
amilies a e inc easingly ge ing conscious o eligious/
spi i ual ac o s in heal h- h ea ening condi ions,
especially in end-o -li e and e minal illnesses [12]. Bu ,
i is necessa y o add ess he spi i ual ac o s by he
heal hca e p o essionals in all ields o medical p ac ice
[13]. I is e iden ha spi i ual in e en ions in heal hca e
equi e bo h knowledge and expe ience, which mus be
acqui ed and cul i a ed. The gap in he academic con ex
o medical educa ion is e iden , and he e is a s ong need
o in eg a e spi i uali y in o he cu iculum. To each his
end, heal hca e p o essionals should be ained in hei
unde g adua e, pos -g adua e, and con inuing medical
educa ion o achie e he equi ed compe ence [14].
Ame ican Associa ion o Medical Colleges, he Wo ld
Heal h O ganiza ion, and The Join Commission on
Acc edi a ion o Heal hca e O ganiza ions ha e
unde sco ed he inclusion o spi i uali y in heal hca e
and medical educa ion [15]. As a esul o his need, mo e
han 90 pe cen o medical schools in he Uni ed S a es
and 59 pe cen in he Uni ed Kingdom ha e included a
kind o aining in he ield o spi i uali y in hei
cu iculum [16], and i is being de eloped in B azil and
o he coun ies [17]. Ne e heless, a ious challenges
ha e impeded he de elopmen o spi i ual heal h
cu icula and hei in eg a ion in I anian medical schools'
p og ams. Cu iculum o e load, clinicians'
unwillingness o esis ance due o un el need o lack o
knowledge, and conside ing spi i uali y as a p i a e
conce n and he idea ha spi i ually could be lea ned
only h ough hidden cu iculum, a e among he obs acles
[18]. None heless, I anian ups eam documen s such as
he "I an's Twen y-Yea Vision Documen ," "The
Islamic Uni e si y Documen ," "I anian Na ional
Scien i ic Map," "I anian Scien i ic Map o Heal h," " he
Announcemen o he Second Phase o he Islamic
Re olu ion," and he "Heal h Sec o Majo Policies"
ou line a u u e ision o I anian highe educa ion as a
ci iliza ion de elope , se ing as an inspi a ion o
Islamic coun ies, commi ed o he goals o he Islamic
e olu ion, capable o nu u ing eli e schola s, and
embodying he I anian-Islamic li es yle model. These
documen s p o ide a pe spec i e o he cons uc ion o
new Islamic ci iliza ion o which bo h educa ion and
heal h sys ems a e o u mos impo ance [19]. Thus,
highligh ing he gap be ween na ional policy isions and
he exis ing s a us in di e en a eas could p o ide he
scene o ac i ely engage in hei implemen a ion. In he
a ea o spi i ual heal h educa ion in medical uni e si ies,
i seems ha he pe spec i es, hough well-designed,
ha e no been ac i ely add essed in eal si ua ions,
pa icula ly in uni e si ies o medical sciences.
The e o e, he in eg a ion o spi i uali y in he heal h
sys em and acco dingly medical educa ion could p o ide
he g ound o aining he heal hca e p o essionals in
acco dance wi h he cul u al and eligious backg ound o
people.This s udy was conduc ed wi h a quali a i e
app oach h ough sc u inizing I anian ups eam
documen s and meanwhile in e iewing medical
educa ion expe s o explo e om hei poin o iew he
acili a o s and ba ie s o in eg a ing spi i uali y in o
medical educa ion. The in e nal ba i e s and acili a o s
we e o ganized in McKinsey 7S (s uc u e, sys em,
s a egies, skills, s a , s yle, and sha ed alues)
amewo k and he ex e nal ac o s we e classi ied wi h
he PEST (poli ical, economic, socio-cul u al, and
echnological) model.
Ma e ials & Me hods
Design and se ing(s)
This si ua ional analysis s udy was ca ied ou using
quali a i e con en analysis. The s udy was based on da a
ob ained om in e iews wi h medical educa ion expe s
and a ho ough examina ion o na ional ups eam
documen s. A di ec ed con en analysis me hod was
employed, u ilizing he ‘s uc u ed’ app oach de eloped
by Elo and Kyngas (2008) ou o a ious app oaches o
di ec ed con en analysis. In he s uc u ed app oach, a
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ca ego iza ion ma ix se es as he amewo k o da a
collec ion and analysis, guiding he e iew and coding o
he da a [20]. Di ec ed con en analysis begins wi h a
amewo k o indings om p e ious s udies, which
se e as a guide o de eloping ini ial codes [21]. We
used McKinsey 7-S amewo k o in e nal ac o s and
PEST model o ex e nal ac o s as he exis ing
amewo ks o ou analysis.
The McKinsey 7-S amewo k, de eloped by Wa e man,
Pe e s, and Phillips in 1980, comp ises se en elemen s:
S uc u e, S a egy, Sys ems, S yle, S a , Skills, and
Sha ed Values. S a egy, s uc u e, and sys em a e
e e ed o as ha d S's, while sha ed alues, s yle, s a ,
and skills a e ca ego ized as so S elemen s. The
elemen s a e de ined as ollows:
S uc u e is he way an o ganiza ion is o ganized and
he way in which asks a e di ided and coo dina ed.
S a egy is he way an o ganiza ion aims o imp o e
i s posi ion in long- e m wi h he leas cos .
Sys ems mean all o mal and in o mal, sho - e m
and long- e m p ocedu es o he o ganiza ion.
S yle is he key manage s' beha io o achie ing he
o ganisa ion’s goals.
S a e e s o he pe sonnel wi hin he o ganiza ion
and hei mo ale, a i ude, mo i a ion, and beha io .
Skills a e he co e compe encies and capabili ies o
he employees o ul ill hei oles.
Sha ed alues o supe o dina e goals e e o he
cen al belie s, guiding an o ganiza ion ha go
beyond he o mal s a emen s [22].
The McKinsey amewo k is an analysis ool by which
he in e nal si ua ion o an o ganiza ion is assessed and
moni o ed. The model is based on he in e dependence
o he 7 elemen s and ha o an o ganiza ion o pe o m
well, hese se en elemen s need o be aligned and
mu ually ein o cing [23].
The PEST model, on he o he hand, consis s o Poli ical,
Economic, Socio-cul u al, and Technological ac o s.
PEST is commonly used o gi e an o e iew o he
di e en mac o-en i onmen al ac o s ha a e beyond
he con ol o an o ganiza ion [24]. PEST concep was
de eloped and in oduced in 1967 by F ancis J. Aguila
in his book: “Scanning he business en i onmen ” [25].
Poli ical ac o s include he poli ical sys em o he
coun y, egula ions, policies, and dec ees issued by
he go e nmen .
Economic ac o s include he coun y's economic
s uc u e, policies o he uling pa y, and he
economic end o he socie y.
Socio-cul u al ac o s include he social
en i onmen in which he o ganiza ion is loca ed
and on which i depends o su i al, including
educa ion, cul u al a i ude, cus oms, belie s, e c.
Technological ac o s e e o he in luence o
science and echnology on an o ganiza ion and i s
inno a ions.
The gene al amewo k o he s udy, based on he
componen s o he wo a o emen ioned models, can be
summa ized in Figu e 1.
Figu e 1. The o e all amewo k o he in e nal and ex e nal con ex o medical educa ion
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Pa icipan s and sampling
Fi een expe s pa icipa ed in he s udy and unde wen
in-dep h semi-s uc u ed in e iews. Theo e ical
sa u a ion was achie ed a e 15 in e iews. To enhance
he c edibili y o he da a, he inclusion c i e ia equi ed
pa icipan s o ha e a minimum o i e yea s o
expe ience as uni e si y ins uc o s in medical educa ion
o esea ch, along wi h published wo ks ele an o he
opic unde s udy. We aimed o maximize pa icipan
di e si y ega ding gende , age, discipline, and a ilia ed
uni e si y o ensu e ha a ange o ideas and opinions
we e ep esen ed, he eby minimizing po en ial pe sonal
and p o essional biases as well as he in luences o he
cul u al con ex o hei espec i e ci ies.
Addi ionally, he key ups eam go e nmen documen s
ele an o ou s udy we e examined and analyzed. These
included I an's "Twen y-Yea Vision Documen ," "The
Islamic Uni e si y Documen ," "I anian Na ional
Scien i ic Map," "I anian Scien i ic Map o Heal h," " he
Announcemen o he Second Phase o he Islamic
Re olu ion," and he "Heal h Sec o Majo Policies."
The inclusion c i e ia o he ups eam documen s
ocused on hei na ional scope, issuance by high
go e ning depa men s, and ele ance o he medical
educa ion sys em in a eas such as educa ion, esea ch,
heal hca e, and cul u al issues wi hin he sys em. This led
o selec ion and inclusion o six ups eam documen s.
The in e iew pa icipan s we e included in he s udy on
he basis o hei p e ious wo ks and he amoun o he
in o ma ion hey could p o ide. Mos o he in e iewees
we e iden i ied and ecognized by he esea che s, while
some pa icipan s we e e e ed o he esea che s by he
in e iewees hemsel es.
Tools/Ins umen s
We de eloped an in e iew guide acco ding o he
li e a u e and he aims o he s udy. The in e iew guide
was modi ied du ing he in e iew p ocess on he basis
o acqui ed da a and he gap o knowledge ha was
equi ed o be add essed.
Da a collec ion me hods
The ups eam documen s we e e iewed by he esea ch
eam membe s speci ically looking o concep s ela ed
o spi i ual heal h and i s in eg a ion o heal hca e and
medical educa ion. The concep s we e w i en on an MS
Wo d ile and we e analyzed. In e iews we e held
acco ding o he pa icipan s' con enience in e ms o
ime and place so ha he in e iews we e done wi h he
leas incon enience o hem and he minimum
in e up ions as a esul o hei pa allel wo k. All he
in e iews we e done by one esea che o keep
consis ency and guide he in e iew di ec ion o ill he
gaps as a as possible. The in e iew p ocess
commenced wi h an opening ques ion abou he cu en
s a us o spi i uali y in medical educa ion, ollowed by
p obing and ollow-up ques ions designed o maximize
he e ec i eness o each in e iew and ga he as much
in o ma ion as possible. Each in e iew las ed 40 o 75
minu es and hey we e eco ded wi h he pe mission and
consen o he in e iewees. A e he comple ion o each
in e iew, he da a analysis began and con inued o he
end o he in e iews. The da a analysis was done using
MS Wo d iles o he
Da a analysis
Du ing da a analysis, he ansc ibed ex s o in e iews
we e ead epea edly and he meaning uni s we e
iden i ied and he codes we e ex ac ed om hem. The
codes p oduced in his phase bo h om he documen s
and in e iews unde wen con inuous compa isons, and
simila codes we e me ged and he mos exp essi e and
app op ia e codes ha mos exac ly desc ibed he
meaning we e adop ed. The esea che highligh ed a
wo d, ph ase, sen ence, o a pa ag aph as a meaning uni .
Then, a code was a ibu ed o his meaning uni . The
codes eme ging in he p ocess o coding we e s a ed as
concep [26]. A concep is he ep esen a ion o an idea
being con eyed in a con en unde analysis [27]. In he
nex phase, he concep s we e loca ed in he ma ix
consisi ing o se en elemen s o McKinsey amewo k
and he ou elemen s o he PEST model, each
con aining a column o acili a o s and a column o
ba ie s.
Resul s
The pa icipan s included educa o s om medical
uni e si ies, encompassing medical doc o s (in e nis s,
su geons, o ensic medicine expe s, and communi y
medicine expe s), pha macologis s, epidemiologis s,
medical e hics expe s, medical educa ion specialis s,
nu sing expe s, as well as expe s in eligious s udies
and u u e s udies. The in e iewees wo ked in di e en
uni e si ies o medical sciences in I an and had ele an
expe iences and publica ions, especially in
in e disciplina y ields. O he demog aphic
cha ac e is ics o he pa icipan s a e summa ized in
Table 1.
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Table 1. Demog aphic cha ac e is ics o he pa icipan s
No
Field o s udy
Academic s a us
Gende
Reason o inclusion
1
Pulmonology
Associa e p o esso
Male
Educa ional adminis a o / Resea che / Educa o
2
Su ge y
Assis an p o esso
Male
Boa d o us ees membe / Dis inguished p ac i ione
3
Fo ensic medicine
P o esso
Male
Medical educa o / Rele an s udies and wo ks
4
Communi y medicine
P o esso
Female
Academic posi ion/ Spi i ual publica ions
5
Communi y medicine
Associa e p o esso
Female
Resea ch epu a ion and publica ions
6
Pha macology
Associa e p o esso
Male
Expe in medical philosophy and humani ies
7
Epidemiology
P o esso
Male
Academic adminis a o , educa o , and esea che
8
Medical e hics
Assis an p o esso
Male
Educa ion and esea ch backg ound
9
Medical educa ion
Assis an p o esso
Female
Me hodological and subjec expe ise
10
Medical educa ion
Assis an p o esso
Female
Me hodological and subjec expe ise
11
Nu sing
Associa e p o esso
Female
Educa ion and esea ch backg ound
12
Fu u e s udies
Assis an p o esso
Female
Medical and in e disciplina y expe
13
Religion s udies
Assis an p o esso
Male
Medical and in e disciplina y expe
14
His o y o medicine
Assis an p o esso
Male
Rele an s udies and published wo ks
15
Qo an and hadi h
Assis an p o esso
Male
Medical and in e disciplina y expe
In addi ion, he ups eam documen s p e iously lis ed
o med ano he sou ce o da a o his s udy. The da a
analysis in ol ed con inuous coding o he da a,
compa ing he codes, me ging simila codes, and
elimina ing duplica es. Finally, 100 concep s en e ed he
s uc u ed con en analysis and we e designa ed in he
p ede e mined amewo ks acco ding o hei ele ance.
Table 2 indica es he acili a o s and ba ie s o
in eg a ing spi i uali y in medical educa ion a he
in e ins i u ional le el.
Table 3 indica es he acili a o s and ba ie s o
in eg a ing spi i uali y in medical educa ion om he
ex a-ins i u ional iewpoin
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Table 2. In e nal acili a o s and ba ie s o he in eg a ion o spi i uali y in medical educa ion acco ding o he McKinsey 7S
amewo k
Fac o s
Facili a o s
Ba ie s
S uc u e
In eg a ed heal h sys em and medical educa ion
Cul u al and eligious pla o ms wi hin uni e si ies
Unde ined p og ams o s uden s' spi i ual cul i a ion in
uni e si ies
Pa ial academic au onomy
Dominan secula ou look
Lack o suppo i e mechanisms owa d spi i uali y
Weak in e disciplina y and in e p o essional in e ac ion
Lack o in as uc u e and esou ces
Sys em and p ocess
Flexibili y owa d scien i ic e idence and indings
Inclina ion o spi i ual ideas and p og ams
E hics and spi i uali y as a componen o medical
educa ion anscendence and ans o ma ion plan
G owing in e ins i u ional and in e na ional
coope a ions
Lack o mo i a ion
Lack o cu icula and educa ional ma e ials
Lack o app op ia e eaching me hods o spi i uali y
Lack o exac scales and indica o s o moni o spi i uali y
Lack o an app op ia e e alua ion sys em in he ield o
spi i uali y
S a egies
Educa o s as ole models and men o s
Ex acu icula and indi ec aining
Recogni ion o complemen a y and al e na i e
app oaches o medicine
Enhanced esea ch and pape s in he ield o
spi i uali y
Tendency o sol e local heal h p oblems
Inconsis ency wi h highe goals and documen s
Failu e o mee he eal needs o socie y
Failu e o ansla e missions in o eal and clea goals and
objec i es
Policymake s and manage s' unaligned p io i ies
Dependence on o eign and secula ex s and sou ces
Inadequa e e ec i eness o some eligious and spi i ual
in e en ions
Skills
Resea ch compe ence o acul y membe s
Insu icien compe ence in spi i ual in e en ions
O e es ima ed and unde es ima ed app oaches o spi i uali y
in medicine
Lack o mo i a ion o de elop equi ed skills
Lack o medical humani ies educa ion
S yle
(Managemen )
Top managemen 's posi i e a i ude owa d
spi i ual issues
The signi icance o p o essional e hics s anda ds
Li le conce n o spi i uali y
Rou ineness and lack o de elopmen al and c ea i e look
Insu icien pa icipa ion o employees in planning
S a egic and ope a ional plans as o mali ies
Hie a chical sys em and weak pa icipa ion
inadequa e knowledge managemen
S a
Educa o s' conce ns and pe sonal in e es s
S uden s' high capaci y and alen
Commi men o excellence and being up- o-da e
Heal hca e p o ide s' eligious and spi i ual
backg ounds
S uden s' eligious and spi i ual capaci ies
Mul iple asks o educa o s
De ec i e c i e ia o s uden admission
Non-inclusi e c i e ia o he ec ui men o educa o s
Lack o spi i ual opics in empowe men p og ams
P io i ies o he han spi i uali y
Failu e o mee essen ial and mo e angible needs
False sense o sa u a ion wi h eligious and spi i ual
concep s
Lack o consensus abou spi i uali y and i s ole in heal h
Insu icien p oduc i i y o human esou ces
Sha ed alues
(Cul u e)
The ounda ion o new Islamic ci iliza ion
Religiosi y and spi i uali y as pe sonal ai s
The spi i o accoun abili y and esponsi eness
The coali ion o wo ldly and a e wo ld conce ns
Islam-based models o spi i ual heal h
The dominance o holis ic heal h and heal hy
pe son model
Conside ing knowledge as a Godly blessing
A bene olen and compassiona e app oach o
heal h
Comme cial app oach o medicine
Dec eased eligious and mo al sensi i i y
Spi i uali y no pe cei ed as a pa ien need and demand
The dominance o he biomedical pa adigm in medicine
The p edominance o sho - e m iew a he han long- e m
plan
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Table 3. Ex e nal acili a o s and ba ie s o he in eg a ion o spi i uali y in medical educa ion acco ding o he PEST model
Con ex
Facili a o s
Ba ie s
Poli ical
Go e nmen al suppo o eligious and spi i ual issues
Ups eam documen s' emphasis on he spi i ual app oach
The ision o new Islamic ci iliza ion
The eligious iden i y o I anian go e nance
Has y and poli icized decision-making
Uns able policies despi e long- e m e ec s o spi i ual
in e en ions
A ibu ion o spi i ual app oaches o go e nance
Economic
Resis an economy app oach
Jihadi managemen as he main app oach o he coun y
Non-go e nmen al and cha i able unds
Unme low-le el needs o people
Economic challenges and issues o he coun y
Di icul y in unding and p o iding in as uc u e
Economic ensions in e e yday li e
Socio-
cul u al
His o ical backg ounds
Rich eligious sou ces
Unique ou s anding ole-models
Emphasis on Islamic-I anian li e-s yle
Family-o ien ed app oach
Religious-based social capi al and social coope a ion
The passi e app oach o spi i ual aining in amilies
Ine icien educa ion o p omo ing spi i ual ou look
Lack o hegemony o law
The eeling o injus ice, disc imina ion, and o he anomalies
inapp op ia e pe o mance o some so-called eligious
people
Insu icien heal h li e acy o people
Technological
Abundan po en ial educa ional capaci ies
Di e se and up- o-da e communica ion media and
acili ies
Mode n educa ional echnologies
The nega i e impac o he media
An i- eligious p opaganda o secula spi i uali y
In e gene a ional communica ion b eakdown
Discussion
This s udy was an a emp o analyze he s a us o
add essing he spi i ual aspec o heal h in he I anian
medical educa ion and explo e i s acili a o s and
ba ie s. The in ains i u ional acili a o s and ba ie s o
in eg a ing spi i uali y in o medical educa ion we e
ca ego ized using he McKinsey 7S amewo k, which
includes s uc u e, sys ems and p ocesses, s a egies,
skills, s a , s yle, and sha ed alues. Meanwhile, he
ex ains i u ional ac o s we e classi ied acco ding o he
PEST model, encompassing poli ical, economic, socio-
cul u al, and echnological ac o s [28]. In o he wo ds,
he s eng hs, weaknesses, oppo uni ies, and h ea s [29]
a ec ing he in eg a ion o spi i ual heal h in medical
educa ion, po en ially o ac ually, we e summed up.
Medical educa ion in I an is in e wo en wi h he
heal hca e sys em and hus, medical uni e si ies a e
mul idimensional o ganiza ions. Mckinsey 7S
amewo k ocuses on he o ganiza ion om he
managemen pe spec i e, emphasizing ha he
dys unc ion o any subsys em could obs uc o hinde
he achie emen o o ganiza ional goals [30].
Fu he mo e, he success o ailu e o he o ganiza ion is
in luenced, di ec ly o indi ec ly, by he poli ical,
economic, social, and echnological ac o s issues [31].
Despi e a consensus on he impo ance o spi i uali y in
heal h [32], he incompe ence o heal hca e p o ide s has
been a majo eason o neglec ing he spi i ual aspec o
heal h. This incompe ence la gely s ems om a lack o
in e p o essional educa ion in his a ea, which in u n
con ibu es o he eluc ance o heal hca e p o ide s o
in eg a e spi i ual issues in o hei p ac ice [33]. The
in eg a ion o spi i uali y in o medical educa ion o
aining mo e compe en heal hca e p o ide s and
consequen ly p o iding mo e espec ul heal hca e is
achie able h ough in e p o essional spi i ual cu icula
[34]. This equi es e isions in di e en pa s o
educa ion sys em as p oposed by Hosseini Moghaddan
and Hamidi who ha e conside ed he dependence o he
u u e o in e disciplina i y in I anian medical educa ion
o changes in ele an laws and egula ions [35].
Spi i ual ca e has been adi ionally ega ded as an op ion
o pallia i e ca e o end-s age pa ien s, bu i is being
ecognized as a necessi y o all pa ien s and hus i s
in eg a ion in o o mal educa ion is g owing inc easingly
[36]. Nea ly 60 pe cen o he pa icipan s o a s udy in
B i ain belie e ha a holis ic app oach in medical
educa ion necessi a es add essing he spi i ual aspec o
heal h in educa ional p og ams [37]. This incompe ence
is mainly in he skills equi ed o spi i ual in e en ions
in heal hca e ha is e idenced in his s udy as well as he
exis ing li e a u e. Since, he unde lying easons o he
lack o compe ence and li le a en ion o
in e p o essional educa ion in spi i ual heal h could be
sough in cul u al, ins i u ional, o cu iculum- ela ed
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ac o s, Imp o emen o he holis ic medical educa ion
could lead o an imp o ed heal hca e p o ision o he
pa ien s [38]. Secula iza ion as a esul o mode niza ion
and enligh enmen discou se on he o he hand, has
in luenced he sepa a ion o spi i uali y and heal h, bu
he enewed ocus on he ela ionship be ween eligion
and heal h is a sign o a pos -secula e a e en in he
highly secula coun ies [39]. To conduc a balanced and
all- ound g ow h and de elopmen , we need adequa e
s uc u e and sys em, ha should be enhanced and his
need is clea ly pe cei ed in p o iding he equi ed
s uc u e. Managemen s yle and he s a egies adop ed
by he manage s ha e a de e mining ole o de elop and
main ain his in eg a ion. I seems ha mo e lexible and
enewed cu icula acco ding o ecen condi ions a e
needed and should be de eloped [40]. P e ious s udies
e ealed ha besides pe cei ed clinical need, he igh
con ex o medical educa ion o change was among he
oppo uni ies o he in eg a ion o spi i uali y in o
medical educa ion [18]. Rega ding he s a , he alen ed
p o essionals including acul y membe s and esea che s
a e aluable asse s ha could be help ul in he
achie emen o goals and he go e ning bodies could
make he bes o hese asse s h ough mo i a ing,
suppo ing, and p o iding he equi emen s. Indi idual
ac i i es by some pionee s and inno a o s ha e always
been a s eng h [41]. Ye , he g owing a en ion o
spi i ual conce ns and conside a ions in ecen decades
in I an has been unde he in luence o he global end
a he han domes ic inno a ions [42], al hough ecen
a emp s and pu sui s a e in p og ess o he de elopmen
o medical humani ies along wi h he global end in I an
[43, 44]. Thus, he p esence o compe en human
esou ces pa icula ly young ac i is s in hese ields om
heo y de elopmen o implemen a ion and leade ship
p o ides op imism o he u u e ha gua an ees a sel -
su icien de elopmen o he coun y accompanied wi h
domes ic cul u al alues ha a e essen ially he
cons i uen s o he alue and belie sys em o he socie y.
When conside ing alues as a co ne s one o in eg a ing
spi i ual heal h in o medical educa ion, i is impo an o
ecognize ha spi i uali y wi hin he con ex o Islamic
ci iliza ion is deeply oo ed in he o iginal and pu e
eachings o he Holy Qu 'an, as well as hose o he Holy
P ophe and he Imams. This spi i uali y has i s
ounda ions in a clea unde s anding o Islamic heology,
and he mono heis ic wo ld iew. Wo ld iew is
e e yone's unde s anding and ep esen a ion o he
uni e se. Ou emphasis on he Islamic wo ld iew in
spi i uali y is based on he ac ha meaning o li e as an
aspec o spi i uali y and spi i ual heal h and e en he
emo ions a e de e mined acco ding o eligious
backg ounds [45]. In ac , e e y human being, e en he
secula s ha e hei own wo ld iew and his is he basis
o hei decisions and cul u e in gene al [46]. This
di e eni i es people in e ms o belie , beha io and
decision making in di e en ci cums ances. While
mode n li es yles equi e he coexis ence o a ious
wo ld iews, bo h eligious and secula , he majo i y o
ou coun y's popula ion iden i ies as Muslim. The e o e,
spi i uali y g ounded in his wo ld iew can be
conside ed a ounda ional in ellec ual amewo k ac oss
a ious sec o s, including medical educa ion. This has
been expe ienced in Pe sian adi ional medicine wi h he
Islamic ci iliza ion a ound one housand ago, whe e
g ea schola s like A icenna, Rhazes, Taba i, and Jo jani
had de eloped a holis ic app oach o medicine [47]. The
main poin and he ad an age o he Pe sian medicine in
he Islamic ci iliza ion e a was he in eg a ion o
spi i uali y ha was deeply embedded in medicine as an
o ganic pa and no me ely as a supplemen . Thei
ou s anding e ec on medicine was me ging I anian
adi ional medicine wi h he Islamic doc ine o igina ed
om Islamic sou ces [48] and i seems ha his could
ake place again wi h mode n conside a ions in p esen
and u u e. This is in line wi h he idea o a communi y-
o ien ed and socially accoun able app oach o medical
educa ion [49]. In his s udy, we ied o emphasize he
mul idimensional na u e o medical uni e si ies in I an
and highligh he impo ance o add essing bo h
o ganiza ional and con ex ual ac o s ha could impac
he success o in eg a ion o spi i uali y in medical
educa ion. Mo eo e , in he p esen s udy, we ied o
p o ide p ac ical solu ions o in eg a ing spi i uali y in
medical educa ion. Bu he s udy con on ed limi a ions
o igina ing om he na u e o quali a i e esea ch and
he se ing o he s udy. I seems ha mo e s udies a e
needed o p ecisely de e mine he solu ions o di e en
in e nal and ex e nal ac o s.
Conclusion
The in eg a ion o spi i ual heal h in o medical educa ion
in I an encoun e s bo h acili a o s and ba ie s.
Facili a o s a e p ima ily oo ed in he s ong cul u al
backg ound and eligious o ien a ion o he people, as
well as in he go e nance ha p o ides a suppo i e
socie al con ex o his in eg a ion. Addi ionally,
g owing ecogni ion among medical p o essionals o he
impo ance o holis ic heal h, including spi i ual aspec s,
con ibu es o a mo e ecep i e academic en i onmen .
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62 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1 ¦ 2025
Howe e , se e al ba ie s hinde his in eg a ion p ocess.
These challenges include a lack o s anda dized cu icula
ha add ess spi i ual heal h, limi ed acul y expe ise in
eaching he spi i ual aspec s o heal hca e, and po en ial
esis ance om indi iduals who iew medicine solely
h ough a biomedical lens. O e coming hese ba ie s
while le e aging exis ing acili a o s will be c ucial o
success ully inco po a ing spi i ual heal h in o I anian
medical educa ion.
E hical conside a ions
This s udy was app o ed by he Na ional Agency o
S a egic Resea ch in Medical Educa ion (code No.
972424). The esea che s adhe ed o e hical p inciples
and guidelines h oughou he cou se o he s udy. To
ob ain in o med consen om he pa icipan s, he
objec i es and o e all amewo k o he s udy we e
clea ly explained. All necessa y measu es we e aken o
ensu e he con iden iali y o he da a du ing he
in e iew, da a analysis, and p epa ing he epo and he
a icle manusc ip . To a oid he po en ial biases o he
esea che ha migh a ise om cul u al backg ounds,
expe iences, and alues and hei in luence on he
in e p e a ion o he da a, di e en s a egies we e
conside ed. The iangula ion o in e iews along wi h
documen analysis was he main s a egy and
u he mo e, b acke ing was used o se aside
p econcei ed no ions and app oach he da a objec i ely.
On he o he hand, he di e si y o he pa icipan s helped
o a oid pe sonal biases by he esea che .
A i icial in elligence u iliza ion o a icle
w i ing
A i icial in eligence was no u ilized in p epa a ion o
his a icle.
Acknowledgmen
The au ho s would like o hank all schola s who kindly
pa icipa ed in his s udy and con ibu ed o ou
indings.
Con lic o in e es s a emen
The au ho s decla e ha hey ha e no con lic o
in e es .
Au ho con ibu ions
All he au ho s con ibu ed in ini ial design and
concep ion o he s udy. MH conduc ed he in e iews
and hei ansc ip ion. HAT, SY, SHA and MA we e
in ol ed in he analysis and in e p e a ion o he da a.
AH p epa ed he d a o he manusc ip and all he
au ho s ead and app o ed i s con en o be published.
Funding
This s udy was unded by he Na ional Agency o
S a egic Resea ch in Medical Educa ion (NASR) wi h
code No. 972424.
Da a a ailabili y s a emen
The da a a e a ailable om he co esponding au ho
upon easonable eques .
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