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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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Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 1¦ 2025 55
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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