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The ole o hidden cu iculum in modeling p o essional e hics by
e alua ing he expe iences o medical s uden s: A
phenomenological s udy
Yadolah Za ezadeh 1 , Yahya Sa a i 2* , Hossein Ash a ian 3 , Nas in Youse pou 2
1Depa men o Medical Educa ion, School o Medicine Ku dis an Uni e si y o Medical Sciences.
2Resea ch Cen e o En i onmen al De e minan s o Heal h (RCEDH), Heal h Ins i u e, Ke manshah Uni e si y o Medical Sciences,
Ke manshah, I an
3Depa men o Heal h Educa ion and P omo ion, Heal h Facul y, KUMS, Ke manshah, I an
A icle in o Abs ac
In oduc ion
The ole o he hidden cu iculum in de eloping
p o essional e hics as a basis o lea ning communica ion
skills wi h pa ien s is a key issue in he medical
p o ession, and his issue, along wi h o he p o essions,
is implici ly conside ed a componen o he hidden
cu iculum in medicine. E idence sugges s a s ong
ela ionship be ween he hidden cu iculum and
p o essional de elopmen [1]. This is because he o mal
educa ion p o ided by uni e si y cou ses in many
acul ies wo ldwide has ailed o achie e he goals
ela ed o he de elopmen o p o essional e hics in
lea ne s [2]. Paying a en ion o he hidden cu iculum is
c ucial in p o iding a pla o m o he de elopmen o
e hics, as lea ne s o en acqui e e hics h ough he
en i onmen and a mosphe e c ea ed by he cu iculum.
The e o e, uni e si ies each s uden s mo e han wha do
hey claim [3]. Al hough some elemen s o he
cu iculum mus be de e mined in ad ance, a wide ange
A icle his o y:
Recei ed 27 Dec. 2024
Accep ed 23 Jun. 2025
Published 13 Jul. 2025
Za ezade e al. J Med Edu De . 2025; 18(2): 75-85 Jou nal o Medical Educa ion De elopmen
Backg ound & Objec i e: Role modeling by physicians plays a key ole in shaping he
p o essional compe encies, alues, and a i udes o medical s uden s. I is pa icula ly
signi ican o s uden s in clinical educa ion se ings. This phenomenological s udy aimed o
elucida e he ole o he hidden cu iculum in modeling p o essional e hics by examining he
expe iences o medical s uden s a Ke manshah Uni e si y o Medical Sciences.
Ma e ials & Me hods: A quali a i e app oach u ilizing a phenomenological me hod was
conduc ed wi h a pu posi e sample o 12 inal-yea medical s uden s om Ke manshah
Uni e si y o Medical Sciences du ing hei in e nship pe iod. The da a collec ion me hod was
a semi-s uc u ed in e iew. The mean du a ion o each in e iew was 75 minu es. Da a
in e p e a ion was pe o med using Colaizzi's se en-s ep app oach.
Resul s: O e all, six main hemes eme ged om he da a, which include (1) Modeling
p o essional e hics di ec ly and indi ec ly h ough he aining and beha io o p o esso s, (2)
Modeling p o essional e hics om socie al in luences and non-p o essional in e ac ions wi h
p o esso s, (3) Modeling posi i e o nega i e p o essional e hics based on ex e nal
ci cums ances (4) Mo i a ion o s uden s o emula e p o essional e hics (5) Belie s in
possessing inhe en abili ies o model p o essional e hics (6) Cha ac e is ics o p o esso s as
models o p o essional e hics.
Conclusion: Acco ding o he esul s o his s udy, s uden s play a signi ican ole in modeling
o p o esso s he impo ance o acqui ing p o essional e hics. This in ol es imp o ing
educa ional condi ions, encou aging eache s o be mind ul o hei beha io in clinical
en i onmen s, and c ea ing sui able modeling oppo uni ies. Addi ionally, i is ecommended
o inc ease he numbe o p o esso s who can se e as ole models in p o essional e hics.
Keywo ds: p o essional e hics, hidden cu iculum, medical educa ion, ole modeling,
phenomenology
*Co esponding au ho :
Yahya Sa a i, Resea ch Cen e o
En i onmen al De e minan s o
Heal h (RCEDH), Heal h Ins i u e,
Ke manshah Uni e si y o Medical
Sciences, Ke manshah, I an.
Email: ysa a [email protected]
O iginal A icle
How o ci e his a icle:
Za ezade Y, Sa a i Y, Ash a ian H,
Youse pou N. The ole o hidden
cu iculum in modeling p o essional
e hics by e alua ing he expe iences
o medical s uden s: A
phenomenological s udy . J Med Edu
De . 2025; 18(2): 75-85.
[ DOI: 10.61882/edcj.18.2.75 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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: Hidden cu iculum and p o essional e hics in medical s uden s
76 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
o eaching me hods should be conside ed a he ime o
implemen a ion o maximize lea ning oppo uni ies.
The e o e, he hidden cu iculum is some imes in line
and occasionally in con lic wi h he o icial cu iculum
[4]. As a esea ch me hodology, phenomenology is
uniquely posi ioned o help heal h p o essions educa ion
(HPE) schola s lea n om he expe iences o o he s.
Phenomenology is a o m o quali a i e esea ch ha
ocuses on he s udy o an indi idual's li ed expe iences
wi hin he wo ld [5]. Philip Jackson de ined he e m
“hidden cu iculum” in 1968 o desc ibe he a i udes and
belie s ha child en mus lea n as pa o he socializa ion
p ocess o succeed in school. F ede ic Ha e y i s
de ined he e m medical educa ion and was he i s o
apply his concep o he medical ield in 1994 [6]. A
s udy en i led "Role Models and Teache s" demons a es
ha doc o s in aining a e no me ely ecipien s o he
hidden cu iculum; ins ead, hey ac i ely engage wi h
e hics in he wo kplace, in luenced by hei pe cep ions
o alues [7]. Meanwhile, ole modeling by doc o s helps
in de eloping he p o essional compe encies, alues, and
a i udes o medical s uden s. The h ee main
cha ac e is ics o a posi i e ole model include clinical
skills, eaching abili ies, and pe sonal quali ies [8]. Role
modeling is impo an o s uden s in clinical educa ion
se ings. Clinical p o esso s' awa eness o hei
p o essional cha ac e is ics, a i udes, and beha io s can
help c ea e be e eaching-lea ning expe iences [9].
I is essen ial o ecognize ha he p ima y objec i e o
eaching s uden s is o shape medical p o essional e hics,
os e a p o essional iden i y, impa e hical p inciples,
add ess challenging clinical expe iences, elimina e
nega i e ole models among doc o s in clinical se ings,
and modi y s uden s' a i udes [10]. The e o e, i seems
necessa y o ha e a sui able cu iculum o eaching
hese compe encies. The s udy by de Lemos Ta a es e
al. [11] i led "Unde s anding he Me hods Used in he
Teaching o Bioe hics in Medical Educa ion
Wo ldwide," analyzed 2,993 a icles, o which 72 me
he p e-selec ed c i e ia and we e included in he e iew.
The cha ac e is ics o bioe hics educa ion ha s ood ou
in he analysis included he ollowing: signi ican
he e ogenei y in eaching ac oss di e en uni e si ies,
he use o a ious me hodologies in he eaching and
lea ning p ocess, and disconnec ion be ween educa ion
and he s uden 's medical p ac ice. This highligh s he
need o in eg a e he cu iculum wi h clinical p ac ice
and add ess he challenges in he eaching and lea ning
p ocess. Mos s udies in his e iew sugges ha he e a e
cu en ly no es ablished minimum pa ame e s o he
ideal me hod o eaching bioe hics. This lack o
consensus may con ibu e o s uden s eeling unp epa ed
o con on e hical issues in clinical p ac ice despi e
ha ing acqui ed he necessa y heo e ical knowledge
[12]. Sulli an e al., in a s udy i led "A No el Pee -
Di ec ed Cu iculum o Enhance Medical E hics
T aining o Medical S uden s: A Single-Ins i u ion
Expe ience," s a ed ha ass oo s medical e hics
educa ion emphasizes expe ien ial lea ning and pee - o-
pee in o mal discou se o e e yday e hical
conside a ions in he heal h ca e se ing. S uden
engagemen in cu icula de elopmen , e lec i e
p ac ice in clinical se ings, and pee -assis ed lea ning
a e s a egies o enhance clinical e hics educa ion [13].
Ga za e al. s udy unde he i le "Teaching Medical
E hics in G adua e and Unde g adua e Medical
Educa ion". None o he ials inco po a ed psychia y
esiden s. E hics educa o s should unde ake addi ional
igo ously con olled ials o secu e a s ong e idence
base o he design o medical e hics cu icula.
Psychia y e hics educa o s can also bene i om he
indings o ials in o he disciplines and unde g adua e
medical educa ion [14]. Passi e al. [15] demons a e
ha s uden s a e in luenced by hei eache s' beha io ,
which se es as ole modeling. This modeling some imes
occu s posi i ely and some imes in a nega i e manne .
The e o e, wha is ans e ed o s uden s in he o m o
di ec educa ion does no necessa ily mean he o ma ion
o p o essional e hics in hem; a he , he posi i e and
nega i e modeling o p o esso s occu s indi ec ly and
wi hou p io in en ion. This opic add esses he p ocess
o s uden s lea ning h ough he ole modeling o hei
p o esso s. Fo his eason, e e y day, he in luence o
clinical en i onmen s is g ea e han he in luence o
o mal educa ion cu icula [16]. By e iewing p e ious
s udies, i can be acknowledged ha despi e being
educa ed abou medical e hics and p o essionalism,
s uden s o en exhibi une hical beha io s. I seems ha
a change in he eaching o p o essional e hics is
necessa y [17]. The esul s o hese s udies p ima ily
indica e he nega i e impac o he hidden cu iculum.
Some aspec s o communica ion a ibu ed o he hidden
cu iculum a e ela ed o he non- o mal cu iculum. This
p ocess shows ha p o essional e hics aining is no
ideal [18]. The e o e, p epa ing and e ising he
cu iculum o p o essional e hics and inco po a ing i
in o he educa ional con en is conside ed necessa y o
imp o e he le el o p o esso s' abili ies in de eloping
s uden s' p o essional e hics [19]. Mo eo e ,
disp opo iona e a en ion o he scien i ic dimensions o
[ DOI: 10.61882/edcj.18.2.75 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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: Hidden cu iculum and p o essional e hics in medical s uden s
Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 77
he cu iculum has led o neglec o o he dimensions and
hei ole in shaping p o essional e hics [20]. The
li e a u e equen ly depic s he hidden cu iculum as
nega i e o in con lic wi h he o mal cu iculum.
Howe e , he hidden cu iculum can ha e a p o oundly
posi i e impac on s uden s' expe iences and hei
de elopmen o p o essionalism. In addi ion, s udies
ha e shown he nega i e ou comes o he hidden
cu iculum, such as he p oblem o ans e ing
p o essional alues and e hics. Fu u e esea che s should
ocus on he posi i e ou comes as a s a egy o
compensa e o he loss o p o essional e hics [21].
Conside ing he impo ance o he subjec and he
exis ing in o ma ion gap in his ield, his esea ch was
designed and implemen ed o explo e he ole o he
hidden cu iculum in shaping p o essional e hics by
examining he expe iences o medical s uden s a
Ke manshah Uni e si y o Medical Sciences using a
phenomenological me hod.
Ma e ials & Me hods
Design and se ing(s)
The p esen s udy employed a quali a i e app oach wi h
a phenomenological me hod a Ke manshah Uni e si y
o Medical Sciences in 2013. Husse l is a key igu e in
phenomenology, and his goal was o gain a deepe
unde s anding o undamen al aspec s o human
expe ience, such as ime, pu pose, colo , and numbe .
Phenomenology a emp s o unde s and how pa icipan s
make sense o hei expe iences. A phenomenologis
conside s he meanings o expe ience and desc ibes he
li e wo ld [22].
Pa icipan s and sampling
The s udy's s a is ical popula ion consis s o all
in e nship-pe iod s uden s and inal-yea medical
s uden s. Sample selec ion was pu pose ul and based on
he p inciple o heo e ical sa u a ion. The numbe o
samples eached 12 pa icipan s wi h heo e ical
sa u a ion. In o ma ion abou he pa icipan s is
p esen ed in Table 1.
The c i e ion o achie ing da a sa u a ion in his s udy
was he epe i ion o p e ious da a, allowing esea che s
o encoun e da a ha we e epea ed egula ly. In his
s udy, he esea che s encoun e ed epe i i e codes
du ing da a coding un il no new hemes we e iden i ied
om he in e iews. As a esul , he low o da a
collec ion was s opped. Sampling was pe o med by
pu posi e me hod. Pu posi e sampling is a me hod
widely used in quali a i e esea ch o iden i y and selec
high-quali y i ems o he mos e ec i e use o limi ed
esou ces. This includes iden i ying and selec ing
indi iduals o g oups o indi iduals who possess he
mos expe ience and knowledge, pa icula ly abou he
phenomenon [23].
Da a collec ion me hods
Da a we e collec ed h ough semi-s uc u ed in e iews.
Be o e he in e iew, each pa icipan was con ac ed ia
mobile phone. In a sepa a e ace- o- ace mee ing, he
pa icipan s we e also sa is ied. Ve bal consen was
ob ained om pa icipan s o pa ake in he in e iews,
and he necessa y explana ions we e p o ided o his
pu pose. The in e iews began wi h gene al key
ques ions and p og essed o mo e de ailed inqui ies.
Sample in e iew key ques ions include: "Who did you
ole model in you expe iences in medical educa ion?"
"Wha cha ac e is ics did hese ole models ha e?"
"Wha was he na u e o hese ole model expe iences?"
"Wha impac did he ole models ha e on you
p o essional li e?" "Who and how ha e you expe ienced
e hical modeling"? All in e iews we e simul aneously
eco ded, and a emp s we e made o con i m he
in e iewe 's pe cep ion o he pa icipan s. The da a
ob ained om each in e iew we e coded and in e p e ed
immedia ely a e da a collec ion. E o s we e also
made o gain pa icipan s' us and unde s anding o he
esea ch en i onmen . Th ee indi iduals who we e
al eady amilia wi h he quali a i e esea ch and coding
p ocess coded h ee eco ds o assess he accu acy and
objec i i y o he da a. The coe icien o simila i y
be ween he code s was es ima ed o be a an accep able
le el. A e coding, he ex s we e e u ned o some
pa icipan s o con i m he accu acy o he ex ac ed
codes and in e p e a ions, allowing he esea che o
each a simila unde s anding. All pa icipan s a emen s
we e eco ded and no ed du ing he in e iew and
con i med by he pa icipan s a he same ime. In cases
whe e he e was ambigui y abou he s a emen , i was
econciled wi h he pa icipan s by elephone o a oid
e o s in da a in e p e a ion and coding. The da a
ob ained om each in e iew we e analyzed using a
phenomenological app oach.
Da a analysis
In his s udy, Colaizzi's se en-s ep app oach was
employed o in e p e he da a. The in o man s' i s
explana ions o he expe iences a e ead o gain a gene al
sense. Subs an ial exp essions a e hen ex ac ed.
Meanings a e o mula ed om impo an p oposi ions.
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78 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
The meanings o mula ed in he hemes a e o ganized.
Themes a e in eg a ed in o a comp ehensi e desc ip ion.
The basic s uc u e o he phenomenon is o mula ed.
Finally, o alida e he in o ma ion p o ided by he
pa icipan s, he analysis esul s a e e alua ed o
de e mine i hey align wi h hei ini ial expe iences [24].
Va ious me hods we e employed h oughou he s udy o
ensu e he accu acy and eliabili y o he da a. E o s
we e made o build us wi h pa icipan s and enhance
hei pe cep ion o he esea ch en i onmen h ough
long- e m communica ion and consis en con ac wi h
he esea ch si es. Th ee indi iduals we e esponsible o
coding he da a o ensu e i s accu acy and objec i i y.
A e coding, he ansc ip s we e e u ned o some
pa icipan s o con i m he accu acy o he ex ac ed
codes and in e p e a ions.
Table 1. Cha ac e is ics o he pa icipan s
Pa icipan
No.
Gende
In e iew du a ion
(minu es)
Age
(yea s)
Ma i al s a us
In e iew
loca ion
Academic
s age
O igin
1
Female
70
25
Single
wa d o ice
in e nship
pe iod
F om
Ke manshah
2
Male
60
31
Ma ied
Lib a y space
inal yea
s uden s
Ou side
Ke manshah
3
Female
75
32
Ma ied
Lib a y space
inal yea
s uden s
F om
Ke manshah
4
Male
70
26
Single
Educa ion
O ice
inal yea
s uden s
Ou side
Ke manshah
5
Male
70
28
Single
Educa ion
O ice
in e nship
pe iod
Ou side
Ke manshah
6
Female
95
30
Single
Educa ion
O ice
inal yea
s uden s
F om
Ke manshah
7
Female
90
27
Single
Educa ion
O ice
inal yea
s uden s
F om
Ke manshah
8
Female
85
30
Single
wa d o ice
in e nship
pe iod
F om
Ke manshah
9
Male
65
34
Ma ied
Educa ion
O ice
inal yea
s uden s
Ou side
Ke manshah
10
Female
80
26
Single
wa d o ice
inal yea
s uden s
F om
Ke manshah
11
Male
60
30
Single
wa d o ice
in e nship
pe iod
F om
Ke manshah
12
Female
80
28
Single
Lib a y space
inal yea
s uden s
F om
Ke manshah
Resul s
In he p esen phenomenological s udy, he esea che
conduc ed he in e iews pe sonally. This was e y
help ul in achie ing a holis ic sense o all he
pa icipan s' expe iences. Audio eco dings we e lis ened
o mul iple imes, and he yped ansc ip s we e ead
ca e ully o gain a deepe unde s anding o he
pa icipan s' hough s and eelings. The esea che
ex ac ed signi ican ph ases om he yped ex , s udied
hem mul iple imes, and analyzed he con en o cap u e
he whole meaning o he expe ience. This p ocess was
conduc ed o iden i y key ph ases wi hin he in e iew
ansc ip s. These s a emen s we e made sepa a ely o
each pa icipan . A o al o 188 codes we e ex ac ed.
Since all he codes a e ex ensi e, Table 2 p esen s a
selec ion o s a emen s om he in e iews along wi h
examples o coding om he in e iew ansc ip s. These
codes we e andomly chosen om ou in e iew. A
o mula ion o meanings, he esea che a emp ed o
o mula e mo e gene al e ellings o meanings o each
impo an ph ase in he ex . Meanings we e o mula ed
om impo an sen ences. This is necessa y because i
helps o p e en misin e p e a ion o he pa icipan 's
iews. These o mula ed meanings we e hen coded and
ca ego ized. A his s age, 31 codes we e de i ed om
he o al o 188 codes ob ained in he second s age. Table
3 shows 31 codes ha show how impo an ph ases
became o mula ed meanings.
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: Hidden cu iculum and p o essional e hics in medical s uden s
Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 79
Table 2. Examples o impo an p oposi ions
Impo an p oposi ions
Sample key poin s in in e iews
Pa icipan
No/Code
- I did no lea n e hics om p o esso s.
- Modeling o doc o s ou side he hospi al.
- Ou mo ali y is in luenced by ex e nal ac o s a he
han he o mal lesson.
I did no lea n om he p o esso s. I emula ed no om he hospi al bu om he
doc o s ou side he hospi al wi h whom I am in ima e. My mo al p ac ice is no o
imi a e p o esso s. The impo an hing is ha we a e all human. Ou mo als a e mo e
in luenced by ex e nal ac o s han o mal educa ion.
1
- Mo e modeling is done a he head o he isi .
- Modeling o amily and en i onmen .
- Modeling he en i onmen and beha io o colleagues
and p o esso s wi h he pa ien .
- The pe sonali y o he p o esso s is modeled.
- De ail and ime.
- Excellen eaching me hod and beau i ul explana ion.
I lea ned he aining mo e du ing he isi . I also lea ned a i udes om my wo k
en i onmen , om he beha io o colleagues and p o esso s. I hink hei knowledge
and cu en p ac ice we e excellen . Thei ea men o he pa ien , pe sonali y,
insigh , and ime we e excellen . Mos mas e s, hough, a e good. His excellen
eaching explains beau i ully.
3
- I I see a sha p eac ion, I will lea n no o be like his
mysel .
- C owded en i onmen and high wo kload a ec e hics.
I did no no ice his issue du ing my clinical wo k, and I ha e no speci ic c i icisms.
Fo example, a Imam Reza Hospi al, some doc o s a e equi ed o demons a e a
g ea deal o pa ience. When I wi nessed a ha sh in e ac ion, I did no eel i was my
place o c i icize. Howe e , I lea ned om i by esol ing no o beha e ha way
mysel . I only wish he doc o had ac ed di e en ly.
4
- I had many mo al ole models among my p o esso s.
-Thei li e acy, diagnos ic abili y, and communica ion
skills se ed as ole models o me.
-I aspi e o ea my pa ien s he way hey do.
-Thei consis en and p o essional p esence in he clinic
was admi able.
-E e y hing abou hei app oach was in e es ing o me.
I had many ole models among my p o esso s, including D . Bus ani (a neu ologis ),
D . Jahanbakhsh (a pulmonologis ), D . Sayad, and D . Da a i Nejad (a
psychia is )
.
I was pa icula ly inspi ed by hei medical knowledge, diagnos ic skills, and he way
hey in e ac ed wi h pa ien s
.
I o en asked hem how hey managed hei ela ionships wi h pa ien s and how hey
el abou wo king wi h di e en diseases. I aspi e o ea my own pa ien s he way
hey did.
5
-My pa en s also played an impo an ole in my success.
-Demons a ing help and genuine en husiasm o he
pa ien is an excellen example o ollow.
-I belie e ha lea ning p o essional e hics occu s mo e
e ec i ely a he pa ien ’s bedside.
They ha e been ole models o me bo h in e ms o hei p o essional e hics and hei
ole as educa o s. In addi ion, my pa en s played a signi ican ole in shaping my
success and li e pa h. My a he is a doc o , and my mo he is a nu se. Thei
pe spec i es on pa ien ca e g ea ly in luenced me and ga e me meaning ul
expe iences. My mo he , in pa icula , speaks abou he pa ien s and hei illnesses
wi h genuine ca e and en husiasm. Bo h o hem ha e uly been inspi ing ole models
in my li e.
6
- Lea ning p o essional e hics happens mo e in he
pa ien 's bedside.
- How o ea he pa ien is a model o me.
- The appea ance is nea and idy and he doc o 's
beha io is modeled
We encoun e pa ien s a he bedside, obse e hei symp oms i s hand, and gain
aluable lea ning expe iences in ha se ing.
7
-The way hey ea ed pa ien s became a model o me.
-Thei nea appea ance and p o essional beha io we e
exempla y.
-Teache s who demons a ed s ong e hics and a solid
wo k e hic became my ole models.
-Un o una ely, some esiden s ques ioned ou ield and
made us eel discou aged.
We lea ned many impo an lessons ou side he class oom.
A signi ican pa o ou lea ning came om obse ing ou p o esso s—especially
how hey in e ac ed wi h each o he .
I also lea ned a g ea deal om senio s uden s and om my own cul u ally g ounded
amily, pa icula ly my a he , who emphasized he impo ance o espec ul beha io .
P o esso s who demons a ed s ong e hics and p o essionalism became ole models
o me.
A he same ime, I made a conscious e o no o ollow he example o hose who
lacked hese quali ies.
I lea ned a lo om obse ing people's a i udes and beha io s.
12
-I also lea ned aluable lessons om hose who lacked
p o essionalism—I lea ned wha no o do.
-The a i udes and beha io s o my p o esso s augh me a
lo .
-A ound 90% o my ole models we e p o esso s.
-The o mal e hics cou se had li le o no impac on me.
-Consis ency in ac ions and beha io became a s anda d I
ied o ollow.
-P o esso s who we e knowledgeable and con iden
se ed as ole models.
We lea ned many aluable lessons ou side he class oom
.
A signi ican pa o his lea ning came om obse ing ou p o esso s—especially
how hey in e ac ed wi h one ano he
.
I also gained a g ea deal om senio s uden s and om my cul u ally g ounded
amily, pa icula ly my a he , who consis en ly emphasized he impo ance o
espec ul beha io
.
P o esso s who embodied s ong e hics and p o essionalism na u ally became ole
models o me
.
A he same ime, I made a conscious e o o a oid ollowing he example o hose
who lacked hese quali ies
.
Much o wha I lea ned came om obse ing people’s a i udes and beha io s in eal-
li e si ua ions. Abou 90% o my ole models we e p o esso s.
8
-I looked up o p o esso s whose wo ds ca ied weigh
and we e consis en o e ime.
-I admi ed hose whose ac ions aligned wi h hei wo ds
and alues— hey we e ue ole models.
-E en hei belie s as doc o s se ed as ole models o
me.
We had a medical e hics cou se in ou second yea (M2), bu i had li le impac
.
Wha uly in luenced me we e hose whose alues we e consis en —whose ac ions
aligned wi h hei wo ds and belie s
.
11
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Table 3. Examples o o mula ed meanings o impo an p oposi ions
I em #
Examples o o mula ed meanings o impo an p oposi ions
1
Lea ning nega i e ole modeling o e hics
2
Modeling om ou side he educa ional en i onmen
3
Di ec posi i e ole modeling o e hics
4
Modeling he eache s' beha io wi h he pa ien
5
Modeling he pe sonali y o p o esso s
6
Modeling he posi i e beha io o eache s
7
Modeling o eache s' aining; posi i e modeling o nega i e beha io
8
Condi ions ha nega i ely a ec modeling
9
The le el o li e acy and knowledge o p o esso s is modeled
10
Tendency o imi a e he beha io o p o esso s in p ac ice
11
All aspec s o eache s' beha io se e as models
12
The ado ned appea ance o he mas e s se es as a model
13
The spi i uali y o eligious belie s is modeled
14
Sac i ice and sel -sac i ice a e exempli ied
15
Belie in he na u e o mo ali y
16
Modeling o p o esso s' in e ac ions
17
Modeling he beha io o pee s in ac ion
18
Teaching e hics has no e ec on e hical p ac ice
19
P o esso s who ac i ely demons a e e hical beha io a e modeled
20
Helping people is a good ole model o e hical ac ion
21
The ole o nega i e ein o cemen in modeling (escape om punishmen )
22
Obse ing e hics o he sake o ma e ial hings
23
The ole o condi ions in obse ing e hics
24
Ad e ising has an e ec on e hics
25
The posi i e e ec o s ic ness on e hics
26
E hics is oo ed in he amily and school
27
The empla e mus be gene ally accep ed
28
Modes p o esso s a e ole models
29
S ic eache s a e mo e likely o be ole models han easygoing eache s
30
Helping he pa ien is a good ole model
31
The ounda ions o mo ali y a e oo ed in amily and iends
A e ob aining he o mula ed meanings o he
impo an p oposi ions, he esea che a anged hem
in o ca ego ies o hemes. The sub hemes we e hen
consolida ed in o eme ging hemes, indica ing ha each
" o mula ed meaning" o igina es om a single clus e o
hemes. A his s age, he 31 sub hemes de i ed om he
s uden s' in e iew expe iences we e combined and
condensed, esul ing in a o al o six main hemes. These
hemes a e shown in Table 4. Findings om he
in e iews led o he iden i ica ion o main hemes
h ough an induc i e p ocess and he o mula ion o
meaning ul insigh s. Sample hemes and pa icipan s'
s a emen s ega ding each heme a e p esen ed below.
Table 4. C ea e clus e s o hemes de i ed om o mula ed meanings
Fo mula ed meanings
Theme clus e s
Lea ning nega i e ole modeling o e hics
Modeling p o essional e hics di ec ly and indi ec ly
om he aining and beha io o p o esso s
Modeling he p o esso s' beha io wi h he pa ien
Modeling he pe sonali y o p o esso s
Modeling he posi i e beha io o eache s
Modeling o p o esso s' in e ac ions
E hics is oo ed in he amily and school
Modeling p o essional e hics om he communi y and
people o he han p o esso s
Disc imina ion and nega i e pa e ning
Modeling om ou side he educa ional en i onmen
The ole o nega i e ein o cemen in modeling
Modeling posi i e o nega i e p o essional e hics
unde he in luence o ci cums ances
In luence o he mo al model o he economic si ua ion
Tendency o imi a e by obse ing he e hics o p o esso s in ac ion
Mo i a ion o s uden s o model p o essional e hics
Con i ming ha ad e ising in luences mo ali y
I he s uden wan s, all aspec s o he p o esso s' beha io a e exempla
Belie in he na u e o mo ali y
Belie s in inhe en capabili ies ela ed o modeling
p o essional e hics
The spi i uali y o eligious belie s is modeled
Sac i ice and sel -sac i ice a e exempla y
No e ec on e hics educa ion
Role modeling posi i e beha io as a esul o obse ing nega i e beha io s
Helping people is a good ole model
Cha ac e is ics o p o esso s who model p o essional
e hics
The ado ned appea ance o he mas e s is pa e ned.
The p o esso s who a e he agen s hemsel es a e modeled
Modes p o esso s a e ole models
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Modeling p o essional e hics di ec ly and
indi ec ly om p o esso s
Pa icipan 1 (Bo n in 1995, non-na i e,. Final yea o
medicine) said,
"I didn' lea n om he p o esso s; I also lea ned om
my wo k en i onmen , om he beha io o my
colleagues and p o esso s, and hei egula p esence a
he clinic." "E e y hing abou hem was in e es ing o
me." "They a e my ole models, bo h in hei p o essional
e hics and in hei educa ional ole." "The way hey
egula ly a end he clinic." "E e y hing abou hem has
been in e es ing o me." "They a e my ole models, bo h
in hei p o essional e hics and in hei educa ional
ole."
Modeling p o essional e hics om he
communi y
Pa icipan 3 (Final yea o medicine s uden p , na i e,
ma ied) said,
"I ook as a model he beha io o many people o he
han p o esso s." "Mo e han 90% o he in e ac ions
wi h o he s we e om p o esso s". "I lea ned e hics om
my amily and iends." "I don' ha e any hing special o
say, bu I can only say ha ex e nal ac o s mo e
in luence ou mo ali y han o mal lessons."
Modeling p o essional e hics unde he
in luence o ci cums ances
Pa icipan 4 (In e n s uden , na i e, single) said,
"Rega ding p o essional e hics, I mus say ha he e a e
se e al issues ha we g ew up wi h and we e in luenced
by since childhood. I didn' lea n om p o esso s." "We
see he pa ien a he bedside, we see he symp oms o
hei illness, and we lea n a lo o hings he e. Passing
classes has no e ec ."
Mo i a ion o s uden s o model p o essional
e hics
Pa icipan 5 (In e n. Non-na i e and single) said,
"I de e mine mos o i mysel ." "I modeled i no on he
hospi al, bu on doc o s ou side he hospi al who I am
close o." "I do wha I know is igh ." "Medicine is bo h
p o i able and accep ed in socie y." "This mo i a es me
o uphold he e ique e."
Belie s in ha ing inhe en capabili ies in
modeling p o essional e hics
Pa icipan 12 (In e n, non-na i e, single) said,
"I like helping pa ien s because o my conscience and he
good eeling i gi es me." "I belie e ha i a pe son's
na u e is pu e, hey will obse e mo ali y." "I conside
God mo e. I don' ca e wha o he people hink o
app o e o me in his ega d." "I you essence is pu e,
e e y hing will be ine."
Cha ac e is ics o p o esso s who model
p o essional e hics
Pa icipan 7 (Final yea o medicine s uden , in e n,
na i e, single) said,
"I was in e es ed in he ype o ela ionship he
p o esso s had wi h he pa ien s." "They' e asking abou
he pa ien 's well-being. Thei sa is ac ion wi h he ype
o illness". "I would like o ea my pa ien s like hey do.
Thei egula p esence a he clinic." "I was in e es ed in
e e y hing abou hem. They a e my ole models, bo h in
hei p o essional e hics and in hei educa ional ole".
Discussion
Medical science p o esso s a e a key elemen in medical
e hics educa ion, as hey can shape he mo al and
p o essional cha ac e o s uden s. This s udy aimed o
explain he ole o he hidden cu iculum in shaping
p o essional e hics by examining he expe iences o
medical s uden s a Ke manshah Uni e si y o Medical
Sciences. F om he in e iews, a o al o 188 open codes
we e iden i ied. By me ging codes wi h simila hemes
du ing he axial coding s age, a o al o 36 axial codes, o
sub hemes, we e gene a ed. In he hi d s age, he
esea che ob ained ca ego ies o he six main hemes.
The i s main heme ob ained om he da a analysis was
"modeling p o essional e hics om he eaching and
beha io o p o esso s di ec ly and indi ec ly." This
heme included six ca ego ies o sub hemes, including
"Nega i e mo al pa e ns, p o esso s' beha io wi h
pa ien s, p o esso s' pe sonali y, p o esso s' posi i e
beha io , p o esso s' aining, and in e ac ions." In line
wi h hese esul s, s udies ha e shown ha pe sonal
ac o s, including indi idual cha ac e is ics, as well as
in e pe sonal and en i onmen al ac o s, play a ole in
he p o essional e hics o doc o s. Fu he mo e, s uden s
end o emula e wha hei p o esso s do a he han wha
hey say [25]. This sugges s ha he impac o clinical
en i onmen s is g ea e han ha o he o mal educa ion
cu iculum. Some s udies show ha , jus as p o esso s’
deal wi h s uden s, s uden s will also deal wi h hei
pa ien s, colleagues, and u u e s uden s. The e o e,
s uden s model he beha io o hei eache s. O cou se,
his modeling occu s in bo h posi i e and nega i e ways.
In any case, medical s uden s ecei e bo h posi i e and
nega i e messages om he clinical en i onmen du ing
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hei in e nship pe iod [14, 15]. The second main heme
ob ained was "modeling p o essional e hics om socie y
and people o he han p o esso s." This main heme had
sub hemes including: "E hical obse ance is oo ed in
amily and school, disc imina ion and a o i ism play a
nega i e ole model, he ounda ions o mo ali y in
amily and iends, ole modeling om pee s, ole
modeling ou side he educa ional en i onmen ." In line
wi h he esul s o his s udy, some s udies ha e ound
ha iends and amily membe s in luence s uden s when
i comes o lea ning medical e hics. Mos o hem belie e
ha he in luence o clinical en i onmen s is g ea e han
ha o he o mal educa ion cu iculum [16]. The hi d
heme ob ained was "modeling posi i e o nega i e
p o essional e hics unde he in luence o
ci cums ances." This main heme included sub hemes,
ca ego ized as ollows: "condi ions ha hu ole
modeling," " he p esence o special condi ions a ec ing
ole modeling," " he ole o nega i e ein o cemen in
ole modeling," and " he in luence o mo al ole models
on economic s a us." In some s udies, s uden s epo ed
ha lea ning medical e hics is in luenced by indi idual
ac o s, such as sel -e icacy and mo al compe ence,
which a ec hei p o essional g ow h and mo i a ion o
coope a e wi h membe s o he he apy eam in
imp o ing hei compe ence and clinical pe o mance
[26]. Acco ding o he indings, ha ing p ope
communica ion as well as ha ing an encou agemen and
suppo sys em and ha ing speci ic ules acili a ing
p o essionalism and he inadequacies o he
o ganiza ional and managemen sys em o he Minis y
o Heal h and he educa ional sys em and no paying
a en ion o he hidden cu iculum in he ans e o
p o essionalism cha ac e is ics, is one o he obs acles o
p o essionalism. The ou h main heme included
"Mo i a ion o modeling p o essional e hics by
s uden s." This heme included ou sub hemes
ca ego ies: " endency o iden i y wi h p o esso s," " he
ole o ad e ising in p o essional e hics," "gene al
accep abili y o he ole model," and "s uden s' endency
o imi a e he eache 's beha io ." In line wi h he esul s
o his s udy, he esea ch demons a ed ha he
willingness o coope a e wi h membe s o he ea men
eam is e ec i e in enhancing he compe ence and
clinical pe o mance o s uden s. Bu gess e al. showed
ha s uden s imi a e he cha ac e is ics and beha io s
hey aspi e o ha e as doc o s in he u u e [9]. Some
p o esso s possess cha ac e is ics ha mo i a e s uden s
o aspi e o be ole models. On he o he hand, some
p o esso s lack hese cha ac e is ics, and s uden s ha e
no mo i a ion o imi a e hei beha io . In any case, he
s uden mus ollow he model and emula e he model's
beha io . The e o e, ha ing he mo i a ion and in en ion
o his wo k has a g ea impac on he ole model o
s uden s [27]. The i h main heme included "Belie s in
ha ing inhe en capabili ies in modeling p o essional
e hics." This main heme consis s o i e sub hemes c:
"Belie in he inna eness o mo ali y," "The spi i uali y
o eligious belie s a e modeled, "Sac i ice and sel -
sac i ice a e modeled, "The lack o in luence o
educa ion on mo al modeling," and "Posi i e modeling
o nega i e beha io ." In line wi h his inding, looking
a he esea ch conduc ed on he componen s o
p o esso s' p o essional e hics, i shows ha some
componen s, such as he accep ance o di e en cul u al
and eligious con ex s, a ec modeling he ole o
p o essional e hics [8]. The e o e, he inhe en
cha ac e is ics o s uden s play a ole in modeling. Due
o his p ocess, an op imal model may be ob ained om
inapp op ia e beha io , and con e sely, a nega i e model
may be de i ed om posi i e beha io . The p o e b
"Lea ning poli eness om ude people" can be an
example o his issue. The six h main heme iden i ied
was "cha ac e is ics o p o esso s who model
p o essional e hics." This main heme consis s o se en
ca ego ies: " he le el o li e acy and knowledge o
p o esso s becomes a ole model," "helping people is a
good ole model," " he well-g oomed appea ance o
p o esso s becomes a ole model," eache s who a e
agen s hemsel es become ole models," "They a e
humble ole models," "P o esso s a e ole models, hey
a e s ic ," "Helping he pa ien is a good ole model."
This opic e e s o he p ocess o ole modeling by
s uden s om p o esso s. Fo his eason, he in luence
o clinical en i onmen s is g ea e han ha o he o mal
educa ion cu iculum e e y day. Some o he
cha ac e is ics ha a e modeled include specialized
compe ence, ecogni ion o comp ehensi e dimensions,
s anda d e alua ion, adhe ence o o ganiza ional ules,
and app op ia e in e ac ion wi h colleagues. Mo eo e ,
he mos impo an cha ac e is ic o an exempla y
p o esso om he s uden 's poin o iew is "mas e y o
he p o esso and gene al knowledge is men ioned abou
he subjec being augh [28, 29]. In con as o he
indings o his s udy, he de e mina ion and s ic ness o
p o esso s we e iden i ied as he leas impo an
cha ac e is ics. Addi ionally, he p esen a ion o
engaging cou se ma e ial, he p o esso 's luency, a close
ela ionship be ween he p o esso and s uden s, and
app op ia e eye con ac we e also no ed as quali ies o
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Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 83
e ec i e p o esso s. [26]. Lempp and Seale and Sa a i e
al. in oduced p o esso s as ole models who ha e been
encou aging and mo i a ing oles o hem. The
commi men and adhe ence o hese p o esso s o
eaching and communica ing wi h s uden s, pa ien s, and
colleagues a e exempla y [30, 31]. As is known, while
some o he componen s exp essed in s udies on he
cha ac e is ics o model p o esso s a e consis en wi h
he esul s o he p esen s udy, o he s di e . This is due
o he di e ence in he goals o hese s udies. This means
ha some s udies ocus on indi idual ac o s, some on
social ac o s, and some on o ganiza ional ac o s.
The da a collec ion me hod used in his s udy was
in e iews, which come wi h hei limi a ions. This s udy
was no excep ion; o example, indi idual di e ences
among pa icipan s may ha e in luenced he a e a
which hey esponded o he in e iew ques ions.
The e o e, i should be expec ed ha he indings o his
s udy co e all he componen s o p o essional e hics.
Howe e , many s udies con i m he esul s o his s udy.
In conclusion, i is impo an o emphasize ha , gi en he
signi icance o he hidden cu iculum in modeling
p o essional e hics, i is essen ial o c ea e conduci e
condi ions o modeling and o ake s eps owa d
es ablishing a heal hy en i onmen . Addi ionally,
os e ing an appealing a mosphe e ha encou ages he
modeling o posi i e beha io s is necessa y. I is
ecommended o inco po a e aspec s o p o essional
e hics in o he selec ion o medical s uden s. Acco ding
o he s udy's esea che s, medical p o esso s need o
iew hemsel es as obliga ed o ins ill he p o essional
e hics o being a doc o in hei s uden s while eaching
he undamen al concep s o medical e hics. In addi ion
o impa ing medical skills, hey should also p io i ize
eaching medical e hics o bo h cu en s uden s and
u u e doc o s.
Conclusion
The indings e ealed six main hemes ela ed o he ole
o he hidden cu iculum in modeling p o essional e hics.
These hemes include "di ec and indi ec modeling,"
"modeling om socie y," "modeling unde he in luence
o ci cums ances," " he necessi y o mo i a ion o
modeling," "belie in inhe en capabili ies o modeling,"
and "cha ac e is ics o eache s as models o p o essional
e hics ". Acco ding o he esul s o his s udy, clinical
p o esso s play a signi ican ole as ole models o
s uden s in de eloping p o essional e hics. I is c ucial o
imp o e educa ional en i onmen s, encou age eache s
o be mind ul o hei beha io in clinical se ings, c ea e
app op ia e modeling oppo uni ies, and inc ease he
numbe o p o esso s who can se e as ole models in
p o essional e hics.
E hical conside a ions
To uphold e hical conside a ions, pa icipa ion in he
s udy was olun a y, and pa icipan s had he eedom o
wi hd aw om he s udy a any ime. As men ioned,
in o med consen was ob ained om pa icipan s, and he
ins umen s con ained no pe sonally iden i iable
in o ma ion and we e coded o ensu e ha he
pa icipan s answe ed olun a ily and eely. The s udy
was egis e ed and app o ed by he Resea ch E hics
Commi ee o he Vi ual Uni e si y o Medical Sciences
(App o al ID: IR.VUMS.REC.1399.007).
A i icial in elligence u iliza ion o a icle
w i ing
No a i icial in elligence was u ilized in w i ing his
a icle.
Acknowledgmen
The pa icipan s in his s udy we e inal-yea medicine
s uden s a he in e nship le el, and we he eby hank all
o hem. This a icle is ex ac ed om he mas e 's hesis
in he ield o medical educa ion a he Vi ual Uni e si y
o Medical Sciences in I an.
Con lic o in e es s a emen
The au ho s decla e no con lic s o in e es .
Au ho con ibu ions
All au ho s con ibu ed equally o he wo k.
Funding
The a icle was w i en wi hou any inancial suppo .
Da a a ailabili y s a emen
The da a is a ailable and can be p o ided o he edi o o
o he esponsible indi iduals a any ime. Fo access,
please con ac he co esponding au ho a :
ysa a [email protected].
Re e ences
1. Kuma Ghosh S, Kuma A. Building p o essionalism
in human dissec ion oom as a componen o hidden
cu iculum deli e y: a sys ema ic e iew o good
p ac ices. Ana omical Sciences Educa ion.
2019;12(2):210–221. [h ps://doi.o g/10.1002/ase.1836]
[ DOI: 10.61882/edcj.18.2.75 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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