The role of hidden curriculum in modeling professional ethics by evaluating the experiences of medical students: A phenomenological study

Copy igh © 2025 Zanjan Uni e si y o Medical Sciences. Published by Zanjan Uni e si y o Medical Sciences. This wo k is licensed unde a C ea i e Commons A ibu ion-NonComme cial 4.0 In e na ional license (h ps://c ea i ecommons.o g/licenses/by- nc/4.0/). Noncomme cial uses o he wo k a e pe mi ed, p o ided he o iginal wo k is p ope ly ci ed. 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 ] 1 / 11 Za ezade e al . : 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 ] 2 / 11 Za ezade e al . : 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. [ DOI: 10.61882/edcj.18.2.75 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 3 / 11 Za ezade e al . : Hidden cu iculum and p o essional e hics in medical s uden s 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. [ DOI: 10.61882/edcj.18.2.75 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 4 / 11 Za ezade e al . : 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 [ DOI: 10.61882/edcj.18.2.75 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 5 / 11 Za ezade e al . : Hidden cu iculum and p o essional e hics in medical s uden s 80 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 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 [ DOI: 10.61882/edcj.18.2.75 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 6 / 11 Za ezade e al . : 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 81 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 [ DOI: 10.61882/edcj.18.2.75 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 7 / 11 Za ezade e al . : Hidden cu iculum and p o essional e hics in medical s uden s 82 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 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 [ DOI: 10.61882/edcj.18.2.75 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 8 / 11 Za ezade e al . : 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 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 ] 9 / 11