Lived Experiences of Undergraduate Medical Students About Hidden Curriculum: A Phenomenological Study


The hidden curriculum refers to student experiences that occur outside the formal structure of the curriculum, and especially the messages provided by the education system concerning values, perspectives, behaviors, and attitudes which has a strong influence on students' professional development. This study aimed at explaining the lived experiences of undergraduate medical students about the “hidden curriculum.” This was a qualitative phenomenological study. Participants were medical students of Iran University of Medical Sciences and they were chosen by purposive sampling method based on the inclusion criteria. Semi-structured interviews with open-ended questions were conducted with 10 students until data saturation, and 7-step Colaizzi's method was utilized for the purposes of analyzing the study findings. In the process of analyzing data from medical students' lived experiences about hidden curriculum, the following three themes were extracted: 1. Conflict in value beliefs (sub-themes: not giving priority to students education, applicability to the clinical practice of  basic sciences, attitude towards discipline, professional ethics, justice in evaluation”) 2. Modeling teacher’s communication skills patterns (sub-themes: “teacher-patient relationship,” “teacher -student relationship and professor-colleagues relationship) 3. Effective teaching (sub-themes: “clinical teaching” and “theoretical teaching”). Based on the results of the study, the hidden curriculum has both positive and negative impacts on various aspects of learning, especially the attitudinal domain. Consequently, paying specific attention to hidden curriculums is an absolute need.

1. Dent J, Harden RM. A practical guide for medical teachers. 5th ed. Amsterdam: Elsevier Health Sciences; 2013.
2. Alizadeh NS, Adib Y. A study of hidden curriculum dimensions in first-grade female high-school teachers method of teaching from the students point of View. Journal of Instruction and Evaluation. 2013;6:55-76.
3. Silver HK, Glicken AD. Medical student abuse: incidence, severity, and significance. JAMA. 1990; 263:527-32.
4. Mehrmohammadi M. Curriculum: Theories, Approaches and Perspectives. Tehran: Samt Publication; 2014.
5. Stanek A, Clarkin C, Bould MD, Writer H, Doja A. Life imitating art: Depictions of the hidden curriculum in medical television programs. BMC Med Educ. 2015; 15:156.
6. Ortega B, Fasce H, Pérez V, Ibáñez G, Márquez U, Parra P. Assessment of hidden curriculum components by medical students. Rev Med Chil. 2014; 142:452-1457.
7. Mulder H, ter Braak E, Chen HC, ten Cate O. Addressing the hidden curriculum in the clinical workplace: A practical tool for trainees and faculty. Med Teach. 2019;41:36-43.
8. Gaufberg EH, Batalden M, Sands R, Bell SK. The hidden curriculum: what can we learn from third-year medical student narrative reflections? Acad Med. 2010; 85:1709-16.
9. Bayanfar F, Maleki H, Seyf A, Delavar A. Explanation of the impact of hidden curriculum on emotional component of learning for middle school students. J Rafsanjan Univ Med Sci. 2010; 5:57-85
10. Mosalanejad L, Parandavar N, Rezaie E. Students' Experience about the Hidden Curriculum: A Qualitative Study. J Rafsanjan Univ Med Sci. 2014;13:111-24.
11. Karimi Z, Ashktorab T, Mohammadi E, Abedi H, Zarea K. Resources of learning through hidden curriculum: Iranian nursing students’ perspective. J Educ Health Promot. 2015;4:57.
12. Van Mook WN, van Luijk SJ, de Grave W, O'Sullivan H, Wass V, Schuwirth LW, et al. Teaching and learning professional behavior in practice. Eur J Intern Med. 2009; 20: 105-11.
13. Glicken AD, Merenstein GB. Addressing the hidden curriculum: understanding educator professionalism. Med Teach. 2007; 29:54-7.
14. Yamani N, Liaghatdar MJ, Changiz T, Adibi P. How do medical students learn professionalism during clinical education? A qualitative study of faculty members' and interns' experiences. Iran J Med Educ. 2010; 9:382-95.
15. Taghvaei Yazdeli Z, Yazdkhasti A, Rahimi H. The study of hidden curriculum situation in Kashan University of Medical Sciences. J of Med Educ Dev. 2013;6:14-23.
16. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching. Bmj. 2004; 329:770-3.
17. Polit DF, Beck CT. Nursing research: Principles and methods. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.
18. Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing: Advancing the humanistic imperative. Philadelphia: Lippincott Williams & Wilkins; 2011.
19. Colaizzi PF. Psychological research as the phenomenologist views it, Valle R, King M, Existential– phenomenological alternatives for psychology, New York: Oxford University Press; 1978.
20. Sum S, Alinegad S, Rastgar Z, Tashakkori F, Khani A, Pourghasem M. Basic science lecturer’s perspectives on integration in Babol University of Medical Sciences. Iran J Med Educ. 2013; 12:807-16.
21. Emami SM, Rasouli Nejad M, Changiz T, Afshin Nia F, Zolfaghari B, Adibi P. Interns'view about basic medical sciences: their knowledge and attitude to national comprehensive exam and basic medical courses in isfahan university of medical sciences. Iran J Med Educ. 2000; 1:21-5.
22. Abdollahi SH, Bakhshi H, Ebrahimi Shahmabadi H,
Soltani Nejad A. The Medical Students' Viewpoints in Achieving Clinical Objectives of Medical Education Program in Rafsanjan University of Medical Sciences in 2010: A Short Report. J Rafsanjan Univ Med Sci. 2017;15:1077-86.
23. Harden RM. The integration ladder: a tool for curriculum planning and evaluation. Med Educ. 2000;34:551-7.
24. Teimouri Jervekani Z, Ashoorion V, Mozafarpour S, Sirous S. Evaluation of Basic Sciences Curriculum Modifications in Isfahan University of Medical Sciences: The Students’ Viewpoint. Iran J Med Educ. 2015; 15:79-88.
25. Rider EA, Hinrichs MM, Lown BA. A model for communication skills assessment across the undergraduate curriculum. Med Teach. 2006; 28:127-34.
26. Haq C, Steele DJ, Marchand L, Seibert C, Brody D. Integrating the art and science of medical practice: innovations in teaching medical communication skills. Fam Med. 2004; 36: 43-50.
27. Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Aff. 2010; 29:1310-8.
28. Taghipoor Zahir A. The Association between Patient-centered Hidden Curriculum and Medical Students’ Communication Skills. Iran J Med Educ. 2014; 13:920-30.
29. Koohestani HR, Baghcheghi N. The effects of team-based learning techniques on nursing students' perception of the psycho-social climate of the classroom. Med J Islam Repub Iran. 2016;30:437.
30. Baghcheghi N, Koohestani HR, Rezaei K. A comparison of the cooperative learning and traditional learning methods in theory classes on nursing students' communication skill with patients at clinical settings. Nurse Educ Today. 2011; 31:877-82.
31. Silvetti M, Alexander W, Verguts T, Brown JW. From conflict management to reward-based decision making: actors and critics in primate medial frontal cortex. Neurosci Biobehav Rev. 2014; 46:44-57.
32. Ghaljeh M, Khanjani N, Latifi M, Dastoorpoor M. Awareness from patient right patent and its observance from patients’ viewpoint. J North Khorasan Univ Med Sci.2015;7:657-68.
33. Baghcheghi N, Koohestani HR. Placebo use in clinical practice by nurses in an Iranian teaching hospital. Nurs Ethics. 2011;18:364-73.
IssueVol 57, No 5 (2019) QRcode
Qualitative research Hidden curriculum Medical students Basic sciences Phenomenology

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How to Cite
Bigdeli S, Koohestani HR, Soltani Arabshahi SK, keshavarzi MH. Lived Experiences of Undergraduate Medical Students About Hidden Curriculum: A Phenomenological Study. Acta Med Iran. 2019;57(5):308-315.