Mahnaz Moghadari Koosha, Iraj Salehi, Elaheh Mousavi, Mohammad Reza Safari, Nasim Alipour, Hossein Vakili Mofrad,
Volume 19, Issue 4 (11-2025)
Background and Aim: The hidden curriculum is considered the most powerful means of transmitting professional values. Given the critical importance of managing the hidden curriculum to institutionalize professional ethics and professionalism within health higher education institutions, the present study was conducted to explore the perceptions of operating room and anesthesia students and instructors regarding the impact of the hidden curriculum on the promotion of professional ethics.
Materials and Methods: This study was conducted using a qualitative approach based on conventional content analysis. The study population included final-year students and instructors from the operating room and anesthesia disciplines at Hamadan University of Medical Sciences. Participants were selected through purposive and theoretical sampling methods. Data were collected via in-depth, semi-structured interviews. Data saturation was achieved after conducting 24 interviews. The data analysis followed the qualitative content analysis approach proposed by Graneheim and Lundman (2004), and was carried out in seven steps: 1. familiarization with the data, 2. identification of meaning units, 3. initial coding, 4. formation of subcategories, 5. development of categories, 6. extraction of themes, and 7. final review.
Results: The content analysis of the interviews resulted in the identification of 456 initial codes. Following refinement and consolidation, these codes were organized into four overarching categories and ten subcategories. The main categories comprised: ‘Components of the hidden curriculum in professional ethics education’, ‘Mechanisms through which the hidden curriculum exerts influence’, ‘Consequences of the hidden curriculum’, and ‘Strategies for enhancing professional ethics’. The findings indicated that the hidden curriculum, manifested through the behavioral patterns of faculty members and instructors, organizational culture, and interpersonal interactions, plays a pivotal role in shaping students’ ethical attitudes and behaviors. Furthermore, the hidden curriculum, through processes of unconscious learning, reinforcement or erosion of formal values, and the manner in which rules are implemented, can yield both positive outcomes—such as the development of ethical decision-making skills—and negative outcomes, including diminished ethical sensitivity.
Conclusion: This study revealed that the hidden curriculum in operating room and anesthesia education functions as a dual-force phenomenon. On one hand, it fosters the development of professional ethics through constructive role modeling and authentic clinical experiences. On the other hand, it can contribute to ethical erosion by conveying contradictory messages and unhealthy norms. Achieving sustainable ethical learning requires active management of the hidden curriculum through three key strategies: aligning the formal and hidden curricula, empowering instructors as agents of ethical value transmission, and shifting the organizational culture paradigm toward learning from error.
