1 Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Department of Philosophy of Science, Institute for Humanities and Cultural Studies, Tehran, Iran

4 4Department of Health in Emergency and Disaster, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 5Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden


Introduction: In medical education, particularly in residencycourses, most of the training occurs in real clinical environments.Workplace-based learning profoundly affects students’ knowledge,attitudes, and practice; therefore, it should be properly planned.Due to the extensiveness of the clinical environment and itsimportance in training residents, investigating how residentslearn in these environments and detecting factors that influenceeffectiveness will help curriculum designers to promoteresidents’ learning by improving their learning environment.Therefore, our qualitative content analysis study, aimed to examinethe experiences and perspectives of internal and surgical residentsand their attending physicians about learning in clinical settings.Methods: This qualitative content analysis study was conductedthrough purposeful sampling. Semi-structured interviews wereconducted with 15 internal and surgical residents and 15 of theirattending physicians at educational hospitals of Tehran Universityof Medical Sciences.Results: The main categories explored in this study were hiddencurriculum, learning resources, and learning conditions. In thecontext of clinical environment and under its individual culture,residents learn professionalism and learn to improve theircommunication skills with patients and colleagues. Because ofclinical obligations such as priority of treating the patients foreducation or workload of the attending physicians, residentsacquire most of their practical knowledge from colleagues, fellows,or follow-up patients in different learning conditions (such as:educational rounds, morning reports and outpatient clinics). Theysee some of their attending physicians as role models.Conclusion: Changing cultural and contextual factors is ofprime importance to promote a learning-oriented environmentin a clinical setting. The present findings will help curriculumplanners and attending physicians to improve residents’ learningby means of appropriate workplace planning and by consideringthe components involved in clinical learning.Keywords: Learning; Teaching hospitals; Workplace; Curriculum; Medical students