Document Type: Original Article


1 School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Medical Ethics, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Medical Education, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran


Introduction: Hidden curriculum plays a main role in professional
learning, formation of professional identity, socialization,
moral development and learning values, attitudes, beliefs, and
knowledge in learners, so it needs to be managed. Although
the majority of the theorists believe in the existence of a hidden
curriculum and its greater effect and sustainability compared to
the formal curriculum; none has proposed a comprehensive model
or approach for its management. This study aimed to design a
hidden curriculum management model in medical education.
Methods: In this study, the authors used the theory or model
construction methodology to synthesize a hidden curriculum
management model in medical education. According to Walker
and Avant; this methodology includes the following three steps
for synthesizing the model: specifying focal concepts, reviewing
the literature, and organizing concepts into an integrated and
efficient representation.
Results: The results of the study showed that numerous factors
affected the hidden curriculum including environmental factors
(professional, organizational), human factors (teachers, peers and
staff), and formal curriculum and learner’s influenceability filter
which bear important messages for learners, staff and teachers. To
manage the hidden curriculum, in addition to the above factors,
it is necessary to manage knowledge and the learners’ learning in
an educational institution.
Conclusion: This study revealed that to achieve the desired
performance in students, the formal curriculum reform is not
sufficient. Moreover, other factors such as environmental factors,
human factors, learner’s influenceability filter, and knowledge
management should also be taken into account. The hidden
curriculum management model can be used for training and
educating the staff and students with the desired performance in
any educational institution.


1. Hafferty FW. Beyond curriculum reform: confronting
medicine’s hidden curriculum. Acad Med: journal
of the Association of American Medical Colleges.
2. Çubukçu Z. The effect of hidden curriculum on
character education process of primary school
students. Educational Sciences: Theory and Practice.
3. Rabah I. The influence of assessment in constructing
a hidden curriculum in higher education: can self and
peer assessment bridge the gap between the formal
and the hidden curriculum. International Journal of
Humanities and Social Science. 2012;2(11):236-42.
4. Mossop L, Dennick R, Hammond R, Robbé I.
Analysing the hidden curriculum: use of a cultural
web. Med Educ. 2013;47(2):134-43.
5. Martin JR. What should we do with a hidden
curriculum when we find one? Curriculum Inquiry.
6. Alsubaie MA. Hidden Curriculum as One of Current
Issue of Curriculum. Journal of Education and Practice.
7. Ahwee S, Chiappone L, Cuevas P, Galloway F, Hart
J, Lones J, et al. The Hidden and Null Curriculums:
An Experiment in Collective Educational Biography.
Educational Studies: Journal of the American
Educational Studies Association. 2004; 30: 24-35.

8. Andarvazh MR. Development a Diagnosis Framework
of Hidden Curriculum in Clinical Education. Tehran:
Shahid Beheshti University of Medical Sciences; 2018.
9. Wear D, Skillicorn J. Hidden in plain sight: The
formal, informal, and hidden curricula of a psychiatry
clerkship. Acad Med. 2009;84(4):451-8.
10. Hafferty FW, Castellani B. The hidden curriculum:
a theory of medical education. Handbook of the
sociology of medical education. UK: Routledge; 2009.
29-49. pp.
11. Hafferty FW, Franks R. The hidden curriculum, ethics
teaching, and the structure of medical education. Acad
Med. 1994;69(11):861-71.
12. Yüksel S. Kohlberg and Hidden Curriculum in Moral
Education: An Opportunity for Students’ Acquisition
of Moral Values in the New Turkish Primary Education
Curriculum. Educational Sciences: Theory & Practice.
13. Goldie J. Review of ethics curricula in undergraduate
medical education. Med Educ. 2000;34(2):108-19.
14. Yamani N, Changiz T, Adibi P. Professionalism and
hidden curriculum in medical education. Isfahan:
Isfahan University of Medical Science, Medical
Education Research Center[cited 2013 Dec 19]

Available from: rds sem-ums ac ir/edc/downloads/
professionalism% 20and% 20hidden pdf. 2004.
15. Wearn A, Wilson H, Hawken SJ, Child S, Mitchell CJ.
In search of professionalism: implications for medical
education. NZ Med J. 2010;2:123.
16. Buyx AM, Maxwell B, Schöne-Seifert B. Challenges
of educating for medical professionalism: who should
step up to the line? Med Educ. 2008;42(8):758-64.
17. Otewa J. Using hidden curriculum principles in
teaching character education in Kenya. Baraton
Interdisciplinary Research Journal. 2016;6:120-6.
18. Shapiro J. Perspective: does medical education promote
professional alexithymia? A call for attending to the
emotions of patients and self in medical training. Acad
Med. 2011;86(3):326-32.
19. Brainard AH, Brislen HC. Learning professionalism: a
view from the trenches. Acad Med. 2007;82(11):1010-4.
20. Egnew TR, Wilson HJ. Role modeling the doctorpatient
relationship in the clinical curriculum. Family
Medicine-Kansas City. 2011;43(2):99.
21. Lempp H, Seale C. The hidden curriculum in
undergraduate medical education: qualitative study
of medical students’ perceptions of teaching. BMJ.
22. Dickerson LW. Postmodern view of the hidden
curriculum. UK: Georgia Southern University; 2007.

23. Blasco M. Aligning the Hidden Curriculum of
Management Education With PRME An Inquiry-
Based Framework. Journal of Management Education.
24. Sever M. A critical look at the theories of sociology
of education. Journal of Human Sciences.
25. Harvey L. Critical social research. Australia: Unwin
Hyman; 1990.
26. Dickerson LW. Postmodern View of the Hidden
Curriculum. Statesboro, Georgia: Georgia Southern
University; 2007.
27. Walker LO, Avant KC. Strategies for theory
construction in nursing. Texas: Pearson; 2010.
28. Nonaka I, Konno N. The concept of “Ba”: Building
a foundation for knowledge creation. California
management review. 1998;40(3):40-54.
29. Mann KV. Learning and Teaching in Professional
Character Development. Lost Virtue: Emerald Group
Publishing Limited; 2006. 145-83. p.
30. Schein EH. Organizational culture and leadership.
New Jersey: John Wiley & Sons; 2010.
31. Hafler JP, Ownby AR, Thompson BM, Fasser CE,
Grigsby K, Haidet P, et al. Decoding the learning
environment of medical education: a hidden curriculum
perspective for faculty development. Acad Med.
32. Armstrong M. Strategic Human Resource
Management-A Guide to Action. USA: Kogan; 2006.
33. Becker B, Gerhart B. The impact of human resource
management on organizational performance: Progress
and prospects. Academy of management journal.

34. Somers MJ. Ethical codes of conduct and organizational
context: A study of the relationship between codes of
conduct, employee behavior and organizational values.
Journal of Business Ethics. 2001;30(2):185-95.
35. Bowles S, Gintis H. Schooling in capitalist America
revisited. Sociology of education. 2002:1-18.
36. Hafferty F, Gaufberg E. The hidden curriculum:
A Pract Guide Med Teach. New York: Churchill
Livingstone Elsevier; 2013.
37. White J, Brownell K, Lemay JF, Lockyer JM. “
What Do They Want Me To Say?” The hidden

curriculum at work in the medical school selection
process: a qualitative study. BMC medical education.
38. Gordon J. Fostering students’ personal and professional
development in medicine: a new framework for PPD.
Med Educ. 2003;37(4):341-9.
39. Duvivier RJ, Dent JA. Student support. A practical
Guide for Medical Teacher. Netherlands: Elsevier;
40. Noddings N. Caring and education. USA: The
encyclopedia of informal education; 2010.
41. Kohlberg L. Moral education for a society in moral
transition. Educational leadership. 1975; 3: 47.
42. Blasco M. Aligning the hidden curriculum of
management education with PRME: An inquirybased
framework. Journal of Management Education.
43. Nonaka I, Konno N. The concept of “ba”: Building
A Foundation For Knowlege Creation. California
Management Review. 1998;40(3):1.
44. Thornberg R. The moral construction of the good pupil
embedded in school rules. Education, citizenship and
social justice. 2009;4(3):245-61.
45. Kohlberg L. Moral Development and the New Social
Studies. USA: ERIC; 1972.
46. Yazdani S, Akbarilakeh M. Explanation and
clarification of the concept of value in medical
education. Journal of Research on Religion & Health.
47. Andarvazh MR, Yazdani S, Afshar L. Development
a Diagnosis Framework of Hidden Curriculum in
Clinical Education. Tehran: Shahid Beheshti University
of Medical Sciences; 2018.
48. Gordon D. Rules and the effectiveness of the hidden
curriculum. Journal of philosophy of education.