Mechanisms of Learning through the Hidden Curriculum in the Perspective of Iranian Nursing Students

Document Type: Original Article


1 Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Associate Professor, Department of Nursing, Nursing & Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, IRAN

3 Department of Nursing, Medical Sciences Faculty, Tarbiat Modares University, Tehran, IRAN

4 Department of Medical-Surgical Nursing. Faculty of Nursing &s Midwifery, Shahid Beheshti University of Medical Sciences, Nyayesh Complex, Nyayesh Cross-section, Vali Asr St, Tehran, IRAN


Background: Human beings use different approaches to learning. Thus the aim of this study is to explore the mechanisms of learning through the hidden curriculum in the perspective of baccalaureate undergraduate nursing students.
Methods: This qualitative study, involving 24 baccalaureate undergraduate nursing students, was done by purposeful sampling strategies. The data were collected using semi-structured interviews and continued until data saturation and emerging categories. Content analysis approach was used for data analysis.
Results: As a result of data analysis, eight categories emerged including learning from observation, auditory learning, learning from feedback, experiential learning, inverse learning, learning through explaining one’s experiences, modeling, and passive learning.
Conclusions: Nursing students learnt the hidden curriculum through different mechanisms. It is recommended that other mechanisms of the running hidden curricula are identified.


1. Iwasiw CL, Goldenberg D, Andrusyszyn MA. Curriculum development in nursing education. 2nd ed. Sudbury:Jones and Bartlett; 2009:212.
2. Harden RM. The learning environment and the curriculum. Med Teach 2001; 23:335-6.
3. Institute of Medicine. Health professions education: A bridge to quality.Washington, DC: National Academy; 2003.
4. Wear D, Skillicorn J. Hidden in plainsight: The formal, informal, and hidden curricula of a psychiatry clerkship. Acad Med 2009; 84: 451-8.
5. Lindberg O. Undergraduate socialization in medical education: ideals of professional physicians' practice. Learning in health and social care 2009; 8(4): 241-9.
6. Ma F, Li J, Liang H, Bai Y, Song J.Baccalaureate nursing students'perspectives on learning about caring in China: A qualitative descriptive study. BMC Med Educ 2014; 14:1-9.
7. Higashi RT, Tillack A, Steinman MA, Johnston B, Harper GM. The worthy patient:Rethinking the hidden curriculum in medical education. Anthropol Med 2013; 20 (1): 13-
8. Witman Y. What do we transfer in case discussions? The hidden curriculum in medicine. Perspect Med Educ 2014; 3: 113-23.
9. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: Qualitative study of medical students’ perceptions of teaching. BMJ 2004; 329: 770-3.
10. Candela L, Dalley K, Benzel-Lindley J. A case for learning-centered curricula. J Nurs Educ 2006; 45: 59-66.
11. Brown T, Zoghi M, Williams B, Jaberzadeh S, Roller L, Palermo C, et al. Are learning style preferences of health science students predictive of their attitudes towards e-learning? Aust J Educ Tech 2009; 25: 524-43.
12. Amin Z, Eng KH. Basics in medical education. New Jersey: World Scientific; 2003:34-38.
13. Frankel A. Nurses' learning styles:Promoting better integration of theory into practice. Nurs Times 2009; 105: 24-7.
14. Ferguson KJ. Facilitating student learning. In: Jeffries WB, Huggett K.(editors). An introduction to medical teaching. USA: Springer; 2010:2.
15. Glicken AD, Merenstein GB. Addressing the hidden curriculum: Understanding educator professionalism. Med Teach 2007; 29: 26-54.
16. Bradshaw MJ, Lowenstein AJ. Innovative teaching strategies in nursing and related health professions. 4th ed. Sudbury: Jones and Bartiett; 2007:16.
17. Bastable SB. Nurse as educator:Principles of teaching and learning for nursing practice. 3rd ed. Sudbury: Jones and Bartlett; 2008:450-451.
18. Clynes MP, Raftery SE. Feedback: An essential element of student learning in clinical practice. Nurse Educ Pract 2008; 8:405-11.
19. Wright K. Student nurses' perceptions of how they learn drug calculation skills. Nurs Educ Today 2012; 32:721-726.
20. Koh LC. Refocusing formative feedback to enhance learning in preregistration nurse education. Nurse Educ Pract 2008; 8: 223-30.
21. Cantillon P, Hutchinson L, Wood D. ABC of learning and teaching in medicine. London: BMJ Publishing Group; 2003:26.
22. Gilmartin J. Teachers’ understanding of facilitation styles with student nurses. Int J Nurs Stud 2001; 38: 481-8.
23. Brammer JD. RN as gatekeeper:Student understanding of the RN buddy role in clinical practice experience. Nurs Educ Today 2006; 26: 697-704.
24. Hemmings A. The hidden corridor curriculum. High Sch J 2000; 83(2): 1-10.
25. Stern DT, Papadakis M. The developing physician-becoming a professional. New Engl J Med 2006; 355(17):1794-9.
26. Swanwick T. Understanding medical education: Evidence, theory, and practice.1st ed. London: Wiley; 2010:30.
27. Balmer D, Serwint JR, Ruzek SB, Ludwig S, Giardino AP. Learning behind the scenes: Perceptions and observations of role modeling in pediatric residents'continuity experience. Ambul Pediatr 2007;7: 176-81.
28. 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.
29. Gaufberg E, Batalden M, Sands R, Bell SK. The hidden curriculum: what can we learn from third-year medical student narrative reflections? Acad Med 2010; 85(11): 1709-16.
30. Liao JM, Thomas EJ, Bell SK. Speaking up about the dangers of the hidden curriculum. Health Affairs 2014;33(1): 168-71.