Journal of Isfahan Medical School

Journal of Isfahan Medical School

Identifying Medical Students' Attitudes to Socialization in Clinical Settings: A Qualitative Study

Document Type : Original Article(s)

Authors
1 MD, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Medical Ethics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Introduction: Professional socialization is a process through which students acquire norms and values in the medical profession. However, this process can, under the influence of some environmental factors, lead to the acceptance of unethical and uncommitted behaviors of students. For this purpose, the study was designed to identify medical students' attitudes towards the instances, causes, and consequences of negative socialization in clinical settings.
Methods: This qualitative study was conducted on medical students in the clinical program of Isfahan University of Medical Sciences. Sampling was purposive and took into account maximum diversity. Data were collected through 31 in-depth semi-structured interviews and analyzed using the framework analysis method.
Findings: Examples of negative socialization were categorized into two categories: “lack of commitment and inappropriate communication” (including failure to comply with informed consent, inappropriate treatment, and discrimination in care) and “ethical and professional misconduct” (including unhealthy competition, imitation of unprofessional behavior, and falsification of medical information). The causes of this phenomenon were identified in five subcategories: strict hierarchies, time and competitive pressures, lack of ethical oversight, unsupportive organizational culture, and gender norms. The consequences of negative socialization also affected three areas: decreased empathy for patients, creating professional cynicism, and students facing personal consequences such as conflict with personal values, reduced motivation, and emotional exhaustion.
Conclusion: Negative socialization in clinical medical education arises from the interaction of systemic and cultural factors and is a significant threat to the development of ethical professionalism and the quality of patient care.

Highlights

Neda Yavari: Google Scholar

Keywords
Subjects

1.     Ghale R. Elmi M. A survey of social factors related to religious and political socialization of high school Students in Pars Abad [in Persian]. Journal of Sociology Studies 2020; 12(4): 105-22.
2.     Wang X, He Z, Shi L. Conformity poses a double-edged sword effect on the evolution of cooperation within heterogeneous endowment populations. Chaos, Solitons & Fractals 2024; 182: 114742.
3.     Fedorov A. An experimental analysis of moral conformity in a situation of passive social pressure. Journal of Higher School of Economics 2024; 21(2): 277-305.
4.     Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med 2015; 90(6): 718-25.
5.     Haruta J, Ozone S, Hamano J. Doctors’ professional identity and socialisation from medical students to staff doctors in Japan: narrative analysis in qualitative research from a family physician perspective. BMJ Open 2020; 10(7): e035300.
6.     Irby DM, Hamstra SJ. Parting the clouds: three professionalism frameworks in medical education. Acad Med 2016; 91(12): 1606-11.
7.     Rohatinsky N, Harding K, Carriere T. Nursing student peer mentorship: A review of the literature. Mentoring & Tutoring: Partnership in Learning 2017; 25(1): 61-77.
8.     Qureshi MA, Khaskheli A, Qureshi JA, Raza SA, Yousufi SQ. Factors affecting students’ learning performance through collaborative learning and engagement. Interact Learn Environ 2023; 31(4): 2371-91.
9.     Lehmann LS, Sulmasy LS, Desai S, ACP Ethics, Professionalism and Human Rights Committee*. Hidden curricula, ethics, and professionalism: optimizing clinical learning environments in becoming and being a physician: a position paper of the American College of Physicians. Ann Intern Med 2018; 168(7): 506-8.
10.  Ansa BE, Zechariah S, Gates AM, Johnson SW, Heboyan V, De Leo G. Attitudes and behavior towards interprofessional collaboration among healthcare professionals in a large academic medical center. Healthcare (Basel) 2020; 8(3): 323.
11.  Menezes P, Guraya SY, Guraya SS. A systematic review of educational interventions and their impact on empathy and compassion of undergraduate medical students. Front Med (Lausanne) 2021; 8: 758377.
12.  Krishnasamy C, Ong SY, Loo ME, Thistlethwaite J. How does medical education affect empathy and compassion in medical students? A meta-ethnography: BEME Guide No. 57. Med Teach 2019; 41(11): 1220-31.
13.  Monrouxe LV, Rees CE. The socialisation of mistreatment in the healthcare workplace: Moving beyond narrative content to analyse educator data as discourse. Med Educ 2023; 57(10): 882–5.
14.  Spányik A, Simon D, Rigó A, Gács B, Faubl N, Füzesi Z, et al. Cynicism among medical students: An in-depth analysis of mental health dynamics and protective factors in medical education using structural equation modeling. PLoS One 2025; 20(4): e0321274.
15.  Fischer A, Shapiro J, Geiger B. Medical students’ experience of negative communication by superiors in a clinical setting. J Psychiatry Behav Sci 2023; 6(2): 1088.
16.  Jeyapalan T, Blair E. The factors causing stress in medical students and their impact on academic outcomes: a narrative qualitative systematic review. Int J Med Stud 2024; 12(2): 195-203.
17.  Yaman GB, Nar B, İşcan G. Perceived Stress in Medical Education: Relationship with Empathy and Stigmatisation. Medical Journal of Süleyman Demirel University. 2024; 31(3): 261-70.
18.  Yousofvand V, Sadeghi A, Kamyari N, Sadeghi B. The effect of perceived social support on the professional socialization of final-year nursing students: A cross-sectional correlational study J Med Edu Dev 2024; 17(56): 50-60.
19.  Yazdani S, Andarvazh MR, Afshar L. What is hidden in hidden curriculum? a qualitative study in medicine. J Med Ethics Hist Med 2020; 13: 4.
20.  Brown ME, Coker O, Heybourne A, Finn GM. Exploring the hidden curriculum’s impact on medical students: professionalism, identity formation and the need for transparency. Med Sci Educ 2020; 30(3): 1107-21.
21.  Bahramirad F, Heshmatifar N, Rad M. Students’ perception of problems and benefits of night shift nursing internship: A qualitative study. J Educ Health Promot 2020; 9: 287.
22.  Vaidyanathan B. Professional Socialization in Medicine. AMA J Ethics 2015; 17(2): 160–6.
23.  Gardeshi Z, Amini M, Nabeiei P. The perception of hidden curriculum among undergraduate medical students: a qualitative study. BMC Res Notes 2018; 11(1): 1–4.
24.  Samouei R, Mohammadi-Sefiddashti F, Meshkineh N, Amini-Rarani M. Psychosocial Determinants related to the ethical performance of researchers [in Persian]. Iranian Journal of Medical Ethics and History of Medicine. 2025 May 7.
25.  Hafferty FW. Socialization, professionalism, and professional identity formation. Teaching Medical Professionalism 2016;2: 54-67.
Volume 44, Issue 858
2nd Week, June
May and June 2026
Pages 554-560

  • Receive Date 05 January 2026
  • Accept Date 07 January 2026