Strides Dev Med Educ. 2019 December; 16(1):e84144. Published online 2019 April 8. doi: 10.5812/sdme.84144. Research Article Qualitative Explanation of the Effect of Changes in the Educational System on the Development of Professionalism in Medical Residents Farangis Shoghi Shafagh Aria 1 , Parvin Samadi 2, * and Shahram Yazdani 3 1 Al-Zahra University, Tehran, Iran 2 Faculty of Education and Psychology, Al-Zahra University, Tehran, Iran 3 Shahid Beheshti University of Medical Sciences, Tehran, Iran * Corresponding author: Faculty of Education and Psychology, Al-Zahra University, Tehran, Iran. Email: psamadi@alzahra.ac.ir Received 2018 September 10; Revised 2019 January 05; Accepted 2019 January 26. Abstract Background: The development of professionalism is one of the fundamental goals of educational systems, especially in medical sciences. Medical students, in addition to acquiring clinical knowledge and skills, should somehow benefit from moral values and professionalism in order to practice in a professional manner. The development of professional ethics is heavily influenced by the hidden curriculum affected by changes in the educational system. The health reform plan is launched in Iran in recent years. Objectives: The current study aimed at qualitatively explaining the effects of changes to the educational system on the development of the professionalism in medical residents. Methods: The current qualitative study was performed by the content analysis method. A total of 26 interviews were conducted with 12 prominent professors of medical education, 13 third-year internal medicine residents, as well as a focus group including 10 residents. The purposive sampling method with maximum diversity was used in the current study and continued until data satu- ration. Data were analyzed using the content analysis method. The Lincoln and Guba criteria were used to increase the credibility of the findings. Results: The most important finding of the current study was the challenge of developing professionalism due to environmental changes. The main theme included the challenges of professionalism development in the existing educational system, changes related to the sociocultural environment of the community, changes related to health reform plan, and the shift from training to health services and promtion of faculty member. Conclusions: Changes and interventions in the health care services sector, such as the health reform plan, greatly affect the devel- opment of professionalism in medical residents. The plans that affect the health system, a special attention should be paid to the education section and the educational documents should be prepared initially and implemented simultaneously. Keywords: Education, Medicine, Hidden Curriculum, Residents 1. Background Health reform plan with the goal of comprehensive health coverage was launched in Iran in 2014. The plan in- cludes eight service packages to reduce the hospitalization cost for patients, support physicians to remain in deprived areas, presence of specialists attending educational hospi- tals, promotion of the quality of services and visits in edu- cational hospitals, the promotion of normal delivery pro- gram, financial protection program for special patients, and launching an air ambulance service (1). The evolu- tionary plan has different dimensions and effects. Several studies were conducted on the effects of this plan, most of which focused on the effects of the plan on expenditure in health care centers. Although medical residents of the most important elements of implementing the plan, the effects of this plan on this group are less addressed (2, 3). Nematbakhsh evaluated the impact of health reform plan on health research projects (4). Molavi et al. showed that professors and residents in Shahid Beheshti University of Medical Sciences were relatively satisfied with the imple- mentation of the health reform plan and the most promi- nent source of dissatisfaction was the lack of hospital facil- ities (5). Professionalism is the important components of medical education, and to the best of authors’ knowledge, no study evaluated the effects of the health reform plan on it. Professionalism are defined as the behaviors, goals, or characteristics that address a profession or a professional person, and include the moral and legal parameters of the profession, the behavior and values of the members of the Copyright © 2019, Strides in Development of Medical Education. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.