The approach of medical ethics training courses at Tehran University of Medical Sciences to change the attitude and promote medical ethics knowledge of learners has challenges. This study aims to identify the challenges in teaching medical ethics at Tehran University of Medical Sciences. Methods: This is a qualitative study with semi-structured interviews conducted in April 2018 at Tehran University of Medical Sciences. Using purposive sampling, 23 participants were selected from the clinicians

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... and faculty members of medical ethics and medical students. Data were analyzed by the content analysis method. Results: The challenges of teaching medical ethics from the participant's point of view are classified into three themes: 1- Hidden curriculum 2- Necessity of completing medical ethics education program 3- Executive and managerial macro factors. The results showed that medical ethics training courses are not effective for changing students' behavior and their moral decision-making. There are substantial shortcomings in the current curriculum in terms of content, format, and implementation that make it unresponsive to ethical needs and concerns. Teaching medical ethics should be turned into a longitudinal theme. The duties and missions of the Department of Medical Ethics at the university are not well understood. The Department does not act as a strong executor and supervisor of medical ethics in interaction with higher authorities to pursue the requirements of effective ethics education and to ensure the implementation of ethical codes. There is no effective mechanism for evaluating the ethical performance of activists and students and giving feedback to them. There is insufficient organizational support for students' complaints and reports about the misconduct and unethical behavior of faculty or staff. Conclusion: The effectiveness and efficiency of medical ethics courses to change the behavior and attitude of learners are not acceptable. Dealing with the existing challenges [...]