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Abedi G, Malekzadeh R. Challenges and Strategies for Enhancing the Effectiveness of Integrating Medical Education With the Health System in Iran. Iran J Health Sci 2026; 14 (2) :169-182
URL: http://jhs.mazums.ac.ir/article-1-1147-en.html

Background and Purpose: The integration of medical education with the health system in Iran is one of the most significant reform policies in recent years. This study aimed to explore the challenges of this integration and identify strategies to enhance its effectiveness from the perspective of key stakeholders.
Materials and Methods: This qualitative study was conducted in 2024 using content analysis based on Graneheim and Lundman’s approach. The participants included 16 policymakers and senior managers from medical universities or faculties, selected through purposive and snowball sampling methods. Data were collected through semi-structured interviews, and saturation was reached when no new themes emerged. All interviews were audio-recorded, transcribed verbatim, and analyzed as meaning units. Initial codes were generated from condensed meaning units and then organized into main themes and sub-themes based on similarities and patterns. 
Results: Analysis of participants’ experiences identified 13 main themes and 41 sub-themes across two dimensions: challenges and strategies. The identified challenges included structural issues, deficiencies in integrated governance, misalignment between education and service delivery, increased pressure on faculty members, institutional and cultural resistance, conflicts of interest, weakened scientific convergence, and deviation from the university’s core missions. The proposed strategies included reforming governance structures, developing need-based and community-oriented education, optimizing faculty roles, strengthening evaluation and accountability systems, fostering a culture of integration, and empowering managers.
Conclusion: The findings of this study indicate that despite the macro-level acceptance of integrating medical education into service delivery, its effective implementation is accompanied by structural, governance, human resources, cultural, and functional challenges. These challenges constrain the achievement of the intended objectives of integration. Accordingly, strategies such as redesigning governance structures, expanding needs-based education, and strengthening accountability and transparency mechanisms are recommended to enhance coherence and effectiveness in the integration process.