en آموزش بهداشت Health Education پژوهشي Original Article <div style="text-align: justify;"><span style="font-size:14px;"><span style="font-family:Tahoma;"><span style="line-height:200%"><b>Background and purpose:&nbsp;</b>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 perspectives of key stakeholders.</span><br> <span style="line-height:200%"><b>Materials and Methods:</b>This qualitative study was conducted in 2024 using content analysis based on the Graneheim and Lundman approach. 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 units of meaning. Initial codes were generated from condensed meaning units, which were then organized into main themes and sub-themes based on similarities and patterns.</span><br> <span style="line-height:200%"><b>Results:</b>Analysis of participants&rsquo; experiences led to the identification of 13 main themes and 41 sub-themes under 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&rsquo;s core mission. 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.</span><br> <span style="line-height:200%"><b>Conclusion:</b>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 resource, 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.</span></span></span></div> Universities, Faculty, Medical, Education, Medical, Delivery of Health Care, Health Policy 0 0 http://jhs.mazums.ac.ir/browse.php?a_code=A-10-949-3&slc_lang=en&sid=1 Ghasem Abedi iq134589@yahoo.com 100319475328460015033 100319475328460015033 No Department of Healthcare Services Management, Health Sciences Research Center, School of Health, Mazandaran University of Medical Sciences, Sari, Iran Roya Malekzadeh Roya.malekzadeh30@yahoo.com 100319475328460015032 100319475328460015032 Yes Department of Healthcare Services Management, Health Sciences Research Center, School of Health, Mazandaran University of Medical Sciences, Sari, Iran