Navigating hidden barriers in clinical medical education in Iran: a qualitative study

Clinical education is the foundation of medical training, transforming theoretical knowledge into practical skills. In Iran, as in many other countries, clinical education faces significant challenges due to systemic inefficiencies and changing perceptions of the medical profession. This study explores the barriers to effective clinical education from the perspectives of both faculty members and medical students.

Using a qualitative content analysis approach, data were collected through purposive sampling and semi-structured interviews with 13 clinical faculty members from diverse specialties, academic ranks, and teaching experience and 11 medical students across different training levels (externs, interns, and residents) at Tabriz University of Medical Sciences. Interviews continued until data saturation was achieved. Analysis followed Graneheim and Lundman's six-step framework, with coding and categorization conducted using MAXQDA10. The study ensured trustworthiness through the principles of credibility, dependability, confirmability, and transferability.

Three major themes emerged: (1) ineffective management of clinical education, including (a) limited resources for clinical education, (b) lack of coherent planning aligned with curricular competencies, (c) poor integration between teaching and clinical service, and d) selection mechanisms for faculty and students that do not support educational goals (2) limited focus on training socially responsive physicians including (a) overemphasis on technology and scientific content, (b) neglect of societal health needs, (c) insufficient assessment of clinical competence and (3) shifts in professional perspectives in medicine, including (a) reduced faculty engagement in mentoring and (b) broader societal influences affecting professional values.

Overcoming the hidden barriers in clinical education demands a comprehensive approach that addresses structural inefficiencies, ensures accountability, and aligns training environments with curricular goals. Policy reforms should focus on redesigning clinical education settings, strengthening faculty mentorship, and fostering professional values. Bridging the gap between theory and real-world practice is essential to prepare competent and socially responsive physicians.