Strides in Development of Medical Education

Document Type : Original Article


Department of Education, Kerman Branch, Islamic Azad University, Kerman, Iran


Background: Nowadays, expectations from higher education systems have changed, and the purpose of these centers is not only to transfer information. One of the solutions to respond to higher education’s new need is to move toward lifelong learning.
Objectives: This research was conducted to investigate the desirable features of content in higher education with an emphasis on the lifelong learning approach.
Methods: This qualitative study was conducted with a content analysis approach in 2019. Nineteen faculty members of Isfahan University, Shahid Bahonar University of Kerman, and Medical Sciences Universities of Kerman and Isfahan, who were experienced in the fields of curriculum planning, higher education, and teaching and learning, were selected to participate in the study through purposive sampling. Data were collected through
open-ended semi-structured interviews. Graneheim and Lundman’s qualitative method was used to analyze the data. The results of data analysis were presented during three stages of open, axial, and selective coding. The peer check method and external observer were used in order to ensure the reliability and acceptability of the data.
Results: According to the results of this research, three main categories were identified as the desirable features of content with an emphasis on the lifelong approach. The first category was “suitability of the content for society and its needs”, which includes the components of being up-to-date and applicability and usefulness. The second category is “suitability for the learner and his/her needs”, which includes the dimensions of matching with the learner’s interest, need, and ability, developing individual skills according to the learners’ potential, and developing excellent thinking skills. The third category is “suitability for curriculum regulations”, which includes the components of continuous education, learning with multiple methods, quality, flexibility, diversity, coherence, and self-direction.
Conclusion: The results of this research can be used in revising higher education content with an emphasis on educating individuals with the feature of lifelong learning.



Lifelong learning is one of the most important capabilities needed in today’s information society. In this society, it is not possible to deal with occupational and social problems with previous information. In order to adapt to these conditions, we need to improve learning (1). Lifelong learning has become a necessity for individuals. Obviously, educational systems, especially higher education, play an important role in achieving this goal (2). Higher education, as the highest level of society’s education, is of significant importance and plays a critical role in the growth and development of society in various scientific, cultural, technological, economic, social, and political dimensions (3). In order to meet these needs, universities must make changes in the goals and content of their curricula (4). Human scientific advances and the human life’s achievements have not only provided a huge amount of information to present but have also become the main factor of instability of information and have made previous information obsolete (5). In the curriculum planning process, after assessing the needs and specifying the goals, determining the content is of particular importance and sensitivity because trying to pave the way for realizing goals is the first step (6). In a university with a lifelong learning approach, there is a need for the content to make some fundamental changes in itself in accordance with global developments (7). Although the number of studies conducted in the field of lifelong learning is small, and their relationship to the curriculum subject is superficial and insignificant, we can mention some of these studies.

Haddadnia et al. suggest that the content element in the curriculum of lifelong education should have features such as being need-oriented, coherent, flexible, attractive, systematic, diverse, fit, comprehensive, specialized, and stimulating (8).

Faroogh et al. stated that lifelong learning was an important element in education and an influential factor in the management of educational institutions and the creation of scientific health (9).

Mashhadi et al. believe that the curriculum content should be such that learners can facilitate and acquire knowledge based on their favorite skills and according to individual differences (10).

Duke and Hinzen have pointed out the commitment and performance of universities in supporting adult education and lifelong learning and believed that the role of higher education centers was research on learning, learning needs, staff career development, and even the new idea of holding global classes, and viewed the role of higher education centers as the fulfillment of learning needs and staff career developments (11).

Karimi et al. suggest inapplicability of learning, unfamiliarity with research methods in the field of study, inattention to teaching an international language, not using interdisciplinary content, low emphasis on general abilities, and inattention to the quality of research work as the problems of the university when content selection and organization (12).

Nasiri, Jafari, and Khazaee, state that the curriculum content with a lifelong learning approach should be an action for learning how to learn, the applicability of the content, suitability of the content for the needs of the society, information literacy, and citizenship education. Instead of emphasizing the content volume, attention should be paid to the content quality. In content organization, attention should also be paid to the interdisciplinary method so that the learner can gain a more comprehensive view of the subject (13).

Nongnafat et al. showed in their research that universities should include lifelong learning in their educational philosophy through goals, content, teaching-learning strategies, etc. (14).

Maleki et al. showed in a study that higher education required a specific model of the curriculum with a lifelong education-based approach in all its elements, including goals, content, teaching-learning strategies, educational materials and resources, comprehensive learning activities, educational time, educational space, and learners’ grouping and evaluation (15).

Kamyabi et al. introduced four main categories entitled creating equal and continuous learning opportunities, flexibility in accepting those who have not entered higher education, diversity of education programs, and inclusiveness as some basic policies of higher education regarding lifelong learning that should be revised (16).

The results of Mohammadi et al. study showed that the degree of tendency to be lifelong regarding the goal, content, and teaching-learning strategies’ elements significantly differed from some current learning elements (17).

According to the mentioned studies, paying attention to the curriculum with a lifelong learning approach in educational centers is necessary. In order to actually implement this important issue, paying attention to the primary and important role of the curriculum based on lifelong learning components is essential. Among the curriculum elements, it is critical to pay attention to the educational content, and the content should not merely convey past and outdated information to the individual.

According to the stated points, this article aims to answer the question of “if higher education wants to move toward a program with a lifelong learning approach and provide better learning opportunities for individuals, what characteristics should the content of this program have?”


This research was conducted to investigate the desirable features of content in higher education with an emphasis on the lifelong learning approach.


Based on the target criterion, the current research is an applied study. This research was conducted as a qualitative study with a content analysis approach in 2019. The studied population included professors and experts of Isfahan University, Shahid Bahonar University of Kerman, and Medical Sciences Universities of Kerman and Isfahan, whose fields of study were educational sciences (with different majors) and medical education. The sampling method in this study was purposeful, and data collection (conducting interviews) continued until data saturation. Theoretical saturation means a stage in which no new data appears concerning the category and the relationships between the categories have been established and confirmed (18).

Finally, 19 people were interviewed, 7 of them were experts from the Medical Education Development Center of Medical Sciences Universities of Kerman
and Isfahan, and 12 were experts in the field of planning and education at Isfahan and Kerman Universities. The interview location was determined at the professors’ offices based on the agreed time. Each interview lasted about 45 minutes. The interviews were semi-structured, and the questions were asked in an open-ended manner.

The general questions of “What is your understanding of lifelong learning in higher education?” and “What elements do you think are necessary to change to guide higher education in the path of lifelong learning?” were raised at the beginning. Then, based on the participant responses, the interview questions were guided to find the content features at a university with an emphasis on lifelong learning. The data obtained from the interviews were analyzed with the content analysis method with the Graneheim and Lundman’s (2004) approach. Based on this approach, interviews were initially conducted and implemented immediately after each interview.

After reading the text and a general understanding of the content, meaningful units and primary codes that contained concepts were extracted. In the next step, similar initial codes were classified into more comprehensive categories, and finally, the general category was determined (19). Polit and Beck (2006) methods were used to increase the scientific reliability and validity of the research results. These researchers consider the four criteria of confirmability, dependability, credibility, and transferability necessary to ensure the robustness of qualitative data (20). Therefore, to ensure the data dependability, the researcher followed this criterion by observing the interview principles, long-term interaction with the participants, and avoiding bias.

In order to ensure confirmability, after forming codes to measure the correctness of the codes and ensure the interpretations, the codes were provided to the participants, and if the codes contradicted the participants’ opinions, they were modified. Also, the control method was used by a faculty member expert in the field of qualitative research, and a consensus was reached on the selected codes and categorization. In order to obtain transferability, the extracted categories were provided to two professors who did not participate in the research to determine whether there was any similarity between the research results and their experiences. Credibility was also provided by the complete and continuous recording of the researcher’s activities on how to collect and analyze data and how to present excerpts from the interviews for each category.

Ethical considerations were respected in this research by providing the participants with oral and written information about the study, the optionality of their participation, and completing the written consent form. The participants were assured about keeping the interviews confidential, respecting the principle of confidentiality, recording the interview anonymously, and deleting the interview file after 6 months. By providing his contact number and e-mail address, the researcher created this opportunity for the participants to inform the researcher of their withdrawal from participating in the study at any stage of the research, and if they wished, the research results would be made available to them. This research has the code of ethics IR.IAU.KERMAN.REC.1400.023 issued by the ethics committee of Islamic Azad University, Kerman branch.


By examining 19 oral interviews, including interviews with 10 women with the academic ranks of
2 full professors, 3 associate professors, and 5 assistant professors, and 9 men with the academic ranks of
1 professor, 4 associate professors, and 4 assistant professors selected from Isfahan University, Shahid Bahonar University of Kerman, and Medical Sciences Universities of Kerman and Isfahan, 153 codes were obtained from the analysis of the interviews; after removing duplicate codes and merging similar cases, finally, 48 codes remained, which were placed in
3 secondary categories and 12 sub-categories (Table 1).

  1. A) Suitability (Attention) for Society and its Needs

According to the participants in the research, one of the desirable features of content in higher education is the suitability for society and its needs. Experts believe that regarding content with an emphasis on lifelong learning, paying attention to the needs of society and the content novelty is of particular importance, and without attention to the needs of society, learning will not be practical.

1) Being Up-to-Date

Participant number 7 stated: “Lifelong curriculum content should be up-to-date and consistent with the needs of science and the progress of society. It should also be consistent with the needs of the individual.”

2) Applicability and Usefulness

Participant number 4 stated: “Learners want to acquire skills that are useful for their personal and professional lives; that is, they can be useful for them at the same moment. They are not looking for a specialty that will help them in the future. So, this must be a feature of content, i.e., its immediate application in individual’s lives.”


Table 1. The coding framework in the analysis of interviews (the results of open coding)

General category

Secondary Category


Desirable features of content in higher education with an emphasis on the lifelong learning approach

Suitability (attention) for society and its needs

Being up-to-date

Applicability and usefulness

Suitability for the learner and his/her needs

Matching with the learner’s interest, need, and ability

Developing individual skills according to the learners’ potential

Developing excellent thinking skills

Suitability for curriculum regulations

Continuous education

Learning with multiple methods







Participant number 8 stated: “An adult person participates in the courses with a specific purpose. If the person feels that this course is useless for him/her, he/she will no longer participate. That is, a person who participates in this course must be aware of these goals and know the purpose of this course to participate and know that it will be useful for his/her life and work.”

  1. B) Suitability for the Learner and His/Her Needs

According to the participants, one of the appropriate features of the curriculum content in universities is the suitability of the content for the learner’s needs. Planning experts believe that responding to the learner’s needs is necessary to move toward the goal of lifelong learning; therefore, they believe in the necessity of this issue.

1) Matching with the Learner’s Interest, Need,
and Ability

Participant number 13 stated: “Learning is personal, like a fingerprint. People have different learning speeds, different rhythms, and different attention. So, the instructor’s role is to determine the appropriate learning method based on individuals’ personal characteristics.”

Participant number 3 stated: “After graduation, we realize that there are many things we should have known, but they were not in our curriculum; that is, the programs had not been prepared based on the needs of the learner. Curriculum planning should make this feeling go away.”

Participant number 15 stated: “Curriculums should be based on the needs assessment of students, not just copying the program of other countries. The curriculum must be consistent with the needs of society. Paying attention to the cultural contexts of the society is very important.”

2) Developing Individual Skills According to the Learners’ Potential

According to the participants, “talents and capabilities are different from one person to another, i.e., the formal education system should be flexible and open to be based on the learners’ needs and potential.”

Participant number 6 believed: “An adult person participates in the courses with a specific purpose. If the person feels that this course is useless for him/her, he/she will no longer participate. That is, a person who participates in this course must be aware of these goals and know for what purpose this course is held, how it will help him/her, and how much it matches with his/her talents to participate in that course.”

3) Developing Excellent Thinking Skills

Participant number 1 stated: “In today’s world where the job market is unknown and changing, learning how to learn problem-solving skills, critical understanding, and forward-looking learning is part of the skills required for everyone, and everyone should be familiar with these skills.”

Participant number 12 believed: “Our emphasis should be on problem-based learning. This type of learning stimulates learners to learn through real engagement with problems and is more focused on critical questions and developing critical skills. This type of learning is learner-oriented and creates a fundamental change: Moving from teaching to learning.”

  1. C) Suitability for Curriculum Regulations

By analyzing the interviews, seven features were identified from the participants’ perspective in the dimension of curriculum regulations, which are mentioned in the following:

1) Continuous Education

Participant number 10 pointed out: “In today’s world, the skills that a person has acquired during the last 50 years are not enough to continue his/her life and work. An individual must be a continuous learner.”

Participant number 8 believed: “Learning is not limited to childhood and the classroom; it should happen throughout life and in different situations. Learning cannot be limited to a specific time, people, and place, and we cannot say that learning is done only in educational centers.”

2) Learning with Multiple Methods

Participant number 2 pointed out that: “In higher education, we should have all education methods, such as formal, informal, and casual education.”

3) Quality

Participant number 16 stated: “Due to the limited time of each semester and the limited time of professors, students only memorize materials for the exam and learning is not stable; it means, we emphasize the quantity of materials and distance ourselves from the quality of learning, while the important thing is the quality of materials and learning.”

Participant number 9 stated: “We must teach a specific amount of basic information for each field of study to the student for deep learning and the student’s mastery of his/her field of study. Here, the emphasis should be on quality, not quantity, i.e., the student really knows the framework of his/her field of study, and from then on, we want him/her to seek more learning by him/herself.”

4) Flexibility

Participant number 7 stated: “The learning content, the learning method, and the learning place depend on the learner. All these show that the formal learning system should be more flexible and open to adapt to the learner’s needs and potential.”

Participant number 13 believed: “It is a wrong expectation that we want our adult learners to learn a set of compulsory subjects with the least choice and a specific period of time with a specific beginning and end and in a specific and focused place. It means lack of flexibility, and we need flexibility and the right to choose for adult learners.”

5) Diversity

Participant number 1 stated: “It is important to
pay attention to the principle of linguistic diversity because, in lifelong learning, other cultures and people must be respected.”

Participant number 12 believed: “Now the information volume and diversity is high and a fixed content cannot provide all of this to people. The content should be diverse so that people can choose the content according to their needs.”

Participant number 3 stated: “In the university, individuals are not homogeneous in terms of age, occupation, etc. For this heterogeneous population, we need flexible and diverse educations that fit their conditions.”

6) Coherence

Participant number 7 believed: “In lifelong learning, attention should be paid to the principle of integration, and this integration should be in vertical and horizontal manners between courses, i.e., the materials should be integrated and connected.”

Participant number 2 stated: “We should have a series of cores; other materials should be related to these cores and main materials.”

7) Self-Direction

Participant number 12 stated: “There comes a time when the student graduates from the university and finds out that all that he/she has read is not useful. A student should know what is useful for him/her, i.e., he/she should be able to recognize his/her learning needs.”

Participant number 11 stated: “A lifelong learner must know what experience has been created for him/her, how to use it, and what correction to make in the field of learning.”


Given the importance and necessity of universities’ moving toward the goal of learning, the desirable features of content in higher education were investigated with a lifelong learning approach in this study.

The analysis of the findings obtained from the interviews in this research showed the three main features of “suitability (attention) for the society and its needs”, “suitability for the learner and his/her needs”, and “suitability for curriculum regulations” as the desirable features of content with an emphasis on lifelong learning. Other studies conducted on the features of content with a lifelong learning approach have listed features inconsistent with the features of the present study.

The first main category in this study was suitability of the content for society and its needs. This main category had the sub-categories of being up-to-date and applicability and usefulness. In fact, one of the characteristics of a modern university is the increasing expectation that the curriculum should be more responsive to society (21). The UNESCO guide also emphasizes the integration of educational centers and organizations to transfer learning results from work to life and vice versa, and the adult learner also expects to transform the knowledge he/she has acquired into a product and be able to use it (22). Attention to society should be considered the most important issue in formulating the goals and the content of the higher education curriculum (23).

The suitability of the content for the learner and his/her needs was expressed as one of the requirements for having a type of content with an emphasis on the lifelong learning approach. The sub-categories of this main category included matching with the learner’s interest, need, and ability, developing individual skills according to the learners’ potential, and developing excellent thinking skills.

In its report “Toward a knowledge-based society”, UNESCO emphasized that the student’s needs should be studied and be considered the basis of educational changes. In this way, the learner’s developing personality is the main axis, but neither the individual sacrifices the society nor the society sacrifices the individual because it creates an overlap between the goal of individual fulfillment and social progress (22). In Chen’s (2019) study, four factors influencing on learning motivation were identified. These factors included: Family, individual characteristics, social factors, and educational environment. Also, these four groups can influence planning for learning, content, goals, and future development (24).

Not recognizing the needs of students and society and revising the curriculum in accordance with the evolution, not predicting the possibility of flexibility in the curriculum, and the existence of centralism in the development of curricula are among the problems of designing higher education curriculum with a learning society approach (10). Also, individuals should be directed toward the appropriate contexts of their learning, which motivates individuals to learn more (25).

Paying attention to the content of learning and individual cultural values is one of the necessary changes in the cultural infrastructure to move toward lifelong learning (26). Karimi et al. stated that the learning community in Iran should provide the opportunity to learn throughout life, learning according to abilities and interests and using different methods of learning motivation, self-directed ability in learning, and learning how to learn in individuals. Also, attention should be paid to the development of various informal and casual types of education (27).

Suitability for curriculum regulations was expressed as one of the main features, and continuous education, learning with multiple methods, quality, flexibility, diversity, coherence, and self-direction were also expressed as its sub-categories. The obtained findings regarding the content features are consistent with various research findings.

In this regard, Lall and Salamati, enumerated some policies for moving toward lifelong learning as follows: Facilitating open access, increasing flexibility, motivating individuals to learn, and increasing the effectiveness and usefulness of learning (28). Observing criteria such as emphasizing the content quality instead of quantity, providing flexible and diverse content, suitability of content for the goal of nurturing lifelong learners, suitability of content for the needs of society, supporting the professor to change the content, using other learning resources in addition to the textbook, and involving students in choosing the content are necessary (29). In Keshavarzi et al. study entitled “Curriculum content based on the development of futurism in Iran’s higher education”, the phenomenon-oriented categories and revision of curriculum content with an emphasis on futurism, strategies, context, intervening conditions, and consequences were emphasized (30). Lifelong learning includes individuals’ personal and professional lives. Also, the learning process should be performed in a formal and informal way and be useful for the learner (31). Regarding lifelong learning, Lall and Aliramaei, consider the flexible learning form necessary to enable the person to learn at all times and places and also learns in his/her own ways (32). Lifelong learning is learning that occurs at all stages of life and covers the entire context of life, from school to work. Lifelong learning is the continuous construction of skills and knowledge and using them throughout an individual’s life (33). The diversity of educational programs is one of the desirable features of higher education to move toward lifelong learning (16). Yazdani et al. concluded that Iran’s higher education health system should consider new solutions such as changes in technology infrastructure, changes in knowledge management, and network cooperation in the use of smart technology and strategic planning (34).

The strength of this research is that it is one of the few studies in Iran that has examined the content features considering the lifelong learning approach. Since the present study has focused on the factors with a qualitative approach, it has been able to deeply examine the professors’ experiences and use these experiences for practical applications.

One of the major limitations of the current research is that the research sample is limited to the professors of Kerman, Isfahan, and Tehran universities. Other infrastructures and curriculum components with a lifelong learning approach can be investigated in future studies. Examining the current status of higher education regarding the amount of attention and application of lifelong learning is also suggested.


In general, it can be concluded that changes in the curricula content can pave the way to move toward lifelong learning. Given the cultural, social, and political changes and the learning needs of today’s society, it is suggested that higher education centers provide individuals with new and applicable information in addition to transferring the basic content of each field of study and pay attention to the needs of students and their individual differences. Curriculum content should be diverse and flexible and help develop features such as thinking skills, problem-solving, self-direction, etc.

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