Explanation of the Optimal Structure for the University Education System in Realizing the Concept of Responsive Medical Education: A Narrative Review Study

Shayan, Shahram; Heidari, Atefeh

doi:10.22062/sdme.2026.200980.1542

Explanation of the Optimal Structure for the University Education System in Realizing the Concept of Responsive Medical Education: A Narrative Review Study

Document Type : Review

Authors

Shahram Shayan ¹

Atefeh Heidari ²

¹ Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran

² Medical Education Research Center, Medical Education Studies and Development Center, Isfahan University of Medical Sciences, Isfahan, Iran

10.22062/sdme.2026.200980.1542

Abstract

Background: Medical universities are tasked with addressing societal needs and improving health outcomes effectively. They must provide education that trains skilled graduates capable of responding to public health challenges in alignment with contemporary requirements. The World Health Organization has underscored the importance of this approach. However, studies show that despite significant efforts, medical education in many universities has not sufficiently met societal demands. Addressing this issue requires fundamental changes to the educational system, effective collaboration with related sectors, such as hospitals and outpatient centers, and a comprehensive revision of curricula to achieve responsive medical education.
Objectives: This narrative review aimed to synthesize literature on the structural components, key challenges, and actionable strategies across leadership, faculty, and student domains required for fostering a responsive medical education system.
Methods: This study is a narrative review. Persian and English articles were retrieved using keywords such as "medical education," "responsive medical education," and "university educational system" from databases, including PubMed, Google Scholar, Scopus, and SID. Ultimately, 55 studies were selected for inclusion based on predefined inclusion and exclusion criteria.
Results: Based on the literature review, the necessity, benefits, challenges in implementation, and effective strategies for achieving responsive medical education were highlighted. These strategies were categorized into three groups according to the roles that universities and faculties play in advancing responsive medical education: The role of university leadership, the role of the faculty, and the role of students.
Conclusion: To implement responsive medical education, a group of individuals must first form with a deep belief in its necessity. Then, a team of experts should define a shared vision and communicate it within the organization to encourage participation in its realization. Empowerment courses and achieving small victories are highly beneficial in this process. This approach is expected to lead to an optimal state in medical education. However, the achievements must be institutionalized within the university's educational culture to ensure sustainability.

Highlights

Shahram Shayan: (Google Scholar) (PubMed)

Atefeh Heidari: (Google Scholar) (PubMed)

Keywords

Medical Education

Social Accountability

Community Health

1. Rezaeian M. An overview of the various dimensions of responsive medical schools in front of society. Journal of Rafsanjan University of Medical Sciences. 2011;11(2):159-72. [In Persian]

2. Woollard RF. Caring for a common future: medical schools' social accountability. Med Educ. 2006;40(4):301-13. doi: 10.1111/j.1365-2929.2006.02416.x. PMID: 16573665

3. Boelen C, Heck JE. Defining and measuring the social accountability of medical schools. Geneva: World Health Organization; 1995.

4. Raja VP, Shivasakthy M, Lavakumar S, Lenin D. Community based medical education in medical curriculum. Int J Community Med Public Health. 2022;9(12):4762. doi: 10.18203/2394-6040.ijcmph20223242.

5. Leinster S. Evaluation and assessment of social accountability in medical schools. Med Teach. 2011;33(8):673-6. doi: 10.3109/0142159X.2011.590253. PMID: 21774656

6. Jalilian Hamed H, Amini A, Alizadeh M. Developing Social Accountability Indicators at Medical Schools. Research and Development in Medical Education 2015; 4 (1): 71-76. doi: 10.15171/rdme.2015.011.

7. Lameie A. Integration between Educational system and service delivery: accountable education. (dissertation). Orumieh: Orumieh University of Medical Science; 2010:14-21. [In Persian]

8. Jahromi MS, Taheri L, Haghbeen M, Chegin M, Fatahi N, Abiri S. Examining the state of responsive education in the clinical education groups of Jahrom University of Medical Sciences. Education & Ethics in Nursing. 2023;12(1):5-11. doi: 10.22034/ethic.2023.704685. [In Persian]

9. Pourabbas A, Amini A, Asghari Jafarabadi M. The status of accountable education in clinical education departments of Tabriz University of Medical Sciences. Research in Medical Education. 2020;12(2):71-82. doi: 10.29252/rme.12.2.71.

10. Akbari-Farmad S, Ahmady S, Hoseini MA. Exploring Faculty Member's Perceptions about Socially Accountable Medical Education Challenges: A Qualitative Content Analysis. Strides in Development of Medical Education. 2016;13(1):1-9. [In Persian]

11. Hennen B. Demonstrating social accountability in medical education. CMAJ. 1997;156(3):365-7. PMID: 9033418 PMCID: PMC1226958

12. Rourke J. Social accountability in theory and practice. Ann Fam Med. 2006;4 Suppl 1(Suppl 1):S45-8; discussion S58-60. doi: 10.1370/afm.559. PMID: 17003163 PMCID: PMC1578672

13. Tatari F, Hosseini SA, Borji A. Investigation the role of faculty members in accountable medical education. Teb Va Tazkieh. 2018: 147-56. [In Persian]

14. Khanpoor H, Amerzadeh M, Alizadeh A, Khosravizadeh O, Rafiei S. Developing a responsive model to societal needs in medical education. BMC Med Educ. 2024;24(1):370. doi: 10.1186/s12909-024-05355-9. PMID: 38575947 PMCID: PMC10996077

15. Golpaigani N, Zameni F, Saeedabasi RU. The Universities Generation-Fourth the On Based 1 Region of Universities Approach. Teb va Tazkiye Journal. 2021;29(2): 117-27.[In Persian]

16. Karimi M. Socially accountable medical education. The Journal of Medical Education and Development. 2013;8(1): 74-6. [In Perain]

17. Bahoo-Toroodi T, Yousefi-Saidabadi R, Saffarian Hamedani S. The Role of Leading Professors and Responsive Teaching on Development of Third Generation University and Presenting a Model in Mazandaran University of Medical Sciences. J Mazandaran Univ Med Sci. 2020; 30 (188): 116-24. [In Persian]

18. Enayati T, Aulipour A. Suggest a model for the academic humanities spin off incubators, move to the fourth generation university. Roshd-e-Fanavari. 2014;3(39):1. [In Persian]

19. Boelen C. A new paradigm for medical schools a century after Flexner's report. Bull World Health Organ. 2002;80(7):592-3. PMID: 12163925 PMCID: PMC2567557

20. Strasser R, Lanphear J. The Northern Ontario School of Medicine: responding to the needs of the people and communities of Northern Ontario. Educ Health (Abingdon). 2008;21(3):212. doi: 10.4103/1357-6283.101547. PMID: 19967640

21. Keshmiri F, Asgari P, Bahramnezhad F. Opportunity to reflection: The missing link in clinical education. The Journal of Medical Education and Development. 2018;13(3):252-9. [In Persian]

22. Rogers DA, Boehler ML, Roberts NK, Johnson V. Using the hidden curriculum to teach professionalism during the surgery clerkship. J Surg Educ. 2012; 69(3): 423-7. doi: 10.1016/j.jsurg.2011.09.008. PMID: 22483148

23. Yazdani S, Akbarilakeh M. The model of value-based curriculum for medicine and surgery education in Iran. Journal of Minimally Invasive Surgical Sciences. 2017; 6(3): 10-5812. doi: 10.5812/minsurgery.14053.

24. Dehghani MR, Azizi F, Haghdoost A, Nakhaee N, Khazaeli P, Ravangard Z. Situation Analysis of Social Accountability Medical Education in University of Medical Sciences and Innovative Point of View of Clinical Faculty Members towards its Promotion Using Strengths Weaknesses Opportunities and Threats (SWOT) Analysis Model. Strides in Development of Medical Education. 2014;10(4):403-12. [In Persian]

25. Alirezaei S, Arji G. Identifying the Situation of Accountable Medical Science Education and Providing Implementation Solutions in Zanjan University of Medical Sciences from the Point of View of Experts in the Field of Education. Journal of Medical Education and Development. 2023; 17(4): 263-272. [In Persian]

26. Zohoorparvandeh V. Evaluation of requirements of social accountability in the curriculum of general practitioners based on structural equation models. Journal of Medical Education. 2019 Mar 10;11(32):69-84. [In Persian]

27. Karimi M, Mirzaei M, Rahim Z. Educational needs of family physicians in Yazd province. The Journal of Medical Education and Development. 2012 Feb 10;6(1):39-46. [In Persian]

28. Boelen C, Pearson D, Kaufman A, Rourke J, Woollard R, Marsh DC, et al. Producing a socially accountable medical school: AMEE Guide No. 109. Med Teach. 2016;38(11): 1078-1091. doi: 10.1080/0142159X.2016.1219029. PMID: 27608933

29. Philibert I, Blouin D. Responsiveness to societal needs in postgraduate medical education: the role of accreditation. BMC Med Educ. 2020; 20(Suppl 1): 309. doi: 10.1186/s12909-020-02125-1. PMID: 32981520 PMCID: PMC7520978

30. Veale P, Busche K, Touchie C, Coderre S, McLaughlin K. Choosing our own pathway to competency-based undergraduate medical education. Acad Med. 2019; 94(1): 25-30. doi: 10.1097/ACM.0000000000002410. PMID: 30113362

31. Yazdani S, Hosseini, Homayoni zand R. Reform in general medical degree curriculum. Tehran: Educational development center, Shahid Beheshti University of Medical Sciences; 2008. [In Persian]

32. Samouei R, Heidari K, Saghaeiannejad S, Karami S, Aghdak P. Evaluating the responsiveness of higher education system in relation to social determinants of health. J Educ Health Promot. 2020;9:291. doi: 10.4103/jehp.jehp_80_20. PMID: 33282996 PMCID: PMC7709764

33. Fomunyam KG. Curriculum theorizing and individualism: An exploration of the curriculum’s relation to the social, personal and political dimensions of schooling. Mevlana International Journal of Education (MIJE). 2014;4(2):122-31.

34. Ahmed TS, Rashid TJ, Huda S, Sultana N, Billah AM. Perception of Medical Students on Current Medical Education in Bangladesh. Bangladesh Journal of Medical Education. 2022;13(2):13-25.

35. Boelen C, Dharamsi S, Gibbs T. The social accountability of medical schools and its indicators. Educ Health (Abingdon). 2012; 25(3):180-94. doi: 10.4103/1357-6283.109785. PMID: 23823638

36. Middleton R, Montgomery A, Murray S, Peters S, Halcomb E. Exploring leadership in health professionals following an industry‐based leadership program: A cross‐sectional survey. J Adv Nurs. 2023;79(12):4747-4755. doi: 10.1111/jan.15738. PMID: 37326228

37. Boelen C. Building a socially accountable health professions school: towards unity for health. Educ Health (Abingdon). 2004; 17(2):223-31. doi: 10.1080/13576280410001711049. PMID: 15763765

38. Entezari A, Momtazmanesh N, Khojasteh A, EYN EB. Toward social accountability of medical education in Iran. Iran J Public Health. 2009; 38(Supple 1): 27-8.

39. Strasser RP, Lanphear JH, McCready WG, Topps MH, Hunt DD, Matte MC. Canada’s new medical school: the Northern Ontario School of Medicine: social accountability through distributed community engaged learning. Acad Med. 2009; 84(10):1459-64. doi: 10.1097/ACM.0b013e3181b6c5d7. PMID: 19881443

40. Baslaugh S. Encyclopedia of Epidemiology. California: SAGE Publications, Inc; 2008.

41. Teichler U. Mass higher education and the need for new responses. Tertiary Education and Management. 2001;7(1):3-7. doi: 10.1080/13583883.2001.9967035.

42. Bridges D, Davidson RA, Soule Odegard P, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online. 2011: 16. doi: 10.3402/meo.v16i0.6035. PMID: 21519399 PMCID: PMC3081249

43. Ghanbari Firuzabadi M, Heydari S, Akhondzadeh B, Mirzaei M. Convergence of sciences for social accountability in education: An experience. Journal of Medical Education and Development. 2022;17(3):236-8. doi: 10.18502/jmed.v17i3.11300.

44. Zandi Ghashghaee K, Hoseini M, Maddah B. Survey of effective Factors in the implementation of community based medical education in the universities affiliated to the Ministry of Health and Medical Education. Armaghane-danesh. 1998;6(4):43. [In Persian]

45. Soltani-Arabshahi S, Monajemi A, Kuhpayehzadeh J, Gholami T, Khajavi M. Evaluation of clinical reasoning of interns and residents of Iran University of Medical Sciences. Razi Journal of Medical Sciences. 2013;22(132):18-25. [In Persian]

46. Karimian Z, Kojouri J, Sagheb MM. A review of evidenced-based medical education at universities in and outside Iran. Interdisciplinary Journal of Virtual Learning in Medical Sciences. 2015;6(1):64-75. [In Persian]

47. Akbari Lakeh, M., Karimi Moonaghi, H., Makarem, A. Medical Faculty Members’ Teaching Competencies and Factors Affecting It. Future of Medical Education Journal. 2012; 2(3): 7-10. doi: 10.22038/fmej.2012.342.

48. Mohammadi A, Manafi F, Shoghi Shafagh Aria F, Mojtahedzadeh R. Factors Affecting Social Accountability and Community Based Medical Education in Medical Universities: Iran’s Educational Development Authorities View Point. Payavard. 2023; 17(4): 336-48. [In Persian]

49. Moezzi M, Shirani M, Majidi F, Saberzadeh M. Design and implementation of communitybased and responsive educational program: Experience report of Shahrekord University of Medical Sciences Center for the Study and Development of Medical Education. Iranian Journal of Medical Education. 2017;17:
120-4. [In Persian]

50. Wijnen-Meijer M, Van den Broek S, Koens F, Ten Cate O. Vertical integration in medical education: the broader perspective. BMC Med Educ. 2020; 20(1): 509.
doi: 10.1186/s12909-020-02433-6. PMID: 33317495 PMCID: PMC7737281

51. Medical Education Studies and Development Center. Introduction of responsive training unit. Isfahan: Isfahan University of Medical Sciences; 2020. [In Persian]

52. Rahbar Taramsari M, Heidarzadeh A, Khoshrang H, Mohseni F, Dadgaran I, Taheri M, et al. Development the field of accountable education: along the way from the comprehensive health service center to the social accountable medical education center: The need for change. Research in Medical Education. 2022;13(4):76-9. [In Persian]

53. Kotter JP. Leading change. Boston, US: Harvard Business Press; 2012. doi: 10.15358/9783800646159.