Review
Fereidoon Azizi; Abbass Entezari; Nader Momtazmanesh; Masoud Pezeshkian; Narges Tabrizchi
Abstract
Background: Following the Iranian Islamic revolution in 1979, two major reforms were implemented in the nationwide health system: Establishment of the Ministry of Health and Medical Education and the development of Primary Health Care Networks. The aim of this article is to review the impact of integration ...
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Background: Following the Iranian Islamic revolution in 1979, two major reforms were implemented in the nationwide health system: Establishment of the Ministry of Health and Medical Education and the development of Primary Health Care Networks. The aim of this article is to review the impact of integration of medical education in the health system.Methods: We review here the birth and growth of the integration of the health care system and medical education, the successes, the aspirations and some of the obstacles and challenges found along this path, as well as the vision and strategies for the future. All articles on this issue published in international Journal and in Iranian medical Journals were reviewed.Results: Health care and medical education in the I.R. Iran have undergone profound reform in the last four decades after integration of the Ministry of Health and all related schools and institutions of medical education. The newly formed Ministry of Health and Medical Education is responsible for every aspect of policy making, planning, leadership, stewardship, supervision and evaluation of health services, in addition to the training and educating of human resources for health, within the “Comprehensive Health Care Delivery System” that makes up Iran’s health infrastructure. From 1979 to 2020, the number of medical, dentistry and pharmacy schools have increased from 7 to 47, 3 to 35 and 3 to 22, respectively, with a rise in student yearly admissions in all programs of medical sciences from 1387 to 48120. There were no PhD or clinical subspecialty programs in 1979, whereas in 2020, annual student admission rates for such programs were 1038 and 219, respectively; these have been accompanied by marked improvements in the quality of education, clinical care and major health indicators such as increase in life expectancy, access to PHC in rural area, access to clean water, total number of rural health houses and vaccination coverage, on the other hand decrease in maternal, neonatal and under 5years mortality rates, decline in the number of patients sent abroad for treatment and also the number of foreign general physicians practicing in Iran..As a result ofsignificant rise in research activitiesthe number of scientific medical publications have increased from less than 2000 to over 70,000 yearly and Iran has achieved rank of 16 among all countries of the world in this regard.Conclusion: Integration of medical education into the health care system has been an appropriate and economical strategy for achieving health promotion and the key point for the improvement of medical education for better social accountability in the Islamic Republic of Iran.
Original Article
Soleiman Ahmady; Gholamreza Hassanzadeh; Ali Namaki; Masomeh Kalantarion; Sara Shahbazi; Amin Habibi; Somaye Sohrabi; Samane Babaei; Sara Bagheri
Abstract
Background: Integrating medical education and healthcare services in Iran represents a unique model that has achieved considerable success but continues to face challenges.Objectives: This study conducted a content analysis of the 7th National Integration Conference to identify indicators, achievements, ...
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Background: Integrating medical education and healthcare services in Iran represents a unique model that has achieved considerable success but continues to face challenges.Objectives: This study conducted a content analysis of the 7th National Integration Conference to identify indicators, achievements, challenges, and solutions from stakeholders’ perspectives.Methods: This qualitative study analyzed speeches from the 7th National Integration Conference in Iran using purposive sampling of 13 experts. Data were gathered from recorded presentations and analyzed inductively through qualitative methods to identify codes, categories, and themes. The study followed rigorous quality criteria and ethical principles, including informed consent, anonymity, confidentiality, and voluntary participation.Results: The study identified three themes, eleven categories, thirty-four subcategories, and 310 initial codes. Discourse analysis highlighted achievements in education, research, services, social outcomes, and economics, as well as challenges at strategic, operational, and influential levels. Proposed strategies included improving public health, implementing organizational solutions, making educational recommendations, and pursuing research-focused actions. Key findings emphasized transitioning to functional integration, maintaining curricula relevancy to societal priorities, and aligning research with public health needs.Conclusion: The conference facilitated knowledge sharing and networking among participants on integrating medical education and healthcare systems. Challenges and opportunities related to convergence were discussed, emphasizing the need for future research to evaluate integration models, enable coordination, and provide data-driven recommendations. Effective collaboration between educators and providers is essential to improve education quality and patient outcomes. A comprehensive assessment of integration strategies is crucial to ensuring the approach’s efficacy and sustainability.
Original Article
Zohreh Bagherinezhad; Roya Malekzadeh; Ghasem Abedi
Abstract
Background: The integration policy was designed and to enhance the bilateral interaction and accountability between the medical education system and the national health system, culminating in the establishment of the Ministry of Health and Medical Education.Objectives: The present research aims to critically ...
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Background: The integration policy was designed and to enhance the bilateral interaction and accountability between the medical education system and the national health system, culminating in the establishment of the Ministry of Health and Medical Education.Objectives: The present research aims to critically examine the integration of medical education into healthcare service delivery using the Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework.Methods: This qualitative study was conducted in 2023. Participants included 22 health system policymakers and managers in the country with a managerial background in universities of medical sciences in the country’s District 1. Data were collected using semi-structured interviews through purposive and snowball sampling methods until data saturation was reached. Questions were asked about the experience of integration and the SWOT of the program. Subsequently, the interviews were transcribed, semantic units were determined, and the themes’ coding, categorization, and identification were conducted. Finally, the data were analyzed using content analysis.Results: The analysis of experiences yielded 14 main themes and 42 subthemes. The main themes encompassed “self-sufficiency in health human resources, expansion of educational fields, enhancement of social accountability, growth of educational and health indicators, improvement of the connection between education and services, development of applied research (strengths), weakened interdisciplinary convergence, deviation from the educational and research mission, conflict of interest (weaknesses), support of laws and regulations for integration, expansion of international interactions (opportunities), incomplete understanding of integration, emergence of new educational approaches, political and social pressures (threats).”Conclusion: The integration of the medical education system and the health system is a complex process. This plan has not performed successfully in providing qualified human resources, improving service indicators, and expanding the scope of medical education in the country. It is recommended to select appropriate strategies to maximize the program’s strengths and opportunities and minimize its weaknesses and threats.
Original Article
Narges Tabrizchi; Mohammad Ali Mohagheghi
Abstract
Background: An integrated health system is a method to establish more efficient and effective healthcare by prioritizing patients and better meeting the health needs of communities.Objectives: The aim of this article is to present Iran’s experience with integration and examine whether other countries ...
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Background: An integrated health system is a method to establish more efficient and effective healthcare by prioritizing patients and better meeting the health needs of communities.Objectives: The aim of this article is to present Iran’s experience with integration and examine whether other countries are adopting a similar approach.Methods: A search was conducted in national and international databases using Farsi and English keywords, without any time limit. Official websites of international organizations, health systems, and well-known universities were also searched. Extracted information was analyzed and organized according to the research goals.Results: There are three general interpretations of the term "integration" in the field of health and medical sciences: "Integration in medical education or integrated curriculum," "Integrated care," and "The integration of medical education and healthcare services." Sub-groups are discussed within each topic, and examples and key points are provided. The Iranian health system is presented as an example of integrated medical education and healthcare provision. In addition, the views of the World Health Organization and the World Federation of Medical Education on this approach are briefly reviewed. Similarities were observed between integrated medical education and healthcare provision, integration in medical education, integrated care, and University Health Systems in terms of addressing community health needs and improving the quality of clinical practice.Conclusion: The review showed that while integration is essential for addressing societal health needs and is recommended by international organizations, accountability cannot be achieved solely through curriculum or health service provision integration. Successful integration relies on strong partnerships, effective mentoring, interdisciplinary education, and a commitment to continuous quality improvement. Establishing a dedicated ministry for medical education could align community health needs with training and foster interdisciplinary collaboration. The Iranian health system model has successfully linked education with practice, enhancing health outcomes, especially in rural and underserved regions.
Original Article
Seyed Hasan Emami-Razavi; Mohammad Hossein Heidarzadeh; Alireza Moshfegh
Abstract
Background: Following several challenges occurred in the country’s health system in the 1980s, including a severe shortage of specialized human resources and inadequate access to high-quality healthcare services in many regions of the country, the medical education and healthcare service delivery ...
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Background: Following several challenges occurred in the country’s health system in the 1980s, including a severe shortage of specialized human resources and inadequate access to high-quality healthcare services in many regions of the country, the medical education and healthcare service delivery systems were integrated, resulting in the establishment of the Ministry of Health, Treatment, and Medical Education. One of the primary goals and features of this integrated system is accountability to the community health needs. Given that no coherent study has been found regarding the level of social accountability within the integrated health system in Iran.Objectives: The current research was conducted aiming to measure the level of accountability of the Iranian health system.Methods: This study sought to evaluate the level of accountability of Iranian integrated health system to societal needs. Following a literature review and holding the expert panel, a questionnaire was developed to measure the level of accountability of Iranian health system across four domains: Generalities, education, healthcare service delivery, and research. The questionnaire was distributed among the target population (faculty members, health system managers, healthcare service providers, and medical students selected in the Health System Management Olympiad of the Ministry of Health), and 11 responses were received. Subsequently, the responses were analyzed using the Kruskal-Wallis and Mann-Whitney U tests.Results: The findings obtained from participants’ responses to the questionnaire revealed that the accountability of the Iranian health system to the community health needs was assessed to be at a moderate level. Furthermore, no significant difference was observed in accountability among the four mentioned domains.Conclusion: Indicators related to the quantitative development of human resource education and service delivery were associated with a reasonable level of success. However, it did not achieve significant success in the areas of improving the quality of medical education, promoting evidence-based decision-making, and making the educational programs community-oriented. According to the results, Iranian integrated educational system has not performed successfully in training non-specialized skills, such as communication, health education for other medical staff members and patients, critical thinking, and healthcare team leadership, as well as the teaching medical students to pay attention to the cost-effectiveness of treatment interventions and prescriptions. Similarly, in the field of medical research, the overall performance was not satisfactory, with the lowest scores had been related to the utilization of research findings in policy-making and improving the cost-effectiveness of services through research results.
Viewpoint
Seyyed Alireza Marandi
Abstract
Background: In Iran, the shortage of medical workforce in the population has caused the health of people to be exposed to many risks in different parts of the country, especially in deprived areas. Therefore, in 1983, the plan for “Integrating Education and Research in Health Care and Services” ...
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Background: In Iran, the shortage of medical workforce in the population has caused the health of people to be exposed to many risks in different parts of the country, especially in deprived areas. Therefore, in 1983, the plan for “Integrating Education and Research in Health Care and Services” was presented by the Supreme Council of the Cultural Revolution and approved in 1985 after some amendments.Objectives: This article reviews the history and evolution of the "Integration of Education and Research in Health Care and Services" project.Methods: The library study method (reviewing reliable sources in domestic and international publications, using the study keywords), recording the author's personal experiences, and content analysis were used.Results: All quantitative indicators (such as the number of educational centers and student admission capacities) qualitative indicators (such as the level of accountability and social commitment of academics and the health culture of the community) and general health indicators in the country were improved.Conclusion: Integrating education and research in health care and services is a revolutionary and beneficial achievement in the country and an inspiring experience for all health systems in the world. If generalized and deepened, it can become the most prominent contemporary healthcare experience in the world.
Viewpoint
Seyed Jamaleddin Sajadi -Jazi
Abstract
Background: This paper provides an overview of the plan of integration of education and research into healthcare services, as outlined in upstream laws and documents. Legal documents serve as a guiding framework for the direction of a nation’s health system. The desired vision for the health system ...
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Background: This paper provides an overview of the plan of integration of education and research into healthcare services, as outlined in upstream laws and documents. Legal documents serve as a guiding framework for the direction of a nation’s health system. The desired vision for the health system is typically reflected in development policies and plans. Having up-to-date health national policies is viewed as a hallmark of good governance in health systems. Fortunately, this issue has been given due attention in our country.Objectives: This paper provides an overview of the plan of integration of education and research into healthcare services, as outlined in upstream laws and documents.Methods: A library-based study method (reviewing reputable domestic and international publications on the keywords related to the study) was used to review upstream laws and documents related to the general health policies and content analysis.Results: The emphasis on the inherent importance and necessity of integration of education and research into healthcare services, as well as the mission to fulfill it, has been clearly articulated in upstream laws and documents in the health sector, at specific time intervals and in accordance with societal needs.Conclusion: The integration of education and research into healthcare services has been a revolutionary and highly beneficial achievement for our country. Thus, given our country’s health system state, the promulgated upstream laws and documents have comprehensively addressed all necessary aspects for strengthening the national health system, and can play a significant role in transforming the health system and advancing its objectives.
