An analysis of facilitating and hindering factors in effective evidence-based medical education: a study within the context of medical education in Iran.

introductionEvidence-Based Medical Education (EBME) is increasingly recognized as a key strategy for enhancing the quality and relevance of medical training. Despite its global endorsement, its implementation in many low- and middle-income countries (LMICs), including Iran, faces significant challenges. Highlighting the Iranian context is particularly important, as Iran represents a unique case of a rapidly expanding medical education system in a middle-income setting with distinct cultural and institutional dynamics. This study aimed to explore the factors that support or hinder the effective implementation of EBME in Iranian medical universities.

methodsThis qualitative study employed a conventional content analysis approach and was conducted between January and May 2025 across five major academic medical centers in Iran (Tehran, Shiraz, Isfahan, Mashhad, and Iran Universities of Medical Sciences). A purposive sample of 25 participants, including medical educators, curriculum developers, academic leaders, national experts, and senior medical students, was selected to ensure diversity in perspective and role. Data were collected through semi-structured interviews and analyzed using Graneheim and Lundman's content analysis framework. MAXQDA 2022 software supported data management and coding. Trustworthiness was ensured through member checking, audit trails, peer debriefing, and external validation.

resultsThe analysis yielded eight main categories and 30 sub-categories representing barriers to EBME implementation, as well as eight main categories and 33 sub-categories as facilitators. Key barriers included insufficient faculty training, lack of institutional incentives, rigid curricula, cultural resistance, low student motivation, poor access to resources, absence of national policy guidelines, and misaligned assessment systems. For example, many faculty members lacked the necessary training to translate EBME principles into teaching practice, while students often demonstrated low motivation due to limited exposure to evidence-based approaches. Facilitators encompassed faculty competence and motivation, strong leadership support, innovative curriculum design, institutional and national-level professional development programs, active student engagement, improved access to educational technologies, supportive accreditation standards, and international collaboration. Illustratively, the presence of motivated faculty with prior EBME training and institutional support through professional development initiatives were repeatedly highlighted as drivers of successful adoption.

conclusionThe study highlights that effective EBME implementation in Iran requires a systemic approach addressing individual, institutional, and policy-level factors. Strategic investments in faculty development, curriculum reform, student engagement strategies, and the establishment of clear national policy frameworks, such as embedding EBME in accreditation standards and ensuring resource allocation, are essential for sustainable progress. The findings not only provide insights into the unique Iranian setting but also offer actionable strategies for practice and policy, particularly in strengthening EBME through faculty training, curriculum reform, and well-defined national guidelines.