Exploring the effects of the health transformation plan on the quality of clinical education in teaching hospitals: a qualitative study.

backgroundClinical education is a cornerstone of medical training and plays a critical role in shaping students' professional competencies and readiness for practice. In 2014, Iran implemented the Health Transformation Plan (HTP) to improve healthcare service delivery, a reform that also substantially affected teaching hospitals and clinical education. This study aimed to explore faculty members' and educational leaders' perceptions of the impact of the HTP on undergraduate clinical education.

methodsThis qualitative study was conducted using a grounded theory approach. Twenty-one participants were purposively selected from teaching hospitals affiliated with Ardabil University of Medical Sciences. Participants included clinical faculty members, some of whom also held educational or managerial roles; however, all participants were actively involved in clinical practice and undergraduate clinical teaching. Data were collected through in-depth, semi-structured interviews and analyzed concurrently using open, axial, and selective coding based on constant comparative analysis until theoretical saturation was achieved.

resultsAnalysis generated a core category describing a perceived process of structural misalignment in which service-oriented priorities became increasingly prominent alongside educational responsibilities. Two interrelated categories were identified. Supportive conditions included expanded clinical exposure, improved infrastructure, and financial incentives that were interpreted as facilitating faculty retention and access to clinical resources. Constraining conditions involved crowded clinical environments, competing service demands, misaligned incentive structures, and the relative marginalization of educational considerations within policy and evaluation frameworks. Participants described how interactions among these conditions shaped teaching practices and learning opportunities over time.

conclusionsThe HTP has been perceived to simultaneously create supportive conditions and structural constraints for clinical education. While structural and resource-related improvements were noted, the increasing dominance of service-oriented priorities and misaligned incentives were perceived as challenging the educational mission of teaching hospitals. These findings highlight the importance of integrating educational goals explicitly within health system reforms to sustain high-quality clinical education.