A qualitative study of stakeholder perspectives on the challenges of the rapid expansion of medical student enrollment in Iran

In response to physician shortages, Iran has expanded medical student enrollment across public medical sciences universities. While this policy aims to strengthen the health workforce, it has raised concerns regarding system capacity and educational quality. This qualitative study explored stakeholder perspectives on the challenges associated with enrollment expansion within Iran’s integrated medical education system. The study was conducted between March and June 2025 across six Iranian medical sciences universities. Twenty-nine participants, including faculty members, educational administrators, students, and policymakers, were purposively sampled. Data were collected through in-depth semi-structured interviews and analyzed using latent content analysis based on the Graneheim and Lundman framework with MAXQDA 2022. Strategies to enhance trustworthiness included prolonged engagement, member checking, and reflexive analysis. Five interrelated themes were identified: structural capacity constraints, human resource strain, disruption of educational processes, student experience and psychosocial impact, and system-level governance and future challenges. The findings illustrate how limitations in infrastructure, faculty capacity, and planning mechanisms interact to influence educational delivery, student experience, and broader system outcomes. The results primarily reflect the perspectives of stakeholders expressing concerns about the consequences of enrollment expansion. Overall, enrollment expansion in Iran is associated with complex, system-level challenges that may affect educational quality and sustainability if not aligned with institutional capacity and workforce planning. These findings should be interpreted in light of stakeholder perspectives and broader policy objectives. Addressing these challenges requires coordinated, evidence-informed strategies across infrastructure, faculty development, governance, and workforce planning. The insights from this study may inform similar expansion efforts in other health education systems with comparable structures.