Extended Abstract
Background
Effective leadership in medical universities plays a pivotal role in ensuring educational quality, research productivity, and institutional accountability. In Iran's universities of medical sciences, heads of educational departments and deans occupy critical leadership positions that directly influence curriculum development, faculty performance, and academic governance. However, current selection processes remain largely appointment-based and often lack transparent, competitive, and competency-driven mechanisms. The absence of a structured merit-based framework has contributed to challenges such as unclear managerial expectations, limited accountability, insufficient leadership development, and weak performance evaluation systems. Given the strategic importance of educational leadership in strengthening the national health system, this study aimed to identify key leadership competencies and develop context-specific and merit-based policy options for selecting educational leaders in Iranian universities of medical sciences, accompanied by prioritized and actionable policy options.
Methods
This study employed a multi-phase mixed-methods design conducted in four sequential phases.
In Phase 1, a scoping review was performed to identify leadership competencies for department heads and educational leaders reported in the national and international literature. Electronic databases were systematically searched, and nine studies met the inclusion criteria. Extracted competencies were categorized into major domains, including communication skills, managerial capability, change management, professional knowledge, and ethical characteristics.
In Phase 2, qualitative data were collected to contextualize and refine the competency framework within Iran's medical education system. Semi-structured interviews and focus group discussions were conducted with medical education experts, experienced department heads, faculty members, and policymakers. Data were analyzed using thematic content analysis to identify context-specific competency dimensions and governance challenges.
In Phase 3, the Delphi technique was employed to achieve expert consensus, prioritize competencies, and assign relative weights. Experts evaluated the importance, feasibility, and relevance of each competency against predefined scientific, managerial, and professional ethics criteria, with consensus thresholds established prior to analysis.
In Phase 4, findings from the previous phases were integrated to develop a merit-based selection model and corresponding policy options. Practical interventions were designed for each competency domain, and policy options were evaluated for feasibility, advantages, limitations, and implementation challenges. This process resulted in a phased, integrated policy package applicable at both the ministerial and university levels.
Results
The integrated analysis identified four core domains forming the foundation of the merit-based model for selecting educational leaders: (1) human resource management and development, (2) organizational behavior and professional culture development, (3) change management and educational innovation, and (4) performance monitoring and evaluation.
The scoping review highlighted that effective educational leaders must demonstrate communication skills, ethical integrity, managerial capability, and the ability to lead change. Qualitative findings further revealed systemic challenges within Iranian medical universities, including centralized decision-making, limited departmental autonomy, unclear role expectations, insufficient performance evaluation systems, and a lack of structured succession planning. The Delphi process confirmed the priority and relative weight of each domain. Experts emphasized that educational departments should function as autonomous units with clearly defined responsibilities and adequate authority, and that leadership roles and required competencies must be explicitly articulated to ensure accountability and clarity of expectations. Department heads, experts agreed, should be selected through the participation of faculty members and majority voting, reinforcing internal legitimacy and representation. Experts further agreed that selected candidates should complete structured leadership development programs within six months of appointment, covering self-management, communication, team building, change management, systems thinking, problem solving, negotiation, stakeholder engagement, conflict-of-interest management, human resource management, and strategic planning.
Building on these findings, Phase 4 translated the competency domains into actionable policy options. Key interventions included establishing a competency-based selection system, implementing structured succession planning programs, institutionalizing continuous leadership training, and developing data-driven performance evaluation systems. Among these, designing and implementing a competency-based selection framework at the ministerial level was identified as the highest priority, since the remaining interventions depend on its institutionalization. Together, these interventions can be implemented as a phased, integrated reform package to strengthen governance, transparency, and accountability in medical universities.
Conclusion
This study offers context-specific, evidence-informed, and merit-based policy options for selecting educational leaders in Iranian universities of medical sciences. By integrating international evidence, qualitative insights, and expert consensus, it bridges the gap between competency identification and policy implementation. Establishing a competency-based selection system is the cornerstone reform needed to enable complementary interventions such as leadership development, succession planning, and performance evaluation. Adopting this phased, integrated policy framework can enhance transparency, institutional autonomy, accountability, and educational quality. Ultimately, strengthening the governance of educational leadership represents a strategic investment in improving the performance and responsiveness of Iran's health system.
Practical Implications of Research
These findings offer a context-specific competency framework for educational managers and point to several policy implications for strengthening academic leadership in health sciences education: Institutionalizing meritocracy in educational governance: Merit-based selection can improve managerial effectiveness and may contribute to higher educational quality and greater job satisfaction among faculty members. Establishing a national system for educational leadership assessment and development: In line with WHO recommendations, the medical education system should move toward developing a National Framework for Educational Leadership Development to standardize managerial competencies at the national level. Fostering organizational learning and mutual trust: A key finding was the need to shift from a control-oriented culture toward a learning-oriented approach which is a prerequisite for successful structural reform in health sciences education management. Integrating formal training with practical experience: Leadership development programs should combine theoretical knowledge with mentoring, coaching, and hands-on leadership experience, consistent with the model proposed in this study.