Table 1 Medical residency challenges

Context Challenges

The Economic and Social Situation of the Country

Inflation and High Prices, Political Issues and Sanctions, Apathy and Discontent in Society

Cultural Factors (Individual and Societal Expectations)

High Societal Expectations, Differences in Individuals’ Expectations from the System, and Comparisons with Other Countries

Challenges in the Education System

Planning Challenges

Lack of a comprehensive, residency program, Mismatch between society’s needs and education Inadequate number of students relative to the workload in certain fields or regions, Insufficient educational infrastructure, including beds and faculty, in proportion to the number of students, Limited patient diversity due to a high number of students, Unclear job status for individuals before the start of their education, The need for a reassessment of the duration of residency programs in some fields, Excessive reliance on diagnostic technologies

Inappropriate Resident Recruitment Methods

Selection of unmotivated and uninterested individuals, low skill levels and abilities of some residents, admission of incompetent individuals to the program, entry into fields without proper knowledge

Challenges in Residency Training

Faculty members’ lack of familiarity with modern teaching methods, Inappropriate selection of faculty members, Inconvenient teaching hours, Inadequate or inappropriate educational curricula, Self-completion of theses by residents, Unclear job descriptions for residents in different years of the program, Thesis requirement as a graduation condition, Inadequate supervision of attending physicians over residents, Professors using their discretion to assign punishments to residents as a disciplinary tool

Weak Existing Laws and Guidelines

Failure to Implement Existing Guidelines, Lack of Setting Shift Limits

Main Job-Related Challenges

Shortage of Welfare Facilities

Lack of Insurance, Absence of Resident Accommodations, Lack of Liability Insurance

High Workload

Heavy Patient Loads, Excessive Work, High Patient Volume, Residents Handling a High Volume of Service Delivery

Income Challenges

Inadequate Income Relative to Workload, Working in Private Hospitals, Rising Cost of Living, Livelihood Challenges

Communication Challenges

Lack of appropriate communication between attendings and residents, Inappropriate confrontations, Military-like confrontations, Development of unhealthy behavior, Absence of attendings, Hierarchical abuse by lower-year medical students, Pressure on residents due to attendings’ dissatisfaction with government sector income

Identity and Role Characteristics

Predominance of Therapeutic Role, Lack of Share in Hospital Income, Limited Decision-Making Power of Residents

Future Career Challenges

Low Income during Training Program, Uncertainty about Future Job Prospects, Progressive Taxation Scheme, Low Income during Training, Limited Job Market

Low Tariffs and Payment Delays

Low Tariffs, Payment Delays, Lack of Tariff Growth, Inadequate Attendings’ Income

Consequential Challenges

Presence of unmotivated and disinterested individuals, Resignations, Suicides, Physical and mental exhaustion of current assistants, Development of unhealthy behavior, especially after completing residency, Mistreatment of residents, Underground economy, Migration, Production of doctors for other countries, Lack of interest in residency programs by, doctors and a continuous decrease in residency applicants, Underutilized capacity, Increase in medical errors, Reduction in the quantity and quality of services provided