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In eg a ing s uden eedback: A comp ehensi e app oach o
quali y imp o emen in medical educa ion using EFQM wi h an
emphasis on enable s
SeyedPou ia Hedaya i1, Soudabeh Hamedi-Shah aki2, Fa emeh Mohaba i1*
1Depa men o Heal hca e Se ices Managemen , School o Heal h, Zabol Uni e si y o Medical Sciences, Zabol, I an
2Depa men o Public Heal h, School o Heal h, Zabol Uni e si y o Medical Sciences, Zabol, I an
A icle in o Abs ac
In oduc ion
In he cu en e a o globaliza ion and
in e na ionaliza ion o highe educa ion, academic
ins i u ions a e in a compe i i e en i onmen . Thus, he
need o implemen quali y assu ance sys ems is e en
mo e necessa y [1]. Se ice quali y, one o he key
ac o s o success and sus ainabili y o any o ganiza ion,
including highe educa ion, has become o undeniable
impo ance. Howe e , as a dynamic and pu pose ul
sys em, highe educa ion aces new challenges and mus
e ol e in bo h quan i a i e and quali a i e dimensions.
The quali y o highe educa ion is a mul idimensional
concep in luenced by a ious ac o s, including he
acul y s a us, he uni e si y sys em, i s mission, and he
condi ions and s anda ds o academic disciplines [2].
This issue is pa icula ly signi ican in he ield o
medical sciences, as he quali y o educa ion di ec ly
impac s public heal h. Resea ch has shown ha
enhancing he quali y o medical educa ion is c ucial o
imp o ing heal hca e se ices [4, 5]. In his se ing, he
quali y o educa ional se ices om he s uden 's poin o
iew, as he main cus ome s o uni e si ies, becomes a
e y impo an ques ion. S uden sa is ac ion was seen as
an impo an componen o highe educa ion se ices'
quali y, as Tee oo engadum e al. poin ed ou [6]. The e
ha e been many s udies on his opic all a ound he
wo ld. Al es and Raposo [7], o example, showed ha
A icle his o y:
Recei ed 27 Dec. 2024
Accep ed 20 Ap . 2025
Published 13 Jul. 2025
Hedaya i e al. J Med Edu De . 2025; 18(2): 17-26 Jou nal o Medical Educa ion De elopmen
Backg ound & Objec i e: E alua ing he quali y o educa ional se ices om he pe spec i e
o s uden s— he p ima y s akeholde s—is essen ial o enhancing uni e si y pe o mance. This
s udy aimed o assess he quali y o educa ional se ices based on he Eu opean Founda ion o
Quali y Managemen (EFQM) excellence model.
Ma e ials & Me hods: This c oss-sec ional s udy was conduc ed om Ma ch o June 2023.
The s a is ical popula ion included all s uden s o a medical sciences uni e si y, selec ed
h ough s a i ied andom sampling based on school a ilia ion. The da a collec ion ool u ilized
was a s anda dized EFQM ques ionnai e de eloped by he i e c i e ia o he EFQM model.
The alidi y and eliabili y o he ques ionnai e we e con i med. Da a we e analyzed using
desc ip i e and in e en ial s a is ics, including independen - es s and ANOVA.
Resul s: Among 327 s uden s, 58.4% we e emale. No signi ican di e ences we e obse ed in
he educa ional e ec i eness componen s be ween male and emale s uden s. The compa ison
ac oss schools indica ed signi ican di e ences in he componen s o acul y, lea ning- eaching
p ocesses, s uden engagemen , and leade ship and managemen (p < 0.05). Howe e , no
signi ican di e ence was obse ed in he educa ional p og am componen . Semes e 6 o lowe
s uden s epo ed signi ican ly highe sco es (p < 0.05) o he acul y, lea ning- eaching
p ocess, and s uden engagemen componen s han hose in highe semes e s. The o e all
quali y o educa ional se ices was a ed as mode a e (mean = 3.4 ± 0.7 on a 5-poin scale;
mode a e ange: 2.5-3.9).
Conclusion: The quali y o educa ional se ices was pe cei ed as mode a e om he s uden s’
pe spec i e. To imp o e quali y, i is ecommended ha uni e si y adminis a o s ocus on
c i e ia wi h lowe sco es and implemen a ge ed quali y imp o emen p og ams.
Keywo ds: e alua ion, educa ional se ices, EFQM, s uden s
*Co esponding au ho :
Fa emeh Mohaba i, Depa men o
heal hca e se ices managemen ,
School o heal h, Zabol Uni e si y o
Medical Sciences, Zabol, I an.
Email: mohaba i @gmail.com
O iginal A icle
How o ci e his a icle:
Hedaya i SP, Hamedi-Shah aki S,
Mohaba i F. In eg a ing s uden
eedback: A comp ehensi e app oach
o quali y imp o emen in medical
educa ion using EFQM wi h an
emphasis on enable s. J Med Edu
De . 2025; 18(2): 17-26.
[ DOI: 10.61882/edcj.18.2.17 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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18 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
he success o highe educa ion ins i u ions is ela ed o
s uden sa is ac ion wi h he quali y o he uni e si y
se ices.
Se e al s udies ha e also been conduc ed in I an. Fo
example, To ighi e al. e alua ed he quali y o
educa ional se ices p o ided by he Teh an Uni e si y
o Medical Sciences om s uden s' poin o iew. They
iden i ied a la ge disc epancy be ween s uden s'
expec a ions and pe cep ions [8]. O e he pas yea s,
nume ous models ha e been used o assess educa ional
se ice quali y. In his case, one such model is he
Eu opean Founda ion o Quali y Managemen (EFQM)
excellence model. This model o e s a sys ema ic
app oach o e alua e and enhance o ganiza ional
pe o mance and has been applied in se e al coun ies,
including I an [9]. The eigh main c i e ia o he EFQM
model a e di ided in o enable s and esul s [10]. Wi h
his model, he quali y o educa ional se ices is assessed
holis ically and sys emically. Qala andi e al. [11]
demons a ed ha he EFQM model, when applied o
highe educa ion in I an, could enhance he quali y o
educa ional se ices a U mia Uni e si y. The e alua ion
sys em o he e ec i eness o educa ion a he
Uni e si y o Medical Sciences is based on an eigh -
domain model di ided in o wo g oups: Enable s and
Resul s. The Enable s consis o i e domains, while he
Resul s comp ise h ee domains. In his s udy, ou
emphasis has been on he Enable s domain, and we ha e
examined hese i e domains o assess he e ec i eness
o educa ion.
Howe e , he s udies conduc ed o implemen he EFQM
model o e alua ing he quali y o educa ional se ices
in I anian medical uni e si ies ha e no been ully
ealized. The s udies ha e mos ly been conduc ed in
la ge and cen al uni e si ies, while smalle and
unde p i ileged ins i u ions a e less a ended. As a
p ominen uni e si y in he coun y's sou heas e n
egion, Zabol Uni e si y o Medical Sciences plays a
i al ole in aining heal hca e and medical
p o essionals. Due o i s geog aphical loca ion and
ce ain egional condi ions, e alua ing he quali y o
educa ional se ices a his uni e si y is qui e impo an .
The e has been no s udy, o da e, on he pe spec i es o
s uden s o his ins i u ion using he EFQM model. I is
impo an o conduc his s udy o he ollowing easons:
o iden i y he s eng hs and weaknesses o educa ional
se ices om s uden s' pe spec i e; o iden i y he gap
be ween he cu en and ideal s a es o educa ional
se ice quali y; o p o ide p ac ical solu ions o imp o e
educa ional se ices; o allow compa ison wi h o he
medical uni e si ies in he coun y; and o suppo
decision making a he s a egic le el o imp o e
educa ional quali y. Conside ing hese poin s and he
emphasis by F enk e al. on he necessi y o ans o m
medical educa ion o enhance heal h sys ems [12], he
p ima y aim o his s udy is o iden i y he quali y gap in
educa ional se ices om he pe spec i e o medical
s uden s a he men ioned uni e si y, based on he EFQM
model, in 2024. E alua ing educa ional p og ams is
c i ical o enhancing hei e ec i eness and ele ance.
Fo ins ance, Mohaba i e al. u ilized he CIPP model o
assess and imp o e Field P ac icum 4 o Heal h Se ices
Managemen s uden s a his uni e si y [13]. Simila ly,
his s udy employs he EFQM model o e alua e he
quali y o educa ional se ices. This s udy's indings
could help uni e si y adminis a o s and planne s ake
e ec i e s eps o enhance educa ional se ice quali y and
aise s uden sa is ac ion. This s udy also can be used as
a model o o he medical uni e si ies in he coun y o
assess and imp o e he quali y o hei educa ional
se ices.
Ma e ials & Me hods
Design and se ing(s)
In his c oss-sec ional s udy, s uden s a Zabol Uni e si y
o Medical Sciences we e e alua ed om Ma ch o June
2022, p o ided hey had comple ed a leas one semes e .
The uni e si y includes i e schools: Medicine,
Pha macy, Public Heal h, Nu sing and Midwi e y, and
Pa amedical, o e ing 15 ields.
Pa icipan s and sampling
The uni e si y se es a di e se s uden body, wi h
app oxima ely 1672 s uden s en olled ac oss
unde g adua e and g adua e p og ams du ing he s udy
pe iod. The sample size equi ed o his s udy was
de e mined based on da a ob ained om he s udy o
Mohammadi and Vakili [14] by conside ing SD = 0.9,
deg ee o p ecision 0.1 (d = 0.1), and α = 0.05. The
sample size eached 312 s uden s using he o mula
p oposed o c oss-sec ional s udies. To achie e an
an icipa ed esponse a e o 90%, he sample size was
inc eased o 345 s uden s. The ques ionnai es we e
adminis e ed elec onically, wi h 327 ully comple ed
ques ionnai es included in he analysis, esul ing in a
95% esponse a e. Sampling was done using s a i ied
sampling echniques based on he numbe o s uden s in
each school.
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Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 19
Tools/Ins umen s
The da a collec ion ool was a s anda dized ques ionnai e
ha included demog aphic ques ions such as gende , age,
academic le el, and school. Addi ionally, he
s anda dized EFQM ques ionnai e was used o e alua e
educa ional e ec i eness. The EFQM ques ionnai e
consis s o 43 ques ions o ganized in o i e domains: he
Facul y Domain (Ques ions 1-12), he Lea ning-
Teaching P ocess (Ques ions 13-23), he S uden
Domain (Ques ions 24-29), he Educa ional P og am
(Ques ions 30-38), and Leade ship and Managemen
(Ques ions 39-43).This ques ionnai e was localized and
e alua ed o alidi y and eliabili y. Feedback and inpu
we e ga he ed om a eam o academic and educa ional
expe s du ing he p epa a ion and e inemen o he
ques ionnai e. The ini ial e sion was de eloped by he
esea che and imp o ed based on indi idual and g oup
eedback o enhance he quali y o he ques ions. The
ques ionnai e was dis ibu ed o nine acul y membe s in
heal hca e managemen , educa ional managemen , and
medical educa ion o con i m con en alidi y. The
Con en Validi y Index [15] was calcula ed based on he
a ings p o ided by he expe panel, wi h each i em
sco ed on a 5-poin Like scale o ele ance. The
o e all CVI o he ques ionnai e was de e mined o be
0.88, which exceeds he widely accep ed h eshold o
0.79. This indica es a high le el o ag eemen among he
expe s ega ding he ele ance o he i ems, con i ming
ha he ques ionnai e e ec i ely measu es he in ended
cons uc s. Simila ly, he Con en Validi y Ra io (CVR)
was compu ed o assess he necessi y o each i em. The
o e all CVR was ound o be 0.81, which su passes he
c i ical alue o 0.74 o a panel o 7 expe s, as pe
Lawshe’s s anda d able. This con i ms ha he included
i ems a e essen ial and sui able o assessing he quali y
o educa ional se ices. These esul s demons a e he
obus ness o he con en alida ion p ocess and p o ide
s ong e idence o he eliabili y and alidi y o he
ques ionnai e used in his s udy. The eliabili y o he
EFQM ques ionnai e was p e iously con i med in an
I anian con ex by Gho bani e al. [16], epo ing a
C onbach’s alpha o 0.895.
Da a collec ion me hods
Da a collec ion was done elec onically o ease o
accessibili y and anonymi y. The ques ionnai e was
dis ibu ed o he s uden s h ough a secu e online
pla o m, and hey we e allowed wo weeks o comple e
i . Responden s we e gi en clea ins uc ions on he
p ocess, and pa icipa ion was olun a y. Da a we e
sc eened o comple eness and consis ency on an a p io i
basis o analysis. Da a se s wi h missing o incomple e
esponses we e excluded o main ain da a in eg i y. The
ques ionnai e was in elec onic o ma , which helped in
e icien da a agg ega ion and educed e o s due o
manual en y. By ollowing his sys ema ic app oach o
da a collec ion, he eliabili y and alidi y o he indings
we e gua an eed, laying a solid g ound o he s udy’s
conclusions.
Da a analysis
Ques ionnai e esponses we e sco ed on a 5-poin Like
scale (1 = s ongly disag ee, 5 = s ongly ag ee), wi h a
maximum o al sco e o 215 (43 i ems × 5). The global
mean sco e was calcula ed by a e aging all 43-i em
esponses ac oss he 327 s uden s and exp essed on he
5-poin scale (di ided by 43). Fo in e p e a ion, sco es
we e ca ego ized as ollows: 1.0–2.4 (poo ), 2.5–3.9
(mode a e), and 4.0–5.0 [17], based on pe cen age
h esholds aligned wi h educa ional quali y s anda ds
(20–48%, 50–78%, 80–100% o he maximum,
espec i ely). The Kolmogo o -Smi no es was used o
assess he no mali y o he da a. The esul s a e p esen ed
as mean ± s anda d de ia ion o quan i a i e da a and
equency (pe cen ) o quali a i e da a. Independen
samples - es was used o compa e educa ional
e ec i eness componen s among a iables wi h wo
g oups, and a one-way analysis o a iance [18] es was
used o a iables wi h mo e han wo g oups. Da a we e
analyzed using IBM SPSS e sion 25 (IBM Co p,
A monk, NY, USA), and in all analyses, wo-sided p-
alues < 0.05 we e conside ed s a is ically signi ican .
The Kolmogo o -Smi no es was applied o explo e
he no mali y o da a. The esul s a e p esen ed as mean
± s anda d de ia ion o quan i a i e da a and equency
(pe cen ) o quali a i e da a. Independen samples - es
was used o compa e educa ional e ec i eness
componen s among a iables wi h wo g oups, and a
one-way analysis o a iance [18] es was used o
a iables wi h mo e han wo g oups. Da a we e analyzed
using IBM SPSS e sion 25 (IBM Co p, A monk, NY,
USA). In all analyses, p- alues o less han 0.05 we e
conside ed s a is ically signi ican .
Resul s
The o e all quali y o educa ional se ices was e alua ed
based on all 43 i ems o he EFQM ques ionnai e
in ol ing 327 s uden s a Zabol Uni e si y o Medical
Sciences. The demog aphic cha ac e is ics o he
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pa icipa ing s uden s, including gende , school, and
academic semes e , a e p esen ed in Table 1. This
assessmen yielded a global mean sco e o 3.4 ± 0.7 (on
a 5-poin scale), which is ca ego ized as mode a e
acco ding o he c i e ia ou lined in he Da a Analysis
subsec ion o he Ma e ials and Me hods sec ion. This
key inding e lec s he uni e si y-wide educa ional
quali y om he s uden s' pe spec i e.
Table 1. Demog aphic cha ac e is ics o he s uden s s udied
(n = 327)
Va iable
F equency
Pe cen
Gende
Female
191
58.4
Male
136
41.6
School
Medicine
72
22.0
Pha macy
49
15.0
Public Heal h
69
21.1
Nu sing and Midwi e y
58
17.7
Pa amedical Sciences
79
24.2
Academic Semes e
Semes e 6 o lowe
190
58.4
Highe han semes e 6
137
41.6
No e: The Chi-squa e es was used o compa e pa icipan s based on ca ego ical
demog aphic a iables
De ailed esul s o each componen , b oken down by
school and semes e , a e p esen ed below as addi ional
analyses. Gende compa isons, seconda y o he s udy's
p ima y objec i e, a e summa ized: no signi ican
di e ences we e ound be ween emale (n = 191) and
male (n = 136) s uden s ac oss he i e EFQM
componen s. The esul s a e as ollows: Facul y: 36.7 ±
9.0 s. 37.1 ± 8.2, = -0.39, p = 0.698; Lea ning and
Teaching P ocess: 33.6 ± 8.0 s. 34.0 ± 7.7, = -0.40, p
= 0.689; S uden : 17.0 ± 4.9 s. 17.2 ± 4.6, = -0.24, p =
0.811; Educa ional P og am: 28.3 ± 7.1 s. 28.6 ± 6.7,
= -0.30, p = 0.766; Leade ship and Managemen : 17.0 ±
5.2 s. 17.3 ± 4.6, = -0.49, p = 0.622.
Table 2 compa es he componen s o educa ional
e ec i eness ac oss schools and p esen s he o e all
mean sco es o Zabol Uni e si y o Medical Sciences (n
= 327). The o al EFQM sco e ac oss all 43 i ems was
146.2 ± 30.1 (ou o 215), suppo ing he uni e si y-wide
quali y assessmen as he p ima y ou come. Signi ican
di e ences we e obse ed in he acul y, lea ning and
eaching p ocess, s uden , and leade ship/managemen
componen s (p < 0.05) bu no in he educa ional p og am
componen (p = 0.207). Addi ionally, he componen s o
educa ional e ec i eness we e compa ed based on
academic semes e s (Table 3). S uden s in semes e 6 o
lowe sco ed signi ican ly highe in he acul y
componen (37.8 ± 8.9 s. 35.5 ± 8.2, p = 0.021), he
lea ning and eaching p ocess (34.6 ± 8.6 s. 32.6 ± 6.7,
p = 0.027), and he s uden componen (17.5 ± 5.4 s.
16.5 ± 3.8, p = 0.033) compa ed o hose in highe
semes e s. Howe e , no signi ican di e ences we e
ound in he educa ional p og am componen (28.9 ± 7.2
s. 27.7 ± 6.4, p = 0.160) o he leade ship and
managemen componen (17.6 ± 5.3 s. 16.5 ± 4.3, p =
0.063).
Table 2. Compa ison o educa ional e ec i eness componen s ac oss schools and o e all a Zabol Uni e si y o Medical Sciences
Componen
Medicine
(n = 72)
Pha macy
(n = 49)
Public Heal h
(n = 69)
Nu sing
&
Midwi e y
(n = 58)
Pa amedical
(n = 79)
O e all
(n = 327)
Sig.
To al EFQM
sco e
157.5 ± 28.6
141.0 ± 25.7
155.7 ± 32.8
132.8 ± 25.8
148.5 ± 31.0
146.2 ± 30.1
F = 7.42, p < 0.001
Facul y
38.6 ± 7.6
35.6 ± 8.7
39.2 ± 8.4
31.8 ± 7.6
37.6 ± 9.2
36.8 ± 8.3
F = 7.85, p < 0.001
Lea ning and
eaching
p ocess
35.5 ± 7.6
30.8 ± 5.8
37.1 ± 8.0
29.6 ± 7.3
34.2 ± 7.8
33.8 ± 7.3
F = 9.12, p < 0.001
S uden
18.9 ± 4.4
15.2 ± 3.5
18.8 ± 5.8
15.5 ± 4.2
16.3 ± 4.4
17.1 ± 4.5
F = 8.63, p < 0.001
Educa ional
p og am
29.3 ± 6.8
28.2 ± 7.1
28.8 ± 7.5
26.6 ± 6.1
28.8 ± 6.8
28.4 ± 6.9
F = 1.48, p = 0.207
Leade ship and
managemen
18.2 ± 4.9
16.2 ± 4.2
17.8 ± 6.0
15.3 ± 3.7
17.6 ± 4.9
17.2 ± 4.7
F = 3.87, p = 0.005
No e: One-way ANOVA es was used o compa e pa icipan s based on quan i a i e a iables ac oss i e schools.
Abb e ia ions: n, numbe o pa icipan s; SD, s anda d de ia ion; F, F-s a is ic; Sig, s a is ical signi icance; p, p- alue; EFQM, Eu opean ounda ion o quali y managemen .
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Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 21
Table 3. Educa ional e ec i eness componen s based on academic semes e om he pe spec i e o s uden s a Zabol Uni e si y o
Medical Sciences
Componen
Semes e 6 o lowe (n = 190)
Highe han semes e 6 (n = 137)
Sig.
Facul y
37.8 ± 8.9
35.5 ± 8.2
= 2.31, p = 0.021
Lea ning and eaching p ocess
34.6 ± 8.6
32.6 ± 6.7
= 2.22, p = 0.027
S uden
17.5 ± 5.4
16.5 ± 3.8
= 2.14, p = 0.033
Educa ional p og am
28.9 ± 7.2
27.7 ± 6.4
= 1.41, p = 0.160
Leade ship and managemen
17.6 ± 5.3
16.5 ± 4.3
= 1.87, p = 0.063
No e: The independen - es was used o compa e pa icipan s based on quan i a i e a iables ac oss wo semes e g oups.
Abb e ia ions: n, numbe o pa icipan s; SD, s anda d de ia ion; , -s a is ic; Sig, s a is ical signi icance; p, p- alue.
Discussion
The p ima y objec i e o his s udy was o e alua e he
e ec i eness o educa ional se ices a Zabol Uni e si y
o Medical Sciences using he EFQM model, wi h a
pa icula ocus on s uden pe spec i es. By analyzing
key componen s such as acul y, he lea ning and
eaching p ocess, educa ional p og ams, leade ship, and
managemen , we aimed o iden i y s eng hs,
weaknesses, and oppo uni ies o imp o emen in
educa ional se ice deli e y.
The indings we e u he examined ac oss demog aphic
and con ex ual ac o s, including gende , academic
semes e , and school, p o iding a comp ehensi e
unde s anding o he ac o s in luencing educa ional
quali y. The o e all sco es o he EFQM componen s a
Zabol Uni e si y o Medical Sciences o e aluable
insigh s in o speci ic s eng hs and a eas ha equi e
imp o emen .
The Facul y componen sco ed highes (36.8 ± 8.3),
sugges ing ha s uden s pe cei e eaching s a as a
ela i e s eng h, possibly due o hei quali ica ions o
engagemen . Howe e , signi ican school a ia ion
(31.8–39.2, p < 0.001) indica es une en quali y. The
Lea ning and Teaching P ocess (33.8 ± 7.3) also a ed
mode a ely high, e lec ing adequa e ins uc ional
me hods, ye lowe sco es in Nu sing and Midwi e y
(29.6 ± 7.3) and Pha macy (30.8 ± 5.8) sugges a need
o pedagogical enhancemen s in hese schools. The
S uden componen had he lowes ela i e sco e (17.1 ±
4.5), pa icula ly among highe -semes e s uden s (16.5
± 3.8 s. 17.5 ± 5.4, p = 0.033).
This sugges s po en ial gaps in s uden suppo o
engagemen as academic demands inc ease. The
Educa ional P og am (28.4 ± 6.9) was consis en ac oss
schools (p = 0.207), indica ing a s able cu iculum,
hough i s mode a e a ing sugges s oom o alignmen
wi h cu en heal hca e needs. Finally, Leade ship and
Managemen (17.2 ± 4.7) a ied signi ican ly by school
(15.3–18.2, p = 0.005), poin ing o inconsis en
adminis a i e e ec i eness ha may bene i om
s anda dized aining. These indings unde sco e he
need o a ge ed in e en ions ac oss componen s o
ele a e o e all educa ional quali y.
A no able inding was ha he e we e no majo
disc epancies be ween male and emale s uden s'
e alua ions o educa ional e ec i eness. I is consis en
wi h se e al domes ic s udies (e.g., Enaya i No in a e
al. [19] and Mohammadi and Vakili [14] ha also ound
no gende di e ences in sa is ac ion wi h educa ional
se ices. This also is in line wi h in e na ional esea ch.
Some s udies, o ins ance, Khoo e al. on Malaysia,
indica e possible links be ween such an ou come and
equi able access o esou ces and lea ning oppo uni ies
[20]. Ou indings sugges ha a ela i ely balanced
educa ional en i onmen is p o ided o bo h gende s a
Zabol Uni e si y. Howe e , con as ing esul s exis . Fo
ins ance, Gha imi e al. epo ed high dissa is ac ion
among emale s uden s [15].
In con as , acco ding o he con ex , Kebe iaei and
Rudba i [21] and Aghami zaei e al. [22] ound highe
sa is ac ion among male o emale s uden s. These
disc epancies poin o he ole o cul u al, social, and
o ganiza ional ac o s, as men ioned by El Ansa i and
S ock [23]. Zabol Uni e si y's abili y o main ain gende
equi y is commendable, bu Wie s-Jenssen e al. [24]
s ess ha i s abili y o main ain gende equi y is only a
con inuous eassessmen ha can ensu e quali y ac oss
all demog aphics.
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Signi ican a ia ions in s uden e alua ions o se ice
quali y we e ound among di e en schools. Facul y and
lea ning eaching p ocess we e a ed mo e a o ably by
Public Heal h and Medicine s uden s, whe eas Nu sing
and Midwi e y s uden s ga e lowe sco es. This is in line
wi h in e na ional esea ch, such as Bu and Rehman's
s udy in Pakis an [25], which also ound school-le el
dispa i ies in sa is ac ion.
Acco ding o Qala andi e al. [11], hese di e ences may
be due o s uc u al and manage ial di e ences be ween
schools. Mo eo e , Mohammadi and Vakili [14] and
Khoo e al. [20] also men ioned ha s uden needs and
expec a ions di e in di e en disciplines. The ac o s
ha a ec sa is ac ion a e also o he ac o s such as
eaching quali y, acili ies, wel a e se ices, and access
o esea ch esou ces, acco ding o Aghami zaei e al.
[22], Tee oo engadum e al. [6], and Odukoya e al. [26].
Quali y imp o emen p og ams should be ailo ed o
each school's needs and conside global ends in
educa ion, such as os e ing posi i e o ganiza ional
clima es and in e na ionalizing.
Resul s o he s udy e ealed signi ican di e ences in
s uden s' pe cep ions o educa ional e ec i eness ac oss
academic semes e s (Table 4). S uden s in semes e 6 o
lowe epo ed highe a ings o acul y (p = 0.021), he
lea ning and eaching p ocess (p = 0.027), and s uden -
ela ed aspec s (p = 0.033), while hose in highe
semes e s exp essed g ea e dissa is ac ion. This is
consis en wi h he indings o Liu [27] and Zhao [28]
ha declining sa is ac ion was due o g owing academic
p essu e, wo ies abou u u e employmen , and
academic a igue.
S udies such as Gholizadeh e al. [29] and Ca moe e al.
[30] indica e ha highe -semes e s uden s ha e highe
expec a ions o educa ional se ices. Such changes
would a ge in e en ions o hese e ol ing demands:
imp o ing ca ee counselling, educing class oom s ess,
and upda ing he cu iculum. On he o he hand, some
s udies, such as Mgaiwa. [31], ha e no e ealed any
signi ican di e ences be ween sa is ac ion in di e en
academic yea s, indica ing ha he ac o s o
me hodology o con ex may be esponsible o he
ob ained esul s. The s udy's educa ional p og am
componen was e alua ed he same by s uden s ac oss
schools, sugges ing ha i was gene ally implemen ed in
he same way.
Sa is ac ion wi h his componen was mode a e, and
he e was oom o imp o emen . This i s wi h
in e na ional esea ch. Fo example, Kim [32] and De-
Juan-Viga ay [33] b oadly ag ee ha he cu iculum
con en and cou se s uc u e a e c i ical ac o s a ec ing
s uden sa is ac ion. Thanh Thuy e al. [34] ound ha
p og am quali y di ec ly a ec s s uden loyal y, hough
ou s udy ocused on e ec i eness (Educa ional
P og am: 28.4 ± 6.9), no loyal y, limi ing di ec
compa ison. Acco ding o he p esen s udy, he indings
o Abdollahzadeh e al. in I an showed low o mode a e
s uden sa is ac ion wi h he educa ional p og ams [35].
Cou se con en , upda es o ma ch labou ma ke needs,
and eaching me hods a e he p io i y a eas o
uni e si ies o ocus on o achie e he goals ou lined in
he 2009 Mas e 's P og am Guidelines [36].
A help ul amewo k o imp o ing educa ional
p og ams could be Tee oo engadum e al.'s hie a chical
model o se ice quali y e alua ion [6].
The e was a signi ican di e ence in leade ship and
managemen componen s ac oss schools. The
componen was a ed mo e a ou ably by s uden s o
Medicine and Pa amedical Sciences and less a ou ably
by hose o Nu sing and Midwi e y. This is likely due o
a ia ions in leade ship s yles and managemen
s a egies, as no ed by B yman [37] and Spendlo e [38].
Some schools may ha e ecei ed highe sco es because
o he impo ance o dis ibu ed and pa icipa i e
leade ship in highe educa ion, as no ed by Bolden e al.
[39].
Rossi and Sengup a [36] poin ed ou a he na ional le el
ha s a egic changes occu ed a a ious academic
le els. Taj a e al. indica ed ha he e we e ew chances
o s uden s' eedback in I anian uni e si ies, which
could be one o he easons o leade ship gaps [40].
Adap ing bes p ac ices om highe -pe o ming schools,
as sugges ed by Heys ek and Emekako [41], migh
imp o e leade ship and managemen , especially in
lowe -sco ing schools.
This s udy has some limi a ions as i only ocuses on he
e ec i eness o educa ional se ices a Zabol Uni e si y
o Medical Sciences. Sel - epo ed da a should lead o
esponse bias, and i only ocuses on one ins i u ion.
Fu he mo e, he c oss-sec ional design is only a
snapsho o s uden pe cep ions and does no conside
changes o e ime. Fo hese easons, he esul s p o ide
impo an di ec ions o u u e esea ch.
To inc ease he scope and include longi udinal designs
and he addi ion o quali a i e and quan i a i e me hods,
he insigh s can be deepe and mo e gene alizable.
Addi ionally, his can aid in unde s anding and e idence-
based imp o emen in medical educa ion by explo ing
he ela ionship be ween EFQM enable domains and
esul domains and a ge ed in e en ions.
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Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 23
Conclusion
The aim o his s udy was o assess he quali y o
educa ional se ices a Zabol Uni e si y o Medical
Sciences by applying he EFQM model, using s uden s'
pe cep ions in ela ion o hei schools and academic
le els.
The indings also indica ed huge a ia ions in
sa is ac ion among di e en g oups, no ably lowe and
highe semes e s uden s, who epo ed highe
sa is ac ion in a eas such as he pe o mance o acul y
and eaching p ocesses. Mo eo e , a iance in how
di e en schools pe cei ed leade ship and adminis a i e
quali y e ealed di e ences in adminis a i e
e ec i eness. In e es ingly, he e we e no signi ican
di e ences be ween he e alua ions o educa ional
p og ams ac oss schools, al hough o e all sa is ac ion
wi h such p og ams was mode a e, which indica es a
need o imp o emen .
These esul s unde sco e impo an educa ional policy
and p ac ice conside a ions, especially in medical
educa ion. Key ecommenda ions include egula ly
upda ing cu icula o align wi h labou ma ke needs,
aining adminis a o s o imp o e hei leade ship and
managemen skills, es ablishing sys ema ic eedback
mechanisms o inco po a e s uden inpu , p omo ing
in e disciplina y lea ning oppo uni ies, and p o iding
a ge ed suppo o highe -semes e s uden s as hey
na iga e hei g ow h and de elopmen . Implemen ing
hese s a egies could enhance he quali y o educa ional
se ices a Zabol Uni e si y o Medical Sciences and
inc ease s uden sa is ac ion in medical educa ion.
E hical conside a ions
This s udy aimed o p io i ize e hical p inciples and
p o ec and digni y all pa icipan s. All pa icipan s
p o ided in o med consen be o e he s udy and we e
in o med abou i s pu pose and hei igh o wi hd aw a
any s age. Anonymized da a was secu ed and kep
con iden ial om unau ho ized access.
The E hics Commi ee o Zabol Uni e si y o Medical
Sciences app o ed he s udy p o ocol
(IR.ZBMU.REC.1401.150). T anspa ency and
accoun abili y we e upheld h oughou he esea ch
p ocess, wi h indings epo ed accu a ely and hones ly.
A i icial in elligence u iliza ion o a icle
w i ing
This manusc ip was no p epa ed using a i icial
in elligence (AI) ools. The au ho s conduc ed all aspec s
o he esea ch p ocess, including da a analysis,
in e p e a ion o indings, and manusc ip w i ing, by
hemsel es. This app oach ensu es ha he wo k emains
o iginal and adhe es o e hical p inciples.
Acknowledgmen
The au ho s would like o since ely hank all he
indi iduals and o ganiza ions who helped o accomplish
his esea ch. We wan o hank he s uden s and acul y
membe s o Zabol Uni e si y o Medical Sciences o
hei aluable assis ance and eedback du ing his s udy.
We also acknowledge he Resea ch and Technology
Depa men o Zabol Uni e si y o Medical Sciences o
i s guidance ega ding e hical compliance.
We also app ecia e he echnical and adminis a i e help
om he uni e si y's esea ch depa men . These
con ibu o s, al hough no sa is ying he c i e ia o
au ho ship, we e key o he de elopmen and execu ion
o his s udy.
Con lic o in e es s a emen
The au ho s decla e ha his s udy does no in ol e
po en ial con lic s o in e es . The au ho s ha e no
inancial, pe sonal, o p o essional in e es s ha could
ha e in luenced he esea ch o i s indings.
Au ho con ibu ions
FM and SPH con ibu ed o all s udy aspec s, including
concep ualiza ion, da a collec ion, analysis, esul
in e p e a ion, and manusc ip w i ing. The s a is ical
consul an was SHS, who ga e essen ial ad ice on
me hodology, da a analysis and in e p e a ion o he
esul s. The inal e sion o he manusc ip has been
e iewed and app o ed by all au ho s o submission.
Funding
No ex e nal g an s, equipmen , o o he esou ces we e
u ilized o suppo he esea ch o p epa a ion o his
manusc ip .
Da a a ailabili y s a emen
The da a used o de i e his s udy's esea ch indings a e
a ailable upon easonable eques . In e es ed pa ies can
con ac he co esponding au ho o gain access o he
da a, which will be made a ailable by e hical guidelines
and ins i u ional policies.
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