Background: The comprehensive exam is a key assessment in Iranian medical Ph.D. programs, intended to evaluate students’ academic and research readiness. Despite its significance, concerns about its effectiveness and fairness persist. This review aims to examine the main challenges of the comprehensive exam in Iranian medical universities and suggest practical strategies for its improvement.
Materials and Methods: A narrative review was conducted by two independent reviewers, who systematically searched ERIC, PubMed, Web of Science, Scopus, and Google Scholar up to March 2025 using relevant English and Persian keywords. Data extraction and thematic analysis were performed to synthesize findings.
Results: Four main domains of challenge were identified: (1) administrative barriers, including fragmented policies, inconsistent procedures, and lack of unified guidelines, leading to variability and reduced fairness; (2) curriculum gaps, such as insufficient training in advanced research methods, academic writing, interdisciplinary integration, and practical skills, leaving students underprepared; (3) student preparedness and support, with high stress, inadequate mentorship, and limited preparatory resources negatively impacting exam outcomes; and (4) contextual and systemic factors, including institutional culture, resource allocation, and resistance to change. The interaction among these domains creates a multifaceted environment that shapes the exam’s effectiveness, fairness, and credibility. The review recommends curriculum modernization, standardized policies, enhanced student and faculty support, and the adoption of alternative assessment methods (e.g., portfolios, continuous assessment, formative feedback) to ensure a more holistic and equitable evaluation.
Conclusion: The effectiveness of the comprehensive exam in Iranian medical Ph.D. programs is limited by various interconnected challenges. Addressing these through curriculum reform, clearer policies, enhanced support, and innovative assessment approaches can improve fairness, reduce stress, and better evaluate doctoral candidates’ abilities.