Developing a structured telemedicine curriculum for medical students: a qualitative study based on expert interviews

Abstract

Background

Telemedicine has become an integral component of modern healthcare, enhancing access, efficiency, and continuity of care. Current medical curricula often lack structured telemedicine training, creating a gap between international advancements and educational needs. This study aimed to develop a contextually adapted telemedicine curriculum for undergraduate medical students, integrating global competencies with local priorities.

Methods

A qualitative study was conducted combining a targeted review of international telemedicine curricula with semi-structured interviews of 14 experts in clinical practice, medical education, and health IT. Data were analyzed using directed content analysis with iterative coding in MAXQDA. Two independent coders reviewed all transcripts, resolving discrepancies through consensus. Data collection continued until thematic saturation was reached.

Results

Three core domains emerged: (1) Learning objectives, emphasizing telemedicine’s role in healthcare delivery, professional competencies, and digital literacy; (2) Instructional strategies, highlighting blended learning, interactive case-based exercises, simulation-based teleconsultations, and interprofessional collaboration; and (3) Curricular content, encompassing legal and ethical frameworks, virtual communication skills, telehealth technologies, clinical applications across diverse patient populations, and preparedness for public health emergencies.

Conclusions

The proposed curriculum provides a contextually relevant yet globally aligned framework for telemedicine education. While it shows potential for scalability, pilot implementation and systematic evaluation are required to assess its effectiveness in enhancing student competencies and contributing to health system outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-08409-8.

Background

Telemedicine, the use of information and communication technologies to provide healthcare remotely, has emerged as a transformative force in modern health systems, improving access, efficiency, and continuity of care ([1]– [2]). Its importance was further highlighted by the COVID-19 pandemic, which necessitated rapid adoption of digital health solutions to maintain care while minimizing physical contact [3]. Telemedicine is particularly valuable in primary healthcare, enhancing access in underserved areas, supporting chronic disease management, and promoting patient-centered care ([4]– [5]).

In Iran, despite growing digital health infrastructure, telemedicine remains underutilized in medical education. National digital health initiatives, such as the Ministry of Health’s e-health expansion program, have improved infrastructure but not yet translated into formal training for medical students. Currently, undergraduate curricula lack structured training in telemedicine competencies, leading to a gap between global technological advances and the skills of future healthcare professionals ([6]– [7]). Preliminary reports indicate that medical students have limited exposure to telehealth platforms, ethical and legal frameworks, and virtual patient interactions, highlighting an urgent need to integrate telemedicine systematically into the curriculum [8]. Addressing this gap is critical, as Iran faces regional disparities in healthcare access, a growing burden of chronic diseases, and periodic public health emergencies, including pandemics and natural disasters ([9]– [10]).

Globally, structured telemedicine curricula have been developed by institutions such as the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC), emphasizing cognitive, technical, and community-oriented competencies ([11]– [12]). Neighboring countries, including Pakistan and India, have also implemented large-scale tele-education initiatives during COVID-19, demonstrating feasibility and effectiveness in resource-constrained contexts ([13]– [14]). Integrating such international best practices while considering Iran’s unique cultural, infrastructural, and policy environment can ensure that medical students acquire competencies aligned with both local needs and global standards.

Educational theory supports competency-based and experiential learning as essential for developing telemedicine skills. Models such as Miller’s pyramid and interprofessional education frameworks highlight the importance of progressive skill acquisition—from knowledge to performance in authentic clinical contexts ([15]– [16]). Incorporating these principles into telemedicine education ensures that students develop not only technical proficiency but also ethical, communicative, and collaborative competencies necessary for high-quality remote care.

This study aims to design a contextually grounded telemedicine curriculum for Iranian medical students by identifying essential domains, instructional strategies, and content areas through expert perspectives. By combining insights from international curricula with local healthcare priorities, the framework seeks to prepare future physicians for ethical, effective, and technology-enabled healthcare delivery.

Methods

Study design

This study employed a qualitative research design to develop a contextually grounded telemedicine curriculum for Iranian medical students. The design combined a targeted review of international telemedicine curricula with semi-structured interviews of national experts in clinical practice, medical education, and health information technology. The international curriculum review included sources from the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), and relevant peer-reviewed publications ([11]– [12]). Findings from this review provided the preliminary conceptual model and informed both the development of the interview guide and the initial deductive coding framework.

Participants and recruitment

A purposive sampling strategy was used to recruit 14 experts with substantial experience in telemedicine deployment, curriculum design, and health system management across Iranian medical universities. Participants included: Physicians from various specialties with telemedicine experience (n = 6), Health information technology (IT) and telehealth specialists (n = 3), Nursing and allied health experts (n = 3) and medical education specialists (n = 2). This composition was designed to capture diverse institutional and disciplinary perspectives. Inclusion criteria were: at least three years of experience in telemedicine or medical education, familiarity with telehealth infrastructure, and willingness to participate. Exclusion criteria included lack of direct involvement in telemedicine implementation or curriculum design Invitations were sent via email and professional networks; of the 20 experts contacted, 14 accepted participations, resulting in information saturation after 12 interviews, confirmed by two additional interviews. The study did not include medical students; however, future research is planned to capture their perspectives.

Data collection

Semi-structured interviews were conducted between March and June 2025, either in-person or via secure video conferencing, depending on participants’ availability. Interviews lasted 45–90 min and followed a guide developed from the literature review, covering: Learning objectives for telemedicine, Instructional methods and evaluation strategies, Essential content areas and competencies.

All interviews were conducted in Persian, audio-recorded with informed consent, and transcribed verbatim. Transcripts were cross-checked against recordings for accuracy. No translation was required for analysis. Field notes documented non-verbal cues and contextual information. Confidentiality and voluntary participation were emphasized at the start of each interview.

Data analysis

Data were analyzed using directed content analysis (DCA) with the assistance of MAXQDA software V.2020. The initial coding framework was deductively derived from international telemedicine competency frameworks (AMA, AAMC), then inductively expanded based on emergent themes from the interviews. Two coders independently coded transcripts; discrepancies were resolved through consensus discussion, ensuring intercoder reliability. The coding process included: Identification of meaningful units, Labeling and categorization into subthemes, Iterative refinement and merging of codes. The final codebook included 36 codes grouped into 8 categories and 3 overarching domains.

Data collection continued until thematic saturation was achieved, defined as the point at which no new codes or subthemes emerged across consecutive interviews (after Interview 12, confirmed by Interviews 13–14). To ensure the credibility and rigor of the analysis, the study applied Lincoln and Guba’s trustworthiness criteria. Credibility was reinforced through member checking during interviews, while transferability was supported by providing detailed contextual descriptions of participants and settings. Dependability was enhanced through an external audit of the data collection and coding procedures, and confirmability was achieved by maintaining transparent records of the coding and analysis process, allowing for external scrutiny and replication if necessary [11–13]. Additionally, an independent expert in qualitative research reviewed the entire coding structure and validated the extracted themes and their categorization to further ensure the integrity of the findings [14]. The research team included scholars in medical education, digital health, and qualitative research, all with prior experience in curriculum development but no hierarchical relationship with participants. Reflexive discussions were held throughout data collection and analysis to acknowledge and minimize potential biases stemming from professional familiarity with the topic.

Results

The qualitative analysis, combining insights from a targeted review of international telemedicine curricula and semi-structured interviews with experts, led to the identification of three overarching domains essential for developing a telemedicine education framework for medical students: learning objectives, instructional methods and evaluation, and essential educational content. The following narrative elaborates on these domains, reflecting the reasoning of participants and integrating direct quotations to illustrate key findings.

Participant characteristics

A total of 14 experts participated in the interviews, representing diverse professional backgrounds (Table 1). Participants had a median of 10 years (IQR 7–15) of experience in telemedicine, clinical education, or health information technology. The group included physicians from multiple specialties, IT specialists, medical education experts, and public health professionals. All participants had prior experience in either curriculum design or telemedicine implementation.

Table 1.

Characteristics of participants

Participant Group	Number	Education Level	Professional Experience in Telemedicine	Gender Distribution (Male/Female)	Prior Curriculum Roles
Health Information Technology and IT Experts	3	MSc/PhD	High (practical implementation and management)	2/1	2
Nursing and Healthcare Professionals	3	MSc/PhD	Moderate to High (clinical applications)	1/2	1
Medical Education Experts	2	PhD	High (curriculum development and pedagogy)	1/1	2
Physicians with Experience in Telemedicine (Family Medicine, Orthopedics, Cardiology, Surgery, etc.)	6	Specialist/PhD	High (direct clinical experience)	4/2	3
Total	14	Mixed	High overall expertise	8/6

Participants represented diverse clinical, technical, and educational backgrounds, ensuring comprehensive perspectives for the development of the telemedicine curriculum

Dimensions of the telemedicine education curriculum

The framework was structured into three main dimensions derived from both the curriculum review and thematic analysis of interview data: Learning Objectives, Instructional Methods and Evaluation, and Essential Educational Content (see Table 2). These dimensions represent the intersection of international best practices and expert insights, forming the foundation for a contextually adapted telemedicine curriculum.

Table 2.

“Key components of a proposed telemedicine curriculum for medical students in Iran (Based on expert Interviews)”

Theme	Subtheme	Details
Course Objectives and Description	Awareness of telemedicine importance	- Understanding telemedicine’s role in healthcare systems; Recognizing telemedicine’s impact on accessibility and service quality
	Methods and principles of service provision	Learning operational workflows of telemedicine; understanding integration with primary care
	Required technologies	- Familiarity with telecommunication tools, EHR systems, and diagnostic platforms
Instructional Methods and Evaluation	Delivery methods	- Blended learning: online + face-to-face sessions; Total: 8 sessions, 16 h
	Active learning strategies	Group projects, collaborative tasks, practical simulations
	Target audience	Medical students, nursing, midwifery, public health, and residents
	Evaluation methods	Pre- and post-course tests, practical and written exams, student feedback surveys
Essential Educational Content	Fundamental concepts	- History and development of telemedicine; Advantages, challenges, and ethical considerations
	Legal and ethical frameworks	- Data privacy, security, medical ethics- Licensing procedures and relevant regulations
	Communication skills	- Verbal and non-verbal communication- Conveying empathy and maintaining privacy in virtual settings
	Technical proficiency	- Use of EHR, video conferencing tools, and tele; diagnostic systems; Basic troubleshooting and system maintenance
	Prevention and general services	- Health promotion and preventive care via telehealth; Conducting follow-ups and remote consultations
	Specialized applications	- Telemedicine in specific medical fields (cardiology, orthopedics, psychiatry, etc.)
	Rehabilitation services	- Role of telemedicine in-patient rehabilitation and monitoring
	Special populations and crisis management	- Providing care for the elderly, children, incarcerated, and mental health patients; Utilizing telemedicine in public health emergencies (e.g., COVID-19)

This table presents the structured framework for telemedicine education derived from semi-structured interviews with 14 experts from diverse clinical, educational, and technical backgrounds, providing a foundation for curriculum design

Learning objectives

Experts emphasized that the primary goal of a telemedicine curriculum is to equip medical students with both conceptual understanding and practical competencies necessary for effective telehealth delivery across diverse clinical settings. Participants highlighted that students must recognize telemedicine not merely as a technological tool, but as a strategic element of modern healthcare systems, with implications for accessibility, quality, and equity of care, particularly in underserved regions. One medical education specialist explained:

“Telemedicine education for students should not be seen as just an extracurricular course to earn a certificate or boost a résumé. Students need to clearly understand the significance of this training—how telemedicine increases access to health services, enhances quality of care, and what role it will play in the future of healthcare delivery.” (Participant 7, Medical Education Expert).

Several participants stressed that the curriculum should be formally integrated into accredited medical universities to ensure standardized delivery, rather than being offered informally or inconsistently across institutions. A clinician with telemedicine experience noted:

“It shouldn’t be assumed that telemedicine training is an informal module or something embedded within internships that each medical school can handle on its own. There must be defined standards for how it is taught. The certificate should be valid, credited, and practical—and only universities that meet the necessary criteria should be authorized to offer the program.” (Participant 4, Cardiologist).

Experts recommended that foundational telemedicine knowledge (conceptual understanding) be introduced during the preclinical phase, while practical skills and simulation-based training should be delivered in the clinical phase, integrated with relevant rotations and hands-on experiences. The interprofessional component of this curriculum encompasses both collaborative learning among medical, nursing, and allied health students and the development of skills necessary to participate in interprofessional teams delivering telemedicine care. Participants emphasized that including interprofessional perspectives helps students appreciate collaborative care in telehealth and exposes them to varied workflows and technology applications, targeting not only medical students but also nursing, midwifery, public health trainees, and residents. An IT specialist highlighted this dimension:

“Students should understand how telemedicine works across different professional roles. They need to see how clinicians, nurses, and IT staff coordinate remotely to ensure seamless patient care.” (Participant 3, Health IT Expert).

Finally, participants recommended aligning curriculum objectives with international standards (AAMC, AMA) while adapting content to local healthcare needs and regulatory environments. Regarding curriculum placement, experts suggested introducing conceptual foundations during preclinical years, followed by practical, simulation-based training in clinical phases, integrated into existing rotations and interprofessional learning sessions.

Instructional methods and evaluation

The experts emphasized that effective telemedicine education requires a pedagogically robust approach that balances theoretical knowledge with practical skills. To achieve this, they strongly advocated for a blended learning model, combining online modules with in-person sessions, as it allows students to experience both the conceptual foundations and hands-on applications of telehealth. The proposed program was envisioned as eight sessions totaling 16 h, integrating lectures, case-based discussions, practical exercises, and simulation-based teleconsultations.

Participants highlighted that active and participatory learning strategies are essential for developing problem-solving abilities, adaptability, and real-world competence in telemedicine. As one IT specialist noted:

“This training shouldn’t consist solely of theoretical lectures. Students need to face the real-world challenges of telemedicine—like dealing with an elderly patient who has hearing issues or coping with a weak internet connection. They must learn how to act in such scenarios. That’s why we need a fully integrated, blended course.” (Participant 3, Health IT Expert).

A cardiologist with telemedicine experience further emphasized the importance of structured practical exercises:

“Students must practice simulated teleconsultations in realistic scenarios. Only then will they understand the workflow, anticipate patient concerns, and learn to make clinical decisions remotely.” (Participant 4, Cardiologist).

A public health expert added the value of interprofessional collaboration in these sessions:

“Telemedicine is rarely practiced in isolation. Students should learn alongside nursing, midwifery, and public health trainees, sharing perspectives and developing collaborative problem-solving skills that reflect real healthcare teams.” (Participant 12, Public Health Expert).

The expert also underscored that evaluation methods should comprehensively assess knowledge, technical skills, and professional behavior. Suggested approaches include pre- and post-course knowledge tests, practical examinations using simulated cases, written assessments, and structured student feedback surveys. An educator specializing in medical curriculum development highlighted:

“Evaluation should measure not only what students know but also how they apply telemedicine in realistic settings. Simulation-based assessments and reflective exercises help capture competencies that traditional exams often miss.” (Participant 7, Medical Education Specialist).

Experts emphasized that key educational content, such as communication skills, ethical practice, and interprofessional collaboration, directly informs instructional strategies and evaluation. This necessitates blended learning, simulation-based teleconsultations, and role-playing exercises, allowing students to apply theoretical knowledge in realistic virtual scenarios. These approaches differ from traditional medical education by emphasizing technology-mediated interactions, interprofessional workflows, and performance-based assessment.

“I think it’s not enough for students to just read about communication or teamwork. They really need to practice these skills in simulated telemedicine sessions, seeing how nurses, doctors, and IT staff work together to manage a patient remotely. That’s when they truly understand the flow and challenges of real patient care.” (Participant 3, Health IT Expert).

“Telemedicine teaching isn’t like traditional classes. Students must learn how to interact with patients virtually, coordinate with multiple professionals, and make decisions when they can’t see the patient face-to-face. This requires new approaches to both teaching and assessment.” (Participant 4, Cardiologist).

By integrating these strategies, the curriculum ensures that medical students develop the necessary cognitive, technical, and collaborative competencies. The combination of multiple learning methods, interprofessional engagement, and diversified evaluation creates a coherent educational pathway that prepares students to deliver effective, patient-centered telemedicine services across varied clinical contexts.

These instructional strategies also facilitate the assessment of student performance through practical evaluations, such as simulation-based exercises and interprofessional OSCEs, allowing educators to measure not only knowledge acquisition but also the application of telemedicine skills in realistic, collaborative scenarios.

The proposed instructional methods align with international standards in medical education, including competency-based education and active learning principles endorsed by organizations such as the AAMC and WHO. Blended learning approaches, integrating online modules with practical sessions, have been successfully implemented in telemedicine curricula globally, demonstrating effectiveness in fostering both knowledge and clinical competencies across diverse healthcare settings.

Essential educational content

The experts described the essential educational content as a progressive and integrated learning pathway rather than a set of isolated modules. They agreed that the curriculum should begin by building a strong conceptual foundation of telemedicine, including its history, evolution, benefits, challenges, and ethical considerations. Understanding these fundamental aspects was considered essential to enable students to appreciate telemedicine not just as a technological tool but as a transformative approach to healthcare delivery. One medical education expert emphasized:

“Many people think telemedicine is just about connecting to a patient over the internet to fix their health problem—and that’s it. But telemedicine is not merely a technological tool. It’s a transformative approach to care delivery. Aspects like confidentiality and trust between the physician and patient are absolutely critical during remote consultations.” (Participant 2, Medical Education Specialist).

Once this conceptual grounding is established, the program should gradually introduce students to the legal and ethical frameworks that govern telehealth services. Issues such as data privacy, patient confidentiality, security protocols, and licensing requirements were highlighted as critical knowledge areas to ensure responsible practice. Experts also stressed the importance of technical proficiency, recommending training in telecommunication equipment, EHR systems, video conferencing platforms, and basic troubleshooting skills to ensure seamless telehealth delivery. A health IT expert noted:

“Students must be comfortable with the technology itself before they can focus on patient care. Practical exercises using real platforms are essential to prevent frustration and errors during actual consultations.” (Participant 3, Health IT Specialist).

Building on these principles, the experts highlighted the necessity of developing strong communication skills, particularly for virtual consultations. Students must learn to convey empathy, use clear and culturally appropriate language, and manage privacy in remote interactions. According to a family physician:

“The patient should feel that they are talking to a compassionate doctor—one who listens carefully and responds sincerely—so much so that they no longer feel the distance. That’s why communication and ethical skills are so important in telemedicine.” (Participant 11, Family Medicine Specialist).

The participants further emphasized the need to introduce telemedicine in preventive and general health services, including health promotion, chronic disease monitoring, routine consultations, and follow-up care. Specialized clinical applications and care for vulnerable populations were also highlighted. Telemedicine should be applied across fields such as family medicine, orthopedics, cardiology, psychiatry, and rehabilitation, and especially for populations with limited access to healthcare, including the elderly, children, incarcerated individuals, and patients with mental health needs. A public health expert commented:

“We must prepare students to serve populations who have difficulty traveling—like the elderly, rural residents, or patients with mental health issues. Telemedicine is most valuable when it bridges these gaps.” (Participant 9, Public Health Specialist).

Finally, the experts emphasized preparing students for telemedicine in public health emergencies, referencing lessons from the COVID-19 pandemic. A clinical faculty member noted:

“Telemedicine proved indispensable during the pandemic. Students should be trained to deliver care remotely in crises—chronic patients, the elderly, and vulnerable populations cannot wait for in-person consultations.” (Participant 12, Cardiologist with telemedicine experience).

Collectively, these interconnected educational components were considered critical for equipping future healthcare providers with the knowledge, technical skills, and ethical awareness necessary to deliver high-quality telemedicine services. Importantly, the recommended instructional content aligns with established international medical education principles, such as competency-based medical education and interprofessional collaborative practice, ensuring that graduates meet both local healthcare needs and global telemedicine standards.

Discussion

This study aimed to develop a telemedicine education framework tailored to Iran’s medical education context by integrating insights from a structured review of international telemedicine curricula and semi-structured interviews with national experts. The resulting framework consists of three key components—learning objectives, instructional methods, and essential content—that together reflect both global best practices and the specific needs of Iran’s healthcare and educational systems. The structure is consistent with established international frameworks, such as those developed by the AAMC, AMA, and WHO’s Global Strategy on Digital Health, while being adapted to local infrastructural and pedagogical realities ([11]– [12, 15–19]).

Regarding learning objectives, the focus on telemedicine’s role in healthcare delivery, technological literacy, and ethical competencies is consistent with global frameworks that emphasize cognitive, technical, and communication skills ([17]– [18]). However, experts underscored that Iran’s framework should more explicitly include competencies in digital leadership and community-based service delivery, aligning with WHO recommendations to train future physicians as active facilitators of digital transformation [19]. This addition would strengthen students’ capacity to implement telemedicine in underserved settings and support continuity of care during crises [20].

In terms of instructional methods, the blended learning approach—combining online self-learning modules with interactive workshops—was viewed as the most effective strategy to balance theory and practice [21]. Evidence from the U.S. and Europe supports hybrid models, showing that they enhance learner engagement and improve clinical competence [22, 23]. Incorporating simulation-based exercises and Objective Structured Clinical Examinations (OSCEs) tailored to telemedicine, as recommended by the AMA, further deepens students’ experiential learning and communication proficiency [11, 12]. Similar reforms in Pakistan’s undergraduate medical curriculum highlight the effectiveness of participatory, case-based, and competency-driven approaches in preparing students for technology-enabled care [13]. Lessons from these regional experiences, including considerations for implementing telemedicine in Iran, underscore that successful adoption requires not only curricular redesign but also institutional leadership, adequate digital infrastructure, and continuous faculty training. Instructional methods and evaluation in telemedicine education must explicitly address communication skills in technology-mediated contexts. Evidence indicates that telehealth requires students to adapt both verbal and non-verbal communication, practice interprofessional collaboration, and respond to real-time challenges in remote patient interactions ([24]– [25]). Accordingly, the curriculum integrates blended learning, simulation exercises, and interprofessional OSCEs to ensure students acquire both theoretical knowledge and practical skills essential for effective telemedicine practice in Iran.

The educational content developed in this framework also reflects strong alignment with international standards. It encompasses core telemedicine concepts, ethical and legal frameworks, virtual communication skills, and specialized applications for vulnerable populations [26]. These priorities are consistent with findings from Pfeil et al. and Catapan et al., who emphasized telemedicine’s vital role in chronic disease management and emergency preparedness [27, 28]. Comparable models in countries such as Brazil and India have demonstrated how integrating telemedicine into medical education can enhance accessibility and equity in health services [14, 29]. Additionally, Saudi Arabia’s integration of telemedicine for geriatric and chronic care provides further validation of this direction [30]. In Pakistan, recent curriculum reforms have focused on similar principles—embedding ethics, patient safety, and communication skills into early medical training—to cultivate technologically competent yet patient-centered graduates [13]. These parallels affirm the regional applicability and relevance of the framework while maintaining a focus on Iran’s national context.

Despite these strengths, several limitations must be acknowledged. First, the framework was developed primarily from expert consensus within Iran, which may not fully represent all stakeholders, including students, patients, and policymakers. Second, implementation challenges—such as limited faculty expertise in telemedicine, infrastructural disparities across universities, and funding constraints—remain critical barriers, as reported in other low- and middle-income countries including Pakistan and India [13, 14]. Third, the study did not include empirical testing or evaluation of student learning outcomes, limiting evidence on the framework’s effectiveness and scalability. Addressing these limitations through pilot programs, longitudinal evaluation, and cost-effectiveness analyses is essential to ensure sustainability and real-world impact.

From an implementation science perspective, the framework can also be interpreted through the Consolidated Framework for Implementation Research (CFIR), which provides a structured lens for understanding factors that influence adoption and sustainability of innovations [31]. Within this framework, the designed telemedicine curriculum reflects strong intervention characteristics, particularly its adaptability to institutional contexts and its evidence base grounded in expert consensus. The inner setting—including university resources, leadership engagement, and organizational readiness—emerges as a critical determinant of success, consistent with findings from similar telemedicine education programs in Pakistan and India [32, 33]. The outer setting, encompassing national e-health policies and regulatory environments, also shapes implementation potential. Finally, the process dimension of CFIR underscores the need for active stakeholder involvement, continuous evaluation, and iterative refinement to ensure long-term integration into Iran’s medical education system. Framing the findings within CFIR thus extends the study’s relevance beyond curriculum design, highlighting its contribution to broader implementation research in digital health education.

Overall, this framework represents a contextually adapted yet globally consistent model for telemedicine education. Regional initiatives, such as Pakistan’s nationwide virtual research education program, further confirm the adaptability of digital health education in resource-limited settings and offer practical lessons for phased implementation in comparable contexts [34]. By integrating these regional insights with international evidence—from Pakistan, India, Brazil, and Saudi Arabia—this framework provides a feasible and scalable pathway for embedding digital health competencies within Iran’s medical education system. Strengthening components such as digital leadership, simulation-based training, interprofessional learning, and cultural competence will ensure alignment with global standards while addressing national health priorities.

Conclusion

This study developed a contextually adapted telemedicine education framework for Iranian medical students, comprising learning objectives, instructional methods, and essential content. The framework aligns with global standards (AAMC, AMA, WHO) while addressing local infrastructural and educational needs. Key elements include digital leadership, community-oriented care, interprofessional collaboration, and blended learning with simulation-based training. Although primarily based on expert consensus, the framework offers a practical roadmap for integrating telemedicine into medical education in Iran. Future research should focus on pilot testing, longitudinal evaluation, and cost-effectiveness analysis to validate its impact and scalability.

Authors’ contributions

SM is the guarantor of authorship and accepts full responsibility for the finished work and/or the conduct of the study, has access to the data, and controls the decision to publish. MA, SM and MH are responsible for conception and design; MK and MA are responsible for administrative support; SM, MH, and MA are accountable for the provision of study materials; MH and MA are responsible for data analysis and interpretation; SM and MA are accountable for manuscript writing; All authors contributed to drafting and revising the paper and approved the final version, and they thus will be held responsible for all aspects of the work.

Funding statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The data supporting this study’s findings are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from the Ethics Committee of Golestan University of Medical Sciences (GOUMS) and approved for the study. Approval is given under reference number IR.GOUMS.REC.1401.445. All ethical principles in the research were observed according to Declaration of Helsinki. participants entered the research with informed consent after the research was explained. All information from individuals was used confidentially and without revealing their names approval and consent to participate.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.