Developing national meta-accreditation standards for medical education accreditation bodies in Iran: a mixed-methods standards development and consensus study

Ensuring the quality and credibility of medical education systems increasingly depends on robust accreditation mechanisms, yet the performance of accreditation bodies themselves often remains insufficiently evaluated. Addressing this gap, this study developed and validated the first national meta-accreditation standards for Iran's Ministry of Health and Medical Education. Using a rigorous mixed-methods design, the study integrated insights from semi-structured interviews with 13 national experts, a comparative review of six international recognition systems, expert panel consensus, and a national survey of 90 stakeholders. From an initial pool of 184 standards, systematic refinement led to a final set of 51 standards. Stakeholder evaluation demonstrated strong consensus across practicality, necessity, and transparency (76-94%), with all standards exceeding the predefined 70% agreement threshold. The resulting framework is structured across three domains: structure and formality, accreditation processes, and accountability and quality improvement. By aligning national needs with international benchmarks, these standards enhance transparency, consistency, and trust in accreditation systems. The high level of expert agreement and methodological rigor underscore the framework's readiness for implementation and its potential as a model for strengthening meta-accreditation in similar centralized health education systems.