Medical students’ experiences of clinical assessment in teaching hospitals affiliated with Lorestan University of Medical Sciences: a qualitative content analysis

Abstract

Clinical assessment plays a central role in developing medical students’ clinical competence and professional identity. However, students’ experiences of clinical assessment remain insufficiently understood, particularly in resource-constrained teaching hospitals. This study explored medical students’ experiences of faculty-led clinical assessment practices in teaching hospitals affiliated with Lorestan University of Medical Sciences, Iran. A qualitative exploratory study using conventional content analysis was conducted in 2025. Eighteen undergraduate medical students in the clinical phase of training (11th academic semester or above) were purposively recruited with maximum variation and participated in 13 semi-structured individual interviews and one focus-group discussion (held in two sessions), with data collection continuing until no substantively new codes or meanings emerged and the categories were sufficiently developed. Data were analysed inductively and concurrently with collection following the approach of Graneheim and Lundman. Trustworthiness was established using Lincoln and Guba’s criteria through member checking, iterative review with the research supervisors, and an audit trail. Reporting followed COREQ guidelines. Analysis generated three main categories and 11 subcategories, capturing assessment as a hindering process (non-transparent assessment, faculty inattentiveness, environmental constraints, and psychological insecurity), a source of motivation (effective feedback, faculty support, and personal and professional growth), and an enabling process (assessor training, modern tools, student participation, and a supportive environment). These findings were synthesised in an interpretive conceptual model, developed by the research team from participants’ accounts rather than empirically tested, indicating that students’ experiences were shaped by the interaction of organisational conditions, interpersonal relationships, and psychological safety rather than by assessment methods alone. Medical students perceived clinical assessment as a multidimensional process shaped by organisational, interpersonal, and psychological factors. Strengthening assessor competence, standardising assessment practices, and fostering psychological safety may enhance the educational value of clinical assessment in teaching hospitals.