Implementation of Student-Selected Components in Iraqi Medical Colleges: A National Cross-Sectional Study
Abstract
Background: Student-Selected Components (SSCs) are a key element of student-centered medical education, promoting self-directed learning, research skills and academic engagement. However, their implementation varies considerably across institutions, particularly in low- and middle-income settings. Despite ongoing curriculum reforms, there is a lack of national-level empirical evidence on SSC implementation in Iraq. This study aimed to assess the implementation of SSCs in undergraduate medical education across Iraqi medical colleges, identify institutional barriers and resource requirements and examine associations between institutional characteristics and SSC implementation. Methods: A national cross-sectional survey was conducted among governmental medical colleges in Iraq between September 2024 and May 2025. A structured, expert-validated questionnaire was distributed electronically to all eligible institutions. Descriptive statistics were used to summarize institutional characteristics and SSC practices and associations were examined using Fisher’s exact test. Results: A total of 27 medical colleges participated. SSCs were implemented in 40.7% of institutions, while 59.3% had not adopted them. Implementation was significantly associated with curriculum model (p = 0.008) and geographic region (p = 0.027), but not with accreditation status (p = 0.692). The main barriers identified were limited administrative support (56.3%) and resource constraints (50.0%). Key requirements included teaching materials (75.0%), faculty training (68.8%) and administrative support (62.5%). Conclusion: SSC implementation in Iraqi medical colleges remains limited and uneven. Addressing institutional barriers and strengthening faculty capacity, resources and digital infrastructure are essential for wider adoption. Targeted national policy interventions, curriculum reform strategies and institutional capacity strengthening are required to support sustainable SSC integration.