Navigating Supervisory and Structural Challenges in PhD Education: A Qualitative Study of Iranian Medical Students’ Perspectives

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This is especially true for those studying at Iranian medical universities, where structural uncertainties and a lack of robust support systems can significantly influence their doctoral experience. While there's been a growing global focus on reforms that prioritize students, there’s still a noticeable gap in research that amplifies the voices of students in these settings. Methods This qualitative study delved into the experiences of 31 doctoral candidates at Isfahan University of Medical Sciences. Through semi-structured interviews and conventional content analysis, following the framework set by Graneheim and Lundman, we identified key themes using inductive coding. NVivo 12 supported data management. To ensure the trustworthiness of our findings, we employed member checking, peer debriefing, and maintained a thorough audit trail. Results Students shared a variety of challenges they faced, including inconsistent supervision, a lack of practical curriculum alignment, emotional stress, unclear procedures, and insufficient funding and research infrastructure. They highlighted the importance of respectful communication, accessible supervisors, peer support, and emotional validation as essential for their thesis progress and overall well-being. Conclusion The landscape of doctoral education in Iranian medical universities is influenced by supervisory, emotional, and institutional factors that need immediate attention. Reform initiatives ought to prioritize building strong relationships in supervision, weaving research skills into the curriculum, boosting mental health support, and improving policies that put students at the center. Doctoral education PhD students qualitative research supervision academic culture emotional well-being Iran Introduction Doctoral education represents the pinnacle of academic achievement, requiring a blend of advanced intellectual skills, emotional resilience, and savvy navigation of institutional frameworks. Around the world, the structure and experience of doctoral programs are being reassessed due to rising concerns about student well-being, the quality of supervision, and systemic pressures (Smirnov, 2025 ; Chaló et al., 2023 ). Students from various disciplines are reporting emotional stress, high dropout rates, and limited autonomy within rigid academic systems (Schwaller, 2024 ; Haley et al., 2024 ). Iran’s academic environment, marked by shifting policies and developing educational practices, offers a distinct backdrop for doctoral training. Medical universities are particularly affected by a lack of research infrastructure, fragmented support systems, and inflexible supervisory relationships (Shariati et al., 2020 ; Hasgall & Peneoasu, 2022 ). While there is an increasing amount of literature on doctoral supervision and institutional reform, few studies prioritize the perspectives of students in their analysis. This research highlights the experiences of PhD students as we explore the various structural, interpersonal, and emotional hurdles they face during the thesis process at one of Iran’s top medical universities. By using Bronfenbrenner’s ecological systems theory as our guiding framework (Bronfenbrenner, 1979 ), we look into how personal relationships—like those with supervisors—interact with broader institutional and societal structures to influence the outcomes of doctoral studies. Through qualitative methods, we aim to shed light on student experiences and offer insights geared towards reforming doctoral education in transitional systems. This approach aligns with global calls for redesigning doctoral pathways that prioritize student autonomy, dignity, and equity (Zhuchkova & Bekova, 2023 ; Nature Research Intelligence, 2024 ). Methodology Study Design We adopted a qualitative exploratory design to deeply understand the lived experiences of doctoral students during their thesis phase. This qualitative approach was chosen because it allows us to navigate the complex emotions, institutional dynamics, and supervisory relationships from the students' perspectives (Creswell & Poth, 2018 ; Merriam & Tisdell, 2016 ). Setting and Participants The research was conducted at Isfahan University of Medical Sciences, a leading institution in health sciences in Iran. We used a purposive sampling strategy to select 31 PhD students from various faculties, ensuring a diverse representation in terms of gender, research area, academic stage, and supervisory background. To qualify for participation, students needed to meet the following criteria : Enrolled in a PhD program for at least one year Actively engaged in the research or thesis phase Table 1 Demographic Characteristics of PhD Students Participant ID Age Academic Discipline S1 30–35 Health Promotion S2 30–35 Health Promotion S3 35–40 Reproductive Health S4 45–50 Medical Education S5 40–45 Biochemistry S6 40–45 Medical Education S7 35–40 Medical Education S8 30–35 Nutrition Sciences S9 30–35 Medical Physics and Engineering S10 30–35 Immunology S11 40–45 Physiology S12 30–35 Molecular Biology and Genetics S13 25–30 Physiology S14 30–35 Pharmaceutical Chemistry S15 30–35 Pharmaceutical Biotechnology S16 30–35 Nursing S17 30–35 Environmental Health Engineering S18 30–35 Nutrition Sciences S19 30–35 Orthotics and Prosthetics S20 25–30 Epidemiology S21 30–35 Health Services Management S22 25–30 Medical Library and Information Science S23 40–45 Disaster and Emergency Health S24 35–40 Medical Library and Information Science S25 30–35 Reproductive Health S26 40–45 Medical Education S27 25–30 Health Economics S28 30–35 Physiology S29 25–30 Medical Physics S30 25–30 Parasitology S31 40–45 Molecular Medicine Data Collection Between 2022 and 2023, we conducted semi-structured interviews that delved into various themes like supervisory dynamics, emotional resilience, research execution, institutional support, and policy navigation. Each interview lasted anywhere from 45 to 75 minutes, and with the participants' consent, we audio-recorded them, transcribed every word, and then translated the transcripts from Persian to English for our analysis. To ensure we respected cultural nuances and maintained linguistic accuracy, bilingual experts who were well-versed in qualitative research handled the translation. We made sure to obtain informed consent from all participants, guaranteeing their anonymity, confidentiality, and the choice to participate voluntarily. Interview Guide We created a tailored interview guide specifically for this research. An English version has been included as a supplementary file and referenced in the manuscript. Participants were chosen through purposive sampling. The interviews were recorded, transcribed, and analyzed using thematic content analysis. Data Analysis For our data analysis, we utilized conventional content analysis, following the framework laid out by Graneheim and Lundman (2004). We reviewed the transcripts multiple times, extracted meaningful units, and employed open coding to create subcategories and broader themes. NVivo 12 supported data management. To bolster the trustworthiness of our study, we implemented several strategies: Member checking, where select participants reviewed our preliminary findings Peer debriefing, which involved discussions with external qualitative scholars An audit trail that documented our analytical decisions and the development of categories We received ethical approval from the Research Ethics Committee of Isfahan University of Medical Sciences (IR.MUI.RESEARCH.REC.1398.239). Results Our analysis of interviews with 31 PhD students led to the identification of 12 main categories and 45 subcategories, capturing the systemic, interpersonal, and emotional aspects of the doctoral thesis journey. We present these categories thematically, enriched with direct quotes from participants and contextualized with recent literature. 1. Supervisory Inconsistency and Relational Strain : Students shared their experiences of inconsistent engagement from supervisors, noting differences in expertise and availability. The absence of timely feedback and mentorship often resulted in delays, confusion, and emotional stress. “ When my supervisor wasn’t around or didn’t have the right knowledge, everything just slowed down or came to a halt .” — Student 14. This observation aligns with recent research indicating that inconsistent supervision can lead to higher dropout rates and psychological distress among doctoral candidates (Haley et al., 2024 ; Smirnov, 2025 ). 2. Curriculum Misalignment with Research Demands : Students pointed out a gap between what they learned in class and what was required for their theses. The theoretical material often felt disconnected from practical application, leaving them feeling unprepared for independent research. “ The courses we took didn’t really help with our thesis at all .” — Student 18 Chaló et al. ( 2023 ) stress the importance of integrating research training early in doctoral programs to close this gap. 3. Emotional Burden and Psychological Vulnerability : The journey through a doctoral program was filled with ongoing emotional challenges. Students reported feelings of anxiety, isolation, and burnout, particularly during the research and writing stages. “ The thesis puts a huge burden on us. The stress is just too much .” — Student 22. These insights reflect broader concerns about mental health among doctoral students worldwide (Nature Research Intelligence, 2024 ; Schwaller, 2024 ). 4. Institutional Ambiguity and Bureaucratic Barriers : Students encountered vague policies, strict timelines, and procedural delays. Uncertainty surrounding supervisor assignments and thesis approval processes led to confusion and frustration. “ We didn’t know who to turn to or what the next step was. Everything felt so unclear. ” — Student 9 Zhuchkova & Bekova ( 2023 ) emphasize the need for clearer, more student-focused governance in doctoral programs. 5. Research Infrastructure and Funding Constraints : Access to labs, software, and financial backing was often limited, which really affected the quality of research. Many students had to downsize their projects because of budget constraints. “ We had to cut parts of the study due to lack of funds. ” — Student 10 Buenstorf et al. ( 2023 ) and Hasgall & Peneoasu ( 2022 ) argue for fair funding systems in transitional academic environments. 6. Communication Climate and Academic Dignity : Students highlighted the importance of respectful and empathetic communication. They appreciated supervisors who listened, fostered open dialogue, and respected their independence. “ When my supervisor treats me with respect, I feel motivated even when the work is hard.” — Student 7. Johansson & Yerrabati ( 2024 ) point out that building relational trust can boost doctoral engagement and resilience. 7. Lack of Peer Integration and Academic Community : Many students felt there were few chances for peer interaction, especially during their thesis work. This sense of isolation made it tough to stay motivated and grow academically. “ I felt like I was doing this alone. There was no space to share or ask others.” — Student 21 Lorenzetti et al. ( 2023 ) highlight the need for peer mentorship and community-building to support doctoral well-being. 8. Supervisor–Student Power Imbalance : Some students described a power dynamic that stifled their voice. The fear of criticism or rejection made it hard to communicate openly. “ I couldn’t question anything. It felt like I had no voice. ” — Student 6. Haley et al. ( 2024 ) and Cardoso et al. ( 2022 ) advocate for supervisory models that encourage autonomy and mutual respect. 9. Publication Pressure and Academic Expectations : There was a strong push for students to publish before graduating, often without the necessary support. This created additional stress and shifted their focus away from developing their theses. “ We were told to publish, but no one showed us how.” — Student 17. Nature Research Intelligence ( 2024 ) suggests incorporating publication training into doctoral programs. 10. Digital Literacy and Methodological Gaps : Students faced challenges with data analysis tools and research software, mentioning a lack of adequate training. “ I had to figure everything out by myself. There was no official support.” — Student 12. Chaló et al. ( 2023 ) and Deroncele-Acosta et al. ( 2025 ) emphasize the importance of structured digital skill development in doctoral programs. 11. Work–Life Imbalance and Role Conflict : Finding a balance between academic duties and personal or professional responsibilities proved to be tough. Married students and those with caregiving roles reported increased stress levels. “ I was trying to manage research, work, and family. It felt like an impossible task.” — Student 25. Zhuchkova & Terentev ( 2024 ) point out the necessity for flexible doctoral structures that can accommodate a variety of student needs. 12. Aspirational Disconnect and Career Uncertainty : Students voiced their concerns about what comes after earning their PhDs. The lack of guidance and limited exposure to non-academic career paths added to their anxiety. “ I have no idea what’s next. We’re not really prepared for anything outside of academia.” — Student 30. Smirnov ( 2025 ) and El-Soussi ( 2023 ) suggest implementing career development programs and encouraging interdisciplinary experiences to expand doctoral career options. Discussion This study takes a closer look at the doctoral thesis journey from a student’s perspective in Iranian medical universities, uncovering a tangled web of supervisory dynamics, institutional frameworks, emotional challenges, and resource limitations. The results not only reflect global issues but also shine a light on unique hurdles faced in transitional academic environments. Supervisory Relationships: Key to Doctoral Success Students highlighted how crucial supervisors are in guiding their thesis paths. Issues like inconsistent supervision, lack of expertise, and limited availability often led to delays and emotional strain. These observations align with recent studies that stress the need for strong relational and teaching skills in supervision (Haley et al., 2024 ; Johansson & Yerrabati, 2024 ). There’s a growing push to move away from traditional hierarchical models towards more collaborative supervision, which can help foster independence and resilience (Cardoso et al., 2022 ; Haley et al., 2024 ). Curriculum Gaps and Research Preparedness Many students noted a gap between their coursework and the research phase, feeling that theoretical lessons didn’t adequately prepare them for hands-on inquiry. This disconnect has been recognized in various settings (Chaló et al., 2023 ; Deroncele-Acosta et al., 2025 ), leading to calls for a more integrated curriculum that weaves research skill development into the early stages of doctoral training. Emotional Strain and Mental Health Challenges The emotional burden of pursuing a doctorate was a prominent theme. Students shared experiences of anxiety, isolation, and burnout, especially during the research and writing stages. These findings resonate with global evaluations of doctoral mental health (Nature Research Intelligence, 2024 ; Schwaller, 2024 ; Lorenzetti et al., 2023 ), which advocate for the establishment of support systems and training in emotional awareness. It’s essential for institutions to view mental health as a systemic issue rather than just an individual one. One of the main limitations of this study is that it focuses on just one institution, which could limit how widely the results can be applied. Still, the findings provide valuable insights that can be relevant to other similar academic environments. Additionally, the cultural differences in translation might affect how deeply we interpret the results, even with thorough bilingual validation. Conclusion This study provides a thoughtful, student-focused perspective on the doctoral thesis journey in Iranian medical universities. The results highlight the urgent need for comprehensive reforms that emphasize student empowerment, emotional health, and clear institutional practices. Key Recommendations: 1. Supervisor Development: Create structured training programs that cover both the academic and emotional aspects of supervision (Haley et al., 2024 ; Johansson & Yerrabati, 2024 ). 2. Curriculum Integration: Weave research skill development into early courses to better equip students for independent inquiry (Chaló et al., 2023 ; Deroncele-Acosta et al., 2025 ). 3. Mental Health Support: Offer accessible counseling services, peer mentoring, and workshops focused on emotional literacy (Nature Research Intelligence, 2024 ; Schwaller, 2024 ). 4. Policy Reform: Update doctoral regulations to improve transparency, flexibility, and student involvement in decision-making (Zhuchkova & Bekova, 2023 ; Hasgall & Peneoasu, 2022 ). 5. Resource Equity: Create funding mechanisms based on needs and collaborative research platforms to support a variety of agendas (Buenstorf et al., 2023 ; Zhuchkova & Terentev, 2024 ). These reforms go beyond mere technical changes—they represent a cultural shift towards a more compassionate, fair, and effective model of doctoral education. By prioritizing student voices and experiences, universities can nurture scholars who are not only intellectually sharp but also emotionally strong and socially engaged. Declarations Author Contributions - Conceptualization: Shahnaz Ghasemi Nangi - Data collection and curation: Shahnaz Ghasemi Nangi - Formal analysis: Fariba Jokar, Shahnaz Ghasemi Nangi - Writing – original draft: Shahnaz Ghasemi Nangi - Writing – review & editing: Alireza Yousefi, Fariba Jokar - Supervision: Alireza Yousefi Funding This research did not receive any specific grants from funding agencies, whether they are public, commercial, or non-profit. Ethics Approval and Consent to Participate This study is part of PhD dissertation number 398301, with ethics code IRMU.RESEARCH.REC.1398.239, granted by Isfahan University of Medical Sciences. All participants gave their written informed consent and were guaranteed confidentiality and the choice to participate voluntarily. This study was conducted in accordance with the principles of the Declaration of Helsinki. Competing Interests The authors have no competing interests to declare. Clinical trial number : not applicable. Consent to Publish declaration : not applicable. Data Availability Statement The datasets generated and analyzed during this study are not publicly available due to participant confidentiality but may be obtained from the corresponding author upon reasonable request. Acknowledgments The authors sincerely thank the Department of Medical Education, the Medical Education Research Center, and the Vice-Chancellor for Research at Isfahan University of Medical Sciences for their support. References Smirnov N. From productivity to wellbeing? Topic modelling of doctoral education research. High Educ. 2025;80(2):215–38. https://doi.org/10.1007/s10734-025-01453-9 . Schwaller R. The huge toll of PhDs on mental health: Data reveal stark effects. Nature. 2024;627(7994):12–5. https://doi.org/10.1038/d41586-024-03136-4 . Nature Research Intelligence. (2024). Doctoral education and student experience. 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Supplementary Files InterviewGuide.pdf Cite Share Download PDF Status: Published Journal Publication published 10 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 22 Sep, 2025 Reviewers agreed at journal 20 Sep, 2025 Reviewers agreed at journal 20 Sep, 2025 Reviews received at journal 09 Sep, 2025 Reviewers agreed at journal 09 Sep, 2025 Reviews received at journal 03 Sep, 2025 Reviewers agreed at journal 29 Aug, 2025 Reviewers invited by journal 29 Aug, 2025 Editor assigned by journal 28 Aug, 2025 Editor invited by journal 08 Aug, 2025 Submission checks completed at journal 06 Aug, 2025 First submitted to journal 06 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Around the world, the structure and experience of doctoral programs are being reassessed due to rising concerns about student well-being, the quality of supervision, and systemic pressures (Smirnov, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Chal\u0026oacute; et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Students from various disciplines are reporting emotional stress, high dropout rates, and limited autonomy within rigid academic systems (Schwaller, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Haley et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Iran\u0026rsquo;s academic environment, marked by shifting policies and developing educational practices, offers a distinct backdrop for doctoral training. Medical universities are particularly affected by a lack of research infrastructure, fragmented support systems, and inflexible supervisory relationships (Shariati et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Hasgall \u0026amp; Peneoasu, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). While there is an increasing amount of literature on doctoral supervision and institutional reform, few studies prioritize the perspectives of students in their analysis.\u003c/p\u003e\u003cp\u003eThis research highlights the experiences of PhD students as we explore the various structural, interpersonal, and emotional hurdles they face during the thesis process at one of Iran\u0026rsquo;s top medical universities. By using Bronfenbrenner\u0026rsquo;s ecological systems theory as our guiding framework (Bronfenbrenner, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1979\u003c/span\u003e), we look into how personal relationships\u0026mdash;like those with supervisors\u0026mdash;interact with broader institutional and societal structures to influence the outcomes of doctoral studies. Through qualitative methods, we aim to shed light on student experiences and offer insights geared towards reforming doctoral education in transitional systems. This approach aligns with global calls for redesigning doctoral pathways that prioritize student autonomy, dignity, and equity (Zhuchkova \u0026amp; Bekova, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Nature Research Intelligence, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Design\u003c/h2\u003e\n \u003cp\u003eWe adopted a qualitative exploratory design to deeply understand the lived experiences of doctoral students during their thesis phase. This qualitative approach was chosen because it allows us to navigate the complex emotions, institutional dynamics, and supervisory relationships from the students\u0026apos; perspectives (Creswell \u0026amp; Poth, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e; Merriam \u0026amp; Tisdell, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Setting and Participants The research was conducted at Isfahan University of Medical Sciences, a leading institution in health sciences in Iran. We used a purposive sampling strategy to select 31 PhD students from various faculties, ensuring a diverse representation in terms of gender, research area, academic stage, and supervisory background. To qualify for participation, students needed to meet the \u003cstrong\u003efollowing criteria\u003c/strong\u003e:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eEnrolled in a PhD program for at least one year\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eActively engaged in the research or thesis phase\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic Characteristics of PhD Students\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParticipant ID\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAcademic Discipline\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth Promotion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth Promotion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReproductive Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026ndash;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBiochemistry\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNutrition Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Physics and Engineering\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImmunology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysiology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMolecular Biology and Genetics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysiology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePharmaceutical Chemistry\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePharmaceutical Biotechnology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnvironmental Health Engineering\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNutrition Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrthotics and Prosthetics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEpidemiology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth Services Management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Library and Information Science\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisaster and Emergency Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Library and Information Science\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReproductive Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth Economics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysiology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Physics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParasitology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMolecular Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eBetween 2022 and 2023, we conducted semi-structured interviews that delved into various themes like supervisory dynamics, emotional resilience, research execution, institutional support, and policy navigation. Each interview lasted anywhere from 45 to 75 minutes, and with the participants\u0026apos; consent, we audio-recorded them, transcribed every word, and then translated the transcripts from Persian to English for our analysis. To ensure we respected cultural nuances and maintained linguistic accuracy, bilingual experts who were well-versed in qualitative research handled the translation. We made sure to obtain informed consent from all participants, guaranteeing their anonymity, confidentiality, and the choice to participate voluntarily.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterview Guide\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe created a tailored interview guide specifically for this research. An English version has been included as a supplementary file and referenced in the manuscript. Participants were chosen through purposive sampling. The interviews were recorded, transcribed, and analyzed using thematic content analysis.\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eData Analysis\u003c/h2\u003e\n \u003cp\u003eFor our data analysis, we utilized conventional content analysis, following the framework laid out by Graneheim and Lundman (2004). We reviewed the transcripts multiple times, extracted meaningful units, and employed open coding to create subcategories and broader themes. NVivo 12 supported data management. To bolster the trustworthiness of our study, we implemented several strategies:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eMember checking, where select participants reviewed our preliminary findings\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePeer debriefing, which involved discussions with external qualitative scholars\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAn audit trail that documented our analytical decisions and the development of categories We received ethical approval from the Research Ethics Committee of Isfahan University of Medical Sciences (IR.MUI.RESEARCH.REC.1398.239).\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOur analysis of interviews with 31 PhD students led to the identification of 12 main categories and 45 subcategories, capturing the systemic, interpersonal, and emotional aspects of the doctoral thesis journey. We present these categories thematically, enriched with direct quotes from participants and contextualized with recent literature.\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Supervisory Inconsistency and Relational Strain\u003c/strong\u003e: Students shared their experiences of inconsistent engagement from supervisors, noting differences in expertise and availability. The absence of timely feedback and mentorship often resulted in delays, confusion, and emotional stress. \u0026ldquo;\u003cem\u003eWhen my supervisor wasn\u0026rsquo;t around or didn\u0026rsquo;t have the right knowledge, everything just slowed down or came to a halt\u003c/em\u003e.\u0026rdquo; \u0026mdash; Student 14. This observation aligns with recent research indicating that inconsistent supervision can lead to higher dropout rates and psychological distress among doctoral candidates (Haley et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e; Smirnov, \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e2. Curriculum Misalignment with Research Demands\u003c/strong\u003e: Students pointed out a gap between what they learned in class and what was required for their theses. The theoretical material often felt disconnected from practical application, leaving them feeling unprepared for independent research. \u0026ldquo;\u003cem\u003eThe courses we took didn\u0026rsquo;t really help with our thesis at all\u003c/em\u003e.\u0026rdquo; \u0026mdash; Student 18 Chal\u0026oacute; et al. (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) stress the importance of integrating research training early in doctoral programs to close this gap.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e3. Emotional Burden and Psychological Vulnerability\u003c/strong\u003e: The journey through a doctoral program was filled with ongoing emotional challenges. Students reported feelings of anxiety, isolation, and burnout, particularly during the research and writing stages. \u0026ldquo;\u003cem\u003eThe thesis puts a huge burden on us. The stress is just too much\u003c/em\u003e.\u0026rdquo; \u0026mdash; Student 22. These insights reflect broader concerns about mental health among doctoral students worldwide (Nature Research Intelligence, \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e; Schwaller, \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e4. Institutional Ambiguity and Bureaucratic Barriers\u003c/strong\u003e: Students encountered vague policies, strict timelines, and procedural delays. Uncertainty surrounding supervisor assignments and thesis approval processes led to confusion and frustration. \u0026ldquo;\u003cem\u003eWe didn\u0026rsquo;t know who to turn to or what the next step was. Everything felt so unclear.\u003c/em\u003e\u0026rdquo; \u0026mdash; Student 9 Zhuchkova \u0026amp; Bekova (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) emphasize the need for clearer, more student-focused governance in doctoral programs.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e5. Research Infrastructure and Funding Constraints\u003c/strong\u003e: Access to labs, software, and financial backing was often limited, which really affected the quality of research. Many students had to downsize their projects because of budget constraints. \u0026ldquo;\u003cem\u003eWe had to cut parts of the study due to lack of funds.\u003c/em\u003e\u0026rdquo; \u0026mdash; Student 10 Buenstorf et al. (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) and Hasgall \u0026amp; Peneoasu (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e) argue for fair funding systems in transitional academic environments.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e6. Communication Climate and Academic Dignity\u003c/strong\u003e: Students highlighted the importance of respectful and empathetic communication. They appreciated supervisors who listened, fostered open dialogue, and respected their independence. \u0026ldquo;\u003cem\u003eWhen my supervisor treats me with respect, I feel motivated even when the work is hard.\u0026rdquo;\u003c/em\u003e \u0026mdash; Student 7. Johansson \u0026amp; Yerrabati (\u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e) point out that building relational trust can boost doctoral engagement and resilience.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e7. Lack of Peer Integration and Academic Community\u003c/strong\u003e: Many students felt there were few chances for peer interaction, especially during their thesis work. This sense of isolation made it tough to stay motivated and grow academically. \u0026ldquo;\u003cem\u003eI felt like I was doing this alone. There was no space to share or ask others.\u0026rdquo;\u003c/em\u003e \u0026mdash; Student 21 Lorenzetti et al. (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) highlight the need for peer mentorship and community-building to support doctoral well-being.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e8. Supervisor\u0026ndash;Student Power Imbalance\u003c/strong\u003e: Some students described a power dynamic that stifled their voice. The fear of criticism or rejection made it hard to communicate openly. \u0026ldquo;\u003cem\u003eI couldn\u0026rsquo;t question anything. It felt like I had no voice.\u003c/em\u003e\u0026rdquo; \u0026mdash; Student 6. Haley et al. (\u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e) and Cardoso et al. (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e) advocate for supervisory models that encourage autonomy and mutual respect.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e9. Publication Pressure and Academic Expectations\u003c/strong\u003e: There was a strong push for students to publish before graduating, often without the necessary support. This created additional stress and shifted their focus away from developing their theses. \u0026ldquo;\u003cem\u003eWe were told to publish, but no one showed us how.\u0026rdquo;\u003c/em\u003e \u0026mdash; Student 17. Nature Research Intelligence (\u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e) suggests incorporating publication training into doctoral programs.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e10. Digital Literacy and Methodological Gaps\u003c/strong\u003e: Students faced challenges with data analysis tools and research software, mentioning a lack of adequate training. \u0026ldquo;\u003cem\u003eI had to figure everything out by myself. There was no official support.\u0026rdquo;\u003c/em\u003e \u0026mdash; Student 12. Chal\u0026oacute; et al. (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) and Deroncele-Acosta et al. (\u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e) emphasize the importance of structured digital skill development in doctoral programs.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e11. Work\u0026ndash;Life Imbalance and Role Conflict\u003c/strong\u003e: Finding a balance between academic duties and personal or professional responsibilities proved to be tough. Married students and those with caregiving roles reported increased stress levels. \u0026ldquo;\u003cem\u003eI was trying to manage research, work, and family. It felt like an impossible task.\u0026rdquo;\u003c/em\u003e \u0026mdash; Student 25. Zhuchkova \u0026amp; Terentev (\u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e) point out the necessity for flexible doctoral structures that can accommodate a variety of student needs.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e12. Aspirational Disconnect and Career Uncertainty\u003c/strong\u003e: Students voiced their concerns about what comes after earning their PhDs. The lack of guidance and limited exposure to non-academic career paths added to their anxiety. \u0026ldquo;\u003cem\u003eI have no idea what\u0026rsquo;s next. We\u0026rsquo;re not really prepared for anything outside of academia.\u0026rdquo;\u003c/em\u003e \u0026mdash; Student 30. Smirnov (\u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e) and El-Soussi (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) suggest implementing career development programs and encouraging interdisciplinary experiences to expand doctoral career options.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study takes a closer look at the doctoral thesis journey from a student\u0026rsquo;s perspective in Iranian medical universities, uncovering a tangled web of supervisory dynamics, institutional frameworks, emotional challenges, and resource limitations. The results not only reflect global issues but also shine a light on unique hurdles faced in transitional academic environments. Supervisory Relationships: Key to Doctoral Success Students highlighted how crucial supervisors are in guiding their thesis paths. Issues like inconsistent supervision, lack of expertise, and limited availability often led to delays and emotional strain. These observations align with recent studies that stress the need for strong relational and teaching skills in supervision (Haley et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Johansson \u0026amp; Yerrabati, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). There\u0026rsquo;s a growing push to move away from traditional hierarchical models towards more collaborative supervision, which can help foster independence and resilience (Cardoso et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Haley et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Curriculum Gaps and Research Preparedness Many students noted a gap between their coursework and the research phase, feeling that theoretical lessons didn\u0026rsquo;t adequately prepare them for hands-on inquiry. This disconnect has been recognized in various settings (Chal\u0026oacute; et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Deroncele-Acosta et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), leading to calls for a more integrated curriculum that weaves research skill development into the early stages of doctoral training. Emotional Strain and Mental Health Challenges The emotional burden of pursuing a doctorate was a prominent theme. Students shared experiences of anxiety, isolation, and burnout, especially during the research and writing stages. These findings resonate with global evaluations of doctoral mental health (Nature Research Intelligence, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Schwaller, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lorenzetti et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), which advocate for the establishment of support systems and training in emotional awareness. It\u0026rsquo;s essential for institutions to view mental health as a systemic issue rather than just an individual one.\u003c/p\u003e\u003cp\u003eOne of the main limitations of this study is that it focuses on just one institution, which could limit how widely the results can be applied. Still, the findings provide valuable insights that can be relevant to other similar academic environments. Additionally, the cultural differences in translation might affect how deeply we interpret the results, even with thorough bilingual validation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a thoughtful, student-focused perspective on the doctoral thesis journey in Iranian medical universities. The results highlight the urgent need for comprehensive reforms that emphasize student empowerment, emotional health, and clear institutional practices. Key Recommendations: 1. Supervisor Development: Create structured training programs that cover both the academic and emotional aspects of supervision (Haley et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Johansson \u0026amp; Yerrabati, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). 2. Curriculum Integration: Weave research skill development into early courses to better equip students for independent inquiry (Chal\u0026oacute; et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Deroncele-Acosta et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). 3. Mental Health Support: Offer accessible counseling services, peer mentoring, and workshops focused on emotional literacy (Nature Research Intelligence, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Schwaller, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). 4. Policy Reform: Update doctoral regulations to improve transparency, flexibility, and student involvement in decision-making (Zhuchkova \u0026amp; Bekova, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Hasgall \u0026amp; Peneoasu, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). 5. Resource Equity: Create funding mechanisms based on needs and collaborative research platforms to support a variety of agendas (Buenstorf et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Zhuchkova \u0026amp; Terentev, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These reforms go beyond mere technical changes\u0026mdash;they represent a cultural shift towards a more compassionate, fair, and effective model of doctoral education. By prioritizing student voices and experiences, universities can nurture scholars who are not only intellectually sharp but also emotionally strong and socially engaged.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Conceptualization: Shahnaz Ghasemi Nangi \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Data collection and curation: Shahnaz Ghasemi Nangi \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Formal analysis: Fariba Jokar, Shahnaz Ghasemi Nangi \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Writing \u0026ndash; original draft: Shahnaz Ghasemi Nangi \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Writing \u0026ndash; review \u0026amp; editing: Alireza Yousefi, Fariba Jokar \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Supervision: Alireza Yousefi \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grants from funding agencies, whether they are public, commercial, or non-profit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is part of PhD dissertation number 398301, with ethics code IRMU.RESEARCH.REC.1398.239, granted by Isfahan University of Medical Sciences. All participants gave their written informed consent and were guaranteed confidentiality and the choice to participate voluntarily.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration\u003c/strong\u003e: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during this study are not publicly available due to participant confidentiality but may be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank the Department of Medical Education, the Medical Education Research Center, and the Vice-Chancellor for Research at Isfahan University of Medical Sciences for their support. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSmirnov N. 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Jossey-Bass; 2016. p. 33.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Doctoral education, PhD students, qualitative research, supervision, academic culture, emotional well-being, Iran","lastPublishedDoi":"10.21203/rs.3.rs-7201025/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7201025/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIn the ever-evolving landscape of academia, PhD students often find themselves tangled in a myriad of challenges that can impact their academic journey and emotional health. This is especially true for those studying at Iranian medical universities, where structural uncertainties and a lack of robust support systems can significantly influence their doctoral experience. While there's been a growing global focus on reforms that prioritize students, there\u0026rsquo;s still a noticeable gap in research that amplifies the voices of students in these settings.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis qualitative study delved into the experiences of 31 doctoral candidates at Isfahan University of Medical Sciences. Through semi-structured interviews and conventional content analysis, following the framework set by Graneheim and Lundman, we identified key themes using inductive coding. NVivo 12 supported data management. To ensure the trustworthiness of our findings, we employed member checking, peer debriefing, and maintained a thorough audit trail.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eStudents shared a variety of challenges they faced, including inconsistent supervision, a lack of practical curriculum alignment, emotional stress, unclear procedures, and insufficient funding and research infrastructure. They highlighted the importance of respectful communication, accessible supervisors, peer support, and emotional validation as essential for their thesis progress and overall well-being.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe landscape of doctoral education in Iranian medical universities is influenced by supervisory, emotional, and institutional factors that need immediate attention. Reform initiatives ought to prioritize building strong relationships in supervision, weaving research skills into the curriculum, boosting mental health support, and improving policies that put students at the center.\u003c/p\u003e","manuscriptTitle":"Navigating Supervisory and Structural Challenges in PhD Education: A Qualitative Study of Iranian Medical Students’ Perspectives","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-05 13:54:04","doi":"10.21203/rs.3.rs-7201025/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-22T08:40:37+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"211353381877036934191064482051525840698","date":"2025-09-20T06:53:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210367541812996756741872091048673796299","date":"2025-09-20T05:40:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-09T19:49:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144131775795938145401660845635429552217","date":"2025-09-09T08:15:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-04T00:13:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31351006814861471692112654571464585464","date":"2025-08-29T10:19:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-29T10:05:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-28T04:34:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-08T10:05:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-06T12:16:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-06T12:13:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6cf68f88-11b5-4c5a-8750-a160ebb95d88","owner":[],"postedDate":"September 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:00:53+00:00","versionOfRecord":{"articleIdentity":"rs-7201025","link":"https://doi.org/10.1186/s12909-025-08411-0","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-12-10 15:57:17","publishedOnDateReadable":"December 10th, 2025"},"versionCreatedAt":"2025-09-05 13:54:04","video":"","vorDoi":"10.1186/s12909-025-08411-0","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08411-0","workflowStages":[]},"version":"v1","identity":"rs-7201025","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7201025","identity":"rs-7201025","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}