Introduction
The educational system from primary school to university is the most crucial factor of human development and training of specialized human resources. What needs to be considered in this regard is the fact that education and its quality must satisfy the real needs of society [1]. With the changing world, university curricula are rapidly becoming obsolete, and as a result, a gap is created between learning and social and practical work situations [2]. The most important challenge that Iran’s higher education faces today is accountability to environmental conditions. To be accountable for changing environmental conditions, universities should adapt to new requirements. The existential philosophy of universities and higher education institutions is to meet the expectations and needs of society. Accountability is an integral part of the higher education system [3]. The World Health Organization (WHO) defines social accountability for medical schools as directing educational, research, and service activities to address community health concerns and needs [4]. Accountability is a criterion for evaluating and measuring the accountability of educational institutions to the needs of society [5], what can be deduced from the works and scientific texts related to the medical education system and the health system, attention to the needs and expectations of society is a social responsibility for universities and educational groups [6]. Educational institutions must actively participate in developing the health system and be effective in the community by following the basic principles (quality, equality, relevance, and effectiveness) [7]. The rapid development and expansion of medical universities in the country and increase in the number of students and graduates of various fields, especially Rehabilitation, has raised many challenges and issues related to the effectiveness and competence of graduates in meeting the needs of the health system and society. Meanwhile, demographic changes and epidemiology of diseases, injuries, and disorders, on the one hand, and increasing the level of public awareness and expectations of the community to benefit from the desired specialized services, on the other hand, urge to review educational policies and programs. Medical education has gone through a difficult path to meet the real needs of society. Thus, the transformation of responsive medical education and success depends on accurate prioritization and rational allocation of available resources. Medical education in this regard should be reconsidered extensively and deeply [8]. According to some experts and scholars in Iran’s medical education, there is a gap in meeting the needs of society. Students’ relationship with society has gradually weakened, and over the years, with the elimination of common chapters, it has given way to impenetrable boundaries [9]. Our current education does not meet the real needs of society. Numerous studies on newly-graduated physicians in the UK have pointed to a lack of skills among physicians. One of the signs of a lack of social accountability in the curriculum is the lack of knowledge, attitude, and skills of physicians in meeting the needs of society [10]. Karimi et al. reported that 54.3% of family physicians acknowledged the large gap between theoretical education during their student years and the expectations required of them in the family physician plan [11]. Some research shows that medical graduates do not consider their preparedness in terms of skills and competence as desirable. To meet this challenge, one of the approaches that planners have considered in recent years to bridge the gap between what university graduates have learned and the needs of society is the “accountable education approach”. Accountable education in medical sciences is a curriculum based on receiving and responding to the community’s health needs, preparing students for work, and providing services to the community [12]. Accountable education directs all education activities towards training professionals who can meet the health needs of the target community [13]. Given the importance of the subject, this study sought to answer the question of what the dimensions and components of accountable education are for the Rehabilitation Science education program at Tehran University of Medical Sciences.
Study plan
This study was conducted with a qualitative approach of conventional content analysis with 25 experts in the field of rehabilitation to identify the dimensions and components of accountable education for the Rehabilitation Science education curriculum at Tehran University of Medical Sciences in 2021. In this method, concepts were extracted through interviews, and after coding the data, the qualitative content analysis was used to interpret the content of the text data [14].
Materials and Methods
Study participants 
The participants were 25 expert people (15 men, 10 women) of rehabilitation specialists from Tehran University of Medical Sciences. A purposeful sampling method was used, and the interviews were continued until data saturation. The inclusion criteria were the faculty members of Tehran University of Medical Sciences with specialization in Rehabilitation, willing to conduct interviews, and having at least five years of experience.
Collecting data
To collect data, face-to-face interviews with experts were used to saturate the data theoretically. On average, each interview lasted 45 minutes to 1 hour. Some questions were “How do you assess the current state of the rehabilitation curriculum to meet the community’s needs?” and “What are the most important dimensions and components of accountable education?”
Data analysis
Graneheim and Lundman’s conventional content analysis method was used to analyze the data. In this method, the content of each interview was read line by line to obtain a general understanding of the text. The sentences that are the answers to the questions raised in the interview were identified as a semantic unit. Then, a summary of semantic units and open coding was performed. After assigning a code to each main concept, similar codes were compared, and a list of subcategories was prepared. Finally, a list of categories was obtained based on the similarities and relationships of the subcategories [15].
Data trustworthiness and strength
In this study, four criteria of credibility, dependability, transferability, and conformability of Guba and Lincoln were used to assess the accuracy of the data. The method of long-term engagement with the data for 4 months and spending enough time to collect and analyze the data was used to confirm the validity and acceptability of the data [16]. The strategy of checking the interview with the participant was used to increase dependability [17]. The third criterion for the trustworthiness and strength of the data is transferability, i.e., the findings can be transmitted and used in other similar environments or groups. In this study, the researcher conducted an in-depth analysis of the background and characteristics of the participants, the study context, and the obstacles and limitations. This information provided the conditions for readers to use the findings in other social contexts. To achieve the criterion of conformability, all stages of the research, especially the stages of data analysis in all directions, were recorded in detail so that If other researchers want to continue research in this field, they can easily follow this work based on the available writings and documents related to interviews, analysis, and other stages of research.
Results
The study findings obtained from interviews with 25 rehabilitation experts are presented in the form of demographic characteristics of experts (Table 1) and dimensions, components, and indicators of accountable education (Table 2).






Research question 1: What are the dimensions of accountable education for the rehabilitation science education curriculum at Tehran University of Medical Sciences from an expert’s point of view? Six dimensions of community, higher education system, university, professor, student, the curriculum were identified through interviews with experts. 
Research question 2: What are the components and indicators of accountable education for the rehabilitation education curriculum in Tehran University of Medical Sciences from an expert’s point of view? Twenty-one components and 136 indicators in this field were identified.
Society
Society is the most important pillar and foundation of organizing and implementing educational curricula. Its related components (expectations and needs, social and cultural beliefs, and demand-driven services) play important roles in guiding educational systems to meet the needs of society. One of the participants (Participant 9) said: “in the current situation, the interaction of education and university systems with the community is not enough, and it is necessary to review it in this regard. Thus, paying attention to community-based rehabilitation programs is a successful strategy that can have a good place in universities’ educational curriculum programs.”
The higher health education system
The higher health education system is another important dimension of accountable education. The components of authority and guidance, macro-planning and policy on the one hand, and the system of admission, recruitment, and selection of students, on the other hand, are of particular importance and sensitivity. Participant number 1 said: “In general, the efficiency of the educational system requires macro-educational planning and policy-making based on facts. Planning and formulating educational policies are among the processes that can help make better use of the country’s resources and facilities and make the education system more efficient.” 
University
Participant number 7 said: “Today, the perspective of accountability and social commitment of the university in serving society is of particular importance, and universities as a social institution to meet the needs and expectations of society are an integral part of the philosophy of higher education.” 
Professor
Capable and motivated professors were identified as one of the most important and influential aspects in the process of accountable education. From the participants’ point of view, the most important component in this regard was the development of the professor in various fields (individual, educational, research, organizational and social). One of the participants (Participant 16) said: “Responsible faculty members are expected to be fully acquainted with the needs of society, job needs, and individual needs of students. In addition to recognizing the educational system, and setting educational goals and preparing educational curriculum, they must try to achieve those goals and respond to students and the education system.” 
Student
Students as actors and main owners of the process of the higher health education system are another dimension identified in the present study. Participant number 4 remarked: “empowerment of knowledge, attitude and skills, and development of their general and professional competencies to prepare for accepting social responsibilities and providing justice-oriented services and their role in the health system, along with the observance of professional ethics, is one of the important tasks and components of higher education that should be considered in the accountable education system.” 
Educational curriculum
The curriculum and other aspects of education are accountable. According to the experts, the components of objectives, content and method, evaluation, and field were of particular importance and priority. Participant number 11 said: “ Setting clear and achievable goals in the field of rehabilitation education programs, using new educational methods appropriate to the changes in society, using various evaluation methods in educational curriculum and curriculum accountability to the environment are prominent features of responsive educational systems to society.” 
Discussion and Conclusion
This study aimed to identify the dimensions and components of accountable education for the rehabilitation science education curriculum. Henen believed that social responsibility in medical education requires a fundamental orientation in society. Therefore, the emphasis is on the level of access, and medical schools should expand their clinical services to society. Suppose universities want to meet the needs of the community under their auspices. In that case, they must design their educational system based on the needs and priorities of community health and improve the level of health and satisfaction of individuals in the community [18]. In this regard, Abdolmaleki studied the various dimensions of social accountability and identified seven dimensions of meeting the needs of community health, accountable educational system structure, community-based policy, community involvement, community-based education, evaluation of the educational system, barriers in the field of social accountability [19]. 
The present study focuses on identifying the dimensions and different components of accountable education in the field of educational and curriculum programs. In other words, it can be said that the present study focuses on demand-oriented education and aims to guide educational and curricular programs to meet the needs and expectations of society. On the other hand, paying attention to society’s expectations and meeting its needs is consistent with the present study. Nekuzad et al. reviewed the situation of accountable medical education in Iran through a review method. The findings of this study indicate that medical education has taken a difficult path to meet the real needs of society. Thus, creating a change in accountable medical education and success depends on precisely determining the priorities and rational allocation of available resources. Medical education must be considered extensively and deeply [8]. 
This study only examined the current status of accountable medical education. In contrast, the present study has comprehensively addressed the aspects, dimensions, and affective components in responsive education in the field of rehabilitation, which in turn can be appropriate and problem-solving in guiding the higher health education system towards demand-driven. However, in terms of emphasizing the real needs of society, it is consistent with the present study. Sandhu et al. presented the AIDER model for social accountability in medical education and practice. This model consists of five stages of assessing, inquiring, delivering, educating, and responding, which are repeated in a continuous cycle [20]. The findings of this study are consistent with the findings of the present study in terms of the importance of education, research, and response. The difference is that the Sandhu model emphasizes social accountability with the approach of education and practice in the field of medicine. Only five dimensions were addressed, while in the present study, the dimensions of society, higher health education system, professor, and student have been addressed as the most important element of accountability to educational curriculum programs in meeting the needs and expectations of society. Tatari et al. examined the role of faculty members in accountable medical education. The findings of this study showed that faculty members, to develop their social responsibility, have a duty to be effective in the economic and social growth of their community and play a role in value creation, entrepreneurship, and innovation [3]. 
Baho Taroudi et al. investigated the role of leading professors and accountable education in developing third-generation universities to provide a model in Mazandaran University of Medical Sciences. The findings of this study show that the role of leading professors and accountable education on the development of the third generation university in Mazandaran University of Medical Sciences is positive and significant. The leading professors have a greater role in developing the third generation university. Therefore, training capable, committed, and accountable graduates to the needs of patients and the health system are the most important mission of medical universities [21]. The findings of this study and the previous study are consistent with the present study in terms of paying attention to the role of professors in training capable and accountable graduates in an accountable education system. Rezaian examined the various dimensions of community-accountable medical schools; the results of his study showed that the community-accountable medical school is a school in which the educational, research, and service content of medical schools is reviewed with the focus on priorities related to community health needs and based on ethical principles and standards. In addition, the method of selecting professors and students as well as the evaluation of the faculties is done based on the idea of accountability to the community [22]. 
The findings of this study are consistent with the findings of the present study in terms of the importance of educational content, research, and service delivery, as well as the selection of professors and students and the health needs of society. The difference was that the important role of the health education system in authority and guiding educational systems had not been addressed in accountable education. In another study, Farmed et al. considered the content of the educational program, teaching method, inappropriate educational goals, and lack of attention to the needs of society in the educational curriculum program as challenges in accountable medical education. These factors indicate the importance of the educational curriculum program in educational systems. According to this view, the finding is in line with the main issue of the present study. In general, curricula are the basis for forming the most important process of the university system, namely learning. Education, research, and the provision of specialized services by higher education institutions depend to a large extent on the dynamics of the curriculum [23]. The present study is of special importance due to the comprehensive attention to various aspects of accountable and demand-driven education in the attention of curricula to the needs and expectations of society.
Conclusion
The present study showed that society, higher health education system, university, professor, student, educational and curriculum program as dimensions of responsive education and related components play an important role in fulfilling the missions of third and fourth generation universities and educational systems accountability to the needs and expectations of society.

Ethical Considerations
Compliance with ethical guidelines
The national system of ethics in research approved this article (Code: I.R.IAU.PIAU.REC.1400.016). Before the interviews, informed consent was obtained from all study participants, ensuring that information was kept confidential and that participants could be excluded from the study at any time.

Funding
The paper was extracted from the MA. thesis of the first author at the Department of Educational Sciences, Faculty of Educational Sciences and Psychology, Islamshahr Branch, Islamic Azad University, Islamshahr.

Authors' contributions
Idea and conceptualization, editing and final approval: Akbar Mirjani Aghdam and Abbas Khorshidi; Methodology: Abbas Khorshidi; Management and Supervision: Abbas Khorshidi, Nader Barzegar, Saeed Moradi, and Soleiman Ahmadi.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We would like to thank the Professors, as well as the Academic Administrations of Departments and Faculty of members Tehran University of Medical Sciences who helped us in this research.


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