This document was developed based on the findings of a mixed study that aimed to design and explain a national meta-accreditation system in the field of medical education in Iran. The study findings showed that the designed model has significant compliance with internationally recognized frameworks, including CHEA, INQAAHE, WFME, ENQA, APQN, and HAQAA, but its governmental structure, compared to global non-governmental or semi-independent models, faces fundamental challenges such as conflict of interest, limitations in professional independence, and reduced international acceptance. However, this structure allows for faster implementation in the current Iranian conditions due to the lack of capable non-governmental institutions and the centralized structure in the Ministry of Health. This document emphasizes that a gradual move towards a semi-autonomous model, while maintaining the role of government policy-making and the participation of specialized institutions and scientific associations, can create a balance between existing structural realities and professional and global aspirations. In this direction, the development of the necessary legal framework, capacity building in civil society institutions, increasing transparency and interaction with international institutions are considered to be the main priorities. The meta-accreditation system is a monitoring tool and a factor for improving quality, accountability and trust in the higher health education system, and its success depends on choosing a realistic, participatory and forward-looking path.