Introduction <p>International accreditation of universities is a comprehensive evaluation process conducted by reputable external bodies to ensure adherence to quality and effectiveness standards in higher education institutions. This study aimed to identify the challenges and strategic solutions related to the international accreditation of Iranian universities of medical sciences (IUMS).</p> Methods <p>This qualitative study was conducted in 2023 across IUMS. Data were collected through purposive semistructured interviews with 36 individuals, including administrators, faculty members, and experts from various university departments under the supervision of the Ministry of Health and Medical Education (MOHME). The interviews continued until data saturation was achieved. The data were analyzed using the conventional content analysis approach proposed by Graneheim and Lundman.</p> Results <p>A total of 52 challenges were identified, the most critical of which were cultural barriers, weak implementation processes, and inappropriate organizational structures. In parallel, 57 solutions were classified into seven categories, including training and education, infrastructure development, communication enhancement, policymaking and planning, self-assessment, improvement of standards and indicators, and process optimization.</p> Conclusions <p>This study identified major barriers to international accreditation in IUMS and proposed practical solutions. Progress requires joint action: universities should strengthen training, infrastructure, documentation, and internal quality assurance, while accrediting bodies and national authorities must provide supportive regulations, adequate resources, and context-sensitive standards aligned with global frameworks. Coordinated efforts at both levels are essential for enhancing accreditation readiness, improving quality, and increasing global competitiveness.</p>