Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 0 0 2026 10 24 1610 1610 Mohammad Hossein Nilforoush Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran AND Department of Medical Education, Isfahan University of Medical Sciences, Isfahan, Iran Mohammad Hosseini Moghadam Futures Studies Department, Institute for Social and Cultural Studies, Tehran, Iran Saeid Mahmoudian ENT and Head and Neck Research Center, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Nikoo Yamani Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran AND Department of Medical Education, Isfahan University of Medical Sciences, Isfahan, Iran 2026 08 23 2026 09 26 Background and aim: Hearing loss already affects about 1.5 billion people worldwide and is expected to reach 2.5 billion by 2050. Traditional audiology training struggles to keep pace with rapid changes in technology, workforce needs and regulation. Earlier reviews have examined isolated educational interventions. This systematic review maps the broader macro-environmental forces reshaping audiology education and identifies directions for curriculum reform. Recent findings: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline, 847 records were identified, 644 records were screened, and 50 sources (2000–2025) were included. Directed qualitative content analysis mapped findings onto a tailored social, technological, economic, environmental, political and values (STEEPV) framework, applying a foresight and horizon-scanning approach to macro-environmental driver identification (technological; workforce and social/economic; regulatory and policy; values-driven curriculum innovations). Technological drivers (artificial intelligence [AI], tele-audiology, connected devices), workforce pressures (task-sharing, competency-based education), curriculum innovations (simulation, interprofessional education, public-health content) and regulatory shifts (over-the-counter [OTC] devices, accreditation standards) interact to produce an adaptation gap between clinical practice and educational preparation. Conclusion: Audiology programmes need to move beyond device-specific training toward durable capabilities: strong scientific foundations, clinical reasoning, digital and basic AI literacy, person-centred communication, ethical judgement, adaptability, innovation and lifelong learning. Competency-based and interprofessional frameworks can help translate these capabilities into observable outcomes while preparing graduates for supervisory and system-level roles. The mapped drivers provide a structured foundation for proactive, context-sensitive curriculum redesign. https://avr.tums.ac.ir/index.php/avr/article/view/1610 https://avr.tums.ac.ir/index.php/avr/article/download/1610/707