Abstract

Background: Discrimination and harassment continue in medical education contexts yet remain under-recognized, with deleterious effects on medical students’ wellbeing and education. The difference in recognition, tolerance, and acceptability of ambiguous discriminatory and harassing scenarios has rarely been studied, yet improved understanding in this area may lead to improved identification and prevention of it. Prior studies suggest female medical students perceive harassing or belittling actions as more harsh, yet few studies discuss wider contexts and which factors influence acceptance or tolerance. This study aims to characterize and compare factors that influence the perceived tolerance and acceptability of scenarios that include discrimination and harassment. Methods: In this exploratory study, quantitative and qualitative data were collected through a survey sent out to a population of 1,318 medical students, asking for personal responses to a range of scenarios, which included different forms of discrimination and harassment in varying degrees of ambiguity. Sixteen students were then invited to focus groups to explore factors in more depth. Quantitative data were analyzed with t-tests and logistic regression; qualitative data with framework analysis. Findings: 20 percent of students (n = 259) responded to the survey. Being singled out based on ethnicity to speak on behalf of a group of people was most negatively perceived (mean professionalism rating on a 1:lowest/worst to 5:highest/best scale, 2.43/5.00, 95% CI 2.31- 2.54), while gender-stereotyped career advice was rated least negative (mean personal rating 3.36/5, 95% CI 3.22- 3.50). Students were more likely to perceive scenarios as unacceptable if they identified as female, black, or from an ethnic minority; had a LGBTQ+ orientation; or had personal experience of discrimination and harassment. Perception of scenarios was influenced by perceived intention and seniority, the gender of those involved, student and relationship factors, and its setting. Conclusions: Scenarios containing discrimination and harassment were perceived as more problematic if students identified as women, black or ethnic minority, had an LGBTQ+ orientation, or had previous experience, and in certain situations, whilst white male students perceived less discrimination and harassment. This highlights the importance of including a diverse range of voices in medical education leadership, and training about discrimination and harassment of all involved in teaching.