ABSTRACT
Introduction: Prejudice is a social phenomenon that, when manifested in different contexts, can negatively impact medical education by affecting students’ academic experiences and the quality of healthcare delivery.
Objective: To analyze the perception of medical students from public and private institutions in Rio Grande do Norte (RN), Brazil, regarding experiences and situations of prejudice during medical training.
Method: This is a descriptive, exploratory study with a quantitative approach, conducted with 588 students from four higher education institutions. Data collection was carried out through a structured questionnaire administered via Google Forms, encompassing sociodemographic information and experiences of prejudice. Data were analyzed using descriptive statistics and bivariate analysis through Pearson’s Chi-square test, with a 5% significance level.
Results: The results indicated that 50.9% of participants observed episodes of prejudice in the academic environment, and 16.8% reported being direct victims. A significant association was found between the experience of prejudice and variables such as sexual orientation (p<0.001), age over 26 years (p<0.001), and marital status (married/stable union) (p<0.001). The most frequently reported types of prejudice were related to sexual orientation, gender, and ageism. It was concluded that prejudice is significantly present in medical education among the analyzed population, leading to the normalization of discriminatory practices in the academic environment. LGBTQIAPN+ students, older students, and those who were married or in a stable union reported higher experiences of prejudice in medical education.
Conclusion: These findings highlight the need for consistent institutional strategies, including the transversal and continuous inclusion of diversity-related topics throughout medical training, the ongoing qualification of faculty members, and the implementation of mechanisms for support and confrontation. Such actions aim to promote more inclusive, humanized, and socially just medical education.
Keywords:
Medical Education; Prejudice; Stigma; Discrimination; Knowledge
RESUMO
Introdução: O preconceito é um fenômeno social que, ao se manifestar em diferentes contextos, pode impactar negativamente a formação médica, afetando a experiência acadêmica dos estudantes e a qualidade do atendimento em saúde.
Objetivo: Este estudo teve como objetivo analisar a percepção dos discentes dos cursos de Medicina públicos e privados do Rio Grande do Norte (RN) acerca das vivências e situações de preconceito durante a formação médica.
Método: Trata-se de um estudo descritivo, exploratório e de abordagem quantitativa, realizado com 588 estudantes de quatro instituições de ensino superior. A coleta de dados ocorreu por meio de questionário estruturado, aplicado via Google Forms, contemplando informações sociodemográficas e vivências de preconceito. Para a avaliação dos dados, utilizaram-se a estatística descritiva e a análise bivariada, por meio do teste qui-quadrado de Pearson, com nível de significância de 5%.
Resultado: Os resultados indicaram que 50,9% dos participantes observaram episódios de preconceito no ambiente acadêmico e 16,8% relataram ter sido vítimas diretas. Houve associação significativa entre a vivência do preconceito e variáveis como orientação sexual (p < 0,001), idade superior a 26 anos (p < 0,001) e estado civil casado/união estável (p < 0,001). Entre os tipos de preconceito mais mencionados, destacaram-se orientação sexual, preconceito de gênero e etarismo. Conclui-se que o preconceito está presente de forma significativa na formação médica entre a população analisada, naturalizando práticas discriminatórias no ambiente acadêmico. Estudantes LGBTQIAPN+, mais velhos e casados/união estável relataram maior vivência de preconceito na educação médica.
Conclusão: Esses achados evidenciam a necessidade de estratégias institucionais consistentes, incluindo a abordagem transversal e contínua de temas relacionados à diversidade ao longo da formação médica, a capacitação permanente do corpo docente e a implementação de mecanismos de enfrentamento e apoio. Tais ações visam promover uma educação médica mais inclusiva, humanizada e socialmente justa.
Palavras-chave:
Educação Médica; Preconceito; Estigma; Discriminação; Conhecimento
INTRODUCTION
Prejudice is a societal issue linked to stereotypes and discrimination, manifesting at individual, institutional, and cultural levels1. Regarding medical education, prejudice constitutes a persistent and multifaceted problem that affects both the students’ training process and the quality of patient care. This prejudice can manifest in various forms, including racism, sexism, disease-related stigma, and discrimination based on physical appearance or social status2)-(3.
Consequently, offensive comments, psychological aggression, and discrimination foster an adverse institutional climate, undermining students’ sense of belonging and safety. An environment marked by prejudice during medical training can diminish self-esteem and professional satisfaction, contributing to higher rates of depression, anxiety, and social isolation 4)-(6.
Thus, discrimination negatively impacts the learning process and the development of clinical competencies, hindering students’ comprehensive professional formation. This occurs because prejudiced comments and attitudes from faculty members serve as negative examples for students. Such behavior can reinforce existing biases, normalize certain conducts, and consequently perpetuate exclusionary practices within the healthcare context 7),(8.
As noted by Fuji (2024), a people’s culture and their customs influence many practices-including medicine-where instances of these issues can be observed in university corridors, classrooms, and interactions with teachers, for example 9.
Therefore, it is evident that prejudice, in any sphere, is part of the institutionalized violence present in modern society and must be studied and effectively combated. The discrimination faced by these groups negatively impacts their communities by undermining their contributions to medical education due to factors beyond their control.
Given the above, this study aimed to analyze the perceptions of medical students from public and private institutions in Rio Grande do Norte (RN), Brazil, regarding experiences and situations involving prejudice during their medical training.
METHOD
This was a descriptive, exploratory study using a quantitative approach. The study describes the frequency of experiences of prejudice among students, as well as their sociodemographic, economic, and academic characteristics.
The study population consisted of 588 undergraduate medical students (basic cycle: 1st-4th semesters; clinical cycle: 5th-8th semesters; and internship: 9th-12th semesters) from four Higher Education Institutions (HEIs) in RN-two public and two private ones-located in the cities of Mossoró and Natal. Participants were recruited through the dissemination of the research and the questionnaire via social media, institutional emails, and in-person outreach at the HEIs. Data collection took place between August 2023 and December 2024.
Students from the basic, clinical, and internship cycles participated in the study. Inclusion criteria comprised students enrolled in medical programs at the participating institutions who were over 18 years of age and voluntarily agreed to participate. Participants who did not fully complete the questionnaire or who did not meet the pre-established criteria were excluded.
Regarding the distribution of participants across the four institutions, participation was not uniform, as enrollment was voluntary and proportional to student availability in each setting.
After the study objectives were explained and the Informed Consent Form was signed, a standardized questionnaire - developed by the researchers and administered digitally via Google Forms - was used to identify characteristics related to experiences of prejudice in the university environment. The questionnaire consisted of 15 items divided into two sections: one covering sociodemographic and academic information, and another aimed at identifying acts of prejudice observed or experienced during the undergraduate course, as well as detailing the nature of these episodes. This second section allowed the assessment of the perpetrators and victims involved, the type of prejudice experienced or witnessed, the reactions that occurred, and the impact of these episodes on the victims’ lives, as well as changes in the learning process and behavioral alterations perceived by observers.
The collected data were organized in an Excel spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 23.0; descriptive statistics (simple frequency and percentage) were calculated. Additionally, Pearson’s chi-square test was performed for dichotomous variables. A 95% confidence interval and a 5% margin of error were used, with a p-value ≤ 0.05 being considered statistically significant.
The project was evaluated and approved by the Research Ethics Committee of Universidade do Estado do Rio Grande do Norte under protocol number 6.098.877.
RESULTS
The study population consisted of students from public (56.3%) and private (43.7%) higher education institutions in the state of Rio Grande do Norte who were at various stages of their degree programs, with a predominance of students in the clinical cycle (47.1%). The majority of respondents were female (62.5%), heterosexual (82.8%), white (65%), Catholic (56%), and single (44.6%). The predominant age group was 18 to 21 years (38.1%), and the most common family income range was between R$ 5,000.00 and R$ 15,000.00 (39.6%) (Table 1).
Among the students who participated in the study, 34.7% (n=204) reported observing prejudice in the academic environment, while 16.3% (n=96) reported having been victims of prejudice. Although a smaller proportion experienced prejudice directly, the perception of discriminatory attitudes is significant, revealing a scenario in which prejudice-even when indirect-is present and observed by half of these future medical professionals.
Analysis of the association between experiencing prejudice and the sociodemographic variables of the interviewed students revealed significant associations with sexual orientation (p<0.001), age group (p<0.001), and marital status (p<0.001). Individuals who did not identify as heterosexual, those over the age of 26, and those who were married (or in a common-law marriage) reported having been victims of prejudiced situations more frequently.
The most prevalent forms of prejudice mentioned by the students-such as those related to sexual orientation, gender, racism, and ableism-are depicted in Figure 1.
As illustrated in Figure 1, the types of prejudice most frequently reported by students were LGBTphobia (n=170), sexism (n=168), and fatphobia (n=84), followed by racism (n=78), ableism (n=70), and ageism (n=69). Other forms, such as religious intolerance (n=54), xenophobia (n=52), and various manifestations grouped under “others” (n=32), were also identified, albeit to a lesser extent.
Furthermore, the results reveal an evolution in the profile of the perpetrators of prejudice as medical students progress through their training. The analysis depicted in Figure 2 shows that the initial Basic Cycle environment is predominantly marked by peer conflicts, where reports of prejudice involving a “medical school classmate” exceed expectations (residual = 2.21). As the student advances to the internship and their immersion in the hospital environment intensifies, the scenario shifts. At this stage, the primary source of reported aggression shifts to “other healthcare professionals” (residual = 4.03), while conflicts with classmates become significantly less common (residual = -2.91), reflecting the change in the student’s primary circle of professional interactions.
Heatmap of standardized residuals for the association between academic cycle and the source of the prejudice. The redder the color (positive residual), the higher the level of prejudice (unexpectedly strong association), and the bluer the color (negative residual), the lower the level of prejudice (unexpectedly weak association).
DISCUSSION
The study results showed that, regarding the experience of prejudice, the discrepancy between students who reported witnessing it and those who stated they experienced it directly may reflect not only a difference in exposure but also the way such situations are recognized. Studies on the academic experience in medical schools indicate that discriminatory manifestations often occur through microaggressions or subtle attitudes, making immediate identification by victims difficult 10. Students deal with the combined effects of race, gender, race and socioeconomic status, making microaggressions-often unintentional-a common part of their academic journey11. Furthermore, there is evidence that some students, even when perceiving situations of prejudice, tend to deny or fail to report these experiences due to fear of retaliation or a lack of belief in the effectiveness of institutional responses 10),(12. Thus, these situations contribute to obscuring the existence of the problem, whether due to the difficulty of recognition or a lack of trust in institutional reporting mechanisms.
Among the groups most vulnerable to experiencing prejudice, the LGBTQIAPN+ population, students over the age of 26, and those who are married or in a common-law marriage stood out. This finding corroborates the existing literature on the subject, as the environment of medical education still involves the stigmatization of LGBTQIAPN+ individuals; discourses are developed that, for instance, associate them with risk conditions rather than focusing on specific aspects of these populations’ health 13),(14.
In academic training and practical settings, it is observed that prejudice related to sexual orientation manifests as discrimination, harassment, and bullying directed at students-particularly those in the LGBTQIAPN+ community-more frequently than at their heterosexual peers. Observing a higher frequency of reports of prejudice among older students-whether married or in a common-law marriage-allows for analysis from a dual perspective. The academic environment can be permeated by ageist attitudes and behaviors, predominantly directed at patients and often occurring implicitly 15),(17.
This prejudice spreads through jokes and negative stereotypes, manifesting as microaggressions that may go unnoticed. Thus, it is possible that greater maturity and life experience enhance one’s ability to recognize such attitudes. The presence of this type of prejudice poses a growing challenge, especially given the increasing age diversity among students and faculty. Ageism can affect both older and younger students, impacting inclusion; it manifests through stereotypes, social exclusion, the devaluation of experiences, and discriminatory practices directed at both older students and teachers 18)-(20.
Age discrimination occurs when beliefs and attitudes use chronological age to determine the allocation of resources and opportunities, causing individuals to suffer consequences ranging from well-intentioned condescension to outright degradation. This type of discrimination must be combated in every setting where it arises, whether through educational programs, government interventions, or even new legislation 21.
Regarding gender, despite the advances achieved by feminist movements over the decades, inequalities persist. These manifest as recurring episodes of sexism, silencing, and sexual harassment within the academic and professional medical environment, compromising equity and the well-being of female students 22. This is evidenced by the fact that female medical students are more likely to experience harassment than students in other fields-a trend linked to the pronounced hierarchy, dependency, and close contact between students and faculty23.
Regarding the identification of aggressors based on the student’s stage of training, it was observed that the source of discrimination shifts dynamically as the course progresses. Thus, during the basic cycle, fellow students are frequently cited as the sources of prejudice-which may manifest as social exclusion, jokes, and peer-to-peer microaggressions within academic settings 10.
However, the scenario shifts during the internship cycle; reports involving other healthcare professionals increase significantly, as the onset of clinical practice introduces intense power dynamics that alter the axis of conflict. Clinical supervisors, directors, and residents are often identified as perpetrators of prejudice, using their positions of power to perpetuate discriminatory practices, conduct biased evaluations, and create barriers to reporting 24)-(25.
Furthermore, the study in question highlighted other forms of prejudice experienced by medical students, such as ableism, bullying, xenophobia, and racism. This underscores the need to incorporate policies and content that address diversity across the entire curriculum and foster efforts to combat prejudice in medical education.
The study results indicated that, although a small percentage of students reported having been victims of prejudice, a very significant number reported witnessing prejudiced behavior directed at their peers within the HEI or clinical placement settings. Data showed that over fifty percent of students had observed acts of prejudice. The literature highlights that medical students contend with the intersecting effects of race, gender, race and socioeconomic status 11.
These findings are in accordance with the study by Schliemann, Souza, and Figueiredo (2020), in which the majority of participants reported having either experienced or witnessed some form of prejudice during their academic journey. This reflects an alarming-and indeed common-reality in medical schools: experiencing and witnessing prejudice is not unique to the context of this study, and there is a need for greater discussion regarding this problem plaguing medical education 26.
Prejudice during medical training can affect the learning process, mental health, and, consequently, academic performance. In the field of medical education, depression is a clear issue with a high prevalence among students. Students are more susceptible to developing mental disorders-largely because the program demands significant effort and alters their life dynamics-and the prejudice they face can act as a trigger for the onset of mental disorders 27.
Literature indicates that the educational environment in medical schools is highly hierarchical and predominantly white, shaped by unequal power relations between men and women and rooted in racial prejudice, which in some cases harms students’ mental health28.
Prejudice and stigma impact the professional lives of physicians, as these situations become entrenched and viewed as normal. Many students fail to recognize these manifestations of prejudice and stigma because society tends to regard them as routine, especially when reinforced by the attitudes of teachers whom students respect. This contributes to a failure among students and trainees to recognize such manifestations as problematic. Consequently, this institutional culture can perpetuate microaggressions, discrimination, and exclusion, making it difficult for those affected to identify and respond to these situations 3),(29.
In this regard, the study results highlighted the significant prevalence of prejudice within medical education. The high rate of observed prejudice suggests a training environment permeated by discriminatory behaviors that impact the student experience, requiring institutional actions aimed at fostering a culture of respect, equity, and diversity in medical training.
Therefore, it is necessary to review curricula and provide training for both faculty and students on issues such as sexuality and other topics related to prejudice in medical education, as well as their relevance to daily medical practice. Reforms in medical education are essential to promote a practice that is inclusive, ethical, and sensitive to the needs of all populations, ensuring that diversity is respected and embraced(30).
FINAL CONSIDERATIONS
The study results demonstrate that medical students encounter various forms of prejudice in their academic routine, such as prejudice based on sexual orientation and ageism. The findings show that prejudice significantly affects the students’ academic experience. Although a smaller proportion of students were direct victims of prejudice, more than half reported witnessing discriminatory episodes during their training. This reality presents a concerning scenario, as it reveals the normalization of prejudice within the institutional culture of medical education.
LGBTQIA+ students, those over the age of 26, and those in common-law marriage or married reported higher levels of discrimination, revealing the presence of structural biases such as ageism, heteronormativity, and academic conservatism. Beyond exacerbating the students’ psychological distress, these factors can compromise their academic performance and emotional well-being.
Furthermore, prejudices related to gender, race, disability, and regional background were also reported, signaling an urgent need for an institutional response. Universities must implement concrete measures, such as incorporating diversity and equity content into medical curricula, providing training for faculty and students, and establishing effective mechanisms for reporting incidents and providing support.
It is important to note the study’s limitations: the research was conducted via an online form rather than through in-person contact with all students, a factor that may have influenced the participants’ perceptions and responses.
Therefore, this study underscores the importance of combating prejudice in medical education-not merely as an ethical issue, but as an imperative for ensuring an education that is more humane, inclusive, and committed to social justice. In this regard, further research on this topic is recommended to generate new findings and subsidize the development of projects and policies aimed at combating prejudice in medical schools.
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Research data are only available upon request.



Source: prepared by the authors (2025).
Source: prepared by the authors (2025).