Mistreatment, gender differences, and reporting behaviors among medical students in clinical training in Taiwan: a nationwide cross-sectional study

Abstract

Mistreatment in the clinical learning environment remains a serious threat to medical students’ professional development and well-being, yet Taiwan lacks nationwide evidence to inform reform. This study aimed to examine the prevalence, patterns, and gender-specific features of mistreatment among medical students during clerkship and to assess their awareness and use of institutional reporting systems. We conducted a nationwide, anonymous online survey from March to May 2025 among final-year students in 6-year medical programs, 4-year postbaccalaureate medical programs, and 7-year dual-degree programs. The questionnaire took reference from the 2024 graduation questionnaires of the Association of American Medical Colleges (AAMC) and the Association of Faculties of Medicine of Canada (AFMC) and was tailored to Taiwan’s regulatory context. Data were analyzed using descriptive statistics and chi-square or Fisher exact tests, as appropriate. Among 187 respondents (91 males, 96 females), 47.6% reported mistreatment during clerkship, and 22.5% reported public humiliation. Gender-related mistreatment was the most frequently reported mistreatment theme. Males more often reported being denied opportunities or receiving lower evaluations because of gender, whereas females more often reported offensive sexist remarks. Awareness of institutional policies and reporting procedures was low, at approximately 42%. Only 5.6% of mistreated students had formally reported the incident. Mistreatment remains an important concern in Taiwan’s clinical training environment, whereas formal reporting is infrequent and institutional policies are not well understood. These findings support targeted interventions to promote equity, improve transparency in assessment, and strengthen reporting systems that trainees perceive as accessible, credible, and safe.