#MEDToo - sexual harassment in medical education: perceptions and coping strategies of medical students in Germany, a qualitative study.

INTRODUCTION: Sexual harassment is a form of power abuse prevalent in healthcare, with medical students experiencing it frequently, especially in practical training. A high proportion of medical students in Germany experience harassment or discrimination during their education, yet detailed data on their perceptions and coping strategies in the clinical environment are lacking. AIM: This study aims to analyze the experiences of final-year medical students in Germany with sexual harassment, identify factors that hinder or support coping, and offer recommendations for preventive measures and support services. METHODS: We conducted semi-structured, guideline-based individual interviews with medical students in their final year of medical training at the University Hospital Augsburg (UKA) who reported a history of sexual harassment during their studies. We analyzed the data using Kuckartz’s qualitative content analysis method. RESULTS: We conducted twelve interviews with ten female and two male medical students. Our analysis revealed five interrelated themes illustrating how experiences of gender-based discrimination and sexual harassment intersect with processes of professional identity formation within hierarchical medical training environments. First, participants described a spectrum of gendered boundary violations occurring in both educational and clinical relationships. These experiences were shaped by the specific relational context and involved supervisors within hierarchical training structures and patients within therapeutic encounters. Second, such incidents were closely intertwined with students’ emerging professional identities, often generating uncertainty in interpretation and tension between maintaining professional conduct and protecting personal boundaries. Third, rigid hierarchies and cultural normalization within medical training environments reinforced silence and limited students’ willingness to challenge inappropriate behavior. Consequently, students often adopted adaptive strategies characterized by restraint, minimization, or strategic silence. Finally, participants articulated the need for institutional structures, cultural change and practical skills to enable them to set professional boundaries with confidence. CONCLUSION: Students’ narratives reflect a dynamic interplay between gendered boundary violations, role insecurity, hierarchical dependency, constrained agency, and perceived gaps in institutional support. Sustainable prevention of SH in medical education requires both structural reforms and educational programs to enhance individual competencies.