558 Powerlessness in the face of racism: an interpretive phenomenological study of medical students’ experiences in the context of clinical training

Abstract OP 29: Health Status 4, B302 (FCSH), September 4, 2025, 16:00 - 17:00 Background Racism remains pervasive in medicine, bleeding into medical education. While human rights instruments prohibit racial discrimination in education, medical students continue to encounter racism in both subtle and overt forms. Being faced with racism impacts not only those directly targeted but also bystanders witnessing it. This study aimed to explore experiences of powerlessness evoked when facing racism in the context of clinical training, both in cases of being targeted as a racialised student and when witnessing it as a bystander. Methods An interpretive phenomenological approach was applied to 33 medical students’ written reflections, collected between 2021 and 2024 in a Swedish medical school. Results Three major themes were identified: (1) feeling powerless when being afflicted by and witnessing racism, including being treated unequally, being excluded, and being silenced when racialised, being made a victim of racism, and witnessing others being submitted to racism; (2) struggling to overcome feelings of powerless in the face of racism, including feeling forced to remain silent due to being in positions of dependence, being dismissed when speaking up and feeling hopeless, and feeling shame, guilt, and regret over not daring to speak up; and (3) being forced to engage in a culture of silence surrounding racism in medicine, including sensing the impact of hierarchical structures, experiencing that racism is made to be a minor problem, and resigning to feelings of powerlessness and accepting exposure to racism. Conclusion Addressing powerlessness in the face of racism in medical education requires institutional commitment to human rights principles and anti-racist practices, including clear reporting pathways, anti-racism training and safeguards, and comprehensive support structures for affected students. Empowering medical students to confront injustice and equipping educators to intervene are essential steps toward creating safer, more equitable learning environments. Yet, without structural and institutional accountability, any progress will be thwarted.