Bias and discrimination in healthcare through the eyes of future professionals: a qualitative study of student observations

Abstract Background Bias and discrimination by healthcare professionals threaten quality of care and disproportionately affect minorities and vulnerable individuals, thereby contradicting ethical standards of equal treatment. During professional socialisation, health profession students acquire clinical skills and internalise norms and behaviours by observing healthcare professionals. This study explored biased and discriminatory behaviour towards patients in clinical training environments, as observed by health profession students. Methods Within a cross-sectional online study ( N = 2176 students) on discrimination in healthcare at ZHAW Zurich University of Applied Sciences, School of Health Sciences, Switzerland, in June and September 2024, students’ experiences of witnessing biased and discriminatory patient care were assessed. Free-text responses were analysed qualitatively using deductive and inductive coding according to Kuckartz. Results Out of 2176 eligible BSc and MSc healthcare students, 422 answered the question whether they had observed biased or discriminatory care of patients by healthcare staff during clinical training (response rate 19.4%). Of those, 210 (49.8%) reported witnessing such incidents and 182 specified them in free-texts. The analysis revealed a wide range of biased and discriminatory actions, most frequently withholding care, support, or medication ( n = 58), verbal discrimination ( n = 57), and ignoring patients ( n = 14). Nine accounts included physical mistreatment. Reported reasons for discrimination were ethnicity/foreign origin ( n = 48), diagnosis ( n = 35; particularly mental health), socio-economic status ( n = 9), gender ( n = 9), age ( n = 7), and disability ( n = 7). Where specified, biased and discriminatory behaviour was attributed to care-team members ( n = 45) or supervising professionals ( n = 14). Reported consequences for patients included prolonged pain, fear, and insecurity. Conclusions Healthcare students witnessed biased or discriminatory behaviour in clinical settings. This is concerning for patients, but also for students, who may internalise inequitable clinical norms during professional role formation, potentially perpetuating discrimination and contributing to health inequities. These results emphasise the need to implement educational measures (e.g., structured reflection, cultural competence, unconscious bias training), and systemic and organisational approaches to foster learning environments based on equity and respect. This includes supportive institutional frameworks, reporting systems for observed or experienced discrimination, and clinical learning environments in which equitable practice is actively modelled and reinforced.