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Policy Brief

Elevating Dignity in Medical Education: A Policy Framework to Promote Respect, Mental Well-being, and Professionalism among Health Sciences Students

[version 1; peer review: 1 approved with reservations]
Mohammad Rasool Khazaei1, Ali Keramati2, Mohammad Mehdi Khazae3, Ghobad Ramezani
https://orcid.org/0000-0002-8192-5587
4
Mohammad Rasool Khazaei1, Ali Keramati2, Mohammad Mehdi Khazae3, Ghobad Ramezani
https://orcid.org/0000-0002-8192-5587
4
PUBLISHED 14 May 2026
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Abstract

Background

Daily interactions between faculty members and students in medical education and clinical training environments directly influence learning, motivation, mental well-being, and the development of professional behavior. Evidence indicates that lack of respect and dignified communication can lead to reduced academic participation, decreased performance, psychological distress, and weakened professional ethics.

Policy and Implications

Data were collected from medical sciences students and faculty members through semi-structured interviews and field observations and analyzed using a thematic approach. Three main dimensions of dignity-based interactions emerged:

  • 1.

    Interpersonal and Communicative Respect – respectful speech, active listening, constructive feedback

  • 2.

    Educational and Clinical Respect – safe learning climate, acceptance of errors, educational justice

  • 3.

    Structural and Institutional Respect – organizational support, ethical policies, behavioral oversight

Respectful educational interactions were found to enhance learning motivation, academic engagement, psychological safety, and professional ethics.

Recommendations

Three main themes and multiple subthemes were identified: interpersonal/communicational respect (politeness, active listening, feedback culture), academic/clinical respect (constructive evaluation, safe learning space, error acceptance), and institutional respect (supportive policies, ethical climate, justice in assessment). Respect positively influenced motivation, engagement, academic performance, and professional formation.

Conclusions

Dignity in medical education is not merely a human virtue but a critical policy element for improving educational outcomes, mental health, and professional development. Institutionalizing respectful communication and adopting supportive policies can sustain this culture and significantly enhance the quality of medical training.

Keywords

Respect, Dignity, Medical Students, Faculty, Educational Environment, Professional Ethics

Corresponding author: Ghobad Ramezani
Competing interests: No competing interests were disclosed.
Grant information: Kermanshah University of Medical Sciences
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:  © 2026 Khazaei MR et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Khazaei MR, Keramati A, Khazae MM and Ramezani G. Elevating Dignity in Medical Education: A Policy Framework to Promote Respect, Mental Well-being, and Professionalism among Health Sciences Students [version 1; peer review: 1 approved with reservations]. F1000Research 2026, 15:728 (https://doi.org/10.12688/f1000research.174923.1) First published: 14 May 2026, 15:728 (https://doi.org/10.12688/f1000research.174923.1) Latest published: 14 May 2026, 15:728 (https://doi.org/10.12688/f1000research.174923.1)

Introduction

Medical students routinely face stressors including heavy workload, clinical pressures, hierarchical structures, and exposure to humiliating behaviors. Such experiences undermine confidence, motivation, and professional ethics. Surveys, including one of 94,153 Chinese medical graduates, show 84% reported at least one episode of mistreatment, linked to burnout, reduced empathy, and career regret. Failure to institutionalize respect risks losing competent, ethical future clinicians and negatively impacts patient care.1–4

Policy outcomes and implications

A qualitative thematic analysis explored perceptions of “respect” among students and faculty:

  • • Setting: Kermanshah University of Medical Sciences

  • • Sampling: Purposive, maximum variation; students with ≥1 semester, faculty with teaching experience

  • • Data Collection: Semi-structured interviews until saturation

  • • Ethics: Approved by Ethics Committee (IR.KUMS.REC.1404.394); written informed consent obtained. Written informed consent was obtained from all participants prior to inclusion in the study. All participants were 18 years of age or older. No minors were involved in this study.

  • • Trustworthiness: Lincoln & Guba criteria, member checking, dual coding, transparent reporting

Key findings

  • 1. Respect as a Multidimensional Experience

    • • Positive experiences → motivation, engagement, sense of value

    • • Negative experiences → anxiety, isolation, reduced participation

    • • Respect is a structural driver of learning quality and professional growth ( Table 1).

  • 2. Effects on Academic Engagement

    • • Enhances motivation, participation, cognitive engagement, and dialogue

  • 3. Effects on Student Mental Health

    • • Acts as a protective factor against emotional exhaustion ( Table 2).

  • 4. Role in Professional Identity & Ethics

    • • Students exposed to respectful environments demonstrate humane patient care

    • • Fosters responsibility, fairness, and ethical integrity

    • • Faculty serve as role models for respectful communication

      Thus, respect is foundational to cultivating ethical physicians and nurses.

Table 1. Multidimensional conceptualization of respect in medical education.

DimensionCharacteristics
Interpersonal / Behavioral Respectful tone, avoidance of humiliation, active listening, reciprocal courtesy
Educational / Academic Opportunities for inquiry, constructive feedback, acceptance of mistakes, educational justice
Structural / Institutional Supportive policies, fair evaluation, workload management, and clear regulations

Table 2. Psychological impacts of respect and disrespect on student mental well-being.

Positive outcomes Consequences of disrespect
Higher self-worth Lower self-confidence
Reduced stress/anxietyPsychological pressure & burnout
Psychological safetyFear of error, performance anxiety
Academic enthusiasmDemotivation, disengagement

Policy message: Failure to institutionalize respect risks losing motivated, ethical, and competent future clinicians—directly impacting the quality of patient care.

Policy options

Cost–Benefit Overview

Option 1: Formal Mistreatment Policy

  • • Benefits: clearer expectations, accountability, cultural shift

  • • Costs: resistance, time for policy design

  • • Risks: low impact without enforcement

Option 2: Professionalism Training

  • • Benefits: improved communication, reduced inappropriate behaviors

  • • Costs: faculty time, financial resources

  • • Risks: short-term effect if not repeated

Option 3: Reporting System

  • • Benefits: real-time identification of issues, deterrence

  • • Costs: digital infrastructure, committee workload

  • • Risks: underreporting if confidentiality not guaranteed

Option 4: Supportive Environment

  • • Benefits: better learning outcomes, reduced burnout

  • • Costs: structural adjustments, workload management

  • • Risks: slow implementation

Option 5: Continuous Evaluation

  • • Benefits: data-driven decisions, transparency

  • • Costs: survey administration, analysis

  • • Risks: symbolic monitoring without action ( Table 3).

Table 3. Five actionable policy instruments were identified.

OptionDescription
1. Formal Policy Against Mistreatment A mandatory institutional policy defining disrespect (verbal, discriminatory, humiliating), clarifying consequences, and applicable to all faculty, clinicians, and staff.
2. Periodic Training on Professionalism & Respect Regular workshops for faculty/clinical staff on communication, constructive feedback, and student dignity.
3. Confidential Reporting & Follow-up System A secure online/paper mechanism with an independent review committee ensuring confidentiality and non-retaliation.
4. Supportive Learning Environments Fair distribution of clinical opportunities, acceptance of errors as learning moments, and recognition of students as team members.
5. Continuous Assessment of Learning Climate Annual surveys, psychological safety indicators, and monitoring of mistreatment/discrimination to inform corrective action.

Implementation roadmap

Phase 1 – Design & Preparation (3–6 months)

  • • Establish multidisciplinary taskforce

  • • Develop official mistreatment policy

  • • Build confidential reporting system

  • • Prepare training modules

  • • Indicators: policy ratified; reporting system operational; first training delivered

Phase 2 – Pilot Implementation (6–12 months)

  • • Launch reporting mechanism and awareness campaign

  • • Deliver training to selected faculty/staff

  • • Conduct baseline learning-environment survey

  • • Indicators: number of reports, training participation, student satisfaction baseline

Phase 3 – Scale-up & Institutionalization (Year 2 and beyond)

  • • Mandatory training for all faculty/clinical units

  • • Integrate professionalism metrics into staff evaluation

  • • Annual surveys on learning climate, mental health, and respect

  • • Long-term indicators: decline in mistreatment reports, higher satisfaction, reduced burnout, stronger professional identity

Policy Recommendations

  • 1. Mandate communication skills and professionalism training for all students and faculty.

  • 2. Adopt and publicly display a “Code of Respect” across classrooms and clinical sites.

  • 3. Implement a protected and confidential reporting system for both misconduct and exemplary behavior.

  • 4. Provide psychological support and workload management to reduce stress and prevent burnout.

  • 5. Establish recognition mechanisms for faculty and students who model respectful behavior.

  • 6. Monitor the educational environment regularly using validated tools with transparent feedback loops.5–7

Conclusions / Discussion

Respect in medical education is not merely an interpersonal courtesy but a policy-driven and structural element essential to educational quality. Integrating respect into institutional policies, training frameworks, monitoring systems, and organizational culture enhances learning outcomes, safeguards mental health, strengthens professional ethics, and supports the formation of humane and responsible healthcare providers.

From a policy standpoint, nurturing a culture of respect represents a strategic investment in the resilience, competence, and ethical integrity of the future healthcare workforce—and, ultimately, in the quality of patient care.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Kermanshah University of Medical Sciences (IR.KUMS.REC.1404.394). All methods were carried out in accordance with relevant guidelines and regulations. Written informed consent was obtained from all participants prior to inclusion in the study.

Consent for publication

Not applicable.

Availability of data and materials

The datasets generated and/or analyzed during this study are not publicly available due to ethical restrictions related to participant confidentiality. The Ethics Committee of Kermanshah University of Medical Sciences reviewed and approved the data management plan to ensure privacy. De-identified data may be made available from the corresponding author upon reasonable request for research purposes, subject to Ethics Committee approval and compliance with institutional regulations. Requests for access should be addressed to the corresponding author: [email protected]

Acknowledgements

we sincerely thank all participants for generously sharing their experiences and insights, which made this study possible.

References

  • 1.  Ma X, Shen Z, Xiao R, et al.: Perceived Mistreatment and Professional Identity of Medical Students in China. JAMA Netw. Open. 2024; 7(11): e2444245. PubMed Abstract | Publisher Full Text | Free Full Text
  • 2.  Cook AF, Arora VM, Rasinski KA, et al.: The prevalence of medical student mistreatment and its association with burnout. Acad. Med. 2014; 89(5): 749–754. PubMed Abstract | Publisher Full Text | Free Full Text
  • 3.  Fnais N, Soobiah C, Chen MH, et al.: Harassment and discrimination in medical training: a systematic review and meta-analysis. Acad. Med. 2014; 89(5): 817–827. as cited in a review of mistreatment programs. Rees CE, Monrouxe LV, “A morning since eight of just pure grill”: a multi-school qualitative study of student abuse. Acad Med. 2011;86(11):1374–1382. doi: 10.1097/ACM.0b013e3182303c4c; as referenced in mistreatment literature reviews. Publisher Full Text
  • 4.  Shoukat S, Anis M, Kella DK, et al.: Prevalence of mistreatment or belittlement among medical students — a cross-sectional survey at a private medical school in Karachi, Pakistan. PLoS One. 2010; 5(10): e13429. PubMed Abstract | Publisher Full Text | Free Full Text
  • 5.  Davis C, King OA, Clemans A, et al.: Student dignity during work-integrated learning: A qualitative study exploring student and supervisors' perspectives. Adv. Health Sci. Educ. 2020; 25(1): 149–172. PubMed Abstract | Publisher Full Text
  • 6.  Soltani Arabshahi K, Sorabi Z, Keshavarzi MH, et al.: Investigation of the Relationship between Self-determined Motivation and Work Engagement of Faculty Members of Iran University of Medical Sciences. JMED. 2019; 12(33): 26–41. Publisher Full Text Reference Source
  • 7.  Yeganeh A, Moghtadaei M, Hoveidamanesh S, et al.: Comparison of Students' Attitudes about the Effectiveness of Algorithm-based Education with Lecture-based Education. Med. J. Islam Repub. Iran. 2022; 36(1): 1309–1314. Publisher Full Text Reference Source

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Khazaei MR, Keramati A, Khazae MM and Ramezani G. Elevating Dignity in Medical Education: A Policy Framework to Promote Respect, Mental Well-being, and Professionalism among Health Sciences Students [version 1; peer review: 1 approved with reservations]. F1000Research 2026, 15:728 (https://doi.org/10.12688/f1000research.174923.1)
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Reviewer Report 11 Jun 2026
Helena Vélez-Botero, National University of Colombia, Bogotá, Colombia 
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https://doi.org/10.5256/f1000research.192865.r490287
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This policy brief addresses the urgent issue of dignity and respect in medical education environments. Using qualitative thematic analysis, the authors identify three core dimensions of respectful interaction: (1) Interpersonal and Communicative Respect, (2) Educational and Clinical Respect, ... Continue reading
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Vélez-Botero H. Reviewer Report For: Elevating Dignity in Medical Education: A Policy Framework to Promote Respect, Mental Well-being, and Professionalism among Health Sciences Students [version 1; peer review: 1 approved with reservations]. F1000Research 2026, 15:728 (https://doi.org/10.5256/f1000research.192865.r490287)
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  1. Helena Vélez-Botero, National University of Colombia, Bogotá, Colombia

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    Alongside their report, reviewers assign a status to the article:
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