'Never Going to be a Cut Above [the Rest].' Medical Students' Perceptions of How Their Personal Protected Characteristics Impacted Surgical Learning.

Background: Differential attainment is a phenomenon studied widely, but the reasons for its existence remain relatively unknown. Discriminatory behaviours have been well documented in the medical field, especially in the surgical environment, and have been shown to impact learning. This study explores experiences of students in the surgical environment which they attribute to their protected characteristics and the impact this had on their learning and attainment. Methods: A mixed methods modified ethnographic approach involving diary study and semi-structured interviewing was used. Data was analysed using thematic analysis with an interpretive approach. An intersectional lens in analysis provided deeper insight into the individualised experiences of students. Results: Students believed that others' reactions to their protected characteristics impacted how they were perceived and treated. They believed this differential treatment impacted their learning and influenced their future career prospects. Participants were not able to adequately compensate for the impact that discriminatory behaviours had on their learning. They were, however, able to suggest areas of improvement which they believed could improve the learning environment. Conclusion: Our study demonstrated discrepancies in student experience based not only on their individual protected characteristics but also upon the way these intersect with one another. This resulted in suboptimal learning, suggesting that attitudes of surgical placement staff and student peers require review to improve student experience in the learning environment. The findings of this study have implications for the academic performance of students and also their postgraduate performance and patient safety.