How Are They Gonna Look at Me? A Constructivist Study of Medical Students' Categorisation and its Impact on Study Experiences.

Introduction: Research shows that medical students from certain minoritised backgrounds often face discrimination and reduced belonging, harming wellbeing and performance. However, such research rarely justifies its focus on these backgrounds, taking the selected categories of minoritized students for granted, even though categorisation itself is neither neutral nor harmless. To offer an alternative perspective, we used theoretical perspectives of categorisation to examine categories students construct for themselves and others, what meanings they attribute to these constructions, and how this affects their study experiences. Method: Using a constructivist approach, we conducted semi-structured interviews with 11 students from two Dutch medical programmes. Students reflected on experiences from application to clinical rotations. Transcripts were coded using theoretical concepts of categorisation. The analysis focused on how and when students invoked categories, their attached meanings, and impact. Findings were synthesized into three crafted stories illustrating students' experiences. Results: Students described categorising themselves and others fluidly, shifting across time and context. Categories became salient when students deviated from an implicit norm (e.g., identifying as lesbian in heteronormative environments or Black among white peers). Students and others valued each other positively, yet sometimes overemphasized categories and negatives. Such dynamics shaped feelings of belonging and exclusion and, sometimes, contributed to dropout. Discussion: Improving students' learning experiences requires acknowledging categorisation's omnipresent nature and its interconnected dynamics. Focusing on individuals' experiences and implicit norms - rather than standard categories - in all stages of educational practice and research is essential for fostering diversity and inclusion in the learning and healthcare environment.