Speaking Up or Staying Silent? Confidence, Barriers and Institutional Readiness Among Syrian Medical and Dental Students:A Cross-Sectional Survey

Background: Raising concerns (speaking up or whistleblowing) is essential to detect and prevent unsafe practice and to uphold professional standards. While medical and dental students are frontline observers during clinical rotations, they face barriers to escalation. However, to guide policy and training, it is essential to gather local data on students' confidence and the readiness of institutions to support them in raising concerns. This paper, therefore, aims to investigate in-depth these topics within the Syrian context. Methods: A cross-sectional survey was administered to a total of 812 medical and dental students in clinical training across Syrian universities between 15 October and 22 December 2025. A scenario-based Arabic questionnaire, translated and backtranslated, was delivered via online and paper modes to maximise inclusion, with a pilot study of 40 students demonstrating excellent internal consistency (Cronbach’s α=0.95). Data were analysed using descriptive statistics, t-tests, one-way ANOVA with Tukey post-hoc tests, and multivariate linear regression to identify predictors of confidence (SPSS v27). Sample size calculations indicated a minimum requirement of 385 participants, and statistical significance was set at p<0.05. Results: Among 812 medical and dental students, 40.9% reported encountering unsafe or unprofessional behavior, yet only 17.6% confirmed the presence of an institutional whistleblowing policy, and 4.8% reported receiving formal training, despite their high interest in education (82.3%). Overall confidence in raising concerns was moderate to high, highest for patient safety issues and when reporting to senior staff, but declined with academic seniority and was slightly higher among males. The most frequently reported barriers were reluctance to “cause trouble” (42.6%), uncertainty about whom to contact (41.9%) and perceived lack of institutional support (39.0%); top enablers were assurances of reporter safety (74.1%) and ensuring changes will be implemented following reporting (59.9%). Conclusion: Although students commonly detect unsafe or unprofessional behavior, unclear pathways, fear, and limited institutional support discourage formal reporting. Syrian medical schools should prioritise accessible reporting routes and assurances of protection and incorporate practical, scenario-based training into their curricula. Future research should evaluate these measures longitudinally among students and extend this work to residents and practitioners.