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.研究背景： 举报（whistleblowing）行为对于发现并制止不安全操作、维护行业专业标准至关重要。医学生与口腔医学生在临床轮转期间均为一线观察者，但他们在上报问题时往往面临诸多阻碍。然而，为制定相关政策与培训方案，亟需收集本地数据以了解学生的举报信心，以及机构是否具备为其提供举报支持的能力。因此，本研究旨在叙利亚语境下对上述议题展开深入调研。 研究方法： 本研究于2025年10月15日至12月22日期间，面向叙利亚各高校临床培训阶段的812名医学生与口腔医学生开展横断面调查。研究采用经翻译与回译的情景式阿拉伯语问卷，通过线上与纸质两种方式发放以最大化样本覆盖范围；此前针对40名学生的预试验显示问卷具有极佳的内部一致性（克朗巴赫α系数=0.95）。本研究使用SPSS v27软件进行数据分析，包括描述性统计、t检验、单因素方差分析（ANOVA）及Tukey事后检验，以及多元线性回归分析以识别举报信心的预测因素。样本量计算显示最低需要385名参与者，本研究将统计学显著性阈值设为p<0.05。 研究结果： 在812名医学生与口腔医学生中，40.9%的受访者表示曾遇到不安全或不专业的行为，但仅有17.6%的学生确认所在机构设有正式的举报制度，仅4.8%的学生接受过相关正式培训——尽管绝大多数学生对相关教育抱有极高兴趣（82.3%）。整体而言，学生的举报信心处于中高水平：针对患者安全问题及向资深员工举报时的信心最高，但信心水平随学术职级升高而下降，且男性学生的信心略高于女性。最常见的举报阻碍因素包括：不愿“添麻烦”（42.6%）、不确定应向何人举报（41.9%），以及认为机构缺乏支持（39.0%）；最有效的促进因素则包括：承诺保障举报者安全（74.1%），以及确保举报后问题将得到整改（59.9%）。 研究结论： 尽管学生通常能够发现不安全或不专业的行为，但模糊的举报途径、恐惧心理以及有限的机构支持阻碍了正式举报行为。叙利亚的医学院校应优先设置便捷的举报渠道，并建立举报人保护机制，同时将情景式实操培训纳入课程体系。未来研究可对上述措施在学生群体中的实施效果开展纵向评估，并将研究范围拓展至住院医师与执业医师群体。