Introduction Forty percent of graduating medical students report experiencing student mistreatment; however, most cases go unreported.

Methods Peer-to-peer, semi-structured interviews with current medical students were conducted to understand medical students’ experiences with mistreatment and reporting. These interviews were inductively coded, and themes were identified to elucidate reasons students do and do not report mistreatment.

Results Twenty-one students were interviewed who described a total of 34 mistreatment incidents. Four main groups of factors that students consider when deciding to report mistreatment were identified: personal, situational, structural, and climate. Personal factors were intrinsically tied to the participant, including their feelings or concerns about mistreatment. Situational factors related to the act of mistreatment, such as who the perpetrator was or the actions of bystanders. Structural factors included elements of the reporting system. Climate factors were concerns related to how the institution viewed mistreatment and the student’s place in medical education.

Discussion This peer-to-peer study revealed four main groups of factors, all of which are influenced by the culture of the institution. Participants were impacted by the inactions of witnesses and their personal sense of justice. An approach to facilitating reporting of student mistreatment must be grounded in improving the culture of medical education.

The authors have declared no competing interest.

This study did not receive any funding.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB of University of Texas gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors