Purpose: Despite the proliferation of initiatives to address well-being and reduce burnout, mental illness and addiction stigma remains rooted within medical education and healthcare. One mechanism to address this stigma is self-disclosure. Given the paucity of literature on self-disclosure in medical learners, we sought to explore perceptions of self-disclosure in medical education. Method: In a mixed method, convergent triangulation design, authors recruited medical learners from across Canada. Quantitative data included the Opening Minds Scale for Healthcare providers (OMS-HC), the Self Stigma of Mental Illness Scale (SSMIS), a well-being measure, and questions regarding substance use from Statistics Canada. Qualitative data included semi-structured interviews, which were collected and analyzed using a phenomenological approach. Data were collected simultaneously, analyzed separately, and then triangulated. Discrepancies were discussed until consensus was achieved. Results: Overall, N= 125 medical learners (n= 67 medical students, n=58 resident physicians) responded to our survey, and N=13 participated in interviews (n = 10 medical students, n =3 resident physicians). OMS-HC scores showed resident physicians had more negative attitudes towards mental illness and disclosure (47.7 vs. 44.3, P = 0.02). Self-disclosure was modulated by the degree of intersectional vulnerability in learner identity. When looking at self-disclosure, people who identified as men had more negative attitudes than people who identified as women (17.8 vs 16.1, P = 0.01). Racialized learners scored higher on self-stigma. Interview data suggested that disclosure was fraught with tensions, but perceived as having a positive outcome, including the perception that self-disclosure made learners better physicians and educators in the future. Conclusion: The individual process of disclosure is complex and appeared to become more challenging over time due to the internalization of negative attitudes about mental illness. Intersectional vulnerability in medical learners warrants further consideration. Fear of disclosure is an important factor shaped by the learning environment.

The authors have declared no competing interest.

This study was funded by the Association of Medical Education of Europe (AMEE) Medical Education Research Grant.

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:

This research was approved by the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary (ID:20-1149) and the Office of Human Research Ethics (OHRE) at Western University (ID: 116634).

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.