Medical students as agents of change: A qualitative study of medical students' self-governance

Medical schools are often characterized by rigid hierarchical structures that may suppress student voices. Student governments provide an avenue for students to represent their peers, influence institutional policies, and foster personal and professional development. This study aims to reveal how participation in self-governance shapes students' attitudes, skills, and orientations toward change within their educational environments.

This qualitative study recruited current executive members and recent graduates who had served in the Japan Association for Medical Student Societies (Igakuren), the only nationally elected medical student body in Japan. Participants were identified through email invitations, personal networks, and official meetings. The first author conducted in-depth online interviews, which were audio-recorded, transcribed verbatim, and analyzed via a thematic analysis using a framework approach.

A total of 21 medical students and doctors participated in the study. A thematic analysis identified four main themes: learning through everyday negotiations; advocacy and empowerment; cooperation and interaction; and contribution to professional development.

Student self-governance cultivates medical students' self-efficacy, leadership, and professional development. Participants acquired key competencies by recognizing systemic issues, collaborating with diverse stakeholders, and leading initiatives for change-demonstrating the principles of Freire's problem-posing education. For health professions education to be genuinely student-centered, faculty and institutional leaders must support and engage in equitable, respectful dialogue with students.