Background: Active participation is often considered a marker of engagement in small-group learning. However, some students contribute minimally despite being attentive, prepared, and academically capable. These "silent learners" may remain unnoticed by faculty, resulting in missed opportunities for support. This study examined the characteristics, learning preferences, and educational needs of silent learners in undergraduate medical education. Methods: An explanatory mixed-methods study was conducted among undergraduate medical students. An anonymous survey first explored classroom participation patterns, perceived barriers to speaking, confidence, psychological safety, and learning preferences. Findings informed subsequent focus group discussions with students identified as infrequent contributors. Quantitative data were analyzed descriptively, while qualitative responses underwent framework analysis to develop an integrated understanding of learner experiences. Results: Silent participation was influenced by multiple interacting factors rather than lack of preparation or motivation. Students described remaining quiet to avoid interrupting peers, fear of giving incomplete answers, uncertainty regarding faculty expectations, and preference for reflective thinking before responding. Many perceived that participation was measured by speaking frequency rather than quality of contribution. Learners suggested alternative avenues for engagement, including anonymous digital responses, structured think–pair–share activities, and written reflections, which they believed better represented their learning. Conclusion: Silence in small-group learning should not be interpreted as disengagement. Recognizing diverse participation styles and creating multiple pathways for contribution may foster more inclusive learning environments while ensuring that quieter learners receive equitable opportunities for feedback, support, and academic growth.