Structural change needed to retain next generation of diverse, first-generation physicians
Key takeaways:
- Researchers identified four common themes experienced by first-generation students, including isolation and exclusion.
- Students reported experiencing an overall sense of needing to rely on grit and resilience to survive.
First-generation medical students reported experiencing increased adversity with inadequate institutional support during undergraduate medical training, according to study results published in JAMA Network Open.
Researchers recommend targeted and flexible interventions so that all students — regardless of background — have the same opportunities to achieve robust professional actualization.
“While this may seem like a niche population, the take-home message of ‘less grit, more support’ has value for everyone,” Catherine Havemann, MD, chief resident in the section of emergency medicine at University of Chicago, told Healio. “Grit is a wonderful quality, but it is not the right tool for every challenge and certainly not the ideal one for structural barriers. Women in medicine are often told that the solution to their experiences of systemic inequity is individual grit and perseverance. I would argue that it is OK — even necessary — to fight for a better and more equitable response.”
‘Disproportionate obstacles’
There are many research-backed reasons to study first-generation college graduates in medicine, according to Havemann.
“As a first-generation and low-income student myself — and an aspiring educator — my experience was that the structure of medical education can present disproportionate obstacles to wellness and achievement for first-generation students,” she said. “This was obvious to me and my ever-growing community of other first-generation students but had never been shown in the literature in this population in medical training, specifically. I must believe that educators care about their students, and if this is true, the problems we face must persist because they simply do not understand the barriers and challenges that medical education often creates for diverse learners.”
This research is the foundational work to demonstrate that rational structural changes can be made to help not only recruit, but also retain and nurture the next generation of diverse physicians, according to Havemann.
Researchers sought to examine the challenges that first-generation students experience during undergraduate medical education and identify opportunities to improve foundational support.
The qualitative study included 37 first-generation students (mean age, 27.3 years; 56.8% women; 62.2% in clinical phase of training) across 27 U.S. medical schools.
Researchers recruited students via a medical student listserv. Medical educators and trainees conducted semistructured interviews between November 2021 and April 2022.
Common themes
Results showed four common themes experienced by first-generation students, including:
- isolation and exclusion associated with being new to the field of medicine;
- difficulty with access to basic resources, such as food, rent and transportation;
- an overall lack of faculty or institutional support to address these challenges; and
- an overall sense of needing to rely on grit and resilience to survive.
“I was stunned by the consistency and magnitude of the themes. Despite knowing the material on a personal level, it was very powerful to read the narratives of strangers putting words to these phenomena happening nationally,” Havemann said. “First-generation students by and large face the same thematic struggles across a number of different institutions, in different regions of the country, and despite coming from wildly different places.
“Our cohort was purposefully very demographically diverse, and yet, the challenges echoed one another,” she continued. “So many students have been overtly discouraged by an educator only to later prove them wrong by succeeding despite the odds. So many of us struggle with food insecurity and unreliable transportation. We often identify more strongly with our patients than with our colleagues. Despite how isolated we often feel, the research could not be more clear that our backgrounds and strengths and values give us a lot in common with one another.”
Encouragement needed
My advice for any oncologist is that if you come across a student interested in your field, err on the side of encouraging them, Havemann told Healio.
“First-generation students swim through a sea of barriers, and even a single encouraging response or bit of advice can be the ‘yes’ that takes them to the finish line,” she added.
Havemann said she has two goals for this research — do justice to the narratives of the students who participated and innovation in medical education.
“I hope that through [the students who participated], first-generation students everywhere feel seen, understood and valued,” she said. “I also hope that through understanding what challenges first-generation students face, educators and student support professionals will be inspired to innovate within their curricula, mentorship programs, financial aid packages, and program structure to make medical training a more accessible and equitable place.
“If we offer appropriate support to first-generation students, we allow them to escape survival mode and refocus on professional actualization,” Havemann said. “First-generation students bring many valuable skills, insights and values to medicine, but if we force them to rely on grit simply to survive their training, they — along with their patients and the health care system — do not get to see the full scope of their potential impact.”
Future research plans include the examination of professional identity information, according to Havemann.
“This is a new area of inquiry and needs a great deal of work,” she said. “First-generation students also have significant overlap with low-income students, and this intersection must also be explored. In addition, as more programs are built to support this student population, following student perceptions, experiences and outcomes will be key.”
For more information:
Catherine Havemann, MD, can be reached at catherine.havemann@uchicagomedicine.org.
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