Faculty Bibliography

BACKGROUND:Diversity in the physician workforce is critical for quality patient care. Students from low-income backgrounds represent an increasing proportion of medical school matriculants, yet little research has addressed their medical school experiences. OBJECTIVE:To explore the medical school experiences of students from low-income backgrounds using a modified version of Maslow's Hierarchy of Needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a theoretical framework. DESIGN/METHODS:We conducted an exploratory qualitative study through in-depth, semi-structured interviews. PARTICIPANTS/METHODS:Forty-two low-income medical students attending US-based MD or DO degree-granting institutions. APPROACH/METHODS:We conducted a content analysis of interview transcripts using deductive and inductive coding. We discussed our independent analyses to reach consensus and shared findings with a subgroup of participants for member checking. RESULTS:Participants described substantial challenges in meeting their basic needs. Unmet physiologic needs included food insecurity, lack of adequate sleep/rest, and poor mental health. Unmet safety needs included lack of reliable transportation and safe housing; threats to financial safety included debt and an inability to cover both medical education-related and non-medical education-related expenses. Unmet belonging needs included difficulty connecting with peers or participating in financially inaccessible social activities. Unmet respect/esteem needs stemmed from bias from peers, teachers, and institutions. Unmet self-actualization needs were uncommon. Participants felt pride in their medical journey; however, some perceived that their financial struggles hindered them from realizing their full potential. CONCLUSIONS:Previously reported attrition and adverse academic outcomes among low-income students may be linked to challenges they experience trying to more fully meet important human needs. This finding underscores the need to approach wellness holistically and ensure students do not exist in a prolonged state of unmet needs. Recommendations that accreditation bodies and medical schools could implement to promote tailored support for low-income and other marginalized learners are provided.

PURPOSE/UNASSIGNED:This study examined the impact of socioeconomic status (SES) on medical education in the context of person-environment fit (PE fit) theory, and specifically focused on the medical school experiences of students from lower-SES backgrounds. METHOD/UNASSIGNED:A constructivist approach was used in this qualitative study of 48 medical students from 27 US medical schools, all of whom self-identified as first-generation college graduates and/or being from a lower-income background (30 were both). Semi-structured audio-only interviews were conducted with these demographically and geographically diverse students from November 2021 through April 2022. Themes were identified using open coding and content analysis software. RESULTS/UNASSIGNED:Almost all, 44 of 48, interviews included themes related to PE fit. Medical students indicated three interacting domains in which PE fit is relevant for them: (1) school, (2) clinical, and (3) professional environments. Learners from lower-SES backgrounds describe struggling to navigate multiple environments that are unfamiliar, culturally complex, and both personally and financially costly. They also describe ways they are addressing gaps, generating positive changes, supporting underserved patients, and broadening the perspectives of peers and educators. CONCLUSIONS/UNASSIGNED:PE fit theory provides a lens to understand unique aspects of lower-SES medical student experiences, including navigation of professional identity formation. It is critical for medical schools, funders, peers, and professional communities to sustain learning environments that support the flourishing of medical students from lower-SES backgrounds. This support includes transferring the burden of addressing fit from individual learners and marginalized classes of learners to educational, clinical, and professional organizations. SUPPLEMENTARY INFORMATION/UNASSIGNED:The online version contains supplementary material available at 10.1007/s40670-024-02174-x.