Into the Unknown: Experiences of Social Newcomers Entering Medical Education.

Abstract

Amid efforts to diversify the medical profession, research has yet to fully explore the role of early social ties to the field. This study examined diversity through the experiences of students without early ties to medicine through family members working in health care (i.e., "newcomers") in comparison with more-connected peers (i.e., "insiders"), examining how social newcomers to medicine negotiate challenges stemming from their outsider status. The author conducted an exploratory qualitative study from 2018 to 2021 using a constructivist grounded theory approach. Following a voluntary preliminary survey of 2 cohorts of first-year medical students about their social connections in health care, the author conducted interviews over the next 2 years with students who had indicated their willingness to participate. Interviews addressed how social context shaped-and continued to influence-their journeys into medicine. Eighty second- and third-year students participated in 94 interviews, including some follow-up interviews for longitudinal insight into outsider status. Interviews from the second year (58 new, 14 follow-up) provided the foundation of the qualitative results. Students experienced outsider status primarily on the basis of being newcomers to medicine, often compounded by intersectional characteristics, including first-generation college status, rural or low-income background, race or ethnicity, and nontraditional status. For some, an early shortage of social capital became internalized, continuing to influence confidence and belonging well into training, in line with social reproduction theory. However, newcomers also experienced benefits associated with diverse backgrounds which helped them find a sense of belonging in medicine, as suggested by community cultural wealth and antideficit perspectives. Newcomer status proved to be a central cause of outsiderness for students from all backgrounds and warrants greater attention from stakeholders, perhaps mirroring the undergraduate focus on first-generation college-goers. Findings suggest institutions that provide robust networking and community-building opportunities are best positioned to support newcomers.