Trailblazers in Medicine: First-Generation Students' Sense of Belonging at Indiana University School of Medicine.

Abstract

Purpose: As medical schools work to diversify the field, it is important to understand the experience of First Generation (First Gen) students. The majority of medical students have a parent with a college degree, and many have a physician parent. This creates an uneven playing field for First Gen students, who make up to 20% of the medical student population; half of these students are also underrepresented in medicine. 1 As the first in their family to graduate from college, these students often do not have access to the same social capital as their peers. Compared with the general population, First Gen students have increased levels of stress, fatigue, financial worries, and a lower quality of life and social support ratings. 2 When medical students feel supported by their medical school, they report higher engagement in self-care and decreased stress levels. 3 This study evaluated the level of support experienced by First Gen students at Indiana University School of Medicine (IUSM) and their sense of belonging. IUSM currently has a First Gen student group and annual programs and this study was developed to determine tangible solutions to provide better support for first-generation students in medical school. Given the dearth of research on First Gen medical students, this study can provide insight to other professionals on factors to be reviewed when developing a holistic approach to First Gen student support. Method: Our research questions were: How are first-generation students in medical school supported or not supported at IUSM, and where are there areas for improvement at IUSM? Which factors, if any, contribute to first-generation students in medical school’s sense of belonging at IUSM? We conducted 16 qualitative Zoom interviews with each interview ranging between 15 and 45 minutes with First Generation medical students at IUSM. Interviews consisted of 6 structured questions and 1 question for additional information. Results: We discovered that students found a sense of belonging through pre-matriculation programs, peer mentors, lead advisors, and through the First Generation Committee. Students did not feel a sense of belonging due to a lack of resources curated specifically for First Generation students, an increased need for specialized training for staff and faculty to better support first-generation students, and more in-person community building events with those who share the first-generation identity. Discussion: To cultivate a diverse workforce, medical schools should provide an increased focus on specialized support services and advising strategies for staff and faculty as they work with First Gen students. To develop a sense of community, schools should collaborate to create more intentional social programming for this subpopulation of students to contribute to greater levels of sense of belonging and support. A registry of First Gen students, faculty, and staff can aid in community building. Schools should consider developing an intentional mentorship through family clusters and peer mentorship pairings with other First Gen community members. Finally, resources explaining the “hidden curriculum” must be developed. Significance: First Gen students are a strength to the profession, often possessing resiliency and an ability to connect with diverse patients. Yet, topics that educators assume students understand—such as Step exams, health care systems, what is an ICU, how much they should expect to pay for study materials—must instead be taught. To support First Gen student wellness and academic performance, new structures must become embedded within undergraduate medical education. Acknowledgments: The authors wish to thank the first-generation medical students at Indiana University for sharing their time and experiences with us.