Abstract
IMPORTANCE: First-generation undergraduate students are underrepresented in medicine and face challenges that affect their application and matriculation to medical school. OBJECTIVE: To understand the barriers and available support at the individual, interpersonal, and organizational levels for first-generation students in premedical programs. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study was part of a larger project on professional identity formation among US medical students from low socioeconomic backgrounds with a focus on first-generation undergraduate students. Semistructured online interviews of 48 students (37 of whom were first-generation students) from 27 US medical schools were conducted from November 1, 2021, through April 30, 2022, and secondary analyses regarding their premedical experiences were performed. Interviews were recorded, transcribed, deidentified, assigned an alphanumeric code, and analyzed using an inductive thematic approach from June 1 through December 30, 2024. Participants were offered a $20 gift card in appreciation for their time. EXPOSURE: Experiences of students identifying as first-generation college students in premedical training. MAIN OUTCOMES AND MEASURES: Main outcomes included themes and subthemes at the individual, interpersonal, and organizational levels constructed from interview data. Bronfenbrenner's ecological systems theory was used as a guiding interpretive framework to analyze participants' experiences within their broader social and environmental contexts. This model allowed examination of how individual perspectives were shaped by interactions across personal, social, and structural contexts. The team engaged in reflexive discussions, memos, and consensus-based refinement to identify key themes. RESULTS: Among 37 participants identified as first-generation students, 21 (56.8%) identified as female (mean [SD] age, 27.3 [2.8] years). One participant (2.7%) identified as American Indian or Alaska Native; 7 (18.9%) as Hispanic, Latino, or Spanish origin; 8 (21.6%) as non-Hispanic Asian or Asian American; 9 (24.3%) as non-Hispanic Black or African American; and 12 (32.4%) as non-Hispanic White. Analyses revealed key themes across all 3 levels of the ecological systems model: individual, interpersonal, and organizational. Individual themes included personal and family background, such as financial instability and lack of clinical exposure. Interpersonal themes included access to premedical advisors, faculty mentors, and peer networks. Organizational themes included limited institutional resources and pathway programs. CONCLUSIONS AND RELEVANCE: In this qualitative study of first-generation students, financial instability, limited medical school-related social connections and resources, and unfamiliarity with academic systems were found to uniquely burden these students. By identifying and improving resources such as tailored mentorship, individualized advising, and participation in pathway programs, medical schools can help reduce structural barriers for aspiring physicians who are first-generation college students.