Into the Unknown: Experiences of Social Newcomers Entering Medical Education

"I get to relate to my patients": Latinx medical students and residents' navigational capital in medical education

While the U.S. Latinx population has rapidly increased in the past 30 years, the number of Latinx physicians has not kept pace. Latinx students are often motivated to pursue medicine to serve those in their communities, which benefits Latinx community health outcomes through patient-clinician cultural and linguistic concordance. However, significant barriers often prevent Latinx people from successfully navigating the transition to and through medical school. This study utilized a qualitative, constructivist approach to investigate the transition to and through medical school and residency to further understand and prevent leakages for aspiring Latinx physicians. Using an assets-based framework of Community Cultural Wealth (CCW), we specifically explored navigational capital, to understand how Latinx learners navigate belonging in medicine. Through semi-structured interviews with 20 Latinx medical students and 14 residents, we found that learners understood and created belonging by navigating help-seeking and the imposter phenomenon through their respective pathways in medicine. Findings from this study may be used to develop support systems and resources to reduce the structural inequalities, barriers, and challenges Latinx students and future physicians encounter through medical education pathways.

Professionalism Policies and Practices as Experienced by First-Generation Medical Students, Residents, and Physicians

Phenomenon: While professionalism is largely understood to be complex and dynamic, it is oftentimes implemented as if it were static and concrete. As a result, policies and practices reflect dominant historical norms of the medical profession, which can cause tension for trainees from marginalized groups. One such group comprises those who identify as first-generation physicians - those whose parents have not earned an associate's degree or higher. This group is highly diverse in terms of gender, race, ethnicity, and socioeconomic status; however, their experiences with institutional professionalism policies and practices has not yet been fully explored. In this study, our aims were to understand the ways in which these participants experience professionalism, and to inform how professionalism can be more inclusively conceptualized. Approach: In November 2022-March 2023, we conducted semi-structured interviews with 11 first-generation medical students, residents, and physicians and analyzed select national and institutional professionalism policies in relation to key themes identified in the interviews. The interviews were designed to elicit participants' experiences with professionalism and where they experienced tension and challenges because of their first-gen identity. Data were analyzed using thematic analysis through a critical perspective, focused on identifying tensions because of systemic and historical factors. Findings: Participants described the ways in which they experienced tension between what was written, enacted, desirable, and possible around the following elements of professionalism: physical appearance; attendance and leaves of absence; and patient care. They described a deep connection to patient care but that this joy is often overshadowed by other elements of professionalism as well as healthcare system barriers. They also shared the ways in which they wish to contribute to changing how their institutions conceptualize professionalism. Insights: Given their unique paths to and through medicine and their marginalized status in medicine, first-generation interviewees provided a necessary lens for viewing the concept of professionalism that has been largely absent in medicine. These findings contribute to our understanding of professionalism conceptually, but also practically. As professionalism evolves, it is important for institutions to translate professionalism's complexity into educational practice as well as to involve diverse voices in refining professionalism definitions and policies.

The maintenance of classism in medical education: "time" as a form of social capital in first-generation and low-income medical students

As first generation (FG)/low income (LI) students enter the elite profession of medicine, schools make presumptions about how FGLI students allocate their time. However, their lives are markedly different compared to their peers. This study argues that while all forms of capital are necessary for success, time as a specific form keeps classism in place. Using constructivist grounded theory techniques, we interviewed 48 FGLI students to understand where, why and how they allocated their time, and the perceived impact it had on them. Using open coding and constant comparison, we developed an understanding of FGLI students' relationship to time and then contextualized it within larger conversations on how time is conceptualized in a capitalist system that demands time efficiency, and the activities where time is needed in medical school. When students discussed time, they invoked the concept of 'time famine;' having too much to do and not enough time. In attempting to meet medicine's expectations, they conceptualized time as something that was 'spent' or 'given/taken' as they traversed different marketplaces, using their time as a form of currency to make up for the social capital expected of them. This study shows that because medical education was designed around the social elite, a strata of individuals who have generational resources, time is a critical aspect separating FGLI students from their peers. This study undergirds the idea that time is a hidden organizational framework that helps to maintain classism, thus positioning FGLI students at a disadvantage.

Methodological Challenges in Studies of Personal and Professional Identity Formation

Demographic information about the identities of faculty, staff, students, and trainees is frequently collected in pharmacy education. A wide range of identities and characteristics can influence the choices and experiences of students as they progress through curricula and develop their professional goals. Understanding personal and professional identity formation within dynamic and complex environments is critical to promoting the success of pharmacy education and practice. Emerging research efforts highlight the importance of considering identity development from varying perspectives, and offer new methods for collecting and analyzing data. The objective of this commentary is to reflect on the methodological challenges of identity formation research in pharmacy education and offer recommendations for those interested in this work.

Racial and Ethnic Diversity in Medical School Admissions in Canada

Importance

Medical schools promote admission pathways as well as diversity and inclusivity to prospective students who are underrepresented in medicine (UIM) primarily via their websites. Research from organizational structures supports the use of instrumental values (which focus on behavior and core beliefs), rather than terminal values (which focus on the end goal), to promote diversity.

Objective

To characterize the use of instrumental and terminal values to promote institutional diversity and inclusivity on Canadian medical school websites.

Design, Setting, and Participants

This qualitative study analyzed the contents and themes of Canadian medical school websites based on a theoretical value framework and an organizational diversity management framework. A literature review was conducted to explore the use of instrumental and terminal values in promoting diversity and inclusivity, and a codebook was created that outlined the characteristics of these values. The content of all application pathway websites for UIM applicants to all Canadian medical schools was coded between July and August 2022.

Main Outcomes and Measures

Use of terminal vs instrumental values across the UIM-targeted admission websites of medical schools.

Results

Twenty-two websites for 17 Canadian medical schools were included. Content on most of these websites promoted diversity in response to government policies or public accountability and often supported a dominant culture while treating diversity as an exception. The use of terminal rather than instrumental values was also more prominent on websites that targeted Indigenous prospective students compared with Black prospective students and applicants with lower socioeconomic status (11 [50%] websites vs 5 [23%] and 4 [18%] websites). Instrumental values, although seldom used, promoted diversity as a means to improve health care and training for all students in a program.

Conclusions and Relevance

Results of this qualitative study suggested that medical schools in Canada promoted diversity and inclusivity to prospective students primarily as an end goal rather than as a core value. Medical schools should highlight the benefits of diverse lived experiences and reinforce their commitment to diversity and inclusion by aligning their website content with their ongoing work in this area.

Influence of social networks in healthcare on preparation for selection procedures of health professions education: a Dutch interview study

OBJECTIVES

Health professions education (HPE) students are often not representative of the populations they will serve. The underrepresentation of non-traditional students is problematic because diversity is essential for promoting excellence in health education and care. This study aimed to understand the perceptions of traditional and non-traditional students regarding facilitators and barriers in preparing for HPE selection procedures, and to determine the role of social networks in their decision-making and preparations to apply.

METHODS

A qualitative study was conducted with 26 Dutch youth who were interested in university-level HPE programmes. Semistructured interviews and sociograms were analysed using thematic analysis, adopting a constructivist approach.

RESULTS

Twenty-six high school students participated, with traditional and non-traditional backgrounds, with and without social networks in healthcare and higher education. Two themes were constructed. First, four high-impact facilitators helped to overcome barriers to apply and in preparation for selection: access to a social network connection working or studying in healthcare, to correct information, to healthcare experience and to a social network connection in higher education. Lack of information was the main barrier while access to social network connections in healthcare was the main facilitator to overcome this barrier. However, this access was unevenly distributed. Second, access alone is not enough: the need for agency to make use of available facilitators is also essential.

CONCLUSIONS

The themes are discussed using intersectionality. Traditional students with access to facilitators develop their self-efficacy and agency within social structures that privilege them, whereas non-traditional students must develop those skills without such structures. Our findings provide recommendations for the ways in which universities can remove barriers that cause unequal opportunities to prepare for the selection of HPE programmes. Along with equitable admissions, these recommendations can help to achieve a more representative student population and subsequently a better quality of health education and care.