Thriving, not surviving: a qualitative study on barriers and strengths of first-generation medical students

BACKGROUND: First-generation students, who do not have parents who attended university, face difficulties to succeed in academia, more stress and fatigue, less social and professional support, and less sense of belonging. They also possess unique strengths to optimize care and education. Less is known on the identity formation of first-generation students within the medical community and how they want to be supported. Therefore, in this study, we aimed to explore the experiences and the perceived barriers and strengths of first-generation medical students and their perceptions of the best strategies to optimize their experiences. METHODS: We performed a qualitative study using semi-structured in-depth interviews. First-generation students in their medical bachelor were recruited by purposive and snowball sampling. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. We also collected sociodemographic characteristics. RESULTS: We interviewed 15 first-generation students. Five themes emerged from the analysis: (1) Study start, (2) The medical community, (3) Social life, (4) Connection with home, and (5) Support strategies, representing different dimensions of first-generation students' experiences in medical school. They faced difficulties in the transition to university and experienced a mismatch between their own identity and typical traits, beliefs, and expressions of the medical community. First-generation students said to form meaningful relationships with peers but to experience a distance from more privileged students and teachers. They missed support from their family and sometimes experienced a loss of connection with them. First-generation students also expressed their strengths, such as persistence, self-trust, and understanding of society. They mentioned mentorship, peer contact, and an information platform as strategies to enhance their experiences. CONCLUSIONS: Our study underscores the need for medical education to move beyond deficit-based views of first-generation students and to actively support their identity development, social integration, and unique contributions. This can foster equity in the medical learning environment to build a more diverse and socially responsive medical workforce.