Barriers and Facilitators to Surgical Career Pursuit Among First-Generation Medical Students: A Multi-Institutional Survey Study

Objective To characterize perceived barriers and facilitators influencing first-generation medical students’ pursuit of surgical residency training and to inform targeted interventions to support their success. Design Cross-sectional, anonymous survey study assessing perceived financial, professional, and structural barriers to pursuing surgical training. Descriptive statistical analyses were performed on quantitative responses, with thematic review of open-ended responses. Setting Multi-institutional study of U.S. allopathic medical schools, with participants recruited through national first-generation medical student listservs and online forums. Participants A total of 215 self-identified first-generation medical students from 24 U.S. medical schools completed at least 1 survey item. Participants were aged ≥18 years; item-level response rates varied across questions. Results Of the 215 first-generation medical students from 24 medical schools that participated, most were White (n = 136, 63.3%), female (n = 152, 70.7%) and either “currently interested” (n = 100, 46.7%) or “previously interested” (n = 50, 23.4%) in surgical training. Among the 68 respondents who reported identity-based discouragement and completed the follow-up question, the most frequently cited deterrents were perceived disadvantages in competitiveness (n = 55, 80.8%), lack of personal belonging (n = 39, 57.3%), and limited family support (n = 32, 47.1%). Among 146 respondents, tailored resources (n = 71, 48.6%) and personal connections (n = 123, 84.2%) were identified as facilitators; however, many respondents reported a lack of institutional resources. Financial constraints discouraged pursuit of surgery, with 24 (16.4%) strongly and 39 (26.7%) somewhat agreeing (n = 146). Open-ended responses highlighted costs associated with away rotations, debt burden, and prolonged training. Conclusion First-generation medical students face substantial barriers to pursuing surgical residency and, despite evidence that tailored resources and mentorship are associated with greater interest, persistent gaps in institutional support, limited mentorship, and financial constraints continue to be perceived as barriers to their pursuit of surgery.