Disrupted and Reconstructed Legitimacy Among Widening Participation Medical Students

Abstract Background Widening participation (WP) initiatives have improved access to medical education, yet less is known about how WP students experience legitimacy, participation, and identity formation after entry. Existing models often conceptualise professional identity formation as a linear process, overlooking the instability and structural constraints that may shape WP students’ trajectories. Methods This qualitative participatory study used a student–researcher partnership to centre WP student perspectives. Medical students in preclinical years (Stages 1 and 2) who had entered the programme via a gateway year participated in peer-facilitated online focus groups. Data were transcribed and analysed collaboratively with student researchers using reflexive thematic analysis. Results Reflexive analysis demonstrated that legitimacy was not conferred at entry but continually negotiated through participation for WP medical students. The hidden curriculum and informal norms regulated access to participation, with WP students disproportionately affected by limited cultural and social capital. Structural inequities extended beyond access, shaping engagement in extracurricular and career-building activities and contributing to burnout. Despite this, students demonstrated significant agency, reconstructing identity in ways grounded in personal values and commitment to medicine, often at personal cost. Discussion We propose a model of disrupted and reconstructed legitimacy comprising four iterative phases: emerging legitimacy, destabilisation during transition, constrained participation, and identity reconstruction through agency and purpose. These findings challenge deficit narratives and extend identity formation theory by emphasising contingency, disruption, and structural context. Participation emerges as a key mechanism through which legitimacy and confidence are produced, rather than inherent individual traits.