Tools and Resources for Advisors of First-Generation Medical School Students

Medical students who are the first in their families to graduate from college bring unique strengths to medical school.

They often possess a track record of highly desirable traits for a physician, such as grit, self-determination, and important insights into the complex health disparities facing the U.S healthcare system today.  

These first-generation college graduates, and others who come from backgrounds with limited exposure to medicine, may also have unique needs and face challenges that are not always readily recognized by their schools.  

For example, cultural capital (what one knows about the culture they are in) and social capital (who one has as their guide) may be in short supply for first-generation students, leaving them encumbered by invisible yet very real barriers that do not affect their continuing generation counterparts.   

Medical schools should consider how they provide academic support for first-generation students from the point of application and acceptance to graduation and beyond. In addition, they should have access to intentional development opportunities and comprehensive support during clerkships and beyond.  

• Academic Support

• Learning Environment

• Professional Development and Career Mentorship

• Emotional Support 

• Financial Support

• Family Connection and Engagement

The learning climate/environment includes psychosocial (personal, social, organizational) and material (physical and virtual spaces) dimensions that affect learning, well-being, professional identity formation, burnout, depression, and marginalization.  

The complex components and interactions within the learning environment are critical to the success of medical students. Therefore, educators and institutions seeking to support first-generation college graduates must make the learning environment a priority.   

Assessments

None of these assessments address first-generation student perceptions specifically. However, assessing the learning environment and/or institutional culture is an important step towards nurturing a diverse, inclusive environment.  

Furthermore, if an institution chooses to assess perceptions of first-generation students, a demographic question could be added to an assessment instrument to obtain that subgroup data.   

• C-Change Faculty, Resident, and Student Surveys

• Standpoint™ Faculty Surveys

• AAMC Year Two (Y2Q) Questionnaire

• AAMC Graduation Questionnaire

• Mayo Well-Being Index

• Dundee Ready Educational Environment Measure (DREEM)

• Clinical Learning Environment Review (CLER) (GME focused)

• Johns Hopkins Learning Environment Scale

• The Educational Climate Inventory

Workshops/Training Programs  

In developing interventions to improve the learning environment, individuals may want to consider collaborating with departments within the institution and/or university who may have expertise such as a center for teaching and learning, teaching academy, or office of inclusion and diversity.  Below are institutions doing exemplary work in this area: 

Yale School of Medicine (Contact: Mytien Nguyen) 

Changing curriculum to improve learning environment 

• Health equity core curriculum 

• US Health Justice Collaborative and elective pre-clinical course that focus on health equity and socioeconomic determinants of health 

• Four-part workshop on fundamentals of inclusive teaching that teaches teaching strategies that consider diverse backgrounds, how to create an equitable environment, and how hidden curriculum influence students’ learning and participation 

• Workshop on teaching first-generation and non-traditional students, in partnership with the Yale Center for Teaching and Learning 

University of South Carolina School of Medicine Greenville (Contact: Dr. Julie Linton) 

The Student Advocates for Diversity, Inclusion, and Equity (SADIE)  

• SADIE exists as a body of welcoming students, faculty and staff committed to: advancing the integration of diversity and inclusion within the medical school’s curriculum; supporting those student organizations with an emphasis on diversity; and fostering an environment for meaningful discussions centered on diversity and inclusion at the School of Medicine. 

•  The students serving on this committee are utilized as conduits for medical students of any race, creed, ethnic background, ability, sexual orientation or gender identity to express themselves in a safe and supportive setting.  

Other possible steps/initiatives for medical schools:

• Create a contact sheet of first-generation college graduate faculty and senior students willing to serve as advisors/mentors to more junior students  

• Hold student workshops (finding a research mentor, managing loans, building a CV) that are developed with the particular needs of first-generation students in mind 

• Train faculty/staff providing student academic support about challenges of first-generation college graduates and encourage dialogue with students about barriers or stresses outside of school that may be contributing to academic issues 

• Please see the many examples and recommendations in other sections of this toolkit that also impact the learning environment 

Return to top ↑

For students from backgrounds that are traditionally underrepresented in higher education, including first-generation college students, persistent negative stereotypes and underrepresentation can lead to uncertainty about belonging, especially when faced with challenges or setbacks.  

In medicine, there is considerable stigma associated with first-generation status, which can cause students to choose to remain invisible. Once they identify, their first-generation background can be viewed as a deficit rather than a strength.  

In addition, first-generation students often have responsibilities at home and often worry about the families they leave behind. Many first-generation students may also struggle with what has been described as “breakaway guilt.” They may feel like they’re abandoning parents or siblings who depend on them.  

Therefore, when it comes to academic aspirations and achievement, first-generation students may have more anxiety than other students due to imposter syndrome and the stereotype threat phenomenon. Moreover, navigating anxiety can exacerbate feelings of isolation and loneliness for first-generation students in medical school. 

#1: Your Office of Student Affairs/Office for Diversity 

The office may organize events that focus on empowerment: 

Transition: Starting at White Coat Ceremony (or even during interviews), it is important to publicly recognize that first-generation college graduates are minoritized and underrepresented in medicine. If possible, have a point person or office that first-generation students can go to as a reference. Transition to medical school is key to student well-being. Administrators should work with advisors to organize sessions and workshops for first-generation students on topics such as adjustment to medical school and the medical profession, cultural capital, and hidden curriculum. In addition, schools should track and identify first-generation students, and student affairs administrators should have ongoing meetings with first-generation students. 

Recognition and visibility: Some schools distribute "First Gen" or "I'm First!" lapel pins to recognize and honor the accomplishments of first-generation college graduate (FGCG) students. Some schools encourage faculty and other mentors to identify as FGCG which can help create a welcoming environment for current students to identify as first-generation college graduates as well.  

Focus on assets: First-generation students have many characteristics that are desired in a physician, including proactivity, goal-oriented, optimism, humanism, and reflexivity. However, first-generation students are also not likely to have this perspective of themselves. Administrators and advisors should facilitate a shifting of perspectives both from the student and within the learning and social environment. An environment that values the unique assets that first-generation students bring to medicine will enable students to further develop their strengths and socioemotional belonging within medicine. 

Imposter syndrome discussion group: This will facilitate a direct confrontation to the concept of imposter syndrome with first-generation students as a means of empowering them to understand their feelings and to encourage asset-based coping strategies as a proactive approach. Shifting to an asset-based lens, where the inherent strengths, talents, and abilities of students are identified and utilized, instills students with a sense of pride and confidence, empowering them to seek support without stigma and increasing their awareness of the tools they possess to navigate struggles both academic and social/emotional.  

Panels: Through in-person meetups, events, and social media, students find an opportunity to connect socially with others from similar backgrounds, express challenges and strengths related to being a first-generation or low-income college student, and seek guidance from older first-generation and low-income students and alumni. All of the work is grounded in an understanding of psychological interventions, such as difference-education, reducing stereotype threat, values affirmation, and social-belonging. 

Discussion series: Partnerships between counseling services and the medical school may organize a discussion series specifically focused on first-generation college graduates.  Learning occurs through dialogue and discussion on topics such as intersectionality of different identities (e.g., race, ethnicity, gender, socioeconomic status, etc.) and how these identities affect the training experience.  Students are encouraged to discover new strengths and potential to help them thrive during medical school training, in addition to learning more about resources on campus that are integral to any student’s success.   

#2: Access to Psychological Counseling and Wellness Programs

Access to psychological counseling and wellness programs are critical for the emotional health of first-generation college graduate students. Students should be able to access counselors who understand the first-generation college graduate experience. In addition, schools should aim to destigmatize mental health. This could be done through intentional peer mentorship with upper class first-generation students. 

Specific examples from medical schools: 

• Geisinger Commonwealth School of Medicine: Student Health Services fully covers unlimited sessions with an onsite license social worker and/or behavioral health specialist. Students also have access to five sessions with a highly trained clinician from Employee Assistance Program (EAP). Additionally, GCSOM has a health and wellness committee that coordinate bi-monthly health and wellness series. Moreover, they have a weekly yoga, meditation and mindful workshops.  

• Yale School of Medicine: Yale Health Plan fully covers one counseling session per week for all medical students, with a psychiatrist of their choosing within the network. Students can request a psychiatrist who matches their race/ethnicity, gender, or other demographics.  

• Southern Illinois University School of Medicine: Center for Human and Organizational Potential to emphasize personal and emotional well-being. 

• Kaiser Permanente School of Medicine: plans to include regular behavioral health visits for all students. 

Return to top ↑

In most instances, parents want to be involved and want to be supportive of their children during medical school, however they are often unsure about what level of involvement is appropriate and what advice to provide. Importantly, research on first generation  undergraduate students has shown that family support can significantly impact students’ academic outcomes. Therefore, it is critical that medical schools not only involve parents in the medical training of its first generation students, but also equip first generation parents with the information and tools to best support their children. 

Anecdotally, we have found that many students benefit from high levels of support from their families. On the other hand, we have found that a proportion of parents of first generation students view the pursuit of higher education as a long and wasted investment (i.e. student loans and many years of financial security deferred). In addition, many first generation students have responsibilities at home (social, emotional and financial) and continue to care for family members in addition to being full-time medical students.  

We hope that providing these resources will allow family members to be more engaged and understanding and feel equipped to support their student in a multitude of ways. Furthermore, by including the family, institutions will convey their understanding that families are a key part of the First Gen medical school journey, and of their student’s future success. 

Examples of Connecting Families of First Generation Students to the Institution 

One of the keys to retaining first generation students is to also make the family feel welcome on the medical campus. It is important to engage the loved ones of students as partners in their success and to help both the student and the family through this transition. Some strategies include creating activities that help to bridge cultural gaps, sending invitations to campus activities, and giving students tools for communicating about their medical training. 

MyMDtoBe

An online tool that keeps family members informed about the medical student’s stage of training 

UC Davis materials for incoming medical student families

• Spanish version (PDF)

• English version (PDF)

UCLA David Geffen School of Medicine 

The school organizes an orientation luncheon with parents of first-generation college graduate students. The welcome lunch and meeting takes place on the day of the White Coat Ceremony, when many family members of incoming medical students are already on campus. The goal is to create a sense of community for the family members of incoming medical students who were the first in their families to graduate from college; and to make family members feel included in the UCLA space.  

Yale School of Medicine

The school provides financial assistance for up to two family members (broadly defined) to attend the White Coat Ceremony. In a White Coat survey that is sent to ALL incoming students, if a student indicates that no family member will be attending the White Coat Ceremony, the student is asked whether it is due to financial constraints. If so, the Admissions Office then reaches out to the student to offer financial assistance (funded by the Office for Diversity, Inclusion, Community Engagement, and Equity) for up to two family members to attend the White Coat Ceremony. 

University of California 

View examples of engaging parents of first-generation students. 

Other initiatives/ideas that can support First Gen parents in their efforts to support their children*

• Assign a family support administrator as a point person between family members and the medical school 

• Provide a list of advice to First Gen parents and families, including changes in family structures. 

• University of Michigan's First Generation Families resources

• This list could be generated by polling current First Gen medical students on “Things I wish my family would know”

• Organize and support a parent community group (or association) that meets and learns about the medical school process and how to support their student

*Brainstormed by FGLIMed, national First Gen and Low Income in Medicine Association, http://FGLIMed.org.

Return to top ↑