LAUSR

Calls for a diverse physician workforce continue to grow, and a key approach to answering these calls lies in ensuring that first-generation (First Gen) undergraduate students are able to become medical students and, eventually, physicians. The Association of American Medical Colleges (AAMC) defines First Gen individuals applying for medical school as candidates “whose parents have not earned an associate’s degree or higher” [1]. Although a large proportion of First Gen students in health professions are also underrepresented minority (URM) students, it is important to note that First Gen students come from different racial and ethnic backgrounds, and differ in regard to socioeconomic and immigration statuses [2]. Moreover, the obstacles faced by students differ depending on students’ backgrounds. For instance, URM First Gen students face different issues (e.g., ethnic and racial biases) than non-URM First Gen students. Published reports have indicated that 51% of First Gen undergraduate students are from minority backgrounds, while only 30% of non-First Gen undergrads are from minority backgrounds [3]. In addition, 27% of First Gen undergraduate students reported parental incomes of less than $20,000, while only 6% of non-First Gen undergrads reported the same [3]. Additionally, 46% of First Gen undergraduates are not US citizens [4]. In addition to diverse backgrounds, advantages that First Gen students bring to the institutions they attend include personal qualities, such as grit, innovative thinking, and insight into health disparities [5]. While this information on undergraduate First Gen students is valuable, it does not reveal the trajectories of First Gen undergraduates who become medical students. Difficulties in studying the First Gen population are due, in part, to historical reports’ infrequent use of the term “first-generation” and conflation of demographic identifiers. Past research has used terms like “underrepresented minority,” “low socioeconomic status,” “disadvantaged,” “at-risk,” and “vulnerable” to describe First Gen students and since these terms were often used as proxies for First Gen status, many historical details on this group went uncaptured. However, more recently, accrediting organizations have begun advising medical schools on how to collect information on First Gen applicants [6]. For instance, beginning in 2017, the AAMC introduced a “First Generation College Student Indicator” on the American Medical College Application Service [1, 5]. The AAMC has also encouraged medical schools to undertake “holistic reviews” that allow admissions committees to give equal consideration to the experiences, attributes (including First Gen status), and metrics of medical school applicants [6]. Since medical schools are increasingly collecting information on their First Gen populations and considering this metric for admission into medical school, residencies, and fellowships, the need for data on First Gen individuals in medical training is a priority for medicine and academia. The specific aims of this commentary are the following: (a) to identify educational challenges unique to the First Gen population and (b) to highlight how First Gen status among physicians can diversify the physician workforce and positively impact healthcare. While URM and First Gen students often share similar life experiences that can help diversify the physician workforce, the First Gen narrative is the primary focus of this commentary. This piece highlights initiatives aimed at diversifying the medical school pipeline and increasing matriculation for First Gen students. This commentary also advocates for research on the First Gen medical student population and illustrates the unique role that academic psychiatrists have in supporting the First Gen physician workforce. * Karen Miotto [email protected]