Mason Hyacinth R C, Webber Alexis, Wyatt Tasha R, Chakraverty Devasmita, Russell Regina G, Havemann Catherine, Boatright Dowin, Farid Huma, Moss Stephanie, Nguyen Mytien
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Department of General Surgery, Albany Medical Center, Albany, NY, USA.
J Gen Intern Med. 2025 May;40(6):1367-1377. doi: 10.1007/s11606-024-09161-3. Epub 2025 Jan 9.
Diversity in the physician workforce is critical for quality patient care. Students from low-income backgrounds represent an increasing proportion of medical school matriculants, yet little research has addressed their medical school experiences.
To explore the medical school experiences of students from low-income backgrounds using a modified version of Maslow's Hierarchy of Needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a theoretical framework.
We conducted an exploratory qualitative study through in-depth, semi-structured interviews.
Forty-two low-income medical students attending US-based MD or DO degree-granting institutions.
We conducted a content analysis of interview transcripts using deductive and inductive coding. We discussed our independent analyses to reach consensus and shared findings with a subgroup of participants for member checking.
Participants described substantial challenges in meeting their basic needs. Unmet physiologic needs included food insecurity, lack of adequate sleep/rest, and poor mental health. Unmet safety needs included lack of reliable transportation and safe housing; threats to financial safety included debt and an inability to cover both medical education-related and non-medical education-related expenses. Unmet belonging needs included difficulty connecting with peers or participating in financially inaccessible social activities. Unmet respect/esteem needs stemmed from bias from peers, teachers, and institutions. Unmet self-actualization needs were uncommon. Participants felt pride in their medical journey; however, some perceived that their financial struggles hindered them from realizing their full potential.
Previously reported attrition and adverse academic outcomes among low-income students may be linked to challenges they experience trying to more fully meet important human needs. This finding underscores the need to approach wellness holistically and ensure students do not exist in a prolonged state of unmet needs. Recommendations that accreditation bodies and medical schools could implement to promote tailored support for low-income and other marginalized learners are provided.
医生队伍的多样性对于高质量的患者护理至关重要。来自低收入背景的学生在医学院录取新生中所占比例日益增加，但针对他们医学院经历的研究却很少。
以马斯洛需求层次理论（生理、安全、爱/归属、尊重和自我实现）的修改版本为理论框架，探索来自低收入背景学生的医学院经历。
我们通过深入的半结构化访谈进行了一项探索性定性研究。
42名就读于美国授予医学博士（MD）或骨科医学博士（DO）学位机构的低收入医学生。
我们使用演绎和归纳编码对访谈记录进行了内容分析。我们讨论了各自的独立分析以达成共识，并与一部分参与者分享研究结果以进行成员核对。
参与者描述了在满足基本需求方面面临的重大挑战。未满足的生理需求包括粮食不安全、缺乏充足的睡眠/休息以及心理健康状况不佳。未满足的安全需求包括缺乏可靠的交通工具和安全的住房；对财务安全的威胁包括债务以及无力支付与医学教育相关和非医学教育相关的费用。未满足的归属需求包括难以与同龄人建立联系或参与经济上难以承受的社交活动。未满足的尊重/自尊需求源于同龄人、教师和机构的偏见。未满足的自我实现需求并不常见。参与者为自己的医学之旅感到自豪；然而，一些人认为他们的经济困难阻碍了他们充分发挥潜力。
先前报道的低收入学生的退学率和不良学业成绩可能与他们在努力更充分地满足重要人类需求时所经历的挑战有关。这一发现强调了全面关注健康的必要性，并确保学生不会长期处于需求未得到满足的状态。本文提供了认证机构和医学院可以实施的建议，以促进为低收入和其他边缘化学习者提供量身定制的支持。
