Medical Schools Must Help First-Generation Medical Students Realize Their Full Potential

To the Editor: Being first-generation (FG) medical students—those who are first in their families to attend medical school—is important intersectionality that impacts how those students become physicians. FG students are an important population in academia, in part due to their unique experiences and challenges, which give them valuable perspectives. For years, undergraduate universities but seldom medical schools have developed FG-centered educational and administrative programs to address some of the most salient of these challenges—including the need for university-culture readiness, financial issues, family misunderstandings and stressors, impostor syndrome, and lack of professional/social networks—to help these students navigate school and career decision making. Awareness at medical schools has evolved recently, with some individual schools developing FG programs. However, these are still sparse, and a collective platform is still very much in its infancy. We and others at the University of California, Los Angeles (UCLA) David Geffen School of Medicine (DGSOM) understand that raising awareness of the FG experience in medical education is an important step in cultivating an academic culture of recognition, support, and inclusion. Working in conjunction with our dean's Office for Equity and Diversity Inclusion, we created the First-Gen at UCLA DGSOM program in November 2017 using built infrastructure and tailoring existing programs. We progressively approached the administration with incremental tasks, starting "simple" and then building out as the perception for FG-specific programming gained traction. Today, our FG program consists of 4 pillars: mentorship, educational transitions and home identity, academic support, and community-building. Our program also aims to improve education of non-FG faculty and staff about the FG experience and, for example, to be an advocate for medical school support services (e.g., mental health) that can connect with FG students. Additionally, we are creating a network of FG individuals that includes our entire medical school community and beyond by involving residents, fellows, faculty, staff, and alumni. Most notably, the current COVID-19 pandemic amplifies the importance of developing FG-specific programs. FG medical students are being additionally taxed in ways that their non-FG counterparts sometimes are not, such as returning home during the pandemic to sometimes multigenerational and crowded home learning environments and having an increased burden of family responsibility. This is another reminder that medical schools must recognize the hurdles that FG students face and create innovative strategies to maximize those students' full potential. This is a pivotal move that could even improve the cultural sensitivity of our entire physician workforce, as the life experiences of FG students poise them to understand and eliminate the structural injustices and disparities that exist in medicine.