Pathways and barriers to becoming physician-scientists for first-generation individuals

Introduction: Physician-scientists are uniquely positioned to contribute translational research that will impact patient care and our understanding of disease. Having a diverse cadre of physician-scientists is critical to ensuring that the biomedical research enterprise explores the breadth of problems affecting the nation's health. The National Institutes of Health has identified diversity, including educational background, to be important for the biomedical workforce. In 2020, less than ten percent of MD-PhD program matriculants were the first in their families to pursue higher education (first-generation) despite the majority of the US population having less than a Bachelor's degree. Little is known about the specific challenges that first-generation students face, which makes it challenging to address this gap in matriculation. Methods: This qualitative study used a phenomenological approach to examine the experiences of first-generation individuals, from the applicant stage to the early-career stage. We conducted semi-structured interviews with 41 participants and analyzed responses in accordance with a networked ecological systems theory. Results: The interviews revealed that first-generation individuals put together a patchwork of support. Whereas many MD-PhD trainees struggle at some point in their training, first-generation individuals tend to lack a support system that may provide proactive advice and prepare them for milestones. Interviews shared a common sentiment of isolation due to both a lack of social capital within medicine and academia, as well as a growing disconnect from their families and community. Discussion: Key interventions that would support first-generation students include greater access to high-quality information about the pathway, tailored mentorship throughout training, and more financial resources at the application stage. Trainees and early career physician-scientists seek more flexibility, opportunities for finding community, financial guidance and options, and mentorship around building their careers.