Author ORCID Identifier

Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Educational Policy Studies and Eval

First Advisor

Dr. Jane M. Jensen


Not enough members of low-income, rural, and minoritized populations are successfully prepared for and recruited into medical school, exacerbating issues of unequal access to healthcare and limiting access to the profession. While a multitude of factors contribute to this problem, early social exposure to others in a field can act as a key contributor to career interest and a key advantage for entering the profession. Meanwhile, students without early social exposure to healthcare may take unconventional paths to medical school or may struggle to fit into the unique culture of medicine when they do enter training, especially if they belong to underrepresented groups.

This project includes 3 papers based on a longitudinal, mixed-methods case study of first, second, and third year medical students at an allopathic medical school at a public university in the Southeastern United States. Participants include 80 interviewees drawn from a pool of 261 survey respondents. Each paper considers a different point along the trajectory into the medical profession: first, the pre-college years; second, the undergraduate stage; and third, medical school itself.

In the first paper, I explore how students with different levels of early socialization into medicine develop initial interest in the profession, and how families, peers, schools, and communities influence students’ aspirations both positively and negatively. In the second paper, I discuss how students from underrepresented backgrounds often avoid identifying as “pre-med” and instead approach the intense preparation process for medical school via independent—rather than collaborative—strategies, with less confidence and insider information than better-connected peers. In the final paper, I map out how early differences in socialization into the field can continue well into medical training, especially for students who continue to feel out of place in the culture of medicine.

Underlying each of these papers are comparisons to literature on first-generation college students, which documents unique challenges faced by students who did not grow up in college-going families and may lack social or cultural capital to facilitate their entrance to postsecondary education. Similarly, I typologize participants as “insiders” in medicine–those with familial connections to healthcare professionals—and “newcomers”—those with no familial connections in healthcare. I find that insiders have significant advantages stemming from their access to the profession, while newcomers are often hindered by a lack thereof. However, I also find that many students from nonmedical families access “inside-adjacent” status in which they align themselves with insiders who provide information and access to the profession, although this is most feasible for students already in positions of relative privilege, such as students at college-preparatory high schools. Nevertheless, students from nonmedical backgrounds still found unique ways to aspire to medicine, prepare for admission to medical school, and navigate training, illustrating that outsider status, while challenging, can also act as an advantage or source of inspiration empowering diverse students.

Digital Object Identifier (DOI)

Available for download on Friday, December 01, 2023