"I am Still the Same Person That Left": Time, Tension, and Identity in Low-Income US Medical Students

Background: Time can serve as a form of oppression when one has control over another's schedule, activities, and timetables. Yet, time as a form of oppression has received little attention in medical education. Students who are considered marginalized, such as low-income (LI) students and LI/first-generation (FGLI) students, have a strained relationship to time because of their unique social positions. In this study, we investigated the temporal experiences of LI and FGLI students using the language they used to talk about time. Methods: This was a secondary analysis of a larger dataset that interviewed 42 students, recruited via listservs and social media. We completed the original interviews between November 2021 and April 2022 and conducted the secondary analysis in 2024. Using methodological bricolage, we analyzed the interview data by: (1) identifying excerpts where a participant discussed time, (2) using functional linguistics to examine these excerpts for participants' representation of agency with respect to time, and (3) analyzing the data for evidence that participants created simultaneous temporalities (i.e., historically contextualized experiences of time). We interpreted agentic acts as a form of resistance, one that is understudied in medical education and resistance studies. Results: LI students resisted medical education's expectation of time by maintaining multiple, simultaneous temporalities that connected them to their communities, family, and themselves. They took time away from medicine to engage in activities including teaching, mentoring, and connecting with others in their communities. They reclaimed time to reflect the values they grew up with and invested time in themselves to support who they are as a person, beyond being a physician. Conclusions: Though the concept of time has received attention in medical education literature, less attention has been paid to time as mechanism for suppressing students' other identities so that a professional identity can be created. This study demonstrates that LI students are aware of this coercive act and actively resist the norms and expectations of medical education by creating new temporalities. These additional temporalities offer glimpses into acts of resistance as protection and promotion; protecting what students care about and promoting a new way of being in medicine.