Entering medicine "on the wrong side"? Caregiving as a legitimate pathway to medicine

Medical education has increasingly incorporated curricular reforms and programming aimed at humanizing care, such as community-based service learning, experiential education, and structural competency training. However, such efforts often overlook the fact that many students already possess deep, embodied knowledge of these social realities. Some medical students come to medicine because they have caregiving experiences and an intimate understanding of the realities of the conditions that patients face. This study examines how caregiving experiences influenced first generation medical students' trajectories into medicine, how these students reflect on current and future patient care, and the realities that they face in medical school when interacting with peers and faculty who do not have, or recognize the value of, their lived experiences. From March to October 2024, we conducted interviews with 55 medical students at a U.S.-based medical school who were first in their families to attend medical school. Drawing on a conceptual framework that integrates lived witnessing and accompaniment, we demonstrate that caregiving has shaped medical students' path to medicine and informed their understanding of patients' lives long before entering medical school. Caregiving experiences and witnessing medical mistreatment also shaped the ways that medical students envisioned their future clinical practice and advocacy work. These rich experiences weighed heavily on medical students, who faced isolation, risk, and the pressure to succeed. Our findings disrupt conventional pathways to medicine, which tend to center experiences of shadowing clinicians, rather than accompanying patients. Our findings also reshape the medical gaze by centering social and relational dimensions of care. We conclude by offering specific recommendations to medical school administrators to better support this student population.