A qualitative exploration of first-in-family medical students' decisions to partake in noncurricular activities

Medical students who are first in family (FiF) to attend college navigate an education system with limited social capital compared to their non-FiF peers. This situation leads to difficult decisions regarding the use of their time. How these students balance their goals inside and outside of medical school is an under-explored area within medical education research. By illuminating how FiF students decide what noncurricular activities to perform, this study aimed to better understand how they relate to and manage their time.

Drawing on aspects of constructivist grounded theory, we interviewed 15 US FiF students between September 2023 and May 2024 regarding the noncurricular activities they participated in and how they made decisions with their time. We collected and analysed data iteratively, adjusting the interview protocol as needed to probe deeper into ideas and themes. Formal data analysis included open and focused coding to identify patterns and relationships within and across the data to understand what drives FiF students in their decision-making processes and how this affects their activities.

FiF students are constantly trying to secure their future, prioritizing their survival and that of their communities. They described how persisting through a lifetime of inequity instilled a skill for resourcefulness, and they draw on this experience when choosing activities. Their choices reflected a sense of what they must do, based on alignment with their personal values and a deep sense of responsibility to others.

FiF students must choose activities that contribute to their survival and that of their communities. By illuminating that survival is at the centre of their decision-making, their narratives challenge the ways that medical training emphasizes extracurricular activities. By not necessarily choosing those activities that are expected of medical students, FiF students exert agency to reclaim aspects of their identity deemphasized by school expectations.