To the Editor:
While medical schools have made serious efforts to address their racial disparities, they have yet to make a concerted effort to address their socioeconomic disparities. Until this occurs, socioeconomically disadvantaged (SED) medical students will remain an unheeded, underrepresented minority within medical education.1 We have written this letter to recommend some ways to remedy this situation.
For SED students, their backgrounds and socioeconomic status can have a profound influence on their education. Their limited familiarity with physician role models before medical school can create a demoralizing transition for them in becoming medical trainees. This occurs as they regularly experience a cultural mismatch between their identities and the sociocultural norms and expectations of medical school. This dissonance can impede these students’ ability to relate to their peers and faculty, and result in their experiencing isolation and alienation.1 SED students can also be affected by social determinants of health (SDOHs), or they can be affected by the various SDOHs that harm their families. These personal stressors can exponentially compound the stress they already experience as medical students and put these individuals at particular risk for depression, self-neglect, and burnout.2 Another issue for SED students is the unintentional harm caused by culturally incompetent faculty. For example, when students request help, unaware faculty may use microaggressions and class-based assumptions in their responses, further exacerbating the students’ stress.
To effectively address the needs of SED students, medical schools must take several key steps within their communities. First, medical schools must teach their faculty the significance of an SED background on a student’s medical education through cultural competence training that highlights the lived experiences of SED students before and within medical school. Next, faculty should be provided tools that can effectively equip them to advise a diversity of students —including SED students—who have a wide range of needs. Another crucial step for medical schools would be collaborating between university schools, programs, and services to improve all medical students’ accessibility to untapped resources, opportunities, and communities that could improve their medical education and experience as a medical student. Eventually, these steps could make medical education a more inclusive space for all students, especially for those who are members of this overlooked minority.
1. Jerant A, Sciolla AF, Henderson MC, et al. Medical student socioeconomic disadvantage, self-designated disadvantage, and subsequent academic performance. J Health Care Poor Underserved. 2019;30:1419–1432.
2. Wild K, Scholz M, Ropohl A, Brauer L, Paulsen F, Burger PH. Strategies against burnout and anxiety in medical education—Implementation and evaluation of a new course on relaxation techniques (Relacs) for medical students. PLoS One. 2014;9:e114967.