Yale School of Medicine (YSM) students have led the effort, on campus and nationally, to advocate for first-generation and low-income (FGLI) students in medicine, creating organizations and developing resources to help students access and navigate medical school. This includes working to end the default perception that FGLI students are high-risk in medical school, and replace it with the recognition that their diverse perspectives significantly enhance medical education and will improve how health care is delivered.
YSM fifth-year MD-PhD student Mytien Nguyen, MS, played a central role in the creation of two toolkits, one for first-generation medical school students and another for their advisors and families, launched nationally through the AAMC in November 2020. She says the student toolkit would have been helpful when she started medical school, a time when there was no first-generation or low-income identity student group at YSM or any other medical school. Nguyen, who grew up as a low-income refugee after her family immigrated to the United States from rural Vietnam when she was eight, helped spearhead the effort to create such a group.
Individual and small group conversations among YSM FGLI students led to a formal dinner in September 2017, where the idea for the Yale First Generation/Low Income (YFLI) student group was launched, co-founded by Nguyen and fifth-year MD student Seong Im Hong. YLFI now includes 80 MD and MD-PhD students focused on promoting recruitment of more diverse medical students, building a more welcoming community, advocating for mentorship, and helping first-generation American/college students and low-income students navigate medical school.
Current YFLI president, second-year MD student Jamieson O'Marr—a first-generation college student—is excited to expand YFLI even more. As of January 2021, YFLI has begun to include Yale Physician Associate and Physician Assistant Online students. He hopes to engage Yale School of Nursing students soon and develop an alumni base as the first YFLI members begin to graduate in the coming years.
YFLI’s significant impact is reflected in how different the environment was when O’Marr applied to YSM from when Nguyen arrived. A significant reason O’Marr chose YSM was because he knew it had a strong first-generation community among students, with committed administrative support through the Office of Diversity, Inclusion, Community Engagement, and Equity (DICE).
Nguyen believes the school “has done so much already these past few years—honestly, I think that YSM is among the leading institutions of the national FGLI in medicine advocacy movement.”
However, Nguyen adds, much remains to be done and “it starts with reflecting on the current ‘norms’ of medical education and how many of those norms were based on the presumption that medical students are from higher socioeconomic backgrounds.” As supportive as YSM is, Nguyen explains students faced challenges inherent to medicine, where more than 70% of trainees are from the highest income households in the country, including the stigma surrounding poverty and classism. Nguyen states that the medical training curriculum is not conducive to the success of first-gen and low-income student.
Nguyen’s frustration led her to reach out to other institutions about their FGLI initiatives and in 2018, students from YSM and Georgetown University School of Medicine launched the National First Generation and Low-Income in Medicine Association (FGLIMed), which now has more than 800 members. Nguyen explains, “we realized that in order to tackle classism in medicine and advocate for FGLI students at our schools, we need a national movement. There is nothing more powerful than a national movement.” Four of the FGLIMed board members are from YSM: Nguyen, O’Marr, second-year MD-PhD student Joanna Chen, and second-year MD student Mursal Gardezi.
FGLIMed provided significant input into the AAMC toolkit project, to which Nguyen devoted close to 100 hours over the past two years. The idea for this resource originated with the AAMC Section on Undergraduate Medical Education of the Group on Educational Affairs. Ten students, faculty, and staff collaborated on the project with the goal of iteratively updating the toolkits.
The student toolkit covers academic support, professional development and career mentorship, emotional support, and financial support, while the advisor/family toolkit focuses on similar topics, plus the learning environment and family connection and engagement.
For each topic, the toolkit provides ideas and resources, as well as specific examples and contact information. Nguyen is listed as a contact for information about steps YSM has taken to change the curriculum to improve the learning environment including, in part, adding health equity to the core curriculum and developing a workshop on teaching first-generation and non-traditional students in partnership with the Yale Poorvu Center for Teaching and Learning.
The family connection and support section discusses how a key way to retain first-generation students is to make their families feel welcome on the campus by creating activities that bridge cultural gaps, inviting them to activities, and providing students tools to communicate about their medical training. Financial assistance from YSM for up to two family members, broadly defined, to attend the White Coat Ceremony is included as an example.
Emotional support, one of the categories Nguyen worked on, discusses how many schools are adopting best practices that celebrate and advocate for the unique strengths of first-generation students and encourages them to use their talents to enhance the medical school experience. It emphasizes that visibility and peer relationships can be important starting points for emotional health and that having a student organization to support first-generation students is fundamental. The section cites YFLI’s monthly community dinners, which DICE funds, as an opportunity for students to talk about their experiences in class, on the wards, and throughout medical school.
“Having these toolkits as a national resource for all students, especially those from first-generation, low-income backgrounds, signals important messages about inclusion and belonging,” states Rochelle Smith, associate dean of diversity and inclusion and associate chief diversity officer.
Deputy Dean and Chief Diversity Officer Darin Latimore, MD, is very proud of the students’ advocacy. He says that as a first-generation and low-income medical student, he would have benefited from such a resource. “Since no one in my family went to medical school, they were ill-equipped to help me and unfortunately my pride often prevented me from reaching out to the school’s administrators for guidance. The toolkits are an additional resource that will help make medicine more accessible for FGLI students.”
O’Marr similarly believes the toolkits will have a significant impact. He says the first-generation community often talks about how “you don’t know what you don’t know,” and the toolkits provide a clear roadmap of relevant issues and a wealth of resources.
Looking forward, Nguyen states, “Yale has always been a leader in medical education innovation, starting with the Yale System. I’m truly hopeful that Yale will also lead the field of medicine in diversifying the socioeconomic diversity of its medical trainees, as well as continuing to support FGLI students along their path to become leaders in medicine.”
She shares a personal example of why this diversity is so valuable. “I remember when a patient was struggling to navigate unemployment and I was able to assist because I had helped my parents navigate unemployment and other social services since middle school.” She adds, “imagine if we have a medical school class, a residency class, a physician workforce that reflects the socioeconomic diversity of our patient population. I think that health care delivery would look dramatically different.”