Professional Identity Formation Among Diverse U.S. Medical Students: A Quantitative Analysis of the Impact of Socioeconomic Status

Purpose:

Professional identity formation (PIF), is described as “the multifactorial phenomenon, shaped by ways that clinical/non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations.”¹ Data suggest that students’ personal characteristics factor in the PIF process.^2,3 This study examined how socioeconomic status (SES), (measured by generation college status [first-generation college graduate [FCG] vs continuing-generation college graduate [CCG]] and household income [high vs low]) might influence PIF among a national cohort of US medical students.

Method:

We analyzed cohort data from an existing dataset of de-identified records from the Association of American Medical Colleges Graduation Questionnaire (GQ).⁴ The GQ asks 2 questions related to PIF: (1) “My medical school has done a good job of fostering and nurturing my development as a future physician” and (2) “My medical school has done a good job of fostering and nurturing my development as a person.” We used GQ data from academic years 2014–2015 and 2015–2016. Multivariate regression models explored relationships between 4 categories of students’ SES with measures of PIF, controlling for covariates such as sex and race/ethnicity. CCG status was defined as having at least 1 parent/guardian with a bachelor’s degree. FCG status was defined as students with no parent with a bachelor’s degree. Household income was determined using 2 self-reported measures of income status: receipt of state or federal financial assistance, and parental income reported on the Matriculating Student Questionnaire.⁵ Students were considered low-income if they indicated that their families were recipient of state/federal financial assistance programs (e.g. Supplemental Nutrition Assistance Program), or if their self-reported parental income was within the lowest 2 quintiles nationally (less than $41,187 for 2014–2015 cohort, and less than $43,512 for 2015–2016 cohort). A 4-level variable SES variable was created to reflect SES: continuing-generation college graduate/high income (CCG/HI); continuing-generation college graduate/low income (CCG/LI); first-generation college graduate/high Income (FCG/HI); and first-generation college graduate/low income (FCG/LI). Statistical analyses were performed using STATA16.1.

Results:

Of the 24,796 students in our sample, 64.4%, 20.9%, 4.2%, and 10.5% identified as CCG/HI, /CCG/LI, FCG/HI and FCG/LI. CCG/LI respondents were less likely than CCG/HI peers to report that their medical school had done a good job of fostering and nurturing their development as a person (aOR: .79, 95% CI: .74, .85), and that their medical school had done a good job of fostering and nurturing their development as a future physician (aOR: .71, 95% CI: .63, .80). Similarly, FCG/LI respondents were less likely than FCG/HI peers to report that their medical school had done a good job of fostering and nurturing their development as a person (aOR: .85, 95% CI: .78, .94), and that their medical school had done a good job of fostering and nurturing their development as a future physician (aOR: .72, % CI: .62, .84). No significant differences were observed between FCG/HI and CCG/HI respondents on either aspect of PIF.

Discussion:

Our study illuminates nuances in PIF and provides new knowledge that, regardless of college graduate generation status, students who self-identified as being from low-income backgrounds were less likely than their high-income peers to report that their medical schools were doing a good job fostering personal and professional identity formation.

Significance:

These results reinforce that understanding the PIF experiences of diverse groups of medical trainees is critical to advance equity. More attention must be paid to the experiences of low-income students to ensure that they are and feel supported in their professional development and leave medical school equipped to thrive in their subsequent careers.