Introduction: Physician-scientists are uniquely positioned to contribute translational research that will impact patient care and our understanding of disease. Having a diverse cadre of physician-scientists is critical to ensuring that the biomedical research enterprise explores the breadth of problems affecting the nation's health. The National Institutes of Health has identified diversity, including educational background, to be important for the biomedical workforce. In 2020, less than ten percent of MD-PhD program matriculants were the first in their families to pursue higher education (first-generation) despite the majority of the US population having less than a Bachelor's degree. Little is known about the specific challenges that first-generation students face, which makes it challenging to address this gap in matriculation. Methods: This qualitative study used a phenomenological approach to examine the experiences of first-generation individuals, from the applicant stage to the early-career stage. We conducted semi-structured interviews with 41 participants and analyzed responses in accordance with a networked ecological systems theory. Results: The interviews revealed that first-generation individuals put together a patchwork of support. Whereas many MD-PhD trainees struggle at some point in their training, first-generation individuals tend to lack a support system that may provide proactive advice and prepare them for milestones. Interviews shared a common sentiment of isolation due to both a lack of social capital within medicine and academia, as well as a growing disconnect from their families and community. Discussion: Key interventions that would support first-generation students include greater access to high-quality information about the pathway, tailored mentorship throughout training, and more financial resources at the application stage. Trainees and early career physician-scientists seek more flexibility, opportunities for finding community, financial guidance and options, and mentorship around building their careers.

The authors have declared no competing interest.

BC was supported by the Medical Scientist Training Program grant from the National Institute of General Medical Sciences of the National Institutes of Health under award number T32GM007739 to the Weill Cornell-Rockefeller-Sloan Kettering Tri-Institutional MD-PhD Program; the Training Program in Developmental and Stem Cell Biology grant from the National Institute of Child Health and Human Development under award number T32HD060600; and the National Research Service Award (NRSA) Individual Fellowship award from the National Institute of Child Health and Human Development under award number F30HD111309-01. JW was supported by the Medical Scientist Training Program grant from the National Institute of General Medical Sciences of the National Institutes of Health under award number T32GM14508 to the Mayo Clinic Alix School of Medicine and Mayo Clinic Graduate School of Biomedical Sciences at Mayo Clinic. BM and RK were supported by the Medical Scientist Training Program grant from the National Institute of General Medical Sciences of the National Institutes of Health under award number T32GM007170 to the Perelman School of Medicine at the University of Pennsylvania MD-PhD Program. RK was also supported by the Training Program in Computational Genomics grant from the National Human Genome Research Institute under award number T32HG000046. MG was supported by the Medical Scientist Training Program grant from the National Institute of General Medical Sciences of the National Institutes of Health under award number T32GM144300 to the University of Pittsburgh-Carnegie Mellon University MD-PhD Program. CS was partially supported by the Medical Scientist Training Program grant from the National Institute of General Medical Sciences of the National Institutes of Health under award number T32GM007288 to the Albert Einstein College of Medicine MD-PhD Program.

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Ethics committee/IRB of Weill Cornell Medicine gave ethical approval for this work

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