Understanding the Medical Education Experiences of Low-Income Students Through a Maslow’s Hierarchy of Needs Lens: An Exploratory Qualitative Study

Background: Diversity in the physician workforce is critical for quality patient care. Students from low-income backgrounds represent an increasing proportion of medical school matriculants, yet little research has addressed their medical school experiences. Objective: To explore the medical school experiences of students from low-income backgrounds using a modified version of Maslow’s Hierarchy of Needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a theoretical framework. Design: We conducted an exploratory qualitative study through in-depth, semi-structured interviews. Participants: Forty-two low-income medical students attending US-based MD or DO degree-granting institutions. Approach: We conducted a content analysis of interview transcripts using deductive and inductive coding. We discussed our independent analyses to reach consensus and shared findings with a subgroup of participants for member checking. Results: Participants described substantial challenges in meeting their basic needs. Unmet physiologic needs included food insecurity, lack of adequate sleep/rest, and poor mental health. Unmet safety needs included lack of reliable transportation and safe housing; threats to financial safety included debt and an inability to cover both medical education–related and non–medical education–related expenses. Unmet belonging needs included difficulty connecting with peers or participating in financially inaccessible social activities. Unmet respect/esteem needs stemmed from bias from peers, teachers, and institutions. Unmet self-actualization needs were uncommon. Participants felt pride in their medical journey; however, some perceived that their financial struggles hindered them from realizing their full potential. Conclusions: Previously reported attrition and adverse academic outcomes among low-income students may be linked to challenges they experience trying to more fully meet important human needs. This finding underscores the need to approach wellness holistically and ensure students do not exist in a prolonged state of unmet needs. Recommendations that accreditation bodies and medical schools could implement to promote tailored support for low-income and other marginalized learners are provided.