Exploring identity conflict for widening access students during early experiences at medical school: an interpretative phenomenological analysis

Medicine is often imagined as a profession built on a single, uniform mold: a specific type of person with a specific type of background, moving through a specific type of training. For decades, the goal of medical education was to produce doctors who could think and act with a standardized set of skills. However, the people who make up the general public are not uniform. They come from every walk of life, with different histories, abilities, and ways of seeing the world. When a society decides that its doctors should reflect the diversity of the people they treat, it must bring students from non-traditional backgrounds into the classroom. These are students who might be the first in their families to attend university, those with disabilities, or individuals whose gender or life experience does not match the long-held image of a doctor.

The challenge, however, does not end at the front door of the medical school. Once inside, these students enter a culture that has deep, often unspoken rules about what a "real" medical student looks like and how they should behave. This creates a tension between who they were before they arrived and who they are expected to become. Researchers use a concept called social identity to understand this. In simple terms, this is the idea that we all belong to many different groups—family, friends, community—and we feel a sense of belonging when we see ourselves fitting in with the people around us. When a student feels that their personal history or identity clashes with the group they have just joined, it can create a deep sense of isolation and stress. Understanding how these students navigate that feeling is crucial, because if the medical profession cannot support them, they may struggle to finish their training or may leave feeling that they do not truly belong.

A team of researchers at Newcastle University set out to explore this experience in detail. They wanted to understand what happens inside the minds of students from widening access backgrounds during their very first months of medical school. Instead of asking hundreds of students for a quick survey, they chose a different path. They sat down for long, deep conversations with four first-year students who identified themselves as coming from non-traditional backgrounds. The researchers listened to how these students described their days, their fears, and their hopes, looking for the specific moments where their old lives collided with their new reality. The goal was not to count how many students felt this way, but to understand the texture of that feeling and how the students tried to make sense of it.

The four students in the study came from distinct and varied places. One was a transgender man who had faced prejudice in his previous school and was now hiding that part of his life from his new peers. Another was a student with a hearing impairment who relied on an interpreter and a note-taker, making their disability immediately visible in every classroom. A third student was a mature student who had earned a PhD in the humanities before deciding to study medicine, while the fourth was the first in their family to attend university and also identified as neurodivergent. Despite their different stories, they all shared a common experience: they felt they were stepping into a room where the furniture was arranged for someone else.

The students described a powerful, almost invisible stereotype of what a medical student is supposed to be. They imagined this "ideal" student as someone who had always been naturally brilliant, who had grown up with parents who were doctors, and who had spent their entire life preparing for this exact moment. They felt that this ideal student did not need to work hard because they were simply smart, whereas the students in the study felt they had to grind and struggle to keep up. One student recalled resitting chemistry exams multiple times, feeling that their hard work was a mark of their lack of natural talent, while the "stereotype" seemed to glide through with ease. Another student noted that many of their peers had family connections that gave them a head start, while they had to figure out the profession from scratch, without anyone to show them the ropes.

This clash created a sense of not fitting in. The students felt that their identities were at odds with the culture of the medical school. For the transgender student, the fear was so intense that they chose to hide their identity completely, even from friends they liked and trusted. They worried that if their peers knew the truth, they would be rejected, so they lived with a constant, low-level anxiety about being discovered. For the student with the hearing impairment, the struggle was different. Because the university provided an interpreter and a note-taker, their disability was visible to everyone. They felt that this visibility led to exclusion; in group work, other students would sometimes forget to include them in the conversation, assuming the interpreter would handle everything. They felt pushed to the edge of the circle, treated as an outsider rather than a peer.

To survive this tension, the students developed different ways of coping. Some tried to change themselves to match the stereotype. They told themselves that they did not need to be perfect or study every single hour of the day, trying to relax their own rigid expectations to fit the group. Others did the opposite: they leaned into their differences. They formed small, tight-knit groups with other students who felt like outsiders. In these groups, they found safety. They bonded over shared struggles, such as the pressure of poverty or the feeling of being the first in their family to achieve something so high. In these small circles, they could be themselves without fear. However, this solution came with a cost. By forming these separate groups, they sometimes found themselves looking down on the "traditional" students, viewing them as immature or oblivious to their own privilege. This created a new divide, where the medical school cohort was split into two camps: those who felt they belonged naturally, and those who had to fight for their place.

The study suggests that the problem is not just about the students needing to adjust. It is about the culture of medicine itself. The researchers found that the students were not the ones who needed to change their fundamental selves to fit in. Instead, the medical school environment needs to change to make space for the full range of human experience. The students in the study showed that they were capable, dedicated, and deeply motivated, often driven by a desire to help people who looked like them or came from backgrounds like theirs. But the pressure to hide who they are, or to constantly prove they belong, takes a heavy toll on their well-being.

The researchers concluded that medical schools need to do more than just open the door to diverse students. They need to actively challenge the old ideas of what a doctor looks like. This means showing students that it is okay to be the first in your family, to have a disability, or to have a different gender identity. It means recognizing that the "traditional" path is just one way among many. If the profession can shift its view to see these diverse backgrounds as a strength rather than a deficit, it might help students feel that they truly belong. The study does not claim to have solved the problem, but it offers a clear map of where the pain points are. It shows that for students from non-traditional backgrounds, the journey to becoming a doctor is not just about learning anatomy or pharmacology; it is a constant, often exhausting negotiation of who they are and who they are allowed to be.