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. 2025 May;40(6):1367-1377.
doi: 10.1007/s11606-024-09161-3. Epub 2025 Jan 9.

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

Hyacinth R C Mason  1 , Alexis Webber  2 , Tasha R Wyatt  3 , Devasmita Chakraverty  4 , Regina G Russell  5 , Catherine Havemann  6 , Dowin Boatright  7   8 , Huma Farid  9 , Stephanie Moss  10 , Mytien Nguyen  11
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Understanding the Medical Education Experiences of Low-Income Students Through a Maslow's Hierarchy of Needs Lens: An Exploratory Qualitative Study

Hyacinth R C Mason et al. J Gen Intern Med. 2025 May.

Abstract

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.

Keywords: Maslow’s Hierarchy of Needs; healthcare workforce; inclusion; low-income students; medical education; medical student support.

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Conflict of interest statement

Declarations:. None Ethical Approval:: All procedures were performed in accordance with the ethical standards of the Institutional Review Board (IRB) at Yale School of Medicine (myIRB#2000028071). Conflicts of Interest:: The authors have no relevant conflicts of interest to disclose. ICJME conflict of interest forms have been completed and are available upon request. Disclaimers:: This work was prepared by a civilian employee of the US Government as part of the individual’s official duties and therefore is in the public domain. The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the US Department of Defense.

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