Labour upon labour: A best evidence medical education (BEME) meta-ethnography of underrepresented students' experiences of medical school

Abstract

Background: To date, advancing social justice in medical education has largely focused on recruitment and numerical representation of equity deserving groups. However, students recruited to diversify the profession often find themselves in an exclusionary environment that overlooks their multiple identities. The aim of this study was to illuminate underrepresented students' experiences of medical school to inform supports for these deserving students.

Methods: This meta-ethnography followed the seven steps developed by Noblit and Hare. Databases were systematically searched for peer-reviewed qualitative articles published between 2000 and late 2024 that described underrepresented students' experiences of medical school. Participants' and authors' concepts were collected and synthesized to develop new overarching concepts.

Results: Forty-nine qualitative studies met the inclusion criteria. Four overarching concepts were developed: working ten times harder; embodying the 'ideal' doctor; invisibility and hypervisibility; and survival strategies.

Conclusions: This meta-ethnography deepens our understanding of historically excluded students' experiences of medical school. The default ideal of the (cis, white, wealthy, male, non-disabled) physician created an exclusionary environment that underrepresented students were forced to manage through additional cognitive, emotional, and embodied effort. This synthesis provides valuable strategies and considerations for medical educators and administrators committed to social justice initiatives grounded in underrepresented student voices.