# The Struggle to Belong for Underrepresented Medical Students: A Narrative Review

## TL;DR

This paper explores how underrepresented medical students struggle to feel they belong in medical school due to systemic issues and social exclusion.

## Contribution

The study applies critical sociological theory to analyze how belonging is shaped by systemic oppression in medical education.

## Key findings

- Underrepresented students feel excluded from peer bonding and perceive medicine as an 'exclusive club'.
- Experiences of prejudice and social exclusion affect students' sense of belonging and well-being.
- The struggle to belong is linked to systemic issues impacting professional identity and career choices.

## Abstract

The concept of belonging (i.e., the feeling of connectedness with the people and environment around you) may, at first glance, seem straightforward and aspirational. However, there is a dark side to belonging when it becomes a driver to conform to unspoken and socially enforced group expectations. Applying critical sociological theory of the personal and political of belonging to undergraduate medical education, we asked: what are the experiences of belonging for underrepresented medical students?

We conducted a narrative review of 16 qualitative research articles. We included papers published up to October 2024 that studied underrepresented medical students, defined as students who have been historically marginalized in medicine. Analysis involved interpreting students’ experiences of personal and political belonging and the consequences of the interplay between these two dimensions.

Underrepresented medical students perceived a marked division between themselves and their peers—who they described as ‘a different breed.’ They saw medicine as an ‘exclusive club’ where their differences were highly visible and felt excluded from activities that were considered foundational for peer bonding. A lack of understanding from, and commonalities with, other students, as well as experiences with prejudice and social exclusion within the curriculum and from educators, negatively impacted students’ ability to feel at home in medical school.

Our review highlights underrepresented medical students’ struggle to belong in medical school. This struggle is not simply a matter of personal connection; it is rooted in systemic oppression and can have profoundly harmful impacts, ultimately influencing professional identity formation, choice of specialty, and well-being.