Living in two worlds: Becoming and being a doctor among those who identify with “not from an advantaged background”

•Medical students with socio-economic disadvantage backgrounds feel a tension between their former lives and medical school•Socio-economically disadvantaged medical students thought they may understand and feel more empathy towards disadvantaged patients•Socio-economic disadvantage among medical students intersects with ethnicity and parental education, immigration and rural backgrounds•The opportunity to reflect on medical school and professional identity development was valued by those from socio-economic disadvantage•Safe, pedagogical opportunities to discuss intersectional socio-economic experiences may support empathy and responsiveness to health inequities We aim to deepen understanding of the experiences of becoming and being a physician among those in medicine who are ‘not from advantaged backgrounds’. Despite modest success with institutional efforts to increase the diversity of medical school students, individuals with this less visible dimension of diversity remain under-represented across North America and the UK. Further, little is known about their experiences and contributions following medical school entry. In-depth interviews were carried out with twelve participants, including eight medical students, a resident and three physicians to explore experiences in medicine among those who self-identify with ‘not from an advantaged background’. Reflection on the meaning of those experiences was encouraged. Intersectional identifications were common in relation to ‘not from an advantaged background’. For some, the latter was background to identification with upbringings that were rural, influence by ethnicity, personal or parental immigration, and parents who were single or had limited education. Themes that arose in relation to being and becoming a doctor for these participants included: (1) the hidden curriculum's contribution to silencing markers of socioeconomic under-privilege; (2) limited formal curriculum opportunities to discuss socio-economic difference; (3) professional identity construction including empathy for the varied challenges of low-income patients in clinical situations and (4) living in two worlds: with a tension between the medical world and one's original world of socializing with friends and family from a non-advantaged upbringing. This study offered a unique, welcome opportunity to reflect on professional identity development in relation to one's family's socio-economic status. Safe, inclusive pedagogical opportunities to