Purpose: The purpose of this research is to identify and describe the impact of the support system on the career development of first generation college graduates. Research Questions: --What comprises the first generation college graduates' support system for each generation (i.e. social network, friends, family and colleagues and mentors)? --What is the relative importance/influence of each support system component in career development for each generation? Design/Methodology/Approach: There were a total of 21 in-depth interviews with equal number of participants for all three generations (Baby Boomers, X and Y). The interviews were recorded, transcribed and then coded. Further, there are cross case and within case analyses. Research Limitations: No participants were born outside of the range of 1946 to 1990. While women were equally represented during the purposeful sample selection, the research did not delve into gender differences study.

First-generation and low-income college graduates are an invisible minority within medicine that has gone largely unstudied. I explored their unique experiences to better understand how diversity and inclusion can be improved. Through gathering stories from students, residents, and attending physicians, I identified unique challenges that they face, and formulated strategies to address them. First-generation college graduates in medicine have a unique set of strengths, challenges, and opportunities that position them to be valuable physicians in the communities that they serve. The American Medical Association states that when minority students finish medical school and residency, they go on to serve society in a way that has not been done before. Furthermore, they are more likely to serve underserved and minority populations, in turn fostering justice and equity in medicine. Some of the qualities that most first-generation college graduates possess that make them well-suited to become successful physicians are resilience, self-motivation, and efficacy. Paving the path for future physicians is a tremendous pressure that can motivate or overwhelm them as they trailblaze their way through medicine. There is an accumulated disadvantage as they are more likely to be underprepared academically, to have less guidance, and to have more financial struggles. First-generation students have several traits that characterize them as an at-risk population in higher education; they take longer to complete their bachelor’s degree and have lower degree aspirations when compared with their peers. They also face moral distress and a growing disconnect as they balance their familial obligations with academics and experience social mobility. Though these are factors that impact their success in college, they do not cease to pose issues when they successfully enter medical school and have to navigate the culture and hierarchy of medicine, as well as the disparate allocation of resources in medical school as they are not deemed as underrepresented in medicine. By understanding these factors, administrators can strengthen pipeline programs and support systems. In supporting the next generation of first-generation physicians at all stages of their training, they can promote a workforce as diverse as the patients it serves. / Urban Bioethics