About this poster

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Panel information
Panel 3. Schooling and Education

Abstract

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Despite increases in the enrollment of underrepresented medical students (URMs) in the United States, medical school attrition rates remain high (Yee & Kravitz, 2023). Current efforts toward the retention of URMs often focus on structural inequities and systemic biases, with less consideration for strengths-based and culturally salient approaches (Strayhorn, 2020). Looking at global contexts that have achieved high success rates in these avenues, the current study focuses on the experiences of medical students in Cuba. Notably, Cuba has been recognized for success in supporting underrepresented students worldwide in successfully navigating medical school (Kirkland et al., 2022). Cuba's medical training is a largely untapped resource for learning about culturally salient protective resources and processes.
Guided by a community cultural wealth framework (Yosso, 2005), the current study employed an asset-based mixed-methods approach to investigate the experiences of medical students near Havana, Cuba. Data were collected from 881 medical students (MAge = 21.51, SD = 2.23; 56% female, 72.2% Cuban) across six years of medical school enrollment (1st year = 14.8%, 2nd year = 10%, 3rd year = 24.2%, 4th year = 19.3%, 5th year = 11.8%, 6th year = 20%). We assessed differences in students’ sense of field belonging by gender, skin color, family legacy in medicine, and employment outside of the field of medicine.
Students indicated their sense of belongingness in the field of medicine by rating their level of agreement with the statement "I feel like I belong in the field of medicine" using a 5-point Likert scale ranging from "very much disagree" to "very much agree." Students also responded to one open-ended question, "Why did you pick that answer?". Thematic analyses were conducted to identify themes in students' justifications for their rating of sense of belonging. Multiple themes could be endorsed in a single response. Responses were coded by three independent coders and interrater reliability was 81%.
Quantitative findings indicate that most students felt as though they belonged in the field of medicine, such that 39.4% of participants indicated that they "agree" and 54.5% reported that they "strongly agree" (%) with the statement "I feel like I belong in the field of medicine." A smaller number of participants (1.5%) indicated that they disagreed or very strongly disagreed with the career belonging statement, and 4.6% of participants indicated that they neither agree nor disagree.
Qualitative findings revealed that the most highly endorsed themes for students feeling as though they belonged to the field of medicine were "enjoyment" (43%) and "personal goals" (23%) (see Table 1). The most endorsed themes for not feeling like they belong in the field of medicine include “lack of identification with the field” (54%) and “negative experiences” (54%). Independent sample t-tests revealed mean level differences in endorsement of the personal goals theme, such that women endorse the theme at higher levels than men t(367) =2.35, p = .02. Non-working students endorsed “enjoyment” t(55) =2.66, p = .01 and “confidence in skills” t(356) =3.36, p < .001 at higher rates than employed students. Theme endorsement did not vary by family legacy. An ANOVA revealed group differences in endorsement of “positive experiences” such that white students endorsed the theme at higher rates than mestiza students.
The current study underscores the importance of fostering supportive environments where future doctors can enjoy being medical students as they immerse themselves in the medical field and work toward their educational and career goals. Implications for interventions and medical school curricula include leveraging positive experiences in medicine and aiding students in accomplishing their career goals to promote a sense of field belonging and thereby promote retention among URM students.

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