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

Introduction: 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? Methods: 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. Results: 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. Discussion: 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.