Reframing Maslow to Comprehensively Consider the Needs of All Trainees.

The medical education system is not designed to recognize and support the nuanced needs of medical trainees from historically marginalized groups. Consequently, many from this cohort must persevere through their medical training with various unmet needs. Within the medical education system, there have long been systemic barriers, or structural inequities, that make training more difficult for trainees from historically marginalized groups; the situation is unfair and can translate into unequal educational outcomes. Regrettably, the convention of ignoring the impact of structural barriers and resultant inequities for trainees from historically marginalized groups may lead to assumptions of innate deficiencies. This deficiency discourse obscures the impact of structural barriers on these individuals' learning, well-being, and academic outcomes. In this paper, we present a novel framework to bring attention to these challenges. This framework emerges from Maslow's 'Hierarchy of Needs' theory to emphasize the importance of comprehensively considering trainee needs that ultimately support their learning and flourishing. Practically, this modified framework may be used directly by trainees themselves to reflect on their needs, and by educators charged with supporting them to more fully bear in mind the lived experiences of trainees. At the programmatic level, the framework may reveal inequities that may be differentially influential within a cohort - thereby informing efforts to support all trainees.