It's easy to forget from our ivory tower that many Americans don’t get beyond high school, making it less likely their kids will. Those kids who do are at a disadvantage compared to peers with college-educated parents. First-generation medical students are even rarer and face more challenges. These students, like PA1 Julie Vuong, M1 Amanda Litka, MD/PhD student Faith Prochaska, and M1 Holly Hemann, bring valuable perspectives to medicine, understanding a wider range of patient experiences and health determinants.

This week we discuss their challenges, the impact on their future practice, and how learning medicine highlights (somewhat uncomfortably) their own families' health struggles. And while some medical schools are going tuition-free, this hasn’t increased low-income student enrollment or primary care graduates...and seems to have done some harm.