Aboudeif et al.

BMC Medical Education (2024) 24:1274 BMC Medical Education

https://doi.org/10.1186/s12909-024-06227-y

RESEARCH Open Access

Inherited privilege? First vs. continuing-

generation medical students in Egypt,
academic performance, extracurricular
training and expectations: a cross-sectional
study
Ayten Aboudeif1*, Youssef Elaraby1, Mohamed Hany1, Sara Nasser1, Nadine Refaat1, Yara Gamal Mohamed1, Reem
Youssry Khalil1, Hashim Khabiry1, Fatma Hussein Raafat1, Nour Ghazy1, Dina N.K. Boulos1,2 and Mostafa Yosef3

Abstract
Background The transition to college life is a highly demanding period for all students, especially when enrolling
into an academically-challenging field as that of medicine. First-generation medical students represent an overlooked
demographic and are thought to be more vulnerable to the stressors of college. This study’s aim is to explore
the differences between first and continuing-generation medical students in Egypt regarding their academic
performance, extracurricular training opportunities and future expectations.
Methods Two identical 24-item online questionnaires, in English and Arabic were distributed with five main themes:
general demographics, academic performance, extracurricular training opportunities (outpatient clinics, hospitals and
operating rooms), future expectations and if participants have relatives in the medical field.
Results Responses from 1652 eligible respondents from all 36 medical universities in Egypt were received.
Continuing-generation medical students achieved a higher cumulative grade, with 46.1% getting an “Excellent”
grade compared to only 38.4% in the first-generation. The gap between the two groups was best noted in Year 1
(p-value < 0.001), as continuing-generation medical students were almost twice more likely to score an “Excellent”
grade [Odds Ratio = 1.85 (1.48–2.31)]. First-generation group had less training opportunities in clinics (p < 0.001)
and operating rooms (p < 0.001). There was a significant difference (p < 0.001) across all three clinical settings in
regard to how the training opportunity was acquired. The majority of continuing-generation medical students
credited their family members for it. Amongst those who wish to travel, the majority of the first-generation medical
students plan to pursue their career in the United States; whereas, most of continuing-generation medical students
aimed for the Middle East and Western Europe.

*Correspondence:
Ayten Aboudeif
ayten.aboudeiff@outlook.com
Full list of author information is available at the end of the article

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Aboudeif et al. BMC Medical Education (2024) 24:1274 Page 2 of 9

Conclusion First-generation medical students had lower grades at first mainly due to their lack of awareness of
proper resources that were provided by the families of continuing-generation medical students. However, the
challenges posed to first-generation medical students prompted the development of higher resilience, enabling
them to catch up and even surpass their continuing-generation counterparts. Continuing-generation medical
students obtained further extracurricular training (outpatient clinics and operating rooms), accessed mainly through
their family members and connections; whereas, first-generation medical students received most of their training by
searching for it themselves.
Keywords First-generation medical students (FGMS), Continuing-generation medical students (CGMS), Egypt,
Academic performance, Extracurricular training opportunities, Future expectations

Background The difficulties that first-generation medical students

First generation medical students face are not limited to academic performance; they also
For ages, college life has presented numerous obstacles have a serious impact on their psychological health and
and challenges to students, owing to the immense load their quality of life (QOL). As indicated in an Associa-
they frequently encounter academically, emotionally, and tion of American Medical Colleges (AAMC) QOL survey
financially. Some students may be unable to endure the carried out in 2013, results of Medical Student Life Sur-
aforementioned hardships, prompting them to give up vey (MSLS), which targeted medical school students and
and drop out. Confronting these issues should be a top their personal wellbeing, showed that first-generation
priority as high quality education has been addressed by students scored worse than all other participants across
both the UN’s Sustainable Development Goals (SDGs) all the well-being measures (higher stress and fatigue,
and Egypt’s vision 2030 Sustainable Development Strat- and lower social support and quality of life) [7].
egy (SDS) to ensure that every student achieves their full On the other hand, confronting the aforementioned
academic potential [1, 2]. obstacles is thought to have caused their heightened
Noticeably, first-generation college students (FGCS) resilience, enabling them to be better adapted in the
(who have no parent or legal guardian with a bachelor’s management of the high pressure and dynamic working
degree or higher) are even more vulnerable to these dif- environment [4].
ficulties. They represent a large, often overlooked demo-
graphic even though a third of all college students in Egypt
the United States are composed of FGCS [3]. A previ- When it comes to Egypt, a severe shortage of doctors
ous study revealed a gap between first and continuing- was noted despite the great number of physicians who
generation college students (CGCS) by demonstrating graduate from medical schools. As of the academic year
that FGCS have lower emotional intelligence levels when 2020/2021, Egypt has had an estimated total number
compared to their continuing-generation counterparts of 70,000 medical students [8, 9] Moreover, with Egypt
despite FGCS having higher resilience levels [4]. possessing one of the oldest medical education estab-
This situation is similar for medical students as the lishments in the Middle East and North Africa (MENA)
level of stress they encounter greatly surpasses what stu- region and having 31 medical colleges registered in the
dents of other majors face. For medical students in the World Directory of Medical Universities, as of 2022; it
US, the four-year graduation rate ranged from 81.6 to is surprising that WHO’s Global Health Workforce Sta-
84.3%; thus, up to 18% of those students had to graduate tistics revealed that Egypt’s ‘Physicians per 1,000 people’
in 5–6 years or simply drop out [5]. has a value of 0.7, a value much lower than the world’s 1.8
In this study, a first-generation medical student (FGMS) and MENA’s 1.4, let al.one the US’s value of 2.6 and the
will be defined as someone who is the first in their family UK’s 5.8 [9, 10].
to enter medical school. FGMS may be unfamiliar with This emphasizes that the Egyptian health sector is
the various studying methods and elements of medi- under severe strain, which extends to the medical stu-
cal school. For instance, they may be unaware of impor- dents. Several Egyptian studies showed that a significant
tant learning materials and resources helpful in medical number of their medical students’ participants suffered
schools. Moreover, FGMS may be deprived of numerous from stress, depression, and burnout [11, 12].
extracurricular training opportunities that continuing- With limited research around the world, and none in
generation medical student (CGMS) may have because Egypt, we aspire to bridge the critical knowledge gap on
of their relatives. Further challenges that FGMS could the next generation of physicians. We will shed light on
encounter during their medical school years are: diffi- the potential dissimilarities between first and continu-
culties with studying and time management, feelings of ing-generation medical students in Egypt, concerning
imposter syndrome, and the fear of failure [6]. their academic performance, extracurricular training
Aboudeif et al. BMC Medical Education (2024) 24:1274 Page 3 of 9

opportunities and future expectations. This research, Pilot study

the first of its kind in Egypt, will serve as a starter study The questionnaire was peer reviewed and a pilot study
that may not only clarify whether these dissimilarities was carried out on 8 students from the school of Medi-
are indeed true, but will also act as a keystone for future cine at Newgiza University for clarity of questions’ word-
research. ing, understandability, as well as the time needed to fill it.
Both surveys (English and Arabic) were attempted dur-
Methods ing the pilot study. The results of the pilot study were not
Definition of first and continuing-generation medical included in the final analysis.
students Pilot results implied a clear discrepancy between
We decided that, for the purpose of this study, a first- FGMS and CGMS in the 3 parameters (grades, training
generation medical student (FGMS) will be defined as opportunities and future expectations), but had mul-
someone who is the first in their family to enter medical tiple drawbacks. Respondents brought to our attention
school, whereas a continuing-generation medical student that some questions were redundant and that the initial
(CGMS) will be defined as someone who comes from a draft took too long to complete. Repetitive revisions led
family in which a parent or a relative is a physician [13]. to using branching logic in the survey design which led to
more efficient data collection and provided a more user-
Study design friendly questionnaire.
The study aimed to assess whether there are differences
between first-generation medical students and continu- Participants
ing-generation medical students in regard to academic The study targeted current medical students in Egypt
performance, extracurricular training opportunities and from both public and private universities due to the
future expectations. This cross-sectional study was con- vastly different backgrounds, financially or socially. Egypt
ducted in Egypt via an online survey collected by conve- has 31 registered medical schools in the world directory
nience sampling. Taking into consideration the limited of medical schools (WDOMS) as of August 2022. All aca-
public platforms connecting medical students in Egypt, demic years’ students in Egypt (1st year through 6th year)
an online survey was the optimal tool to be used. were eligible to participate. Non-Egyptian medical stu-
dents studying in Egypt were excluded as they don’t face
Questionnaire and distribution the same circumstances that Egyptian students face.
The items in the questionnaire comprised a mixture of
question styles including multiple choice questions and Sample size
matrices. Two identical 24-item questionnaires, in Eng- Using PASS 15 program for sample size calculation, it is
lish and Arabic were distributed with five main themes: estimated that a sample of 1000 first-generation and 500
continuing-generation medical students can detect even
1. General demographics. a small effect size difference between the two groups
2. Annual grades (for each previous year). regarding qualitative outcome measures (academic
3. Whether participants have relatives in the medical grade) (Cohen’s h coefficient = 0.2) with power 99% and
field or not. alpha error 0.05.
4. Extracurricular medical training (not included in
current medical college program), if any and how Data analysis
they were acquired. The collected data was analyzed using IBM SPSS Statis-
5. Participants’ expectations of their future salary and tics 27. Differences between first and continuing-gener-
desired region to work in. ation medical students regarding grades, opportunities
and future expectations were tested for significance using
The full English Questionnaire is presented in supple- the Chi-Square test. p-value less than 0.05 was considered
mentary material (1). statistically significant for all tests. Cumulative grade was
Clinical opportunities were assessed in terms of extra- calculated by taking the average of the 5 years’ grades and
curricular training in 3 clinical settings: outpatient clin- rounding it to the nearest whole grade (Excellent ≥ 85%,
ics, hospitals and operating rooms (OR), the extent of Very good ≥ 75%, good ≥ 65%, pass ≥ 50% and fail < 50%),
involvement was assessed (observation or hands-on par- which is the established grading system in Egypt.
ticipation) in each setting. The questionnaire was built
using Microsoft form and distributed through social Results
media channels (Facebook and WhatsApp) from the 1st Cohort demographics
of August 2022 till the 2nd of November 2022. Upon applying the inclusion and exclusion criteria onto
a total of 1856 responses, 1652 were eligible respondents
Aboudeif et al. BMC Medical Education (2024) 24:1274 Page 4 of 9

Table 1 Percentage of medical students achieving each [30.5% (n = 314)] with an odds ratio (95% CI) of 1.85
cumulative grade in both groups (1.48–2.31) (p < 0.001). This difference in Year 1 grades
FGMS CGMS was the main contributor to the significant differences
Fail 0.2% (n = 2) 0.6% (n = 3)
of “Excellent” grade percentages seen in the cumulative
Pass 3.7% (n = 38) 3.9% (n = 19)
grade between both groups. (Tables 1 and 2)
Good 18.6% (n = 191) 19.1% (n = 93)
An apparent trend was observed in the percentages
Very Good 39.2% (n = 403) 30.2% (n = 147)
of “Excellent” grades along the years between the two
Excellent 38.4% (n = 395) 46.1% (n = 224)
groups. Both groups had a progressive increase in the
Pearson Chi-Square p-value = 0.008. The significance was due to differences in
“Very Good” and “Excellent” grades percentages of students achieving “Excellent” grades
along the years. For CGMS, it was a slow fluctuating
increase with a head start in front of FGMS in Year 1
(Egyptian Medical students), 67.4%(n = 1114) were first- (44.9% in CGMS vs. 30.5% in FGMS). However, FGMS
generation medical students (FGMS) and 32.6% (n = 538) had a steep constant increase; where they were achieved
were continuing-generation medical students (CGMS). similar grades to CGMS in Year 3 (45.6% in FGMS
Responses of 154 medical students were excluded from vs. 44.6% in CGMS), surpassed them in Year 4 (52.1%
the Opportunities subsection due to a discrepancy in in FGMS vs. 47.4% in CGMS), and almost having the
answering questions 17 and 18 in the survey. Responses same percentages in Year 5 (53.4% in FGMS vs. 55.4% in
were collected from 36 medical schools across Egypt, CGMS). (Fig. 1)
82.6% (n = 1364) of responses came from public universi-
ties while 17.4% (n = 288) of responses came from private Opportunities
universities. The majority of respondents were from Year Outpatient clinics & hospitals
6, 21.7% (n = 358), while the minority of students were CGMS had better opportunities in both observation and
from Year 1, 8.2% (n = 137). Mean age of respondents hands-on participation (p < 0.001) in outpatient clinics.
was 21.42 ± 2.21 and of the total eligible respondents, 758 For observations, CGMS were 18.0% (n = 88) vs. 10.0%
(45.9%) were male and 894 (54.1%) were female. (n = 101) in FGMS and for hands-on participation, CGMS
were 6.7% (n = 33) vs. 3.1% (n = 31) in FGMS. However,
Grades upon comparing the hospital setting, there was no statis-
There was a significant difference in cumulative grade tically significant difference (p = 0.455). (Table 3)
between the first and continuing-generation medical stu-
dents (p-value = 0.008). The significance was due to dif- Operating rooms
ferences in “Very Good” and “Excellent” grades. CGMS had more opportunities in both observation and
The most frequent cumulative grade obtained by each hands-on participation (p < 0.001) in operating rooms.
generation was “Very Good” in FGMS [39.2% (n = 403)], For observations, CGMS were 22.7% (n = 111) vs. 16.7%
and “Excellent” in CGMS [46.1% (n = 224)]. Moreover, (n = 169) in FGMS and for hands-on participation, CGMS
the percentage of CGMS having “Excellent” as cumula- were 4.9% (n = 24) vs. 1.8% (n = 18) in FGMS. (Table 3)
tive grade was 7.7% higher than the percentage of FGMS When assessing how the clinical opportunity was
having “Excellent” as cumulative grade 38.4% (n = 395). accessed, in all three clinical settings, most FGMS
(Table 1) accessed the opportunity by their own search. Moreover,
Only the first-year score exhibited a significant differ- CGMS had a much higher percentage of accessing the
ence between the two groups as the percentage of CGMS opportunity through family members than FGMS in the
scoring “Excellent” grade [44.9% (n = 218)] was higher 3 clinical settings; in outpatient clinics, 49.6% (n = 60) of
than the percentage of FGMS achieving “Excellent” grade CGMS vs. 7.6% (n = 10) of FGMS (p < 0.001), in hospital

Table 2 “Excellent” grade & other grades in each year between FGMS & CGMS
Grade FGMS CGMS p-value Odds Ratio (95% CI)
Year 1 Other grades 69.5% (n = 715) 55.1% (n = 268) < 0.001 1.85 (1.48–2.31)
Excellent 30.5% (n = 314) 44.9% (n = 218)
Year 2 Other grades 61.6% (n = 514) 57.9% (n = 223) 0.218 1.17 (0.91–1.49)
Excellent 38.4% (n = 320) 42.1% (n = 162)
Year 3 Other grades 54.4% (n = 360) 55.4% (n = 164) 0.768 0.96 (0.73–1.26)
Excellent 45.6% (n = 302) 44.6% (n = 132)
Year 4 Other grades 47.9% (n = 226) 52.6% (n = 101) 0.270 0.83 (0.59–1.16)
Excellent 52.1% (n = 246) 47.4% (n = 91)
Year 5 Other grades 46.6% (n = 124) 44.6% (n = 41) 0.734 1.09 (0.67–1.75)
Excellent 53.4% (n = 142) 55.4% (n = 51)
Aboudeif et al. BMC Medical Education (2024) 24:1274 Page 5 of 9

Fig. 1 Percentages of “Excellent” grade in each year between FGMS & CGMS

Table 3 Participation in each clinical setting between FGMS & CGMS

None Observation Hands-on p-value
Outpatient Clinic FGMS 86.9% 10.0% 3.1% < 0.001
(n = 877) (n = 101) (n = 31)
CGMS 75.3% 18.0% 6.7%
(n = 368) (n = 88) (n = 33)
Hospital FGMS 69.0% 22.1% 8.9% 0.455
(n = 696) (n = 223) (n = 90)
CGMS 66.1% 24.9% 9.0%
(n = 323) (n = 122) (n = 44)
Operating Room FGMS 81.5% 16.7% 1.8% < 0.001
(n = 822) (n = 169) (n = 18)
CGMS 72.4% 22.7% 4.9%
(n = 354) (n = 111) (n = 24)

settings 25.3% (n = 42) of CGMS vs. 1.9% (n = 6) of FGMS When asked whether they plan on pursuing their career
(p < 0.001) and in OR 34.1% (n = 46) of CGMS vs. 1.1% in Egypt or abroad, no significant difference was found
(n = 2) of FGMS (p < 0.001). (Table 4) between the two groups (p = 0.075); as 50.7% (n = 565)
of FGMS wanted to travel abroad vs. 55.4% (n = 298) of
Future expectations CGMS. Upon calculating the total of all respondents
Regarding the expected future salary, no significant dif- who want to travel abroad in both groups, 52.2% (n = 863)
ferences were noted between the 2 groups (p = 0.195). wanted to continue abroad.
However, it is worth noting that the majority of both Nevertheless, amongst those students who intend to
groups expect that their future salary to be either insuf- travel abroad, a significant difference was noted between
ficient or just sufficient and a small percentage [8.1% the region they plan to work in (p = 0.017), the signifi-
(n = 90) in FGMS & 10.8% (n = 58) in CGMS] expect it to cance was due to differences in choosing the US and
be more than sufficient. Western Europe. The majority of FGMS [31.7% (n = 179)]
Aboudeif et al. BMC Medical Education (2024) 24:1274 Page 6 of 9

Table 4 How the clinical opportunity was accessed between FGMS & CGMS
FGMS CGMS p-value
Outpatient Clinic Family Member 7.6% (n = 10) 49.6% (n = 60) < 0.001
Family Friend 21.2% (n = 28) 7.4% (n = 9)
Own Search 71.2% (n = 94) 43.0% (n = 52)
Hospital Family Member 1.9% (n = 6) 25.3% (n = 42) < 0.001
Family Friend 8.9% (n = 28) 6.6% (n = 11)
Own Search 89.1% (n = 279) 68.1% (n = 113)
Operating Theatre Family Member 1.1% (n = 2) 34.1% (n = 46) < 0.001
Family Friend 15.5% (n = 29) 9.6% (n = 13)
Own Search 83.4% (n = 156) 56.3% (n = 76)

Table 5 FGMS & CGMS desired work abroad destination family members whenever they encounter obstacles with
FGMS CGMS studying.
Middle East 24.2% (n = 137) 29.2% (n = 87) As illustrated in Fig. 1, the difference in “Excellent”
Eastern Europe 4.8% (n = 27) 4.7% (n = 14) grades in both groups is clearly diminishing along the
Western Europe 22.1% (n = 125) 29.2% (n = 87) years with a steady and sustained rate, obliterating any
USA 31.7% (n = 179) 24.5% (n = 73) major differences seen in first academic years. Our lead-
Other 17.2% (n = 97) 12.4% (n = 37) ing suggestion is that due to hardships experienced in
Pearson Chi-Square p-value = 0.017. The significance was due to differences in the foundation years, FGMS have already gained enough
choosing the US and Western Europe
experience and adaptability to perform on an equal foot-
ing with their continuing-generation counterparts, giving
chose the US, followed by the choice of the Middle East them greater resilience and flexibility than their peers.
[(24.2% (n = 137)], while the majority of CGMS chose Two further investigations conducted in the United
equally between the Middle East [(29.2% (n = 87)], and States in 2017 and 2021 reached similar conclusions [4,
Western Europe [(29.2% (n = 87)]. (Table 5) 6].
Year 4 often marks the initiation of the clinical years
Discussion of medicine in most Egyptian universities, which
The study aimed to detect the difference between FGMS may explain why more FGMS scored an “Excellent”
& CGMS in “Excellent” grade rate throughout the years. grade compared to CGMS [14]. As clinical experience,
The difference in “Excellent” grade between the two undoubtedly, differs from the previous foundation years,
groups was most noticeable in Year 1. Another unex- our study suggests that the reason behind the grade turn-
pected finding was the difference in the extracurricular over was the developed adaptability of FGMS, which
training opportunities and how they were accessible. allowed them to adapt and adjust to the perplexity of the
experience quicker.
Grades
The differences in “Excellent” grades seen in the first year Opportunities
could possibly be attributed to the probability that FGMS A LinkedIn study examined how connections in online
may enroll into medical school with unrealistic expec- social networks impact job search results. Users’ strong
tations, not realizing the need to change their simpler links were especially useful in producing employment
methods of studying in high school into the demanding leads, interviews, and offers, whereas weak ties were inef-
methods of studying the subjects of medicine. In con- fective in generating positive outcomes [15]. The medical
trast, CGMS are provided guidance on the complexities field is no exception to this phenomena as nepotism is
of medical school and have more realistic expectations. prevalent in medicine throughout the world. An exam-
Another probable cause of this gap may be linked to ple of this is expressed by an article in Greece, suggested
various benefits more readily available to CGMS, such that a continuing-generation medical student may be
as having better knowledge about the medical academic co-author in over 200 publications at a young age due to
system and necessary studying resources (medical text- “support” from the entire school’s faculty in hopes of gra-
books, online videos, and tutorials, etc.). Such invaluable tuity from the student’s parent [16].
tools are underutilized by the academically-naive FGMS, Our findings were consistent in both outpatient clinics
perhaps due to being unaware of their existence, under- and operating room (OR). Even though most clinics in
estimating their importance, or being unable to select the Egypt do not offer training programs affiliated with medi-
most beneficial and relevant resources to their academic cal universities, numerous medical professionals train
stage. In addition, the CGMS are directly assisted by their members of their immediate families in their own clin-
ics to ease the transition of “inheriting” the family clinic.
Aboudeif et al. BMC Medical Education (2024) 24:1274 Page 7 of 9

Similarly, in OR Training setting, many surgeons allow students in Egypt face a myriad of struggles, with the
their medical relatives to attend and sometimes even par- financial situation being the main driving factor, often
ticipate in operating rooms, so that they get the chance to resulting in them leaving the country, contributing to
view procedures and gain early firsthand experience. Egypt’s ever-growing brain drain problem [19, 20].
On the other hand, our analysis of hospital training When asked about their abroad postgraduate employ-
revealed no statistically significant difference between ment goals, respondents revealed an unexpected ten-
the two generations. It is presumed that this is because dency. The fact that the United States is the most desired
many hospitals in Egypt adhere to a higher standard of destination by FGMS may be attributed to not having
professionalism regarding their training programs, mak- enough information, optimism, or simply personal pref-
ing them accessible to all medical students regardless erences. Unlike CGMS, who may have firsthand advice
of their parentage. Furthermore, both groups routinely from medical relatives, FGMS may not be aware of the
attend various hospital visits during their clinical years enormous number of challenges in the path of obtaining
in their current curriculum, possibly leading to a general an American medical license.
disinterest in pursuing additional hospital visits for both The CGMS’ most desired destinations (Western Europe
groups. and Middle East equally) could be highly influenced by
With most CGMS citing family members as the reason their medical relatives’ experiences. The general medical
behind opportunities in the three clinical settings, hav- council reported that the number of Egyptian doctors
ing a family member in the medical industry was iden- joining the United Kingdom medical system has tripled,
tified as the primary cause of disparity between the two with that being the case, it was expected to witness such
groups. To the contrary, FGMS still depended heavily answers [21].
on their own search to acquire the training and had to For several reasons (cultural and bureaucratic), the
actively seek out training opportunities, requiring more Middle East, especially the Gulf area, was found to be a
time and effort. FGMS attempted to use family-friends as common destination for both generations. Young doc-
connections, which turned out to be a weaker tie com- tors find it appealing as it provides a work-life balance,
pared to the familial ties of CGMS. Yet, they fell short to sufficient income along with career development. Not to
the amount of training received. These findings demon- mention that they would be close and within the same
strate that there is a lack of official routes for opportuni- home region. Although European nations are among the
ties in Egypt and a heavy reliance of the Egyptian medical top destinations, some young doctors are starting to pre-
field on connections. fer the Saudi option [22].
For long, undergraduate universities in the USA have
Future expectations had first-generation centered educational and adminis-
As previously mentioned, WHO’s Global Health Work- trative programs to address the pressing challenges they
force Statistics exhibited that Egypt’s ‘Physicians per face; the need for university-culture readiness and the
1,000 people’ has a value of 0.7, a value much lower than lack of professional/social networks required in career
the world’s 1.8 [10]. The results of the future expectations decision making [13]. Recently, US medical schools
in this study may explain some reasons behind such a low started following the footsteps of other universities,
number. which led to several strategies and efforts being launched
In terms of salaries, the majority of both groups believe recently as mentioned by the AAMC [23].
that their salaries won’t be more than sufficient. These Internationally, several programs have been founded
findings came as no surprise given the current inflation- to address and treat the gaps between first and continu-
ary state of Egypt and the fact that physicians’ careers ing-generation students in different fields. An inspiring
typically begin late [17]. example is the David Geffen School of Medicine at Uni-
These findings can also be explained by the latest trend versity of California Los Angeles (UCLA) establishing a
of multiple job holdings. According to the Medscape First-Gen program in 2017, with mentorship, academic
2022’s physician compensation report, 36% of physicians assistance, educational transitions and home identity,
took on additional work to increase their income [18]. and community-building defining the four pillars of their
Physicians typically work at their private clinics, hospi- program [13]. Such worldwide initiatives act as an alarm
tals, and universities. With this in mind, medical students that medical schools in Egypt must develop creative solu-
are inclined to believe that a single source of income will tions to maximize students’ full potential.
be insufficient to fulfill their future needs. Based on the study findings, it is recommended that
Analyzing whether the participants planned on pursu- medical universities in Egypt initiate a program aimed
ing their career in Egypt or abroad, it was alarming that at first-year medical students as well as high-school
more than half of our respondents (52.2%) in both groups students interested in attending medical school. This
plan on working abroad. It is well known that medical program should include a detailed illustration of what
Aboudeif et al. BMC Medical Education (2024) 24:1274 Page 8 of 9

medical school entails, such as: a clear tutorial of sub- CGMS obtained further extracurricular training (out-
jects taught in the foundation years of medicine, educa- patient clinics and operating rooms), accessed mainly
tion about the Egyptian medical school system, different through their family members and connections; whereas,
studying resources and supplementary material (ques- FGMS received most of their training by searching for it
tion-banks and mock exams) that are appropriate for on their own.
their academic stage.
Abbreviations
Another program could be integrated for medi- AAMC Association of American Medical Colleges
cal students of all years. One suggested program would CGCS Continuing-generation college students
inform them of the different specialties in medicine and CGMS Continuing-generation medical students
FGCS First-generation college students
their advantages and disadvantages along with detailed FGMS First-generation medical students
information of possible routes to each of the regions MENA Middle East & North Africa
mentioned in our study. Furthermore, universities may MSLS Medical Student Life Survey
OR Operating Room
implement programs to provide FGMS with critical QOL Quality of life
extracurricular activities such as internships, elective SDGs Sustainable Development Goals
modules, research opportunities, and clinical training. SDS Sustainable Development Strategy
UCLA University of California Los Angeles
A mentorship program that pairs First-generation US United States
alumni doctors in mentor roles with FGMS as their
respective mentees would enable them to provide knowl-
edge on how they overcame the hurdles that come with Supplementary Information
being a first-generation. The online version contains supplementary material available at ​h​t​t​​p​s​:​/​​/​d​o​​i​.​​o​r​
g​/​1​0​.​1​1​8​6​/​s​1​2​9​0​9​-​0​2​4​-​0​6​2​2​7​-​y​​​​.​ ​​
A nationwide initiative of student-led associations
where FGMS engage and share their experiences with Supplementary Material 1
one another could garner a feeling of solidarity, raise
Supplementary Material 2
morale, and help in eliminating the feeling of imposter
Supplementary Material 3
syndrome.
Further studies are needed to determine whether or
not implementing these initiatives is effective. Acknowledgements
The authors thank all the study participants and Habiba Elmahy, our dear
colleague who assisted us with the initiation of the study.
Limitations
The use of non-random convenience sampling via social Author contributions
All authors actively participated in the development and evolvement of the
media platforms (Facebook and Whatsapp) resulted in a paper’s topic. AA devised the initial idea for the research. AA and YE created
lack of generalizability in the sample. Another limitation the online questionaries. NR, MH, YE helped in acquisition of data. SN and
of using an online survey is our inability to calculate the MY substantially contributed to data analysis and interpretation. MH and
SN designed the tables and figures. YE, AA, MH, NR, YM, RK, HK, FH, and NG
response rate. Thus, the number of students in the study took part in the drafting and writing of the manuscript. MY, YE, MH, AA, RK
is not an accurate representation of the total number of substantively revised the paper’s content and linguistics. MY supervised all the
students in each university. proceedings. DB reviewed the paper. All authors gave final permission of the
manuscript to be published and agree to be accountable for every aspect of
Thirdly, using an online survey makes the results liable the paper.
to selection bias. To address this limitation, a large sam-
ple size was targeted. In addition, the survey was shared Funding
No funding was received from any institute, company, organization or
on different social media platforms to attempt equitable individual.
reach to the intended population. Open access funding provided by The Science, Technology & Innovation
Our data was gathered through self-reporting, which is Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank
(EKB).
prone to bias, especially when it comes to their academic
performance; thereby, an anonymous questionnaire was Data availability
provided. The datasets used and/or analyzed during the current study are available from
the corresponding author on reasonable request.

Conclusion
Declarations
FGMS initially had relatively poorer grades than CGMS
in Year 1, maybe due to their lack of awareness of proper Ethical approval and consent to participate
resources that were provided by the families of CGMS. Ethical approval was taken from Newgiza University School of Medicine’s
Research Ethics Committee (REC). All ethical rules were followed according to
However, the challenges posed to FGMS most-likely the Declaration of Helsinki. Medical students’ participation was voluntary, and
prompted the development of greater resilience, enabling all responses were anonymous. An introductory paragraph at the beginning
them to catch up with and even surpass their CGMS of the questionnaire was used to explain the main objective of the study
and to confirm that responses would only be used for research purposes. An
counterparts.
Aboudeif et al. BMC Medical Education (2024) 24:1274 Page 9 of 9

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