The Appalachian Medical Student Experience: A Case Study

The Appalachian region is a rural swath of mountainous terrain home to a historically distinct culture. The region’s population suffers from a multitude of health issues and disparities. Notably, the region also experiences a major healthcare provider shortage despite the fact that states, like West Virginia, produce per capita, a high volume of physicians. Appalachia, and particularly West Virginia, also suffers from a number of educational disparities, which culminates into low numbers of college graduates within the population. There is a plethora of research that has explored the first-generation college student, students from rural and Appalachian backgrounds, first-generation and rural students who go to medical school, and what factors ultimately motivate a physician to choose practice in a rural locality. However, there is a dearth of literature related to the experience of medical students from Appalachia. This project begins filling that chasm. This case-study utilizes a constructivist epistemology and leverages semi-structured interviews of ten final year medical students at one medical school. All medical students in this study spent formative years in Appalachia. The researcher employed open-coding techniques and NVivo software to analyze and organize collected data. The project includes three research questions. The first two questions relate to how relationships with home and family change throughout the students’ academic journey to and through medical school and what serves as motivators or barriers for student academic success. The two questions are analyzed through Bourdieu’s habitus. Students in this study largely recognized a close association with family and tight social circles in their home community. Moreover, they expected, from an early age, to go to college. While many felt support for college, it was not uncommon to face questioning parents or occasional derisive attitudes from extended family when considering medical school. Moreover, students struggled to access reliable resources in their community, including physicians. Despite these challenges, students in this study were well positioned to connect with and treat patients in the clinical phase of the curriculum, in-large part due to reconnecting with cultural associations. The third question relates to motivations and barriers to staying and practicing in Appalachia and West Virginia. This question is explored through the lens of Tönnies’ gemeinschaft/gesellschaft. Students regularly feel pulled in two directions, such as returning home to serve their local community, or at least staying in the region, while also feeling the allure to seek specialties and opportunities in population centers and medical centers outside of Appalachia. On one side, students are drawn to a familiar rural lifestyle and tight family bonds versus pursing medicine elsewhere, which include personal and professional benefit. Graduating medical students from Appalachia have spent their life working toward attaining the medical doctorate, and ultimately they are left to decide what they will do next, which may include leaving Appalachia altogether