Defense Date

3-11-2026

Graduation Date

Spring 5-9-2026

Availability

Immediate Access

Submission Type

dissertation

Degree Name

EdD

Department

Educational Studies (General Education)

School

School of Education

Committee Chair

Gretchen Generett

Committee Member

Tara Abbott

Committee Member

Amy Olson

Committee Member

Alydia Thomas

Keywords

Social Determinants of Learning, Medical Student Well-being, Social Determinants of Health, Time Poverty

Abstract

Medical education traditionally follows a biomedical paradigm that emphasizes academic rigor but often overlooks non-academic factors that fundamentally influence student success. The aim of this study was to reconceptualize medical student development by shifting focus from traditional academic metrics to the systemic, non-academic factors that affect learning and well-being.

This study employs a systemic analysis of structural barriers, defined as institutional policies, practices, and environments that create and perpetuate inequity in medical education. This investigation was grounded in the Integrated Social-Ecological Framework for Learning (ISEF-L), a three-tiered conceptual framework developed for this study. The ISEF-L includes Social Determinants of Learning (SDOL), such as mental health, financial stability, and sense of belonging, at its foundation, along with Social Cognitive Theory (SCT) and Trauma-Informed Practices (TIP) to examine the entire learning environment. The ISEF-L helps identify systemic barriers and guides institutions in creating comprehensive, multi-level interventions that promote equitable outcomes for all students.  Using a descriptive quantitative method, the study analyzed survey data from 119 first- and second-year medical students (OMS1 and OMS2) at Nexus University College of Osteopathic Medicine (NUCOM), an institution with a stated mission to increase diversity of the physician workforce and serve underserved marginalized communities.

The findings reveal an interesting paradox: while students demonstrate a strong proactive desire to seek support, such as mental health support and academic support, they encounter significant structural barriers specifically time poverty and administrative ambiguity that result in low resource utilization. Data indicates a pattern of “passive awareness,” where students are aware of available services but lack procedural clarity on how to access them. This suggests a disconnect between resource visibility and proactive seeking behavior, as awareness alone is insufficient to drive engagement. Consequently, even when students are aware of a resource in theory, navigational and structural barriers like time poverty may leave them functionally unable to access it. Additionally, the study identifies a "belongingness gap" and emphasizes how "time poverty" and financial strain act as environmental factors that diminish the effectiveness of academic tools. This research argues that it is not enough to “teach a man to fish” if the institutional barriers and time poverty leave the pond inaccessible, shifting the responsibility for success and student well-being from solely individual student resilience to balancing institutional accountability for the environment it creates. This does not mean abandoning student agency but recognizes that student well-being is a product of environmental design. By identifying these barriers early in a newer institution's development, this study offers a legally defensible and mission-critical roadmap for creating a "fishing ecosystem" that all future physicians, particularly those from marginalized backgrounds, can thrive rather than just survive.

Language

English

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