Faculty Approaches to Equitable Support for Underperforming Medical Students: A Qualitative Study

OBJECTIVE: To explore faculty members' perceptions and practices in supporting underperforming medical students and identify differences between the academic or emotional support they offered. STUDY DESIGN: A qualitative case study grounded in a constructivist paradigm. Place and Duration of the Study: Department of Medical Education, Bahria University Health Sciences Campus, Karachi, Pakistan, from May to September 2025. METHODOLOGY: A qualitative study involving 18 in-depth interviews, 2 focus group discussions, and reflective journaling was conducted among 47 faculty members at the Bahria University Health Sciences campus. Faculty members with at least five years of teaching experience in clinical or academic medical education settings were included. Faculty members with mostly administrative roles were excluded. A maximum variation purposive sampling method was employed to ensure diversity. Data were collected through in-depth interviews, focus group discussions, and reflective journaling, with thematic saturation reached after 18 interviews. RESULTS: Data were analysed using Braun and Clarke's six-step thematic analysis approach. Thematic saturation was achieved, with twelve major themes emerging across participants' perceptions of practices to support underperforming students: perceptions of ability, early identification of struggling students, tailored support, systematic barriers, faculty training, psychological support, emotional investment, institutional expectations, implicit bias, emotional labour of faculty, hidden curriculum of compassion, and student empowerment. Each theme revealed complex and, at times, contradictory attitudes towards underperforming medical students. CONCLUSION: Faculty members play a critical role in shaping the academic journey of medical students; however, their support is often influenced by personal perceptions, emotional investment, systemic pressures, and implicit biases. To ensure equitable learning experiences, institutions should provide faculty with appropriate training, resources, and policies that promote consistent and fair support for all students, particularly underperforming students. KEY WORDS: Faculty bias, Underperforming students, Medical education, Qualitative research, Student support.