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U.S. physicians are predominantly white and male, although research indicates that diverse physicians can more effectively address the needs of diverse patients. This study investigated how underrepresented medical students in Hawaiʻi navigated the academic pipeline to their profession. Bridging Multiple Worlds Theory was applied to understand how low-income and ethnic minority students moved through the academic pipeline and into medical school. Five medical students from underrepresented backgrounds were interviewed about how being underrepresented influenced their experiences as learners. Students faced challenges, such as lack of resources, balancing medical and personal life demands, and imposter syndrome. Their perseverance was rooted in identification as underrepresented. Mentorship from individuals with similar backgrounds, in and outside of medicine, was key to their success.