Higher education is understood as essential to enabling social mobility. Research and policy have centred on access to university, but recently attention has turned to the journey of social mobility itself--and its costs. Long-distance or "extreme" social mobility journeys particularly require analysis. This paper examines journeys of first-in-family university students in the especially high-status degree of medicine, through interviews with 21 students at an Australian medical school. Three themes are discussed: (1) the roots of participants' social mobility journeys; (2) how sociocultural difference is experienced and negotiated within medical school; and (3) how participants think about their professional identities and futures. Students described getting to medical school "the hard way", and emphasised the different backgrounds and attitudes of themselves and their wealthier peers. Many felt like "imposters", using self-deprecating language to highlight their lack of "fit" in the privileged world of medicine. However, such language also reflected resistance to middle-class norms and served to create solidarity with community of origin, and, importantly, patients. Rather than narratives of loss, students' stories reflect a tactical refinement of self and "incorporation" of certain middle-class attributes, alongside an appreciation of the worth their "difference" brings to their new destination, the medical profession.