The problem is instructor engagement with first-generation medical assistant students is minimal, resulting in decreased graduation rates in medical assistant programs. The purpose of this qualitative descriptive study was to describe perceptions of instructors regarding how student-instructor relationships influence program completion with first-generation students in a medical assistant program. A purposive sampling process was used to select instructors. The study included 10 medical assistant instructors from one college in the Northeastern region of the United States and nationwide from LinkedIn. Two research questions were addressed: (1) What are instructor perceptions of how student-instructor relationships influence program completion with first-generation students in a medical assistant program? (2) What are instructor perceptions of successful student engagement strategies that influence student-instructor relationships supporting program completion with first-generation students in a medical assistant program? The data collection strategy was one-on-one semi-structured interviews. Data analysis included a multistep process of member checking, coding, and a constant comparison analysis to reveal emergent themes. The following themes emerged: (1) Engagement Strategies Specifically for First-Generation Students; (2) Variances in Perceptions of Job Roles and Responsibilities; (3) Understanding Unique Challenges of First-Generation Students; and (4) Inadequately Prepared First-Generation Students. Recommendations are inclusion training specifically for first-generation students, clearly defined instructor job roles and responsibilities, enhanced student orientation, and enhanced first-year seminar courses for first-generation students. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]