“As a resistor, you are not alone”: Locating the collective in uncoordinated acts of professional resistance

Introduction: When trainees encounter social harm and injustice in clinical and educational settings, they engage in acts of professional resistance. These efforts can either be coordinated or uncoordinated and implemented as individuals or collectives. Although it is easy to see the relationship between the collective and individuals in coordinated acts, it is unclear what role a collective plays in uncoordinated resistance efforts. This study investigated the role of a larger collective, including whether such a collective exists, among a group of trainees engaged in professional resistance. Specifically, we were interested in what trainees contribute to and draw from these collectives as they address social harm and injustice within medical education. Methods: Trainees were recruited through professional networks and snowball sampling, with in-depth interviews conducted in two phases. Phase one included interviews with 18 trainees from the U.S. and Canada, and phase two involved re-interviewing 13 of them. We used constant comparative analysis and a social movements framework (collective identity, framing processes, resource mobilization and strategies) to analyse the data. Results: Despite a lack of coordination, trainees consistently narrated a reliance on a larger collective, which they actively curated to include individuals from outside of medicine. Trainees drew from this collective a shared identity and a unifying ‘injustice frame’ for understanding social harm. In return, they contributed new strategies and tactics, which they shared with their colleagues. However, trainees did not receive emotional support or resource mobilization from these collectives. A few trainees expressed a desire for more coordinated action, whereas one reported feeling alienated by it. Discussion: Our findings demonstrate that uncoordinated resistance is not an isolated endeavour but is sustained by a dynamic, reciprocal relationship with a broader, self-curated collective. Although this collective provides a shared identity and a steady influx of new strategies, it may not be able to offer the emotional support and resource mobilization necessary for more sustained, coordinated change.