TY - JOUR
T1 - “I never wanted to burn any bridges”
T2 - discerning between pushing too hard and not enough in trainees’ acts of professional resistance
AU - Wyatt, Tasha R.
AU - Jain, Vinayak
AU - Ma, Ting Lan
N1 - Publisher Copyright:
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2024.
PY - 2024/9
Y1 - 2024/9
N2 - As trainees resist social harm and injustice in medicine, they must navigate the tension between pushing too hard and risking their reputation, or not enough and risking no change at all. We explore the discernment process by examining what trainees attend to moments before and while they are resisting to understand how they manage this tension. We interviewed 18 medical trainees who shared stories of resisting social harm and injustice in their training environments. Interviews were analyzed using open and focused coding using Vinthagen and Johansson’s work, which conceptualizes resistance as a dynamic process that includes an individual’s subjectivity within a larger system, the context in which they find themselves, and the interactions they have with others. We framed these acts as an individuals’ attempt to undermine power, while also being entangled with that power and needing it for their efforts. When deciding on how and whether to resist, trainees underwent a cost-benefit analysis weighing the potential risk against their chances at change. They considered how their acts may influence their relationship with others, whether resisting would damage personal and programmatic reputations, and the embodied and social cues of other stakeholders involved. Trainees undergo a dynamic assessment process in which they analyze large amounts of information to keep themselves safe from potential retaliation. It is by attending to these various factors in their environment that trainees are able to keep their acts professional, and continue to do this challenging work in medical education.
AB - As trainees resist social harm and injustice in medicine, they must navigate the tension between pushing too hard and risking their reputation, or not enough and risking no change at all. We explore the discernment process by examining what trainees attend to moments before and while they are resisting to understand how they manage this tension. We interviewed 18 medical trainees who shared stories of resisting social harm and injustice in their training environments. Interviews were analyzed using open and focused coding using Vinthagen and Johansson’s work, which conceptualizes resistance as a dynamic process that includes an individual’s subjectivity within a larger system, the context in which they find themselves, and the interactions they have with others. We framed these acts as an individuals’ attempt to undermine power, while also being entangled with that power and needing it for their efforts. When deciding on how and whether to resist, trainees underwent a cost-benefit analysis weighing the potential risk against their chances at change. They considered how their acts may influence their relationship with others, whether resisting would damage personal and programmatic reputations, and the embodied and social cues of other stakeholders involved. Trainees undergo a dynamic assessment process in which they analyze large amounts of information to keep themselves safe from potential retaliation. It is by attending to these various factors in their environment that trainees are able to keep their acts professional, and continue to do this challenging work in medical education.
KW - Professional resistance
KW - Proportionality
KW - Social harm
KW - Trainees
UR - http://www.scopus.com/inward/record.url?scp=85185104870&partnerID=8YFLogxK
U2 - 10.1007/s10459-024-10312-8
DO - 10.1007/s10459-024-10312-8
M3 - Article
AN - SCOPUS:85185104870
SN - 1382-4996
VL - 29
SP - 1379
EP - 1392
JO - Advances in Health Sciences Education
JF - Advances in Health Sciences Education
IS - 4
ER -