{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T21:00:01Z","timestamp":1791320401512,"version":"4.3.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T00:00:00Z","timestamp":1707782400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T00:00:00Z","timestamp":1707782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007188","name":"Uniformed Services University of the Health Sciences","doi-asserted-by":"publisher","award":["R.0038013.3.11"],"award-info":[{"award-number":["R.0038013.3.11"]}],"id":[{"id":"10.13039\/100007188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Adv in Health Sci Educ"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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\u2019s work, which conceptualizes resistance as a dynamic process that includes an individual\u2019s <jats:italic>subjectivity<\/jats:italic> within a larger system, the <jats:italic>context<\/jats:italic> in which they find themselves, and the <jats:italic>interactions<\/jats:italic> they have with others. We framed these acts as an individuals\u2019 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 <jats:italic>professional<\/jats:italic>, and continue to do this challenging work in medical education. <\/jats:p>","DOI":"10.1007\/s10459-024-10312-8","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T12:02:29Z","timestamp":1707825749000},"page":"1379-1392","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["\u201cI never wanted to burn any bridges\u201d: discerning between pushing too hard and not enough in trainees\u2019 acts of professional resistance"],"prefix":"10.1007","volume":"29","author":[{"given":"Tasha R.","family":"Wyatt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinayak","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"TingLan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,13]]},"reference":[{"key":"10312_CR1","doi-asserted-by":"crossref","unstructured":"Baaz, M., Lilja, M., & Vinthagen, S. (2018). Research Resistance and Social Change: A critical Approach to Theory and Practice. Rowman & Littlefield.","DOI":"10.4324\/9781351057455"},{"key":"10312_CR2","doi-asserted-by":"publisher","unstructured":"Baum, K. D., Resnik, C. D., Wu, J. J., & Roey, S. C. (2007). Implementing change in health professions education: stakeholder analysis and coalition building. Journal of Veterinary Medical Education, 34(2), 79\u201384. https:\/\/doi.org\/10.3138\/jvme.34.2.79. PMID: 17446631.","DOI":"10.3138\/jvme.34.2.79"},{"key":"10312_CR3","doi-asserted-by":"publisher","unstructured":"Beagan, B., MacLeod, A., Owen, M., Pride, T., & Sibbald, K. (2022). Lower-class origin professionals in Canadian health and social service professions: A different level of understanding. Social Science & Medicine, 309. https:\/\/doi.org\/10.1016\/j.socscimed.2022.115233.","DOI":"10.1016\/j.socscimed.2022.115233"},{"key":"10312_CR4","doi-asserted-by":"publisher","DOI":"10.1007\/s10459-022-10183-x","author":"E Blalock","year":"2022","unstructured":"Blalock, E., & Leal, D. (2022). Redressing injustices: How women students enact agency in undergraduate medical education. Advances in Health Sciences Education. https:\/\/doi.org\/10.1007\/s10459-022-10183-x.","journal-title":"Advances in Health Sciences Education"},{"key":"10312_CR5","doi-asserted-by":"publisher","unstructured":"Brockie, T., Haroz, E., Nelson, K., Cwik, M., Decker, E., Ricker, A., Littlepage, S., Mayhew, J., Wilson, D., Wetsit, L., & Barlow, A. (2021). Wak\u021f\u00e1\u014bye\u017ea (Little Holy One) - an intergenerational intervention for native American parents and children: A protocol for a randomized controlled trial with embedded single-case experimental design. Bmc Public Health, 21(2298). https:\/\/doi.org\/10.1186\/s12889-021-12272-9.","DOI":"10.1186\/s12889-021-12272-9"},{"key":"10312_CR6","doi-asserted-by":"publisher","first-page":"1870","DOI":"10.1056\/NEJMms1907237","volume":"381","author":"M Chowkwanyun","year":"2019","unstructured":"Chowkwanyun, M., & Howell, B. (2019). Health, social reform, and medical schools \u2014 the training of American physicians and the dissenting Ttadition. New England Journal of Medicine, 381, 1870\u20131875. https:\/\/doi.org\/10.1056\/NEJMms1907237.","journal-title":"New England Journal of Medicine"},{"key":"10312_CR7","doi-asserted-by":"publisher","unstructured":"Courpasson, D. (2016). Impactful resistance: The persistence of recognition politics in the workplace. Journal of Management Inquiry, 25(1), 96\u2013100. https:\/\/doi.org\/10.1177\/1056492615600354.","DOI":"10.1177\/1056492615600354"},{"issue":"3","key":"10312_CR8","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1287\/orsc.1110.0657","volume":"23","author":"D Courpasson","year":"2012","unstructured":"Courpasson, D., Dany, F., & Clegg, S. (2012). Resisters at work: Generating productive resistance in the workplace. Organization Science, 23(3), 801\u2013819.","journal-title":"Organization Science"},{"key":"10312_CR9","doi-asserted-by":"crossref","unstructured":"DiAngelo, R. (2016). What does it Mean to be white? Developing white racial literacy. Peter Lang.","DOI":"10.3726\/978-1-4539-1848-7"},{"key":"10312_CR10","unstructured":"Duberman, M. (1993). Stonewall: The definitive story of the LGBTQ rights uprising that changed America. Penguin Random House."},{"issue":"11","key":"10312_CR11","doi-asserted-by":"publisher","first-page":"1524","DOI":"10.1097\/ACM.0000000000004225","volume":"96","author":"R Ellaway","year":"2021","unstructured":"Ellaway, R., & Wyatt, T. R. (2021). What role should resistance play in training health professionals? Academic Medicine, 96(11), 1524\u20131528. https:\/\/doi.org\/10.1097\/ACM.0000000000004225.","journal-title":"Academic Medicine"},{"key":"10312_CR12","unstructured":"Engler, M., & Engler, P. (2016). This is an Uprising: How nonviolent revolt is shaping the twenty-First Century. Nation Books."},{"issue":"6","key":"10312_CR13","doi-asserted-by":"publisher","first-page":"1328","DOI":"10.1086\/378035","volume":"108","author":"P Ewick","year":"2003","unstructured":"Ewick, P., & Silbey, S. (2003). Narrating social structure: Stories of resistance to legal authority. American Journal of Sociology, 108(6), 1328\u20131372. https:\/\/doi.org\/10.1086\/378035.","journal-title":"American Journal of Sociology"},{"key":"10312_CR14","unstructured":"Freeman, R. E. (1984). Strategic Management: A Stakeholder Approach. Pitman Publishing."},{"issue":"10","key":"10312_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/ACM.0b013e3182a34b05","volume":"88","author":"H Frost","year":"2013","unstructured":"Frost, H., & Regehr, G. (2013). I AM a doctor: Negotiating the discourses of standardization and diversity in professional identity construction. Academic Medicine, 88(10), 1\u20138. https:\/\/doi.org\/10.1097\/ACM.0b013e3182a34b05.","journal-title":"Academic Medicine"},{"key":"10312_CR16","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1007\/s11206-004-0694-5","volume":"19","author":"J Hollander","year":"2004","unstructured":"Hollander, J., & Einwohner, R. (2004). Conceptualizing resistance. Sociology Forum, 19, 533\u2013554. https:\/\/doi.org\/10.1007\/s11206-004-0694-5.","journal-title":"Sociology Forum"},{"key":"10312_CR17","unstructured":"Horkheimer, M. (1972). Critical theory: Selected essays. Continuum Publishing Company."},{"key":"10312_CR18","unstructured":"Horowitz, J., Igielnik, R., & Kochhar, R. (2020). Economic Inequality. Pew Research Center. Retrieved August 5 from https:\/\/www.pewresearch.org\/social-trends\/2020\/01\/09\/trends-in-income-and-wealth-inequality\/."},{"issue":"2","key":"10312_CR19","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1111\/j.1365-2929.2005.02378.x","volume":"40","author":"T Kennedy","year":"2006","unstructured":"Kennedy, T., & Lingard, L. (2006). Making sense of grounded theory in medical education. Medical Education, 40(2), 101\u2013108.","journal-title":"Medical Education"},{"key":"10312_CR20","doi-asserted-by":"crossref","unstructured":"Kincheloe, J., & McLaren, P. (2011). Rethinking critical theory and qualitative research. In K. Hayes, S. Steinberg, & K. Tobin (Eds.), Key work in critical pedagogy (pp. 285\u2013326). Sense Publishers.","DOI":"10.1007\/978-94-6091-397-6_23"},{"key":"10312_CR21","doi-asserted-by":"publisher","DOI":"10.1007\/s10459-023-10263-6","author":"A Konopasky","year":"2023","unstructured":"Konopasky, A., Wyatt, T., & Blalock, E. (2023). Past resources, future envisioning, and present positioning: How women who are medical students at one institution draw upon temporal agency for resistance. Advances in Health Science Education. https:\/\/doi.org\/10.1007\/s10459-023-10263-6.","journal-title":"Advances in Health Science Education"},{"issue":"5","key":"10312_CR22","doi-asserted-by":"publisher","first-page":"607","DOI":"10.4300\/JGME-D-21-00752.1","volume":"13","author":"K LaDonna","year":"2021","unstructured":"LaDonna, K., Artino, A., & Balmer, D. (2021). Beyond the guise of saturation: Rigor and qualitative interview data. Journal of Graduate Medical Education, 13(5), 607\u2013611. https:\/\/doi.org\/10.4300\/JGME-D-21-00752.1.","journal-title":"Journal of Graduate Medical Education"},{"key":"10312_CR23","doi-asserted-by":"publisher","unstructured":"Leisy, H., & Ahmad, M. (2016). Altering workplace attitudes for resident education (A.W.A.R.E.): Discovering solutions for medical resident bullying through literature review. BMC Medical Education, 16. https:\/\/doi.org\/10.1186\/s12909-016-0639-8.","DOI":"10.1186\/s12909-016-0639-8"},{"key":"10312_CR24","doi-asserted-by":"crossref","unstructured":"Medina, J. (2013). The epistemology of resistance: Gender and racial oppression, epistemic injustice, and resistant imaginations. Oxford University.","DOI":"10.1093\/acprof:oso\/9780199929023.001.0001"},{"issue":"9","key":"10312_CR25","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1177\/0170840617717554","volume":"38","author":"D Mumby","year":"2017","unstructured":"Mumby, D., & Robyn, T. (2017). Resistance redux. Organizational Studies, 38(9), 1157\u20131183. https:\/\/doi.org\/10.1177\/0170840617717554.","journal-title":"Organizational Studies"},{"issue":"3","key":"10312_CR26","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1177\/1350508413515541","volume":"22","author":"R Paulsen","year":"2015","unstructured":"Paulsen, R. (2015). Non-work at work: Resistance or what? Organization, 22(3), 351\u2013367. https:\/\/doi.org\/10.1177\/1350508413515541.","journal-title":"Organization"},{"issue":"4","key":"10312_CR27","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1287\/orsc.11.4.387.14597","volume":"11","author":"P Prasad","year":"2000","unstructured":"Prasad, P., & Prasad, A. (2000). Stretching the iron cage: The constitution and implications of routine workplace resistance. Organizational Science, 11(4), 387\u2013403. https:\/\/doi.org\/10.1287\/orsc.11.4.387.14597.","journal-title":"Organizational Science"},{"key":"10312_CR28","unstructured":"Schoenfeld, A. (2011). Noticing matters. A lot. Now what? In M. Sherin, V. Jacobs, & A. Phillipp (Eds.), Mathematics teacher noticing: Seeing through teachers\u2019 eyes (pp. 223\u2013238). Taylor & Francis."},{"key":"10312_CR29","doi-asserted-by":"crossref","unstructured":"Scott, J. (1989). Everyday forms of resistance. In F. D. Colburn (Ed.), Everyday forms of peasant resistance (pp. 3\u201333). M. E. Sharpe.","DOI":"10.22439\/cjas.v4i1.1765"},{"key":"10312_CR30","unstructured":"Scott, J. (1990). Domination and the arts of resistance: Hidden transcripts. Yale University Press."},{"key":"10312_CR31","unstructured":"Sharp, G. (1973). The politics of nonviolent action, part 1\u20133. Extending Horizons Books, Porter Sargent Publishers."},{"issue":"2","key":"10312_CR32","doi-asserted-by":"publisher","first-page":"140","DOI":"10.2304\/power.2010.2.2.140","volume":"2","author":"S Steinberg","year":"2010","unstructured":"Steinberg, S., & Kincheloe, J. (2010). Power, emancipation, and complexity: Employing critical theory. Power and Education, 2(2), 140\u2013151. https:\/\/doi.org\/10.2304\/power.2010.2.2.140.","journal-title":"Power and Education"},{"issue":"8","key":"10312_CR33","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.7326\/M21-0369","volume":"174","author":"M Taiko","year":"2021","unstructured":"Taiko, M., South, E., & Ray, V. (2021). Medical schools as racialized organizations: A primer. Annals of Internal Medicine, 174(8), 1143\u20131144. https:\/\/doi.org\/10.7326\/M21-0369.","journal-title":"Annals of Internal Medicine"},{"key":"10312_CR34","unstructured":"Thompkins, P., & Leonhard, R. (2017). The science of resistance. Retrieved July 21 from https:\/\/smallwarsjournal.com\/jrnl\/art\/the-science-of-resistance."},{"issue":"1","key":"10312_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1163\/156853106776150207","volume":"34","author":"S Vinthagen","year":"2006","unstructured":"Vinthagen, S. (2006). Power as subordination and resistance as disobedience: Non-violent movements and the management of power. Asian Journal of Social Science, 34(1), 1\u201321. https:\/\/doi.org\/http:\/\/www.jstor.org\/stable\/23654397.","journal-title":"Asian Journal of Social Science"},{"key":"10312_CR36","unstructured":"Vinthagen, S., & Johansson, A. (2013). Everyday Resistance: Exploration of a concept and its theories. Resistance Studies Magazine, 1, 1\u201346. Retrieved September 1, 2022, from http:\/\/resistance-journal.org\/wp-content\/uploads\/2016\/04\/Vinthagen-Johansson-2013-Everyday-resistance-Concept-Theory.pdf."},{"key":"10312_CR37","doi-asserted-by":"publisher","DOI":"10.1111\/medu.15256","author":"TR Wyatt","year":"2023","unstructured":"Wyatt, T. R., Jain, V., & Ma, T. (2023). When I stood up for something it\u2019s because I felt a\u2026 moral violation\u2019: Trainees\u2019 acts of resistance against social harm and injustice. Medical Education. https:\/\/doi.org\/10.1111\/medu.15256.","journal-title":"Medical Education"},{"key":"10312_CR38","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000004373","author":"Z Zaidi","year":"2021","unstructured":"Zaidi, Z., Young, M., Balmer, D., & S Park, Y. (2021). Endarkening the episteme: Critical race theory and Medical Education Scholarship. Academic Medicine. https:\/\/doi.org\/10.1097\/ACM.0000000000004373.","journal-title":"Academic Medicine"}],"container-title":["Advances in Health Sciences Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10459-024-10312-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10459-024-10312-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10459-024-10312-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T09:30:21Z","timestamp":1725269421000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10459-024-10312-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,13]]},"references-count":38,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10312"],"URL":"https:\/\/doi.org\/10.1007\/s10459-024-10312-8","relation":{},"ISSN":["1382-4996","1573-1677"],"issn-type":[{"value":"1382-4996","type":"print"},{"value":"1573-1677","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,13]]},"assertion":[{"value":"1 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This work was prepared by a civilian employee of the US Government as part of the individual\u2019s official duties and therefore is in the public domain. The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}]}}