"I knew I was not going to get fired … I know what the line is": How HPE Faculty Support Trainees' War Against Social...

Introduction: Trainees are adept at locating social harm and injustice in medical education. One of the ways in which they work for change is through ongoing acts of professional resistance. However, knowing how, when, and where to resist requires some institutional knowledge. Previous research shows that trainees garner clandestine support from faculty members who share similar values and interests. These faculty work in the shadows, assisting trainees to meet their goals of destabilizing harmful systems and structures in medical education, yet little is known about the role these faculty play. This study was designed to explore the kinds of support faculty provide, the role they play in supporting resistance efforts, and how faculty ensure their own safety. Methods: We used methodological bricolage to guide both data collection and analysis. We recruited 24 faculty from a variety of health professions and interviewed them on when they would/would not support trainees in their resistance efforts. Participants came from 12 different medical education institutions across four geographic regions of the U.S., along with one Canadian medical school. As the data came in, it was transcribed and analyzed using open coding, at which point we noticed that participants framed their roles using constructs found in the literature. Rather than continuing to open code, we refined our analysis using a deductive coding approach in which we drew on the concepts of supporters and auxiliary staff, cultural brokers, and tempered radicals. Through constant comparison, we identified patterns across participants in the roles they played and the kind of support they offered. Results: As trainees fight a metaphorical war against social harm and injustice in medical education, faculty play several key roles in supporting trainees. They protect the integrity of the institution and ensure trainees' efforts are not disruptive to the institution's function. They contextualize trainees' efforts within institutional goals. They also mediate relationships between students and institutional leadership. While helping to keep themselves, trainees, and institution safe, they reinforce the importance of being a life-long resistor against social harm and injustice to continue this work. Discussion: Efforts at changing health professions education is not new; each generation gives rise to trainees who cannot bear to experience or witness the harm and injustice present in the profession's educational and training programs and must work to change it. However, what appears to be new is that faculty are deeply engaged in this process of transformation, working alongside trainees. Given their role in the institution, they serve as the strategist in fighting this war, providing big picture opportunities and risk assessments for trainees to consider. Whereas trainees serve as the tacticians doing the work on the ground, faculty provide critical support toward the transformation of medical education.