"To Serve My Community Better": Exploring Resistor Identity Formation and Its Impact on Physician Professional...

Introduction. Medical trainees often confront a healthcare system entrenched in longstanding social harm, including racism, sexism, and homophobia. Yet, advocacy remains vaguely addressed in U.S. medical training, leaving trainees without structural support as they engage in acts of professional resistance to social injustice. This study explores medical trainees' development of a "resistor identity" and how this identity shapes their professional identity as physicians committed to challenging systemic injustices. Methods. Using a qualitative approach, we applied constructivist grounded theory to semi-structured interviews with 18 medical trainees known for engaging in professional resistance. Data collection spanned two interview rounds, 10 months apart. Drawing from Selinger's professional development identity framework of "being" and "becoming," and Syed and McLean's identity integration theory, our analysis examined the origins of resistor identity and its dynamic interrelations with professional identity. We employed constant comparative analysis to identify patterns. Results. Findings reveal that trainees' resistor identities emerge in response to conflicts between their professional roles and their desire to address systemic injustice within medical education and practice. Three relationships between their resistor and professional identities were identified: (1) Conflict: Trainees perceived tension between their resistor and professional identities, and avoided the former being assimilated into the latter to maintain awareness of systemic injustice. (2) Intertwining: Some saw these identities as deeply connected but maintained some level of distinctness. They observed role models who demonstrated ways to help both identities coexist harmoniously. (3) Integration: Some trainees experienced an initial conflict or intertwinement between identities, but later achieved integration, transforming their professionalism to include humane concerns and mature expressions of resistance. Discussion. These interrelations are fluid rather than fixed or mutually exclusive. Trainees critically reflect on what it means to be a physician, actively expanding their professional identities to incorporate values of advocacy and justice. The resistor identity allows trainees to resist privileged norms of the profession while still fulfilling their roles as competent and effective physicians. Findings highlight both challenges and possible pathways to professional identity integration, while call for acknowledging advocacy and professional resistance as key roles for future physicians.