'Still standing, quietly decaying': How professional legitimacy in medical education creates trainee harm

For nearly a century, medical education has operated in a self-proclaimed state of crisis. Contemporary issues heavily focus on the escalating rates of trainee burnout, moral distress and attrition. However, despite persistent attempts at curricular reform and individualised wellness initiatives, the continued presence of physical and mental harm suggests that these superficial interventions are failing to address the root causes of systemic distress.

Drawing on the critical work of cultural theorist Jack Halberstam, this article makes a departure from the traditional assumption that institutional systems must be cared for, reformed and preserved. Instead, I analyse how the foundational design and cultural expectations of medical training inherently perpetuate the very harm they seek to mitigate.

Interweaving Halberstam's theories with legitimacy theory, I show how medical education maintains its social contract and institutional power by adhering to a rigid, Flexnerian model of normative success. This factory-like system prizes standardised excellence, relentless assessment, performative professionalism, and strict hierarchy over human authenticity. Consequently, institutional legitimacy is pursued at the expense of trainee well-being. Rather than attempting to patch up a fundamentally broken system, the profession must allow these rigid structures to collapse to make way for new growth. This transition involves shifting toward 'wildness' and embracing failure as a productive detour. In doing so, we can transition our efforts from training compliant, assembly-line physicians to fostering adaptive, authentic healers commissioned to work in a shifting healthcare landscape.

In short, using Halberstam's framework, this paper argues that true systemic health cannot be achieved through incremental reform. Medical education must allow the normative success model to collapse so that we can dismantle rigid structures and build adaptive, human-centred systems genuinely concerned about humanity.