Publicly praised but privately undermined: the hidden costs of equity work in medical education

Over the past decade, medical schools worldwide have launched equity, diversity, inclusion, and accessibility (EDIA) initiatives to foster more inclusive learning environments. Yet, skepticism persists around whether the medical education community is genuinely committed to equity. Progress is often slow and met with resistance-particularly in highly competitive environments like medical schools, which rely on entrenched notions of meritocracy. While it is important to acknowledge the gains made, there is equal value in examining the unspoken challenges experienced by those advancing EDIA. Drawing on feminist scholar Sara Ahmed's critique of institutional change, this paper explores the hidden costs of equity work at one Canadian medical school. Between October 2020 and December 2021, 19 semi-structured interviews were conducted with learners, faculty, community members, and student affairs and admissions staff. Reflexive thematic analysis guided our interpretation. Results are presented as composite narratives. Participants described growing momentum and small wins but raised concerns about barriers to lasting change-including over-reliance on diversity quotas, rushed implementation, and performative approaches. Many discussed the emotional burden of pursuing equity, often feeling torn between advocating for change and protecting their psychological safety. They reflected on the tension between institutional image-making and meaningful structural transformation. Our work is timely in the current cultural landscape of rapidly shifting political and institutional dynamics. More attention must be paid to the costs borne by those advancing equity, and greater resources and institutional accountability are needed to support those who carry its weight.