{"title":"Navigating Dilemmas Arising from Advocacy and Resistance in Medical Education and Medical Practice.","authors":"Rachel H Ellaway, Tasha Wyatt, Maria Hubinette","doi":"10.5334/pme.1619","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Advocacy and resistance are undertheorized in medical education, yet trainees are often encouraged by their teachers to engage in these activities as a way of helping patients, mitigating healthcare system weaknesses, or challenging harms or injustices. How health professionals can and should engage in advocacy or resistance (which can be treated as a dyad of advocacy-resistance) is undertheorized, which can create confusion for trainees and lead to harms. Although acts of advocacy-resistance are often framed as pro-social, applications of advocacy-resistance can create inequity in seeking to reduce it, and they can create challenges for those trying to negotiate this perilous landscape.</p><p><strong>Method: </strong>The authors respond to the need for a more robust theoretical grounding in this space by taking a dialogical approach (based on abductive group discussion and debate, reading and rereading the literature, and collaborative writing and theory building) to explore ethical dilemmas that can arise from healthcare practitioner and trainee engagement in acts of advocacy-resistance.</p><p><strong>Findings: </strong>Four broad dilemmas arising from healthcare practitioner and trainee acts of advocacy-resistance are described: where the loci of responsibilities lie, how professional identity and agency are situated within a collective, balancing competing needs and priorities, and managing harm that can result from engaging in advocacy-resistance. The authors describe contributing factors including equity, identity, needs, priorities, responsibilities, and the advocacy-resistance dyad itself.</p><p><strong>Conclusions: </strong>In better understanding the dilemmas that acts of advocacy-resistance can create, healthcare providers, educators, and trainees should be better able to negotiate this complex and yet necessary space.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"85-91"},"PeriodicalIF":4.8000,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869828/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perspectives on Medical Education","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5334/pme.1619","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"EDUCATION, SCIENTIFIC DISCIPLINES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Advocacy and resistance are undertheorized in medical education, yet trainees are often encouraged by their teachers to engage in these activities as a way of helping patients, mitigating healthcare system weaknesses, or challenging harms or injustices. How health professionals can and should engage in advocacy or resistance (which can be treated as a dyad of advocacy-resistance) is undertheorized, which can create confusion for trainees and lead to harms. Although acts of advocacy-resistance are often framed as pro-social, applications of advocacy-resistance can create inequity in seeking to reduce it, and they can create challenges for those trying to negotiate this perilous landscape.
Method: The authors respond to the need for a more robust theoretical grounding in this space by taking a dialogical approach (based on abductive group discussion and debate, reading and rereading the literature, and collaborative writing and theory building) to explore ethical dilemmas that can arise from healthcare practitioner and trainee engagement in acts of advocacy-resistance.
Findings: Four broad dilemmas arising from healthcare practitioner and trainee acts of advocacy-resistance are described: where the loci of responsibilities lie, how professional identity and agency are situated within a collective, balancing competing needs and priorities, and managing harm that can result from engaging in advocacy-resistance. The authors describe contributing factors including equity, identity, needs, priorities, responsibilities, and the advocacy-resistance dyad itself.
Conclusions: In better understanding the dilemmas that acts of advocacy-resistance can create, healthcare providers, educators, and trainees should be better able to negotiate this complex and yet necessary space.
期刊介绍：
Perspectives on Medical Education mission is support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices.
Official journal of the The Netherlands Association of Medical Education (NVMO).
Perspectives on Medical Education is a non-profit Open Access journal with no charges for authors to submit or publish an article, and the full text of all articles is freely available immediately upon publication, thanks to the sponsorship of The Netherlands Association for Medical Education.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
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