Teaching and Learning in Medicine最新文献

{"title":"Does the Timing of USMLE Step 1 Affect Performance? A Comparison of Pre- and Post-Clerkship Timing in the Pass/Fail Era.","authors":"Marc Johnson, Sally Santen, Arnyce Pock, Nadia Ismail, Rebecca L Toonkel, Karen E Hauer, David Gordon, Seetha U Monrad, Jennifer Kogan, Christine Seibert, Daniel Jurich, Michael S Ryan, Sara B Fazio, Aubrie Swan Sein, Michelle Daniel","doi":"10.1080/10401334.2026.2662341","DOIUrl":"10.1080/10401334.2026.2662341","url":null,"abstract":"<p><p>In 2022, Step 1 of the United States Medical Licensing Examination transitioned to pass/fail scoring, removing a major performance-oriented incentive that historically shaped how and why students prepared for the exam. While Step 1 is typically taken before clerkships, some medical schools have shifted the exam to after core clerkships, citing potential benefits for learning and integration. This study examined whether the timing of Step 1 continues to influence performance outcomes in the pass/fail era, using achievement goal theory and self-determination theory as conceptual lenses. Achievement goal theory distinguishes among mastery-approach, performance-approach, and performance-avoidance goals that fluctuate across contexts; self-determination theory emphasizes how assessment environments support autonomous versus controlled forms of motivation. This study compared outcomes at 20 US medical schools that administered Step 1 after clerkships to those at a matched group of schools that administered the exam pre-clerkships. All students matriculated in 2020 and took Step 1 on or after January 26, 2022, when pass/fail scoring began. We matched schools based on average Medical College Admission Test (MCAT) scores to help control for incoming academic ability. We used a resampling procedure with 10,000 replications to estimate average differences in Step 1 and Step 2 Clinical Knowledge (CK) failure rates and scores. Compared to matched pre-clerkship schools, post-clerkship schools had a slightly lower Step 1 failure rate (mean difference: 1.02%, SD = 0.89, CI = 1.00-1.04%). In contrast, Step 2 CK outcomes modestly favored pre-clerkship schools: failure rates were 0.39% lower (SD = 0.21, CI = 0.39-0.4%) and scores were 1.03 points higher (SD = 0.53, CI = 1.02-1.04) on average. Across all outcomes, differences were small and unlikely to be educationally meaningful. Among students at post-clerkship schools, a shorter interval between Step 1 and Step 2 CK was associated with slightly higher Step 2 CK scores for students with lower MCAT scores, whereas the interval had little impact for students with higher MCAT scores. In the pass/fail context, the timing of Step 1, before or after clerkships, appears to have minimal influence on performance outcomes. These findings suggest that changes to Step 1 scoring and timing alone are unlikely to shift learner behavior; broader assessment and curricular reforms that intentionally foster autonomous, mastery-oriented learning may be needed to support deep learning, well-being, and readiness for practice.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-11"},"PeriodicalIF":1.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conceptualizing Humility in Medical Education: Insights from US Student Perspectives.","authors":"Barret Michalec, Jennifer A Best, Kaitlyn N Félix, Matthew J Rustici, Helene Starks, Frederic W Hafferty","doi":"10.1080/10401334.2026.2660188","DOIUrl":"https://doi.org/10.1080/10401334.2026.2660188","url":null,"abstract":"<p><p>Humility is increasingly recognized as a vital element of medical professionalism, yet little is known about how medical students perceive and enact it during their formative training years. This cross-sectional study explores US medical students' (n = 104) understandings and experiences across four years of medical education. Quantitative analyses, drawing on the Honesty-Humility subscale of the Honesty-Humility (H), Emotionality (E), Extroversion (X), Agreeableness (A), Conscientiousness (C), Openness to Experience (0) Personality Inventory Revised (HEXACO-PI-R), revealed no significant differences in humility by year, gender, or race/ethnicity. Qualitative analyses of survey narratives, however, highlighted three interrelated themes: (1) humility is learned primarily through informal mechanisms such as role modeling, patient encounters, and reflection rather than through formal curricula; (2) humility is seen as essential for fostering teamwork, collaboration, and trust among peers, colleagues, and patients; and (3) students grapple with balancing humility and projecting confidence, especially in clinical contexts where they feel patients' trust depends on perceived competence. Findings suggest that humility in medical education is not simply a personal disposition but a relational and cultural practice shaped by organizational norms, hidden curricula, and professional identity formation. Embedding humility-supportive practices into mentorship, feedback, and team-based learning environments may help normalize humility as a valued dimension of professionalism and enhance the cultivation of reflective, collaborative physicians.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-16"},"PeriodicalIF":1.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authentic Learning, Authentically Lived: Student Insights from a Medical Education Scholars Program.","authors":"Elena Gupta, Trevor Canty, Kuan Jiang, Rajiv Potluri, Joseph M Minichiello, Linda Morris, Abigail Konopasky","doi":"10.1080/10401334.2026.2658026","DOIUrl":"https://doi.org/10.1080/10401334.2026.2658026","url":null,"abstract":"<p><p>Hands-on experience with medical education research, scholarship, and practice allows medical students to develop valuable skills, such as project design, evaluation, time management, and communication. The Medical Education Scholars (MES) Program at the Geisel School of Medicine at Dartmouth is one such opportunity for medical students to obtain hands-on experience. Six learners from the program, including five past MES leaders, engaged in a reflective approach on their experiences in MES under the guidance of a past MES faculty advisor. During this process, we found the Theory of Authentic Learning by Hill and Smith to be a helpful tool in making sense of our experiences. The lessons learned from learners' experiences, such as those included here, offer a unique, yet resonant, perspective to enrich the medical education literature.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-10"},"PeriodicalIF":1.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Multiple Researcher Roles in the Analysis of Video-Recorded Simulation-Based Learning.","authors":"Amisha Kanji, Jennifer Watermeyer","doi":"10.1080/10401334.2026.2660190","DOIUrl":"10.1080/10401334.2026.2660190","url":null,"abstract":"<p><p><b><i>Issue:</i></b> Although literature suggests different ways research teams can engage with qualitative data, there is little guidance on how researchers' different perspectives can be reconciled. This article presents reflections and insights from a team-based analysis of video-recorded data. <b><i>Approach:</i></b> We analysed a subset of 58 video-recorded simulation-based learning experiences (SLEs) in the field of Audiology. This subset comprised nine videos, which were first analysed by team members individually. We subsequently used a paired analysis approach for five of these videos, selecting two for team discussion because paired analysis revealed varying perspectives that required further 'unpacking'. We reflect on our experience here as an opportunity to illuminate the process, affordances, and challenges of analysing qualitative data via a multidisciplinary team approach comprising academics with different backgrounds, roles, and experience levels, influencing their positionality relative to the phenomenon under investigation. <b><i>Insights:</i></b> Multidisciplinary qualitative data analysis can be both valuable and complex. We refined our assumptions about researcher positionality and how it can be limiting, particularly as one's positionality can shift during the analytic process. Our reflections led us to understand that positionality and reflexivity are co-constructed and constantly negotiated. <b><i>Recommendations:</i></b> Multidisciplinary teamwork is valuable in qualitative data analysis, offering more than one perspective on the data. Multidisciplinary qualitative data analysis needs to be further interrogated as team member roles are fluid and cannot be solely defined by 'insider'/'outsider' boundaries. Hence, the analytical process needs to be refined over time, together with and in relation to ongoing reflection on positionality.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-11"},"PeriodicalIF":1.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Step 1 Predictive Methods Across 12 US MD-Granting Medical Schools.","authors":"Christian C Steciuch, James H Baños, Todd A Bates, Kyle A Bauckman, Karina R Clemmons, Joshua M Costin, Hilary Fairbrother, Martha E García Osorio, Amy Greenberg, Brook A Hubner, Phuong B Huynh, Meghan Kiefer, Sheela Lahoti, Heather S Laird-Fick, Xiaomei Song, Joy E Sturtevant, Ling Wang, Anne Zinski, Joseph D Fontes","doi":"10.1080/10401334.2026.2655826","DOIUrl":"https://doi.org/10.1080/10401334.2026.2655826","url":null,"abstract":"<p><p>Since the United States Medical Licensing Examination (USMLE) Step 1 scoring transitioned from reporting numerical scores to reporting only pass or fail in 2022, the national first-time Step 1 failure rate has increased. In this shifting educational landscape, students require more detailed guidance to reach their Step 1 goals. Ideally, this would be based on data-driven methods for identifying students at-risk for failing Step 1, leveraging data to support student success. However, developing methods to identify at-risk students early enough for personalized interventions to be put in place can be difficult as every medical school has unique structures and assessment methods. To bridge this gap, the current study compared 12 US MD-granting medical schools' Step 1 predictive models used to identify students at-risk for Step 1 failure. Each institution reported their Step 1 predictive method via virtual meetings and a brief survey. We assessed each model in terms of sensitivity, specificity, and timing of risk identification with respect to when students take the Step 1 exam. Six institutions identified students at-risk through categories of risk (scoring below a threshold, having a combination of risk factors). Three institutions identified risk using multiple regression models. Two institutions used a combination of categorical risk assessment and regression methods. One institution used growth mixture modeling to track student performance. Across the 12 participating institutions, performance on a National Board of Medical Examiners (NBME), Comprehensive Basic Science Examination (CBSE), or Comprehensive Basic Science Self-Assessment (CBSSA) exam were the most meaningful predictors. Most institutions identified at-risk students at the onset of a dedicated Step 1 study period. Although each predictive method had strengths, each also had limitations in identifying students at-risk for failing Step 1. Schools had varying thresholds for identifying and/or intervening with at-risk students. All institutions noted they were continually striving to improve their predictive model performance to enhance student learning outcomes. Overall, the current study describes and compares 12 contemporary Step 1 predictive methods, noting key features and recommendations for the development, implementation, and refinement of Step 1 predictive methodology.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-13"},"PeriodicalIF":1.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Pediatric Residents' Experiences with Decision-Making in Complex Hospital-Based Clinical Learning Environments in the United States.","authors":"Margaret A Robinson, Sandrijn M van Schaik, Judith L Bowen","doi":"10.1080/10401334.2026.2654090","DOIUrl":"https://doi.org/10.1080/10401334.2026.2654090","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b>Residents traditionally developed decision-making skills through increasingly independent practice, but many now report diminished roles in decision-making leading to concerns about readiness for practice. The clinical learning environment (CLE) shapes residents' experiences through interacting social, personal, and organizational factors that create tensions residents must navigate. Such tensions likely impact if and how residents engage in clinical decision-making, and understanding these tensions may offer insights into how to best support residents in today's CLE. This study aimed to explore how residents perceive navigating tensions in the CLE through their participation in clinical decision-making. <b><i>Approach</i></b>As part of a larger qualitative study on resident decision-making, we conducted semi-structured interviews with 38 second- and third-year pediatric residents across three academic medical centers in the United States. Using a constructivist paradigm and template analysis, we analyzed narrative excerpts focused on tensions in hospital-based clinical decision-making. We selected three representative narratives and present them in their entirety to illustrate a more complete picture of the complexity of the CLE. <b><i>Findings</i></b>The narratives described tensions in 1) who makes decisions, 2) when and where decisions are made, and 3) how decisions are made. Sometimes residents successfully addressed these tensions and described learning, but other times they described being marginalized, resulting in disengagement. <b><i>Insights</i></b>We propose a model for understanding residents' involvement in clinical decision-making in the CLE that combines elements of Lave and Wenger's Communities of Practice and Vygotsky's Zone of Proximal Development (ZPD). In this new model, residents can be in their ZPD as either central or peripheral participants in clinical decision-making or be marginalized participants and disengaged from learning. By highlighting the workplace tensions that different interacting factors in the CLE create, we propose new ways to support residents' development of decision-making skills in increasingly complex clinical contexts. We suggest conscious deliberation for residents, supervisors, and education leaders. By paying close attention to the context of each dynamic, evolving decision-making process, residents can adjust their expectations for participation; supervisors can support residents within their ZPD as central or peripheral participants; and education and clinical leaders can strive to create schedules, team structures, and workflows that support resident involvement in patient care. Successful navigation of CLE complexity is necessary to ensure that residents develop decision-making skills for future independent practice.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-11"},"PeriodicalIF":1.8,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Language Matters: Integrating Community Voices into the University of Utah Quick Language Guide.","authors":"Jacob R Knight, Jasmine M Abril, Rawad Farhat, Candace J Chow, Paloma F Cariello, Tiffany Ho, Jessica L Jones","doi":"10.1080/10401334.2026.2654089","DOIUrl":"https://doi.org/10.1080/10401334.2026.2654089","url":null,"abstract":"<p><p>Language affects patient experiences. Healthcare professionals' words can enhance or detract from patient care. Several organizations and scholars have published evidence of how language can reflect bias and have recommended the use of person-centered language in healthcare to promote respect, reduce stigma, and enhance patient-centered care. However, we have not found an inclusive language guide that reflects a culturally humble approach, covering multiple patient populations in one document and incorporating feedback from community members. Thus, we created the University of Utah Quick Language Guide (UU Guide), which aims to help healthcare educators and professionals use anti-biased language with students and their patients. This project's goal was to explore community perspectives on the UU Guide and use the community insights to improve it. In January 2024, 20 of the 27 Community Health Workers (CHWs) employed at our institution took part in one of three 1-hour focus groups to discuss the UU Guide's language. Three themes characterized their perspectives on the guide's language: (1) Terms used by academics that are confusing to community members; (2) Terms considered stigmatizing by academics but preferred by community; (3) Medical information considered offensive/controversial by community members. While the guide was created to make healthcare more patient-centered and was well-received overall by CHWs, focus group conversations highlighted challenges with the guide. More community-informed language was needed, and we found certain terms considered inclusive in academic settings were unfamiliar or unclear to CHWs. Our findings also showed how the perception of stigma varies across communities. Our study emphasizes how language is perceived differently among different communities and the importance of context. Moving forward, revisions of the UU Guide must involve the voices of the communities it seeks to serve. Furthermore, fostering a collaborative dialogue between academics, healthcare professionals, and community members will be essential in designing language tools that are respectful and inclusive for patients.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-7"},"PeriodicalIF":1.8,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147619180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching US Pediatric Trainees to Discuss Race and Racism in the Primary Care Setting: Implications of Learners' and Families' Differing Perspectives.","authors":"Josh Kurtz, Emma Gerstenzang, Christine Liverpool, Sophie Lieberman, Hannah L Kakara Anderson, George Dalembert, Noreena Lewis, Jessica C Fowler, Aditi Vasan, Beth Rezet","doi":"10.1080/10401334.2025.2509173","DOIUrl":"10.1080/10401334.2025.2509173","url":null,"abstract":"<p><p><b><i>Background.</i></b> Despite their impact on children's health and well-being in the U.S., race and racism are not routinely discussed during pediatric outpatient visits. It is unclear whether families want to discuss race and racism with their pediatrician and - if so - how pediatric residents should be trained to facilitate these conversations effectively. <b><i>Objective.</i></b> We explored the perspectives of physician parents, community members, and pediatric residents on discussing race and racism during outpatient pediatric visits as part of a needs assessment to inform the development of a curriculum to teach pediatric residents how to discuss race and racism with families in the primary care setting. <b><i>Methods.</i></b> We recruited pediatric residents (n = 6), physician parents (n = 6), and community members (n = 2) to participate in focus groups. Participants were divided into focus groups based on their stakeholder role and self-identified race. We recorded and transcribed focus group dialogue and used thematic analysis to examine the data. Results: Participants expressed hesitancy regarding discussions about racism between families and their pediatrician, given possible unintended consequences. Participants felt that shared experiences amongst patients and providers could help improve provider and patient comfort during these conversations. Black physician parents and community members highlighted the importance of celebrating children's racial identities and avoiding preemptively broaching conversations about racism. White physician parents and residents, in contrast, expressed desire for standardized guidance and suggested phrasing to improve their comfort. To effectively train pediatricians to have conversations about racism, all participants expressed the importance of pediatricians learning about racism's effects on children's health, both broadly and locally. To learn this information, community members felt community involvement would be most beneficial, whereas pediatric trainees and white physician parents felt standardized training with role play would be most helpful. <b><i>Conclusions.</i></b> Facilitating conversations about race and racism in the outpatient setting requires a patient-and family-centered, nuanced approach. Educators developing curricula to teach trainees how to have these conversations should consider including information on how racism impacts children's health, both broadly and locally. Recognizing the divergent perspectives between stakeholder groups, educators may consider developing structured, longitudinal curricula focused on the current and historical health impacts of race, racism, bias, and discrimination, incorporating experiential learning in the community setting instead of focusing on developing curricula specifically focused on teaching trainees how to discuss racism in the primary care setting.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"215-225"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Benevolence of Heuristic Thinking.","authors":"Hartley Perlmutter","doi":"10.1080/10401334.2026.2616712","DOIUrl":"10.1080/10401334.2026.2616712","url":null,"abstract":"<p><p>In this narrative recounting call-shifts at two separate points in his training, a pediatric resident reflects on the evolution of his heuristic thinking. Developed through pattern recognition and illness scripts, heuristic thinking enables clinicians to perform timely assessments and formulate organized diagnostic and management plans. However, beyond efficiency, the resident discovers-first in observation and later in practice-the benevolence that emerges with refined heuristic thinking.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"264-267"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I knew I was not going to get fired … I know what the line is\": How HPE Faculty Support Trainees' War Against Social Harm and Injustice.","authors":"T R Wyatt, C Chow, Q Nguyen, E Scarlett, T Ma","doi":"10.1080/10401334.2025.2486383","DOIUrl":"10.1080/10401334.2025.2486383","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; 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. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; 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 &lt;i&gt;supporters and auxiliary staff, cultural brokers,&lt;/i&gt; and &lt;i&gt;tempered radicals.&lt;/i&gt; Through constant comparison, we identified patterns across participants in the roles they played and the kind of support they offered. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; 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. &lt;b&gt;&lt;i&gt;Discussion:&lt;/i&gt;&lt;/b&gt; 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 &lt;i&gt;strategist&lt;/i&gt; in fighting this war, providing big picture opportunities and risk assessments for trainees to consider. Whereas trainees serve as the &lt;i&gt;tacticians&lt;/i&gt; doing the wor","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"226-235"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}