"I never wanted to burn any bridges": discerning between pushing too hard and not enough in trainees' acts of professional resistance

Subversive mythical figures and feminist resistance: On the rise of posthuman 'professionals'

Within the context of neoliberal healthcare, nurses and other health professionals face working conditions that leave them perpetually feeling inadequate, as though they are not enough. They are consistently expected to achieve more with less resources. In such an environment, mere professionalism proves wholly insufficient, enforcing norms of altruism and kindness. Professionals must transcend this disciplinary tool and embody a 'more-than-professional' approach. This study, informed by critical posthumanism, employs three mythical archetypes-the Medusa, the Witch and the Siren-to illuminate potential avenues for resistance against prevailing trends in healthcare. Drawing on the perspectives of Hélène Cixous, Silvia Federici and Jacques Rancière, we introduce a process of resistance for healthcare professionals pushing back against the challenges of crumbling healthcare systems. Cixous' feminist reimagining of Medusa symbolizes intensified embodied sensory experiences, emphasizing the power of irony, laughter and writing in highlighting the daily struggles faced by healthcare workers. Federici's depiction of the Witch exposes clandestine alliances among healthcare workers and patients, akin to a pact with the devil, countering the individualistic, alienating approach to care provision and resisting neoliberal pressures. The Witch archetype embodies resistance grounded in creativity against the commodification of public healthcare. Finally, Rancière's 'politics of the Siren' offers a strategy for disrupting entrenched hierarchies from the underworld. Like Sirens, healthcare workers and patients can subversively transform their silence into songs of resistance, simultaneously operating from beneath the surface of accountability measures. Our intention is to showcase the emergence of posthuman 'professionals' who adapt by forging new modes of social relations in response to neoliberal constraints, straying from conventional, apolitical notions of 'professionalism'. Drawing lessons from mythical figures of resistance offers a fresh understanding of subversion as a catalyst for social and political transformation within the healthcare sector.

The enemy within: The new war in medical education

INTRODUCTION

War and military metaphors have long been used in clinical medicine to describe medicine's collective fight against disease. However, recently resistor trainees have used similar language to describe their acts of professional resistance against social harm and injustice. To understand the contours of this war, this study analyzes the metaphoric language these trainees use to describe their acts of resistance.

METHODS

We recruited 18 resisting trainees using our personal and professional networks and snowball sampling. Participants were interviewed from July 2022-February 2023. Using methodological bricolage, we analyzed the data using Wickens' analytical approach, which draws on constant comparative analysis and discursive textual analysis. Data were analyzed in three phases that included a consult with a military historian, isolation of metaphoric language, and a textual analysis using context clues from participants' descriptions of their acts of professional resistance.

RESULTS

Resisting trainees used metaphorical language to signal an insurgency to topple power. These trainees referenced two conflicts: the mistreatment of patients and the mistreatment of trainees. Enemies were conceptualized as anyone who actively protects institutions and the traditions of medicine, such as leaders of medical schools and hospitals, and physicians trained in a more traditional system. Trainees conceptualized the primary battlefield as medicine's process of socialization that integrates trainees into a profession, and accepts mistreatment as the norm. Weapons included LCME site visits and sympathetic faculty members.

CONCLUSION

Whereas metaphorical language around war and the military was previously the purview of physicians, resistor trainees have adopted war metaphors for their own purposes. They do not use these metaphors accidently; they are meant to signal their intentions to restructure medical education. Leaders must begin working with trainees in sincere partnership to create widespread change.

Navigating identity dissonance: subjectification to balance socialization

One of the main goals of medical education is to facilitate the development of a professional identity. As part of this effort, trainees are exposed to the values and cultures of the profession in a process known as socialization. Learners must then negotiate incongruent aspects between their preexisting identities and nascent professional identities. Individuals from historically underrepresented ethnic groups often undergo more significant changes due to their values and culture not being as prevalent within the dominant ideology of medicine. This transformative process can lead to identity dissonance and manifest as an internal discomfort resulting from perceived contradictions between one's existing identity and the required professional identity. Identity dissonance may be traumatic and pose a threat to the academic performance and professional integration of trainees. These detrimental effects harm the medical workforce by depriving it of a group crucial in addressing health inequities. Educators tasked with facilitating the professional development of learners must consider their implicit expectations about professionalism, explore the distinct challenges experienced by individuals from underrepresented backgrounds in their professional development, and work to develop strategies to help trainees navigate identity dissonance. Subjectification, an education philosophy that focuses on compelling individuals to explore the new possibilities and responsibilities imparted to them by their education, provides a theoretical framework to help educators guide learners through identity dissonance.