Navigating Dilemmas Arising from Advocacy and Resistance in Medical Education and Medical Practice.

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.