Pushing, standing and bringing to light: How medical trainees conceptualise professional resistance.

BACKGROUND: Much of the literature on harm and injustice in medical education focuses on the impact of oppression rather than trainees' efforts to create change. To acknowledge and make visible these efforts, medical education professionals must grasp how trainees perceive resistance and their role in effecting change. Employing functional linguistic and 'everyday' resistance theories, this critical qualitative study aims to understand trainees' conceptions of resistance practices and their representational choices in moments when they talked about and conceptualised resistance. METHODS: Gathering participants through professional networks and snowball sampling, this study employed in-depth interviews to explore the conceptualisations of resistance among North American medical trainees (9 medical students, 9 residents and fellows). With the use of an applied functional linguistic analysis framework, we analysed the representational metafunction in trainees' conceptualisation of their resistance efforts against social injustice. We began with open coding for 'everyday' acts of resistance and then shifted to focused coding on verbal process types in participants' language to characterise their conceptualisations of resistance. FINDINGS: Participants conceptualised their resistance practices in three distinct ways: first, an almost physical pushing back, drawing largely on material process types (doing); second, an embodied standing up and being present, based predominantly on material and relational process types (being); and third, an epistemic bringing to light, grounded mostly in mental and verbal process types (thinking). These processes of resistance reflect participants' conceptualisations of their efforts to challenge the status quo around inequity, harm and injustice in medical education. CONCLUSION: This study builds on resistance literature, offering a potential typology of resistance practices as pushing back, being and bringing to light. Because these are 'everyday' acts of resistance, these are tactics available to everyone, including faculty; we all have the power to resist, whether it is in teaching and learning or interacting with larger structures in medicine.

'When I stood up for something it's because I felt a moral violation': Trainees' acts of resistance against social harm and injustice.

INTRODUCTION: As medical students around the world enter their chosen profession, they inherit a system that they did not design nor create, yet are still responsible for it. This system is rooted in centuries of social harm and inequity. This study examines trainees' professional acts of resistance to understand what trainees hope to accomplish in their resistance efforts, why they are resisting, and the tactics they use. METHODS: Drawing on counter-storytelling and critical theory, we collected in-depth qualitative interviews from nine medical students and nine residents/fellows across North America. Using theoretical guidance on how to study acts of resistance, data were analysed using a combination of coding techniques to understand resistors' intentions in resisting and the tactics they used to understand what, why, and how trainees were resisting. The analysis was returned to participants for member checking. RESULTS: Trainees described resisting systems of harm and injustice bequeathed to them by an older generation whose values and practices were reflective of a different time. Their motivations stemmed from deep-seated moral distress from the mistreatment of patients and learners. They hoped to re-envision medical education to be patient- and learner-centred. The tactics they chose depended on the level of power they had in the system and the extent to which they wished to have their efforts known. DISCUSSION: Trainees described intentional and deliberate acts of resistance to the social harm and injustice embedded in the broader profession to re-create the profession. Given that these acts spanned a large geographical area, this study suggests that trainees may be part of a larger social movement aimed at creating widespread change within the profession.

Profiles of Military Medical Students' Well-being, Burnout, and Retention.

BACKGROUND: Well-being concerns among medical students are more prevalent than their age-matched peers in the United States. It remains unknown, however, if individual differences in well-being exist among U.S. medical students serving in the military. In this study, we sought to identify profiles (i.e., subgroups) of well-being in military medical students and examine the associations between these well-being profiles and burnout, depression, and intended retention in military and medical fields. METHODS: Using a cross-sectional research design, we surveyed military medical students and then conducted latent class analysis to explore profiles of well-being, and applied the three-step latent class analysis method to assess predictors and outcomes of well-being profiles. RESULTS: Heterogeneity in well-being was identified among the 336 military medical students surveyed, portraying medical students' falling into three distinct subgroups: High well-being (36%), low well-being (20%), and moderate well-being (44%). Different subgroups were associated with different risks of outcomes. Students in the subgroup of low well-being were at the highest risk of burnout, depression, and leaving medicine. In contrast, students in the moderate well-being group were at the highest risk of leaving military service. CONCLUSIONS: These subgroups may be clinically important as burnout, depression, and intention to leave medical field and/or military service occurred with varying likelihoods among medical students across the different well-being subgroups. Military medical institutions may consider improving recruitment tools to identify the best alignment between students' career goals and the military setting. Besides, it is crucial for the institution to address diversity, equity, and inclusion issues that may lead to alienation, anxiety, and a sense of wanting to leave the military community.

Military Medical Students' Coping With Stress to Maintain Well-being.

INTRODUCTION: Previous studies have shown that medical students experience a great level of burnout and poor well-being during their clinical training periods. In this study, we sought to understand how military medical students cope with stress to prevent burnout and support their well-being. We also investigated if these coping strategies are associated with military medical students' self-reported well-being, burnout, and depression levels. The findings could help inform programming, resources, and educational strategies to better support students to thrive in their careers long term. METHODS: Using a cross-sectional research design, we surveyed military medical students and conducted content analysis on participant responses to the open-ended item by trained coders. Coding was based on the existing coping theory frameworks as well as categories that emerged inductively to represent the data. RESULTS: The primary four strategies military medical students utilized included social connection (59.9%), exercise (58.3%), personal relaxation (36%), and work-life balance (15.7%). The use of work-life balance strategy was significantly associated with more positive well-being and lower depression compared to those who did not use this strategy. Three main coping typologies were further extracted, including personal care, connection, and cognitive strategies. Based on the typologies, 62% of students were recognized as multi-type copers (who combined more than two coping typologies), who reported significantly more positive well-being compared to students who relied on a single typology. CONCLUSIONS: The findings demonstrate that certain coping strategies are more positively associated with a good state of well-being and less burnout, and that utilization of multiple types of coping strategies is more supportive. This study amplifies the voice of military medical students concerning the importance of prioritizing self-care and available resources given the unique pressures and demands of their dual military medical curriculum.

Physician resistance to injustice: A scoping review.

Throughout history, physicians have been involved in acts of resistance to systems of harm and injustice. However, resistance has seemed to have had little legitimate place in physician professionalism or in formal professional practice. As the challenges to physicians and the profession continue to mount, there is a pressing need to understand how it might be articulated and understood. To do that we need to consider past instances of physician resistance to injustice and harm. A scoping review was conducted to understand how often and in what contexts physicians have been engaged in resistance. A search of multiple bibliographic databases returned 2123 papers, which, after filtering for relevance and inclusion, left 60 articles for full-text review. Of these, 95% were from the United States, suggesting that issues of legitimacy are even more acute outside the U.S. Narrative findings were organized around four themes: professional responsibility to resist, legitimate resistance, resistance to perceived threats, and resistance as moral agency. When physicians have resisted, they have done so with a sense of moral agency albeit with different levels of altruism. They have often engaged in resistance when they felt their personal and professional interests are threatened, with particular emphasis on threats to physician autonomy. The study suggests that, within the U.S. at least, physician resistance is a matter for concern but, it has been approached with little or no guidance or grounding. Moreover, there is a longstanding tension between those who have argued that physicians have a professional responsibility to resist and those who have considered resistance to be extraneous and even harmful to their work as healers. At a time when physicians are facing an ever-growing number of practical, ethical, and moral challenges, professional acts of resistance are of critical concern within the profession.

Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education.

PURPOSE: Faculty within interprofessional education (IPE) are essential contributors to IPE implementation efforts. Although the majority of existing IPE literature consists of reports on IPE innovations, few insights are available into the experiences of the faculty members who deliver IPE. This critical narrative review was designed to synthesize the knowledge available about (1) roles assigned to IPE educators and (2) IPE faculty members' experiences of fulfilling these roles. METHOD: Six databases for English-language studies published between 2000 and March 2021 were searched: PubMed, Embase, Web of Science, MEDLINE, CINAHL, PsycINFO, ERIC, and MedEdPortal. A total of 1,717 manuscripts were identified for possible inclusion. After applying inclusion/exclusion criteria, 214 articles constituted the final literature corpus. Harden and Crosby's original framework of 6 roles of medical educators augmented with the manager role introduced in Harden and Lilley's 2018 framework informed the analysis. RESULTS: IPE faculty take on all 6 roles identified by Harden and Crosby: facilitator, planner, information provider, examiner, role model, and resource developer, as well as the manager role. Faculty were most commonly identified as facilitator and planner, and rarely as role models. The authors identified 3 main struggles experienced by IPE faculty: personal (e.g., confidence as a cross-professions educator), interpersonal (e.g., co-teaching IPE), and institutional (e.g., supporting IPE logistics). CONCLUSIONS: This review highlights the complexity of the roles taken on by IPE faculty and the struggles they experience in the process. The results suggest that attention to the different roles that IPE faculty play in educational interventions and to equipping faculty with the necessary competencies, tools, and support, is fundamental to the success of IPE. Future research should harness the explanatory power of theories to help explain dynamics at play between personal, interpersonal, and institutional barriers to identify interventions that can aid IPE faculty in delivering collaboration-ready professionals.

The development of cooperation and self-control in middle childhood: Associations with earlier maternal and paternal parenting.

Developmental theories and previous research have emphasized the significance of cooperation and self-control in middle childhood. The present study extends previous research by examining (a) the growth of cooperation and self-control as well as the relations between them in middle childhood (third to sixth grade) and (b) the extent to which mothers' and fathers' parenting during early childhood (54 months and first grade) was associated with children's cooperation and self-control. The sample included 705 children (51% female, 86% White) and their mothers, fathers, and teachers in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (SECCYD). Children, on average, exhibited increases in self-control but not cooperation from third to sixth grade though the increases were smaller for children who had higher self-control or cooperation at third grade. Children who exhibited higher self-control at third grade tended to exhibit higher cooperation at third grade; similar positive associations emerged for the changes in self-control and cooperation over time. In addition, if a child exhibited higher self-control at one time point relative to their typical average level, they tended to also exhibit higher cooperation at the same time point relative to their typical average level. However, these relative deviations within person were not associated over time. Lastly, maternal and paternal sensitive and stimulating parenting in early childhood was positively associated with children's cooperation and self-control in middle childhood. Overall, our findings shed light on the growth of and the relations between cooperation and self-control in middle childhood and highlight the role of maternal and paternal parenting in early childhood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Children's developing work habits from middle childhood to early adolescence: Cascading effects for academic outcomes in adolescence and adulthood.

Children's work habits at school include being a hard worker, turning in work on time, following classroom rules, and putting forward one's best effort. Models on youth character, noncognitive skills, and social-emotional learning suggest that self-management skills like work habits are critical for individuals' subsequent academic success. Using data from 1,124 children in the NICHD Study of Early Childcare and Youth Development (49% female; 77% White), we examined children's developing work habits from first to sixth grade and their developmental cascading effects on academic outcomes at the beginning and end of high school as well as at age 26. The findings on differential stability of work habits (i.e., bivariate correlations) suggest that children were likely to maintain their relative position among peers from first to sixth grade. The complementary findings on mean-level changes from the latent growth curves suggest that children's work habits exhibited mean-level increases over the same period, meaning that children's work habits became more advanced from first to sixth grade. Models used to examine the developmental cascades of work habits suggest that children's work habits at first grade and the growth in children's work habits from first to sixth grade (a) directly predicted their academic outcomes at the beginning and the end of high school, and (b) indirectly predicted their educational attainment at age 26 through their academic outcomes during adolescence. These findings underscore the importance of foundational noncognitive skills during middle childhood that predict individuals' academic outcomes up to 20 years later in adulthood. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

School-wide social emotional learning (SEL) and bullying victimization: Moderating role of school climate in elementary, middle, and high schools.

Guided by the school-wide social-emotional learning framework and social-ecological model, in this study we examined the associations between students' perceptions of four core social emotional learning (SEL) competencies (i.e., responsible decision-making, social awareness, self-management, and relationship skills) and school climate and their experience with bullying victimization through a multilevel framework. We also examined the multilevel moderating effects of students' perceptions of school climate, gender, and school levels (elementary, middle, and high schools) on the association between SEL competencies and bullying victimization. Participants were 23,532 students (4th to 12th grade) from 90 schools in Delaware. Using hierarchical linear modeling and controlling for demographic factors and school climate at both student and school levels, we found that three of the four core SEL competencies (i.e., social awareness, relationship skills, and self-management) and student-level school climate perceptions had significant associations with students' bullying victimization experiences. Moreover, the positive association between social awareness and bullying victimization and the negative association between self-management and bullying victimization were both mitigated in schools with more positive school climate at the student level. The association between some of the SEL competencies and bullying victimization varied depending on students' gender and grade levels. The findings highlight the unique and differentiated relations among the four core SEL competencies and students' bullying victimization experiences; they also suggest the importance of including school climate assessment and applying gender- and grade-level-specific efforts in bullying prevention programs with an SEL focus.

Adolescents' willingness to help with peer victimisation in Taiwan: The role of individual and situation-specific characteristics.

The purpose of this study is to evaluate adolescent bystanders' willingness to help and specific help responses as predicted by both individual characteristics (e.g., gender, empathy, victimisation experiences) and situation-specific characteristics (i.e., bystander's relationship with the victim and the presence of another bystander). The study used an experimental vignette method with a sample of Taiwanese adolescents. Participants included 730 seventh graders (49% girls, mean age 12.8 years) attending one middle school in a southern city in Taiwan. Results show that both individual characteristics (e.g., gender, empathy) and a situation-specific characteristic (i.e., the relationship a participant had with the victim) predicted adolescents' willingness to help. However, only individual characteristics predicted adolescents' specific help responses including telling the teacher, telling the bully to stop, and comforting the victims. Directions for future research and implications for interventions and prevention programs are discussed.

Brief report: Patterns of prosocial behaviors in middle childhood predicting peer relations during early adolescence.

INTRODUCTION: Early adolescence is a developmental period in which peer victimization, bullying, relational aggression, and social exclusion are particularly prominent. As these behaviors have long-term implications for children, in this study, we investigated early variations of prosocial behaviors as one of the critical precedents that shape youth's subsequent peer relational outcomes. Specifically, we identified different profiles of prosocial behaviors in middle childhood (Grade 4) and related these profiles to peer relationships in early adolescence (Grade 6). METHOD: Using longitudinal data from the NICHD Study of Early Child Care and Youth Development (N = 914; 52% girls), a three-step latent profile analysis was conducted on Grade 4 prosocial behaviors, which were then related to Grade 6 teacher- and student-rated peer relationships (e.g., relational aggression). RESULTS: Four patterns of prosocial behaviors emerged: low prosocial (18%), high prosocial (67%), primarily friendly (8%), and primarily kind (7%). These four patterns of prosocial behaviors were differentially related to later problematic peer relationships: Low prosocial youth demonstrated the most problematic peer relationships (Mdiff = 0.36-0.93, all p < .001). Primarily friendly (but not kind) youth displayed more general and relational aggression (Mdiff = 0.22, SE = 0.07, p = .002; and Mdiff = 0.18, SE = 0.06, p = .006, respectively). CONCLUSION: Both low prosocial and primarily friendly youth are at risk for displaying peer-related problems; interventions that build prosocial behaviors in youth with a low prosocial or primarily friendly profile may help prevent problematic peer relationships at early adolescence.

Defending behavior of peer victimization in school and cyber context during childhood and adolescence: A meta-analytic review of individual and peer-relational characteristics.

Adolescent defending of peer victimization in the school and cyber context has received increased attention in developmental science and is an important component of antibullying interventions. However, the overall prevalence, and individual characteristics that correlate with defending in adolescence, have not been systematically and statistically reviewed. Framed in Bronfenbrenner's social-ecological theory, this meta-analytic review included 172 reports out of 155 studies of defending including 150,978 children and adolescent participants from 4 continents (i.e., North America, Europe, Asia, and Australia) to analyze two aspects: (1) the average proportion of defenders in the population and (2) associations between defending and individual and peer-relational correlates of defending in school and cyber contexts. Using mixed-effects modeling, our results confirmed prior findings of gender differences (favoring girls) and age differences (favoring younger children) in defending. We found positive correlations between defending and affective empathy, cognitive empathy, experiences of peer victimization, self-efficacy, popularity, and acceptance, and a negative correlation between defending and moral disengagement. We also found substantial heterogeneity in these effect sizes. The reporter of defending consistently moderated all mean effect sizes. Implications for prevention efforts and future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The moderation of culturally normative coping strategies on Taiwanese adolescent peer victimization and psychological distress.

The current study aimed to investigate the moderation effects of coping strategies on the association between perceived peer victimization and psychological distress including loneliness and depression. Applying the person-context fit developmental model, this research hypothesized that adaptive coping strategies, which are normative in Taiwan's culture (i.e., social support seeking), would buffer the link between peer victimization and psychological distress (i.e., depression and loneliness) in comparison with the culturally non-normative coping (i.e., problem-solving strategies). We also expected maladaptive coping strategies (i.e., internalizing strategies) would exacerbate the link between peer victimization and psychological distress. A latent interaction model was conducted with a sample of 730 Taiwanese adolescents attending one middle school. The results indicated that both support seeking strategies and problem-solving strategies buffered Taiwanese adolescents from loneliness and depression. Internalizing coping strategies placed Taiwanese adolescents at great risk of depression and loneliness. Support seeking strategies that are aligned with interdependent cultural contexts appeared to have greater protective effects than the culturally non-normative problem-solving strategies for adolescents who perceived high levels of victimization. The implications for prevention and intervention were discussed.

A two-method investigation of early adolescents' responses upon witnessing peer victimization in school.

Given the passivity of many adolescents upon witnessing peer victimization, the goal of this study was to evaluate the features of school-based peer victimization events that promote helping. A sample of 470 early adolescents (52% girls; 71% White, 9% Black, 6% Latino, 2% Asian, 1% American Indian, 8% Multiethnic, and 3% Other) reported likelihood of helping and specific helping and non-helping behaviors with an experimental vignette method and through descriptions of recently witnessed real-life victimization events. With both methods, an adolescent's relationship with the victim predicted likelihood of helping and specific helping behaviors above and beyond the contribution of other key personal characteristics including gender, empathy, communal goal orientation, and previous victimization experiences. Examination of adolescents' real-life experiences yielded systematic patterns between their responses and their reasoning about the responses undertaken. The results illustrate the relevance of taking into account peer victimization event characteristics for promoting witness intervention in adolescence.

Peer victimization and parental psychological control in adolescence.

With a sample of 831 U.S. adolescents (49% girls) followed from 9th to 11th grade, the directionality of the association between school-based peer victimization and adolescents' perception of their parents' psychological control were examined. Possible mediating influences of internalizing symptoms were also explored. The results highlight the relevance of adolescent-to-parent influences during adolescence by demonstrating that physical peer victimization was predictive of increases in mother's psychological control but parental psychological control did not predict subsequent peer victimization. These direct effects were present above and beyond the contribution of adolescent internalizing symptoms to higher parental psychological control. Practical implications of the primacy of adolescent-to-parent influences in predicting the social adjustment of victims of peer harassment are discussed.

School context protective factors against peer ethnic discrimination across the high school years.

Ethnically diverse high school contexts present unique social opportunities for youth to form interethnic relationships, but they may also subject students to certain social challenges such as peer ethnic discrimination. With a sample of 1,072 high school students (55% girls; 54% Latino, 20% African American, 14% Asian, 12% White) attending 84 high schools, school context factors that protect students' exposure to peer ethnic discrimination across the high school years were investigated with a three-level hierarchical linear model. Each spring for four consecutive years (grades 9-12), self-reported peer ethnic discrimination, interracial climate at school, and perceived school ethnic composition were assessed. At the school level, objective high school ethnic composition data were collected. Peer ethnic discrimination was found to decline slightly across the high school years. Above and beyond this decline, more positive perceptions of the school interracial climate and both objective and perceived numerical ethnic majority status predicted lower levels of peer ethnic discrimination. Taken together, the results highlight the significance of both objective (e.g., ethnic composition) and subjective (e.g., interracial climate) aspects of the school ethnic context to students' high school social experiences.