AMEE guide to resistance in medical education: AMEE Guide No. 197

As attention to resistance in medical education has grown, the need for clear understanding and guidance for educators and learners alike has become ever more necessary. This AMEE Guide seeks to meet this need by presenting an overview of the many dimensions of resistance that intersect with medical education. Both as a concept and as a practice, resistance can be many things and take many forms, including various cultural constructions ranging from heroic activism freedom to self-indulgent anarchy. In terms of what is resisted in medical education, there are three broad areas: practice-oriented and institutional change, relational hierarchies, and ideological conflicts. Although the literature attends more to learner resistance, teachers can also be involved in acts of resistance, as can other players within medical education and even institutions. There are a great many reasons for engaging in resistance ranging from personal inconveniences to high moral causes. Expressions of resistance vary widely, lying along a continuum between overt, explicit acts and subtle, covert behaviors. Resistance may be a purely individual undertaking, but it often takes on quite different forms with greater impact when undertaken with others. It is important to differentiate between nonprofessional resistance (quite disconnected from professional practice), unprofessional resistance (that falls below standards of professional conduct), and professional resistance (that reflects professional standards and adds to rather than subtracts from professional integrity). In considering resistance in medical education, the authors also considered how to react if you become the focus of resistance or are otherwise caught up in it. The authors also argued that professional resistance needs to be explicitly addressed in medical education, although that may take many different forms. In summary, this AMEE Guide serves as a conceptual, evidence-informed, and practical resource on resistance for all those involved in medical education.