INTRODUCTION: Augmenting training on the social and structural determinants of health in medical education is essential for addressing health disparities and fulfilling medical schools' accreditation-mandated social accountability obligations. Despite these mandates, significant implementation challenges impede curricular efforts, including faculty capacity and resistance to teaching equity-focused content. To navigate this resistance, we must first understand it. METHODS: An institutional ethnography was conducted over 18 months at a Canadian medical school to trace how faculty resistance is socially and institutionally organised. Data included field observations, interviews with 14 faculty and curriculum leaders and analysis of 124 institutional and regulatory texts. Analysis traced how ruling relations and text-mediated practices shape faculty engagement with social justice education. RESULTS: Faculty resistance-manifesting as scepticism, discomfort and disengagement-was shaped by professional identities rooted in biomedicine and authoritative expertise, hierarchical structures and sociopolitical discourses that framed equity as ideological. Licensing examination objectives operated as boss texts that perpetuated these dynamics, producing tensions that sidelined health equity and social justice content in favour of biomedical priorities. A recursive ideological circle and institutional circuit reinforced the marginalisation of social justice in medical education. DISCUSSION: Faculty resistance to teaching health equity and social justice-oriented content is not simply individual or attitudinal, but an institutional product shaped by professional, structural and sociopolitical relations. Addressing this requires structural re-alignment across governance, regulatory frameworks and professional norms to position social justice as integral, rather than peripheral, to contemporary medical education and practice.
Brown et al. (Wed,) studied this question.