Actions Speak Louder than Words: A Qualitative Study of US Clinical Students' Allyship Experiences and Their Relation to Professional Identity.

Purpose: Enabling undergraduate medical trainees to develop professional identities consistent with their consciousness of inequities in healthcare and their obligation to provide just healthcare is a pressing challenge. Except as a duty not to discriminate, the positive obligations of a physician's commitment to social justice in the clinic can be unclear, including for educators seeking to empower learners to incorporate such commitments into their developing identities. This study explored the pedagogical value of allyship-to be in supportive association with a marginalized or mistreated group-seeking to understand the allyship issues students in clinical training reflect on as noteworthy and how they assess allyship-related encounters with respect to their professional identity. Method: We conducted a qualitative content analysis of 110 vignettes and reflections that students doing their clerkships as acting interns submitted as part of a required ethics course at a US allopathic medical school in 2020-21. Independent coders followed an inductive, iterative process to code the submissions. Results: Students reflected on demonstrated acts of allyship in 65.5% of cases, and in 34.5% of cases, students described situations in which allyship was warranted but lacking. Students most frequently reflected on the allyship needs of those who were racially minoritized, identified as LGBTQ+, were perceived as "difficult," and had complex care needs, and they specified issues like disparaging remarks, implicit bias, ignored patient needs, and treatment refusals as calling for allyship. The highlighted issues reflected their salience in contemporary social justice discourses in medicine. All analyzed submissions also featured meaningful reflections on at least one demonstrated act of allyship or failure thereof. Students discussed these acts' significance by connecting them to a constellation of professional values, such as the obligation to treat the whole person, be inclusive, be fair, and advocate. Conclusions: This study's results show allyship can be a pedagogically useful concept with which students can reflect on and raise their consciousness of vulnerable patients and populations, what acts of allyship can look like at the bedside, and how their commitment to allyship connects with and is reinforced by other professional values.