Supplementary file 1_Competing institutional logics in surgical training: a qualitative study of coping strategies in China's dual-track system.docx

Second, institutional barriers: participants perceived temporal constraints from research demands, an evaluative emphasis on research achievements, and relational barriers related to supervisors’ control over learning opportunities. Third, coping strategies: students developed temporal reappropriation, informal learning communities, strategic visibility, and technology as a learning prosthesis, effectively “practicing in the cracks”.

A proposed Institutionally Mediated Model illustrates how macro-level logics shape meso-level mechanisms and micro-level agency.</p>Conclusion<p>The findings suggest that, within the integrated professional master's and standardized residency training context, competing research and clinical demands may create temporal, evaluative, and relational barriers to surgical learning. Participants developed individual and collective coping strategies to preserve opportunities for clinical skill development, revealing a potential gap between formal training objectives and experienced learning priorities.

System-level efforts are needed to align evaluation practices, protect opportunities for deliberate practice, support supervisors’ educational roles, and integrate effective informal learning resources into surgical training.</p>