At the subsequent Eleventh Party Congress (March–April 1922), Medvedev, Shlyapnikov and Alexandra Kollontai (who, too, had co-signed the letter)  were charged with having insisted on factional work and their expulsion from the party was proposed. Eventually, a resolution was passed allowing the three to remain in the party unless they committed further violations of its discipline, while two other signatories of the appeal, F. Mitin (b. 1882) and N. Kuznetsov (1898-1935), were expelled.
Together with Alexander Shlyapnikov and others, he participated in the Workers' Opposition, a tendency of the Russian Communist Party, which called for worker initiative in managing the economy and for working-class members to prevail in leading organs of the Communist Party. At the Tenth Party Congress of 1921, however, internal factions were banned and the Workers's Opposition was dissolved with immediate effect, even though Medvedev was elected a candidate member of the Central Committee. In February 1922 he was a signatory of the so-called Letter of the Twenty Two, whereby several former members of the Workers' Opposition and other party members of working class origins appealed to the 1922 conference of the Comintern Executive against the undemocratic internal practices in use within the Russian party.