When Medicine Teaches Healers Not to Be Human — and How to Change That
The Arnold P. Gold Foundation champions humanism in health care. This work faces a strong headwind, however, from the system that trains clinicians to dehumanize themselves.
Addressing that headwind is at the core of Dr. Javeed Sukhera’s work. Dr. Sukhera is a psychiatrist, clinician-scientist, and Chair of Psychiatry at Hartford Hospital’s Institute of Living. Dr. Sukhera was a Gold Humanism Scholar at the Harvard Macy Institute and has been a Gold Foundation grantee.
This Roundup began with Gold Foundation President and CEO Dr. Kathleen Reeves being inspired by Dr. Sukhera’s question for former Surgeon General Dr. Vivek Murthy at the 2025 AAMC’s Annual Meeting. His question centered the paradox between how medicine valorizes vulnerability in the abstract while building training environments in which any expression of fallibility can feel like a mortal threat. When I spoke with Dr. Sukhera recently, he reflected on an observation from early in his career: patients in his care were being harmed, not by indifferent clinicians, but by well-meaning colleagues working within a system he too was part of. That recognition — that we can cause harm despite our best intentions — stimulated his scholarly work and drove the research that you’ll read about below.
This Roundup highlights three articles by Dr. Sukhera and colleagues. Each resonates with the values guiding the Gold Foundation’s work, and I hope readers come away with pragmatic insight they can use and with hope for more humanistic systems that benefit learners, faculty, clinicians, and patients alike.
Exploring self-censorship and self-disclosure among clinical medical students with minoritized identities. Sankar, V., Atkinson, T.M., Sukhera, J. Perspectives on Medical Education 14, no. 1 (2025): 107. Access the Free Article
What This article centers the tension medical students with minoritized identities negotiate between who they are and who medicine expects them to be. Using in-depth interviews with 16 medical students across the U.S. and Canada, the study examines how students use self-censorship (suppressing aspects of oneself) and self-disclosure (revealing information about oneself) to navigate clinical training environments.
Students described censorship as a survival mechanism marked by constant hypervigilance — driven by fear of negative evaluation, of becoming “a target,” or of having their identity “used against them.” Examples include styling natural hair to appear “less noticeable,” avoiding speaking Spanish, and adjusting tone of voice to counter racial stereotypes. Disclosure was carefully tiered: Students disclosed identities they perceived as carrying more privilege first, keeping more marginalized identities hidden longest. Most began each rotation in a default state of censorship, using small disclosures to “test the waters” — a safety assessment made quickly, often during the first team introduction.
So What Censorship pushed students to the “sidelines” — perceived as disengaged even when they were not — consuming cognitive and emotional resources that would otherwise go toward learning. One student described the result as “giving off the illusion of learning.” The authors connect this to increased mental burden, disengagement, and depersonalization, noting that minoritized students are already at greater risk of burnout.
Disclosure, when safe, had the opposite effect: It enabled humanization in patient encounters, helped patients who distrust the medical system feel more comfortable, and built bonds with clinical teams that surpassed hierarchical relationships. Physician self-disclosure increased perceived empathy among patients and was directly linked to students feeling safe enough to learn rather than merely perform.
Now What The authors are clear that the environment — not the student — is the primary determinant of whether disclosure is possible. When attendings and residents modeled disclosure, students felt safer; when faculty were not forthcoming, students received no signal that vulnerability was permitted.
Educators should model disclosure first and co-construct opportunities for students to share, beginning with start-of-rotation introductions. Clinical teams and program directors should examine hierarchy directly: Students on teams with more autonomy disclosed more and learned more. And institutional leadership should address the structural conditions that make disclosure unsafe — including the pervasive culture that normalizes and anticipates bias — with explicit acknowledgment that individual interventions are insufficient without attention to these root causes.
The experiences described above don’t happen by accident. The pressure minoritized students feel to mask and manage their identities is a symptom of a deeper professional culture — one in which emotions themselves are treated as a threat. The following review asks why.
Pedagogies of discomfort and disruption: a meta‐narrative review of emotions and equity‐related pedagogy. Sukhera, J., Atkinson, T., Hendrikx, S., Kennedy, E., Panza, M., Rodger, S., and Watling, C. Medical Education 59, no. 6 (2025): 581-588. Access the Article
What Equity-related pedagogy — the theory and practice of teaching and learning aimed at improving health equity and advancing social justice — is emotionally charged work. This meta-narrative review, drawing on 58 articles across medicine, nursing, and teacher education, examines how each profession understands the role of emotions in that work.
Three findings specific to medicine and nursing deserve special note: First, medical education more often frames emotional dissonance as a catalyst for individual cognitive disruption — useful for provoking disequilibrium and prompting transformative learning, but not extended beyond the individual level. Second, both medicine and nursing locate emotional learning at the self-level — self-knowledge, self-regulation, self-reflection — in contrast to teacher education’s view of emotions as fundamentally collaborative and dynamic. Within this shared tendency the two professions diverge: nursing more often acknowledges that emotions bring “authenticity” to equity-related pedagogy, framing them as both potentially constructive and disruptive; medicine more consistently frames emotions as a “barrier to be overcome.” Third, medicine specifically may represent a performance-based culture where vulnerability is associated with shame, making the emotional openness that equity-related pedagogy requires structurally difficult to sustain.
So What Scholars such as Megan Boler and bell hooks have long positioned emotions as political, relational, and intrinsic to transformative change. The findings above suggest that health professions education remains fundamentally misaligned with that view — with direct implications for clinician wellbeing and patient safety.
Medical educators report not being adequately taught to navigate tension, conflict, and emotional dissonance. In busy clinical environments, emotionally heightened conversations about equity are therefore at risk of being shut down — not from indifference, but from a professional culture that has not equipped educators to work with emotional tension constructively. The comparison with teacher education is instructive: where teacher education treats emotions as a socio-cultural connector and community resource, medicine and nursing largely do not.
Now What The authors call for three shifts. Educators need to acknowledge their tendency to shut down emotionally sensitive conversations rather than facilitate them. Institutions need to invest in faculty development oriented toward skilled emotional facilitation — not one-time bias training, but sustained capacity to work with emotional tension constructively. And critically, the authors warn that training faculty without adequate structural supports risks placing a disproportionate burden of emotional labor on already-overburdened faculty — particularly those from minoritized communities. Advancing equity-related pedagogy requires going beyond merely acknowledging discomfort to embracing dissonance and dialogic forms of learning as essential practice.
Understanding what goes wrong, and why the culture produces it, still leaves the most practical question unanswered: What does it actually look like when an educator gets it right — and what is at stake when they don’t?
Normalizing Vulnerability, Humanizing Learning: A Qualitative Exploration of Dissonance and Growth in Clinical Learning Environments. Sukhera, J., Atkinson, T.M., Fahed, M. Medical Education (2026) Online first: https://doi.org/10.1111/medu.70228. Access the Article Here
What This qualitative study draws on interviews with 15 medical students, residents, and faculty across 10 institutions in the U.S. and Canada to examine what determines whether dissonance leads to growth or panic. Dissonance is defined as the discomfort that arises when new experiences conflict with existing values and beliefs, and participants described it as a continuum ranging from manageable discomfort to acute threat. Dissonant moments became especially intense when they involved hierarchy, surveillance, identity risk, or ethical conflict. In those conditions, learners typically shifted toward self-protection and cognitive shutdown — redirecting energy away from learning and toward survival. Growth, by contrast, was more likely when educators normalized struggle, modeled vulnerability, and created structured opportunities for reflection.
So What The authors make an important distinction: Whether dissonance becomes panic or growth depends less on learner resilience and more on the relational and structural conditions educators and institutions create. The authors further found that conditions for growth are reciprocally co-created. When teachers signaled curiosity and care, learners disclosed uncertainty and remained engaged, prompting further investment from teachers, creating an upward cycle. The reverse was equally true: When faculty missed opportunities to debrief or respond to learner distress, trust eroded and learners withdrew.
Now What The authors identify three priorities for educators: naming and normalizing dissonance when it arises; creating brief but predictable opportunities for reflection and debriefing; and separating teaching from threat by modeling uncertainty and offering feedback without excessive surveillance cues. For institutions, the asks are structural: protect time for reflection, invest in longitudinal mentorship, and recognize relational facilitation as core educational work rather than optional labor. Creating an educational culture that normalizes struggle and supports meaning-making, the authors conclude, may help learners navigate the complexities of clinical practice with greater integrity and compassion.
Taken together, these three articles trace a path from the lived experience of minoritized students navigating a system that asks them to be less than whole, to the cultural norms that make medicine resistant to the emotional work equity requires, to healing-centered pedagogy as a remedy.
I encourage readers interested in medical education research to explore Dr. Sukhera and colleagues’ 2024 article What are we made for? Mobilizing medical education research for impact in Academic Medicine. Addressing the gap between research and practice, the authors argue that research should move away from seeking to produce generalizable findings to “generating context-specific insights and embracing participatory knowledge mobilization.”
Readers interested in learning more about healing-centered pedagogy are encouraged to explore Chapter 5 — Healing-Centered Pedagogy: Understanding and Addressing Minoritized and Marginalized Trauma, Stress, and Healing in Medical Education in the AMA textbook Reimagining Medical Education: The Future of Health Equity and Social Justice.
And for healthcare and medical education leaders, Dr. Sukhera talks with the Leading Minds Revealed Podcast with Michael Apollo about healing-centered leadership.
You can also read more about Dr. Sukhera’s research in the May 2021, October 2021, and January 2022 Research Roundups.
