Objective: We present the perspectives of learners, preceptors, and institutional leaders regarding equity, diversity, inclusion (EDI) in the context of graduate medical education, with a specific focus on palliative residency. Dialogical Process and Findings: In this perspective piece, we share five key learnings established through a series of dialogical sessions, in which we highlight that while all individuals in medicine want to support the growth and safety of underrepresented learners, pervasive barriers prevent change. For learners, fear of repercussions and lack of safe feedback mechanisms prevent many from sharing perspectives around EDI. Underrepresented learners feel particularly powerless when witnessing care provided by preceptors to diverse populations in a manner that goes against their knowledge of cultural safety. For preceptors and institutional leaders, lack of training in cross-cultural education, fear of conflict and crossing boundaries, alongside challenges navigating how to support others using an EDI lens, prevents many from acting. Notably, all groups express self-doubt when experiencing microaggressions, but power dynamics particularly amplify this among underrepresented learners. A desire to maintain a guise of peace and harmony also perpetuates silence and inaction when opportunities to work through conflict arise. Conclusion: Our findings indicate that the current models of EDI in medical education take a reductionist approach centering on reprimand and blame of individual actors, resulting in increasing silence and siloing. We posit that a more humane and unifying approach that emphasizes the complexity and value of holding space for diverse views using dialogical skill provides essential grounding to better operationalize inclusivity and belonging in medical education.
Arora et al. (Sun,) studied this question.