Presence and Vulnerability in Medical Education

By Sunny Nakae

In my MSW program I took a diversity and social justice course.  The class was very engaged and often intense; we became well acquainted as we shared our stories.  Mid-way through the semester the instructor assigned us to read an article from our local newspaper about living with HIV.  The article, unbeknownst to the instructor, happened to feature an individual in our class.  Everyone was acutely aware as we shuffled into the classroom that day. We did not know what to expect…

This illustrates one of the dichotomies in education – the false wall between what we are learning and our identities and experiences.  It was a powerful moment for me.  It demonstrated that my education was not about theoretical ‘people over there,’ but people right here, my friends and colleagues, myself.  It is one thing to discuss an article about a person living with HIV.  It is another to consider that the person is a fellow graduate student pursuing their dreams right alongside you.

Medical education, in particular, is guilty of this separated presentation.  We talk about diseases as if no one in the room has them.  Medical student Katherine Brooks eloquently wrote a reflection that discussed this dichotomy in terms of race and health disparities. We easily cite the facts around racial disparities in health, but we fail to acknowledge what is happening on the streets of our own cities where racial inequality and police brutality are major social issues that affect faculty, students and patients.

Vulnerability can perforate and break down the false wall.  As we engage material more fully and become present to our students, we begin to foster learning in community.  The connections between what we are learning, why we are learning it, and to whom it matters become more significant.  As educators we frequently avoid this intersection because it requires vulnerability.  A learning community founded on trust with individual and collective vulnerability has the power to transform.

To be fully present as educators we must seek the connections as we teach and model vulnerability to our students.  When something happens outside the classroom, the act of pausing and acknowledging IS teaching.  When the video of LaQuan McDonald’s shooting was released in Chicago did we pause to examine the impact on our community and the patients we serve?  Did we stop to talk about violence as a public health epidemic, or the privileges inherent in being safe at school while many people fear for their lives on the street?  How can physicians bridge this gap in experience, and more importantly, how can they find shared humanity with patients for whom this is reality?

Parker Palmer wrote in The Courage to Teach that “we teach who we are.”  If we are closed off to the impact of the material we teach, we extend that same closure to our students.  If we remain open and willing to engage, our students receive that in kind. We must elucidate the intersections and nurture their connective capacity to be present and vulnerable as practitioners.

My challenge to all educators is this: each time you teach, make an acknowledgement and an invitation.  Acknowledge what is happening in the world that day, a bias you have uncovered in your expert sources.  Acknowledge missing persons, stories and perspectives.  Invite your learners to connect ‘in here’ with ‘out there,’ and to do so personally.  Invite your learners to be present and channel current purpose for today as it relates to the larger classroom, community and profession.  With these small acknowledgements and invitations, we can consciously construct a connected community of learners that welcomes vulnerability.  We as educators must embrace the power of vulnerability and cultivate the connective capacity within our students so they emerge ready for the complexities of their roles as healthcare providers.

Kathryn Brooks (2015). A Silent Curriculum. JAMA 313(19): 1909-1910.



Sunny Nakae, MSW, PhD, is a clinical associate professor of social medicine, population, and public health and Associate Dean for Student Affairs at the University of California-Riverside School of Medicine. She has previously held administrative positions at the University of Utah School of Medicine, Feinberg School of Medicine at Northwestern University, and Loyola University Chicago Stritch School of Medicine. She is the author of Premed Prep: Advice from a Medical School Admissions Dean (Rutgers University Press, 2020)

3 thoughts on “Presence and Vulnerability in Medical Education

  1. Reflective MedEd
    I know how uncomfortable it can be when you fill a person with HIV might be sitting next to you. But when you experience having a fellow student with HIV being in the same class or even sitting in a chair next to you, the experience is really helpful in facing reality. We need to break the wall that separate us from each other as individuals of a groups, including discrimination, prejudice, stereotyping, racial and cultural barriers.
    In order to transform the community we need to take the courage and face intersections and fear. When we are well determined, we can stop these negative agents such as discrimination, prejudice, stereotyping, bias, racial and other forms discrimination.
    As an educator it is very important to acknowledge what is happening in the world that day or few days back and also to connect students so that they welcome vulnerability. If we instill in our students the connect power of vulnerability, then they can be well able to undertake the complexities when they embrace the role of Healthcare Provider.


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