Holding Space: Learning How to Lean into Hard Conversations

Facilitating conversations on controversial topics in medicine can be an uncomfortable experience but it is a necessary part of medical education. These conversations require respect, empathy, and a willingness to lean into the discomfort of hearing a colleague, patient, or classmate express views that may starkly differ from your own.

Engaging in thoughtful dialogue, however, is a powerful way to build trust and understanding across differences. It’s a skill especially important for those embarking on a career in healthcare where patient trust, team collaboration, and informed decision-making are paramount.

To support this effort, faculty from Yale School of Medicine’s (YSM) Professional Responsibility course and from the Advocates for Collaborative Excellence (ACE) Advisory Council participated in a two-day training session on facilitating intergroup dialogue led by Kimberly Williams Brown, PhD, and Meredith Madden, PhD.

The idea for the training session emerged from a meeting between a group of students and Deputy Deans Jessica Illuzzi, MD, MS, and Darin Latimore, MD, to discuss strategies to foster difficult conversations within the classroom setting. The students made several recommendations, including the creation of opportunities for students to develop and practice skills in engaging in open-minded and respectful inquiry about other perspectives.

They also suggested that faculty who teach in small groups and lead panel discussions would benefit from training in encouraging dialogue on challenging topics. As a result, the Offices of Medical Education and Collaborative Excellence hosted the two-day workshop, designed for faculty who facilitate small-group discussions in which there is a diversity of opinion and perspectives on a topic.

“Dialogue allows us to see each other as a whole person, and when that happens the dynamics of a classroom begin to change,” said Williams Brown.

Unlike debate, which is oppositional, dialogue is a collaborative process where participants are invited to listen, contribute, and meaningfully engage in conversation to develop a greater understanding of different perspectives.

The goal isn’t to win or determine whose view is correct, but to understand each perspective and the experiences that inform it.

Throughout the training, Williams Brown and Madden provided tools and evidence-based strategies for creating classroom spaces where conversations on complex topics can thrive.

“It’s important to recognize the difference between what is unsafe and what is uncomfortable,” said Madden. “Facilitating intergroup dialogue is about holding people safely in discomfort.”

The training also provided an opportunity for faculty to practice facilitating small group conversations. In each group, one faculty member led a conversation on a controversial topic and worked to maintain a respectful, open dialogue as people shared perspectives that aligned with or differed from the majority.

After the practice rounds, attendees were asked to reflect and share what went well, what was challenging, and what they might change in the future.

At the end of the training, Madden and Williams Brown reminded participants that “effective facilitation is not about eliminating discomfort. It’s about creating an environment where participants can remain present, challenged, respected, safe, and able to learn.”