Charged Topics in Medical Education: Students' Perspectives on Power, Voices, and Faculty Engagement.

Introduction: Medical education learning environments involve charged topics at the intersection of social, political, and cultural domains. Growing student diversity and political polarization add complexity to the discussion of charged topics, yet current literature lacks insight into student perspectives. This study explores how medical students position themselves during charged topic discussions and their preferences for educators' engagement. Methods: Using educational cultural hegemony as a theoretical framework and a critical constructivist approach, the research team conducted semi-structured interviews with sensitizing scenarios addressing three charged topics: gun control, reproductive healthcare coverage, and affirmative action. Following IRB approval, twenty medical students across all training years were interviewed. Transcripts were analyzed using Braun and Clarke's reflexive thematic analysis. Findings: We identified four themes: 'Constrained Voices' describes how power hierarchies influence student engagement with charged conversations. 'Burdened Voices' reveals how marginalized students bear a disproportionate burden when educator avoidance of discussions can reinforce dominant perspectives. 'Finding Voice' highlights how students use personal experience to center patient perspectives despite hierarchical constraints. In 'Guiding Voice', students describe the ideal educator as one who uses their experience and evidence-based knowledge to facilitate discussions. Conclusion: Power hierarchies constrain student engagement in charged discussions, with marginalized students bearing a disproportionate burden when educators avoid these topics. Despite these constraints, students assert agency through personal experience to center patient perspectives. Students seek educators who actively guide discussions using expertise and evidence, viewing neutrality as itself a stance. The findings underscore the need for faculty development addressing these dynamics.