Training Pediatricians for Courage: The Case for Brave Spaces in Medical Education

As our political climate becomes increasingly polarized, conversations about topics that directly impact child health, including anti-racism, reproductive justice, and gender-affirming care, are becoming more challenging to navigate in medical education. Medical educators face a critical dilemma: restrictive legislation may prevent clinicians from providing holistic care, yet we have an ethical obligation to train future pediatricians to practice with integrity and mitigate health disparities affecting children from marginalized communities. The traditional "safe space" model designed to allow students and trainees a space to discuss "difficult" topics free from potential harm, while well-intentioned, can inadvertently limit necessary dialogue and avoid discussions of power, privilege, and structural inequities that perpetuate health disparities. The "Brave Spaces" framework, adapted from higher education, applies to pediatric medical education. This approach, grounded in scholarship on courage, psychological safety, and humble inquiry, acknowledges that ethical discomfort signals opportunities for growth. The framework provides 6 pillars-vulnerability, perspective, leaning into fear, critical thinking, examining intentions, and mindfulness-that equip learners to engage in difficult conversations with skill and courage. By training pediatricians to navigate complexity rather than avoid it, we prepare them to advocate effectively for all children, especially those most marginalized by current social and political forces.