Normalising vulnerability, humanising learning: A qualitative exploration of dissonance and growth in clinical learning environments

INTRODUCTION: Dissonance is common in clinical learning, especially when experiencing conflict with prior beliefs, expectations, or developing identities. Yet, an understanding of how teachers and learners move from dissonance to growth in emotionally charged, hierarchical clinical environments remains underexplored. In this study, the authors sought to explore how teachers and learners experience and navigate dissonance in the context of equity-related pedagogy. METHODS: This qualitative study employed Constructivist Grounded Theory (CGT). Fifteen participants including medical students, residents, and faculty were recruited through purposive, theoretical, and snowball sampling. Data were collected through semi-structured interviews, which were analysed using constant comparative analysis to develop a theoretical framework. RESULTS: Participants described dissonance as a dynamic experience ranging from manageable discomfort to panic. Dissonant moments were especially intense when they involved hierarchy, surveillance, identity threat, ethical conflict, or perceived harm. In these conditions, learners often shifted toward self-protection and cognitive shutdown. Growth was more likely when educators normalised struggle, modelled vulnerability, and created structured opportunities for reflection. Participants also described trust and safety as reciprocally co-created: when teachers signalled curiosity and care, learners were more willing to disclose uncertainty and remain engaged, which in turn prompted further teacher investment. DISCUSSION: Findings reinforce that learners need supportive conditions to grow through dissonance. Such conditions include spaces where they can face challenges without fear of judgement or punishment. Findings suggest that creating such conditions remains difficult in medical education, where rigid hierarchies and institutional norms often erode psychological safety. This work extends prior research by showing how trust and safety are co-created in real time, with both learners and educators influencing and reinforcing each other's openness and vulnerability.