Belonging Without Controversy: Using Self-Determination Theory to Reframe Inclusion in Medical Education.

Abstract

Issue: Global reforms under the banner of diversity, equity, and inclusion (DEI)-and more recently, justice-oriented frameworks such as justice, equity, diversity, decolonization, indigenization, and inclusion (JEDDII)-aim to strengthen belonging in medical education, yet DEI language and governance have become politicized in some jurisdictions, exposing institutions to audits, reputational attacks, and funding risks. Evidence: Self-Determination Theory (SDT) offers an evidence-based framework centered on relatedness-the universal psychological need for authentic connection-that can complement DEI/JEDDII efforts by translating inclusive aims into observable practices and measurable learner experiences, even amid contested discourse. This article situates belonging within relatedness, synthesizes international evidence, identifies structural barriers, and proposes multilevel strategies-policy, curricular, and bedside-for cultivating relatedness. Implications: By aligning belonging with universal psychological needs and defensible educational outcomes, institutions can sustain progress and meaningfully support medical learners in ethical and enduring ways.