Trigger warnings in medical student education: A scoping review

Background

Medicine is recognised as a challenging course where exposure to potentially distressing content is inevitable. Some educators provide students with warnings before they encounter potentially upsetting content—trigger warnings. In this scoping review, we mapped the existing literature seeking to better understand how trigger warnings are implemented in medical schools and how they are influencing education within them.

Methods

Bibliographic databases were searched to identify relevant literature, including searching for grey literature. Articles were included if they focussed on medical school education and were written in English. Data analysis was undertaken using both quantitative and qualitative approaches (thematic analysis).

Findings

Searching generated 1284 potential records for inclusion. Articles not related to the primary research question were excluded. Abstracts of the remaining 841 articles were screened, and ultimately, 12 articles met criteria for full-text review. Of these, there were three empirical research studies. Qualitative analysis identified five main themes: purpose, implementation, student distress, responsibility and problems with terminology.

Conclusions

The use of trigger warnings within medical student education remains contentious. There is a lack of consensus as to their purpose and much diversity in how they are implemented. There was limited published empirical evidence to inform practice in this area.