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Trigger warnings are statements offering prior notification of sensitive content, allowing recipients to prepare for and avoid ensuing distress. Students are increasingly reporting expectations for warnings in classrooms and learning contexts. Discussions regarding use of warnings have clear relevance to healthcare education, which regularly explores sensitive content. Their use has been positioned as a measure for inclusive education and as a means to enhance trauma awareness and empathy. Expectations for warnings need to be considered in the context of preparedness for professional practice. This Twelve Tips paper explores the evidence in relation to warnings and its applicability to social learning contexts. These tips highlight considerations and strategies for the use of warnings in the context of healthcare education, balancing issues of inclusivity, learner and educator wellbeing, and professional preparedness. These discussions are situated within the context of current classroom-based healthcare education. [ABSTRACT FROM AUTHOR]

Background: While definitions of trigger warnings vary, it is generally accepted that they caution about potential reactions arising from exposure to distressing material. Controversy surrounds use of warnings in education, with concerns noted regarding impacts on academic freedom, "coddling", thereby undermining resilience, reinforcement of traumatised identity and enablement of avoidance. Proponents of warnings position them as accommodations for those affected by trauma, enhancing inclusion, and suggest warnings empower choice and enable informed engagement in learning. A recent meta‐analysis of warnings' efficacy demonstrated no effect on affective responses or comprehension. Findings regarding avoidance suggested warnings may increase engagement with material. Synthesis of heterogeneous results relating to context of warning application necessitates cautious interpretation of findings. Furthermore, controlled experimental designs do not reflect complex ecologies of social learning environments. Methods: Evidence relating to warnings in healthcare professions education remains limited. We undertake a narrative review and synthesis of evidence regarding the role and functions of trigger warnings from a range of disciplines, to inform healthcare education practice. We apply this evidence in considering how warnings may act within a range of theoretical frameworks for healthcare professionals educations including andragogy, self‐directed learning and, ultimately, transformative learning. Tensions between exposure to emotionally stimulating learning episodes and the necessity of emotion for learning while simultaneously attending to learners' needs and fulfilling educators' responsibilities are explored. We probe gaps and contentions in existing theoretical frameworks for learning, and consider implications of recognised limitations with reference to warnings. We summarise by proposing a conceptual model for the role of warnings that considers wider salient factors for fostering effective learning. Discussion and conclusions: Difficulties associated with deriving contextually‐relevant evidence and conclusions relating to warnings as an evolving cultural concept are highlighted. We propose warnings as tools to enable critical reflection and emotional literacy, to curate effective learning environments and support humanistic healthcare professional identity formation, within wider trauma‐informed pedagogies and educator practice. Nolan and Roberts demonstrate how trigger warnings may function within education by using theoretical frameworks aimed at promoting conditions for learning. To do so, they consider the roles of warnings within wider trauma‐informed pedagogies. [ABSTRACT FROM AUTHOR]

Medical trainees and students are required to report concerns where they identify concerning practice or behaviours. While leadership attributes and skills are increasingly expected curricular outcomes, students still struggle to report concerns due to a variety of factors. Changing societal awareness and expectations continue to shine light on poor professionalism and unethical behaviours whose reach extends to medical training and education and that need to be systematically reported and addressed. To prepare graduates for these challenges in professional practice and for exercising skills of reporting concerns, education and training environments must ensure that speaking up is ingrained in the organisational ethos. Supported by evidence from the literature and our experience of revising and enhancing approaches, this paper outlines tips for developing and embedding an infrastructure that facilitates robust concerns reporting and management. Further, we consider mechanisms that support students to develop tendencies and skills for reporting concerns. [ABSTRACT FROM AUTHOR]

Background: Trigger warnings—prior notification of topics so recipients may prepare for ensuing distress—are encountered widely in contemporary culture. Students at some universities have expressed expectations for trigger warnings. Medical education routinely exposes students to numerous potentially distressing topics. However, this topic remains understudied in medical education. Little is understood about educators' views or practice relating to warnings in the context of medical education. Methods: Twenty medical educators from a medical degree programme in the UK participated in a semi‐structured qualitative interview study, exploring medical educators' views and experiences of managing distressing situations and, specifically, their use of warnings. We analysed interview transcripts by thematic coding and identified themes. Results: Analysis identified themes relating to educators' conceptualisation of trigger warnings and rationale for use, concerns about the use of warnings and the critical purpose of medical school in ensuring preparedness for clinical practice. Participants shared that warnings were given to empower students in approaching distressing topics and to enable engagement with learning. Warnings acknowledged that some experiences would be distressing and normalised and signalled acceptability of emotional responses. Decisions to use warnings were influenced by the nature of content and, reactively, in response to experiences of student distress. Terminology regarding trigger warnings was interpreted varyingly by participants. A broad variety of topics were identified as potentially sensitive. A number of concerns were noted regarding the use of warnings. Discussion: Warnings alone did not fulfil educators' responsibility in supporting students' professional development, but may be a useful adjunct, signalling that self‐care is valued and should be prioritised. Despite frequent use of warnings, individual educator practice was shaped by varying rationale. A framework that addresses competing tensions of preventing distress and supporting professional development is needed as part of a trauma‐informed approach to medical education. Trigger warnings are demonstrated to have supported students' professional development by signalling the need to recognise emotional responses and manage wellbeing. [ABSTRACT FROM AUTHOR]

Summary: Many opportunities for patient and public involvement already exist in medical education. Current approaches may not fully harness the educational potential of the patient voice, so it appears that new approaches are worth exploring. This article, co‐written by students and faculty members, describes an educational initiative in which medical students had opportunistic conversations with randomly selected members of the public to explore their priorities regarding health care. Methods: The 'Design my Doctor' project enabled medical students to hear participants' spontaneous responses to the question 'What should our medical school teach your future doctors?' Students experienced the unfiltered patient voice. The 183 responses were recorded in writing, and on video, and were analysed using the nominal group technique. The themes focused on the health care priorities of members of the public. Results: Themes from the public data included 'interpersonal qualities', 'empowering patients', 'medical knowledge' and the 'health system'. Student reflective pieces showed how powerful hearing first‐hand unfiltered feedback can be. Engagement in collecting and interpreting data enhanced the significance of the content and the process for the learners. Students realised that 'medical knowledge', although important, was not the overriding priority for patients. Students identified specific areas for future application and considered how it could be incorporated systematically into their programme. Discussion:As medical educators, we can use interventions like 'Design my Doctor' to facilitate and support students to proactively seek and reflect on patient feedback. [ABSTRACT FROM AUTHOR]