Warwick Medical School, Coventry, UK.
Med Educ. 2024 Feb;58(2):185-195. doi: 10.1111/medu.15172. Epub 2023 Aug 1.
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.
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.
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.
虽然触发警告的定义各不相同，但人们普遍认为，它们警告可能会因接触令人痛苦的材料而产生反应。在教育中使用警告引起了争议，有人担心这会影响学术自由、“娇惯”，从而破坏韧性、强化创伤身份认同，并使人们逃避。警告的支持者将其定位为受创伤影响的人的适应措施，增强包容性，并认为警告赋予选择的权力，并使人们能够在学习中知情地参与。最近对警告功效的荟萃分析表明，警告对情感反应或理解没有影响。关于回避的发现表明，警告可能会增加对材料的参与度。与警告应用背景相关的异质结果的综合需要谨慎解释研究结果。此外，对照实验设计并不能反映复杂的社会学习环境生态系统。
医疗保健专业教育中关于警告的证据仍然有限。我们从多个学科中对警告的作用和功能进行了叙述性回顾和综合，为医疗保健教育实践提供信息。我们将这些证据应用于考虑警告如何在医疗保健专业教育的一系列理论框架内发挥作用，包括成人教育、自主学习，最终是变革性学习。我们探讨了在情感刺激学习事件和情感对学习的必要性之间的紧张关系，同时关注学习者的需求和履行教育者的责任。我们探究了现有学习理论框架中的差距和争议，并考虑了与警告相关的公认局限性的影响。我们通过提出一个用于警告角色的概念模型来总结，该模型考虑了促进有效学习的更广泛的显著因素。
强调了与作为一种不断发展的文化概念的警告相关的获取上下文相关证据和结论相关的困难。我们提出警告是一种工具，可以支持批判性反思和情感素养，在更广泛的创伤知情教学法和教育者实践中，精心策划有效的学习环境，并支持人文主义的医疗保健专业身份形成。
