Students' Perceptions of Trigger Warnings in Medical Education.

Phenomenon: Trigger warnings are verbal statements or written warnings that alert students in advance to potentially distressing material. Medical education includes numerous subjects frequently identified as triggers, such as abuse, rape, self-injurious behaviors, eating disorders, drug and alcohol addiction, and suicide. Thus, exploring medical students' perceptions of trigger warnings may provide a valuable perspective on the use of these warnings in higher education. APPROACH: As part of a larger descriptive, cross-sectional survey study on medical education, we assessed 1st- and 2nd-year medical students' perceptions of trigger warnings in the preclinical curriculum. Five questions specific to trigger warnings explored students' knowledge, prior experience, and perceptions of trigger warnings in medical education. Frequencies of individual question responses were calculated, and qualitative data were analyzed via content and thematic analyses. FINDINGS: Of the 424 medical students invited to participate, 259 completed the survey (M = 24.8 years, SD + 3.4, 51.4% female, 76.1% White, 53.7% 1st-year students). Few students (11.2%) were aware of the term trigger warning and its definition. However, after being presented with a formal definition on the online survey, 38.6% reported having had a professor use one. When asked whether they supported the use of trigger warnings in medical education, respondents were distributed fairly equally by response (yes = 31.0%, maybe = 39.2%, no = 29.7%). Qualitative analysis revealed three themes: (a) Trigger Warnings Allow Students to Know What is Coming and Prepare Themselves: Respondents believed that trigger warnings would benefit students with a history of trauma by providing them additional time to prepare for the material and, if appropriate, seek professional help; (b) Students Need to Learn How to Handle Distressing Information: Respondents agreed that they needed to learn and cope with highly sensitive material because they would be confronted with difficult and unexpected situations in clinical practice; and (c) Trigger Warnings Help Students Understand the Severity of the Material: Respondents felt that trigger warnings may help students understand the severity of the material being covered and increase awareness about trauma and its effects on health and well-being. Insights: Findings did not reach consensus for or against the use of trigger warnings in medical school; however, students emphasized the importance of learning how to cope with distressing material. Trigger warnings may represent a teaching tool to facilitate classroom discussions about the severity of trauma-related material and problem-focused coping strategies.

Changing first-year medical students' attitudes toward primary care.

BACKGROUND AND OBJECTIVES: With the passing of the Patient Protection and Affordable Care Act, an additional 34 million people will gain access to health care. Combined with population growth and aging adults, expanded insurance coverage will dramatically increase the demand for primary care services. To encourage medical students to pursue primary care, medical schools are integrating courses that will expose students to primary care medicine early in their education. METHODS: We used a descriptive, cross-sectional study design to evaluate the impact of a week-long intensive course in primary care on first-year medical students' attitudes toward primary care. We developed a 25-item survey to assess medical students' knowledge, perception, and attitudes about primary care; the survey was administered before and after the course. RESULTS: A total of 125 first-year medical students (mean age=23.7 ± 2.9 years, 52.4% female, 75.8% Non-Hispanic white, 11.2% rural) completed the pre-course survey, and 117 completed the post-course survey. We observed positive improvements in attitudes toward primary care in 20 of the 25 survey questions (with effect sizes ranging from 0.16--0.33). Further, students stated that the course improved their understanding of the scope of primary care and emphasized the importance and complexity of primary care medicine. CONCLUSIONS: A week-long intensive course in primary care can influence medical students' attitudes toward primary care; however, the long-term impact on students' decision to pursue primary care is not known and needs to be evaluated. These findings provide empirical support for the integration of primary care courses into medical school curricula.