Trigger Warnings in Medical Education

To the Editor: As medical educators, we are charged with teaching students and trainees how to cope with the chronic stress and trauma that occurs in medicine. When a student asks for a trigger warning before class or to be excused from a small-group session because of the anticipated emotional impact, how do we support that student while preparing him or her to be an effective physician? We have found ways to do our work as healers, even when we have needed healing ourselves. Many of us have used unhealthy coping strategies such as displacement of our pain onto our loved ones, emotional numbing, substance use, or humor that dehumanized our patients. Sadly, as members of a profession with high rates of divorce, substance use disorder, burnout, and suicide, we do not have the evidence to support that the majority of us have been coping well. We need to do better for the future generation of physicians, using our knowledge of how resiliency is cultivated. When students tell us that the material we are trying to teach them is too triggering, what I hear them saying is, “Show me how to cope with this.” We want to help our students, as we help our patients with posttraumatic stress disorder, to be able to tolerate the triggers rather than avoid them. We want our students to feel that it is acceptable to say, “This is difficult for me,” and stay in the room. We need them to recognize when they have had a particularly difficult day and how to care for themselves in the aftermath, including when and how to get professional help through therapy or medication management. Our students and trainees can learn from our stories, including those that exemplify how poorly we may have cared for ourselves when we were in their position, but without the glorification that tends to suffuse those recollections. We can acknowledge that the culture we entered and accepted is not the only way for it to be done and certainly does not appear to be the healthiest way. Through this process, we can become better role models for our students and healthier physicians for ourselves, our families, and our patients. Katrina DeBonis, MDAssistant clinical professor of psychiatry, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; [email protected]; ORCID: https://orcid.org/0000-0002-9264-7914.