Undergraduate medical education (UGME) necessarily includes content that is emotionally challenging. Learners are exposed to material involving death and dying, violence, abuse, reproductive loss, severe illness, structural inequity, and other forms of human suffering. While this content is essential for the development of competent and compassionate physicians, it can also provoke significant emotional distress in learners. Triggering content can be conceptualized in two broad categories. First, inherently distressing content refers to material that can reasonably be anticipated to evoke emotional responses in most learners, such as graphic injuries, intimate partner violence, and child abuse and neglect (Armstrong & Jaffray, 2021). Second, personally triggering content refers to material that intersects with an individual learner’s lived experience. Because trauma exposure is common in the general population, it is highly likely that medical students have lived experiences of trauma (Wathen et al., 2023; WHO, 2022). Faculty are typically unaware of these lived experiences, but may encounter the distress of students whom they teach and train. When learners are triggered, they experience trauma responses—physiological and psychological reactions to perceived threat, harm, or loss (Gerber, 2019). These may include anxiety, dissociation, emotional withdrawal, hyperarousal, or difficulty concentrating. Neurobiologically, trauma can impair higher-order cognitive processing and stress regulation, thereby directly affecting attention, participation, and learning (Ford-Gilboe, 2018; van der Kolk, 2003). In addition to re-traumatization, learners may experience secondary traumatic stress through repeated exposure to distressing material, associated with burnout and erosion of compassion (Kinker et al., 2018). These concerns are directly relevant to accreditation standards. CACMS Standard 3.5 requires a safe and respectful learning environment. Standard 6.3 addresses learner self-directed and lifelong learning, which includes the capacity for self-regulation. Standard 12.3 requires access to personal counseling, health, and wellbeing services. Failure to proactively address triggering content may have implications for educational effectiveness, learner wellbeing, and accreditation compliance. Trauma-informed medical education (TIME) offers a framework for addressing these issues through universal precautions, psychological safety, predictability, learner agency, and transparency (Government of Canada, 2025; Radwi, 2022; Brown et al., 2021). However, while conceptual guidance exists, there is limited local data on learner experiences of triggering content within our UGME curriculum and limited formalized processes to support faculty in prevention and mitigation. Furthermore, faculty members are likely to have their own lived experiences of trauma and may be triggered by curricular content which they teach and may be triggered by student distress resulting from exposure to difficult curricular content (Gillespie & King, 2024; Nedrow et al., 2013, Wathen & Varcoe, 2023). There is a pressing need to develop a trauma-informed strategy to prevent and mitigate triggering and re-traumatization of learners when presented with emotionally and psychologically difficult content (Okoli, et al, 2024). There is a parallel need to both support faculty when teaching challenging curricular material and to increase faculty capacity to anticipate and provide immediate and compassionate response to student distress during their teaching encounters (Government of Canada, 2025). This project proposes to explore how to operationalize trauma-informed approaches to triggering content within UGME.
Project Objectives:
- To explore medical student experiences of triggering content within the UGME curriculum.
- To identify curricular contexts and teaching practices associated with learner distress.
- To develop evidence-informed, trauma-informed recommendations tailored to our institution.
- To create practical tools or resources to support faculty and learners.
Methodology:
Phase 1: Environmental Scan
- Review of institutional policies and existing supports.
- Mapping of curricular sessions that include potentially distressing content.
- Literature review of trauma-informed medical education practices.
Phase 2: Learner Data Collection
- Anonymous survey distributed to medical students across all years.
- Optional semi-structured focus groups or interviews to explore themes in greater depth.
- Questions addressing types of triggering content, learner responses, and perceived helpful supports.
Phase 3: Analysis
- Thematic analysis of qualitative data.
- Descriptive statistics for survey responses.
- Identification of key risk factors and protective practices.
Phase 4: Resource Development
Based on findings, the student would develop:
- A faculty “one-pager” on trauma-informed delivery of distressing content.
- A student guidance document on self-regulation and help-seeking.
- Sample language for content notes or opening statements.
- Recommendations for scheduling, advance notification, and debriefing practices.
Other information:
Guiding Questions
- What types of curricular content do learners identify as inherently distressing?
- How do learners and faculty describe personally triggering experiences within required educational activities?
- What impacts do triggering experiences have on participation, learning, and professional identity formation?
- What prevention and mitigation strategies do learners perceive as helpful?
- What supports are needed for faculty?
Deliverables
- Written report with recommendations for UGME leadership.
- Presentation to the Undergraduate Education Executive Committee.
- Faculty-facing toolkit (brief guidance document).
- Student-facing wellness and resilience resource.
Significance
This project aligns directly with CACMS Standards 3.5, 6.3, and 12.3 by addressing the safety of the learning environment, supporting learner self-regulation, and strengthening connections to wellbeing resources. It advances educational quality without compromising academic rigor. Importantly, it positions the institution as proactive rather than reactive in responding to learner distress.
By systematically examining triggering content within UGME and developing structured, trauma-informed supports, this project has the potential to enhance learner engagement, protect wellbeing, and strengthen accreditation readiness.
Dissemination
The plan includes sharing with local and national medical education networks and submitting abstracts to medical education conferences (e.g., International Congress on Academic Medicine (ICAM) and the International Association for Health Professions Education (AMEE) Conference).
References
- Armstrong, A., & Jaffray, B. (2021). Government of Canada, Statistics Canada. https://www150.statcan.gc.ca/n1/pub/85-002-x/2021001/article/00017-eng.htm
- Brown, T., Berman, S. , McDaniel, K., Radford, C., Mehta, P., Potter, J. & Hirsh, D. (2021). Trauma-Informed Medical Education (TIME): Advancing curricular content and educational context. Academic Medicine, 96 (5), 661-667. doi: 10.1097/ACM.0000000000003587.
- Ford-Gilboe, M. (2018). Understanding and addressing trauma and violence at the point of care. https://www.youtube.com/watch?v=i5nV6DKE8rM&t=5s
- Gerber, M. R. (2019). Trauma-informed healthcare approaches: A guide for primary care. Springer Nature Switzerland.
- Gillespie, R. J., & King, A. (2024). The trauma-informed pediatric practice: A resilience-based roadmap to foster early relational health. American Academy of Pediatrics.
- Government of Canada. (December 3, 2025). Chief Professional Conduct and Culture, Director General Professional Conduct Development. Trauma-informed approach to training and education. https://www.canada.ca/en/department-national-defence/services/conduct-and-culture/training-and-education/psychological-safety/trauma-informed-approach-training-education.html
- Kinker, B., Arfken, C., & Morreale, M. (2018). Secondary traumatic stress in medical students. Academic Psychiatry, 42(1), 181–182. https://doi.org/10.1007/s40596-017-0767-4
- Nedrow, A., Steckler, N. A., & Hardman, J. (2013). Physician resilience and burnout: can you make the switch?. Family Practice Management, 20(1), 25–30.
- Okoli, D., Dobson, M., Schneiderhan, J., Moravek, M., Stojan, J., & Haas, M. (2024). 12 tips for implementing trauma-informed care within undergraduate medical education. MedEdPublish, 14, 281. https://doi.org/10.12688/mep.20612.1
- Radwi, G. (2022). Trauma-Informed Medical Education (TIME). Canadian Medical Association Physician Wellness Hub. https://www.cma.ca/physician-wellness-hub/content/trauma-informed-medical-education
- van der Kolk B. A. (2003). The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatric Clinics of North America, 12(2), 293–317. https://doi.org/10.1016/s1056-4993(03)00003-8
- Wathen, N. (2018). Trauma and violence informed care: Principles and practices. https://www.youtube.com/watch?v=E2DsJ1xe_Lg&t=2s
- Wathen, C. N., & Varcoe, C. (2023). Trauma- & violence-informed care and provider well-being. EQUIP Healthcare; GTV Incubator.
- Wathen, C. N., Varcoe, C., et al. (2023). Implementing trauma- and violence-informed care: A handbook. University of Toronto Press.
- World Health Organization. (2022). Violence info – intimate partner violence. https://apps.who.int/violence-info/intimate-partner-violence/