Toward Trauma-Informed Pedagogy: An Intersectional Analysis of Pimping in Medical Education

Kherani, Imaan Zera; Sharma, Malika

doi:10.1097/acm.0000000000004724

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…Engagement with and reflection on experiences and emotions is intrinsic to many adult learning paradigms. With growing recognition of societal issues and their salience in health professional education, we posit that safe and supported discussion of challenging issues, including those with potential personal relevance to learners, should be promoted 85,86 . Preparation and intentionality, through deployment of warnings by informed and skilled educators, can support learning here.…”

Section: Discussionmentioning

confidence: 99%

“…Liberatory learning environments emphasise knowledge co‐creation through learner and educator collaboration. This results in learner empowerment and encourages metacognition, reflection and development of trust and empathy 85,88 …”

Section: Discussionmentioning

confidence: 99%

“…This results in learner empowerment and encourages metacognition, reflection and development of trust and empathy. 85,88 Taylor concludes that truly fostering transformative learning requires more than perfunctory use of designated instructional strategies. In learning settings, warnings are contextualised by other supports (academic, peer and pastoral).…”

Section: Acknowledging Power Differentials In the Learning Environmentmentioning

confidence: 99%

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Trigger warnings as tools for learning—theorising an evolving cultural concept

Nolan,

Roberts

2023

Medical Education

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BackgroundWhile 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.MethodsEvidence 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 conclusionsDifficulties 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Acknowledging Power Differentials In the Learning Environmentmentioning

confidence: 99%

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Trigger warnings as tools for learning—theorising an evolving cultural concept

Nolan,

Roberts

2023

Medical Education

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“…Constrained Agency Theory (CAT) highlights that power in clinical organizations operates through forces that may constrain an individual's agency to disrupt the status quo [14]. The potential for anticipatory approaches to uproot entrenched hierarchies and create an affirming and supportive learning environment, therefore requires cultivating trust and shared responsibility [13], well before any microaggression may occur. Ultimately, a deeper understanding of how preemptive approaches to microaggressions may be enacted within real-world clinical learning environments has the potential to provide insights into fostering greater inclusion and belonging for all medical learners.…”

Section: Introductionmentioning

confidence: 99%

It is Challenging to Shift the Norm: Exploring how to Anticipate and Address Microaggressions in Clinical Learning Environments

Sukhera,

Atkinson,

Bullock

2023

Perspectives on Medical Education

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Purpose: Increased attention to improving a culture of belonging in clinical learning environments has led to various approaches to addressing microaggressions. However, most approaches in the literature focus on responding or reacting to microaggressions with insufficient attention to building trust before microaggressions might occur. Research on microaggressions in clinical learning environments suggests anticipatory or preemptive conversations about microaggressions may foster greater trust. In this study, the authors explored how diverse participants perceived the experience of anticipatory conversations about potential microaggressions. Overall, the authors sought to gain a deeper understanding of how pre-emptive and anticipatory conversations may influence an organization's approach to addressing microaggressions in clinical learning environments. Methods:The authors utilized constructivist grounded theory methodology and conducted individual qualitative interviews with 21 participants in an academic department within a larger health sciences center in the United States.Results: Findings suggest that anticipatory conversations about microaggressions were challenging due to existing norms in dynamic clinical learning and working environments. Participants shared that the idea of anticipating microaggressions elicited dissonance. Conversations about microaggressions could potentially be facilitated through leaders who role model vulnerability, organizational supports, and an individualized approach for each team member and their role within a complex hierarchical organization.Discussion: Anticipating and addressing microaggressions in clinical learning environments holds tremendous potential, however, any conversations about personal identity remain challenging in medical and healthcare environments. This study suggests that any attempts to address microaggressions requires attention to cultural norms within healthcare environments and the ways that hierarchical organizations can constrain individual agency.

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The need for critical and intersectional approaches to equity efforts in postgraduate medical education: A critical narrative review

Lam,

Coret,

Khalil

et al. 2024

Medical Education

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BackgroundRacialised trainees in Canada and the USA continue to disproportionately experience discrimination and harassment in learning environments despite equity, diversity, and inclusion (EDI) reform efforts. Using critical approaches to understand what problems have been conceptualised and operationalised as EDI issues within postgraduate medical education (PGME) is important to inform ongoing learning environment reform in resident training.MethodsWe conducted a critical narrative review of EDI literature from 2009–2022 using critical race theory (CRT) and the concept of intersectionality to analyse how issues of discrimination in PGME have been studied. Our search yielded 2244 articles that were narrowed down to 349 articles for relevance to Canadian and American PGME contexts. We attended to reflexivity and our positionality in analysing the database and identifying themes related to EDI reform.ResultsInterest convergence was noted in how EDI reform was rationalised primarily by increased productivity. Problems of learner representation, gender inequities and curricular problems were conceptualised as EDI issues. The role that racism played in EDI‐related problems was largely invisible, as were explicit conceptualisations of race and gender as social constructs. Overall, there was a lack of critical or intersectional approaches in the literature reviewed. Misalignment was noted where studies would frame a problem through a critical lens, but then study the problem without attention to power.DiscussionInterest convergence and epistemic injustice can account for the absence of critical approaches due to the alignment of existing EDI work with institutional interests and priorities. Interest convergence conceptually limits existing EDI reform efforts in PGME. CRT and intersectionality connect racialised learner experiences to systemic phenomena like racism and other forms of discrimination to challenge dominant assumptions. Because they attend to power, critical approaches are key to understanding why inequities have persisted to advance equity in learning environments for racialised and intersectionally marginalised learners.

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Toward Trauma-Informed Pedagogy: An Intersectional Analysis of Pimping in Medical Education

Cited by 3 publications

References 22 publications

Trigger warnings as tools for learning—theorising an evolving cultural concept

Trigger warnings as tools for learning—theorising an evolving cultural concept

It is Challenging to Shift the Norm: Exploring how to Anticipate and Address Microaggressions in Clinical Learning Environments

The need for critical and intersectional approaches to equity efforts in postgraduate medical education: A critical narrative review

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