Storylines of Trauma in Health Professions Education: A Critical Metanarrative Review

Abstract

Phenomenon

Learners in medical education are often exposed to content and situations that might be experienced as traumatic, which in turn has both professional and personal implications. The purpose of this study was to synthesize the literature on how trauma has been conceptualized and approached within medical education, and the implications thereof.

Approach

A metanarrative approach was adopted following the RAMESES guidelines. Searches of 7 databases conducted in January 2022 with no date limitations yielded 7,280 articles, of which 50 were identified for inclusion through purposive and theoretical sampling. An additional 5 articles were added from manual searches of reference lists. Iterative readings, interpretive and reflexive analysis, and research team discussions were performed to identify and refine metanarratives.

Findings

Five metanarratives were identified, including the concept of trauma, the trauma event, the person with trauma, the impact of trauma, and addressing trauma, with each metanarrative encompassing multiple dimensions. A biomedical concept of trauma predominated, with lack of conceptual clarity. Theory was not integrated or developed in the majority of articles reviewed, and context was often ambiguous. Trauma was described in myriad ways among studies. Why certain events were experienced as trauma and the context in which they took place were not well characterized. The impact of trauma was largely concentrated on harmful effects, and manifestations beyond symptoms of post-traumatic stress were often not considered. Furthermore, the dominant focus was on the individual, yet often in a circumscribed way that did not seek to understand the individual experience. In addressing trauma, recommendations were often generic, and earlier research emphasized individually-focused interventions while more recent studies have considered systemic issues.

Insights

Multiple dimensions of trauma have been discussed in the medical education literature and from many conceptual standpoints, with biomedical, epidemiologic, and individualized perspectives predominating. Greater precision and clarity in defining and understanding trauma is needed to advance research and theory around trauma in medical education and the associated implications for practice. Exploring trauma from intersectional and collective experiences and impacts of trauma and adapting responses to individual needs offers ways to deepen our understanding of how to better support learners impacted by trauma.

Keywords:

• Psychological trauma
• medical students
• residents
• metanarrative review

Acknowledgments

We would like to thank Dr. Todd Hill for contributing to the process of screening articles for inclusion. We also acknowledge Dr. Aliya Kassam, Dr. Todd Hill, and Dr. Pamela Roach for their review of findings from the metanarrative analysis and of the thesis chapter from which this manuscript was developed.

Ethics statement

Not required.

Author contributions

Both authors made substantial contributions to conception and design of the research, data analysis, drafting the article, and revising it critically for important intellectual content. Both authors approved the final version to be published.

Disclosure statement

The authors do not have any conflicts of interest.

Additional information

Funding

Robert Maudsley Fellowship for Studies in Medical Education, Royal College of Physicians and Surgeons of Canada.