Background Experiences that interrupt routine perception—labelled in health professions education (HPE) as surprise , cognitive dissonance , unsettling encounters or wonder —are used to stimulate reflection but remain conceptually dispersed. This review examines how such experiences, treated analytically as astonishment-related triggers , are described, theorised and mobilised in HPE, and how they relate to dimensions relevant to patient safety. Methods A Focused Mapping Review and Synthesis (FMRS) was conducted. Searches were undertaken in MEDLINE, CINAHL, ERIC, PsycINFO and Google Scholar. Eligible publications were those describing educational or clinical experiences in HPE characterised by perceptual or interpretive interruption. Twelve empirical, conceptual and descriptive studies met the inclusion criteria. Data were mapped according to terminology, context, trigger type, reflective processes and safety relevance, and analysed using an interpretive synthesis approach. No formal risk of bias or certainty-of-evidence assessment was undertaken. Results Across heterogeneous contexts and learner groups, a recurring pattern emerged in which interruption of habitual perception was followed by a reflective opening prompting reconsideration of prior interpretations. These interruptions clustered into three analytically distinct—though sometimes overlapping—patterns: experiential (situational or sensory disruption), transformational (cognitive or affective dissonance) and contemplative (ambiguity, wonder or kairotic moments). Although none of the studies examined patient safety outcomes, several reported learning processes—such as noticing, interpretive openness and anticipatory awareness—conceptually adjacent to capacities discussed in the patient safety literature. Discussion This FMRS delineates a descriptive conceptual map of how astonishment-related triggers are framed across HPE and the reflective processes they activate. It highlights the pedagogical value of perceptual interruption and the importance of structured post-event reflection. Although the included studies were conceptually heterogeneous and no methodological appraisal was conducted, the synthesis offers a foundation for future empirical work examining how learners engage with uncertainty and perceptual mismatch in educational and clinical environments.
Boloré et al. (Wed,) studied this question.