Commentary on Boxed In: Lessons From the Margins of Medical Student Comics
Quite simply, many medical students are marginalized in the clinical setting2; that is, they feel superfluous within the very system into which they are being socialized. This sentiment is immortalized as one of the famous laws in the House of God: “SHOW ME A [MEDICAL STUDENT] WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.”3 Much of what we know about the issue of student abuse is derived from quantitative surveys such as the Association of American Medical Colleges’ Graduation Questionnaire.4 Such surveys describe the frequency and types of mistreatment endured by students, but lack descriptions of students’ lived experiences. Narrative analysis can delve below the numerical surface to unlock meanings that may be missing from quantitative data.
Within medical education, creating narrative through comics is a relatively new way to foster student expression. This medium, which frees students to communicate their thoughts honestly and vividly using visual metaphor and satire, offers a variety of advantages over written and spoken language.5 As the realist painter Edward Hopper once commented, “If you could say it in words, there would be no reason to paint.”6
The comics on the facing page were created by three of the fourth-year medical students who have completed an elective course on comics and medicine at Penn State College of Medicine. In this month-long seminar/workshop, students not only read and discuss book-length comics about medically themed topics but also create their own short comics about formative medical school experiences.7,8 Previously, we noted that almost half of the comics contain themes from the horror genre.9 Additionally, as reflected in the panels here, a more subtle, yet pervasive theme students express is feeling marginalized in a clinical environment bereft of supportive mentorship.
In “Adventures in the O.R.,” Yvonne Y. Tsui shows herself literally and figuratively minimized by an imposing operating room nurse who shouts (among other things) “YOU’RE NOT IMPORTANT!” Whereas the nurse and her words are large and bold, the student is tiny and isolated. The message is sharp and clear: the student, at the bottom of the operating room hierarchy, is not a valued member of the team.
“Medical Student: A Tragic Comedy,” by Michael Pitzer, depicts the student’s interactions with an attending physician portrayed as a horned, white-coated devil. While the drawings of the attending remain largely unchanged, the student shrinks under withering invective by the physician who basically commands him to disappear. Missing the opportunity for positive role modeling, the physician berates the student as being little more than a nuisance—not the mentor Pitzer hoped for or deserved.
“Culture of Compassion,” by Jennifer Rice, depicts an attending physician shredding the student’s history and physical writeup while insouciantly commenting, “Yeah, that patient history looks great.” The student notes that “nothing we did really mattered,” perfectly capturing the disempowerment experienced during clinical rotations. In the adjacent panel, the cross-armed doctor sternly proclaims, “I’m going to call you ‘med student’ until you prove you’re worthy to be called by name,” sending the message that students must prove their value before being granted the basic dignity of their names. Rice’s comic raises the question of how a student can prove worthy when genuine attempts to contribute are not valued.