{'fraction_non_alphanumeric': 0.02902124430955994, 'fraction_numerical': 0.005311077389984826, 'mean_word_length': 5.4620098039215685, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Mentors, monsters, and medical education

I recently found several angry old men lurking in a place I least expected—the drawings of fourth-year medical students at Penn State College of Medicine. Only, these images were not depicting irascible geriatric patients encountered in clinical rotations or nursing home visits, they were caricatures of the students’ physician mentors. The drawings emerged from a month-long “Comics and Medicine” humanities elective taught by a colleague (MJG), where students who are concluding their fourth-year of medical school create graphic narratives, or comics, that reflect on formative experiences from their medical education. Storylines vary—some students write about their proudest moments, while others share particularly intense, surreal, or humbling experiences or satirize the quirky training rituals, processes, and arcana of medical culture. Since 2009, sixty-six students have created comics, all of which can be found on our department’s website. Last year, when I helped my colleague code and analyze the comics, we had a jarring finding—47% of them contained horror imagery (George & Green 2015). In drilling more deeply into these darkly themed drawings, we documented numerous instances where students depicted their clinical mentors as monstrous figures—devils, demons, cannibals, land sharks, and belligerent old men. In every case, the white-coated creatures were a source of menace, evoking fear, loathing, and resentment in the student narrators. Though often tongue-in-cheek, some of the depictions even showed these raving, wild-eyed mentors as perpetrators of cartoonish acts of violence—devouring or decapitating underperforming trainees, barking out death threats, or posturing in ways that were so intimidating as to cause students to lose control of their bladders. While these depictions were certainly exaggerated to maximize dramatic effect, the pervasiveness of this horror imagery nevertheless raised concerning questions about the way we are training today’s medical students and how modern clinical environments may be creating conditions for abuse and neglect (Runye & Snell 2014). But, as someone who studies intergenerational relationships, I’ve also been dwelling on how sad it is that students seemingly feel so stifled by their older mentors. Indeed, while modern medical education has traditionally been split between classroom learning and hospital rotations, the “art of medicine” is perhaps most powerfully conveyed to students through the delicate mechanics of intergenerational mentoring from practiced physicians in clinical settings. Indeed, the term “hidden curriculum” has been so widely embraced in recent decades because of its ability to describe the implicit lessons of medical training imparted outside the formal classroom, through activities such as clinical mentorship (Hafferty 1998). So, when students willingly choose to draw their supervisors—professionals who should be nurturing them to become skilled, compassionate healers—as monsters who regard them as “worthless puddle[s] of dog sick” (as one student wrote in their comic), it implies there is something amiss in this critically important intergenerational covenant. One worries about the degree to which this aspect of the “hidden curriculum” will be internalized and perpetuated by the next generation of healers as they themselves become mentors within a system that has normed such seemingly aberrant behaviors. The comics beg their readers to ask how this cycle might be broken. As with most problems in medicine and in life, the challenge is complex, multi-factorial, and resistant to single solutions. But one obvious starting point is to scrutinize why “elders” in medicine are displaying problematic behaviors in the first place. Burnout is an obvious challenge in the profession, as doctors must work quickly and effectively in high-pressure, high-volume environments while shouldering onerous clerical demands (e.g. the electronic health record and sundry paperwork) (Shanafelt et al. 2012). Troublingly, recent research has also established high prevalence of burnout among trainees, with levels higher than in the general population (Dyrbye & Shanafelt 2016). One fears that today’s doctors (and increasingly trainees) fundamentally lack time to process experiences and reconnect to the humanity, passion, and altruism that led them into medicine. There would seem to be a need to reconnect professionals to the arts and humanities, which can provoke reflection on important existential questions like the purpose and meaning of one’s vocation, and the imprint one wishes to leave on the next generation. At Penn State, we have offered “humanities mini-courses” that allow professionals in our teaching hospital the opportunity to experiment with different forms of creative expression and reflection (e.g. photography, essay/poetry-writing) in the service of better self-care, but it is admittedly difficult to provide transformative programing for people with such busy lives. Increasingly, these comics feel like a canary in the coal mine. When I recently asked a group of 23 graduating students how many would elect to attend medical school over again, only a single hand was raised. Students spoke