Purpose: It has long been known that medical students become more cynical as they move through their training, and at times even exhibit “ethical erosion.” This study examines one dimension of this phenomenon: how medical students perceive and use derogatory and cynical humor directed at patients.
Method: The authors conducted five voluntary focus groups over a three-month period with 58 third- and fourth-year medical students at the Northeastern Ohio Universities College of Medicine in 2005. After transcribing the taped interviews, the authors analyzed the data using qualitative methods and identified themes found across groups.
Results: The categories that emerged from the data were (1) categories of patients who are objects of humor, including those deemed “fair game” due to obesity or other conditions perceived as preventable or self-inflicted; (2) locations for humor; (3) the “humor game,” including student, resident, and faculty interaction and initiation of humor; (4) not-funny humor; and (5) motives for humor, including coping and stress relief.
Conclusions: The authors offer recommendations for addressing the use of derogatory humor directed at patients that include a more critical, open discussion of these attitudes and behaviors with medical students, residents, and attending physicians, and more vigorous attention to faculty development for residents.
Dr. Wear is professor of behavioral sciences, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio.
Dr. Aultman is assistant professor of behavioral sciences, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio.
Dr. Varley is associate professor of clinical psychiatry, and director, Psychiatry Residency Program, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; and chair, Department of Psychiatry, and a fellow of the Institute for Professionalism Inquiry, Summa Health System, Akron, Ohio.
Dr. Zarconi is professor of internal medicine, and associate dean for clinical education, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; and vice president for medical education and research, and founding director of the Institute for Professionalism Inquiry, Summa Health System, Akron, Ohio.
Please see the end of this report for information about the authors.
Correspondence should be addressed to Dr. Zarconi, Office of Medical Education, Summa Health System, 55 Arch Street, Suite G4, Akron, OH 44304; telephone: (330) 375-3106; fax (330) 375-3804; e-mail: 〈firstname.lastname@example.org〉.