Graphic Medicine in Graduate Medical Education

Medical residency is a transformational journey when residents and fellows develop long-term habits, attain professional competencies, grow their professional identities, and build relationships from shared experiences. It is also often a taxing time as residents may feel isolated and overwhelmed from cognitive overload and a stressful work environment. The challenge is how to incorporate opportunities for self-expression, creativity, and potential community building into residency education.

Graphic medicine, a field at the intersection of comics and health care, can help faculty and trainees explore the triumphs and struggles of the residency experience. As an art form that combines words and images to sequentially tell a story, comics allow the reader—and author—to reconceptualize their experiences and thus may support a more affirming residency climate. This emphasis on storytelling distinguishes comics from other visual art. Comics can deliver information effectively and efficiently as well as address topics in a variety of genres (eg, fiction, nonfiction, memoir, reportage).

In the context of medical education, comics serve as powerful communication tools for both receiving and delivering information. While there is growing literature on the use of comics in undergraduate medical education (UME), the use of comics in graduate medical education (GME) is not as well explored. Their use generally involves 2 types of activities: (1) reading and discussing medically relevant comics (receiving), and (2) drawing comics as a form of self-expression and to share experiences (delivering). For example, when comics were used to teach aspects of patient safety, residents in one study reported increased awareness of patient safety risks and greater enjoyment than with standard educational activities.¹ In other work, comics were used to educate residents about neurological diseases, with outcomes of increased appreciation of the illness experience, deeper empathy, and willingness to explore new approaches to patient communication.² 

Comics also support self-expression, personal reflection, and communication. Even those without prior drawing experience can author comics to effectively share their experiences, emotions, and ideas in ways beyond that of written text.³  Comics creation has been used to gather feedback and to debrief with medical students.⁴  In general, using comics has been associated with self-reported improvements in empathy, communication, awareness of bias, and nonverbal cues.⁵ 

1. Start reading graphic medicine content. Talk with your colleagues, including librarians, faculty, and staff, to find out who reads comics and why. The Graphic Medicine website (www.graphicmedicine.org) can help you explore medically themed comics (M.N. and M.J.G. are contributing site editors). On this site, explore the resources tab and scan Essential Graphic Medicine: An Annotated Bibliography. Select a health-related comic and dive into it with an open and empathetic frame of mind.

2. Just draw something. While a blank page might intimidate, see it is an invitation to share honest thoughts. If you aren't sure where to start, some helpful resources include Lynda Barry's Making Comics (https://drawnandquarterly.com/books/making-comics/) or exercises from the Graphic Medicine website's Drawing Together series (www.graphicmedicine.org/drawingtogether). We all can draw, even if it's a stick figure. Turn off your inner critic and sketch something you want to teach, reflect on, or learn. Try the following exercise and explore how making comics can help us tell stories and gain insights into the patient-physician interaction. Fill in the blank panels by drawing what happens before and after the scene presented.

3. Gather colleagues together. Consume and produce comics collaboratively. Pick a comic and find several colleagues who share this interest, then come together to discuss. Host a “comic jam,” an exercise where each participant adds one panel to an improvised comic narrative. Pitch a prompt and have everyone create a 4-panel comic in response. Creating and sharing comics can simultaneously spur creativity, strengthen your storytelling mindset, and help you relax.

1. Use comics to teach. Add a relevant comic to your next lecture or case conference. During rounds, give residents 10 minutes to draw a comic about a challenging interaction with one of their patients, then ask for a volunteer(s) to share their comic and discuss with the group. Use comics to stimulate conversations during debriefing sessions to reflect on challenging patients, diagnostic reasoning, medical errors, or cognitive biases.

2. Comics clubs. Comics can enhance an existing journal club. Encourage trainees to start new or integrate with an existing journal club to focus on graphic medicine. Journals such as Annals of Internal Medicine (www.acpjournals.org/topic/web-exclusives/annals-graphic-medicine), AMA Journal of Ethics (journalofethics.ama-assn.org/art-gallery), and Graphic Medicine Review (graphicmedicinereview.com) often feature comics. Others, including the Journal of Graduate Medical Education, publish comics. Additional comics club resources include published graphic novels, digital comics, and trainees' own personal work.

3. Partner with local librarians. Librarians can find physical and digital comics for learners and offer expert guidance on gathering evidence regarding their use in medical education. They can aid in development and coordination of speaker events and offer a hub for community gathering. Librarians are usually knowledgeable about avenues for publishing the comics you produce and can help you navigate the complicated world of scholarly publishing.

4. Join the graphic medicine community. Graphic medicine is a burgeoning transdisciplinary field with practitioners around the globe. Join conversations on social media using #graphicmedicine or #comics. Submit a guest post to the Graphic Medicine website (www.graphicmedicine.org/contact). For those wanting to join this growing international community, we recommend connecting with others in the field through collectives (eg, Graphic Medicine International Collective) and attending annual conferences.