Abstract:

The object of the research was to analyze recent efforts to counteract negative behaviors arising from asymmetrical power relations in medical education, the professional workplace and the medical encounter through the use of humor, parody and satire. Medical humanities interventions, such as reflective writing, doctor’s stories, and graphic medicine, hold great promise as instruments of catharsis to relieve negative emotions and to temper hierarchical structures that lead to intimidation. The methods were to define the scope of the problem as reported in the medical literature, and propose solutions based the use of art and the humanities in pilot programs in the U.S., such as Hershey Medical School. Two classic works in educational sociology– Philip W. Jackson’s Life in Classrooms (1968) and Benson R. Snyder’s The Hidden Curriculum (1970)–helped to defined what is now well known as the Hidden Curriculum (HC). Broadly defined, the HC represents the disjunction between what is taught in the formal explicit curriculum and behaviors that are transmitted to students through observation and role-modelling. Based on Merton’s and Becker’s works in the 1950s and 60s on the socialization and acculturation of physicians, Hafferty et al. extended the concepts of the HC in the 1990s to medical education and practice. The HC was invoked to explain the paradox of bullying, abuse, intimidation, undermining, and harassment in a profession which ostensibly adhered to a strict ethical code, the Hippocratic Oath or its variants. The baseline study of Henry K. Silver and A.D. Glicken in 1990 found after surveying medical students at a well-known U.S. medical school that “46.4% of all respondents stated that they had been abused at some time while enrolled in medical school, with 80.6% of seniors reporting being abused by the senior year” (Silver and Glicken, 1990, p. 527). The literary theoretical basis of comedy, parody and satire is examined to determine their role in understanding human power relationship differentials. The results were that some success has been achieved and reported in the use of humor to defuse medical undermining, harassment and bullying and that a more robust theoretical base drawn from literary theory needs to be established in order to proceed with further pilot programs.

Keywords:

Medical education abuse and bullying, hidden curriculum (HC), socialization of doctors.