Reimagining the Cape: Exploring New Metaphors for Emerging Medical Professionals

Abstract

Becoming a doctor has always been difficult. Medical training is long and arduous, requiring intelligence, resilience, judgment, and perseverance. Historically, the goals of this journey seemed reasonably clear and the path straightforward. These days, however, students must contend with an evolving landscape in medical education where their roles are shifting and amorphous (1); financial burdens are immense (2); and depression, burnout, and suicide are commonplace (3). Having a better understanding of medical students experiences with medical education can help educators better prepare students for the inevitable challenges they will face. The 4 comics published in this issue of Annals (47) show the vulnerability students feel during the liminal phase when they are neither doctors nor laypeople. While family, friends, popular culture, and the students themselves construct a fantasy of doctor as superhero (8), the students lived experience belies such expectations. In one example, Mollie Kotzen depicts her patient (Mr. T) as a lone pair of red eyeglasses and herself as disembodied questions nested within word-bubbles (4). When Mr. T becomes confused, his glasses rupture and he cries out for help. Kotzen reflects: 3rd-year med students are generally pretty powerless. We try. But our assessments are rarely correct and our plans are rarely put into action. We often feel like just more work for the rest of the team. Her self-deprecating observation spurs her to action, and she seeks to be useful despite her limited experience. Kotzen hunts down a AA battery and repairs a broken clock in Mr. T s room, which helps him become less confused and makes her proud that she finally helped a patient. In her quest to find meaning in her efforts, Kotzen discovers that making someone feel even the slightest bit better for a moment is valuableeven if this unassuming goal is at odds with the popular portrayal of doctors as lifesaving superheroes. The superhero theme is explored further in a pair of comics by Michelle Syad (5) and Shruti Sudhakar (6). In each, the medical student is initially swathed in standard issue superhero attire: cape, logo, boots, and swagger. In Syad s aptly titled The Tale of a Wannabe Superhero (5), she describes 2 patients with sepsis who have antipodal outcomes. After one dies (Sayad s first experience with death), she becomes dejected and cries at the patient s bedside before realizing that the superhero metaphor itself is part of the problem. She replaces her cape with a white coat and acknowledges that in the end, we re just people trying to care for our patients the best we can. Likewise, in Sudhakar s comic (6), the death of a patient leads her to question her own assumptions about what should be expected from the medical profession. She indicates that when I was accepted into med school I felt like I had been accepted into a profession of superheroes. But when the surfeit of technology and expertise failed to save the life a 19-year-old trauma victim, the cape no longer seemed an apt fit. In the comic s final panel, her anesthesiologist mentor delivers a nugget of wisdom: [A]llowing our patients to die is not admitting defeat . [T]he dress code is white coat, not capes Gazi Rashid reveals what lies beneath the protective guise in a different way, addressing the question of what it is really like to be a medical student (7). In a playful interpretation of Rudolph Franz Zallinger s famous illustration The Road to Homo Sapiens (9), the author depicts medical students evolving as they arise from a primordial sea and pass through various stages, including a bug-like creature burdened with a huge backpack. But unlike Zallinger s inevitable march toward progress, students are confronted with seemingly insurmountable barriers. Beginning with the customary inventoryendless hours studying, uncomfortable interactions with patients, being intimidated by mentors and peersRashid moves on to describe what s really hard: feeling alone and adrift. And here, the author offers insights on how to endure and flourishagain, drawing on more humble metaphors than the superhero. These stories reveal the vulnerability and dissonance students often feel as they adopt new professional identities (10). Although we relate to the stories honesty and good humor, the medium of comics itself also should be credited for illuminating such disquiet. Despite (or perhaps because of) their disarming appearance, comics have a long history of challenging social conventions, addressing taboo topics, providing agency to those at the margins, and offering a perspective not generally seen or heard in academic discourse. So it is not surprising that when medical students are given the opportunity and means to express themselves through this medium, they tell stories that may be at odds with conventional narratives about medical education. Superman, the archetypal superhero with clarity of vision and impenetrable armor, no longer serves these students. They relate more to vulnerable and imperfect characters like Spider-Man, a doubt-ridden youth grappling with newly acquired power and uncertainty about how to responsibly deploy it. These days, turning conventional superhero stories on their head is commonplace (for example, Deadpool, Iron Man, Ant-Man), and the students use such cultural knowledge to express their fears and doubts in ways that would have been frowned upon a generation ago. Their willingness to share such uncertainties about who they are and what they should be doing is both a testament to their generosity and, perhaps, an expression of emerging cultural change in medical education. As students give voice to their authentic experiences, we see the disassembling of a mythology that no longer reflects the world in which students actually live. And this is a good thing, because there is a cost to perpetuating this myth, particularly for those who doubt they are living up to lofty expectations propagated through such stories. In the context of the growing epidemic of duress among medical students (3), we must thank these creators for providing a glimpse into their worlds, and implore medical educators to find ways to help students not shoulder the burdens of medical education by themselves.