There is an increasing awareness of the role of mass media and popular culture in communicating health information to the general public and medical students. 1 Medical television series in particular have been identified as a rich source of health information and medical ethics training, depicting doctor–patient relationships that are both entertaining and educational. Recent research has shown that these fictional representations of the medical profession have an impact on perceptions of real-life doctors, and can influence recruitment of students into medical, nursing and health science degrees. 2 Beginning with CBS’s City Hospital in 1951, medical television dramas have remained a staple of prime-time television. 3 In his book, Medicinema, Brian Glasser notes that popular film culture and medicine have always been intricately connected, with film historians placing the first representations of medical personnel in fictional films before that of ‘cowboys, criminals or the clergy.’ 4 With such a historically entrenched relationship between fact and fiction, it is unsurprising that medical dramas regularly come under scrutiny regarding their potential influence on public perceptions of doctors and the health system. 5 Furthermore, there is ongoing debate regarding the usefulness of televised medicine in medical and health science curriculum , with Roslyn Weaver and Ian Wilson reporting that university educators often seem concerned about ‘how the fictional world of medicine intrudes on and influences the real one.’ 6
The purpose of this edited collection is to discuss the use of popular culture in medical education, paying particular attention to medical television dramas. While there are many aspects of popular culture that go beyond television, Victoria Rideout notes that:
As a communications tool, TV continues to dominate, primarily because the size of its audience is unrivaled, dwarfing that of even the most popular websites. But hard evidence about the impact of so-called “edu-tainment” is hard to come by, and opportunities for large-scale, nationally representative evaluations of health messages in TV shows are rare. 7
These difficulties are present both when evaluating the impact of popular television on the general public, as well as for medical and health students. With many tertiary education providers moving towards more evidence-based pedagogical practices, there is an urgent need to explore how educators are engaging with popular culture and the impact this is having on students’ learning. This process has been under way for some time, with previous studies demonstrating various methods of incorporating popular culture into university teaching and health communication more generally. The studies contained within this collection add to this knowledge base, in addition to providing practical teaching tips for educators in this field looking to exploit the power of popular media, while simultaneously avoiding some of the pitfalls associated with it. As such, it would be beneficial to first briefly review the results of recent research on this topic. This introduction will then conclude with a summary of each of the chapters in the collection.
How has Popular Culture been Used in Medical Education?
At its most basic, ‘popular culture ’ can be defined as the cultural and artistic expressions that appeal to a large audience, whose dissemination is often facilitated through mass media , and which is generally distinguished somehow from ‘high’ or ‘elite’ culture. 8 The most common use of popular culture reported in the medical education literature involves using episodes of popular medical television dramas in the place of more traditional case studies. Pablo Blasco et al. claim this method generates classroom discussion in a similar way to problem-based learning activities. 9 These discussions also occur outside the classroom, when students and members of the general public engage with these shows and talk about the medical and ethical issues portrayed in them. As such, Weaver et al. claim that medical television forms part of the ‘informal curriculum ’ of medicine, exposing students to new perspectives about how medicine can or should be practised. 10 With a particular focus on medical ethics training, Angelo Volandes notes:
Film offers a powerful and underutilised medium in which clinical vignettes come alive in their rich and textured details, both medical and non-medical … Phrases often appearing in written vignettes, such as “aggressive procedures” and “futile care”, lose their amorphous qualities as students see and experience ventilators and medical emergencies on the screen. 11
Other authors agree that television episodes may be better suited to generating discussion than the short written scenarios often used in medical education. Jeffery Spike claims that this only works if the audience sees the whole story, rather than just a short clip, as familiarity with the television characters is essential for teasing out the complexities of the issues they face as doctors and patients. 12 He relates how an episode of Scrubs (‘My Fifteen Seconds’) was inspired by contemporary studies that showed doctors typically interrupted their patients after just 12–18 seconds, even though most patients would be able to convey their full message within 26–30 seconds if allowed to speak uninhibited. 13 The consequences of such an affront to the model doctor–patient relationship are conveyed well in the episode, in part because the series’ lead doctor, J.D., is the one who must come to the realisation that he was wrong when he said an average of fifteen seconds per patient was ‘all the time you need.’ When he almost loses a patient because he didn’t take the time to hear her whole story, he finally learns that as a doctor ‘you can never underestimate the importance of listening’—a lesson the viewer learns alongside him. 14 As the lovable, but flawed, fictional doctor, J.D. personifies the real-life doctors in those studies on average listening times, showing viewers not only how these situations come to be common in medical practice, but also why we should be campaigning to change them. Such a poignant message is likely to stay with all viewers, but particularly those embarking on the very career depicted in the show. However, for the episode to have its full effect it must be watched in its entirety.
If devoting a significant proportion of an already limited class time to watching or discussing a medical television series, it is necessary to first have clear learning objectives in mind. Similarly, if hoping to use popular culture references to communicate health information to the lay public, evidence of the efficacy of this technique is needed. Two examples in the literature stand out as particularly well designed in this matter: one focused on teaching non-clinician epidemiologists about medical issues, and the other on educating the general public on HIV transmission rates. The first was a study by Truls Østbye et al. in 1997, in which epidemiologists and biostatisticians were asked to watch episodes of ER in tutorials. As stated by the authors, the established goals of this educational intervention were ‘to illustrate referral bias and other epidemiological issues in a clinical setting ’ and ‘to provide human faces to the disease data students usually work with.’ 15 As it was deemed impractical for these students to attend ward rounds, the fictional clinical setting of ER was used as a substitute, with students expected to record presenting symptoms and demographic information on the patients admitted in the episodes. The results of the study indicated students found the sessions interesting and informative, and tha...