Graphic medicine and health professional education: An internship comic book case study

Introduction: This study aimed to determine whether comics in medical education ("graphic medicine") can enhance professional identity formation (PIF) of junior doctors. This was accomplished through a multi-year trial of an internship comic book handbook that was specially designed to be used as part of an internship orientation program at Mackay Base Hospital. Methods: A 24-page comic was distributed during the hospital's intern orientation in 2014-2017. Surveys were conducted with 2014-2017 interns (n = 54) to assess how prepared they felt to meet the challenges of internship and how helpful they had found several orientation publications, with surveys of the 2013 interns providing control data (n = 13). Qualitative interviews from the 2014 cohort (n = 9) were analysed thematically and matched to groups of thematically similar survey responses. Results: Interns reported feeling more prepared to face the challenges of internship following the introduction of the comic in 2014, compared to the 2013 control group, and this remained generally consistent throughout 2015, 2016 and 2017. At the end of internship, 92% of interns recalled the comic (n = 47) and 89% rated it as at least somewhat helpful (n = 42). The interviews and surveys were thematically grouped by the interns' responses to the comic: resistant (n = 8), ambivalent (n = 9), ecumenical (n = 23) and enthusiastic (n = 7). A single variable linear regression analysis showed a statistically significant (p = 0.04) and mildly positive (r = 0.29) correlation between how helpful the interns found the comic and how well they felt they had been prepared for the challenges of internship. The comic was the only publication significantly correlated with preparedness (p < 0.05). Conclusions: Comics can be a useful tool for medical education. Further use of comics in internship programs could improve how prepared interns are for the challenges of internship and, therefore, enhance their PIF.