Of the 36 cartoons included in the analysis, four (11%) were positive, eight (22%) were mixed, and 24 (67%) depicted negative emotions. Of the negative cartoons, the most common subdomains present were incompetence, negative hierarchy and culture, and a lack of time. The most prevalent subdomain in the negative cartoons was incompetence, specifically students’ negative impressions of their own capabilities. One cartoon depicts a student practicing auscultation (Fig. 1a), failing to hear abnormal heart sounds multiple times. Ironically, the moment they claim to hear an abnormal heart sound, the murmur is, in fact, absent, suggesting a sense of incompetence and futility among the medical students.

Comics by medical students about incompetence and power gradient

Several of the negative cartoons presented the negative effects of the medical hierarchy by depicting seniors using horror imagery. One cartoon depicts an attending, presumably a surgeon given the scrub cap, mask, and scalpel, as a monster with horns and teeth towering over a cowering medical student rhetorically asking if the student is intimidated (Fig. 1b). The cartoon may have fantastical imagery, but the attending inspires such fear in the student that they had chosen to portray them inhumanely.

The hierarchy of medicine is sometimes critiqued in more direct ways. Another cartoon presents the three stages of becoming a doctor, representing each stage quite unappealingly, first as a baby, then as an enthusiastic child, and finally as a decrepit older adult (Fig. 2a). The captions underscore what the student views as a vicious cycle, where the baby (a medical student) cries for a higher grade, the intern gives the medical student scut work, and the final year resident is just waiting for the promised “attending year salary.”

Comics by medical students about infantilization of medicine

Sometimes, visual illustrations can embody multiple themes; for instance, a cartoon compares medical education to non-medical careers, underscoring the infantilization present in medical education (Fig. 2b). The medical student is told that they are not trusted to do anything, while their peer in a business field has just had their plan approved by a senior. No doubt, the illustrator of this cartoon may be looking at their non-medical peer quite enviously.

Another common negative theme expressed is lack of time. A cartoon depicts an internally fuming pregnant medical student (Fig. 3a) listening to a pregnant patient complaining about being tired after taking two naps. The medical student seems to be losing her empathy as although she and the patient are in similar situations, the student does not have enough time to rest due to the conditions of the medical training system.

Comics by medical students about a lack of time and self-care

Students not only highlighted the lack of personal time but the unhealthy coping mechanisms that they must undertake. One cartoon (Fig. 3b) demonstrates the food pyramid of a third-year medical student, highlighting coffee as a foundational food group and sleep being “the rarest of all food.”

Although students used graphic medicine to depict mostly negative emotions, positive comics often focused on the role of supportive mentors and teachers. One of the positive cartoons depicted a relationship between an attending and a medical student that gave them the confidence to learn and grow, basing the imagery on a Calvin and Hobbes cartoon (Fig. 4a). This contrasts with many other cartoons that depict the hierarchy of medicine negatively and demonstrates how a good relationship with a supervisor can completely shape a student’s outlook on medical training. Another positive cartoon demonstrated an attending who agreed with the medical student’s judgment and thanked the student for taking the time to help (Fig. 4b). This echoes the importance of positive verbal feedback, which can help facilitate a student’s confidence in making medical decisions.

Comics by medical students depicting positive interactions with teachers