Dancing with skeletons and mocking dermatologists in medical-student comedy shows.

Health and medicine explained.
Nov. 7 2008 5:50 PM

Future Doctors Behaving Badly

Dancing with skeletons and mocking dermatologists in medical-student comedy shows.

For decades, medical students have written and acted in satirical comedy shows spoofing their experiences. Such shows were almost always closed events, presented by the students to one another and the faculty. Audience members, the students' senior colleagues, have long tolerated fairly outrageous behavior onstage. Now, though, the videos of such shows have begun to appear on YouTube and other Internet sites. The public can watch students criticizing one another's behavior, mocking their professors, and identifying apparent flaws in the educational process.

Medical school comedy shows date back at least as far as 1897, according to a 2006 article written in the Journal of Medical Humanities by Dr. Charles R. Hayter of the University of Toronto. He traces the roots of medical school shows to the tradition of vaudeville, in which satirical skits and musical selections poke fun at others. Such humor, anthropologist Anne Burson-Tolpin has written in Literature and Medicine, "challenges the existing social structure." But there's a difference between a closed-door performance and a publicly accessible YouTube video. Should the medical profession reveal its dirty laundry publicly? More importantly, perhaps, do these skits identify genuine flaws in how doctors learn and practice medicine?

In addition to caricaturing their peers, their professors, their future bosses, and their future selves, students performing in such shows routinely criticize behaviors they find objectionable, inappropriate, or ludicrous. One target is the "cowboy" surgeon, whose operating room resembles a saloon more than a temple of science. Students at the University of Texas Medical School at Houston filmed a video to the tune of Weird Al Yankovic's "Like a Surgeon," itself a spoof of Madonna's "Like a Virgin." In the clip, one surgeon drinks from a liquor bottle while the surgical patient has a helpful bull's-eye painted on his abdomen. Students at the Washington University School of Medicine also jabbed at surgeons in a skit drawing on Anheuser-Busch's well-known "Real American Heroes" advertising spots. "Dr. Unnecessarily Angry Surgeon" acts "like a 5-year-old," throwing tantrums in the operating room.

At other times, the criticisms point out issues rarely discussed in the open in medical schools. Is there anything wrong with pursuing a medical specialty that is especially lucrative? As Hayter notes, student shows often parody dermatologists and anesthesiologists as doctors who earn great salaries while working relatively few hours. My own fourth-year medical student show featured a song, "Zits or Gas," to the tune of "Dance: Ten; Looks: Three" from A Chorus Line. * One representative line was "No emergency, lots of time to ski."

Another unspoken issue is raised by a second "Real Teaching Heroes" clip that mocks "Dr. Male Ob-Gyn Resident," the "Prince of the Paps," who chooses to surround himself with female patients, nurses, and colleagues. The skit doesn't explicitly object to such a career choice, but it raises complicated gender issues. Why do some men choose to specialize in women's medicine? Should this topic be discussed in medical school?

Other targets of the satirical performances are the medical students themselves—and their behavior. In a video from the University of Kentucky, students are portrayed as willing to do anything their senior physicians want, including washing their cars and rubbing their feet. Performers also target misconduct in the anatomy laboratory, where students at times place objects in body cavities or give dissected bodies names like "Dead Earnest." In this case, the student performers themselves may be as guilty as anyone of misbehavior. In a video made by students at the University of Chicago's Pritzker School of Medicine, two female students dance seductively with a plastic skeleton. * And a male student, having left the anatomy class for a bar without showering, tries to pick up women with rap lyrics: "Listen, girls, give me a try/ 'Cause formaldehyde's like Spanish fly."

So are medical schools full of uncaring students and professors who disrespect their patients then wink and nod to one another about their antics? Should people who stumble upon these videos, who may be surprised to see their current and future medical-care providers acting this way, be concerned?

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I don't think so. Hayter terms medical school comedy shows a "controlled episode of misrule," allowing students to challenge aspects of medical education and patient care in a comfortable setting. As in vaudeville, while the skits are often based on reality, the bad behavior shown is (for the most part) exaggerated. Burson-Tolpin agrees, arguing that the skits provide a "safe arena" for airing concerns without undermining the ability of senior physicians to continue their clinical and educational roles. And the skits are not just outlets for students to air their frustrations. Some of the recent impetus to reform medical education may have stemmed in part from comedy shows exposing formerly hidden concerns. For years, topics such as professional incompetence and unkind behavior toward patients appeared publicly only in annual medical student shows. That schools now emphasize the production of humanistic doctors is a response, in part, to the prima donna surgeons of earlier eras.

Even the shows themselves have been forced to change over the years. For example, Hayter writes, it was once nearly impossible to attend a medical school show that did not feature male medical students in drag, often playing seductive nurses. Male rugby players long dominated shows at Columbia, recalls Dr. Linda D. Lewis, longtime dean of students there. But as women and minorities entered medicine, the frat-boy atmosphere of the shows tempered, leading to the elimination of material perceived as racist, sexist, or homophobic. In some instances, the process of writing the shows might even lead to productive discussions about the appropriateness of material proposed by the larger group. In my fourth-year show, lyrics of a barbershop quartet song were changed when some students felt they unfairly stereotyped women of a specific ethnic group.

Beyond serving as a potential tool of reform, these shows have another virtue, promoting what Hayter terms "teamwork, bonding and development of communal spirit." Medical students who perform together ultimately affirm their allegiance to the norms of the profession they are about to enter—and show that they're willing to have a sense of humor and humility about themselves, their colleagues, and their future careers.

Correction, Nov. 7, 2008: This article originally gave the wrong title for the song "Dance: Ten; Looks: Three" from A Chorus Line. (Return  to the corrected sentence.)

Correction, Nov. 10, 2008: This article originally said that a video showed two students dancing with a real skeleton. The skeleton was fake. (Return  to the corrected sentence.)

Barron H. Lerner, M.D., Ph.D., and Angelica Berrie-Gold Foundation professor of medicine and public health at Columbia University Medical Center is author, most recently, of When Illness Goes Public: Celebrity Patients and How We Look at Medicine.

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