Hasan N HaboubiMBBS, BSc(Hons), MRCP1,2

Holly MorganMBBCh2

Omar AldalatiMD, MRCP2

1 Swansea University,Swansea, UK.

2 Abertawe Bro MorgannwgUniversity Health Board,

Swansea, UK.

h.n.y.haboubi@swansea.ac.uk

doi: 10.5694/mja15.01068

462

Hospital doctors’ Opinions regardingeducational Utility, public Sentimentand career Effects of Medical televisionDramas: the HOUSE MD study

Abstract

career in medicine haslong been considered an

Objectives: To evaluate the opinions of practicing clinicians on medicaltelevision dramas and the effects these series have on society as well astheir own practice.

Design, setting and participants: Observational study using a structuredquestionnaire disseminated among doctors of all grades and specialties atone tertiary centre and two large secondary care district general hospitals inWales, United Kingdom. Three hundred and seventy-two questionnaireswere distributed over a 3-month period, with 200 completed questionnairesreceived (response rate, 54%).

Main outcome measures: Frequency and reasons for watching theseprograms, and opinions regarding realism, educational value and publicperception, evaluated by doctors’ grades and specialties. Identification ofwork practice with any observed traits in fictional doctors was alsoanalysed.

Results: 65% of doctors surveyed admitted to watching these programson more than one occasion. Junior doctors (interns and resident medicalofficers) were more regular viewers. Most doctors who admitted towatching medical dramas did so for entertainment purposes (69%);8% watched for educational purposes and, of these, 100% watched HouseMD, 82% felt that these dramas were unrepresentative of daily practice,and 10% thought that they accurately portrayed reality. Most of the positiveresponses were from junior doctors. 61% of doctors identified some aspectof their clinical practice with another doctor (fictional or non-fictional;most junior doctors identified with a fictional doctor, compared withnon-fictional role models for more senior practicing clinicians.

Conclusions: This survey shows that a large body of the medical workforcewatches medical television dramas and that such programs exercise agrowing influence on the practice of junior doctors, particularly those inphysicianly specialties. The reasons for certain role model selectionsremain unknown and may require further evaluation.

Aapprenticeship, with mentorsproviding guidance to their trainees.The word mentor finds its originsin Greek mythology. In Homer’sOdyssey, the confidant of kingOdysseus, Mentor, was trusted toguide his son and oversee his educa-tion while Odysseus fought in theTrojan War.1

The modern practice of medicine,with an emphasis on shift work, hasmade the classical mentorementeerelationship more challenging,2

but the modelling of one’s practiceon observed social and clinicaltraits of a mentor or role modelremains.3 Moreover, such exposurescan be factors in students’ decisionsto pursue a career in medicine andeven in their subsequent choice ofspecialty.4

The eventual choice of role model isoften a personal one and may noteven involve one’s own supervisingsenior, although it is often based onclinical experiences.5 While knowl-edge and clinical competence havebeen cornerstones of role modelselection, growing evidence suggeststhat factors relating to personalitysuch as compassion, good commu-nication and enthusiasm may in facthave more influence on the expand-ing minds of trainees.6 Furthercompounding this, in some educa-tional situations, less than half ofsenior clinicians were subsequentlyidentified as being excellent rolemodels.7

While social interactions with par-ents, teachers or even peers mayimpact on personality, outlook andpractice, other media such as litera-ture and television (TV) havebeen demonstrated to be significantcomponents of this role modelhypothesis.8

MJA 203 (11) j 14 December 2015

Medical TV programs have grown inpopularity from the 1960s onwardsand are now considered a staple ofprimetime TV.9 It has only been inmore recent years that the effects ofthese health and illness TV narrativeshave been studied in greater detail.

Although their true purpose has beenone of entertainment, much of theirappeal is basedon theperception thatthey are an accurate reflection ofreality.10

It has been well accepted that TVcan have an impact on society,increasing knowledge and influ-encing behaviour.11 TV medical

dramas have also been shown to beof educational worth to patients12

and even doctors.13

However, they have occasionallycome under criticism for unrealisticmedical content, ranging fromdemonstration of intubation tech-nique14 to cardiopulmonary resusci-tation (CPR).15 Frequently, in CPRsituationsonTVcomparedwithactualpractice, there is a higher volume oftrauma cases as an underlying aeti-ology. Further, these scenarios oftenshow considerably younger patientsthan those seen in routine CPR andsurvival to discharge is muchbetter than clinically encountered.16

1 Grade and specialty of respondents (n ¼ 200)

Grade and specialty No. (%)

Grade

Intern 49 (24.5%)

Core trainee (RMO) 60 (30.0%)

Registrar (specialist trainee) 36 (18.0%)

Consultant 55 (27.5%)

Specialty

Medical 83 (41.5%)

Surgical 36 (18.0%)

Acute non-medical 27 (13.5%)

Non-acute 20 (10.0%)

GP or GP trainee 34 (17.0%)

RMO ¼ resident medical officer. u

Concerns that this may influence theattitudes of members of the publicwho watch these dramas for educa-tional purposes remain.

More recently, there has been agrowing emphasis on the use ofthese programs as educational re-sources.17 In particular, some of theestablished role model personalitytraits such as ethical astuteness,communication and empathy havebeen sufficiently demonstrated inthese series to warrant use in un-dergraduate teaching videos.18

Although much of the learningthat can be gleaned from observingthe practices of TV doctors hasfocused on perceived softer under-graduate educational domains,19

their use in postgraduate settings isalso increasing.20

TV is amedium throughwhichmanyhealth care workers not only taketheir minds off work, but also reflectboth consciously and unconsciouslyon experiences. Students and doctorsdo indeed watch these programs atleast as often as the general publicdoes and, when questioned, are quitepositive regarding them.21 Althoughnot yet demonstrated, watchingthese seriesmay form an early part ofany role modelling or identificationwith certain character traits that bothtrainee and established medicalpractitioners may have.

Methods

A structured questionnaire wasdistributed among doctors of allgrades and specialties in three largeteaching hospitals in Wales, UnitedKingdom (Morriston Hospital,Singleton Hospital and Princess ofWalesHospital) within theAbertaweBro Morgannwg (ABM) UniversityHealth Board, to allow capture ofdata from a diverse range of spe-cialties. These were disseminatedthrough various different locations,including departmental meetingsand on-call rooms.

Questions related to respondents’gender, specialty and grade, whetherthey watched medical TV dramasand their opinions regarding them,and whether they identified withcharacters from these programs (and

if so, who) or with a non-fictionaldoctor encountered during theirclinical careers.

Hospital grades were summarised asconsultant, specialist trainee (regis-trar), core trainee (resident medicalofficer [RMO]), and foundation doc-tor (intern). For simplification, spe-cialties was separated into medical,surgical, acute (eg, accident andemergency, intensive care unit, etc)and non-acute (eg, pathology, radi-ology, etc), although note was madeof individual subspecialty answersfromwithin these broader categories.

Statistical analysisA cumulative odds ordinal logisticregression with proportional oddswas run to determine the effect ofgrade and specialty on the choice andfrequency of viewing of medical TVdramas. Statistical significance wasset at P< 0.05. Statistical calculationswere performed using SPSS Statis-tics, version 21.0 (IBM).

Ethics approvalEthics approval was granted by theABM University Health BoardResearch and Development JointScientific Review Committee.

Results

Three hundred and seventy-twoquestionnaires were disseminatedand 200 completed questionnaires

were returned (response rate, 54%).Forty-six per cent of individualscompleting questionnaires werewomen and 88%had graduated froma UK medical school. Grades andspecialties of respondents are pre-sented in Box 1.

How often do clinicians watchTV medical dramas?One hundred and twenty-nine doc-tors (65%) surveyed admitted towatching TV medical dramas onmore than one occasion and14% considered themselves to beregular viewers; 15% of respondentsfelt that watching them as a schoolstudent positively influenced theirdecision to pursue a medical career.

Junior doctors were five times morelikely to have watched these pro-grams asmedical students comparedwith more senior doctors (odds ratio[OR], 5.2; 95% CI, 2.5e10; P< 0.01).The ORs for RMOs and specialisttrainees were 3.1 and 2.5, respec-tively, in relation to consultants(P<0.05). Further, UK graduateswere five times more likely to havewatched these medical TV dramas asmedical students compared withnon-UK graduates (OR, 4.8; 95% CI,2.4e9.6; P< 0.01).

The most commonly watchedTV programs were Scrubs (49%),House MD (35%) and ER (21%).Most doctors who admitted towatching medical dramas did so for

MJA 203 (11) j 14 December 2015 463

2 Most popular fictional television doctor role models

Rank Doctor Show Most popular among:

1 Elliot Reid Scrubs Women, junior trainees

2 Perry Cox Scrubs Specialist trainees, physicians

3 Leonard McCoy Star Trek Consultants, anaesthetists

4 John Carter ER Physicians, acute specialties

5 R Quincy Quincy ME Consultants, non-acutespecialties (pathologists)

464

entertainment purposes (69%);19% watched because there wasnothing else on TV; 5% for insight

3 Dr Evil (Austin Powers film series) wsome surgical trainees (Getty Imag

MJA 203 (11) j 14 December 2015

into media perceptions of medicalpractice; and 8% for educationalpurposes.

as an interesting selection amonges)

Clinicians’ opinions regardingTV medical dramasWe asked individuals if they felt thatTV medical dramas were educa-tional, gave doctors a bad name,accurately showed the doctorenurserelationship, and represented thespectrum of illnesses commonlyencountered.

One hundred and three respondents(52%) felt that these shows displayedno educational value whatsoever, 52(26%) were unsure, and 45 (23%)believed there were some educa-tional benefits from watching them.

Evaluating the spectrum of illnessrepresented in these dramas, 82%felt that those shownwere unrealisticof daily practice. However, 20respondents (10%) thought that theyaccurately portrayed reality. Most ofthese positive responses (16/20)were from junior doctors. No associ-ations between the belief thatmedicaldramas portrayed realistic life situa-tions and specialty or frequency ofviewing were observed.

Grade, specialty and country ofqualification had no effect onwhether a doctor believed that theprograms represented current medi-cal practice. Neither did currentfrequent watching or having been aregular viewer at undergraduatelevel.

Twenty-seven per cent of doctorssurveyed felt that these programsgave doctors a bad name, althoughno significant differences wereobserved between any of the groups.

Only 13% of respondents felt thatmedical dramas accurately portrayedthe doctorenurse relationship, mostof whom were self-admitted non-regular viewers (P¼ 0.01) and generalpractitioners or GP trainees (19/25;P¼ 0.05).

Outcomes of watchingTV medical dramasThirty per cent of foundation doctors(interns) and 25% of core trainees(RMOs) felt that watching medicalTV programs may have affectedtheir career choice (to any extent)compared with more senior doctors(18%).

Compared with consultants, the ORfor interns considering that watchingmedical TV dramas had any effect ontheir subsequent career choices was4.8 (95% CI, 1.6e13.7; P¼ 0.013); forRMOs and specialist trainees, theORs were 2.5 (95% CI, 1.3e5.8) and2.7 (95% CI, 1.3e5.8) respectively;P¼ 0.09 and 0.13).

Specialty and country of qualifica-tion did not influence doctors’ beliefsthat watching medical dramas hadan effect on their career choice.

4 House MD was considered the most educational among respondents(Getty Images)

Clinicians’ identification withdoctors in TV medical dramas?A total of 121 respondents (61%) rolemodelled aspects of their practice onanother doctor (fictional and non-fictional).

Junior doctors, particularly internsand RMOs were more likely to findcommonality in their practice withfictional TV characters comparedwith more senior doctors (OR, 2.7;95% CI, 1.3e5.8; P¼ 0.008).

Consultants were most likely not tospecify any role models and, if theydid so, were more likely to identifythemselves with non-fictional char-acters (32/55) compared with otherdoctors, particularly interns (4/49).

Medical doctors were more likely toidentify themselves with a fictionalTV character (OR, 3.2; 95% CI,1.08e9.43; P¼ 0.035). This wasfollowed by 19% of acute spe-cialty doctors and 14% of surgicalspecialty doctors. Non-acute spe-cialty doctors were least likely toidentify themselves with a fictionalTV doctor.

The top five most popular fictionalrole models are shown in Box 2.Leonard McCoy (Star Trek) andQuincy (Quincy ME) were the mostpopular choices among consultants;the majority of positive responderswere anaesthetists and pathologists.A more varied response was seenamong physicians and surgeons,but note was made of a peculiarpopular choice: Dr Evil (from theAustin Powers film series, Box 3) wasnamed by four trainees, all surgical(three orthopaedic and one generalsurgery).

Discussion

There is a known association be-tween clinical role models in under-graduate medicine and careerchoice.22 Therefore, TV medicaldramas could potentially influencedoctors’ and students’ opinions andhave been found to be a source ofentertainment for both health careprofessionals as well as the widerpublic.23

Fictional doctors have evolved intotelevision heroes and much of theirappeal is their on-screen personality

as well as, in some cases, their abso-lute prioritisation of scientific chal-lenge over social relationships.24

Further, much of their appeal istheir ability to navigate throughdifficult ethical dilemmas, to makedecisions that are often perceived byclinical trainees as being positiveones.25

Although clinicians watching theseprograms appear to do so predomi-nantly for entertainment purposes,we found that those who watch foreducational reasons show that juniortrainees exposed to this genre of TV

MJA 203 (11) j 14 December 2015 465

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entertainment are more influencedby these series than their moresenior counterparts. Interestingly, allrespondents who admitted towatching TV medical dramas foreducational reasons watched HouseMD (Box 4), perhaps suggesting thatthey value its learning input.

In keepingwithprevious studies,14-16

most doctors felt that a large pro-portion of what was televised maynot be a true representation of clinicalpractice; however, suggestions thatmore junior trainees believe this tobe so could be explained by theirrelative lack of clinical experiences todate.

Identifying aspects of one’s practicewith witnessed exposures has been acornerstone of the role modellingtheory, but data generated from thisquestionnaire-based study suggestsome interesting differences be-tween specialties. Doctors whoanswered negatively to currentlyviewing or having ever viewed thistype of program were least likely toadmit to having been influenced into

MJA 203 (11) j 14 December 2015

a career in medicine on the basis ofTV medical dramas, thus validatingthe data.

It is to be assumed that consultantsmay look on their past seniors as rolemodels to identify commonality ofpractice but the high proportion ofrespondents among all grades whoadmitted to being influenced, atleast in part, by medical TV dramassuggests a much higher effect thananticipated.

Further, differences between speci-alities — for example, medical doc-tors identifying more with TVdoctors compared with their surgicalpeers — might be explained by thesizeable volume ofmedically themedprograms as opposed to more surgi-cal ones. It is plausible, however, thatsome of the core learning traits seenin physicianly specialties, particu-larly regarding difficult diagnosticsand ethical dilemmas, strike a chordwith this group of clinicians. Specificchoice of TV doctor hero as a poten-tial role model will require furtherevaluation. Motivations for the

popular choice of a Star Trek char-acter among anaesthetists mayinclude an interest in futuristic tech-nology. Likewise, the interestingpreference for Dr Evil among somesurgical trainees may be due to aninterest in world and/or careerdomination, or it may be suggestiveof professional ambition rather than adisplay of true megalomaniac traits.

While we may be some years fromcontinuing medical education cred-itation obtained from Saturday eve-ningviewing, this studydoes suggestthat the current generation of juniordoctors relies on medical TV dramasfor entertainment and education inparallel. Further observation mayshow some interesting effects duringcareer progression, particularlyregarding the atypical answers wereceived to our questions about TVdoctor identification.

Competing interests: No relevant disclosures.n

ª 2015 AMPCo Pty Ltd. Produced with Elsevier B.V. All rightsreserved.

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