A new look MJA

On behalf of the entire editorial team, welcome to the new look MJA. Over the past 6 months, we have reviewed every aspect of our editorial process and production, all in an effort to provide you the reader and all prospective authors with the best possible experience that we can. We are excited to debut this new look issue with an Indigenous health theme and are grateful for the input of Guest Editor Professor Shane Houston for his valuable insights in this important field.

Your journal is now divided into three distinct sections — blue, red and green. The blue section starts us off and contains important news, perspectives, debates, lessons from practice, clinical snapshots with an image, a new educational series, information on medical law and ethics, historical vignettes, and other articles that are of broad interest to all. For example, in this issue we are proud to launch our new clinical skills series that we hope will be of value not only to doctors in training and medical students but also to experienced clinicians. This year we will also commence a new series in innovations in medical education and a series to demystify research methodology and statistics.

The red section follows, led by editorials usually linked to research articles, original research articles, and short research reports. Based on reader and author feedback, we have dispensed with only publishing summaries of research articles in print; instead we will publish research in full in the red section. A new feature included with original research articles will be a summary box highlighting the known, the new and the implications, to help guide readers to studies that they will want to read in detail. We will also publish excellent systematic reviews, meta-analyses, expert reviews and guidelines in the red section, and we strongly encourage their submission for consideration. A fresh letters to the editor section has been reinstated; the online response section has been retained. We are especially interested in letters that provide insights into research that we have published, as this is a key final part of the peer review process. Finally, the green section wraps up the content with careers and miscellaneous material of general interest.

We welcome your feedback on the new format and other aspects of the Journal.

All articles, including original research, reviews and perspectives, will continue to undergo multiple layers of rigorous review to ensure that we publish the best possible content. Initially, submitted articles are reviewed by an experienced medical editor, who will obtain a second medical editor opinion if needed. If the manuscript passes this stage, formal peer review is obtained and, if relevant, also a statistical review. The manuscript and reviewer comments are then discussed by the entire team of editors including, where applicable, an expert statistician at the manuscript review meeting, held twice weekly. If the manuscript passes this stage, it is returned to the authors for revision. We are working to streamline our processes so authors receive a more rapid decision while always maintaining our high standards.

I am very pleased to announce that we have new MJA editorial advisory group (https://www.mja.com.au/journal/staff/mja-editorial-advisory-committee). The members include leading clinicians and academics from multiple fields, and a medical student representative. The advisory group has met with the editorial team twice now, and is providing guidance and input that we deeply value. You will notice that we have included prominent international colleagues from New Zealand, Hong Kong, the United Kingdom and Canada. This is consistent with the Journal’s interest in taking Australia’s best research to the world and bringing such research here for our readers, and expansion of international membership will be considered.

Guest editors will also appear in the Journal to contribute to the development of themed issues and the teaching series.

As well as doing all we can to look after our readership, we will continue to support our prospective authors in every possible way. We provide as much guidance as we can because we want to improve promising articles. Translation of research into practice is a priority for health and for this reason we will now offer a fast track process for clinical trial manuscripts. We will also streamline the publication of clinical guidelines and consensus statement manuscripts that have already been through a rigorous peer review process.

Thank you to everyone who has published in the MJA since my tenure began in December 2015.1 Your work is deeply valued and I remain impressed by the very high quality of submissions we are seeing every day. We can only publish a fraction of what we receive but there are many advantages to publishing in the MJA.2 Along with the MJA being one of the world’s leading general medical journals (ranked among the top 20 globally in 2015), an obvious advantage is that there is no cost to authors but every original research article is immediately made available in full for free. This means that clinicians, policy makers and researchers can read and cite your work as soon as it is published. We believe important research should be widely accessible, with no barriers. By making your research available in this fashion, we are doing our part to support the advancement of medicine here and around the world. Please refer to the updated author guidelines on our website for all the information needed for submission (https://www.mja.com.au/journal/mja-instructions-authors).

I would like to personally thank all our authors and readers, peer reviewers, new members of the editorial advisory group, and my team for your contributions to the MJA. Your support ensures that the proud tradition of the MJA continues.

[Editorial] Communicating risk about children’s heart surgery well

Telling parents that their child has congenital heart disease and needs heart surgery is a difficult task. Parents will rightly ask what is the risk for my child, what are a particular hospital’s or an individual surgeon’s outcome statistics, and which hospital should they choose. As a result of the Bristol Inquiry in 2001, which was initiated following an unusually high mortality rate at the Bristol Royal Infirmary, the UK has been at the forefront of publishing these individual statistics, and since 2013, 30-day survival rates after heart surgery have been published for each hospital.

The first incision

Winner — Student category

The scalpel sparkled in the dim, cold room. I watched with great anticipation as it was placed onto the thin lifeless arm, and I felt myself draw a sharp, shallow breath as it began to separate the layers of the skin. Pulsating waves of excitement washed over me as I watched the blood ooze rhythmically. It was as if my adventurous spirit had truly returned, unadulterated and overwhelming. The rawness of it all astounded me.

Yesterday was the first time I had been allowed into the operating room; and, apart from the brief frustration of having to account for some missing equipment, it had been an exhilarating injection of variation into my life of unceasing boredom. Medicine had recently become so tedious, a constant battle to meet its academic and emotional demands. I could not remember the last time I had actually enjoyed waking in the morning; every day seemed best spent in bed. It took all of what little strength I had remaining to undertake the long drive to the hospital.

But this moment was so real, I could feel life flowing through me, coursing through my veins. I looked around the room: it was enclosed and stuffy, but I felt unimaginably secure. The silence and darkness had a calming effect, for there was meaning and purpose in this moment. It was unlike the previous weeks, when I had struggled to pay attention to all the chaos and confusion; here I was finally in control.

As I watched the scalpel being placed on the table, some blood dripped onto the floor. My knees weakened and I became queasy, yet I did not speak out. I was surprised: I had not felt this way yesterday; maybe it was because today I had not eaten. Thankfully, over the past few months I had become accustomed to not eating, so I was confident that I could endure this until it was over; and even though my stomach churned, it was an enjoyable sensation, proof of my ability to persist in this task.

It was so difficult to find time for meals during my placement on the wards. Every day was characterised by an all-consuming, harrowing rush. Medical teams seemed to scamper from patient to patient as if the spindly fingers of death were gripping at our heels. No time for rest from a busy day’s work, no time for reflection after telling a patient that they had cancer. Onwards they strove, relentless in their quest to finish their allocated tasks. I often struggled to match their haste, unsure if it was because I was tired or because I was slow.

The serenity of the operating room stood in stark contrast to this, my sanctuary where a transcendent sense of peace met a fervent desire to explore the wonders of the human body. I could enjoy my glorious rest, forever still and quiet.

Pride swelled inside me as I began to reflect upon my life, the hours spent poring over anatomy texts, the exams I had stressed over, the patients I had seen. I could recite the structures of the carpal tunnel in my sleep, and here I was, watching them exposed. Studying medicine had brought me here: in a way, it had changed my life, and I was grateful. I had begun with the wonder of believing I could do anything or be anyone, but now I realised that this was what I truly wanted. A cool, dark, quiet room, where the outside world would not affect me anymore. Pain, pleasure, purpose: they all meant something here. My life would no longer be wasted running after empty hopes and dreams. It was as if my very existence had been fully realised.

I was startled by a loud knocking on the door, and heard a familiar cry. My mother was calling me to come downstairs for dinner. But I was unfazed. I could already see the darkness descending across my vision, I knew she would find the note on my desk after unlocking my door. I looked down to the gathering pool of blood, my life force so visibly displayed and accessible. I glanced over and saw that the blood on the scalpel had begun to coagulate, and I smiled. In the dimness of my life, this beautiful instrument had restored my spark, and I was glad, because it was the first time, in a long time, that I could feel again.

And I had never felt more alive.

[Editorial] Sickle-cell disease: managing comorbidities

To coincide with World Sickle Cell Day on June 19, The Lancet is publishing its first haematology Series commissioned to review three topical and clinically important aspects of sickle-cell disease.

The changing face of the MJA

A new look

In July 2016, we will be changing the face of the Medical Journal of Australia with a new improved layout to make the Journal easier for you to use. We have also adjusted the formats of some of our article types (our revised Instructions for Authors are now available at https://www.mja.com.au/journal/mja-instructions-authors). Watch for the July issue marking the next volume and new look of your Journal.

A call for submissions

The MJA welcomes article submissions from individual researchers and from academic, medical and other institutes. When you submit a manuscript to the Journal, you enjoy a range of advantages:

The MJA is one of the world’s leading general medical journals (ranked globally among the top 20).
The MJA has a high impact factor (4.089 in 2014).
The MJA has an extensive domestic and global readership.
The MJA has a regular print distribution of more than 31 000 copies each issue.
The articles online at https://www.mja.com.au receive more than 395 000 page views from almost 188 000 users each month.
Unlike many journals, it is completely free to publish in the MJA.
Unlike many journals, all original research articles are open access and made freely available.
You will be working with a professional team of editors who will guide you through the publishing process from manuscript to final publication.
The MJA is highly influential and its articles attract community and press interest.
You will be contributing to public knowledge and debate about current research in clinical medicine and public health policy.

All submissions are subject to our rigorous peer review and assessment process in order to maintain the high scientific and intellectual standards that underpin the reputation of the MJA. We are working to maintain these high standards while providing a more rapid turnaround of decisions. You can find detailed information on how to format your manuscripts for submission at https://www.mja.com.au/journal/mja-instructions-authors.

Thank you for reading and contributing to the MJA.

News briefs

UK experts want ban on tackling in school rugby

More than 70 UK doctors and health experts have written an open letter addressed to government ministers, chief medical officers and children’s commissioners, calling for a ban on tackling in school rugby games, The Guardian reports. “The majority of all injuries occur during contact or collision, such as the tackle and the scrum,” the letter says. “These injuries, which include fractures, ligamentous tears, dislocated shoulders, spinal injuries and head injuries, can have short-term, life-long and life-ending consequences for children.” Rugby is a compulsory part of the UK physical education curriculum from the age of 11 in many boys’ schools, particularly in the independent sector, The Guardian says. The letter’s authors urged schools to move to touch and non-contact versions of the game. “Repeat concussions have been found to have a link to cognitive impairment, and an association with problems such as depression, memory loss and diminished verbal abilities. Children also took longer to recover to normal levels on measures of memory, reaction speed and post-concussive symptoms.” The Rugby Football Union said it took player safety “extremely seriously” and that recent changes meant young players underwent a “gradual and managed” introduction to the contact version of the game.

PLOS ONE paper provokes social media backlash

Retraction Watch reports that a paper on the biomechanics of the hand published in PLOS ONE has provoked a social media backlash for using apparently religious language in the abstract, introduction and conclusion. “In conclusion, our study can improve the understanding of the human hand and confirm that the mechanical architecture is the proper design by the Creator for dexterous performance of numerous functions following the evolutionary remodeling of the ancestral hand for millions of years.” Some commentators on Twitter described the publication of the paper as “an absolute joke” and “a big problem”. A spokesperson for PLOS was quoted by Retraction Watch as saying: “PLOS has just been made aware of this issue and we are looking into it in depth. Our internal editors are reviewing the manuscript and will decide what course of action to take. PLOS’ publishing team is also assessing its processes.” The corresponding author is listed as Cai-Hua Xiong, based at Huazhong University of Science and Technology in China.

Australian health system “underprepared” for heatwaves

A Climate Council report has found Australia’s health system is underprepared to deal with longer, hotter and more intense heatwaves, the ABC reports. “The Climate Council report … found nursing homes and medical centres across the country may not be equipped with necessary back-up energy and water supplies in extreme heat. The council noted several states had upgraded heat and health warning systems since the deadly heatwaves in 2009, but the lack of a streamlined response system was putting lives at risk. The report found heatwaves put pressure on health services, with emergency call-outs jumping almost 50 per cent and heart attacks almost tripling in the heatwaves of January and February 2009. By 2030, Australia’s annual average temperature is predicted to rise by 0.6 to 1.3 per cent, with the globe continuing to heat up to the end of the century, the report said. The report highlights the global problem of heatwaves, pointing to 55 700 deaths during the Russian heatwave in 2010, and 3700 killed in India and Pakistan in May 2015.”

Astronaut Scott Kelly and his twin a boon to science

Commander Scott Kelly has returned to Earth after 340 days on board the International Space Station (ISS) and a raft of scientists and doctors can’t wait to get their hands on him, Forbes reports. Any astronaut coming home is scrutinised, but Cmdr Kelly’s return was particularly anticipated because he has a twin brother. Retired astronaut Mark Kelly has spent the past year on Earth, providing scientists conducting NASA’s Twins Study with the chance to conduct the ultimate “controlled experiment”. Weightlessness can lengthen the spine and body by up to 3%, can cause loss of muscle — most notably in the heart — and bone mass; cause the head to swell; and cause dizziness and fainting on return to Earth. There are also issues of radiation exposure without the shield of the Earth’s atmosphere.

MJA chief embraces latest career twist

When the position as Editor in Chief for the Medical Journal of Australia became vacant last year, Nick Talley’s wife told him, “You should take that role”.

At the time, Professor Talley was well ensconced in his position as the University of Newcastle’s Pro Vice Chancellor (Health) and, with much already on the go, let the idea slide.

But, as has happened at other times in his life, a call out of the blue set Professor Talley’s career on a new path.

The Board of AMPCo, which publishes the MJA, approached him about becoming its Editor in Chief – an offer he happily accepted.

“My wife was right, that I would enjoy the role,” he told Australian Medicine.

Becoming the MJA Editor in Chief is not, on the face of it, an obvious move for Professor Talley, a gastroenterologist who has enjoyed a stellar career as a medical researcher and administrator, with more than 1000 publications to his name.

It is not the first time he has been head-hunted for a position that has taken his career – and life – in an unexpected direction.

In the early 1990s, while working at the Mayo Clinic in the United States, he was approached to become Foundation Professor of Medicine at Nepean Hospital in Western Sydney.

As he himself describes it, it was a significant challenge.

“I was 37 years old, had virtually no administrative experience, and was charged with the daunting task of developing teaching and research plus new clinical departments in a hospital that didn’t even yet have a physician’s training program,” he recalls.

After nine years in the position he was lured back to research and the Mayo Clinic Rochester in 2001.

Five years later, he was “tapped on the shoulder” to transform the Department of Medicine at Mayo’s Florida centre into “a cohesive academic entity”.

It was, Professor Tally says, an exhilarating experience: “I learnt more about the science of leading and management than at any other time in my career”.

This knowledge was to stand him in good stead when he was poached in 2010 to become Newcastle University’s Pro Vice Chancellor (Health), a post he has held ever since.

But, while overseeing the University’s research and education programs, Professor Talley is excited about the opportunities and demands of guiding the MJA in coming years.

It is a testing time to be assuming the helm of such a publication.

The rise of the internet has changed the way people access information, and vastly increased the amount that is available.

It has led many to question whether the days of MJA-style publications, particularly in their hard-copy format, are numbered – doubts sharpened by plunging ad revenues.

Questions are also being asked whether then process of peer review, used by the MJA to help verify the quality of the research that it publishes, is any longer suitable.

But Professor Talley looks on the task ahead of him with enthusiasm.

“We are in the middle of a digital revolution,” he says. “The way people obtain and use information is rapidly changing and evolving. It’s a very challenging and interesting time to be in the field of publishing.”

Armed with years of experience as a researcher and educator, Professor Talley has clear ideas about what the MJA needs to do.

“To provide important information and updates to clinicians at the coalface; to be a publication for first-class research of relevance to Australia; and to make clinicians aware of developments that will impact on what they do,” he says. “That is an enormously important role.”

Some believe the proliferation of open-access online journals in recent years may marginalise, if not kill off, publications like the MJA, but Professor Talley doubts this.

Though welcoming the idea that study data and results be open to all, he questions whether many such publications will survive, particularly because concerns about quality will have many doubting their usefulness.

While he is not sure that, in 10 years’ time, the journal will still be a print publication, he has no doubt that the MJA in some form has a strong future.

“There is a very important place for peer reviewed journals of high quality that act as gatekeepers for advances in science and scientific knowledge,” Professor Talley says. “There will still be a critical role for journals like the MJA, which has a pretty rigorous process of peer review, modelled on the best in the world.”

Adrian Rollins

[Comment] In appreciation of the peer-review heroes from 2015

The Lancet is responding to the increased volume of high quality research by not only expanding the number of specialty journals within our family, but also by publishing more research studies. In 2015, we published almost 20% more research papers than in the previous year. And we did this more quickly, by offering the possibility of 10 + 10 rapid publication for randomised controlled trials sent for peer review. We also launched The Lancet Clinic, published highly clinical and global health Commissions, and Series on topics as diverse as radiation and religion.

[Comment] Protocol review at 1997–2015

Stimulated by Muir Gray and others, critical appraisal of the scientific literature excited widespread interest in the 1990s. A natural extension of the critical examination of research papers was to question the quality of research protocols. In response to questions about the peer-review process for research grants, and concern about whether the process discouraged innovation,1 The Lancet was asked to consider publishing protocols. We did this, in an abridged form, from January, 1997.2 Our decision was based on a desire to get closer to authors, accelerate time to publication, and to reduce bias against well-designed and adequately powered randomised controlled trials of important questions that showed no difference in outcomes.

Hospital doctors’ Opinions regarding educational Utility, public Sentiment and career Effects of Medical television Dramas: the HOUSE MD study

A career in medicine has long been considered an apprenticeship, with mentors providing guidance to their trainees. The word mentor finds its origins in Greek mythology. In Homer’s Odyssey, the confidant of king Odysseus, Mentor, was trusted to guide his son and oversee his education while Odysseus fought in the Trojan War.1

The modern practice of medicine, with an emphasis on shift work, has made the classical mentor–mentee relationship more challenging,2 but the modelling of one’s practice on observed social and clinical traits of a mentor or role model remains.3 Moreover, such exposures can be factors in students’ decisions to pursue a career in medicine and even in their subsequent choice of specialty.4

The eventual choice of role model is often a personal one and may not even involve one’s own supervising senior, although it is often based on clinical experiences.5 While knowledge and clinical competence have been cornerstones of role model selection, growing evidence suggests that factors relating to personality such as compassion, good communication and enthusiasm may in fact have more influence on the expanding minds of trainees.6 Further compounding this, in some educational situations, less than half of senior clinicians were subsequently identified as being excellent role models.7

While social interactions with parents, teachers or even peers may impact on personality, outlook and practice, other media such as literature and television (TV) have been demonstrated to be significant components of this role model hypothesis.8

Medical TV programs have grown in popularity from the 1960s onwards and are now considered a staple of primetime TV.9 It has only been in more recent years that the effects of these health and illness TV narratives have been studied in greater detail.

Although their true purpose has been one of entertainment, much of their appeal is based on the perception that they are an accurate reflection of reality.10

It has been well accepted that TV can have an impact on society, increasing knowledge and influencing behaviour.11 TV medical dramas have also been shown to be of educational worth to patients12 and even doctors.13

However, they have occasionally come under criticism for unrealistic medical content, ranging from demonstration of intubation technique14 to cardiopulmonary resuscitation (CPR).15 Frequently, in CPR situations on TV compared with actual practice, there is a higher volume of trauma cases as an underlying aetiology. Further, these scenarios often show considerably younger patients than those seen in routine CPR and survival to discharge is much better than clinically encountered.16 Concerns that this may influence the attitudes of members of the public who watch these dramas for educational purposes remain.

More recently, there has been a growing emphasis on the use of these programs as educational resources.17 In particular, some of the established role model personality traits such as ethical astuteness, communication and empathy have been sufficiently demonstrated in these series to warrant use in undergraduate teaching videos.18 Although much of the learning that can be gleaned from observing the practices of TV doctors has focused on perceived softer undergraduate educational domains,19 their use in postgraduate settings is also increasing.20

TV is a medium through which many health care workers not only take their minds off work, but also reflect both consciously and unconsciously on experiences. Students and doctors do indeed watch these programs at least as often as the general public does and, when questioned, are quite positive regarding them.21 Although not yet demonstrated, watching these series may form an early part of any role modelling or identification with certain character traits that both trainee and established medical practitioners may have.

Methods

A structured questionnaire was distributed among doctors of all grades and specialties in three large teaching hospitals in Wales, United Kingdom (Morriston Hospital, Singleton Hospital and Princess of Wales Hospital) within the Abertawe Bro Morgannwg (ABM) University Health Board, to allow capture of data from a diverse range of specialties. These were disseminated through various different locations, including departmental meetings and on-call rooms.

Questions related to respondents’ gender, specialty and grade, whether they watched medical TV dramas and their opinions regarding them, and whether they identified with characters from these programs (and if so, who) or with a non-fictional doctor encountered during their clinical careers.

Hospital grades were summarised as consultant, specialist trainee (registrar), core trainee (resident medical officer [RMO]), and foundation doctor (intern). For simplification, specialties was separated into medical, surgical, acute (eg, accident and emergency, intensive care unit, etc) and non-acute (eg, pathology, radiology, etc), although note was made of individual subspecialty answers from within these broader categories.

Statistical analysis

A cumulative odds ordinal logistic regression with proportional odds was run to determine the effect of grade and specialty on the choice and frequency of viewing of medical TV dramas. Statistical significance was set at P < 0.05. Statistical calculations were performed using SPSS Statistics, version 21.0 (IBM).

Ethics approval

Ethics approval was granted by the ABM University Health Board Research and Development Joint Scientific Review Committee.

Results

Three hundred and seventy-two questionnaires were disseminated and 200 completed questionnaires were returned (response rate, 54%). Forty-six per cent of individuals completing questionnaires were women and 88% had graduated from a UK medical school. Grades and specialties of respondents are presented in Box 1.

How often do clinicians watch TV medical dramas?

One hundred and twenty-nine doctors (65%) surveyed admitted to watching TV medical dramas on more than one occasion and 14% considered themselves to be regular viewers; 15% of respondents felt that watching them as a school student positively influenced their decision to pursue a medical career.

Junior doctors were five times more likely to have watched these programs as medical students compared with more senior doctors (odds ratio [OR], 5.2; 95% CI, 2.5–10; P < 0.01). The ORs for RMOs and specialist trainees were 3.1 and 2.5, respectively, in relation to consultants (P < 0.05). Further, UK graduates were five times more likely to have watched these medical TV dramas as medical students compared with non-UK graduates (OR, 4.8; 95% CI, 2.4–9.6; P < 0.01).

The most commonly watched TV programs were Scrubs (49%), House MD (35%) and ER (21%). Most doctors who admitted to watching medical dramas did so for entertainment purposes (69%); 19% watched because there was nothing else on TV; 5% for insight into media perceptions of medical practice; and 8% for educational purposes.

Clinicians’ opinions regarding TV medical dramas

We asked individuals if they felt that TV medical dramas were educational, gave doctors a bad name, accurately showed the doctor–nurse relationship, and represented the spectrum of illnesses commonly encountered.

One hundred and three respondents (52%) felt that these shows displayed no educational value whatsoever, 52 (26%) were unsure, and 45 (23%) believed there were some educational benefits from watching them.

Evaluating the spectrum of illness represented in these dramas, 82% felt that those shown were unrealistic of daily practice. However, 20 respondents (10%) thought that they accurately portrayed reality. Most of these positive responses (16/20) were from junior doctors. No associations between the belief that medical dramas portrayed realistic life situations and specialty or frequency of viewing were observed.

Grade, specialty and country of qualification had no effect on whether a doctor believed that the programs represented current medical practice. Neither did current frequent watching or having been a regular viewer at undergraduate level.

Twenty-seven per cent of doctors surveyed felt that these programs gave doctors a bad name, although no significant differences were observed between any of the groups.

Only 13% of respondents felt that medical dramas accurately portrayed the doctor–nurse relationship, most of whom were self-admitted non-regular viewers (P = 0.01) and general practitioners or GP trainees (19/25; P = 0.05).

Outcomes of watching TV medical dramas

Thirty per cent of foundation doctors (interns) and 25% of core trainees (RMOs) felt that watching medical TV programs may have affected their career choice (to any extent) compared with more senior doctors (18%).

Compared with consultants, the OR for interns considering that watching medical TV dramas had any effect on their subsequent career choices was 4.8 (95% CI, 1.6–13.7; P = 0.013); for RMOs and specialist trainees, the ORs were 2.5 (95% CI, 1.3–5.8) and 2.7 (95% CI, 1.3–5.8) respectively; P = 0.09 and 0.13).

Specialty and country of qualification did not influence doctors’ beliefs that watching medical dramas had an effect on their career choice.

Clinicians’ identification with doctors in TV medical dramas?

A total of 121 respondents (61%) role modelled aspects of their practice on another doctor (fictional and non-fictional).

Junior doctors, particularly interns and RMOs were more likely to find commonality in their practice with fictional TV characters compared with more senior doctors (OR, 2.7; 95% CI, 1.3–5.8; P = 0.008).

Consultants were most likely not to specify any role models and, if they did so, were more likely to identify themselves with non-fictional characters (32/55) compared with other doctors, particularly interns (4/49).

Medical doctors were more likely to identify themselves with a fictional TV character (OR, 3.2; 95% CI, 1.08–9.43; P = 0.035). This was followed by 19% of acute specialty doctors and 14% of surgical specialty doctors. Non-acute specialty doctors were least likely to identify themselves with a fictional TV doctor.

The top five most popular fictional role models are shown in Box 2. Leonard McCoy (Star Trek) and Quincy (Quincy ME) were the most popular choices among consultants; the majority of positive responders were anaesthetists and pathologists. A more varied response was seen among physicians and surgeons, but note was made of a peculiar popular choice: Dr Evil (from the Austin Powers film series, Box 3) was named by four trainees, all surgical (three orthopaedic and one general surgery).

Discussion

There is a known association between clinical role models in undergraduate medicine and career choice.22 Therefore, TV medical dramas could potentially influence doctors’ and students’ opinions and have been found to be a source of entertainment for both health care professionals as well as the wider public.23

Fictional doctors have evolved into television heroes and much of their appeal is their on-screen personality as well as, in some cases, their absolute prioritisation of scientific challenge over social relationships.24 Further, much of their appeal is their ability to navigate through difficult ethical dilemmas, to make decisions that are often perceived by clinical trainees as being positive ones.25

Although clinicians watching these programs appear to do so predominantly for entertainment purposes, we found that those who watch for educational reasons show that junior trainees exposed to this genre of TV entertainment are more influenced by these series than their more senior counterparts. Interestingly, all respondents who admitted to watching TV medical dramas for educational reasons watched House MD (Box 4), perhaps suggesting that they value its learning input.

In keeping with previous studies,14–16 most doctors felt that a large proportion of what was televised may not be a true representation of clinical practice; however, suggestions that more junior trainees believe this to be so could be explained by their relative lack of clinical experiences to date.

Identifying aspects of one’s practice with witnessed exposures has been a cornerstone of the role modelling theory, but data generated from this questionnaire-based study suggest some interesting differences between specialties. Doctors who answered negatively to currently viewing or having ever viewed this type of program were least likely to admit to having been influenced into a career in medicine on the basis of TV medical dramas, thus validating the data.

It is to be assumed that consultants may look on their past seniors as role models to identify commonality of practice but the high proportion of respondents among all grades who admitted to being influenced, at least in part, by medical TV dramas suggests a much higher effect than anticipated.

Further, differences between specialities — for example, medical doctors identifying more with TV doctors compared with their surgical peers — might be explained by the sizeable volume of medically themed programs as opposed to more surgical ones. It is plausible, however, that some of the core learning traits seen in physicianly specialties, particularly regarding difficult diagnostics and ethical dilemmas, strike a chord with this group of clinicians. Specific choice of TV doctor hero as a potential role model will require further evaluation. Motivations for the popular choice of a Star Trek character among anaesthetists may include an interest in futuristic technology. Likewise, the interesting preference for Dr Evil among some surgical trainees may be due to an interest in world and/or career domination, or it may be suggestive of professional ambition rather than a display of true megalomaniac traits.

While we may be some years from continuing medical education creditation obtained from Saturday evening viewing, this study does suggest that the current generation of junior doctors relies on medical TV dramas for entertainment and education in parallel. Further observation may show some interesting effects during career progression, particularly regarding the atypical answers we received to our questions about TV doctor identification.

Box 1 –
Grade and specialty of respondents (n = 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 = resident medical officer.

Box 2 –
Most popular fictional television doctor role models

Rank

Doctor

Show