Humour in medical teaching The place of humour in medical teaching seems paradoxical | 
MJA 1999; 171: 579-580 |
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A "laughing room" was established recently at a hospital in New South
Wales.1 This move was inspired by the
many claims of clinical benefit from the use of humour, and much
research showing that humour and laughter have psychological,
physiological, and immunological benefits and other positive
effects.2 Humour has been claimed to
reduce pain, anxiety, depression, and stress; to reduce blood
pressure; to enhance humoral (no pun intended) immune responses; and
to improve coping with death and dying.2 Indeed, the association of
humour and medicine has a long history: in the medieval commedia
dell'arte puppet theatre the doctor appeared alongside the
clown and the ballerina. A little more recently, the perceived
healing properties of humour have led to the use of clowns in
children's hospitals, namely the Robin Williams character in the
Patch Adams motion picture, and Dr Peter Spitzer and his clown
doctor colleagues of the Humour Foundation at Sydney Children's
Hospital.
Despite the considerable body of evidence in favour of using humour as an adjunct to pharmaceutical and psychological therapies, there have been very few randomised controlled trials of humour or laughter in therapy (blinding is difficult), and the use of such therapy is very limited. No doubt once we have evidence for its efficacy and cost-efficiency, our political masters will immediately set about providing the funding for hospital jokers and jesters and laughing rooms, with joke books in every clinic. In addition to its role in patient care, humour helps clinicians to cope with uncertainty and plays a role in relieving tension in the clinical setting, but its use for these purposes is also limited.3-5 Humour appears to be widely used in medical teaching. At the Sydney Children's Hospital, a recent survey of senior staff showed that almost all used humour in their teaching (personal unpublished data). Almost 80% included humour in their teaching sessions, and regularly elicited laughter from their students. Most found it difficult to use humour and would like to use it more. Although they do not see humour as essential to good teaching, they believe that too little use of humour is made in teaching and that humour in teaching reduces stress; increases motivation; improves morale, enjoyment, comprehension, interest and rapport; and facilitates socialisation into the profession. They did not think humour trivialised, distracted, encouraged dogmatism, or demeaned patients (if used in bedside teaching) or that its use was unprofessional. They thus attributed to the use of humour in education those qualities which are claimed for it in the educational literature.6 They stressed that humour should be appropriate to the topic and should be in context. The importance of using humour that is relevant to the subject is stressed by Ziv.7 | |||
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Although humour is used regularly by medical (and other) teachers,
there is almost no literature on the use of humour in medical
education; indeed, there is a paucity of research on its use in
education generally. There have been few published controlled
studies of the use of humour in learning, and only about half of these
have demonstrated improved learning outcomes.6,7 There is
almost no literature on the use of humour in medical teaching.
For example, in a bibliography of almost 200 citations related to
humour, health and medicine maintained by the International Society
for Humor Studies, only 13 articles related to the education of health
professionals, and most of these were in nursing
journals.8 In reviewing this topic
recently,6 I was able to identify only
two relevant articles in medical journals or books.9,10
The place of humour in medicine thus appears to be paradoxical. Humour is widely used in medical teaching, although rarely mentioned in medical educational writings and apparently virtually never researched in this context. There is significantly more literature on the therapeutic value of humour, yet its clinical use is so rare that it attracts media attention.1 Would it be useful to have the results of research into the use of humour in teaching? Possibly these results might assist teachers to identify useful forms of humour for lectures and tutorials, and other benefits for teaching style, methods and content might also emerge. However, if it is true that humour which improves student learning must be relevant to the subject,7,11 teachers would need to be aware of this, and, of course, the corollary might be true: irrelevant humour might detract from the value of teaching. | |||
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Should medical teachers who use humour in their teaching be criticised for engaging in a practice for which there is little supporting evidence? This would be unfair, as the research is very difficult to carry out. Blinding would be very difficult unless the subjects were not aware that they were involved in a teaching experiment, and this would raise ethical issues. Further, even if a satisfactory experimental design could be developed, the choice of outcome measures would be difficult. The temptation, of course, would be to make an immediate or short-term measurement of learning (or other result) -- but the goals of medical teaching are to produce long term effects in students. (Some potential effects of humour in teaching are summarised in the Box.) It is also possible that the use of humour in teaching could "seduce" students into believing the teaching to be of high quality, a concept studied in the "Dr Fox" experiments.12,13 This research showed that a charismatic and impressive teacher could be rated highly by students, despite the absence of content in the material presented. Surprisingly, student performance may be enhanced by a "seductive" lecture, even though they may have learned nothing. Content, on the other hand, affects student learning, but does not affect student rating of the teacher.14,15 While better evidence of its educational value is awaited, humour will, no doubt, continue to be used in medical teaching, at least by those who accept that supporting evidence is not always available in the form of randomised controlled studies. John B Ziegler
©MJA 1999
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