17. Medical Trainees’ Perspectives and Use of Humor in Clinical Settings: A Systematic Review and Metasynthesis

Abstract

Background: Clinical settings represent the site of both patient care and clinical education for medical students and residents. Both processes involve social interaction, and humor is a fundamental component of social interaction that remains underexplored in medical education. A nuanced analysis of humor is important for understanding the relations that shape everyday experiences of medical trainees. Qualitative studies are relevant in this context, as they account for the variability across different clinical environments. The aim of this study was to examine how medical trainees perceive and use humor during clinical training, by conducting a systematic review and analysis of primary qualitative studies. Methods: In May 2021, the authors searched six databases, and selected studies according to inclusion/exclusion criteria. They assessed study quality using the Critical Appraisal Skills Program, coded data from the final selection of studies, and synthesized findings using qualitative analysis. Results: The initial search resulted in 2,098 articles, of which 36 met the inclusion criteria. Four major themes emerged on humor use in clinical training settings: (1) types of humor; (2) managing and expressing emotion; (3) facilitating interpersonal interactions; and (4) contributions of negative humor to culture of academic medicine. Humor assumed a variety of forms in clinical settings and served a range of positive and negative psychosocial functions. Humor use was important for trainees’ psychological well-being and for connecting with patients, peers, and other health care professionals. However, aggressive humor was used to tease, ridicule, or disparage trainees; to enforce social norms; and to maintain power hierarchies. Conclusion: Humor plays an integral role in medical students and residents’ everyday experiences in clinical settings. Positive use of humor should be understood as an important emotion regulation strategy and communication skill. In contrast, negative forms of humor can adversely impact clinical learning environments, by functioning as a subtle, yet powerful, medium for communicating prejudice and delegitimizing others, through processes unique to humor. Further research exploring more fully how humor works in clinical settings may identify ways to reduce adverse effects and promote well-being, diversity, and equity in medical education.