The rise of the meme
Are memes harmless fun or something sinister?
The concept of the internet meme will be familiar to medical students, even if the word itself is not. Coined by Richard Dawkins in his book The Selfish Gene, the term “meme” describes an information packet—an idea, style, or behaviour—“with attitude” that spreads mind to mind within a culture. Memes can take many forms, but perhaps the most popular medical meme site, US blog What Should We Call Med School?, features “a collection of gif video files and captions that capture the experience of struggling medical students everywhere.” Other popular medical memes commonly found on social media site Facebook consist of captioned stock images. For example, the stock image represents paranoia, and is captioned to relate the meme to a situation medical students will recognise
Can memes be dangerous?
In the same way a virus replicates its genetic information to infect a host, a meme infects a culture through the replication of an idea. But what if a meme is used to spread a toxic idea? Take this example (bit.ly/1jBHmJz) from What Should We Call Med School?, suggesting that all neurosurgeons are arrogant. This meme has been reblogged nearly a hundred times, and the more it is replicated, the more it becomes a part of our collective perception of medical school. It would take an impressionable person to believe that every neurosurgeon is arrogant after viewing this meme—but in the absence of anything to balance the argument, a student might end up with different expectations for their next neurology placement. Michael Schachter, a lecturer and senior clinical welfare tutor at Imperial College London, agrees that such a scenario could “colour one’s views,” and ideally on such an online platform there should be room for “honest, constructive criticism [but not for] defamation or insult.”
The effects aren’t limited to the clinical environment. Exams are a source of great anxiety for medical students and often feature as meme fodder, typically depicted as being impossibly difficult. The relation between perception of the difficulty of an exam and exam performance has been well examined. In a study of 208 undergraduates, it was found that the perception of test difficulty had a significant effect on how much a student worried, which in turn had a strong inverse relation with performance. Theoretically a meme could influence a student to believe an exam is particularly difficult—or add to a student’s anxiety about the difficulty of an exam—and consequently cause the student to perform worse.
Lack of moderation
Part of the problem is the lack of moderation present on meme websites. Typically, because memes are submitted and then reposted by the site’s administrator, the content creators do not have to identify themselves and therefore can remain unaccountable. Even when the original poster is identified, they are often disguised by a screen name or pseudonym. “Any situation,” Schachter continues, “that allows people to say what they like [without having to identify themselves] is dangerous.” Perhaps this will change in future when the new GMC guidelines regarding social media come into effect, preventing anyone who identifies themselves as a doctor online from doing so under the guise of anonymity. However, it is unclear at the moment whether this will apply to medical students and even more unclear as to how the guidelines will be enforced, if at all.
Should medical schools be taking note?
When IBM researcher Dr Jennifer Thom came across the meme collection created by IBM employees she spotted a prime opportunity. “[The memes] reflected what it’s like to work at almost any large corporation. Employees are naturally talking about these things online; employers should learn from them.… The content [of these memes] may be useful in the acculturation process for the new employee, as cues about dominant work practices are identified, and norms of conversation and insider language can be exposed to new employees during training.” If businesses can learn from their employees in this way, it might not be too much of a stretch to suggest that medical schools can too. Perhaps if medical educators were to harness the meme as a way to gain insight into the student experience it could be used to tackle dissatisfaction felt among students. The opportunities for students to feed back about their experiences at medical school are already plentiful—according to Schachter, universities are in general “much more aware” of the student voice. Rather than airing views online, which is unproductive at best, students might have more impact directing criticism at their educators, which might be more likely to be taken seriously.
Just a cheap gag?
So should medical students be avoiding meme sites? The cathartic nature of memes is much lauded by supporters of meme sites, with many keen to push the “all in the same boat” philosophy. “It is this sort of humour,” says Chetan Khatri, a fifth year medical student and avid supporter of the meme, “in which we find, rather paradoxically, a sense of reassurance. That we aren’t the only ones spending our Saturdays in the library and that there are indeed plenty of others in a similar position who can readily empathise with our suffering. Perhaps it is a little sadistic, that we smile on our collective sorrow, but I believe it takes great maturity to be able to laugh at oneself.”
Despite this, the potential amusement and reassurance on an individual level does have to be balanced against the potential harm caused by the spread of negative and anxiety inducing stereotypes. Perhaps complete avoidance is unrealistic and unnecessary; when visiting such sites, students might keep in mind the thoughts of University College London fourth year Peter Woodward-Court, who sees memes as “nothing more than a cheap gag at a depressing time.” Ultimately, students could be better off entrusting their troubles to friends and colleagues—from whom they are much more likely to get a balanced and helpful opinion—and reserving the precious time they have in front of a computer for study.
Jennifer Adaeze Anyaegbunam, fourth year medical student, University of Virginia, and medical journalist (jenniferadaeze.com)
On the most basic level I think websites like What Should We Call Med School? speak to the universals and commonalities in the medical student’s experience. In the absence of context, many of these images are meaningless. Students understand and appreciate them because they reflect experiences they have had or the urban legends that keep them up at night. I do think that memes about medicine and medical education have the potential to exert both positive and negative effects on medical students. It’s important to realise, however, that this influence is not simply unidirectional in nature. When it comes to memes about medical education, life imitates art, and art imitates life.
Many memes are innocuous. Some function to increase students’ empathy and awareness of their patient’s experiences. Some images (see bit.ly/1tsjb3j) can cause a student to balance their thirst for clinical knowledge with respect for the realities of living with disease. I believe that the most concerning memes are artefacts of a phenomenon known as the “hidden curriculum,” or the unintended side effects of medical education. Sometimes, these unintentional lessons directly undermine the oaths we take to practice medicine with integrity, humility, and compassion (bit.ly/Rh4xNK), and poison interpersonal relationships between students, their physician-teachers, and other healthcare personnel (bit.ly/1lHKGzR). While negative memes depict and reinforce the hidden curriculum and can influence behaviour, they are merely symptoms of greater ailment. I think it’s much more important for the medical establishment to investigate the negative impact of the experiences that inform these memes in the first place.
Dissatisfaction is tough to define. Students are often dissatisfied with their educational experiences for different reasons, so I’m not sure it’s fair to make generalisations about whether memes increase or decrease satisfaction in medical school. Medical educators are constantly trying to reform the way physicians are trained to provide them with the skills needed to address the healthcare needs of society. These objectives must be balanced by social, cultural, political, and economic imperatives. Furthermore, medical knowledge is always expanding, new technologies are developed, and personal priorities of each generation of physicians evolves. It might be safe to say that people will always find a reason to be dissatisfied with the state of medical education. Online platforms have become a medium for medical students to voice discontent, but I don’t think that phenomenon is unique to our profession. Online media have increased the visibility of issues that have existed under the radar for years.
Correspondence to: email@example.com
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
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Cite this as: Student BMJ 2014;22:g3490