Educ Med. 2019;20(5):295---303 EducaciónMédica www.elsevier.es/edumed ORIGINAL ARTICLE The usefulness of TV medical dramas for teaching clinical pharmacology: A content analysis of House, M.D.夽 Josep-Eladi Baños a,∗ , María Isabel Lucena b , Magí Farré c,d , the Group for the Study of the Teaching Effectiveness of TV series♦ a Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain b Department of Clinical Pharmacology, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Department of Pharmacology, Universidad de Málaga, Málaga, Spain c Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain d Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain Received 16 April 2018; accepted 5 July 2018 Available online 4 April 2019 KEYWORDS Abstract Medical TV series; Introduction: Television medical dramas enjoy great popularity among the general public and Medical curricula; university students. These dramas have been used to illustrate important aspects of medical Clinical training (doctor---patient relationships, professionalism, ethical conflicts), but their usefulness pharmacology; for discussing the use of drugs in medical care remains unexplored. We analyzed pharma- Undergraduate cological issues in House, M.D. to determine their potential usefulness in teaching clinical Teaching pharmacology. Material and methods: Two investigators, blind to each other’s responses, reviewed each of the 22 episodes of the first season of House, M.D., recording the main and secondary topics dealt with as well as the drugs portrayed and rating the episode’s interest for teaching clinical pharmacology (High/Medium/Low). Discordant ratings were settled by a third (or fourth, if necessary) investigator. Results: Most episodes included information on drugs; in six, pharmacologic issues were the main topics. The episodes dealt with 115 drugs, mainly anti-infective (16.5%), cardiovascular (12.2%), CNS-acting (12.2%), and analgesic or anti-inflammatory (12.2%) drugs. Five episodes were considered very useful for teaching clinical pharmacology. 夽 A preliminary version of this study was presented in the XXXVI Congress of the Spanish Society of Pharmacology, held in Valencia in 2015. ∗ Corresponding author. E-mail address: josepeladi.banos@upf.edu (J.-E. Baños). ♦ Group members: Ana Lucía Arellanoc,d , Ana Maria Barriocanalc,d , Inmaculada Bellidob , Encarnación Blancob , María del Rosario Cabellob , Anna Lópezc,d , Eva Montanéc,d , Esther Papaseitc,d , Clara Pérez-Mañác,d , Jordi Planesa , Judith Sanabriab , Mahmoud Slimb , Sebastià Videlaa and Judith Villara . https://doi.org/10.1016/j.edumed.2018.07.011 1575-1813/© 2019 Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/). Descargado para Anonymous User (n/a) en Autonomous University of Barcelona de ClinicalKey.es por Elsevier en marzo 26, 2021. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2021. Elsevier Inc. Todos los derechos reservados. 296 J.-E. Baños et al. Discussion: The episodes of the first season of House, M.D. contained frequent references to drug treatment and pharmacological issues; in a few episodes, the main topic was related with clinical pharmacology. Before medical dramas are recommended as a regular teaching tool, their pedagogical efficacy should be tested empirically. © 2019 Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). PALABRAS CLAVE La utilidad de las series médicas de televisión en la enseñanza de la farmacología Series médicas clínica: un análisis de contenido de House, M.D de televisión; Resumen Estudios médicos; Introducción: Las series médicas de televisión disfrutan de gran popularidad entre los estu- Farmacología clínica; diantes universitarios, y se han empleado para ilustrar aspectos importantes de la educación Docencia de grado médica (relación médico-paciente, profesionalismo, conflictos éticos). Su utilidad para debatir el empleo de medicamentos en la práctica médica no se ha evaluado. En el presente estu- dio analizamos los temas farmacológicos presentes en House, M.D. para establecer su interés potencial en la docencia de la farmacología clínica. Material y métodos: Dos investigadores, desconocedores de las respuestas mutuas, revisaron los 22 episodios de la primera temporada de House, M.D., y registraron los temas principales y secundarios de cada episodio, así como los fármacos empleados. Asimismo, puntuaron su interés para la docencia de la farmacología clínica (alto/medio/bajo). Cuando existía discordancia, un tercer evaluador (y un cuarto, si era necesario) establecía la decisión final. Resultados: La mayoría de los capítulos contenían información de medicamentos; en 6 los temas farmacológicos constituían el principal elemento argumental. Los episodios refirieron 115 fár- macos, principalmente antiinfecciosos (16,5%), cardiovasculares (12,2%), neuropsicofármacos (12,2%) y analgésicos o antiinflamatorios (12,2%). Se consideró que 5 episodios podrían tener utilidad docente alta. Discusión: Los episodios de la primera temporada de House, M.D. contenían referencias fre- cuentes a medicamentos y a temas farmacológicos. En un número reducido de episodios, el argumento principal se vinculaba a la farmacología clínica. Antes de que pueda recomendarse su empleo en docencia, debe evaluarse empíricamente su eficacia pedagógica. © 2019 Elsevier España, S.L.U. Este es un artı́culo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/). Introduction authors have recently suggested that medical dramas could be used as a teaching tool.11,12 Some studies have dealt Since the beginning of motion pictures, the plots of fea- with their usefulness for analyzing students’ perceptions ture films have often involved medicine. The diverse reasons on medical professionalism and ethics13---17 and for teaching for using medicine in fiction include the social impor- psychotherapeutic18 and communication techniques.19 How- tance of disease and suffering as human experiences, the ever, the lack of published experiences on the actual value impact of medical discoveries on health and social progress of medical series in improving learning limits their use. in modern societies, and the general perception of physi- Since home television became available more than cians as distinguished professionals.1,2 In recent decades, sixty years ago, series have often portrayed physicians feature films have been increasingly used in teaching and medicine.20 Early medical series such as Dr. Kildare medical3,4 and nursing students5 as well as in training (1961---1966) and Marcus Welby, M.D. (1969---1976) were very residents in different specialties.2,6 Various authors have popular. More recently, Chicago Hope, ER, Grey’s Anatomy, proposed different ways to improve the effectiveness of and Scrubs have been very successful, especially among audiovisual fiction in medical education,7,8 and some authors students of the health sciences.21,22 Various authors have have recently reviewed the portrayal of medical matters in analyzed this popularity.23---30 Undoubtedly, one of the most television series.9,10 popular medical dramas has been House, M.D., which was Television series might have some advantages over fea- broadcast for eight consecutive seasons (2004---2012). ture films. First, every episode is shorter than a feature film House, M.D. has many elements of interest for the lay and usually explains a full story. Second, each episode has a public as well as for health professionals and health sciences different plot, so it increases the likelihood of finding mate- students.22 The main character, Gregory House, is a brilliant rial appropriate for the purpose of the class. Third, many physician who is interested only in the scientific side of the series can be used, so there is a wide field to explore. Various medical profession. He distrusts patients and hates working Descargado para Anonymous User (n/a) en Autonomous University of Barcelona de ClinicalKey.es por Elsevier en marzo 26, 2021. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2021. Elsevier Inc. Todos los derechos reservados. TV medical dramas for teaching clinical pharmacology 297 under the hospital rules. He became addicted to opioid • Topics: analgesics after taking them regularly for chronic pain. ◦ Main topic: defined as the topic that focused most atten- House’s diagnostic reasoning is comparable to the method tion of the chapter; exceptionally, more than one topic of reasoning Sherlock Holmes used to solve crimes, and could be considered. some authors have suggested there is a close relationship ◦ Secondary topics: any other medical topic included in the between the logics of clinical reasoning and crime solving.31 chapter. Dr. House’s continuous questioning of the members of his ◦ Drugs: identified by their generic names and classified in team during the diagnostic process also brings to mind their pharmacological group. Socratic and problem-based learning methods. This medical drama illustrates a model of doctor---patient relationship • Interest for the teaching of clinical pharmacology, scored that rejects patients’ autonomy in taking medical decisions as follows: about their own health,32 and Wicclair33 suggested that ◦ High: when the main topic depicted important concepts analyzing this approach to the relationship might be useful in clinical pharmacology or the use of drugs in clinical in teaching ethics to medical students. practice, for example, drug abuse as a cause of disease, As feature films have been successfully used in the teach- adverse effects that explained the clinical picture, or ing of pharmacology,34,35 we hypothesized that television unexpected poisoning by chemicals. series could also be used for this purpose. First we aimed ◦ Medium: when the secondary topics depicted important to determine whether the episodes contain enough mate- concepts in clinical pharmacology or the use of drugs in rial related to pharmacology issues to justify this approach; clinical practice, for example, occurrence of important this is a very important issue, as the potential value of the adverse reactions or therapeutic efficacy. episode is highly dependent on its relevance.29 ◦ Low: when important concepts in clinical pharmacology We present here the results of a content analysis of the or the use of drugs in clinical practice were not depicted first season of House, M.D. The analysis aimed to answer or depicted only cursorily. two questions: (1) what types of pharmacological topics are portrayed? And (2) can the episodes be useful for teaching Analysis clinical pharmacology? A preliminary analysis of this study was published elsewhere.36 After all chapters had been reviewed, the results were ana- lyzed as follows: Methods • Main topic: the topic was included when both evaluators agreed. The medical drama: House, M.D. • Secondary topics: given the wide diversity, all topics cho- sen by at least one evaluator were included. This series created by David Shore ran on the Fox • Drugs: all drugs listed by at least one evaluator were network comprising a total of 177 episodes in eight sea- included. sons. The main character is Gregory House (played by • Interest for the teaching of clinical pharmacology: when Hugh Laurie), who chairs a diagnostic team in the fic- both evaluators rated the interest of the episode High, tional Princeton-Plainsboro Teaching Hospital in New Jersey. Medium, or Low, that rating was final. When the two eval- Inspired by Dr. Lisa Sanders’ New York Times Magazine col- uators gave discordant ratings, a third evaluator, blind to umn ‘‘Diagnosis’’, Paul Attanasio came up with the idea for the others’ ratings, rated the interest. If the third eval- a medical procedural drama, and Shore created the charac- uator’s rating was concordant with one of the first two ters. The first season introduced other important characters, evaluator’s rating, the concordant rating was considered including Dr. Lisa Cuddy, the hospital administrator (played final. If the third evaluator’s rating was discordant with by Lisa Edelstein), Dr. James Wilson, an oncologist and those of the first two evaluators, a fourth evaluator rated House’s friend (played by Robert Sean Leonard), and the the interest and thus decided the final rating. The third members of House’s unit: Dr. Robert Chase (played by Jesse and fourth evaluator were full professors of Pharmacol- Spencer), Dr. Allison Cameron (played by Jennifer Morrison), ogy and Clinical Pharmacology. To evaluate the interest of and Dr. Eric Foreman (played by Omar Epps). The series each episode, the correctness of the information provided achieved large audiences and critical acclaim. was always considered. The present study analyzed the 22 episodes in first sea- son, which aired from November 16, 2004 to May 24, 2005. Results Topics considered in the episodes Study protocol Tables 1 and 2 describe the main and secondary topics iden- Investigators who reviewed the episodes hold a PhD in tified for each episode. Only one major topic was identified pharmacology and/or were board certified in clinical phar- for 13 episodes; two major topics were identified for 7, three macology, and had experience of several years of teaching major topics for 1, and four major topics for 1 (#21). A clin- these disciplines to medical students. Two of them, blind to ical pharmacology issue was the sole main topic in three each other’s responses, reviewed one episode and collected episodes (#3 colchicine side effects, #8 organophosphate the following information: poisoning, and #14 ipecac cardiomyopathy) and one of the Descargado para Anonymous User (n/a) en Autonomous University of Barcelona de ClinicalKey.es por Elsevier en marzo 26, 2021. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2021. Elsevier Inc. Todos los derechos reservados. 298 J.-E. Baños et al. Table 1 Main and secondary topics portrayed in episodes 1---11 in the first season of House, M.D. Chapter Title Main topic Secondary topics 1 Pilot. Everybody lies Neurocysticercosis by taeniasis Allergic reaction. Bronchoconstriction. Unconfirmed vasculitis. Placebo effect by analgesics. Self-medication. 2 Paternity Subacute sclerosing panencephalitis Neurosyphilis. Multiple sclerosis. Vaccination refusal. Informed consent. 3 Occam’s Razor Colchicine side effects Viral infection. Sinusitis. Hypothyroidism. Dispensing error. 4 Maternity Cardiac fibrosis from viral infection. Bowel obstruction. Fever of unknown origin. Febrile syndrome in newborn Vancomycin in kidney failure. Aztreonam in kidney failure. Treatment withdrawal. Informed consent. 5 Damned if You Do Copper allergy by intrauterine device Churg-Strauss syndrome. Contact dermatitis. Cardiac arrest due to drug side effect. Asthmatic crisis. Agitation. Herpetic encephalitis. Hallucination. 6 The Socratic Method Wilson’s disease. Vitamin K Schizophrenia. Thrombotic disease. Upper deficiency. Liver cancer digestive bleeding. Agitation. Possible drug side effect. Cirrhosis. Liver tumor. 7 Fidelity African trypanosomiasis Paraneoplastic syndrome. Tularemia. Adverse effect of antihypertensive drugs. Cardiac toxicity as drug side effect. Pruritic skin eruption as drug side effect. Hallucinations. Hypotension as drug side effect. 8 Poison Organophosphate poisoning Therapeutic refusal. Use of antidotes. Adverse effects of pralidoxime. Tertiary syphilis. Poisoning of unknown origin. 9 DNR Paralysis due to medullary Amyotrophic lateral sclerosis. Multifocal motor arteriovenous malformation neuropathy. Do-not-resuscitate orders. Therapeutic response of unknown origin. Erectile dysfunction. Pneumonia. Lung embolism. Wegener’s granulomatosis. Embolism to arms. Diabetes mellitus. Side effects of immunoglobulins. Hypothyroidism. 10 Histories Rabies encephalitis and tuberculoma Münchausen syndrome. Drug anaphylaxis. Serotonin syndrome. Tuberculosis. Bacterial meningitis. Korsakoff syndrome. Supraventricular tachycardia. Hypoglycaemia. Vomiting. Electrolyte disorder. Anemia. Respiratory arrest. Depression. Ovarian cancer. Fever. Infection of unknown origin. 11 Detox Opioid abuse. Naphthalene poisoning Intentional fracture. Hemolytic anemia. Retinal thrombosis. Myocarditis. Lupus. Hepatitis E. Provocation of an adverse reaction. Addison disease. Chest pain. Suicide attempt with digitalis. main topics in another three (#11 opioid abuse, #12 anabolic Drugs steroid doping, and #15 estrogen abuse). A total of 131 secondary topics were identified. The num- Table 3 shows the drugs that appeared in the episodes; ber of secondary topics in each episode ranged from 1 (#13) 115 drugs appeared (mean, 5.2 drugs/episode). Fig. 1 shows to 16 (#10). In 32 episodes, secondary topics were con- the drugs by pharmacological group; the most common drug sidered pharmacological issues; in one episode (#7), five groups were anti-infectious drugs (n = 19, 16.5%), cardiovas- secondary topics were considered pharmacological issues. cular drugs (n = 14, 12.2%), central nervous system acting Descargado para Anonymous User (n/a) en Autonomous University of Barcelona de ClinicalKey.es por Elsevier en marzo 26, 2021. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2021. Elsevier Inc. Todos los derechos reservados. TV medical dramas for teaching clinical pharmacology 299 Table 2 Main and secondary topics portrayed in episodes 12---22 in the first season of House M.D. Chapter Title Main topic Secondary topics 12 Sports Medicine Cadmium poisoning. Steroid Addison disease. Hypokalemia. doping 13 Cursed Anthrax and leprosy Neuropathy from anticancer drugs. 14 Control Congestive heart failure due Hoarse voice after tracheal intubation. Ethical to bulimia and use of ipecac aspects of clinical trials. Conflict of interest. 15 Mob Rules Ornithine transcarbamylase Hepatitis C. High levels of estrogen in blood. Liver deficiency. Liver failure after failure. Feminization. estrogen abuse 16 Heavy Cushing’s disease Myocardial infarction. Skin necrosis. Myoma. Psychotic syndrome. 17 Role Model Brain toxoplasmosis. Sexsomnia. Epilepsy. Conflict of interest Phenytoin-mediated with pharmaceutical companies. immunodeficiency 18 Babies & Bathwater Lamber-Eaton syndrome after Clinical trials with drugs. Follow-up of clinical lung cancer. Therapeutic trials. Di George’s syndrome. Urinary abortion incontinence. Lambert-Eaton syndrome. Preeclampsia. Pneumonia. Premature delivery. Malnutrition and low neonatal weight. 19 Kids Thrombotic thrombocytopenic Bacterial meningitis. Petit mal. Intracranial purpura and pregnancy bleeding. Abortion. Meningitis. 20 Love Hurts Osteomyelitis. Brain embolism Erectile dysfunction. Vaginal lubrication. Thrombosis. Bacterial endocarditis. 21 Three Stories Muscle necrosis. Necrotic Postoperative pain. Hyperkalemia. Chronic pain. fasciitis due to dog bite. Hypothyroidism. Snake bite. Adverse reaction due Osteosarcoma. Streptococcal to allergy to antidote. Tendinitis. Paroxysmal infection ventricular arrhythmia. 22 Honeymoon Acute intermittent porphyria Guillain-Barré syndrome. Anxiety crisis. Non-therapeutic sedation. Anaphylaxis. Panic attack. drugs (n = 14, 12.2%), analgesic and anti-inflammatory drugs Discussion (n = 12, 10.4%), and miscellaneous drugs (n = 10, 8.7%). The drugs that appeared most often were anticoagulants and The present study shows that the use of drugs and other benzodiazepines (each appearing in 7 episodes), followed pharmacological issues are widely represented in the medi- by corticosteroids and ␤-lactam antibiotics (each appearing cal drama House, M.D. Pharmacological topics are dealt with in 6 episodes). in most episodes and are the main topic in six. These find- ings confirm the potential interest of this television series Interest for the teaching of clinical pharmacology as a pedagogical tool to complement the use of traditional teaching activities. Table 4 reports the evaluators’ ratings for the interest of Hoffman et al.34 analyzed the use of television medical each episode. Interest was considered high in 5 episodes, dramas in health sciences education in a systematic review, medium in 13, and low in 4. The two initial evaluators’ rating finding that ER and Grey’s Anatomy were the most com- were concordant for 12 (54.5%) episodes; the third evalua- monly used in reported studies; House was used in several tor’s rating resolved the discrepancy for 5 (22.7%) episodes, studies to educate in ethics and professionalism15,16,34,37 and and the fourth evaluator’s rating resolved it in the remaining doctor/patient communication.19 The authors concluded 5 (22.7%). Among the five episodes finally classified as high that the use of television medical dramas in classroom set- interest, the initial two evaluators’ ratings were concordant tings helped students learn. However, none of the included for only one episode; the third evaluator’s rating was suffi- studies were used specifically for teaching clinical pharma- cient for three episodes, and the four evaluator’s rating was cology. required for one episode. By contrast, the two initial evalua- Only a few content analyses of medical dramas have been tors’ ratings were concordant in 10 of the 13 episodes finally published. Makoul and Peer24 carried out the first study, ana- classified as medium interest. lyzing how healthcare issues, doctors, and patients were Descargado para Anonymous User (n/a) en Autonomous University of Barcelona de ClinicalKey.es por Elsevier en marzo 26, 2021. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2021. Elsevier Inc. Todos los derechos reservados. 300 J.-E. Baños et al. Table 3 Drugs portrayed in the episodes of the first season of House, M.D. No. Title Drugs 1 Pilot/Everybody lies Gadolinium, albendazole 2 Paternity Penicillin, interferon, lorazepam 3 Occam’s Razor Ampicillin, levothyroxine, granulocyte stimulating factor, colchicines antibodies 4 Maternity Aztreonam, vancomycin 5 Damned if You Do Diphenhydramine, corticosteroids, adrenaline, prednisone, nicotine 6 The Socratic Method Heparin, ethanol, ampicillin, antipsychotics 7 Fidelity Lorazepam, haloperidol, dopamine, beta-blockers, melarsoprol 8 Poison Mevinphos, atropine, diazepam, gamma-hydroxybutyrate, pesticides, pralidoxime 9 DNR Antibiotics, immunoglobins, corticosteroids, levothyroxine, cyclophosphamide, heparin 10 Histories Lorazepam, insulin, iron dextran, adrenaline, fluoxetine, bromocriptine, amphetamines, isoniazid, rifampicin, streptomycin, ceftriaxone, haloperidol, thiamine, adenosine 11 Detox Hydrocodone, methamphetamine, cocaine, anticoagulants, cyclophosphamide, corticosteroids, immunosuppressive drugs 12 Sports Medicine Morphine, cocaine, digitalis, leuprolide, insulin, atropine 13 Cursed Cefuroxime, levofloxacin, lorazepam, rifampicin, methotrexate, cyclophosphamide, corticosteroids, thalidomide 14 Control Anticoagulants, morphine, antibiotics, vasodilators, botulinum toxin 15 Mob Rules Interferon, Chinese herbal remedies, estrogens 16 Heavy Heparin, warfarin 17 Role Model Antiretroviral agents, gamma-hydroxybutyrate, antidepressants, phenytoin, immunoglobulins 18 Babies & Bathwater Oxybutynin, magnesium sulfate, antibiotics, terbutaline, anticancer drugs, angiogenesis inhibitors, streptokinase, dopamine, immunoglobulins 19 Kids Rifampicin, procaine, lorazepam 20 Love Hurts Sildenafil, estrogens, anticoagulants, antibiotics, antidepressants 21 Three Stories Meperidine, anti-snake venom serum, adrenaline, NSAID, thyroxine, corticosteroids, anticancer drugs, morphine, calcium gluconate 22 Honeymoon Amphetamines, immunoglobulins, adrenaline, lorazepam, glucose + hematin portrayed and the primary frames highlighting medicine, analyze bioethics and professionalism. They concluded that doctors, and patients in ER and Chicago Hope. However, they both of them were rife with powerful portraits of bioethical did not consider any aspects related to drug therapy. issues and important deviations from the norms of profes- Another content analysis focused on the depiction of sionalism. Both series have been used as pedagogical tools illness and other matters, including therapy, in Grey’s in recent years.34,38 Anatomy and ER.29 The authors reported that drug treat- Cowley et al.39 recently published the only pharma- ment was used in 40% of episodes. Although they carried out cological analysis of television medical dramas, in which no further analyses of drug treatments in these series, their they assessed the appropriateness of medications in five results suggested that drugs were very common in television series, including House. House was considered the most medical dramas and that this aspect might be of interest in useful of all the medical dramas analyzed, and this finding the teaching of pharmacology. Czarny et al.15 surveyed the supports our choice of House for the current study. Their contents of a season of Grey’s Anatomy and House MD to main conclusions were that drugs were often used for Descargado para Anonymous User (n/a) en Autonomous University of Barcelona de ClinicalKey.es por Elsevier en marzo 26, 2021. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2021. Elsevier Inc. Todos los derechos reservados. TV medical dramas for teaching clinical pharmacology 301 18 16 14 12 10 8 6 4 2 0 si c er us g ar g se g g es s nc tio tin ul ct in bu ct in at in ot ou lge a ac sc l id e na tic ec d- va S- a fa e- a du nt an nf o ll a An i-i oo io N s on o a ce an d An t Bl ar d C ru g m o m an d is s C D hor un s M ID d Im m on SA an is N es Po on o rm H Figure 1 Drugs by pharmacological groups (in percentage) depicted in the episodes of House, M.D. Table 4 Scores of the evaluators (Ev) and their agreement in the interest of each chapter for teaching clinical pharmacology [categories: A: high interest; B: medium interest; C: low interest; see text for details]. No. Title Ev #1 Ev #2 Ev #3 Ev #4 Decision 1 Pilot/Everybody lies Medium Medium Medium 2 Paternity Medium Medium Medium 3 Occam’s Razor High High High 4 Maternity High Medium Medium Medium 5 Damned if You Do Medium High Low High High 6 The Socratic Method Low Medium High Low Low 7 Fidelity Medium Medium Medium 8 Poison Medium High High High 9 DNR Medium Medium Medium 10 Histories Medium Medium Medium 11 Detox High Low High High 12 Sports Medicine Medium Low High Medium Medium 13 Cursed Low Low Low 14 Control Medium High High High 15 Mob Rules Medium Medium Medium 16 Heavy Medium Medium Medium 17 Role Model High Low Medium Medium Medium 18 Babies & Bathwater Medium Medium Medium 19 Kids Medium High Low Low Low 20 Love Hurts Low Medium Low Low 21 Three Stories Medium Medium Medium 22 Honeymoon Medium Medium Medium their correct indications, but that other aspects, such number of drugs used in each episode of House in our study as key safety checks or medication-related advice, were (5.2) was similar to the mean reported in their analysis (6), frequently omitted; our analysis did not consider safety there were some minor differences in the drug categories. checks or advice related to medication. Although the mean Whereas they found that cardiovascular drugs were the Descargado para Anonymous User (n/a) en Autonomous University of Barcelona de ClinicalKey.es por Elsevier en marzo 26, 2021. Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2021. Elsevier Inc. Todos los derechos reservados. 302 J.-E. Baños et al. most common, followed by anti-infective drugs, we found acceptable under any circumstances. In fact, House, M.D. that anti-infective drugs were the most common, followed can be used to highlight important ethical issues, as it por- by cardiovascular drugs. These authors did not specify the trays the way a physician never should behave.33 A recent seasons that they reviewed in their analysis, and this might study has also shown how it may successfully be used to explain some discordance between their results and ours. motivate medical students in the learning of rare diseases.44 However, we consider that the two studies generally agree A recent survey in United Kingdom showed that 65% of on most figures related to drug use. doctors stated they had watched medical dramas on more One important issue that teachers take into account than one occasion.45 Even though most watched them for when considering whether to use particular medical dramas entertainment, 8% also watched them for educational pur- is the accuracy and plausibility of the facts depicted in the poses; of these, all watched House, M.D. Most considered episodes. In the end, it boils down to whether the fictional that medical series did not accurately portray real prac- portrayal reflects plausible medical circumstances. We did tice, and only 10% thought they did. Junior doctors were not analyze the full accuracy of all medical topics in the first more likely to identify with some aspects of clinical prac- season of House but only the pharmacological ones. How- tice depicted in the episodes. Hirt et al.12 suggested how ever, certain circumstances suggest that the treatment given House, M.D. should be used in medical education, and out- to medical topics might be accurate. The technical consul- lined the interest of using some clips from episodes of this tant of the series, Dr. Lisa Sanders, an associate lecturer at series in the clinic, as well as their usefulness for begin- Yale University School of Medicine and a columnist for the ning learners. We agree that clips are useful, but we stress New York Times Magazine, recently explained the origins of that they should be carefully chosen; we prefer to use the House and how the medical content of each episode was full episode to benefit from the storyline. The main draw- considered.40 She reviewed each chapter to identify inaccu- back of using full episodes is the need to assign time for this racies in the script and confirmed that they were righted in activity instead of including the episode in regular teaching the final versions of the episodes, although some infrequent activities, such as lectures. situations were accepted to make them more attractive to A thorough content analysis of the episodes was the first the public. In an example of the veracity and usefulness step to obtain evidence on the presence of pharmacological of the medical information in the series, Dahms et al.41 issues in the episodes before tackling the question of to what reported that an episode of House helped them reach the extent this medical drama would be to useful for teaching diagnosis of cobalt intoxication in one of their patients. clinical pharmacology to medical students. We are designing We also reviewed the scientific evidence for the content an experimental study to address this question and to estab- of two episodes that we considered potentially useful for lish if they can improve the learning and understanding of teaching clinical pharmacology. For the first, Poison (episode pharmacological issues of medical students. #8), we found an article that justified the assumptions In conclusion, we found that drug treatments and phar- in the episode, where a patient was poisoned by wearing macological issues are highly prevalent in House, MD. A clothing impregnated with an organophosphate.42 For the preliminary analysis also showed that the use of drugs is second, Control (#14), the possibility of developing car- accurate and that some of the episodes might be useful for diomyopathy by ipecac ingestion is clearly established in teaching clinical pharmacology to medical students. Their the literature.43 Therefore, we believe that the medical use as educational adjuvant, but not as a substitute of reg- information presented in most episodes of House is prob- ular learning, merits further assessment. The present study ably accurate, although teachers should review all episodes only analyzed how drug treatments appeared in this medical carefully before using them to teach medical students. drama but not established the actual value in teaching the Interestingly, the two initial evaluators’ ratings were discipline. An empirical study is needed to confirm this pos- concordant for 12 (54.5%) of the episodes; a third evalua- sibility and to further recommend television medical dramas tor was needed for 10 episodes, and a fourth evaluator was in medical education. needed for only 5 episodes. We did not address the reasons for these discrepancies; we speculate that the evaluators’ different academic backgrounds and experiences might help Conflict of Interest explain them. In any case, two evaluators were sufficient to qualify more than half of the episodes and two or three The authors of this article declare no conflict of interest. were sufficient to qualify more than three quarters of them, suggesting acceptable agreement among evaluators in this study. References An important point regarding the use of House, M.D. for teaching medical students is concern about his behavior 1. Cappelletti GL, Sabelli MJG, Tenutto MA. Ca we teach better? when treating patients. As Sanders40 pointed out, his inap- The relationship between the cinema and teaching. J Med Mov. 2007;3:87---91. propriate approach to the doctor---patient relationship was 2. Darbyshire D, Baker P. A systematic review and thematic analysis chosen to set this medical drama apart from previous ones, of cinema in medical education. Med Human. 2012;38:28---33. where the physicians were kind and respectful with their 3. González Blasco P. 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