Comics are an emerging medium in medical education for communicating clinical information and patient perspectives. Thus, comics are a promising vehicle for orienting learners to potentially challenging clinical experiences like bedside rounding. The authors asked the following research questions: Does use of comics to orient learners to bedside rounding improve learner self-efficacy? Does use of comics improve attending comfort with orienting learners? The authors created a comics-based orientation to bedside rounding grounded in existing literature and faculty input. The comic book depicted a hospital team performing bedside rounds and included scripts and trouble-shooting strategies. The authors randomized faculty along with their teams to use the comic book for orientation or to usual practice, from July 2023 to June 2024. Baseline surveys of learners assessed self-efficacy with bedside rounding and attending comfort with orienting learners to bedside rounding. The authors compared baseline survey data to post-intervention survey data among comics-based orientation recipients versus the control group. Twenty-one attendings participated, along with their teams (233 total participants). Response rates were 75% (175/233, baseline survey) and 72% (133/186, post-intervention survey). At baseline, 17% (20/117) of non-resident learners reported feeling comfortable with bedside rounding, and 17% (20/117) reported feeling competent. After the intervention, 78% (29/37) in the comics group reported feeling comfortable, compared to 61% (28/46) among controls, and 73% (27/37) reported feeling competent, compared to 43% (20/46) among controls. Among the attendings in the intervention group, 100% (9/9) felt comfortable orienting learners, compared to 67% (6/9) in the control group. The authors found that a higher proportion of learners reported self-efficacy related to bedside rounding in the groups randomized to the comics intervention versus usual practice. The orientation was feasible to implement. Next steps include assessing whether a comics-based orientation increases uptake of bedside rounding.
This article explores the role of comics as a sustained pedagogical practice within medical education, presenting findings from a longitudinal qualitative study conducted at Penn State College of Medicine, United States. Over two pre-clinical years, a self-selected group of medical students-known as the Comics Cohort-were given comics-making assignments to integrate into their required Humanities curriculum. Through focus groups, individual interviews, and visual narrative analysis of students' drawings, the study investigated how engaging with comics over time shaped medical students' ways of seeing, learning, and becoming. We identified three main thematic domains: 1) students learn more deeply when they engage visually; 2) the personal reflection and vulnerability that arise from making comics can be challenging but are also tools for growth; and 3) making and sharing comics creates community and connection. Building on participants' accounts of repeated comics-based practices, this article conceptualizes drawing as a form of reflective engagement that shapes how students attend to clinical encounters. The act of drawing-repetitive, situated, and open-ended-functioned as a reflective tool through which students developed what we conceptualize as visual attunement: an ethically engaged perceptual stance that integrates attention to bodies, silences, emotions, and context. Rather than using art as an occasional creative supplement, this study found that drawing comics can serve as both a medium and method through which students cultivate professional identity, visual thinking, and critical reflection.
Panels are a fundamental unit of comics, yet basic data about their usage in comics from around the world has not been widely investigated. Here we analyze panel information in the TINTIN Corpus consisting of 1,030 comics from 144 countries-comprising over 14,000 pages with over 76,000 panels-all annotated using the Multimodal Annotation Software Tool (MAST). We examined both the number of panels per page and the relative size of those panels to their pages, finding that they varied in dimensions of the style that they are drawn in, the global region they come from, the typological properties of the languages spoken by their authors, and the year of their publication. In addition, a clear tradeoff occurred between these dimensions of structure, where larger panels appeared for fewer panels per page, and vice versa. This relationship appeared to be "universal", persisting similarly no matter the variation across style, region, language, or publication date of the comics. Altogether, this work reveals that the structure of panels on comic pages involve a tension between variability across numerous sources and universal consistencies of properties that persist across all comics.
Research has reported persistent word reading deficits in adults with dyslexia. Comics, with their pictures, might be an effective way to facilitate word recognition and comprehension processes. This study aims to test the potential benefit of comics for reading comprehension in university students with dyslexia. 40 French-speaking university students with dyslexia and 40 skilled readers read two stories in both comic and text formats while their eye movements were recorded and then answered comprehension questions. Although there was no difference between readers with and without dyslexia on comic reading comprehension, the difference between the time needed to read the two formats was larger in participants with dyslexia than in skilled readers, suggesting that the former benefitted more from reading comics than skilled readers. Additionally, both groups of readers read words in balloons faster than words in linear text, although participants with dyslexia were still slower than skilled readers. Finally, readers with dyslexia relied more on picture processing to understand the comics' content, spending more time on pictures, revisiting previously seen pictures more often, and making more saccades between balloons and their corresponding pictures than skilled readers. Picture processing may be central to comic reading comprehension and may enhance reading outcomes by facilitating the processing of both the story's content and the words in balloons, especially for students with dyslexia.
To evaluate the effectiveness of pictorial comics as a supplementary educational tool for home-based self-management in patients with a permanent colostomy after colorectal cancer surgery. A two-arm, non-randomized comparative study. A total of 104 patients were enrolled and divided by admission date into a control group (n=52) receiving standard education and an experimental group (n=52) receiving additional pictorial comics education. Outcomes included stoma self-care ability, psychosocial adaptation, quality of life, and complication incidence, assessed before discharge and at 1, 3, and 6 months post-discharge. Two patients dropped out, leaving 51 per group for analysis. The experimental group had significantly higher scores in self-care ability, adaptation, and quality of life at all time points (all p<0.05), and significantly lower stoma-related complication rates (p<0.05). Pictorial comics education can effectively improve self-care capacity, accelerate psychosocial adaptation, enhance quality of life, and reduce complications. As a low-cost, intuitive tool, pictorial comics simplify medical information, improve understanding and adherence for middle-aged and older patients, reduce nursing burden, and optimize clinical outcomes.
This study presents a multimodal framework that uses smartphone motion sensors and generative AI to create audio comics from live news headlines. The system operates without direct touch or voice input, instead responding to simple hand-wave gestures. The system demonstrates potential as an alternative input method, which may benefit users who find traditional touch or voice interaction challenging. In the experiments, we investigated the generation of comics on based on the latest tech-related news headlines using Really Simple Syndication (RSS) on a simple hand wave gesture. The proposed framework demonstrates extensibility beyond comic generation, as various other tasks utilizing large language models and multimodal AI could be integrated by mapping them to different hand gestures. Our experiments with open-source models like LLaMA, LLaVA, Gemma, and Qwen revealed that LLaVA delivers superior results in generating panel-aligned stories compared to Qwen3-VL, both in terms of inference speed and output quality, relative to the source image. These large language models (LLMs) collectively contribute imaginative and conversational narrative elements that enhance diversity in storytelling within the comic format. Additionally, we implement an AI-in-the-loop mechanism to iteratively improve output quality without human intervention. Finally, AI-generated audio narration is incorporated into the comics to create an immersive, multimodal reading experience.
This study examines the potential of comics as an infotainment strategy for engaging the public in climate change mitigation from the perspective of the situational theory of public. A 2 × 2 × 2 factorial experiment (N = 320) was conducted to evaluate the effects of narrative forms (comics vs. text-only), problem recognition (high vs. low), and constraint recognition (high vs. low) on individuals' intention to mitigate climate change. Three-way ANCOVA results suggest that the comic narratives combining high problem recognition and low constraint recognition about climate change will significantly increase individuals' intention to engage in climate change mitigation behaviors. Furthermore, the effect was found to be mediated by individuals' proactive climate change information seeking, involving the self-directed acquisition of climate change-related knowledge. In contrast, the passive route of climate change information processing, which involves incidental exposure and reactive engagement with information regarding climate change, failed to demonstrate significant mediation effects.
Understanding humor, especially when it involves complex and contradictory narratives requiring comparative reasoning ability, remains a significant challenge for large vision language models (VLMs). This limitation hinders AI's ability to engage in human-like reasoning and cultural expression. In this paper, we investigate this challenge through an in depth analysis of comics that juxtapose panels to create humor through contradictions. We introduce the YESBUT, a novel benchmark with 1,262 comic images from diverse multilingual and multicultural contexts, featuring comprehensive annotations that capture various aspects of narrative understanding. Using this benchmark, we systematically evaluate a wide range of VLMs through four complementary tasks spanning from surface content comprehension to deep narrative reasoning, with particular emphasis on comparative reasoning between contradictory elements. Our extensive experiments reveal that even the most advanced models significantly underperform compared to humans, with common failures in visual perception, key element identification, comparative analysis, and hallucinations. We further investigate text-based training strategies and social knowledge augmentation methods to enhance model performance. Our findings not only highlight critical weaknesses in VLMs' understanding of cultural and creative expressions but also provide pathways toward developing context-aware models capable of deeper narrative understanding through comparative reasoning.
This article examines how composing and interpreting comics in a narrative medicine classroom can improve medical students' capacity to tolerate uncertainty. The study, conducted in The Ohio State University course From Page to Bedside: Literature for Physicians, invited students to read Julia Wertz's Impossible People: A Completely Average Recovery Story and then respond in both written and comic form. Twenty-four medical students participated. Their written and visual responses were analysed qualitatively for patterns in affective engagement, self-reflection and interpretive openness. Students reported that comics released them from perfectionist tendencies and invited experimentation that was not possible in their other coursework. While the findings are limited in scope, the study suggests that comics complement narrative medicine's goal of helping practitioners recognise the partiality and contingency of clinical understanding to see their picture of a patient is a picture forever incomplete.
Introductory undergraduate science courses often aim to achieve two key goals: (i) build a foundation of knowledge and (ii) prime a deeper understanding of the natural world to help cultivate scientifically literate citizens. However, retention of knowledge and critical understanding of complex concepts in these foundational courses remains a challenge. While facts can fade from memory, content presented in the form of stories captures attention and is easier to recall. Narrative-based learning provides a powerful way to support STEM education, helping students grasp complex concepts, connect more meaningfully with the natural world, and view science as accessible and relevant. In this study, we evaluated how students engage with microbe-centered comic narratives designed around concepts students themselves identified as challenging in a foundational microbiology course. We started by collecting data around how students engage with an existing course resource, an open educational textbook designed specifically for the course, and identified key concepts that students indicated were still challenging. Comic narratives were created specifically to address these concepts. Student perception data showed that integrating the comics with the course reading helped to improve their understanding of the concepts using memorable examples of microbes and overall increased their curiosity about the microbial world. Here, we show that comic storytelling can be a powerful pedagogical tool in higher education, bridging abstract and complex scientific concepts with personal connection and curiosity.
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The present study was to evaluate adolescents' knowledge of contraceptive methods before and after an educational intervention using a comic book. This quasi-experimental study was conducted from September to October 2023, with 62 high school adolescents from Maceió-AL. Knowledge about contraceptive methods was assessed at four different points in time. The Friedman, Wilcoxon, and McNemar tests were used for analysis. The median knowledge score was 8 (p25-p75; 4-12) at the pre-test, 14 (p25-p75; 5-15) at the immediate post-test, 13 (p25-p75; 5-15) at the 7-day post-test, and 13 (p25-p75; 6-15) at the 15-day post-test. Adolescents' knowledge at the three post-intervention assessments was significantly higher than at the pre-test (<0.001). When comparing post-test scores, no change was found between the immediate post-test and the seven-day post-test (p=0.108), between the immediate post-test and the 15-day post-test (p=0.262), and between the 7-day post-test and the 15-day post-test (p=0.442). Knowledge scores were maintained up to 15 days after the intervention. The comic book "Methods of contraception: I'm young and I don't want to have a baby yet" is a resource with potential to increase adolescents' knowledge about contraceptive use. Objetivou-se avaliar o conhecimento de adolescentes escolares sobre métodos contraceptivos antes e após intervenção educacional com história em quadrinhos. Estudo quase experimental, realizado de setembro a outubro/2023, com 62 adolescentes escolares do ensino médio de Maceió-AL. O conhecimento sobre métodos contraceptivos foi avaliado em quatro momentos. Para análise, utilizou-se os testes de Friedman, Wilcoxon e McNemar. A mediana do escore de conhecimento no pré-teste foi 8 (p25-p75; 4-12), no pós-teste imediato foi 14 (p25-p75; 5-15), após sete dias foi 13 (p25-p75; 5-15) e após 15 dias foi 13 (p25-p75; 6-15). O conhecimento dos adolescentes nas três avaliações após a intervenção foi significativamente maior que no pré-teste (<0,001). Na comparação entre os momentos pós-teste, não foi identificada variação entre pós-teste imediato e pós-teste de sete dias (p=0,108), entre pós-teste imediato e pós-teste de 15 dias (p=0,262) e entre pós-teste de sete dias e pós-teste de 15 dias (p=0,442). Os escores de conhecimento mantiveram-se até 15 dias após a intervenção. A história em quadrinhos “Métodos contraceptivos: sou jovem e ainda não quero gerar uma vida” é um recurso com potencial para aumentar o conhecimento de adolescentes sobre o uso de métodos contraceptivos. El objetivo fue evaluar el conocimiento de adolescentes escolares sobre métodos anticonceptivos antes y después de una intervención educativa con historieta. Estudio cuasi experimental, realizado de septiembre a octubre de 2023, con 62 adolescentes de educación secundaria en Maceió-AL. El conocimiento sobre métodos anticonceptivos fue evaluado en cuatro momentos. Para el análisis se utilizaron las pruebas de Friedman, Wilcoxon y McNemar. La mediana del puntaje de conocimiento en el pretest fue 8 (p25-p75; 4-12), en el postest inmediato fue 14 (p25-p75; 5-15), después de siete días fue 13 (p25-p75; 5-15) y después de 15 días fue 13 (p25-p75; 6-15). El conocimiento de los adolescentes en las tres evaluaciones posteriores a la intervención fue significativamente mayor que en el pretest (p<0,001). En la comparación entre los momentos postest, no se identificó variación entre el postest inmediato y el de siete días (p=0,108), entre el postest inmediato y el de 15 días (p=0,262), ni entre el postest de siete y el de 15 días (p=0,442). Los puntajes de conocimiento se mantuvieron hasta 15 días después de la intervención. La historieta “Métodos anticonceptivos: soy joven y aún no quiero tener un hijo” es un recurso con potencial para aumentar el conocimiento de los adolescentes sobre el uso de métodos anticonceptivos.
There is a need to modernize the dissemination of clinical guidelines, making them more accessible and engaging for health care professionals. Concise Medical Information Cines (CoMICs) are peer-reviewed videos created by medical students that distill complex guidelines into learner-friendly visuals. This study aimed to describe the process of co-designing an audiovisual version of a clinical guideline and explore the experiences of co-designing audiovisual guideline summaries using the CoMICs model. A 4-part CoMICs series on glucocorticoid-induced adrenal insufficiency was codeveloped by clinicians and medical students through 10 iterative steps. A patient version of these CoMICs was then created in multiple languages. Semistructured interviews with authors, reviewers, and student collaborators assessed the clarity, usability, trustworthiness, and educational value of these CoMICs. Reflexive thematic analysis then identified key themes. CoMICs improved guideline accessibility, comprehension, and global adaptability, while the collaborative process promoted interdisciplinary learning and underscored the efficacy of audiovisual tools for complex content. Student collaborators reported greater confidence in interpreting and communicating clinical guidance, renewed interest in endocrinology, and a deeper appreciation of its academic dimensions. Cocreating audiovisual resources, such as CoMICs, enhances guideline dissemination. Student involvement can foster curiosity, encourage academic career pathways, and reshape engagement with evidence-based medicine.
This article examines representations of aging female bodies and sexuality in two contemporary Franco-Belgian graphic novels: Le Plongeon (2018) by Séverine Vidal and Victor Pinel and L'Obsolescence programmée de nos sentiments (2021) by Zidrou and Aimée de Jongh. While the scholarship on aging in comics has focused primarily on narratives of illness, decline, or intergenerational care, much less attention has been given to depictions of older women's desire and erotic agency. Our analysis sets these works within the long-standing Franco-Belgian comics tradition, where women over sixty are rarely to be found as central characters. By comparing two protagonists at different stages of later life -one in her sixties, the other in her eighties- we explore how the graphic novel as a multimodal form engages ambivalently with cultural anxieties about aging, sexuality, and visibility. We argue that these works both challenge and reproduce dominant imaginaries of female sexuality and desire in old age, hinging our analysis in theories by Kathleen Woodward, Margaret Gullette, and Lynne Segal with the aim of offering a fertile ground for analyzing the intersections of gender, body, and temporality in contemporary European comics.
Stigma among healthcare providers toward people living with hepatitis B and C can negatively impact quality of care and health outcomes. Stigmatizing perceptions, attitudes, and behaviors are common among trainees, but effective interventions and curricula to reduce stigma are lacking. Crowdsourcing asks a group to solve a public health problem and then share optimal solutions back to the community. We organized a crowdsourcing open call at Nanjing Medical University to generate stigma-reduction materials tailored to medical students. We conducted a crowdsourcing open call informed by a World Health Organization practical guide. The open call involved four steps: (1) forming a stakeholder steering committee; (2) promoting the open call on campus; (3) screening and judging entries, which included text, posters, comics, or videos, in Chinese or English. Each submission was scored using prespecified criteria across five dimensions from one (poorest quality) to ten (highest quality) by three independent judges; (4) sharing and evaluating finalist ideas. Thematic analysis was applied to all entries. The open call was conducted from September 15 to October 15, 2023. Across online and offline channels, the recruitment materials received over 13,000 views. 170 students participated in the open call and 114 entries were collected, including nine videos, 54 posters or comics, and 51 text submissions. The average score across all entries was 7.3 and the four highest-scoring entries were developed into educational materials. Among all 170 participants, 24% had family or friends living with HBV or HCV and 38% had participated in volunteer activities related to hepatitis. Thematic analysis revealed five core themes: (1) legal rights and protections for people living with hepatitis; (2) hepatitis-related awareness enhancement; (3) social support for people living with hepatitis; (4) hepatitis-friendly healthcare system; and (5) stigma reduction through digital health platforms. This crowdsourcing initiative successfully engaged medical students in generating stigma-reduction materials, demonstrating its feasibility as a participatory approach to developing student-centered educational materials. Further research will focus on the effectiveness of these materials in hepatitis-related stigma reduction.
Despite decades of clinical practice, education and integration with other healthcare teams, palliative care remains enshrouded by myth and misconception. Through the powerful medium of comics, this article presents ten of the most misunderstood areas in palliative care. The topics explored were produced in conjunction with practising UK palliative care trainee doctors and realised to artistic form by a physician expert in graphic medicine. A novel infographic approach was carefully developed to be approachable yet thought-provoking. Each infographic is paired with content created to encourage reflection and provide applicable, real-world palliative care advice for all healthcare professionals. The historical connection between art and medicine is utilised in this modern article with the goal of improving patient care.
While models of discourse comprehension describe the process of structure building during mental model construction, neurophysiological explorations of this process are limited. Here, we use time-frequency analysis of EEG data to explore the spectral power dynamics associated with the narrative comprehension of comics. Using an existing dataset wherein 22 participants viewed sets of six sequential comic panels, we performed spectral decomposition from theta to gamma bands over the full extent of narrative processing (10+ seconds). Power incrementally decreased in both alpha (8-12 Hz) and low beta (12.5-20 Hz) frequency bands as narratives unfolded. These results are contextualized in the literature, where some suggest that alpha and low beta frequency bands act as mechanisms of suppression and enhancement to modulate attention. Study findings are consistent with changes in alpha and low beta power reflecting domain-general processes of narrative structure building during discourse comprehension.
This research investigates the potential for graphic medicine to foster resistance to medical ableism among those with feminized pain (i.e., endometriosis). We unite community and health psychology and disability studies to explore readers' engagement with a chronic pain webcomic and resistance to medical ableism via the construction of social media pain worlds. A qualitative case study of the graphic medicine webcomic Chronic Pain Is a Party was undertaken. A systematic thematic analysis of 28 comics and 209 reader comments was completed by multiple coders; several coders identified as disabled and experienced chronic pain. Three themes were constructed from the data. Readers' resistance to medical ableism was characterized by an ethic of care, reclaiming epistemic agency, and solidarity through shared experiences. Readers recognize that ways of knowing, loving, and surviving are an important but underaddressed strategy in a world hostile to access and interdependency. They counter epistemic injustice via care webs that value experiential knowledge and connect individual encounters with medicine to broader collective issues, enabling structural analysis. Digital graphic medicine communities, particularly social media pain worlds, hold the potential to facilitate a deeper intersectional understanding of feminized pain experiences and mobilize collective advocacy for greater health equity. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Familial imprisonment is one of ten recognised adverse childhood experiences (ACE), with established long-term impacts on health, care and wellbeing. Where safe and appropriate, the right of a child to protect and maintain family life (and therefore visit and/or remain in contact with a family member in prison) is protected in the United Nations Convention on the Rights of the Child (UNCRC). Despite this, families face many barriers when visiting prison, and children and young people's experiences of doing so, in their own words, are less widely reported. Drawing on serial longitudinal interviews and the curation of creative methods with 19 children and young people (age 7-16) who have a family member in prison across Northern England and Scotland, the aim of this study was to explore the impact of familial imprisonment on children and young people's health and wellbeing, and to utilise our findings to develop a rights-based framework for prison social visits. Reflexive thematic analysis identified three intersecting themes: (1) navigating complex, adult systems; (2) distress, grief and trauma; (3) acceptance, normalisation and coping mechanisms. In this paper, we illustrate how these themes were harnessed to co-produce a child-centred framework for social visits based on children and young people's priorities for change, a framework we articulate as 'The Three Cs'. Contact, which strengthens family ties and protects health and wellbeing, requires approaches which are child-centred, consistent and compassionate. Crucial to this are enhancements to prison officer mandatory training on family ties and the impact of family imprisonment as well as exploration of how to harness existing support pathways designed for vulnerable children and young people to ensure that those experiencing familial justice-involvement do not fall through gaps in service provision. From its inception, this project was a partnership between academia and two voluntary sector organisations that support families experiencing imprisonment with the core project team being split between academic and practice-based partners (reflected in this article's authorship). An international stakeholder group was also convened to support the study across its duration and who supported the research team in the development of research questions, topic guides and participant materials, guided the interpretation of our findings, and provided input into our impact and dissemination strategy. This group met quarterly and included representation from voluntary sector and grassroots organisations, academics with experience of working with children, families and justice-involved populations, prison and probation service colleagues and creative practitioners. Aligned with this partnership approach, we established regular satellite check-ins with other voluntary sector organisations across the United Kingdom who support families experiencing imprisonment to embed relationality and feedback loops for actionable change. Five study participants were involved in the co-creation of comics, illustrated by Jack Brougham (see 'Materials and methods' section for further insight). Finally, during the analysis, dissemination and impact phases of the project, we worked with a youth board of children with experience of familial imprisonment (recruited through a partner organisation) to sense-check our findings and to develop a campaign video (an approach chosen by the board). The video was based on the analysis of project data and the youth board's own experiences. This process was held over 3 full-day sessions, co-facilitated by a locally based arts organisation and involved a range of creative activities. Participants were thanked for their time with gift vouchers. Both processes with young people (data collection and engagement activity) further informed our analysis and were fundamental to shaping our three Cs framework, a framework co-produced with our core voluntary sector partners and illustrated by Nifty Fox.