Impostor follows four Singaporean friends reflecting on and sharing their experiences of shame during their medical training and current medical practice. The group—comprising house officer/intern Nur Saliza, medical officer/junior resident Rajesh Kamal, registrar/senior resident Daniel Souza, and associate consultant Lim Hui Ying—takes turns recounting specific moments during their medical training when they were made to feel shame. These experiences have left lasting marks, influencing both their personal and professional identities.
Their stories highlight shame as a pervasive and hidden feature of medical education. However, they also explore how factors like gender (and socially imposed gender expectations), academic prestige, and shifting power dynamics play a crucial role in the ways in which shame is experienced and processed within medical training environments. Despite its serious subject matter, Imposter’s playful art style and writing offer readers an accessible entry point to think critically about the role of shame in medical education. Impostor is an example of the work being done in medical education in conjunction with graphic medicine, using the comic form to initiate conversations about the often difficult and under-discussed dimensions of training in the medical profession.
Over the past decade, clinical educators have increasingly embraced graphic medicine as a versatile and accessible pedagogical tool. Comics have been used to prompt reflection and discussion around topics such as medical ethics (Myers et al., 2022), doctor-patient communication (Green & Myers, 2010), difficulties of medical training (Maatman, 2022), transitions in training (Fishman et al., 2025) and professional development (Green, 2015), among others. Similarly, medical students and healthcare professionals at various stages of their careers have turned to graphic medicine to express the negative emotions elicited by their training and their work. Many share personal reflections through social media and academic outlets, including journals like this one and Annals of Internal Medicine, which dedicates a section to graphic medicine. Comics are uniquely positioned to convey deeply personal experiences while simultaneously making them accessible and relatable to a broad audience (Czerwiec et al., 2015).
A central negative emotion within the medical profession is shame (Lazare, 1987). Despite its prevalence, shame remains the ‘elephant in the room’ in clinical contexts, insofar as it is something pervasive that powerfully shapes interactions and outcomes but continues to be unspoken and underacknowledged (Davidoff, 2002). Shame has been characterised as an unpleasant emotion (Stearns, 2017, p. 4), with its discomfort stemming from a sense of personal inferiority and inadequacy and the perceived threat this poses to the individual’s social bonds and social standing (Dolezal & Lyons, 2017). Research has shown that shame among medical learners arises from experiences such as making mistakes, struggling with workload and learning tasks, feeling like an outsider, failing exams and undergoing remediation. Shame in medical learners can cause isolation, psychological distress, poor job performance, loss of self-confidence, impaired empathy, and disengagement from learning (Boehm et al., 2019; Bynum et al., 2019; Bynum et al., 2021).
Graphic medicine is a powerful medium for self-expression and personal reflection, providing an outlet for expression of emotions that might be difficult to articulate through language alone (Maatman et al., 2022; Whitlock 2006). In particular, using graphic medicine to communicate experiences that are taboo or not openly spoken about—such as shame—can be a powerful way to illuminate and normalise what might feel too risky to share with others and, as a result, remains hidden from view. For example, the graphic perspective Breathe, published in the New England Journal of Medicine, depicts the story of a doctor, who has just graduated from residency, on call at her job in a new hospital. The comic conveys her heightened emotional state when she thinks she has poorly supervised a resident performing a procedure which looks as though it will lead to a bad outcome (Colaianni et al., 2021). Her panic, internal turmoil and a shame spiral are all depicted powerfully in the comic. However, as the story unfolds, we see that her emotions and thoughts remain invisible to her resident and other colleagues. This comic, along with others that depict shame experiences in clinical contexts (e.g., Davies et al., 2022; Vilkelyte et al., 2024), provide important insights into affective experiences that are frequently hidden and unacknowledged in healthcare, ultimately shining light on the existence of these experiences. Over time, these graphic representations can help lift the taboo around medical errors, imperfect performance, or emotional distress, conveying a more well-rounded and realistic view of what it means to be a human working and learning in a high-stakes, emotionally complex profession.
Imposter is an adaptation of a poem written by Duke-National University of Singapore (Duke NUS) Medical School medical student Gideon Purwono. The poem was submitted as part of “Shame.less,” a story-sharing event from The Shame Space (https://www.theshamespace.com/) in May 2023. Sponsored by a Duke-Exeter Fund grant, the event invited medical students from Duke University (USA), the University of Exeter (UK), and Duke NUS (Singapore) to submit stories about their experiences of shame during their medical training.
Gideon’s poem was selected from the Duke NUS entries to be adapted into a comic in collaboration with award-winning Singaporean artist Alan Bay (https://www.smallguydoodle.com/). Alan, whose work focuses on fiction and scientific divulgation, has previously collaborated with healthcare professionals on informative comics, for example the educational book World of Science: Adventures with Germs and Your Health (Boo & Bay, 2022). Together, Gideon and Alan transformed the original poem into the narrative of four healthcare professionals. Each story told through the four fictional characters represents different aspects of shame and shaming that can take place during medical training, along with Singapore’s diverse cultures.
To create Impostor, Gideon and Alan worked collaboratively over approximately fifteen hours, with extra hours of individual work used to craft the narrative and draft storyboards. Alan remarked that their detailed conversations were crucial to understanding the local context of hospital and medical school culture in Singapore, as well as the technical aspects of the medical procedures depicted and mentioned in the comic. Initially, Alan felt Gideon’s poem exaggerated certain experiences to get his point across; however, after chatting with Gideon, he realised that the situations were real, and he reflected on the frequent lack of empathy towards healthcare workers from those outside the profession. Gideon and Alan also highlighted that the project tackled a serious and important issue, one that might be difficult to represent in other formats, by rendering it in an engaging and entertaining creative piece.
The Shame Space team (Will Bynum, Luna Dolezal, Charlotte Wu and Juanita Navarro-Páez) provided ongoing support and feedback throughout the project. With periodic input from the team, Gideon and Alan developed storyboards, drafts, and the final version of the comic. In Impostor, Alan’s engaging and playful style brings Gideon’s personal experiences of shame to life through the stories of the four characters. One of the unique aspects of the comic is its use of colloquial Malay, Hokkien and Singlish terms in the dialogue. The local languages highlight the rich, diverse cultures that come together in Singaporean healthcare contexts and provide a layer of authentic storytelling grounded in cultural acknowledgement.
With its rich imagery and language, Imposter serves not only as a representation of medical culture in Singapore but also as a narrative that can be appreciated by international readers. After completing the project, Alan reflected “I’m really proud that this comic will be read by a lot of people (I hope a lot of people will get to read it!). In a way, this comic represents Singapore. It is a very localised comic, without being too exaggerated.” While Impostor is rooted in Singaporean culture, the stories it tells are highly relatable to medical students and patients globally and should be appreciated by international audiences.
Although the consequences of shame in medical training can be severe, research on this subject is still relatively recent, and there is more to be done. As shame is an often unspoken and taboo experience for healthcare providers, Impostor is a meaningful contribution to the growing body of research and engagement about shame in medicine (e.g., The Nocturnists Shame in Medicine: The Lost Forest audio documentary series - https://thenocturnists.org/shameinmedicine). By encouraging open dialogue and reflection, Impostor helps to destigmatise discussions of shame. In doing so, it offers an important avenue for improving the working conditions and emotional wellbeing of healthcare learners and professionals, ultimately supporting better outcomes for patients as well.
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