title: Derogatory and cynical humour directed towards  patients: views of residents and attending doctors.
abstract: BACKGROUND
  A study of medical students' perspectives on derogatory and cynical humour was published in 2006. The current study examines residents' and attending doctors' perspectives on the same phenomenon in three clinical departments of psychiatry, internal medicine and surgery.
  
  
  METHODS
  Two focus groups were conducted in each of the three clinical departments, one with residents and one with attending doctors,during the 2006-07 academic year. Seventy doctors participated, including 49 residents and 21 attendings. The same semi-structured format was used in each group. Questions focused on characterisations of derogatory and cynical humour along with motives and rules for its use.All focus groups were audiotaped and the tapes transcribed. Each transcript was read independently by each researcher as part of an inductive process to discover the categories that describe and explain the uses, motives and effects of such humour.
  
  
  RESULTS
  Three categories that appeared in the first study with medical students - locations for humour, the humour game, and not-funny humour - emerged as virtually identical,whereas two others--objects of humour and motives for humour - were more fully elaborated.
  
  
  CONCLUSIONS
  Discussions of derogatory and cynical humour should occur in any department where teaching and role modelling are priorities. In addition, the tenets of appreciative inquiry and the complex responsive process,particularly as they are used at the Indiana University School of Medicine, offer medical educators valuable tools for addressing this phenomenon.
authors.affiliation: Department of Behavioral Sciences, Northeastern Ohio UniversitiesCollege of Medicine, Rootstown, Ohio, USA. dw@neoucom.edu
authors.forename: Delese
authors.initials: D
authors.lastname: Wear
authors.forename: Julie M
authors.initials: JM
authors.lastname: Aultman
authors.forename: Joseph
authors.initials: J
authors.lastname: Zarconi
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Varley
mesh_terms: D001291:Attitude of Health Personnel; D003469:Culture; D004501:Education, Medical / Q000379:methods; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology*; D010817:Physician-Patient Relations; D012933:Social Identification; D012938:Social Perception; D013337:Students, Medical / Q000523:psychology; D014925:Wit and Humor as Topic