AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

AMA Journal of Ethics. February 2018, Volume 20, Number 2: 154-157.
doi: 10.1001/journalofethics.2018.20.2.medu1-1802.

Medical Education

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Teaching Confidentiality through Comics at One Spanish Medical School

A comic is used to demonstrate that medical ethics topics, such as confidentiality, can be effectively taught with specially designed comics.

Artwork by Mónica Lalanda, MD, MSc, and caption by Mónica Lalanda, MD, MSc, Rogelio Altisent, MD, PhD, and Maria Teresa Delgado-Marroquín, MD, PhD


At the University of Zaragoza in Spain we developed an innovative way to teach the concept of confidentiality to medical students, which we tested by comparing the use of customized comics with more traditional methods. We proved that using comics is more attractive to students than lectures and class discussions, that it increases class participation and students’ self-awareness of learning, and that it maintains the same academic results. We share our experience visually in a two-page comic.


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Figure 1. Comics for Medical Education: A Spanish Experience, by Mónica Lalanda, Rogelio Altisent, and Maria Teresa Delgado-Marroquín
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Comics are increasingly used in medical schools as a tool for students to reflect on their own experience, increase their empathy towards patients, and improve their communication skills [1]. However, as far as we are aware, using customized comics to teach students specific content in health care ethics has not been attempted anywhere before. At the University of Zaragoza in Spain, we developed an innovative educational project: we created comics about confidentiality specifically for medical students and used them to teach preclinical students as part of their compulsory training. We’re now so convinced that comics should be used to teach even the most ethically complex concepts that we use a comic format to explain our experience to you as readers.


  1. Green MJ. Use of comics in medical education and patient care. BMJ. 2010;340:c863. Accessed November 29, 2017.

Mónica Lalanda, MD, MSc, is an emergency medicine physician in Spain and holds master of science degrees in medical ethics and bioethics. She is also a comic artist.

Rogelio Altisent, MD, PhD, is a general practitioner with the Research Group in Bioethics at the University of Zaragoza in Aragón, Spain. His professional interests include family medicine, bioethics, professionalism, education, teaching innovations, and clinical ethics committees.

Maria Teresa Delgado-Marroquín, MD, PhD, is an assistant professor of ethics at the University of Zaragoza Medical School in Aragón, Spain, where she also practices at Delicias Norte Health Center. She is trained as a bioethicist and general practitioner.

Go Home, Med Student: Comics as Visual Media for Students’ Traumatic Medical Education Experiences, February 2018

Roles of Graphic Pathographies in Clinical Training, February 2018

Smiles, Apologies, and Drawing Trauma-Informed Care in the PurpLE Clinic, January 2017

They Are People First, Then Patients, May 2017

The Use of Visual Arts as a Window to Diagnosing Medical Pathologies, August 2016

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.