Medical doctors as the captain of a ship: an analysis of medical students’ book reports on Joseph Conrad’s “Lord Jim”

Purpose: In South Korean ferry disaster in 2014, the captain abandoned the ship with passengers including high school students still aboard. We noticed the resemblance of abandoning the ship with passengers still aboard the ferry (named the Sewol) and the ship Patna, which was full of pilgrims, in Joseph Conrad’s novel “Lord Jim.” The aim of this study is to see how medical students think about the role of a medical doctor as a captain of a ship by analyzing book reports on Conrad’s “Lord Jim.” Methods: Participants included 49 third-year medical students. Their book reports were analyzed. Results: If placed in the same situation as the character of Jim, 24 students of the 49 respondents answered that they would stay with the passengers, while 18 students indicated they would escape from the ship with the crew. Most of the students thought the role of a doctor in the medical field was like that of a ‘captain.’ The medical students reported that they wanted to be a doctor who is responsible for his or her patients, highly moral, warm-hearted, honest, and with high self-esteem. Conclusion: In conclusion, we found that “Lord Jim” induced the virtue of ‘responsibility’ from the medical students. Consequently, “Lord Jim” could be good teaching material for medical humanities.


INTRODUCTION
The sinking of a South Korean ferry (the "Sewol") occurred on April 16, 2014.Of the 476 people aboard, 174 survived, 286 died, and 11 were missing at the end of June, 2014.While the ship sank, a teenage victim recorded an audio clip of an announcement inside the ship [1] that stated, "Do not move from your present location and please stay" [2].The clip also recorded one passenger's voice stating, "What's the captain doing?" [2].On April 19, 2014, the captain of the ferry was arrested on suspicion of negligence of duty, violation of maritime law, and other infringements [3].While South Korean law explicitly requires captains to remain on the ship during a disaster, the captain had abandoned the ship with passengers still aboard the ferry.Upon hearing the news, we remembered Joseph Conrad' s noble story "Lord Jim" a 1965 film of the same name, based on the novel and directed by Richard Brooks.Specifically, we noticed the resemblance between abandoning the ship with passengers still aboard the ferry that carried 325 members of a school's junior class and 12 of its teachers [4], and the Patna, full of pilgrims travelling to Mecca for the Hajj.As a medical educator and medical students, we wanted to determine how medical students conceive the role of a doctor, and what kind of doctor they want to be by analyzing their book reports on this novel.The aim of this study is see what medical students think about the role of a medical doctor compared to a captain of a ship by analyzing their book reports on Conrad's "Lord Jim." http://jeehp.orgJ Educ Eval Health Prof 2014, 11: 33 • http://dx.doi.org/10.3352/jeehp.2014.11.33

Participants
Participants included 49 medical students in their junior class (3rd year of a 4 year course).The mean overall age was 28.67 ± 2.83 years.A month before the classroom lecture, they were asked to read Conrad's "Lord Jim" and have a discussion with 7 other students allocated into group.The Korean translation of Conrad' s original "Lord Jim" and the "Lord Jim" DVD (1965, Director: Richard Brooks,) were provided to students.One student from each group presented the group's opinions in an open forum.After the forum, students were asked to write a book report.

Questionnaires
In students' book reports on "Lord Jim, " they were asked to respond to the following items: "If I were in the same situation as Jim, would I stay with the passengers or escape from the ship with the crew?"; "How would I compare the captain of the Sewol to the character of Jim in Patna?"; "What is the role of a doctor in the medical field compared to the crew of a ship?"; and "What kind of doctor will I be?"

Stay with the passengers or escape the ship with the crew?
Of the 49 respondents, 24 students (49.0%) answered that they would stay with the passengers, while 18 (36.7%)indicated they would escape from the ship with the crew.The remaining 7 (14.3%)could not decide.The reasons for choosing stay with the passengers were "for the honor of the crew" (14) or "responsibility of the crew" (10).The reasons for escaping from the ship were "needlessness of sacrifice" (12) or "there is no honorable death in a life-or-death situation" (6).Students under 28 years were less likely to pursue honor over survival than older students (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.26 to 3.10).However, there was no significant difference between them (P = 0.86).Males were more likely to pursue honor over survival than females (OR, 1.43; 95% CI, 0.30 to 6.70), although this difference was not statistically significant (P = 0.65).In addition, although the difference was not significant (P = 0.76), unmarried students were more likely to pursue honor over survival than female students (OR, 1.38; 95% CI, 0.17 to 10.82).Finally, students with more than 5 family members were more likely to pursue honor over survival than students with less than 4 family members (OR, 1.32; 95% CI, 0.27 to 6.41), although this difference was non-significant (P = 0.73).

How would I compare the captain of the Sewol to the character of Jim in Patna?
Of the 49 respondents, 21 students (42.9%) stated that Jim and the captain of Sewol are very similar, while 16 (32.7%)wrote they are quite different.The remaining 12 (24.5%)did not discuss this.Of the 22 answers from 21 respondents, the reasons for similarity between Jim and the Sewol captain were that both were irresponsible in their duty (12, 54.5%), selfish (5, 22.7%), had a lapse in judgment (3, 13.6%), and were dishonorable, as a result of their behavior (2, 9.1%).Of the 17 answers from 16 respondents, the reasons for the differences between Jim and the captain were that Jim expiated his guilt, while the Sewol's captain did not (17, 70.6%), Jim and the Sewol's captain were in a different situation (3,17.6%),and Jim was faithful while the Sewol's captain was not (2, 11.8%).
What are the roles of a doctor in the medical field as compared to the crew of a ship?
Most of the students thought the role of a doctor in the medical field was similar to that of a 'captain' (36, 73.5%) and a mate (6, 12.2%) compared to the crew of a ship.The remainder viewed the role of a doctor as that of an engineer (2, 4.1%), helmsman (1, 2.0%), helm (3, 6.1%), and pilothouse (1, 2%).Of the 42 answers from 36 respondents who chose 'captain, ' the reason provided was that a medical doctor, like a captain, should have leadership (21, 50.0%), responsibility (18, 42.9%), and communication skills (3, 7.1%).

DISCUSSION
The plot summary of "Lord Jim" is as follows.Jim, a young British seaman, becomes first mate on the Patna, a ship full of pilgrims travelling to Mecca for the Hajj.When the ship starts rapidly taking on water and a disaster seems imminent, Jim joins his captain and other crew members in abandoning the ship and its passengers.A few days later, they are picked up by a British ship.However, the Patna and its passengers also saved later, and the reprehensible actions of the crew are exposed.The other participants evade the judicial court of inquiry, leaving Jim in court alone.Subsequently, the court strips him of his navigation command certificate for his dereliction of duty.Jim is angry with himself, both for his moment of weakness http://jeehp.orgEduc Eval Health Prof 2014, 11: 33 • http://dx.doi.org/10.3352/jeehp.2014.11.33 and for missing an opportunity to be a 'hero.' Jim moved to a remote inland settlement with a mixed Malay and Bugis population, where his past can remain hidden.While living on the island he acquires the title 'Tuan' ('Lord').Here, Jim wins the respect of the people and becomes their leader by relieving them from the predators and protecting them from the corrupt local Malay chief.A few years later, the town is attacked by the marauder 'Gentleman' Brown.Although Brown and his gang are driven off, the son of the leader of the Bugis community is slain.Jim returned to the Bugis leader, and willingly takes a fatal bullet in the chest as retribution for the death of his son [5].
Of the 49 respondents responding to appropriate actions to take while the ship sank, about half chose 'honor' (staying on the ship) rather than 'survival' (abandoning the ship), while about one third preferred 'survival' over 'honor.' Since all respondents were medical students in the 3rd year of a 4-year program they had already completed undergraduate courses and held a bachelor's degree.Thus, it is likely that they already had experience of University or social life and entered medical school by choice.Therefore, they were well aware of vocational ethics and emphasized the responsibility of their job.Although not statistically significant, males were more likely to pursue honor over survival than females.Males showed a romantic idealist character while females displayed intellectual realism.In addition, students with more than 5 family members were more likely to pursue honor over survival than students with under 4 family members although this was also non-significant.Thus, it may be that the more family members one has, the higher the opportunity to learn the social roles from family interactions.Therefore, it is hypothesized that honor, which is a social value, was preferred among this group.
Most of the 49 respondents compared the escape of Jim and the Sewol captain from the sinking ship.Twenty-one stated that the two are very similar, while 16 wrote they are quite different.Reasons for the similarity were that both of them were irresponsible in their basic duty or selfish.Since the students had recently heard about how the Sewol captain had abandoned the ship with passengers aboard, it is likely that students read the novel and watched the film with a critical view.Jim hesitated at a critical moment.Specifically, Jim could not display his heroic thoughts and basic duty during the Patna accident.However, later in the Patusan, he demonstrated heroic actions to compensate for his earlier mistake.Consequently, he demonstrated two extremes.
Most of the students thought the role of a doctor in the medical field as similar to a 'captain' of a ship because a medical doctor, like a captain, should demonstrate leadership, responsibility, and communication skills.After hearing about the fer-ry disaster, students seemed to carefully consider the role of a ship captain.As a result, it appears that they equated the role of a doctor in the medical field with a ship captain.Students wanted to be a doctor that is responsible for his or her patients, highly moral, warm-hearted, or honest.Thus, it is evident that students viewed the virtues of a good doctor as responsible, high moral, warm hearted, and honest.Among those responses, 'responsibility' was the first virtue doctors should have.
Therefore, through consideration of the ferry disaster and reading "Lord Jim, " students paid attention to responsibility and this was reflected in their answers to the question "What kind of doctor will I be?" in their book reports.After hearing about the ferry disaster, students paid more attention to the attribute of responsibility.In reading "Lord Jim" and writing the book reports, about half (46%) of the medical students wanted to be a doctor who is responsible for his patients.Consequently, we could state that "Lord Jim" induced a virtue of 'responsibility' from the medical students and could, therefore, be a good teaching material in disciplines related to the medical humanities.