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Table 1 Themes and representative quotes

From: “Brought to life through imagery” – animated graphic novels to promote empathic, patient-centred care in postgraduate medical learners

Theme/subtheme Representative quote(s)
1. The curriculum accurately reflected and addressed issues in real world medical practice
 1a. Level of empathy “I think that I am reflective of the general literature that empathy does kind of decline throughout medical education … I think that there’s a little bit of cycle, so times of higher stress and higher burnout, are the times when empathy becomes the hardest but then you kind of get back on your feet again.” – PPI8
 1b. Other humanities/communications training “I think it was a component of the medical school curriculum … it was kind of a longitudinal part of our non-clinical course. So that was kind of the only formal training I’ve had in empathy.” – PPI6
2. The comics curriculum facilitated holistic development
 2a. Demonstration of institutional commitment to wellness “I think it is valuable to have these sessions to show that like y’know it’s still supported like, she’s done this research and it’s been..y’know funded by grants so like people still care about that, and that to have the time and space to have refreshments and to spend that time talking about this is valuable.” – FG1
 2b. Provided techniques to practice patient centered approach “I think it probably impacted me the most as a physician. It just made me more cognizant of specific interactions and strategies with patients. I wouldn’t say it’s something I thought about all the time but particularly when there was a challenging case or a patient who I felt I didn’t have a good connection with for whatever reason.” – FG2
 2c. Fostered resilience “I think the most important part was normalization of experiences and the chance to talk about it with the other students, having that safe space and time to do that. And I find that just talking about it itself could be somewhat therapeutic” – PPI8
 2d. Provided tools to help students tackle challenging situations “It also gave me more tools to be able to talk to them about ok, this patient isn’t following recommendations or wants to leave against medical advice, or is feeling burnt out. You need more tools about how to talk to students about different ways of approaching those situations.” – PPI8
3. Participants appreciated the comics as an educational medium
 3a. Positive aspects of comics “Part of what was engaging about the comic was the fact that it was a bit of a unique form of art, and in turn was helpful to pay attention” – PPI6
“Yeah I felt the comics were really good seeing both sides, and seeing what it’s like from the patient side to live with diabetes...” – PPI8
 3b. As an educational medium “… you can say a lot in a picture which could take a chapter of a textbook and get that message across really quickly. And I think that’s the real power of it really.” – PPI7
 3c. Refinement of material “Like a framework to think of how to reach those goals, so in that way I dunno if that’s something that could be added to this … so it’s a bit more technical and to show us how to reach those goals cause I think we all want to be compassionate, it’s just how do you do it is the issue” – FG1
“The part where they’re showing you sort of what not to do and what to do sometimes it’s a bit too obvious or maybe at too much of a basic level … so maybe if that could delve more into some of the subtleties … not as like one disastrous situation and one amazing situation, but something more subtle where the lines are more blurred might be a bit more thought provoking I think” – FG3
4. Participant feedback on the curriculum
 4a. Value of reflective exercises and discussion “I liked the reflective exercises cause then you really think about your own patients and your own interactions … I can still think of the patients I discussed earlier in the year I think that was probably the most beneficial for me personally” – FG2
 4b. Relevance of curriculum “I felt the messages that they were delivering were relatively fundamental. I’d like to think that most of the people watching the comics and discussing them already had a lot of those clinical skills. I appreciated medical school, but then you sort of forget it as a clinician and the comics probably brought people up to a level” – PPI8
“they do focus on some challenges that might be specific to patients with a chronic illness like diabetes. So in that way … it’s more like directly applicable to our future careers” – FG2
 4c. Facilitator of curriculum integration “I think the timing of them in the academic half day works really well, cause this is the only time really in the week that we have protected time for these kinds of things.” – FG3
“It didn’t feel didactic, I mean the way the sessions were delivered was more of a discussion piece where you could also bring your own ideas and experiences to it. So in that sense it felt more of an informal formal program, if that makes sense” – PPI7