EDITORIAL

Moving pictures, moving hearts and moving minds: using cinema in medical education

John Yaphe*

*Associate Professor, Community Health, University of Minho

Endereço para correspondência | Dirección para correspondencia | Correspondence

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If a picture is worth a thousand words, then a moving picture is certainly worth more. This is also true when considering the role that films can play in medical education. This editorial will explore the use of cinema in teaching medical students, vocational trainees, and colleagues.

An excellent place to start is a book called Cinemeducation.¹ Several medical humanities websites explain the use of films in education.² There are also medical journals devoted solely to this topic, such as the Journal of Medicine and Movies.³

Films can entertain and teach us. The challenge in education is to clarify learning objectives and find the method that reinforces the message. Readers who want to try showing films in their own teaching settings may be helped by recent experience in other centres.

Family, Society and Health is one example of a course that uses films as a teaching aid. This is a course in medical sociology given to second and third medical students at the University of Minho. Though most of the readers of Revista Portuguesa da Medicina Geral e Familal are professionals in practice and may be involved in postgraduate training, a smaller number are involved in undergraduate teaching. However the messages and methods of this course may be of interest to both junior and senior specialists. The objectives of this course include acquiring knowledge about the social factors that influence health and disease, developing skills in interpersonal communication, and fostering attitudes favourable to a broad social perspective in medicine.

Topics covered include definitions of health and disease, indicators of health in Portugal, family structure, function and assessment, culture and health, sexuality and gender, professionalism, behavioural change, interpersonal communication, social equity, heal-thy aging, end of life issues, medicalization, quality of life, ethics, complementary medicine, patient satisfaction and the health of doctors. Films have proved to be a helpful resource in teaching these concepts along with more traditional methods such as lectures, case discussions, and other exercises.

A few examples taken from seminars in the Family, Society and Health course may clarify this. One favourite film in this course is “The King’s Speech” (2010), widely praised by critics and the public. It tells the story of George VI who struggled with a speech fluency disorder as prince and later as king. A healing relation-ship with a devoted speech therapist helped him to overcome this. A brief scene of 3-minutes duration occurring early in the film shows the first meeting between therapist and client. This is used at two points in the course. In the opening session, on the definitions of health and disease, there is a lively discussion of the question: “Is the prince healthy or sick?” Issues explored include the definition of health, normal growth and speech development, speech pathology, the role of stress, and the relationship between health and function. Later in the course, in the session on Professionalism, the same film clip is shown. Students are asked to identify behaviours in the therapist that are characteristic of a true professional. Items identified include greeting the patient, making people feel comfortable, forms of address, body language, interpersonal distance, the use of humour, the demonstration of knowledge and experience in one’s field, the use of authority, setting limits, therapeutic contracts, dealing with VIP patients, compassion, caring and empathy.

The session on sexuality, gender and health centres on the film “Real Women Have Curves” (2002). Ibanez et al. have described the charm and educational value of this film.⁴ In a few brief sequences of no more than two or three minutes each, the film presents issues of body image, fashion, adolescent sexuality, contraception, virginity, promiscuity, pregnancy, menopause and empowerment.

A third film, which is central to this course, is “Wit”, used in the session on end of life issues. This film, based on a stage play, was originally made for television in 2001. The Robert Wood Johnson Foundation has supported the creation of the “Wit” film project. This has made teaching materials available on a website with the aim of reaching all medical schools in America with this material.⁵ Ideally the whole 90-minute film should be shown to the learners with time for reflection and discussion following the viewing. Alternatively, a few brief segments of the film are shown during a session. The segments chosen explore breaking bad news, obtaining informed consent, patient autonomy, pain control, advance directives and stages of dying. The strong emotional impact of this film requires careful attention of the teacher to the needs and responses of the learners in the classroom.

Excerpts from other films used with success in the course include My Big Fat Greek Wedding (medical anthropology), Sicko (equity and health), What’s Eating Gilbert Grape (developmental delay and family function) Prime (professional boundaries), Eat, Pray, Love (alcoholism and behavioural change), Something’s Gotta Give (healthy aging), Do No Harm (ethics and evidence based medicine), Million Dollar Baby (euthanasia), Love and Other Drugs (medicalization), and selections from Grey’s Anatomy (burnout and doctors’ health).

A few words about legal and copyright issues are also necessary. There are legitimate concerns about the possibility of copyright infringement when using commercial films in teaching. Recent changes in copyright law in the United States have made this simpler. The American Library Association has summarized the updated rules on video and copyright.⁶ The doctrine of fair use allows the use of film clips in teaching if certain conditions are met. Teaching face to face, in a not-for-profit educational institution, is the first condition. Use of short clips of a few minutes duration, that are relevant to the message of the teaching session, that are not used for entertainment, and for which no fee is charged, is considered fair use. Students should be encouraged to purchase their own legal copies of a film if the want to enjoy the whole film. These issues need to be clarified by qualified authorities in different jurisdictions.

There is a wealth of audio-visual material that is readily available and that can enrich the teaching of core concepts in medicine. We look forward to hearing from readers about their own experiences and their favourite films and would be happy to publish the results of successful efforts in this developing field of medical education.

 

REFERENCES

1. Alexander M, Lenahan P, Pavlov, A, editors. Cinemeducation: a comprehensive guide to using film in medical education. Oxford, UK: Radcliffe; 2005.         [ Links ]

2. Medical Humanities on-line. Available at: http://medhum.med.nyu.edu/ (accessed 23/01/2014).         [ Links ]

3. Revista de Medicina y Cine: Journal of Medicine and Movies. ISSN 1885-5210. Available at: http://revistamedicinacine.usal.es/ (accessed 24/01/2014).         [ Links ]

4. Ibáñez L, Pinotti L, Witriw A. Adolescence and the Risk of Stereotypes: Real Women Have Curves (2002) J Med Mov 2008; 4: 161-8.         [ Links ]

5. Wit Film Project. Available at: http://www.growthhouse.org/witfilmproject/ (accessed 24/1/2014).         [ Links ]

6. American Library Association. Video and copyright. ALA library fact sheet 7. Available at: http://www.ala.org/tools/libfactsheets/alalibraryfactsheet07 (accessed 24/1/2014).         [ Links ]

 

Endereço para correspondência | Dirección para correspondencia | Correspondence

yonahyaphe@hotmail.com

 

Conflict of interest

The author has no conflict of interest in the publication of this editorial.