Stories and narratives
The efficient use of movies in a crowded curriculum Peter Gallagher, Medical Education Unit, University of Otago, Wellington, New Zealand Nick Wilson and Richard Jaine, Public Health Department, University of Otago, Wellington, New Zealand
What can be jettisoned from a congested curriculum to accommodate new ideas
SUMMARY Background: The undergraduate medical curriculum has earned a reputation for being overcrowded. The dilemma for educationalists is to determine what, if anything, can be jettisoned from a congested curriculum to accommodate new ideas or material. Context: We report on a small study that demonstrated that when movies are used innovatively,
they enhance students’ understanding of medicine and also have a minimal impact on the ‘crowded’ curriculum. Innovation: During a 5–weeklong Public Health module students could borrow from the medical school library, free of charge, one or more movies, each with a public health message. In the final week of the module a 1.5–hour-long class was allocated
when each student offered a brief synopsis of a movie that they had watched, and then identified key public health issues discussed in the movie. Implications: Our study supports the view that the creative use of classroom time not only allows for better use of the timetable, but also proves to be an integrative, stimulating, and fun way for medical students to learn.
88 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93
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Student learning was actually enhanced and curriculum time was not compromised
INTRODUCTION
T
he undergraduate medical curriculum is often a packed one, and introducing new material may mean jettisoning or condensing existing content. Paradoxically, in the small study presented here, it was found that by adding material to an existing programme student learning was actually enhanced and curriculum time was not compromised.
THE INNOVATION During a 5–week-long Public Health module students could borrow from the medical school library, free of charge, one or more movies, each with a public health message. In the final week of the module, a 1.5–hour-long class was allocated when each student offered a brief synopsis of a movie that they had watched and then identified key public health issues dramatised in the movie. Our approach differed significantly from other studies that have reported the use of movies in health professional education.1–3 We chose not to show entire movies or extracts in class, did not direct students to any one particular movie and did not identify any specific public health issues in advance. It was the individual student who selected the movie and teased out the issues that they regarded as important.
METHOD Cohorts comprising 14 fourthyear medical students from a total group size of 84 rotated in 2012 through the Public Health module. Data collection incorporated an optional written questionnaire completed in class prior to a focus group discussion, which followed the students’ synopsis of the movies. Ethical approval was granted by the University of Otago. A total of 78 survey questionnaires were completed out of 84
students in the year group (93% completion; Table 1). The comments written on the returned survey forms were scrutinised and then combined with the field notes made by one of the researchers (P.G.) during each group discussion.
RESULTS That nearly 54 per cent of students chose to watch two or more movies when they were obliged only to watch one was notable (Table 1). The majority of students found that they not only reflected upon the messages contained within the movie but also chose to discuss the thought-provoking impact of the movie with their peers. The students reported watching a median of two movies each, and 15 per cent had watched four or more movies by the time the session took place. Viewing alone (49%) and with others (51%) was similarly common. The major barrier reported to watching more than one movie was ‘lack of time’ (60%). Students usually discussed the public health and social issues of the movie with other people (54% for the first movie selected). Other aspects of the movie were also discussed with others (31%). The movie was also described as having a ‘moderate impact’ (‘thought about it between five and 10 times since’)
by nearly half of the students (47%), and 13 per cent even considered the impact to be ‘major’ (‘thought about it a lot and/or it had significant emotional impact on me’). Results were similar concerning impact with regard to the public health and social issues in the movie: that is, 36 per cent reported ‘moderate impact’ and 17 per cent reported ‘major impact’. When asked if watching movies helped medical students learn more about health and social issues, most ‘agreed’ (55%) and a third ‘strongly agreed’ (33%). In terms of the type of movie favoured, there was a fairly even split among factual documentaries (36%), documentaries where the director has an obvious opinion (32%) and dramas that have some plausible real-world aspects (32%). From analysis of the qualitative data it was evident that students considered that watching movies was thought-provoking, encouraged links to be made with other course material and was an enjoyable way to learn. The thought-provoking nature of movies The students were mildly surprised that commercial movies made primarily for entertainment
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93 89
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Watching movies was thoughtprovoking and encouraged links to be made with other course material
Table 1. Results of the anonymous written survey of students on attitudes and behaviours related to movies and books (with public health themes) from the medical school library during 2012 Question (n = number of relevant respondents/responses)*
Response options
%
1. ‘How many movies with public health themes from the medical school library did you watch since the start of the public health run (note: include movies that others loaned but you also watched)?’ (n = 78 respondents)
0
12
1
35
2
28
3
10
4+
15
Lack of time
60
2. ‘If you watched just zero or one of these movies from the library, please circle the main reason why you did not watch more?’ (n = 31 respondents)
Lack of interest
7
Other
34
3. ‘If you watched more than one of these movies from the library since the start of the run, please give the main reason for this?’ (n = 44 respondents)
Entertainment
64
Interest in a specific topic area
32
4. ‘When you watched your first movie from the library collection did you (circle all that apply)?’ (n = 73 respondents)
Watch it alone
49
Watched it with other people
51
5. ‘After you watched your first movie from the library collection which of the following apply? (Circle all that apply).’ (n = 91 responses selected)
I did not discuss it with anyone else afterward
15
I subsequently (hours or even weeks afterwards) discussed this movie and the public health and/or the social issues it raised with other people
54
I subsequently (hours or even weeks afterwards) discussed other aspects of this movie with other people (but not the public health and/or the social issues)
31
6. ‘Regarding the first of the movies you watched from the library since the start of the run, please state the impact it had on you overall.’ (n = 75 respondents)
7. ‘Regarding the first of the movies you watched from the library since the start of the run, please state the impact it had on you with regard to the public health and/or social issues in the movie.’ (n = 76 respondents)
8. ‘In your view does watching movies help medical students learn more about health and social issues?’ (n = 76 respondents)
Other
5
Other
0
Negligible impact (hardly thought about it again)
4
Slight impact (thought about it several times since)
36
Moderate impact (thought about it 5 to 10 times since)
47
Major impact (thought about it a lot and/or it had significant emotional impact on me)
13
Other
0
Negligible impact (hardly thought about it again)
7
Slight impact (thought about it several times since)
37
Moderate impact (thought about it between five and 10 times since)
36
Major impact (thought about it a lot and/or it had significant emotional impact on me)
17
Other
4
Strongly disagree
1
Disagree
0
Neither agree nor disagree
10
Agree
55
Strongly agree
33
90 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93
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Table 1. (continued) Question (n = number of relevant respondents/responses)*
Response options
%
9.’ In your view does providing you with a list of public health related movies seem to be a worthwhile part of the public health run in the fourth year?’* (n = 78 respondents)
Strongly disagree
3
Disagree
2
Neither agree nor disagree
8
10. ‘In your view, what type of movies (albeit all with public health themes, unless otherwise stated) should be in the library’s collection (circle as many as apply)?’ (n = 182 responses selected)
Agree
55
Strongly agree
32
Factual documentaries
36
Documentaries where the director has an obvious opinion (e.g. movies by Michael Moore or movies like ‘Supersize Me’)
32
Dramas that have some plausible real-world aspects (e.g. like Erin Brockovich)
32
None of the above 11. ‘How would you compare watching a movie versus reading a novel (both with public health themes)?’** (n = 78 respondents)
12. ‘With regard to hard copy and e–book novels with public health themes in the medical school library (circle all that apply).’* (n = 76 responses selected)
13. Respondent gender (n = 78 respondents)
Use of movies in medical education can alleviate some congestion in the ‘crowded curriculum’
0
Much prefer a movie
53
Somewhat prefer a movie
22
Fairly similar
21
Somewhat prefer a novel
4
Much prefer a novel
1
I was not aware that these were in the library
54
I was aware of these being in the library but have not read any
42
I have taken out one or more of the hard-copy novels
4
I have taken out the Kobo Reader and read one or more of the e–book novels
0
Female
55
Male
45
Percentages may not total to 100% as a result of rounding. *Initial results for these questions from the first two groups of students (in March/May 2012) were previously published in a letter about e–books.10 **Both with public health themes.
could be so relevant to their studies. One student commented: ‘I enjoyed it [the movie]…it was interesting how public health themes are incorporated into movies’. Making links A student remarked that: ‘It [the experience of watching a movie] was reflective…made me think about the movies and the topic’. Another student believed that: ‘[The movie] made me think about various issues’ and
‘Improved my general knowledge about the subject’.
POSSIBLE LESSONS FOR MEDICAL EDUCATION
Learning can be fun For most of the students their initial motivation to watch a movie was for entertainment value; however, when students reflected upon the content of the movie they acknowledged that the movie had affected them to either a moderate or a major extent: ‘It’s [watching movies] a good way to learn’ and ‘…a very creative approach to teaching medicine’.
We accept that this was a smallscale study and respondents may exhibit social desirability bias in verbal responses (and even in anonymous written responses). Nevertheless, the findings suggest that the careful use of movies in medical education (Box 1) can alleviate some congestion in the ‘crowded curriculum’. Movies can also assist with the integration of subject matter from a
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93 91
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3/6/2014 11:39:51 AM
drug trials and the cost-effectiveness of medical interventions.
The use of movies can provide the potential for the integration of concepts
range of medical disciplines, and for us highlighted the importance of a constructivist approach to adult education. Addressing the crowded curriculum If the method we adopted is replicated, no significant burden would be placed on scheduled classroom teaching. In our study, most of the time involved (i.e. watching and reflecting) was outside of the formal curriculum hours (representing approximately three-quarters of the time spent by students on the movies). Furthermore, the time allocated to feedback and discussion was merely 90 minutes of a conventional ‘9 to 5’ teaching day. Integration Integration in the education of health care professionals is strongly encouraged, and it has
been demonstrated that students pursuing integrated curricula display an improvement in knowledge and skills4; however, conventional and modular degrees, by their very structure, have a considerable propensity for the separation rather than the integration of concepts. What this study suggests is that the use of movies can provide the potential for the integration of concepts by introducing thought-provoking public health and medical issues to students. For example, Motor Cycle Diaries prompted discussion around infectious diseases and the stigmatisation associated with some diseases. Whereas Milk and The Band Played On provoked discussion about health professionals’ attitudes towards patients diagnosed with HIV/AIDS. Those two movies along with The Constant Gardener also provoked discussion around the ethics of
Box 1. Tips for using movies effectively • In addition to adequate topic content (e.g. public health in our study), use established review criteria to help select your movies (e.g. scores from Rotten Tomatoes™) to ensure a minimum level of entertainment value • Regularly review and update your list of movies to help with current relevance • Ask students to suggest additional movies for consideration • Keep each synopsis brief
The importance of constructivism Constructivism is an educational view of learning in which the learner incorporates new knowledge into existing knowledge and experience.5 No two medical students can have exactly the same clinical exposure, and students will be motivated to follow the specific health issues in which they are interested; however, the individualistic nature of learning is not generally replicated in the classroom setting, where experts in the discipline lead the teaching on a predetermined topic. In our study, each student could, out of 25 different movies, select movies that interested them. As the class discussions around each movie developed, the students referred to other subject matter that they had previously learned. Watching Supersize Me produced a wider debate, incorporating blood biochemistry, laboratory testing procedures, obesity, bariatric surgery and nutrition. Sicko evoked a strong debate about pluralist health care systems, the role of family medicine and the expensive nature of pharmaceutical products. Extending the use of movies in medical education Although other medical disciplines sometimes use films in student training, those films are usually ‘training films’ of a technical or professional nature, rather than commercial movies with a primary purpose to entertain. Topics such as medical professionalism and ethics, the portrayal of mental illness, cigarette smoking and alcohol consumption are covered by available commercial movies.6–9
• Allow the discussion to be wide ranging • Ensure minimal input from the facilitator
There is of course no educational reason why other
92 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93
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disciplines could not use commercial movies in the manner that we suggest in our studies. Cancer treatment and palliative medicine come to mind, and there are movies (50/50 and Step Mom) in which those specialties are central to the storyline. It may appear that particular medical specialties are less amenable to the use of commercial movies; however, some authors strongly recommend specific must-see movies for medical students.10 Hallberg was so convinced of the potential that movies have for informing medical education that he posed the following question to faculty members at the University of Minnesota Medical School: ‘Which film or films would you recommend to incoming medical students?’ Nearly 100 of his colleagues responded, and recommended a total of 148 movies. This suggests that there are many movies that could be used across a range of medical specialties.
CONCLUSIONS In this small study we found that the use of commercial movies appears to encourage both independent and collaborative learning, promotes discussion, integrates subjects and is efficient in the use of scheduled class time. Maybe even more importantly, students found this form of learning to be enjoyable, and as one student commented: ‘It’s a great idea, I will be watching some more of the movies on the list during the holidays!’ REFERENCES
4. Supiano MA, Fitzgerald JT, Hall KE, Halter JB. A vertically integrated geriatric curriculum improves medical student knowledge and clinical skills. J Am Geriatr Soc 2007;55:1650–1655. 5. Peters M. Does constructivist epistemology have a place in nurse education? J Nurs Educ 2000;39:166–171. 6. Lumlertgul N, Kijpaisalratana N, Pityaratstian N, Wangsaturaka D. Cinemeducation: A pilot student project using movies to help students learn medical professionalism. Med Teach 2009; 31:e327–e332. 7. Datta V. Madness and the movies: an undergraduate module for medical students. Int Rev Psychiatry 2009;21:261–266.
1. Gallagher P, Wilson N, Edwards R, Cowie R, Baker M. A pilot study of medical student attitudes to, and use of, commercial movies that address public health issues. BMC Res Notes 2011;4:111.
8. Worth KA, Cin SD, Sargent JD. Prevalence of smoking among major movie characters: 1996–2004. Tob Control 2006;15:442–446.
2. Akram A, O’Brien A, O’Neill A, Latham R. Crossing the line–learning psychiatry at the movies. Int Rev Psychiatry 2009;21:267–268.
9. Welsh CJ. OD’s and DT’s: using movies to teach intoxication and withdrawal syndromes to medical students. Acad Psychiatry 2003;27:182–186.
3. Klemenc-Ketis Z, Kersnik J. Using movies to teach professionalism to medical students. BMC Med Educ 2011;11:60.
The use of commercial movies appears to encourage both independent and collaborative learning
10. Hallberg J. 8 films medical students should see. Minn Med 2007;90:28–32.
Corresponding author’s contact details: Dr Peter Gallagher, Medical Education Unit, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: Ethical approval for the study was granted by the University of Otago. doi: 10.1111/tct.12178
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The efficient use of movies in a crowded curriculum Peter Gallagher, Medical Education Unit, University of Otago, Wellington, New Zealand Nick Wilson and Richard Jaine, Public Health Department, University of Otago, Wellington, New Zealand
What can be jettisoned from a congested curriculum to accommodate new ideas
SUMMARY Background: The undergraduate medical curriculum has earned a reputation for being overcrowded. The dilemma for educationalists is to determine what, if anything, can be jettisoned from a congested curriculum to accommodate new ideas or material. Context: We report on a small study that demonstrated that when movies are used innovatively,
they enhance students’ understanding of medicine and also have a minimal impact on the ‘crowded’ curriculum. Innovation: During a 5–weeklong Public Health module students could borrow from the medical school library, free of charge, one or more movies, each with a public health message. In the final week of the module a 1.5–hour-long class was allocated
when each student offered a brief synopsis of a movie that they had watched, and then identified key public health issues discussed in the movie. Implications: Our study supports the view that the creative use of classroom time not only allows for better use of the timetable, but also proves to be an integrative, stimulating, and fun way for medical students to learn.
88 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93
tct_12178.indd 88
3/6/2014 11:39:48 AM
Student learning was actually enhanced and curriculum time was not compromised
INTRODUCTION
T
he undergraduate medical curriculum is often a packed one, and introducing new material may mean jettisoning or condensing existing content. Paradoxically, in the small study presented here, it was found that by adding material to an existing programme student learning was actually enhanced and curriculum time was not compromised.
THE INNOVATION During a 5–week-long Public Health module students could borrow from the medical school library, free of charge, one or more movies, each with a public health message. In the final week of the module, a 1.5–hour-long class was allocated when each student offered a brief synopsis of a movie that they had watched and then identified key public health issues dramatised in the movie. Our approach differed significantly from other studies that have reported the use of movies in health professional education.1–3 We chose not to show entire movies or extracts in class, did not direct students to any one particular movie and did not identify any specific public health issues in advance. It was the individual student who selected the movie and teased out the issues that they regarded as important.
METHOD Cohorts comprising 14 fourthyear medical students from a total group size of 84 rotated in 2012 through the Public Health module. Data collection incorporated an optional written questionnaire completed in class prior to a focus group discussion, which followed the students’ synopsis of the movies. Ethical approval was granted by the University of Otago. A total of 78 survey questionnaires were completed out of 84
students in the year group (93% completion; Table 1). The comments written on the returned survey forms were scrutinised and then combined with the field notes made by one of the researchers (P.G.) during each group discussion.
RESULTS That nearly 54 per cent of students chose to watch two or more movies when they were obliged only to watch one was notable (Table 1). The majority of students found that they not only reflected upon the messages contained within the movie but also chose to discuss the thought-provoking impact of the movie with their peers. The students reported watching a median of two movies each, and 15 per cent had watched four or more movies by the time the session took place. Viewing alone (49%) and with others (51%) was similarly common. The major barrier reported to watching more than one movie was ‘lack of time’ (60%). Students usually discussed the public health and social issues of the movie with other people (54% for the first movie selected). Other aspects of the movie were also discussed with others (31%). The movie was also described as having a ‘moderate impact’ (‘thought about it between five and 10 times since’)
by nearly half of the students (47%), and 13 per cent even considered the impact to be ‘major’ (‘thought about it a lot and/or it had significant emotional impact on me’). Results were similar concerning impact with regard to the public health and social issues in the movie: that is, 36 per cent reported ‘moderate impact’ and 17 per cent reported ‘major impact’. When asked if watching movies helped medical students learn more about health and social issues, most ‘agreed’ (55%) and a third ‘strongly agreed’ (33%). In terms of the type of movie favoured, there was a fairly even split among factual documentaries (36%), documentaries where the director has an obvious opinion (32%) and dramas that have some plausible real-world aspects (32%). From analysis of the qualitative data it was evident that students considered that watching movies was thought-provoking, encouraged links to be made with other course material and was an enjoyable way to learn. The thought-provoking nature of movies The students were mildly surprised that commercial movies made primarily for entertainment
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93 89
tct_12178.indd 89
3/6/2014 11:39:49 AM
Watching movies was thoughtprovoking and encouraged links to be made with other course material
Table 1. Results of the anonymous written survey of students on attitudes and behaviours related to movies and books (with public health themes) from the medical school library during 2012 Question (n = number of relevant respondents/responses)*
Response options
%
1. ‘How many movies with public health themes from the medical school library did you watch since the start of the public health run (note: include movies that others loaned but you also watched)?’ (n = 78 respondents)
0
12
1
35
2
28
3
10
4+
15
Lack of time
60
2. ‘If you watched just zero or one of these movies from the library, please circle the main reason why you did not watch more?’ (n = 31 respondents)
Lack of interest
7
Other
34
3. ‘If you watched more than one of these movies from the library since the start of the run, please give the main reason for this?’ (n = 44 respondents)
Entertainment
64
Interest in a specific topic area
32
4. ‘When you watched your first movie from the library collection did you (circle all that apply)?’ (n = 73 respondents)
Watch it alone
49
Watched it with other people
51
5. ‘After you watched your first movie from the library collection which of the following apply? (Circle all that apply).’ (n = 91 responses selected)
I did not discuss it with anyone else afterward
15
I subsequently (hours or even weeks afterwards) discussed this movie and the public health and/or the social issues it raised with other people
54
I subsequently (hours or even weeks afterwards) discussed other aspects of this movie with other people (but not the public health and/or the social issues)
31
6. ‘Regarding the first of the movies you watched from the library since the start of the run, please state the impact it had on you overall.’ (n = 75 respondents)
7. ‘Regarding the first of the movies you watched from the library since the start of the run, please state the impact it had on you with regard to the public health and/or social issues in the movie.’ (n = 76 respondents)
8. ‘In your view does watching movies help medical students learn more about health and social issues?’ (n = 76 respondents)
Other
5
Other
0
Negligible impact (hardly thought about it again)
4
Slight impact (thought about it several times since)
36
Moderate impact (thought about it 5 to 10 times since)
47
Major impact (thought about it a lot and/or it had significant emotional impact on me)
13
Other
0
Negligible impact (hardly thought about it again)
7
Slight impact (thought about it several times since)
37
Moderate impact (thought about it between five and 10 times since)
36
Major impact (thought about it a lot and/or it had significant emotional impact on me)
17
Other
4
Strongly disagree
1
Disagree
0
Neither agree nor disagree
10
Agree
55
Strongly agree
33
90 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93
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Table 1. (continued) Question (n = number of relevant respondents/responses)*
Response options
%
9.’ In your view does providing you with a list of public health related movies seem to be a worthwhile part of the public health run in the fourth year?’* (n = 78 respondents)
Strongly disagree
3
Disagree
2
Neither agree nor disagree
8
10. ‘In your view, what type of movies (albeit all with public health themes, unless otherwise stated) should be in the library’s collection (circle as many as apply)?’ (n = 182 responses selected)
Agree
55
Strongly agree
32
Factual documentaries
36
Documentaries where the director has an obvious opinion (e.g. movies by Michael Moore or movies like ‘Supersize Me’)
32
Dramas that have some plausible real-world aspects (e.g. like Erin Brockovich)
32
None of the above 11. ‘How would you compare watching a movie versus reading a novel (both with public health themes)?’** (n = 78 respondents)
12. ‘With regard to hard copy and e–book novels with public health themes in the medical school library (circle all that apply).’* (n = 76 responses selected)
13. Respondent gender (n = 78 respondents)
Use of movies in medical education can alleviate some congestion in the ‘crowded curriculum’
0
Much prefer a movie
53
Somewhat prefer a movie
22
Fairly similar
21
Somewhat prefer a novel
4
Much prefer a novel
1
I was not aware that these were in the library
54
I was aware of these being in the library but have not read any
42
I have taken out one or more of the hard-copy novels
4
I have taken out the Kobo Reader and read one or more of the e–book novels
0
Female
55
Male
45
Percentages may not total to 100% as a result of rounding. *Initial results for these questions from the first two groups of students (in March/May 2012) were previously published in a letter about e–books.10 **Both with public health themes.
could be so relevant to their studies. One student commented: ‘I enjoyed it [the movie]…it was interesting how public health themes are incorporated into movies’. Making links A student remarked that: ‘It [the experience of watching a movie] was reflective…made me think about the movies and the topic’. Another student believed that: ‘[The movie] made me think about various issues’ and
‘Improved my general knowledge about the subject’.
POSSIBLE LESSONS FOR MEDICAL EDUCATION
Learning can be fun For most of the students their initial motivation to watch a movie was for entertainment value; however, when students reflected upon the content of the movie they acknowledged that the movie had affected them to either a moderate or a major extent: ‘It’s [watching movies] a good way to learn’ and ‘…a very creative approach to teaching medicine’.
We accept that this was a smallscale study and respondents may exhibit social desirability bias in verbal responses (and even in anonymous written responses). Nevertheless, the findings suggest that the careful use of movies in medical education (Box 1) can alleviate some congestion in the ‘crowded curriculum’. Movies can also assist with the integration of subject matter from a
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93 91
tct_12178.indd 91
3/6/2014 11:39:51 AM
drug trials and the cost-effectiveness of medical interventions.
The use of movies can provide the potential for the integration of concepts
range of medical disciplines, and for us highlighted the importance of a constructivist approach to adult education. Addressing the crowded curriculum If the method we adopted is replicated, no significant burden would be placed on scheduled classroom teaching. In our study, most of the time involved (i.e. watching and reflecting) was outside of the formal curriculum hours (representing approximately three-quarters of the time spent by students on the movies). Furthermore, the time allocated to feedback and discussion was merely 90 minutes of a conventional ‘9 to 5’ teaching day. Integration Integration in the education of health care professionals is strongly encouraged, and it has
been demonstrated that students pursuing integrated curricula display an improvement in knowledge and skills4; however, conventional and modular degrees, by their very structure, have a considerable propensity for the separation rather than the integration of concepts. What this study suggests is that the use of movies can provide the potential for the integration of concepts by introducing thought-provoking public health and medical issues to students. For example, Motor Cycle Diaries prompted discussion around infectious diseases and the stigmatisation associated with some diseases. Whereas Milk and The Band Played On provoked discussion about health professionals’ attitudes towards patients diagnosed with HIV/AIDS. Those two movies along with The Constant Gardener also provoked discussion around the ethics of
Box 1. Tips for using movies effectively • In addition to adequate topic content (e.g. public health in our study), use established review criteria to help select your movies (e.g. scores from Rotten Tomatoes™) to ensure a minimum level of entertainment value • Regularly review and update your list of movies to help with current relevance • Ask students to suggest additional movies for consideration • Keep each synopsis brief
The importance of constructivism Constructivism is an educational view of learning in which the learner incorporates new knowledge into existing knowledge and experience.5 No two medical students can have exactly the same clinical exposure, and students will be motivated to follow the specific health issues in which they are interested; however, the individualistic nature of learning is not generally replicated in the classroom setting, where experts in the discipline lead the teaching on a predetermined topic. In our study, each student could, out of 25 different movies, select movies that interested them. As the class discussions around each movie developed, the students referred to other subject matter that they had previously learned. Watching Supersize Me produced a wider debate, incorporating blood biochemistry, laboratory testing procedures, obesity, bariatric surgery and nutrition. Sicko evoked a strong debate about pluralist health care systems, the role of family medicine and the expensive nature of pharmaceutical products. Extending the use of movies in medical education Although other medical disciplines sometimes use films in student training, those films are usually ‘training films’ of a technical or professional nature, rather than commercial movies with a primary purpose to entertain. Topics such as medical professionalism and ethics, the portrayal of mental illness, cigarette smoking and alcohol consumption are covered by available commercial movies.6–9
• Allow the discussion to be wide ranging • Ensure minimal input from the facilitator
There is of course no educational reason why other
92 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 88–93
tct_12178.indd 92
3/6/2014 11:39:51 AM
disciplines could not use commercial movies in the manner that we suggest in our studies. Cancer treatment and palliative medicine come to mind, and there are movies (50/50 and Step Mom) in which those specialties are central to the storyline. It may appear that particular medical specialties are less amenable to the use of commercial movies; however, some authors strongly recommend specific must-see movies for medical students.10 Hallberg was so convinced of the potential that movies have for informing medical education that he posed the following question to faculty members at the University of Minnesota Medical School: ‘Which film or films would you recommend to incoming medical students?’ Nearly 100 of his colleagues responded, and recommended a total of 148 movies. This suggests that there are many movies that could be used across a range of medical specialties.
CONCLUSIONS In this small study we found that the use of commercial movies appears to encourage both independent and collaborative learning, promotes discussion, integrates subjects and is efficient in the use of scheduled class time. Maybe even more importantly, students found this form of learning to be enjoyable, and as one student commented: ‘It’s a great idea, I will be watching some more of the movies on the list during the holidays!’ REFERENCES
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The use of commercial movies appears to encourage both independent and collaborative learning
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Corresponding author’s contact details: Dr Peter Gallagher, Medical Education Unit, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: Ethical approval for the study was granted by the University of Otago. doi: 10.1111/tct.12178
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