Everyone loves a good movie, and doctors are no exception. So when health educators wanted to teach young doctors how to recognize and deal with patients' emotions, they hit on the idea of showing them clips from mainstream films. They call it "cinemeducation."
The clips and suggestions for how to use them in teaching have been collected into a book edited by Matthew Alexander, professor of family medicine in North Carolina.
"Doctors are usually more interested in learning how not to kill people than in recognizing their psychological state," Alexander says.
Teaching behavioral sciences that include normal developmental issues, common mental-health problems and the doctor-patient relationship is a challenge for educators because the students often fail to see its importance.
My own experience as a doctor certainly bears that out. When I was a pre-clinical medical student in the 1980s, only creeps and losers went to sociology and psychology lectures. Most of us bunked off and sat around in the canteen moaning about how much revision we had to do. We meant revising the "real" subjects -- biochemistry, anatomy and physiology. After two years of basic science teaching, we were let loose on the wards. We trailed around in large groups behind dictatorial consultants, gathered round the bedsides of patients too tired to protest and had questions fired at us by the consultant.
Public humiliation of those who didn't "get the diagnosis" was the teaching method of choice.
Twenty years on, I remember very little of the basic sciences I was taught. From the consultant teaching on the wards, I learned how to avoid eye contact so I wouldn't be asked any questions. And I noticed that most senior hospital doctors had such poor communication skills that they would never get a job in the real world. I had no teaching at all on difficult topics such as how to break bad news to people. My first experience of that was a lone junior doctor on a cancer ward, having to tell the family of a 42-year-old man that he had died in the night.
My one abiding regret about my time in medical school is that I didn't engage with the very limited amount of teaching that was on offer about the social and psychological factors that contribute to ill health.
Today's medical students get far more structured teaching about communication skills than we ever did. And the young students who come to our general practice to learn how we do things seem more aware of the patient as a whole person rather than a set of diseases.
But I still notice that they tend to glaze over when we discuss issues, attitudes, ethical dilemmas and feelings that medical consultations often engender. Give them a succinct list of five common causes of a chronic cough or an easy mnemonic to remember the symptoms of tuberculosis and they beam with delight. Test them on the different types of heart murmurs or watch them examining a knee, and they'll eat out of our hands.
They tend to be very nice and bright young people and most of them have reasonable social skills. But some have already picked up bad habits from their time in hospital. Some students fail to introduce themselves, or forget to ask the patient whether they mind talking to them before seeing the doctor. Others don't ask the patient's name and then refer to them as "he" or "she." Some don't listen properly to the patient, while others talk in "medispeak" and fail to offer a translation.
Challenging students' behavior and attitudes can be very difficult for the doctors who are supposed to be educating them.
Alexander's book, Cinemeducation: A Comprehensive Guide to Using Film in Medical Education, is a fantastic teaching tool. It lists 400 specific scenes from 125 movies and suggests trigger questions that you can discuss with students after watching the clip. You can show the clip without sound and discuss what's happening to show students how much information you can get from non-verbal cues. Film clips can show powerful emotions, portray difficult ethical dilemmas, expose students to cultural traditions they may not be aware of, and highlight what it is like to live with a chronic disease or face death.
Cynics will say that movies deal in stereotypes and fantasies and not in the real world. You may find it worrying to think that your doctor is examining you while thinking of the latest Quentin Tarantino film. And you may think that discussion based on film clips will be trite and superficial. Perhaps, but any discussion is better than none. And you have to give the students a bit of credit for being able to separate fact from film. I've had a lot of contact with doctors recently from a patient's point of view. Most of them could do with getting out of the hospital and into the cinema a bit more.
It might do wonders for their communication skills.
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