Educating through Movies : How Hollywood Fosters Reflection

Pablo G. Blasco, Mariluz González Blasco, Marcelo R. Levites, Graziela Moreto, James W. Tysinger Brazilian Society of Family Medicine Rua Silvia, São Paulo, Brazil; Philosophy Department Mirasierra Institute, Madrid, Spain; Brazilian Society of Family Medicine, São Paulo, Brazil; Faculty Development University of Texas, Health Science Center, San Antonio, USA. Email: pablogb@sobramfa.com.br, mlgonzalezblasco@educa.madrid.org, marcelolevites@sobramfa.com.br, graziela@sobramfa.com.br, tysinger@uthscsa.edu Received April 14, 2011; revised May 7, 2011; accepted May 20, 2011.


Background: Why Teach with Movies?
Using movies to educate and facilitate reflection among physicians is an important instructional method for medical educators.As children, our parents taught us much through movies, but many medical teachers don't use this method either because they are unfamiliar with it, or are reluctant to use engage in the discussion that is so integral to this approach.Consider how Frank Capra's "It's a Wonderful Life" teaches us about valuing relationships; or Gary Cooper's "Sergeant York" models steadfastly holding onto one's values.This method of using movies to teach was re-discovered by one of the authors at a meeting of Family Medicine educators.At this meeting he and two copresenters, both medical students, showed a movie clip to the session's attendees.After the clip was shown, this author commented on the scene, but was surprised to see his co-presenters crying.Afterwards, he asked: "What was wrong?You already knew what was in this clip, but you had this emotional response when viewing it.Why?" The students responded by identifying a key attribute of this method: "Preparing and previewing the clip is one thing, but watching it here made us think how the content of the clip applies to our lives".
After this experience, the authors started integrating movies into medical talks.Thus, lectures like "Patient-Centered Medicine" and "Leadership Strategies for Medical Students" went from traditional presentations to interactive discussions among faculty, residents, and medical students with movie clips always included.Even lectures specifically developed for faculty also included movie clips.At that point, this same author's academic research which resulted in his PhD dissertation was supported by movies: "Medical education, family medicine and humanism: analyzing medical students' expectative, dilemmas and motivation through a cinema teaching context".Thus, since 2002 the authors' presentations have always contained movie clips.
During the last eight years the Brazilian Society of Family Medicine (SOBRAMFA, www.sobramfa.com.br ) and its close colleagues have spread this cinema-based teaching method in two main venues.One, our presentations at medical meetings like the Society of Teachers of Family Medicine's Annual Spring Conference and the World Family Doctors Organization's (Wonca) meetings have used movies to teach faculty, medical students, and family medicine residents (Blasco, Levites et al., 2008;Blasco, Garcia et al., 2010;Blasco, Mônaco et al., 2010).Two, the authors have used movies while teaching high school students and faculty.
This article describes the authors' movie-based teaching experiences from 2003 to present in workshops with high school students and teachers and faculty development workshops to physicians in Spain, Brazil, Latin America, and Europe.We encourage other medical school and residency faculty to adapt our approach to their particular learners.

From Emotions to Reflection: Movies' Contributions to Education
Technical knowledge and skills can be acquired through training with little reflection; but refining attitudes, acquiring virtues and incorporating values requires reflection.In life, people learn important attitudes, values, and beliefs by observing role models, a process that impacts learners' emotions (Ruiz, 1999).Since feelings exist before concepts, the affecttive path is a critical way to the rational process of learning.Learning through aesthetics-in which movies are included-stimulates learner reflection.
Teaching through humanities includes several modalities in which art is involved.Literature and theatre (Shapiro, 2000), poetry (Whitman, 2000), opera (Blasco, Moreto, & Levites, 2005) are all useful tools when the goal is to promote learner reflection and construct what has been called the professional philosophic exercise.
Using movies in teaching is an effective way to reach people's affective domain, promote reflective attitudes (Blasco, Mônaco et al., 2010;Blasco, Moreto et al., 2006), and link learning to experiences.Teaching using movies triggers disclosing emotions, and this allows questions, expectations and dilemmas to arise for both learners and faculty.Movies provide a narrative model grounded in the learners' familiar world that are framed in emotions and images.
Life stories are a powerful resource in teaching.In ancient cultures, such as classical Greece, the art of story-telling was often used to teach ethics and human values (MacIntyre, 1984).Stories are one reasonable solution to the problem that most people, especially young people, can only be exposed to a limited range of life experiences.Story-telling, theatre, literature, opera, and movies all have the capacity to supplement learners' understanding of the broad universe of human experience.Exposure to life experience-either the real lived one or the one lived through story-provides what Aristotle called catharsis.Catharsis has a double meaning, both of which deal with a human's feelings.One, catharsis means literally to "wash out" the feelings retained in the soul.Two, catharsis implies an organizing process in which the person sorts through, orders, and makes sense of emotions.In short, in the normal course of events people keep their feelings inside, storing them in an untidy fashion, but don't think about them.Catharsis helps empty one's emotional drawers and reorganized them in ways that provide a pleasant sense of order and relief.
Beside this classic concept regarding aesthetic learning, the educator needs to recognize that learners are immersed in a popular culture framed in emotions and images (Ferres, 2000).Emotions and images are privileged in popular culture so they should be the front door in learners' learning process.Life stories and narratives enhance emotions, and therefore lay the foundation for conveying concepts.When strategically incurporated into the educational process and allowed to flow easily in the learning context, emotions facilitate a constructive approach to understanding that uses the learners' own empathetic language.Furthermore, in dealing with the learners' affective domain the struggle in learning comes close to the felt pleasure, and it is possible to take advantage of emotions to identify attitudes and foster reflection over them.Thus, when the subject is emotions, attitudes, and promoting reflection, life histories derived from movies fit well with the learners' context and expectations.
Because they are familiar, evocative, and non-threatening, movies are useful in teaching the human dimension required for a developing personality and for building identity in young learners and confirm teaching roles in their faculty.The movie learning scenario allows teaching points quickly and directly with specific scenes, putting emotions together, and helping the learners immediately understand and recognize issues.Fostering reflection stimulates discussion about the breadth of human experience and this discussion often elicits profound conflicts and concerns learners have about their future professional roles and personal lives.
In addition, learners have the opportunity to "translate" life stories from movies into their own lives.In this way movies create a new learning process, and through it learners integrate learning into their lives.The movie experience acts like emotional memory for learners' developing attitudes and allows them to proceed through daily activities.
Real learning has more to do with the affection and love teachers invest in educating people that with theoretical reasoning (Palmer, 1998).To educate through emotions doesn't mean to limit learning about values and attitudes exclusively in the affective domain.The point is to provoke students to reflect on those values and attitudes (Blasco & Alexander, 2005) To impact emotions is the short-cut for reaching learners, a type of track for taking-off and moving deeper afterwards.Besides the specific knowledge students must master, learners must refine attitudes, construct identities, and develop personalities.Fostering reflection is required to do this.
Teaching reflection is a goal for excellent educators who want to move beyond transmitting subject matter content.These faculty view teaching as fostering learning, and they believe that they will better understand their students and the nature and processes of learning if they can create more supportive learning environments.The best teaching is often both an intellectual creation and a performing art, and teaching is conceived by excellent educators as the opportunity to create good learning environments (Bain, 2004).Therefore, excellent teachers develop their teaching skills through constant selfevaluation, reflection, the willingness to change, and the drive to learn something themselves (Palmer, 1998).Teaching with movies is an innovative method for promoting learning that education requires today.

Preparing for the Presentation
Although this movie-based educational methodology was positively received by Brazilian medical students and faculty, we wondered if the approach would also work with people from different cultures and educational and social backgrounds.Language barriers also concerned us: We use American movies with subtitles in Portuguese that almost no one in these settings could read.Thus, before every presentation we asked: "Will this approach work with this audience?" We consider two variables when planning a presentation: The number of people in the audience and the amount of teaching time available.Experience has taught us that a small audience (e.g., 30 people) and a larger time period (e.g., 2 hours) is the best scenario for a workshop that uses movie clips.However, the method can also work with a larger audience (e.g., 100 people) and a shorter time period (e.g., 1 hour), but we adapt by giving a shorter lecture using fewer movie clips to stimulate discussion.
Next, we consider our presentation attendees.Who are they, and why will they attend our session?If the audience is small (e.g., less than 30 people) and have enough time, we ask attendees individually what they want to gain from the session.Some people attend because they have heard about our teaching methodology and want to learn more; others just love watching movies, and those who already use movies in their teaching want to compare their approach with ours.If the audience is large and the presentation time brief, we write potential responses on a flipchart and ask people to raise their hands when the response that matches their reason for attending is read aloud.In each situation, the audience feels comfortable in sharing what they want to hear and learn.

The Strategy for Planning the Session, Selecting Movie Clips, and Making Comments
We start each session by briefly introducing the facilitators and stating the session objectives.For the next 20 -30 minutes multiple movie clips are shown in rapid sequence with a facilitator following each with focused comments.A discussion follows with the audience asking questions and sharing their reflections, feelings, and thoughts.If the audience is large and we have enough time, we break the audience into small groups to encourage discussion.At the end of the session the small groups reform into the large group, and a spokesperson from each small group will share the topics discussed in his/her group.
Selecting the movies and specific scenes on a specific topic to stimulate discussion and adapting the movies to the audience or to the topics being presented takes experience.Our basic guidance: Insure the clips relate to your presentation's objecttives.For a broad selection of movie clips, we refer readers to several papers we have published (Blasco, Moreto et al., 2006;Blasco, Garcia et al., 2010;Blasco, Pinheiro et al., 2009).However, presenters must adapt their comments to the specific audience.Adapting to the audience requires facilitators to understand the people to whom they are speaking and to reflect on the clips before framing their comments.The point is to promote participant reflection on attitudes, human values from a broad perspective.The comments that really stimulate reflection are those based on the audience's response to the clip being shown.

What Happens in the Session? Is It All about
Tears or Is There Reflection?
Emotions can be seen on the participants' faces as they view the movie clips and hear the facilitators' comments.Sighs are heard, handkerchiefs appear, and some people are seen crying with no shame as room lights are turned on.People from both genders, including facilitators, cry.Sometimes everyone is moved and in tears.Fostering reflection is next.
"Fostering reflection" is the main concept noted in all evaluations from the audience.The whole process-brief movie clips along with the facilitator's comments-stimulates reflection.While the clips' quickly changing scenes evoke concerns and reflection in individual audience members, the facilitators' comments amplify the whole process.Because each member of the audience is involved in her personal reflective process, she/he may agree or disagree with the facilitator's comments and draw their own conclusions.This is a desirable outcome once participants note that divergent comments are desired to facilitate reflection.

Understanding Audience Feedback and Making Connections
The value in teaching with movies is reinforced through the audience's feedback.Analyzing data from participants (i.e., comments through field notes and session evaluations, interviews and written assignments) have helped us see the value of teaching with movie clips.Since it is well suited for such an analysis, we use a qualitative approach to analyze this data.
Qualitative analysis is useful for researchers who understand their discipline as more empirical and craft-based than theoretical (Crabtree & Miller, 1999).This is especially true when the session objectives deal with emotions, attitudes and professional values.Qualitative designs are flexible, iterative, and continuous.Good qualitative research is always more of a circular process than a linear one.The ultimate canon of evidence in any qualitative research is that the report carries "sufficient conviction" to enable others to obtain the same results and appreciate the account's truth as the original observer.Discussion and focus group are one of the features of qualitative research.The goal of a discussion group is to gather information based on the participant's interaction, not to build consensus or aid decision-making.Through an interactive exchange among the participants, multiple stories are produced, diverse experience related, similarities and differences emerge, and contrary opinions can be explored to generate new areas of inquiry.Thus, a qualitative approach is well suited for analyzing the data and identifying the results from the movie clips and educational experiences.It must be said that the results include the researchers' interpretation of notes and records of what was observed.As the literature states, "the researcher is the primary research tool, so it is essential to include his/her feelings and reflections over the analysis.The experience had in the field is not merely observed and recorded, but is also felt.Reflection on feelings is essential (Crabtree & Miller, 1999)".
Audience feedback consists of ratings (e.g., "The presenters allowed me to interact with others": 5-point scale ranging from "strongly disagree" to "strongly agree") and comments made in response to specific questions.When analyzing audience comments, we divide the data into two specific groups: Learners and faculty.If necessary, each group can be further divided into other units (e.g., medical students, first year residents, second year residents).Here comments from high school students and faculty are included to illustrate key themes.

Comments from High School Students
Young people today live in a dynamic and sensitive environment characterized by rapid information acquisition and high emotional impact.Movies provide a quick and direct teaching scenario that accesses their emotions. "If I were a teacher, I would try to improve communication with my students and reach their emotions, touching them since in this way they will grow up like human beings.
There is a barrier between teachers and students, and we need to go further than (subject matter) content to overcome this barrier.We need to reach peoples' heart for providing good education".(Student's quote) (Sq).Students want more practical education: Not just theoretical content, but concepts connected with reality.They want room for more creativity.Education must foster their creativity and imagination. "When Aristotle and Plato talk about education they focus it on the person.It is a kind of education for life, education for relationships, for citizenship in society.Teachers need to help us grow up and develop as people instead of just focusing on learning issues, content…" (Sq). "There is a problem with (subject matter) content.And that is students are unable to find out how such content will help them.There is a gap between theoretical issues and real life.
Students must understand why the content we are taught is really useful for us."(Sq).We strive to help students reflect, rather than to show them how to incorporate a particular attitude.High school students exposed to this method often change their attitudes. "You need to get students motivated the right way, get them involved somehow."(Sq). "What really matters in education is to foster people's development as human beings.We need to value the person more than content.In this way we can get from them the best they have in their minds."(Sq).
The movie clip method is used to direct student attention to professional attitudes and to produce leaders.Showing movie clips fits well with the dynamic and emotional nature of students' lived experience.In this context using movie clips to teach is logical because they are brief, many can be shown quickly, and they impact the emotions.From factors related to career choice, idealism, unspoken vocational doubts; students move to a more reflective attitude in choosing their professional careers, become more committed to their career choices, and recognize that the movie discussions make them aware of struggles they could not articulate before. "Maybe one of the best outcomes in education is to accomplish what happens in the 'Lion King' movie clip we saw a few minutes ago.Teachers should get students to look inside, like the Lion King, and to find their own motivations to take their place in the circle of life.When you find your own motivations, they are more powerful and stronger than motivations coming from the outside."(Sq).

Comments from Faculty
Faculty groups often come anticipating this methodology, and their expectation are supported.That is, faculty realize they can improve their teaching strategies to reach students more efficiently. "I was told about the informal curriculum, and they said it works fine among the students.How can I be more credible to my students and help them more?Must their teachers have special skills?"(Faculty quote) (Fq). "What can we do when we are short of time, have a lot of work to do, too many students, and can't give them good feedback?Is there any short-cut I can use?Am I missing something in this?Maybe we don't reach the students because we don't understand them.How can we ask them the right questions?" (Fq).Faculty face challenges when they teach alone.Even when they discuss educational issues with their colleagues, they often spend most of this time talking about problematic students.Faculty seldom think about themselves and usually lack the time to disclose their feelings before encountering new challenges.When searching for excellence in teaching, one's fellow teachers are useful resources.After all, our colleagues can teach us a great deal about ourselves and our craft. "We need to meet and get in touch with each other, before we start teaching.And the teaching session we just finished showed us how to do this in a fun way.We get to grow in our relationships.(…) We have limited time to reflect on our teaching endeavors" (Fq). "I want to be comfortable in teaching, teach well, know my colleagues, and feel supported by them.(…) We can set an informal group to continue these reflections on teaching.Nothing official, but a good informal get-together for mutual support.(…) This workshop at the very beginning of the year, in advance, is a good start."(Fq). "Get common ground among us.Be positive, and we will try to reach consensus in each meeting.(…) We need to share the outcomes: the good ones, what is working, and the bad ones, what is not working (...) We also need to learn to value an individual's success.If we get a few faculty involved, we could achieve much more because the news about having a reflective environment spreads quickly.(…) Cooperation and service: We must get the faculty to adopt these attitudes as a team."(Fq).Movie clips offer faculty a special environment for fostering open discussions that help them better know themselves, improve their self awareness, and develop closer relationships with colleagues and students through the affective domain.Thus, the process helps faculty become more reflective: They begin by sharing their weaknesses and frustrations as teachers and asking why they lose energy and ideals. "We are ashamed of sharing our feelings, frustrations, and expectations.We don't talk about what really matters, those major issues that really concern."(Fq)  "We can't cope with our frustrations and bad results with the students.And we don't talk about out bad outcomes because we have no room for it.All we talk about is problematic students, not about our failures."(Fq)  "What gets me down is to lose my ideals, I mean, my enthusiasm for teaching."(Fq). "My doubts are not just mine: They are others' doubts, too.
We need to share knowledge and methods."(Fq).The clips help faculty state new paradigms, gain skills that help them better communicate with learners, and recognize the need to better know themselves so they can facilitate learning. "We are teaching in the same way we were taught.And that might change in these sessions."(Fq) There are many ways to reach my students.And there will always be students we can't reach."(Fq). "What first matters is the human side of students (…) We need to love and have fun while communicating something: That's teaching.Improving the way I communicate is like that."(Fq). "I wish I had words for this.I have just emotions (...) I need to look inside me to be a better teacher.And for now, there is a challenge: To be divided no more, so I am the same person in life and as when I teach."(Fq). "The teacher's role?To foster reflection, that's the cornerstone.And to share our expectations and dilemmas with the students.They are grown people."(Fq).Finally, there are always major questions that call for answers.The movie clip education method is an opportunity to pose these inquiries so faculty can reflect on them.That is the method's good outcome: Ongoing reflection. "How can I be effective with all my students?How do I get to know them?How do I get them involved and committed to solving educational problems?How can I have the student on my side?" (Fq). "Could I reach my students through emotions?How do I motivate them?How do I better communicate with them?How do I measure the outcomes in all this?" (Fq). "Am I losing my ideals?Are we afraid of innovation?
Could we, as faculty, share experiences and disclose ourselves?How can this workshop be a starting point and that gets us to engage in reflective practice?"(Fq).

Summary
Movie clips are useful resources for teaching medical students, residents, and faculty because they help people better understand human emotions.The learners' emotions easily emerge through movies, and faculty can impact learning by broadening their perspectives of learner development.Likewise, faculty use their own emotions in teaching, so learning proper methods to address their affective side is a complementary way to improve their communication with students.
.  "For sure, what really matters in education is what we do, more than what we say.We teach what we are.(…) Raise your flag, don't say anything.Attitude is the best resource for a leader."(Fq). "That's the main faculty role: Foster reflection, help students find their gifts and use them properly.(…) Don't ask students for what you are not ready to give them.Get the best from them.This is what we must do all the time as teachers."(Fq). "Students are the principal characters in education.So the Oscar for best actor and actress always should go to them, not to the teacher.A good teacher deserves the Oscar for the best supportive actor or actress.Not more than that."(Fq). "Throw out the schedules (like in that movie, with the chessboard without pieces)… Maybe schedules and syllabi impede good teaching."(Fq).The movie clip method can improve faculty teaching and stimulate their professional growth.The clips point out solutions and challenges they want to face to refine their teaching role. "We need much more simplicity.Be realistic, and just start improving what we already have.(…) And, for sure, work with patience and learn how to wait.I like that expression: 'watchful waiting'."(Fq). "What really matters is not my subject matter, but the concepts that interest students.(…) The best outcome for me: