Beyond Facts and Psychomotor Skills New Methods in Teaching Family Medicine by hongkonguniv

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									The University of Hong Kong Ap Lei Chau Clinicl September 14, 2004 Hong Kong

Beyond Facts and Psychomotor Skills
New Methods in Teaching Family Medicine
Ryuki Kassai, MD, PhD(DClSc) The Hokkaido Centre for Family Medicine Caress Alliance Medical Corporation Muroran, Hokkaido, Japan
ryukikas@nikkomhp.dp.u-netsurf.ne.jp

Objectives of learning and teaching
In becoming physicians, students pass through 3 phases
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Gaining technical competence in dealing with disease
Developing a professional identity

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Learning to heal
(Weston WW & Brown JB, 1995)
The Hokkaido Centre for Family Medicine: R Kassai 2004

The light and the darkness
Who, in later times, will be able to understand that we had to fall again into the darkness after we had once known the light?
SEBASTIEN CASTILIAN: De arte dubitandi 1562.

The healer and the healed
Oe explores how his family's care of Hikari and his own writing about his life with Hikari have brought him personal healing. Thus, Oe’s works and life show us that the roles of the healer and of the healed can coexist within one person.
(Taylor ND & Kassai R: Lancet 1998)
The Hokkaido Centre for Family Medicine: R Kassai 2004

Every word is part of a picture. Every sentence is a picture. All you do is to let your imagination connect them together.
-from the movie, “The Mighty”

Cinemeducation
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encountered at the ABSAME’s Annual Conference in1994 in Santa Fe. Matthew Alexander, PhD “Cinemeducation: an innovative approach to teaching multi-cultural diversity in medicine.” innovative use of movie clips to educate multicultural aspects conducted Cinemeducation to deepen our understanding of cross-cultural issues, and to evoke imagination, empathy, power and narrative
The Hokkaido Centre for Family Medicine: R Kassai 2004

What is Cinemeducation and how is it conducted?
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small group of trainees (5-10 persons)
consists of two parts:
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watching each movie clip together with a group of trainees facilitating discussion as to what the trainees have observed in the clip

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The Hokkaido Centre for Family Medicine: R Kassai 2004

What is Cinemeducation and how is it conducted?
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select and prepare movie clips
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a part of a popular movie 5-10 minutes long

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contain >1 theme
“impact of illness”, “death of a family member”, “aging”, “divorce”, “acceptance and empathy of impairment”, etc.

The Hokkaido Centre for Family Medicine: R Kassai 2004

What is Cinemeducation and how is it conducted?
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do not tell the themes of the clips beforehand
explain a brief plot of the movie to understand the context discussion session
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open discussion first focused discussion afterward ask to find titles (i.e., themes) of the clips

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30 minutes with one clip (60 minutes with 2)
The Hokkaido Centre for Family Medicine: R Kassai 2004

Cinemeducation
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Ikiru (To live) (1952)
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Directed by Akira Kurosawa Written by Shinobu Hashimoto, Akira Kurosawa, Hideo Oguni Starring Takashi Shimura Kanji Watanabe is a longtime bureaucrat in a city office who, along with the rest of the office, spends his entire working life doing nothing. He learns he is dying of cancer and wants to find some meaning in his life.
The Hokkaido Centre for Family Medicine: R Kassai 2004

Ikiru (To live)

The Hokkaido Centre for Family Medicine: R Kassai 2004

Cinemeducation
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Lorenzo’s Oil (1992)
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Directed by George Miller Written by George Miller & Nick Enright Starring Nick Nolte, Susan Sarandon A boy develops a disease so rare that nobody is working on a cure, so his father decides to learn all about it and tackle the problem himself.

The Hokkaido Centre for Family Medicine: R Kassai 2004

Lorenzo’s Oil

Cinemeducation
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Lorenzo’s Oil (2)

The Hokkaido Centre for Family Medicine: R Kassai 2004

Lorenzo’s Oil (2)

Cinemeducation
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Mrs. Doubtfire (1993)
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Directed by Chris Columbus Written by Anne Fine, Randi Mayem Singer Starring Robin Williams, Sally Field How far would an ordinary father go to spend more time with his children? Daniel is no ordinary father, so when he learns his ex-wife needs a housekeeper, he applies for the job. With the perfect wig, a little makeup and a dress for all occasions, he becomes Mrs. Doubtfire, a devoted British nanny. Daniel creates a whole new life with his entire family.
The Hokkaido Centre for Family Medicine: R Kassai 2004

Mrs. Doubtfire

Cinemography
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Ikiru (To Live)
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Doctor gives a diagnosis of gastric ulcer to a patient who believes he has cancer. <truth telling> 0:18’04”~0:29’23” Family cannot tolerate the diagnosis of a malignant disease. <impact of illness>
0:11’13”~0:16’15” 0:13’02”~0:20’44”

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Lorenzo’s Oil
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parents.
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1:38’13”~1:48’07”

Doctor gives the diagnosis of ALD to patient’s <impact of illness; family suffering> Father calls his friend to heal his sick son. <healing power>

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Mrs. Doughtfire
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Divorced couple find a solution to take care of their children. <definition of family>
1:51’45”~2:00’30”
The Hokkaido Centre for Family Medicine: R Kassai 2004

Cinemography
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Akahige (Red Beard)
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0:08’39”~0:12’00” New

time.
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trainee meets his preceptor for the first <classical Japanese apprenticeship> <mentorship>

2:57’13”~2:58’52” The

trainee decides to stay with his preceptor.

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On Golden Pond
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1:40’35”~1:46’44” An

wife.
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old man has an angina attack in front of his <aging; death and dying>

Children of a Lesser God
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1:48’20”~1:55’00” Teacher

and his deaf and dumb girlfriend find a way to understand each other. <finding common ground>
The Hokkaido Centre for Family Medicine: R Kassai 2004

Cinemography
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In Country
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1:40’01”~1:54’50” Daughter,

mother and brother of a dead soldier visit to the war memorial park. <grief work in family> and daughter have different expectations of education. <conflict in family> Mother and daughter find it difficult to understand each other.
0:40’29”~0:45’51” 0:34’34”~0:40’27” Mother

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The Joy Luck Club
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<generation gap; multi-cultural diversity>
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listens to a story of her mother’s hardship during the war. <family reunion; hope>
The Hokkaido Centre for Family Medicine: R Kassai 2004

2:01’22”~2:08’25” Daughter

Teaching objectives
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a variety of objectives can be set

excellent teaching method of NBM
NBM requires the ability to use proper words, phrases, sentences and stories

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many emotions arise w/o any corresponding narrative
find narrative to explain our own emotions to others different narrative to describe the same emotions share the common narrative (image/metaphor/symbol) “finding common ground” in the patient-centered

clinical method.
The Hokkaido Centre for Family Medicine: R Kassai 2004

Patient-centered clinical method
(Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. 2003)

(1) Exploring both disease and illness experience
Cues and prompts Disease History Physical Lab Illness Feeling Ideas Function Expectations

(2) Understanding the whole person
Disease Person

(3) Finding common ground
- problems - goals - roles

Illnes s Proximal context Distal context

(4) Incorporating prevention and health promotion

Mutual decisions

(6) Being realistic

(5) Enhancing the patient-physician relationship

Patient-centered clinical method
(Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. 2003)

(1) Exploring both disease and illness experience
Cues and prompts Disease History Physical Lab Illness Feeling Ideas Function Expectations

(2) Understanding the whole person
Disease Person

EBM

NBM

(3) Finding common ground
- problems - goals - roles

Illnes s Proximal context Distal context

(4) Incorporating prevention and health promotion

Mutual decisions

(6) Being realistic

(5) Enhancing the patient-physician relationship

Sevenfold rationale for Cinemeducation in family medicine education
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capture a trainee’s attention
broaden trainees’ awareness of diverse life-styles engage the humanistic side of physicians imprint powerful pictorial images in memory time efficient to generate meaningful discussion emotionally engaging experiences for preceptors and trainees movie clips as windows to explore the life
The Hokkaido Centre for Family Medicine: R Kassai 2004

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Pitfalls to avoid
discussion should not be led to the one single goal films’ copyright protection

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powerful emotional reactions from unresolved issues in their own lives

The Hokkaido Centre for Family Medicine: R Kassai 2004

How to evaluate Cinemeducation
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no systematic approach to evaluate Cinemeducation yet describe experience with Cinemeducation as feedback

Cinemeducation can be considered as a good module to
teach and learn patient-centered medicine through art, humanity and NBM

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innovative methods to evaluate the process and outcome of Cinemeducation are to be explored further

The Hokkaido Centre for Family Medicine: R Kassai 2004

Looking for an innovative method

Not everything that can be counted counts and not everything that counts can be counted.
-ALBERT EINSTEIN

The Hokkaido Centre for Family Medicine: R Kassai 2004

17th World Conference of Family Doctors October 13-17, 2004 Orlando, USA



Workshop

“Cinemeducation: A Teaching Module

for Patient-Centered Medicine”

The Hokkaido Centre for Family Medicine: R Kassai 2004

Cinemeducation: A Teaching Module for Patient-Centered Medicine
objectives
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to share the teaching experiences with this kind of module among the participants to exchange ideas on how to improve our teaching with it to formulate a network for further information and activities

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The Hokkaido Centre for Family Medicine: R Kassai 2004

Cinemeducation: A Teaching Module for Patient-Centered Medicine

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expected participants
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teachers (at any level) in family medicine around the world who are keen to implement art and narrative into their teachings.

The Hokkaido Centre for Family Medicine: R Kassai 2004

Cinemeducation: A Teaching Module for Patient-Centered Medicine
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contents of the workshop
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introduction of the workshop and self-introduction among the participants [15 min] demonstrate a Cinemeducation session by using a Japanese movie clip [30 min] discussion [30 min]. review and evaluate the workshop [15 min]

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proposal of an international teachers’ network to develop this field of education in family medicine
The Hokkaido Centre for Family Medicine: R Kassai 2004

Cinemeducation: A Teaching Module for Patient-Centered Medicine
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discussion
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methodology difficulties and pitfalls

cross-cultural consideration
evaluation methods participants’ experiences

other potential modules for teaching of art and medicine, medical humanities and narrative-based medicine
The Hokkaido Centre for Family Medicine: R Kassai 2004

Thank you very much!
WONCA 2005

See you all again in…

October 13-17, 2004 Orlando, U.S.A.
and

May 27-31, 2005 Kyoto, Japan
The Japanese Academy of Primary Care Physicians


								
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