**4. Teaching with movies to foster reflective practice**

A film is the favored medium in our current culture, teaching with cinema is particularly well-suited to the learning environment of medical education. Cinema is the audiovisual version of the narrative, framed in emotions and images. A reality very close to the language of the student who is inserted in this emotional and visual culture and which makes it easier for him to enter the world of his interlocutor: the patient, with all the circumstances that surround him.

We know of the pedagogical power of narratives, something secular that comes from classical Greece, where stories were resources to teach ethics and values [68]. Cinema, illustrating stories in a modern way, helps to expand life experiences, to get to know the human being. On the other hand, film stories act as a catharsis of emotions - something that Aristotle already warned with stories in Greek education. Emotions are revealed, brought out, and capable of being sorted, educated, through reflection. This is the core of the use of cinema in the education of affectivity.

Cinema provides a fast and straightforward teaching setting [69]. The scenes suggest important issues, emotions appear, students can better understand the universe of affection, which is often tumultuous. It is common for them to transport the projected scene to their own reality, to their own lives, because they act as an emotional wake-up call that evokes daily realities, not only from the medical learning environment, but from life itself. And in the same way, the experiences they have in the pedagogical environment with cinema are then taken to their daily lives, as a resource that helps to remember all that learning. Cinema, therefore, works as an emotional alarm that facilitates the student's posture in analogous situations they face in their daily lives.

For teaching ethics, we can follow the rational method, approaching the theoretical basis to refine attitudes, acquire virtues and incorporate values. But this classic method of medical deontology classes finds an alternative path when using films. In cinema, the examples are accompanied by a strong emotional charge, leading the viewer to accept or reject that attitude presented. Reflection also accompanies this experience; and from reflection comes the desire to incorporate an attitude, not just intellectually, but beginning from emotions as a starting point. When individual reflections are amplified by facilitated discussion, the motivations, and incentives in the construction of ethics also grow in the group of students.

This learning scenario stimulates learner reflection. In life, important attitudes, values, and actions are taught using role modeling, a process that impacts the learner's emotions. Since feelings exist before concepts, the affective path is a critical shortcut to the rational process of learning. While technical knowledge and skills can be acquired through training with a little reflection, reflection is required to refine attitudes and incorporate values. As already explained, this methodology with the cinema does not intend only to provide "sentimental, emotional education", but to provoke reflection that leads to incorporating attitudes. Reflection is, without a doubt, the bridge that allows the transition from emotions to attitudes. This universe is not limited to the solution of purely medical issues, but it reaches out to life, awakens desires for integrity. Education with cinema does not intend to offer results - something like the moral of the fable, to show the right way to behave - but rather to provoke the reflection that leads to lasting attitudes [70]. To foster reflection is the main goal in this cinematic teaching set. The purpose is not to show the audience how to incorporate a particular attitude, but rather to

#### *Reflections in Medical Education: Empathy, Emotions, and Possible Pedagogical Resources… DOI: http://dx.doi.org/10.5772/intechopen.101832*

promote their reflection and to provide a forum for discussion. And this works for any kind of audience, despite cultural background or language [71].

This is possible when reflection and discussion are allowed in the pedagogical environment where cinema is instituted. Doubts and dilemmas often emerge about the professional role, ethical attitudes, reporting of good examples – and some that are not edifying- for which the student usually does not have space in the curriculum. It is precisely this attitude, thinking and reflecting relentlessly, and not giving in to mediocrity, that Hannah Arendt suggested as prevention so as not to fall into the banality of evil [72].

Film education is also useful for continuing training with doctors, so that they learn to deal with their own emotions. Little attention is paid -both in the undergraduate and graduate curriculum space- to the education of emotions. When emotions -especially negative ones- are not ventilated and dealt with, the most common is to assume an attitude of emotional closure with the patient, a distance that leads to a lack of competence in care and destroys professionalism [73].

Cinema offers a wide range of possibilities for learning to deal with negative attitudes and values. Without necessarily solving dilemmas, it offers the opportunity to reflect calmly, with emotional detachment. The film allows us to go beyond illustrations of theories and principles so that we can develop a range of emotional and interpretive skills, including habits of the heart. Discussions among colleagues are exciting and enriching that make us reflect on who we are and who we want to be [74].

In this sense, film, like art, can affect the root of our being. Using film clips in a structured way allows for new opportunities in ethics education. Here comes the specific methodology using movie clips.

#### **4.1 The movie clip methodology: using wisely short time teaching**

Which movies are useful for teaching this or that point? This is a common question people ask. The answer could be something like this: "What you get out of a film often depends upon what you bring to it". Useful movies for teaching whatever you want, are those that are valuable to you, those that touched you and lead you to reflect. I can share what movies touched me and why, but I am not able to say what will impress you and be part of your life. When a movie seems remarkable for the educator, we always find a way to incorporate our teaching set. So, you need to build your own experience before sharing it with your audience. Keep in mind what you want to teach, the specific ethical dilemma.

Although, in education with cinema some use medical films-as a case discussion- it is not the usual pedagogical resource that we are discussing here [75], Our goal is to go beyond the medical scene to immerse into the human reality, where attitudes, emotions and responses emerge. Therefore, it is not medical-themed films that we have used the most in our pedagogical scenario. However, the "translation" of human problems to the medical environment is done with enormous facilities by students.

Do you use a whole movie or just some scenes? Here comes another usual question. The answer depends on what you want to point out, the time you have at your disposal, and the outcomes you expect. Our experience affirms the effectiveness of using the movie-clip methodology in which multiple movie clips are shown in rapid sequence, along with facilitator comments while the clips were going on [76]. Using clips with scenes from different movies is, in our experience, more profitable than projecting entire movies. Besides, the time available is not always a lot. With a few minutes, it is possible to raise many questions, all saturated with emotions, when the clips are used with agility. The facilitator's comments enhance the reflection, amplifying it. They are not an obstacle to following the scenes presented, but, in our experience, they function as a resource that facilitates shifting the reflection from the clip's report to life itself. As someone in the audience once commented: "the comments are not about the film, nor about the teacher's experience... It's something that goes in between and touches our lives".

The comments are not sought for student agreement, but only intended to provoke individual reflection. In essence, the facilitator's comments are their own reflections made aloud.

The most used resource in our experience are scenes from different films, with varied themes, which when presented together provoke a real flood of emotions. They are not projected according to a thematic background, but varied, showing a wide spectrum of attitudes. The joint reflection and discussion about this collection of scenes are what causes the real learning. Several previous publications have covered the methodology in detail, and the appendix of many of them contains a list of films, with suggested scenes to be used and comments [77].

Proving the effectiveness of this methodology is something that often arises in the academic community, especially in international congresses and various presentations. It should be remembered that excellent education does not imply measuring -with the usual metrics- all pedagogical tools. It is known that many of the so-called "intangible themes" are difficult to assess, although it is possible to see the results. Thus, themes such as empathy, ethics, compassion, and commitment -which are factors of professionalism- can be pointed out and promoted with the resource of education with cinema. Without a doubt, esthetic education -this is the core of the humanities- necessarily completes the education of physicians. They are, in Pascal's words, "the reasons of the heart, which reason is not capable of understanding".

In cinema education, the educational outcomes do not materialize simply from watching movies. People attend cinema all the time and see the same scenes, and while they might have similar emotions, the reflective process is lacking. This is where the competence and the teaching skills of the facilitator come into play, that is by putting all the scenes together and fostering reflection through comments and personal thoughts, even as unanswered open questions are introduced. That is the teacher's role.

There is still a remaining question. Does this movie teaching methodology depend on the charisma of the presenter or can it be well developed by anyone? There is no definitive answer. All we can say is: if you love movies, if you like to teach deep from your heart you deserve to try this. Try it and wait for the surprises!

## **Author details**

Graziela Moreto\*, Pablo González Blasco, Maria Auxiliadora C. De Benedetto and Marcelo Rozenfeld Levites SOBRAMFA - Medical Education and Humanism, São Paulo, Brazil

\*Address all correspondence to: graziela@sobramfa.com.br

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Reflections in Medical Education: Empathy, Emotions, and Possible Pedagogical Resources… DOI: http://dx.doi.org/10.5772/intechopen.101832*
