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The University of Hong Kong Ap Lei Chau Clinicl September 14, 2004 Hong Kong Ryuki Kassai, MD, PhD(DClSc) The Hokkaido Centre for Family Medicine Caress.

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Presentation on theme: "The University of Hong Kong Ap Lei Chau Clinicl September 14, 2004 Hong Kong Ryuki Kassai, MD, PhD(DClSc) The Hokkaido Centre for Family Medicine Caress."— Presentation transcript:

1 The University of Hong Kong Ap Lei Chau Clinicl September 14, 2004 Hong Kong Ryuki Kassai, MD, PhD(DClSc) The Hokkaido Centre for Family Medicine Caress Alliance Medical Corporation Muroran, Hokkaido, Japan Beyond Facts and Psychomotor Skills New Methods in Teaching Family Medicine

2 The Hokkaido Centre for Family Medicine: R Kassai 2004 Objectives of learning and teaching Gaining technical competence in dealing with disease Developing a professional identity Learning to heal In becoming physicians, students pass through 3 phases (Weston WW & Brown JB, 1995)

3 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 The light and the darkness

4 The Hokkaido Centre for Family Medicine: R Kassai 2004 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)

5 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”

6 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemeducation 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 multi- cultural aspects conducted Cinemeducation to deepen our understanding of cross-cultural issues, and to evoke imagination, empathy, power and narrative

7 The Hokkaido Centre for Family Medicine: R Kassai 2004 What is Cinemeducation and how is it conducted? small group of trainees (5-10 persons) consists of two parts: watching each movie clip together with a group of trainees facilitating discussion as to what the trainees have observed in the clip

8 The Hokkaido Centre for Family Medicine: R Kassai 2004 What is Cinemeducation and how is it conducted? select and prepare movie clips a part of a popular movie 5-10 minutes long contain >1 theme “impact of illness”, “death of a family member”, “aging”, “divorce”, “acceptance and empathy of impairment”, etc.

9 The Hokkaido Centre for Family Medicine: R Kassai 2004 What is Cinemeducation and how is it conducted? do not tell the themes of the clips beforehand explain a brief plot of the movie to understand the context discussion session open discussion first focused discussion afterward ask to find titles (i.e., themes) of the clips 30 minutes with one clip (60 minutes with 2)

10 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemeducation Ikiru (To live) (1952) 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.

11 The Hokkaido Centre for Family Medicine: R Kassai 2004 Ikiru (To live)

12 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemeducation Lorenzo’s Oil (1992) 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.

13 Lorenzo’s Oil

14 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemeducation Lorenzo’s Oil (2)

15

16 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemeducation Mrs. Doubtfire (1993) 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.

17 Mrs. Doubtfire

18 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemography Ikiru (To Live) 0:11’13” ~ 0:16’15” Doctor gives a diagnosis of gastric ulcer to a patient who believes he has cancer. 0:18’04” ~ 0:29’23” Family cannot tolerate the diagnosis of a malignant disease. Lorenzo’s Oil 0:13’02” ~ 0:20’44” Doctor gives the diagnosis of ALD to patient’s parents. 1:38’13” ~ 1:48’07” Father calls his friend to heal his sick son. Mrs. Doughtfire 1:51’45” ~ 2:00’30” Divorced couple find a solution to take care of their children.

19 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemography Akahige (Red Beard) 0:08’39” ~ 0:12’00” New trainee meets his preceptor for the first time. 2:57’13” ~ 2:58’52” The trainee decides to stay with his preceptor. On Golden Pond 1:40’35” ~ 1:46’44” An old man has an angina attack in front of his wife. Children of a Lesser God 1:48’20” ~ 1:55’00” Teacher and his deaf and dumb girlfriend find a way to understand each other.

20 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemography In Country 1:40’01” ~ 1:54’50” Daughter, mother and brother of a dead soldier visit to the war memorial park. The Joy Luck Club 0:34’34” ~ 0:40’27” Mother and daughter have different expectations of education. 0:40’29” ~ 0:45’51” Mother and daughter find it difficult to understand each other. 2:01’22” ~ 2:08’25” Daughter listens to a story of her mother’s hardship during the war.

21 The Hokkaido Centre for Family Medicine: R Kassai 2004 Teaching objectives a variety of objectives can be set excellent teaching method of NBM NBM requires the ability to use proper words, phrases, sentences and stories 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.

22 History Physical Lab Feeling Ideas Function Expectations Illness Patient-centered clinical method (Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. 2003) Cues and prompts (1) Exploring both disease and illness experience (2) Understanding the whole person (3) Finding common ground (5) Enhancing the patient-physician relationship (4) Incorporating prevention and health promotion (6) Being realistic - problems - goals - roles Mutual decisions Disease Illnes s Disease Person Proximal context Distal context

23 History Physical Lab Feeling Ideas Function Expectations Illness Patient-centered clinical method (Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. 2003) Cues and prompts (1) Exploring both disease and illness experience (2) Understanding the whole person (3) Finding common ground (5) Enhancing the patient-physician relationship (4) Incorporating prevention and health promotion (6) Being realistic - problems - goals - roles Mutual decisions Disease Illnes s Disease Person Proximal context Distal context EBM NBM

24 The Hokkaido Centre for Family Medicine: R Kassai 2004 Sevenfold rationale for Cinemeducation in family medicine education 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

25 The Hokkaido Centre for Family Medicine: R Kassai 2004 Pitfalls to avoid discussion should not be led to the one single goal films’ copyright protection powerful emotional reactions from unresolved issues in their own lives

26 The Hokkaido Centre for Family Medicine: R Kassai 2004 How to evaluate Cinemeducation 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 innovative methods to evaluate the process and outcome of Cinemeducation are to be explored further

27 The Hokkaido Centre for Family Medicine: R Kassai 2004 Not everything that can be counted counts and not everything that counts can be counted. - ALBERT EINSTEIN Looking for an innovative method

28 The Hokkaido Centre for Family Medicine: R Kassai th World Conference of Family Doctors October 13-17, 2004 Orlando, USA Workshop “Cinemeducation: A Teaching Module for Patient-Centered Medicine”

29 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemeducation: A Teaching Module for Patient-Centered Medicine objectives 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

30 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemeducation: A Teaching Module for Patient-Centered Medicine expected participants teachers (at any level) in family medicine around the world who are keen to implement art and narrative into their teachings.

31 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemeducation: A Teaching Module for Patient-Centered Medicine contents of the workshop 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] proposal of an international teachers’ network to develop this field of education in family medicine

32 The Hokkaido Centre for Family Medicine: R Kassai 2004 Cinemeducation: A Teaching Module for Patient-Centered Medicine discussion 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

33 The Japanese Academy of Primary Care Physicians WONCA 2005 Thank you very much! See you all again in… October 13-17, 2004 Orlando, U.S.A. and May 27-31, 2005 Kyoto, Japan


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