Academic Psychiatry 29:100-104, March 2005
© 2005 Academic Psychiatry
Using Film as the Basis of an American Culture Course for First-Year Psychiatry Residents
Frederick S. Sierles, M.D.
Dr. Sierles is Professor and Director of Medical Student Education in Psychiatry and Behavioral Sciences at Rosalind Franklin University of Medicine and Science/The Chicago Medical School, North Chicago, Illinois. Address correspondence to Dr. Sierles, Rosalind Franklin University School of Medicine and Science/The Chicago Medical School, 3333 Green Bay Rd., North Chicago, IL 60064; Frederick.Sierles{at}rosalindfranklin.edu (E-mail).
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ABSTRACT
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OBJECTIVE: There is a developing literature on the use of movies for educating psychiatric residents. This may be the first report of the use of film as the basis of a psychiatric resident acculturation course. METHOD: The author describes an American culture course for PGY-1 psychiatric residents and presents satisfaction and construct validity data. RESULTS: Resident satisfaction was high. Three staff members scored higher than international medical graudates (IMG) residents on a precourse exam. CONCLUSION: Feature films can be used as the basis for an enjoyable acculturation course.
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INTRODUCTION
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There is an expanding literature on film in the education of psychiatric residents (1, 2). Feature films can provide "emotionally meaningful experiences that make for lasting teaching points" (1). In one survey, most residencies using movies for acculturation found them to be beneficial (3). To my knowledge, this is the first report about the use of film as the basis of an American culture course for psychiatric residents.
Since 1955 (every year except 2004–2005), most of our residents have been international medical graduates (IMGs), requiring that—over and above immersing them in patient care at our broad variety of sites—we present American culture classes. ACGME (4) requires programs to:
provide residents with instruction about American culture and subcultures, particularly those ... in the patient community associated with the training program. This ... should include ... gender, race, ethnicity, socioeconomic status, religion/spirituality and sexual orientation. Many physicians may not be sufficiently familiar with attitudes, values, and social norms prevalent among various groups of ... Americans ... The curriculum should contain enough instruction ... to enable residents to render competent care to patients from various cultural and ethnic backgrounds. Understanding cultural diversity is an essential characteristic of good ... care. The program must devote sufficient didactic training to residents whose ... backgrounds are different from those of their patients.
Our film-based program began in 1994. The main topics are: 1) African American culture (approximately one-half of our affiliates’ patients are African American); 2) military culture (one-half the residents are at the VA, and some are at the Navy); 3) gender (approximately one-half the patients, residents and faculty are women); 4) Jewish American culture (some of our senior faculty, patients, and many national leaders in psychiatry, are Jewish); and 5) socioeconomic status (our affiliates serve the social class spectrum).
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METHOD
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I run this course and watch the movies with the residents. The course occupies 3-hour blocks—two for the movie, 30–45 minutes for the postmovie discussion—during Thursday classes. There are five feature films and a written précis (5).
I give a multiple-choice exam and gather anonymous course ratings (Table 1). In 2002, to ascertain the exam’s construct validity, I hypothesized that our three department administrative staff members would score higher than the PGY-1 IMGs on this exam, given before the course, because they had lived in the U.S. all their lives (though they lacked college degrees). They agreed to participate if they could omit their names from the answer sheet, making responses anonymous.
The first course section is Malcolm X, John Singleton and Late 20th Century African American History. Its major goal is to depict a spectrum of African Americans’ views about race, presuming that this spectrum still applies to African American patients and others with whom the residents need to empathize.
Malcolm X
Born Malcolm Little in Omaha in 1925, Malcolm’s family moved to Lansing, Michigan when he was 8 years old. In Lansing, his father, a preacher who followed Marcus Garvey, was murdered. His mother became distraught and was hospitalized for 26 years. Although Malcolm was a good student and eighth-grade class president, a teacher told him that because he was Negro, he should limit his aspirations. Malcolm lived in foster homes and moved to Roxbury, then Harlem, as a teenager. He shined shoes, waited tables, straightened his hair, drifted into crime and addiction, and was arrested and imprisoned (6, 7).
In prison, Malcolm was initially nicknamed "Devil" for his angry, antireligious attitude. Later, he educated himself intensively. He began following Muslim teachings and exchanged letters with Black Muslim founder Elijah Muhammad, who became his mentor. Tireless, intense and a brilliant extemporaneous speaker, Malcolm proselytized for the Muslims before and after leaving prison. The Muslims gained wide publicity, including praise for rehabilitating members’ lives, criticism for opposing integration, and fear because of claims it preached violence against whites. Actually, they preached self-defense only if attacked.
Malcolm and Elijah’s relationship deteriorated after Malcolm learned that Elijah had fathered out-of-wedlock children. Elijah suspended Malcolm for commenting that President Kennedy’s assassination represented "chickens coming home to roost." Estrangement intensified as Malcolm formed another Muslim group, visited leaders of Muslim nations, and espoused international unity among blacks. He was assassinated in 1965 (6, 7).
The documentary (6) includes portions of Malcolm’s speeches, clips of Martin Luther King, Muhammad Ali, Jackie Robinson, Ossie Davis’ eulogy, lunch counter sit-ins, and police hosing demonstrators. Postfilm discussion includes: 1) Explain the comment, "Malcolm was fundamentally American. All he asked was for the black man to be treated like a human being." 2) Discuss the accomplishments of Malcolm, Martin Luther King, Louis Farrakhan, Jesse Jackson and Al Sharpton. 3) Discuss nature, nurture and anger in Malcolm’s development. 4) Summarize Malcolm’s views about slavery and integration. 5) Discuss Rosa Parks, Jackie Robinson, Muhammad Ali, Sonny Liston, Roy Wilkins, James Farmer, Lyndon Johnson and Barry Goldwater.
Boyz N the Hood
I included John Singleton’s Boyz N the Hood (1991) to convey the need to view people as unique individuals rather than as class or ethnic stereotypes and to depict character development amid hardship. Boyz (8) covers 7 years in the life of Tré Styles, a child of divorce in South Central Los Angeles. Tré has devoted parents, his well-educated, proud mother, Reva, and his philosophically-minded, confident father, Furious.
Following a powerful opening sequence, Tré must move from Reva’s to Furious’ home: Walking to school, Tré and his friends view the corpse of a recently-murdered young man and make blasé comments. At school, Tré wisecracks while his patronizing teacher drones about Pilgrims, and he is sarcastically called to the front of the room to address the class. When a classmate heckles him, he starts a fight and is suspended.
Soon after Reva delivers Tré to Furious, Furious appropriately requires Tré to rake their lawn. Tré’s laudable upbringing by Furious contrasts with that of Tré’s friends, the brothers Doughboy and Ricky Baker, children of different, absentee fathers and a disparaging mother. Mrs. Baker snipes at Doughboy, "You just like your daddy. You don’t do shit, and you never gonna amount to shit. All you do is eat, sleep and shit." Doughboy runs afoul of the law, does prison time, and has a street-gangster’s demeanor, but he protects Tré and Ricky and poignantly summarizes outsiders’ views of South Central: "They don’t know, don’t show, or don’t care about life in the ‘hood." When Ricky is shot, Tré and Doughboy face a crisis in which each of their fates is determined by his character.
Postfilm questions include 1) Compare North Lawndale (near Mount Sinai) and South Central; 2) State how and suggest why Doughboy, Tré and Ricky differ; 3) Explain Doughboy’s statement, "They don’t know, don’t show, or don’t care about ... the ‘hood."
Bananas
I included Bananas (9) to present Woody Allen’s views of foibles of American culture, including Jewish, urban, middle class life. As most readers know, Bananas exemplifies Allen’s early work, heavy in gags and not as manifestly serious as his later feature films. The residents enjoy the gags, which illustrate the awkwardness of dating and sex, the pervasiveness of narcissism and self-consciousness, the ambitiousness of parents, and media’s power. To impress his liberal-minded, rejecting girlfriend (Louise Lasser), Fielding Mellish (Allen), a neurotic corporate products tester, finds himself in a Cuban-type revolution in a stereotypical South American dictatorship.
Scenes include Howard Cosell commentating on the dictator’s assassination as if it were a prizefight, Mellish trying to buy a pornographic magazine discreetly, Mellish’s surgeon parents letting him scrub into an operation, and Cosell commentating on the consummation of Mellish’s marriage. Postfilm discussion questions: 1) Compare Allen’s character as reflected in his movies and depicted in the media; 2) Speculate about why psychiatrists are particularly familiar with Allen’s movies; and 3) Discuss the influence of psychoanalysis on everyday U.S. culture.
Life So Far
I included a précis of Betty Friedan’s book (5) to depict this pioneering feminist’s views. Born Betty Goldstein in Peoria in 1921, Friedan was a top high school student who was told she was a talented leader. At Smith, she graduated summa and was politically active. She commented, "Most of my women professors ... were spinsters or mannish, as were the one or two women doctors and lawyers at Peoria. Even at ... Smith, women were expected to be responsible ... community leaders, good wives and mothers ... patrons of the arts and hostesses for our husbands."
She did psychology graduate work at Berkeley, then married and worked for a newspaper, which fired her for being pregnant: "There was no term for or law against sex discrimination then." Her husband became abusive. Friedan began writing a magazine article that expanded into her classic The Feminine Mystique (10). The idea came from a questionnaire she developed in angry response to the assertion that "something is ... wrong with American women—they’d had too much education, and it is keeping them from ‘adjusting to their role."
She interviewed housewives, "and I ... sensed that they all seemed to share the same ‘problem with no name:’ ‘I’m Jim’s wife and Janey’s mother, a putter on of diapers ... But who am I, as a person myself?’ " Friedan helped found the National Organization for Women, and still publishes and participates in the women’s movement. She discusses the politics and diverse perspectives of the women’s movement, stating, "I came to realize that women did not have to ... assume a male ... style to be effective leaders (5)."
Discussion includes: 1) Review Friedan’s position on whether women leaders should adopt a male style. 2) Comment on the extent to which the feminist movement is unified. 3) Suggest strategies for increasing the proportion of women in top academic positions.
Platoon
Chris Taylor (Charlie Sheen), the lead character of Oliver Stone’s 1986 Vietnam War movie Platoon (11), quit college to enlist. This seems irrational to his platoon, many of whom are draftees—and black—"guys who nobody cares about from places you never heard of." One asks Chris, "How the fuck did you get here? You look educated. Only rich people would think of stuff like that." The platoon’s tension is relentless, and they hold cynical, nihilistic attitudes, including that it’s better to die in the first few weeks so you don’t have to worry about dying anymore; "We’re gonna lose this war"; and "The poor have always been fucked over by the rich."
They have no clear objectives, only coordinates to overrun. They see a comrade’s corpse pinned to a tree, anger reaches a fever pitch, and they brutalize a village’s denizens (suggesting how My Lai might have occurred). A conflict between sergeants divides them. Chris opines, "Hell is the impossibility of reason." The happiest moment occurs when Chris’s buddy completes his tour.
Postfilm discussion includes: 1) Compare liberal and conservative views about the Vietnam War. 2) To what extent do Vietnam veterans agree with how Platoon depicts the war? 3) Why did the U.S. remain at war so long? 4) Compare Chris’ final act with Doughboy’s final act in Boyz. 5) Define The Nam, on point, cherry, dink, boo-coo, to hump, R and R, getting greased, do ‘em, frag ‘em, tag and bag ‘em, grunts, catching Z’s, NVA, VC, brothers and bloods.
Sexual Harassment Videotape
The format of this VA-sponsored sexual harassment videotape (12) is a lively interaction between attorney Jonathan Segal and an audience. The audience and viewers are asked to decide whether the behavior depicted in each of 15 vignettes is sexually harassing. For each, Segal presents the correct answer and rationale and discusses ways to prevent and address harassment. Because the video is self-explanatory, no postvideo discussion is needed.
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RESULTS
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On the course pretest, the mean score (72.2%) for the staff members was significantly higher (t=5.135, df=1.148, two-tailed p=0.006) than the mean (49.9%) for the seven IMG residents. Including the pre- and postcourse scores of the one U.S. medical graduate resident, the residents’ postcourse mean (80.3%) was significantly higher (t=–0.556, two-tailed p=0.01) than their precourse (55.7%) mean.
Table 1 presents course ratings. In 2003, one of the residents, who saw Malcolm X but not Boyz N the Hood, gave a low rating and spontaneously approached me after a class late in the course to say that the course mistakenly stereotyped African Americans as having antiwhite attitudes. No other residents in any year wrote or said the course was biased.
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CONCLUSIONS
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The ratings indicated considerable satisfaction. The staff members outscoring the IMG residents suggests that the course and exam present core aspects of American culture not requiring college education. These results suggest that movies can form the basis of a valuable acculturation course. Other movies might be preferable in other programs.
The course has several weaknesses: 1) I did not discuss Hispanic culture because I could not find an appropriate movie. 2) Although the residents appreciate the Friedan précis, it is not as engaging as a good movie with a feminist perspective, or reading Friedan’s book, would be. 3) Since 10 years have elapsed, the course might need revision. For example, corporate culture and religious fundamentalism have become prominent.
Finally, a case could be made for the course being taught by experts on each topic. During one course orientation, a resident suggested this but changed his mind later. Courses taught by "cavalcades of stars" often lack continuity and responsiveness to trainees’ needs (13).
The small, single-school sample is limited. None of the results prove that the course improved the residents’ patient-related cultural competence. No course can replace live experiences. However, this description could provide a starting point for other programs’ courses.
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ACKNOWLEDGMENTS
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The author thanks David Garfield for helping to develop the course, Nutan Atre-Vaidya for preparing the postcourse exam, Michael Schrift for contributing to the literature search, Terrie Stengel for making revisions, and Eugene Beresin for suggesting revisions. An earlier version of this article was presented at AADPRT’s 2002 meeting.
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REFERENCES
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- Kaye DL, Ets-Hokin E: The Breakfast Club: utilizing popular film to teach adolescent development. Acad Psychiatry 2000; 24:110–116[Abstract/Free Full Text]
- Miller F: Using the movie "Ordinary People" to teach psychodynamic psychotherapy with adolescents. Acad Psychiatry 1999; 23:174–179[Abstract/Free Full Text]
- King R, Koopman C, Millis D: Training on ethnic and gender issues in psychiatry residency programs: a national survey. Acad Psychiatry 1999; 23:20–29[Abstract/Free Full Text]
- Accreditation Council for Graduate Medical Education: Program Requirements for a Residency in Psychiatry, January 2001
- Friedan B: Life So Far: A Memoir. New York, Simon and Schuster, 2000
- Noble G: Malcolm X (documentary). Prior Lake, Minn, Mntex Entertainment, 1992
- Malcolm X, told to Alex Haley: Autobiography of Malcolm X. New York, Ballantine, 1973
- Singleton J: Boyz N the Hood. Hollywood, Calif, Columbia/Tri-Star Pictures, 1991
- Allen W: Bananas. Hollywood, Calif, Metro Goldwyn Mayer/United Artists Studios, 1971
- Friedan B: The Feminine Mystique. New York, Norton, 1963
- Stone O: Platoon. Hollywood, Calif, Orion Pictures/Metro Goldwyn Mayer, 1986
- Segal J: The New Sexual Harassment Quiz (videotape). Washington, DC, Federal Training Network, 2004
- Manley MRS, Trachtenberg D: Preclinical undergraduate curricula, in Handbook of Psychiatric Education and Faculty Development. Edited by Kay J, Silberman EK, Pessar LF. Arlington, Va, American Psychiatric Publishing, 1999, pp 231–254
This article has been cited by other articles:
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R. F. Lim, R. J. Diamond, J. B. Chang, A. B. Primm, and F. G. Lu
Using Non-Feature Films to Teach Diversity, Cultural Competence, and the DSM-IV-TR Outline for Cultural Formulation
Acad Psychiatry,
July 1, 2008;
32(4):
291 - 298.
[Abstract]
[Full Text]
[PDF]
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ABSTRACT
INTRODUCTION
