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Existing studies have explored the use of feature films to teach undergraduate medical students about psychiatric conditions.1–3 However, there are no existing studies examining medical students’ perceptions of the use of film to teach the mental state examination (MSE)—the clinical tool by which clinicians assess and report a patient's mental state separate from any purported diagnosis. Since students are most likely to undertake an MSE when meeting patients with mental illness for the first time, it seems practically more useful for film to be used to teach this.
The MSE is divided into several sections: appearance and behaviour, speech, mood, thoughts, perceptions, cognition and insight. Since portrayals of mental illness on film vary in the veracity of their depictions, focusing students’ observations on these specific areas may help prevent generalisation about how mental illness presents.
We explored students’ experience of teaching the MSE using film clips along with their perceptions of which aspects of the MSE such media are best suited to teach.
A short teaching session using clips from feature films and television dramas was delivered to 33 medical students from the University of Grenada. Clips were chosen to demonstrate a variety of psychopathologies: ‘Twelve Monkeys’, 1995 (delusional beliefs, perceptual disturbance); ‘The Caine Mutiny’, 1954 (paranoia); ‘The Soloist’, 2009 (thought disorder); ‘ER’, 2001 (mania).
After a brief overview of the MSE, students were asked to assess characters’ mental states in each clip, based on their observations. Group discussions followed each exercise and written materials were provided.
Using a structured questionnaire, students’ perceptions of the use of film to teach the MSE were elicited. Quantitative and qualitative data were collected.
A total of 27 students responded to the questionnaire (81.8% return). 96% (n=26) felt that using film was an effective and enjoyable way of teaching the MSE. Film clips were felt to maintain interest leading to increased attention. They also seemed to stimulate a higher level of interactivity in the group, which was evident in the postclip discussions, with one student reporting that this ‘creates a good learning atmosphere’.
Students felt that using videos ‘makes learning and retaining information easy’ and that it is ‘easy to relate with what is being talked about’. The ability of film to aid visualisation of psychiatric presentations was highlighted, while using films means a ‘great variety of cases can be presented in short period of time’ and that educators are ‘able to depict and highlight specific areas of MSE’.
In relation to disadvantages, students felt ‘unable to get the full picture of the presentation without seeing the entire film’. They felt that they needed training in how to pick up features normally described in the MSE and reported finding it hard to comment without having any background or context to the presentation. Short clips were felt to impede the assessment of some aspects of the MSE, particularly where the clip did not directly portray information related to individual sections, for example, insight. The students also acknowledged that the portrayal of mental illness on film may not be accurate and reported missing the opportunity to interact with someone when eliciting the MSE.
In general, students felt that film clips were able to teach all sections of the MSE well. Opinion did, however, vary from section to section (table 1).
The overall opinion among the students was that using film to teach the MSE was an enjoyable and effective exercise. Film appeared important for visualising mental illness and stimulating immediate engagement in the material. This, in turn, seemed to improve retention of the material learnt. This may have been mediated by increased attention, but may also have related to the stimulation of an emotional reaction (since a number of the clips were emotionally charged).
Overall, students felt that all aspects of the MSE can be portrayed well using film. They were more unanimous in their opinion that it can better represent appearance, behaviour and speech than it can thought form/content and auditory/visual hallucinations, and it would be useful to assess why this was felt to be the case. Perceptions of the ability of film to portray insight varied most widely. This likely reflects the complex nature of this subsection. As such, other teaching methods may be necessary to improve understanding of complex or subtle concepts in the MSE, including insight.
In our study, some students felt unsure of how exactly to assess and report symptoms using the MSE. This suggests that more didactic teaching is required. However, there was clearly an iterative process taking place since students improved in their description of mental states as the session went on.
The choice of film clip appears crucial. Clips should be long enough for students to feel able to comment on the mental state but not so long as to threaten engagement. Additionally, they should be used to illustrate specific aspects of the MSE rather than to teach the examination in its entirety. In particular, clips should be chosen in relation to specific learning outcomes, for example, the ability to recognise the features of thought disorder. Such specificity of use has not hitherto been the general means by which film clips have been used in psychiatric education.
It follows, too, that educators seeking to give medical students an idea of psychiatric presentations in general should choose clips not on the basis of their representation of a specific diagnosis, but on their ability to portray a particular symptom. This would avoid the risk of generalising about the presentation of psychiatric conditions where the veracity of a film's portrayal of that condition is questionable.
Finally, students reported missing interacting with a patient. MSE teaching should, therefore, be complemented with the opportunity to assess a real or simulated patient. This would allow for application of the concepts learnt. As such, adopting a blended approach to teaching the MSE that includes didactic components, film clips and simulated or real encounters would ensure better achievement of desired learning outcomes.
Contributors Both authors made substantial contributions to the conception or design of the work and to the acquisition, analysis, or interpretation of data for the work. CK was responsible for drafting the work, submitting it for publication and revising it accordingly. Both authors gave final approval of the version to be published. CK agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Competing interests None declared.
Ethics approval University of Grenada.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement All data created during this research are openly available on request.
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