Commercial Cinema as a learning tool in medical education, from potential medical students to seniors

The use of Commercial Cinema in education has a long tradition, but using movies to teach medical students is a relatively recent application. This topic is emerging as a learning tool to retrieve many of the essential values of the medical profession. There are various experiences of the use movies during pre-graduate and post-graduate medical periods. Medical issues, but also social, historical and humanistic elements are valuable, useful aspects available in a number of movies. In particular, General Medicine as well as Psychiatry are two of the medical specialties that have more experience in this ﬁeld. Medical topics considered include doctor–patient relationship, medical professionalism, pre-clinical and clinical research, bioethics, and others. The learning methodology is simple, and the ﬁnal results obtained by many working science-health groups are very good. We conclude that critically viewing selected commercial movies academic and humanistic training of future physicians and health professionals improve.The use of Commercial Cinema in education has a long tradition, but using movies to teach medical students is a relatively recent application. This topic is emerging as a learning tool to retrieve many of the essential values of the medical profession. There are various experiences of the use movies during pre-graduate and postgraduate medical periods. Medical issues, but also social, historical and humanistic elements are valuable, useful aspects available in a number of movies. In particular, General Medicine as well as Psychiatry are two of the medical specialties that have more experience in this ﬁeld. Medical topics considered include doctor–patient relationship, medical professionalism, pre-clinical and clinical research, bioethics, and others. The learning methodology is simple, and the ﬁnal results obtained by many working science-health groups are very good. We conclude that critically viewing selected commercial movies academic and humanistic training of future physicians and health professionals improve.


Introduction
The history of cinema opens on December 28, 1895, when Louis and Auguste Lumière brothers made the first public projection of images in movement. Since then, Commercial Cinema has been used on countless occasions in Medicine as a common thread in movies, many of them based on or inspired by real events. "Medicine and Cinema" have become for decades an indivisible "binomial". However, its use as a learning tool in the field of Medicine is much more recent. It is well established that during the formative period of medical undergraduate or postgraduate students, they must not only assimilate most of the theoretical knowledge acquired during their years of academic training, but also to understand and meet the more human aspects of sick individuals, who will eventually asking for his/her help. It is here where commercial movies can be helpful to achieve this noble and essential aim, helping to developing the best health professionals.

Commercial movies as a teaching tool
"A doctor without humanism is not a complete doctor, but rather a kind of mechanical engineer". This sentence pronounced some years ago by Prof. Dr. González-Blasco, Director of Medical Education and Humanism in Brazil and one of the worldwide promoters of Commercial Cinema as a teaching tool (Blasco, 2001;Blasco et al., 2006;Blasco et al., 2010), appears now more valid than ever. There are several authors and international institutions that advocate a return to the "humanization" of medicine (Bakht, 2018;Skinner et al., 2018). The fast medical developments during the last century (Pal'tsev, 2008) and other factors have contributed to a dehumanization of medicine (Haque et al., 2012). The use of Commercial Cinema is emerging as an educational option to retrieve many the essential values of the medical profession (Shankar, 2016;Singh, 2017). In this sense, González-Blasco, among other authors, by defending the value of Humanism in Medicine, relies on the use of Commercial Cinema to achieve this goal . In addition, several Medical Schools in a number of countries such as Spain, the USA, China and Canada, among others, have already incorporated for years in their curricula subjects and tracks entitled "Medicine and Cinema" or "Medicine, Literature and Cinema", with excellent results in terms of registration numbers, degree of assistance and positive results (feedback from students, practical knowledge or skills) (Loscos et al., 2006;Rivas, 2013;Kadivar et al., 2018).
Also in the postgraduate medical period, there are various experiences of the use of commercial films as a teaching tool. General Medicine as well as Psychiatry are two of the medical specialties that have more experience in this field Akram et al., 2009;Kalra, 2011;Gramaglia, 2013). The methodology even includes variations according to the working groups and is considered rather straightforward (Frenadillo Martínez et al., 2005;Baños et al., 2015). After viewing selected movies, via individual work, public lecturing of results, and structured group discussion, with options to write and present a final essay, you can get medical, social, scientific and even axiological objectives that will help future doctors to become even better performers of their profession (Frenadillo Martínez et al., 2005). To fulfil this, it is necessary for the teaching team to identify an appropriate selection of movies, short films and documentaries, that enable them to achieve pre-established learning objectives (Baños et al.,2015) (Table 1) (Figures 1-4). Therefore these future doctors can improve many skills and competencies, with all likelihood needed in their daily work practice (Table 2). (Loscos et al., 2006;Rivas, 2013;Kadivar et al., 2018     2.-To demonstrate, in the professional activity, a critical, creative and research-oriented point of view.

3.-To demonstrate research skills at a fundamental level.
4.-To incorporate knowledge of the historical foundations on health, disease, and the medical profession.
5.-To recognise the essential elements of the medical profession as a result of an evolutionary, scientific and socio-cultural process, including ethical principles, legal responsibilities, and professional practice that is patient-centered.

6.-To incorporate and use new information and communication technologies on the professional activity.
7.-To assess and use clinical and biomedical information sources to obtain, organise, interpret and communicate scientific and clinical information.
By the critical viewing of these "selected" movies, we can further engage and enlighten our students in classical topics such as ethics or bioethics courses (Farré et al., 2013;Arawi, 2010), (Figure 1) but we can also perform an "early clinical dive" in College, outpatient hospitals, regional hospitals, mobile ICU, psychiatric and palliative centers, community health centers or delving into the homes of patients themselves, as per the figure of the country doctor through "The confessions of Dr Sachs" (1998). Also, commercial movies can be a helpful tool to reaffirm both values and principles of fundamental and universal medical professionalism, which remain the ideals procured by all practitioners of medicine (Klemenc-Ketis et al., 2011;Shevell et al., 2015).
Among the resources available in "Open Access" is The Journal of Medicine and Movies (JMM), based at the University of Salamanca in Spain. It is an on-line free publication published quarterly, bilingual (Spanish and English). Since its inception in 2005, it has become the international reference in the field. As outlined in its first issue, its primary objective was "…to analyse the contents of bio-sanitary cinema for all medical purposes, including educational, discursive, awareness and divulgative". Moreover, as well spotted by another collaborator of the journal: three verbs synthesise their claims: "inform, disclose and form" .
Having said all of the above, as professionals involved in medical education, we understand that it is vital to raise awareness and educate our students in subjects such as human ethics, identity, and proximity to patients. Also, enhance empathy (Dobson, 2004), the experience of the environment closest to the patient and his/her disease, their life project, their spiritual sensitivities, their fears, their prospects or their way of life for now and the future, to serve them, understanding and respect them at all times. Ultimately, by this training "focused on people", doctors will serve better their patients.
Cinema has many characteristics that make it an ideal source to be used for outreach, awareness and education, something that today no one should put in doubt, because it combines art, entertainment and communication skills. It is a product of mass consumption in our daily environment, and as such a means of ideal communication between undergraduate and postgraduate students, junior and senior medical professionals, and other health related colleagues, as well as patients and the general population. As emphasized in a report by Dr González de Dios, author of several books and a blog entitled "Pediatrics and Cinema", Cinema is "art, science and conscience" (González de Dios et al., 2012). If what we are aiming for are promoting aspects related to health and disease, some films could help mentalizing, disseminating and training students of bio-health sciences, health related professionals, patients and the general public (García Sánchez et al., 2008;Chen et al., 2017).

Conclusions
In summary, since the beginning of Commercial Cinema, Medicine has been part of Cinema. Cinema is an ideal media among students, professionals, patients and their careers and family members. The institutional capacity of Commercial Cinema as a learning tool among students improves if the viewing becomes an activity directed by teachers specialised and subjected to personal work or in a final discussion group. Therefore, the use of Commercial Cinema, both in the undergraduate and the postgraduate curricula, improves academic and humanistic training of future physicians and health professionals.

Take Home Messages
Commercial Cinema can be a powerful teaching tool. 1.
It is necessary for teachers to identify an appropriate selection of movies to achieve pre-established learning 2. objectives.
In this field, individual work, public lecturing, discussion groups and an optional final essay are the main 3.
activities for students. Some films could help mentalizing, disseminating and training students, physicians, patients and the general 4.
public. Commercial Cinema has an established role as "vehicle communication" between the science-health 5.
community and the general public.