Psychiatric illnesses are common and pharmacists need to be able to recognize the signs and symptoms of the illnesses and know how they are appropriately treated. Not all pharmacy students will have an opportunity to intern in a psychiatric setting during their fourth year, and there is not adequate time in the course of a problem based learning (PBL) therapeutics curriculum to teach many of the psychiatric illnesses and their treatment. This article describes an elective course in psychiatry offered to third-year pharmacy students, which incorporates the viewing of movies and reading of books related to psychiatric illness, in order to allow students to develop a working knowledge of basic and advanced therapeutic issues related to psychiatry and psychopharmacology.
INTRODUCTION
Media has a profound influence on the way we understand our world. Of the different types of media, movies may have the greatest influence of all of the art forms.1 Good movies and books draw us in so that we perceive the experience as if we were a participant. The audience can be captivated by the story, and the emotions and experiences in which the characters find themselves. It is rare that any two people experience a movie or book in the same way. Audiences bring their own life experiences and perceptions into what they watch or read, and they translate that information into their own personal story. Often audiences are profoundly affected by the experience of what they see or read and can in fact relate to the characters in the movie or book.
Media can have both positive and negative influences on the way mental illness is viewed. Since most people are unfamiliar with the complexities of mental disorders, news reports, television shows, including “reality television”, movies and books can shape people's attitudes concerning the mentally ill. There are sympathetic portrayals of the mentally ill and mental health care professionals in movies, such as “Ordinary People”, or “Three Faces of Eve”.1 Other movies portray the mentally ill as dangerous, aggressive or violent, and mental health care professionals as passive, inept, arrogant, or manipulative. Media can perpetuate incorrect stereotypes of both the mentally ill and treatments given to them. Movies, such as Albert Hitchcock's “Psycho”, maintain the myth that schizophrenia and multiple personalities are the same disorder, and “One Flew Over the Cuckoo's Nest” has influenced many people's opinion on electroconvulsive therapy (ECT), and the sense that psychiatric facilities are little more than prisons with mental health practitioners as wardens.
It is important that pharmacy students have the opportunity to clear up misconceptions about psychiatric illnesses. Mental disorders are the leading cause of disability in the United States.2 Approximately, 26% of people in the United States have a diagnosable mental disorder in any given year.3 Of those diagnosed with a mental disorder, almost half have been diagnosed with two or more mental disorders.3 The cost of mental health is the largest driver of global economic burden among all non-communicable diseases, making up more than half of that projected burden over the next 20 years.4 In addition to this, 15% of the top 200 prescribed drugs in the United States are psychotropics, which means that pharmacists will continue to be intimately involved with dispensing, monitoring and counseling patients on these medications regardless of their work setting.5
BACKGROUND
In 2008, Auburn University Harrison School of Pharmacy (AUHSOP) moved to a new curriculum including a problem based learning (PBL) method for teaching therapeutics to third year pharmacy students. While the previous traditional curriculum allowed a psychiatric trained clinician to spend approximately ten days to teach a module involving didactic and case based instruction, the new curriculum allows non-specialist faculty-facilitated small groups (6–8) of students to work through a case for approximately nine hours using PBL techniques. Additionally, the new curriculum provided an opportunity to develop an elective in psychiatry for students with an interest in learning more about psychiatric illness and psychopharmacology. An interest in teaching adult learners with different learning styles led to the development of an elective in which students could see, hear, and read about a variety of the most common mental illnesses.
Movies and Mental Illness, a 2-credit hour elective in Psychiatry, was developed for third year pharmacy students in 2008. The objective of the course was to expose pharmacy students to psychiatry and for them to develop a working knowledge of basic and advanced therapeutic issues related to psychiatry and psychopharmacology.
DESIGN
The initial course design included a variety of teaching methods including: disease state discussions, student-led case presentations, student-led journal clubs, movie viewing in and out of class followed by a student reflection, and reading a book outside of class followed by a student reflection. Prior to 2012, the Movies and Mental Illness elective was capped at a maximum of 24 students. An increase in the overall size of the third year class in 2012 led to opening the elective to more students, while at the same time discontinuing the time consuming student-led journal clubs and case presentations. In 2012, 31 students chose the elective, and in 2013, 51 students chose to take the elective.
In the current course, the topics discussed include: Schizophrenia, Depression, Bipolar Disorder, Anxiety Disorders, Substance Abuse and Dependence, Attention Deficit Hyperactivity Disorders, and Eating Disorders (Table 1). During the first week of class, students are oriented to the requirements of the course in the first hour, and they are shown a history of psychiatry in pictures during the second hour. For the remainder of the topics, the first 20–30 minutes are spent discussing the Diagnostic and Statistical Manual criteria for a specific disorder. The remainder of the course time is spent viewing a documentary on the illness being discussed. A list of documentaries used is listed in Table 2. Four quizzes are completed during the semester, each consisting of ten questions, and a fifteen minute time limit covering the previously completed topic (See Table 1). A quiz for ADHD and Eating Disorders is included in the cumulative examination. After completing the quiz, approximately 15 minutes are used to discuss and clear up any misconceptions from either the quiz, or the movie the students viewed the previous week. The remaining class time is spent discussing specific drugs used to treat the illness, clinical pearls regarding the medications, and treatment of patients with the disease state. Students are provided with a complete handout to study, and they are responsible for reviewing the handout and asking questions of the faculty.
Students have two activities that they are asked to complete outside of class. These include watching two pop-culture movies, and reading a book related to psychiatric illness. The faculty gives the students a list of movies and books that they can choose from on the first day of the class. The students are asked to form small groups of 3 or 4 students to watch the movies. They are then asked to write an individual reflection for each movie. They are also asked to choose a book and to write a reflection. Movies and books are chosen based on their psychological relevance. New movies and books are added to the listing throughout the year. A list of movies used for the course is in Table 3, and a list of books in Table 4.
On the first day of class, students are asked to give a listing of their top three movie and book choices. The students have one week to send these to the faculty. The faculty attempts to give the students their first choice, but only allows a small number of students or student groups (no more than 2 or 3) to watch a particular movie or read a particular book to promote a wider range of discussion in the course. While the preceptors own the vast majority of movies and books to lend, most students are able to acquire them on their own (e.g., Netflix). Although students at AUHSOP are accustomed to writing reflections, directions are given to them for writing reflections for their movie and book. Students are asked to use the “what?” (describe), “so what?” (examine), “now what”(contemplate and plan) model of reflection.6 These reflections must include a descriptive component in which the event in the book or movie is described. Next, there is an examination component in which the event(s) are explored and the students' feelings or reactions are discussed, and last there is contemplation and planning component where students determine how what they learned will impact their future experiences and responses to the movies and books that they read. They also are to explore their biases and prejudices and determine how the experience will change the way they think or act in the future. The faculty grades each reflection with a rubric and gives written feedback to each student (Rubric available per request to author). Reflections count a total of 30% of the grade.
While students are required to watch a pop-culture movie and read a book related to psychiatric illness, the appropriateness of having third year pharmacy students watch a pop-culture movie in class, rather than a documentary is still being considered. The reason for watching a documentary concerning the illness initially is so that students begin to understand the illness including what actual patients and their families are like, and what kind of issues they deal with without the addition of erroneous information used for audience entertainment. Once students understand the basic tenants of the illness, it is easier for them to separate fact from fiction in the pop-culture movies that they watch independently.
DISCUSSION
Overall feedback, collected by the school's Office of Teaching, Learning and Assessment (OTLA), from students taking this course has been positive. Students seem to enjoy both the movies and the books and look forward to taking the class in order to have the opportunity to learn about psychiatry through these art forms. Many of the student reflections have been insightful and it has been beneficial to correct any misperceptions the students have when grading their reflections. Student evaluations of the faculty rate the quizzes and examination as fair, even though the students continue to have final grades spread evenly on a bell shaped curve, with the majority of students having a B in the course. In 2010, a pre-course and post-course assessment of knowledge was given to students, but it did not show a significant difference, and the faculty determined that the assessment needed to be rewritten. The pre- and post-course assessment has not been given in the past two years, but it is the intent of the faculty to institute this again in the coming year.
The Movies and Mental Illness course slightly evolves each year based on comments from students and ideas from the faculty instructors. Flipping the classroom, and making the movies into cases for students to work during class time is one idea being discussed for 2014.
There are many books and movies available that involve mental illness, and the ones selected are only a few of the potential choices available. Some practitioners may not agree with the psychological relevance of the ones listed, while others may be aware of other books and movies that are available in the public domain. Of note, a new documentary “Of Two Minds” directed by Lisa Klein and Doug Bush will be released the first of March and will premiere at the CPNP Annual Meeting in April 2013.
CONCLUSION
Psychiatric illnesses are common and, regardless of their work setting, pharmacists need to recognize the signs and symptoms of the illness and how they are most appropriately treated. Not all pharmacy students will have an opportunity to work in a psychiatric setting during their fourth year, and there is not sufficient time in the course of a PBL curriculum to teach many of the psychiatric illnesses and their treatment. In addition, many students without specific training in psychiatry get their information about psychiatric illness from movies, news reports and “reality television”. A Movies and Mental Illness elective exposing third year pharmacy students to psychiatry topics and movies where actual symptoms and treatments can be separated from the Hollywood portrayal of these illnesses may be beneficial to improving students perceptions and attitudes regarding caring for the mentally ill.