All basic science undergraduate medical (MD) students at XUSOM were included in the sessions. At XUSOM, as with other offshore Caribbean medical schools, students do their clinical rotations in affiliated hospitals in the US and Canada; so we could not include clinical students in the present study. We decided to select students from the most senior semester to serve as student facilitators who would act as team leaders and also assess other group members using a structured rubric. [Table/Fig-1] shows the rubric used to evaluate student participation in the session. Certain statements were modified from the instrument used during in session assessment of problem-based learning (PBL) sessions at the institution (which was modified from the one developed by Elizondo-Montemayor [7]).

The sessions were held in the school auditorium from 1 to 4 pm. Around 60 students participated and there were five faculty facilitators. Students were divided into seven or eight groups (depending on the total number of students). Each group included students from all basic science semesters and provided the senior students an opportunity to mentor their juniors. The movie-related activities were finalized by the faculty group. Thirty minutes was allotted to the activities. The group presented their findings to other groups and the facilitators using flip charts/power point slides.

During the spring 2015 (January-April) the movie ‘Wit’, a story of a Professor of English Literature dying from ovarian cancer, was screened. Creating a common time slot for the screening and activities for all basic science MD students was challenging but we were able to address this during the integration meetings, which decide on the teaching-learning schedule for the forthcoming three weeks. Informal student feedback obtained at the conclusion of the activity was positive and after discussing with the curriculum committee and the academic leadership we decided to have two sessions during a particular semester, beginning from summer 2015 (May-August). During the summer semester the movies screened were ‘The Doctor’ and ‘People Will Talk’. [Table/Fig-2] provides a list of group activities used during the movies ‘Wit’ and ‘People Will Talk’.

Each student was assessed by the student facilitator and also by the faculty facilitator. Scores obtained account for a certain percentage of the grade of the system: Patient, Doctor and Society (PDS), which is offered during basic science semesters 1 to 5 [8]. The student facilitator is evaluated by the faculty facilitator. Each group presents their report to other groups and faculty using either a flip chart or power point slides. The movie shown is of approximately ninety minutes to two hours duration, around thirty minutes is provided for group work and the presentation and inputs by the facilitators lasts from around thirty to forty-five minutes.

Towards the end of June student feedback was obtained using a questionnaire designed by the authors. The questionnaire was circulated among different faculty members for their opinion regarding readability and ease of comprehension of the statements. Participants were asked to rate their degree of agreement with the set of statements and provide an overall rating of the sessions. No demographic details about the student respondents were collected. Cronbach’s alpha was calculated as a measure of internal consistency of the questionnaire. The study was approved by the Institutional Review Board of the institution vide notification XUSOM/IRB/2015/04

Forty-nine of the 63 students (77.8%) participated. Cronbach’s alpha value was 0.868. On conducting the one sample Kolmogorov-Smirnov test for normality of distribution it was found that only overall rating of sessions was normally distributed. Hence the median is used as a measure of central tendency for the scores of individual statements and the mean for overall rating of the sessions. The median agreement scores regarding sessions being important to the respondents’ future practice was 3.00. The median agreement with the statements that facilitators fulfilled their roles effectively was 5.00. The median scores for all other statements was 4.00. The mean rating of the movie screening and activities by the participants was 7.10. [Table/Fig-3] shows the questionnaire used and the median scores of different statements.

Among the free text comments were: the sessions should be held in the morning; sessions should only have the movie screening and not have any associated group work; sessions seem pointless and a waste of time; and the sessions should not be held before quizzes and other exams and the best time would be during the medical humanities module. However, for each negative statement there was only one respondent. Majority of the respondents did not mention any free text comments.

Student feedback about the activity was positive. It may have been difficult for students during their basic science years to understand about the importance of the issues depicted in the movie and explored during the subsequent activities to their future practice. This may have accounted for the low score with regard to that statement. In XUSOM the primary focus of students during the basic science years is to perform well on the United States Medical Licensing Examination (USMLE) Step 1 and activities not primarily directed toward this goal get less priority and importance.

In New Zealand study the authors commented that careful use of movies can reduce some congestion in the crowded curriculum [3]. The researchers mainly used the activity outside formal teaching hours and have suggested tips for using movies efficiently. They mention that the movies selected should have entertainment value, the movie list should be regularly reviewed and updated, students can suggest additional movies for consideration, and the discussion should be wide ranging and inputs from the facilitator/s should be minimal [3]. At XUSOM the movies were selected by the faculty team. During the group work facilitators only guide the process and provide less input. Each group has students from both junior and senior semesters providing seniors withthe opportunity to guide juniors. At a Slovenian medical school, movies were used in an elective fourth year course on professionalism and students recognized the dimensions of communication, empathy, doctors’ personal interests and palliative care in the movies shown [9]. The movies provided a safe and controlled environment enabling students to explore their values, beliefs and attitudes towards different aspects of professionalism. These aspects were also addressed in the movies shown at XUSOM and were further explored during the group activities, discussions and plenary sessions.

Movie snippets or short clips from movies have been used by certain educators [5,10]. At Monash University in Australia, one to two minutes movie clips containing a reference to the subject being discussed were incorporated into power point presentations and shown during Pharmacology lectures [10]. The authors mentioned the positive effects were students were able to relate theory to simulated practice, were motivated to attend lectures and the clips provided a sectioning break keeping students engaged throughout the lecture. We showed an entire movie and primarily used the movie to explore issues: of death, dying, mortality, morbidity, empathy and professionalism. Our experience with movie screening and activities provides preliminary evidence that movies could be used to strengthen learning of humanistic issues, enhance understanding of death and dying, and encourage professionalism among medical students in a Caribbean medical school.

We plan to continue the activity during fall 2015 and subsequent semesters. Detailed feedback about the activity will be obtained in future. At present, students are assessed by the faculty facilitators and the student group leader during the group work and presentations; we plan to continue this in the future. We also plan to study the impact of movie screening and activities on student behaviour and professionalism. There may be challenges in this and in studying the long term impact of the initiative. Other medical schools could consider implementing a similar initiative.

We did not measure the impact of the movie screening and activities on medical student attitudes and behaviour. Attitudes, behaviour and professionalism are however, measured using various measures and instruments during both the basic science and clinical years of the course. Measuring long term impact of various medical humanities initiatives is challenging. Movie screenings have only been employed for a short time, future plans are to study their impact once the initiative is well developed and established. However, as mentioned in the literature, behaviour and professionalism are influenced by a number of factors, and only studying the influence of movie screening and activities on behaviour and professionalism will be difficult.

Not all students provided feedback about the sessions. Student feedback was obtained using a simple instrument designed by the authors. The instrument was circulated among faculty members for their comments and suggestions. The instrument was not pretested.

The authors were able to conduct movie screening and activities in a Caribbean medical school. Various challenges had to be addressed to ensure that all basic science undergraduate medical students could participate. Student feedback about the sessions was positive. Movie screening and activities though mentioned in the literature are not common in offshore Caribbean medical schools to the best of our knowledge. Students from the senior semesters were used as team leaders, who could mentor and support students from the junior semesters.