A Scoping Review of the Use of Cinema Education in Training Medical Preceptors

Abstract

Background

Medical students’ education is strongly influenced by learning experiences with their preceptors. Continuing education programs (CEPs) are an excellent vehicle for training preceptors who supervise students in clinical settings. Continuing education programs sometimes include innovative teaching strategies such as cinema education, meaning the use of film in medical education. This study explores the use of cinema education in training medical preceptors, focusing on the type of cinema education used, the content presented, its application and its evaluation.

Method

This review was planned and conducted in accordance with the steps described by Arksey and O’Malley, and in compliance with Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews guidelines. Primary sources searched included Medline, Embase, CINAHL, APA PsychINFO, ERIC, Education Source, and Scopus. All studies conducted with preceptors were included. All research designs detailing the use of cinema education in training for preceptors were considered. The articles were processed and evaluated by 2 pairs of reviewers using the COVIDENCE tool and then synthesized in narrative form.

Results

Of the 4719 studies reviewed, 14 were selected for extraction. This scoping review shows that cinema education is used chiefly in the form of video mini-series. The videos are generally viewed remotely in asynchronous mode, and they typically feature simulated clinical situations designed to develop preceptors’ feedback skills. The videos are normally evaluated through post-screening surveys.

Conclusion

This scoping review examined the type (format), content, application, and evaluation of cinema education in training programs for medical preceptors. The predominant format consisted of a series of video clips depicting clinical scenarios. Most of the videos were designed to enable preceptors to develop their feedback skills. The videos were mainly viewed remotely in asynchronous mode. Future studies could assess how effective cinema education is in training medical preceptors.

Introduction

Continuing medical education (CME) has long relied on traditional teaching methods such as lectures and textbooks.^1,2 In recent years, however, the importance of engaging learners in their learning and encouraging critical thinking has gained increasing recognition. One approach that meets this objective is the use of cinema education, particularly in the context of preceptor training. ³

Preceptors play a fundamental role in the educational development of undergraduate medical students and residents. They supervise these learners in clinical settings, enabling the students to develop skills essential to their future practice. ⁴ The use of cinema education in training these preceptors has grown in popularity, as it offers a unique and stimulating way to teach concepts related to clinical supervision skills. It is an accessible tool, capable of offering rich and realistic representations of medical situations, ethical dilemmas or interprofessional interactions.^5,6 This teaching tool also offers preceptors a learning experience that goes beyond the traditional classroom setting, allowing them to explore issues from different perspectives and tackle the emotional and ethical dimensions of clinical practice. ⁵

Studies on this subject show that cinema education is indeed used in training for medical preceptors. This includes, for example, the use of video mini-series to help preceptors develop their interprofessional skills or improve the accuracy of their assessment of students in clinical settings.^1,7 Other studies use short videos of simulated clinics to help preceptors develop interpersonal skills, such as how to provide effective feedback. In addition, some video vignettes depicting preceptor-student scenarios are used to strengthen preceptors’ communication skills. ⁸

Cinema education is therefore proving to be a useful tool in training preceptors, enabling them to develop critical skills for supervising students. However, the studies and reviews published to date have focused almost exclusively on learners rather than on the development of preceptors. This difference is important, as our review moves the discussion away from the impact of cinema education on students and instead examines how these tools are used to support those responsible for supervising and evaluating them.

Objective

The objective of this scoping review is to explore practices related to the use of cinema education in CME for medical preceptors, looking at the format or type of cinema education used, the content presented, application methods, and the evaluation strategies used.

Methodology

Study Protocol and Registration

This scoping review was planned and conducted in accordance with the steps described by Arksey and O’Malley ⁹ and enhanced by Levac. ¹⁰ This framework is described in 5 steps: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarizing, and reporting results. Steps 1 to 5 are presented below. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews checklist statement, ¹¹ which can be found in Supplementary Digital Appendix 1. This scoping review was registered with the Open Science Framework software (doi:10.17605/OSF.IO/HZVTC). ¹⁰

Step 1: Identifying the Research Question

The purpose of this study is to explore the academic literature on the use of cinema education in CME for medical preceptors. More specifically, the research questions are:

1. What types of cinema education are used to train preceptors?

2. What content is presented in this cinema education?

3. What are the applications for this cinema education?

4. How is this cinema education evaluated?

Step 2: Identifying Relevant Studies

The search strategy was developed in consultation with an experienced information specialist (NL) and reviewed by a second specialist, as recommended by the Peer Review of Electronic Search Strategies guide. ¹² The strategy, presented in Supplementary Digital Appendix 2, focuses on keywords found in current practices of cinema education used to train medical preceptors. The search was conducted in the following databases: Medline, Embase, CINAHL, APA PsychINFO, ERIC, Education Source, and Scopus. Subsequently, the reference lists of the selected articles were manually searched in order to identify other potentially relevant publications. The entire literature search was conducted in consultation with a University of Ottawa, Faculty of Medicine librarian (NL).

Step 3: Study Selection

All studies identified were uploaded into Covidence systematic and scoping review software (version 2.0, Veritas Health Innovation). Duplicate articles were removed. Studies were selected in 2 steps. First, 5 reviewers (AA, VL, AS, MR, and FK) independently screened titles and abstracts to determine study eligibility based on predefined criteria for inclusion and exclusion. Next, the same reviewers screened the entire texts of the articles they considered potentially relevant, using the same criteria. Each assessment and screening step was performed by 2 reviewers (VL and AS; MR and FK), and any discrepancies were resolved by a third reviewer (AA). The final list of articles was reviewed by the larger research team to determine whether additional articles should be included or excluded; they concluded that no further changes were required. The studies that were included met the following criteria:

1. Conducted in a CME context for preceptors, using cinema education as a teaching tool

2. Published in peer-reviewed journals

3. Described any of the following designs: randomized controlled trials (RCTs), non-RCTs, matched-comparison group studies, pre-post studies, post-only studies, cohort studies or qualitative studies in which cinema education was implemented with preceptors supervising medical students or residents

All these types of design were considered without restriction, as long as the studies reported data relevant to our research objective, irrespective of their primary objective. Only articles published in English or French were included, with no date restrictions. Inclusion and exclusion criteria are presented in Table 1.

Table 1.

Inclusion and Exclusion Criteria.

Inclusion criteria	Exclusion criteria
Studies in English or French	Studies in a language other than English or French
Studies conducted with preceptors/instructors who supervise and train medical students and residents	Studies lacking stratification in the study population (ie, Faculty of Medicine employees vs preceptors/instructors, admin, and students)
Study on the use of videos (cinema education at large)	Nonpeer-reviewed articles
Study design: randomized controlled trials (RCTs), non-RCTs (NRCTs), matched comparison group studies, pre-post and post studies, cohort studies, and qualitative studies	Conference abstracts
Implementation of cinema education with preceptors/instructors	Letters to the editor, editorials, comments

Following screening of the titles and abstracts, it was determined that 117 articles met the inclusion criteria. After a full-text review, 14 articles were selected for final analysis.

Step 4: Charting the Data

The research team developed an extraction data sheet under the supervision of the principal investigator (SF). A detailed description of all variables included in the data extraction form is available in Supplemental Digital Appendix 3. The extraction sheet included publication features (name of lead author, year of publication, data collection location), study characteristics (study design, participants, inclusion/exclusion criteria), sociodemographic characteristics, training context (academic environment, clinical environment), characteristics of cinema education (duration, type, application process, content, and evaluation methods). A pilot data extraction from 2 articles was conducted with all reviewers to ensure a consistent understanding of the definitions and variables in the extraction sheet. The sheet was then imported into Microsoft Excel (version 2306) to facilitate its use during the extraction. The final version of the data extraction sheet is presented in Supplementary Digital Appendix 4. Five reviewers (AA, VL, AS, MR, and FK) extracted data from each included article. The articles were randomly assigned among them, and the extraction was performed using the data extraction sheet provided for this purpose.

Step 5: Collating, Summarizing, and Reporting Results

The lead author (AA) analyzed and synthesized the extracted data. These results were then reviewed by the principal investigator (SF) before being made available to the whole research team. The lead author then analyzed emerging trends based on the extracted data and grouped them according to recurring themes, resulting in a narrative synthesis of the qualitative results. Next, the lead author (AA) compiled a descriptive summary of the extracted data, using key characteristics and themes. Synthesis of the results focused primarily on the types of cinema education, their application, content and evaluation in the context of CME for medical preceptors.

Results

The literature review generated a total of 4719 studies. After duplicates (1897) were removed, 2822 articles were screened for eligibility, and 117 were selected for full-text review (Figure 1). Of these, 103 articles were excluded, and 14 were selected for extraction, as they met the inclusion criteria. Several excluded articles described programs that did not have medical preceptors as subjects (n = 46), others described training programs that did not contain cinema education (n = 34), others did not correspond to the study design sought (n = 21) or did not report results following implementation (n = 1). All the articles were in English. The majority of included studies were conducted in the United States (n = 9), with additional studies originating from Taiwan (n = 1), Iran (n = 1), Germany (n = 1), Malaysia/Sri Lanka (n = 1), and Russia (n = 1). These studies were conducted with clinical preceptors and clinical supervisors (n = 10), academic or faculty staff involved in teaching or student support (n = 3), and PBL tutors (n = 1). A description and summary of all included studies are presented in Appendix 4, notably the types of cinema-based strategies used, the outcomes measured, and the targeted skills and knowledge.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) 11 flow diagram.

Characteristics of Sources of Evidence

A total of 14 articles published between 2004 and 2023 were included in this exploratory study. The studies were conducted in various countries, including the United States,^{1,7,8,13–18} Taiwan, ¹⁹ Russia, ²⁰ Malaysia, and Sri Lanka. ²¹ Research designs included quasi-experimental studies, for example, single-group post,^{1,7,13–15,17,19,21,22} single-group pre-post,^8,16,18,20 and a RCT. ²³

Types of Cinema Education

All of the included articles described programs in which cinema education was used as a training tool. Most of these programs used a series of short video clips.^{7,8,13,14,17–22} Other studies used a single video clip. These included, for example, a clip embedded in a PowerPoint presentation, ¹⁶ a video featuring actual recorded teaching scenarios, ²⁰ or a short sequence designed to demonstrate skills that preceptors need to learn. ¹ A final study included both a 15-min orientation video and a distance-learning CD-ROM containing a module of about 40 min. ¹⁵

Some programs used videos that were more passive, that is, merely presenting knowledge without any interaction. For example, one of the studies explained concepts to preceptors through a video in which an educator presented his “pearls of wisdom.” ¹⁴ Another contained a video on the curriculum, the course structure and precepting skills. ¹⁵ There was also a program that used video to present sensitive topics such as sexual harassment, depression, and the risks of self-harm, as well as student adjustment to life far from home. ²¹ Other programs used videos, sometimes taken from films, with simulated interactions between actors in a clinical setting. For example, one program featured 18 video clips of challenging interaction scenarios between supervisors and students. ²² Others presented simulated feedback between a preceptor and a student in a clinical supervision setting to demonstrate, among other things, effective and ineffective feedback scenarios.^8,16 Others featured simulated interactions between students and patients (Renting et al, 2023), followed by feedback sequences with supervisors (Moser et al, 2017).

Application

Videos were used in different ways in preceptor training programs. In several programs, videos were sent by email to be viewed remotely by preceptors.^1,7,8,15 In other cases, the videos were viewed in groups during in-person training that featured other teaching tools.^{13,14,16–22} When the videos were viewed in person as a group during training, they could be incorporated into the instructor's PowerPoint presentation,^14,16 viewed just prior to group discussions^13,21 or viewed at the end of the training program activities. ¹⁹

Content

The results show that videos were used in preceptor training programs to teach a variety of topics, including clinical interaction between preceptors and students, and professional dilemmas, both positive and negative.^13,21 Many of the videos were aimed at developing specific preceptor skills, such as those related to formative feedback. Several programs addressed effective strategies for giving feedback to students during clinical supervision.^{1,8,13,14,18,19} Moreover, videos for some programs dealt with obstacles to group work ²² while others addressed the specific role of preceptors in clinical supervision.^1,14,15

Evaluation

The majority of the studies used post-test assessments featuring questionnaires^{1,7,13–15,19,21,22} to assess the impact of using videos for improving preceptors’ knowledge. In addition, some studies used pre-post test assessments, comparing preceptors’ knowledge or attitudes before and after training.^1,16,20,22 These assessments sought to examine changes in teaching skills or self-efficacy in clinical supervision that could be attributed to the use of videos.

When mapped to Kirkpatrick's 4-level evaluation framework (reaction, learning, behavior, and results), ²⁴ most of these outcomes correspond to the first 2 levels. Specifically, posttraining questionnaires often captured participants’ reaction to the educational activity (eg, satisfaction, perceived relevance), while pre-post measures reflected self-reported learning gains such as increased confidence or perceived improvement in teaching skills. Overall, this mapping indicates that current evaluations of cinema education in CME predominantly emphasize short-term, self-reported learning outcomes, with limited evidence of objective or practice-based impact.

Discussion

This scoping review describes various cinema education practices used to train medical preceptors. Although other studies on the use of cinema education in medical education exist,^25–27 this scoping review is, to our knowledge, the only one that deals exclusively with the use of cinema education in the context of medical preceptor training. The 14 articles included describe various types of cinema education used in preceptor training, such as series of short video clips or a single video clip of variable length incorporated into the training medium, for example, PowerPoint presentation. Videos could be either passive, in the form of explanatory lectures presenting concepts to preceptors, or active, featuring simulated situations with professional actors playing the roles of students, patients, preceptors, or staff in a clinical setting. During preceptor training, the videos were sent to be viewed remotely or in person during the course. The content of the videos was varied, covering professional dilemmas, preceptorship skills, and the role of preceptors in clinical supervision. Lastly, various evaluation methods were used to assess the impact of the videos, mainly questionnaires administered after the fact or according to a pre-post scheme.

The findings of this scoping review on the use of cinema education in preceptor training are in line with observations in the general medical education literature. First, this study reports on the use of active videos showing medical team interactions, echoing the findings of Rasul and colleagues who, in a recent publication in 2024, reported on the use of video clips showing medical team interactions to enable students to develop their professional skills. ²⁸ Similarly, in another recent study published in 2020, Mulcare and colleagues reported that the use of video clips featuring actor-led interactions contributes significantly to the development of medical students’ communication skills. ²⁹

Second, scenes that were played by professional actors were taken from movie clips and TV series, such as House M.D., concurring with the findings of Shevell and colleagues who, in a 2015 study, had clips from the TV series ER screened in a course on professionalism for medical students. ²⁷ Similarly, in a recent systematic review published in 2024 on the impact of film and TV series in medical education, Piqué-Buisan and colleagues reported their use in teaching not only medical professionalism but also bioethics and critical thinking to medical students. ³⁰ The use of video clips as a teaching tool for preceptors or students is broadly rooted in Mayer's cognitive theory of multimedia learning, which explains how people learn from words and images. It is based on the idea that learners have different ways of processing words versus images, such that viewing this audiovisual medium provides a unique approach to learning. ³¹ Nonetheless, given the multitude of clips depicting scenarios that can be extracted from a film or TV series, choosing clips that meet training objectives and that allow learners to develop skills remains a challenge. In an ideal world, medical schools would shoot their own video clips with professional actors to overcome this obstacle. However, the issue of financial resources arises, with the production of high-quality video clips featuring professional actors representing a significant cost for teams and institutions. Beyond financial considerations, the use of clips from commercial films or television shows can raise copyright or licensing issues. Educators incorporating such materials should ensure that any audiovisual content complies with local copyright requirements. Simulated or locally produced videos generally avoid these constraints.

Also, in most of the studies, the videos were watched as a group during in-person training. This approach ties in with the work of Badge and colleagues, who stressed the importance of group discussions in medical education, as these have the advantage of promoting active participation, stimulating critical thinking and facilitating the practical application of skills. ³² Hence, by watching the videos as a group, preceptors can collectively discuss their opinions on the content they’ve just seen and draw conclusions applicable to their own supervisory experience. These observations highlight the importance of facilitation, as guided discussions help preceptors interpret the scenarios, identify key supervisory behaviors, and link what they observe to their own practice. The other method of administering cinema education was remote viewing. This has the advantage of enabling preceptors to more easily access the educational material from the comfort of their own homes. It also allows them to view the material at their own convenience, which can be very useful for preceptors with busy schedules. However, the disadvantage of this approach is that group discussions and exchanges of ideas are no longer possible.

The study also reports that the content of the videos was varied, addressing professional dilemmas, preceptorship skills and the role of preceptors in clinical supervision. Content aimed at enabling preceptors to develop their skills in giving feedback to students was the most recurrent. ³³ Since feedback is an essential element in clinical supervision, it seems logical that preceptor training on this topic should be a recurring one. The use of video in training preceptors seems to be popular, especially in clinical supervision settings in which students are increasingly being evaluated on whether or not they have mastered entrustable professional activities. Our findings are in line with those of Buyck and colleagues who, in a recent study, assessed the impact of a workshop on preceptor behavioral change. In particular, this study measured the number of assessments of entrustable professional activities performed by participants after the workshop, which used prerecorded videos simulating feedback sessions between preceptors and students. ³⁴ The use of video in preceptor training has considerable benefits: this instructional format gives participants the opportunity to compare different feedback scenarios, whether satisfactory or unsatisfactory, in order to adjust their own practices in real-life situations.^8,13 Moreover, this format allows for self-directed learning, giving preceptors the flexibility to view content at their own pace, according to their availability.

In evaluating training programs that use cinema education, most studies have assessed learning success through a survey administered after the videos were viewed. This approach provides an overall idea of how much the preceptors’ knowledge and skills have improved after training, and which aspects of training need to be improved. These individually self-administered surveys also enable preceptors to share their views anonymously, without any of the fear that might arise if they had to criticize the program in front of colleagues as a group. One study in particular conducted 2 post-test surveys at one month and then again at 12 months. ²⁰ This could be a worthwhile approach, since it provides an overview of the impact of training, and therefore of the use of videos, on preceptors’ skills in their clinical supervision roles in the short term and on its impact in the long run.

Limitations

This study has a few limitations that must be considered. First, in more than half of the articles selected, the videos were viewed during a training course that also used other types of teaching tools, making it sometimes difficult to clearly determine which content was dealt with specifically in the videos, and to affirm whether the learning objectives were achieved through their use. Second, the number of articles in this review was relatively small, which could also limit the generalizability of results on the use of cinema education in medical preceptor training. Third, research designs varied considerably from one study to the next, making it impossible to directly compare the relative effectiveness of different types of cinema education. However, that was not the aim of this scoping review, which aimed to explore the uses of cinema education in medicine and not to assess its comparative effectiveness, as a systematic review would. Lastly, although several keywords were used, it is possible that the search strategy did not capture some synonyms or alternative phrases, which may have affected the thoroughness of the identification of relevant studies. Also, we did not calculate inter-rater reliability (eg, Cohen's kappa), which may limit the assessment of consistency in study selection.

Conclusion

In conclusion, this exploratory review identified 14 articles describing how cinema education has been used with regard to type (format), content, application, and evaluation. The results show that a variety of formats are used, ranging from series of short video clips to single videos of varying length, which are occasionally incorporated into presentation media such as PowerPoint slides. These videos are either viewed remotely in asynchronous mode or presented to groups during in-person training sessions. Content focuses mainly on professional dilemmas, clinical supervision skills, and the role of preceptors. Different evaluation methods are reported, including questionnaires administered before and after training, or only after viewing. One of the limitations of our study is that in more than half of the articles selected, the videos were viewed during a training course that used other types of teaching tools, making it sometimes difficult to clearly determine which content was specifically covered in the videos and to affirm whether the videos helped to achieve the learning objectives. Furthermore, the articles in these studies used different research designs, making it impossible to objectively compare the effectiveness of cinema education in this context according to type, content, and application. Further research could also focus on the effectiveness of cinema education in medical preceptor training. Taken together, these findings make a significant contribution to the knowledge base on best practices in the use of cinema education for training preceptors who supervise medical students in clinical settings.