Using film and literature for cultural competence training

Through novels and films, we learn about different portrayals of cultural norms and culture conflicts in different parts of the world. A basic tenet of training in cultural competence is that people become aware of the differences and similarities across cultures, allowing them to be more conscious of their own cultural world view, and also better able to deal with any differences and to learn from them. Reading novels and seeing films can help to develop trainees’ humanism and capacity for understanding and so facilitate their learning about cultural competence (Fritz & Poe, 1979). One drawback of using films in this way is that the dramatic points in the stories may hinge on social stereotypes. For example, in several recent Hollywood blockbusters the British characters were portrayed as butlers, buffoons or villains using their accent and caricatured appearance to emphasise differences. In this paper I highlight some of my favourite novels and films to use in teaching about cultural competence. Facilitated discussion of different aspects of the novel or film is the best way for trainees to learn in a nonthreatening manner.


Using film and literature for cultural competence training
Through novels and films, we learn about different portrayals of cultural norms and culture conflicts in different parts of the world.A basic tenet of training in cultural competence is that people become aware of the differences and similarities across cultures, allowing them to be more conscious of their own cultural world view, and also better able to deal with any differences and to learn from them.Reading novels and seeing films can help to develop trainees' humanism and capacity for understanding and so facilitate their learning about cultural competence (Fritz & Poe, 1979).One drawback of using films in this way is that the dramatic points in the stories may hinge on social stereotypes.For example, in several recent Hollywood blockbusters the British characters were portrayed as butlers, buffoons or villains using their accent and caricatured appearance to emphasise differences.
In this paper I highlight some of my favourite novels and films to use in teaching about cultural competence.Facilitated discussion of different aspects of the novel or film is the best way for trainees to learn in a nonthreatening manner.

Principles
Some novels provide a wonderful insight into the way individuals think and about how their cultures deal with particular concerns.In addition, these stories show an insight into the cognitive schema of individuals and the cultural norms.Novels by an Indian author in Hindi or Punjabi may reflect a different perspective but whether the English translation retains that perspective is questionable.If an Indian author writes in English a story set among slum dwellers in India is the characters' English dialogue a real reflection of what these people think or speak?Do the novels of V. S. Naipaul or Salman Rushdie, set in Trinidad and India, respectively but written by migrant Anglophile authors, have the same impact on the reader as Vikram Seth writing about India while living in India?Do they reflect the same things in the same ways?Boisaubin & Winkler (2000), in a discussion of the use of the visual arts in medical education, caution against trying to make the image fit the needs of the course, wrenching it out of context, and failing to reflect the subtlety and complexity of its meaning.

Using literature
Hampshire & Avery ( 2001) recommend that medical students should have the opportunity to study medicine in literature as it allows them to reflect on their clinical experience and to understand the consequences of illness for patients and their families.For both medical students and psychiatric trainees, reading novels and also watching clips from selected films can help to illustrate cultural nuances.Both trainees and teachers can bring their own experiences and suggestions for novels and films, which can lead to seminars on different cultures.

Goals
Literature study is helpful in: . illustrating, renewing and expanding students' information about influences on the development of individuals in the context of their culture, including the development of cultural identity; .understanding cultural influences on individual development, highlighting the similarities and differences across cultures; .sharing teacher-trainee experiences in personal development; this will raise awareness of cultural sensitivities, differences and commonalities.

Examples
For Trinidad, V. S. Naipaul's A House for Mr Biswas gives a wonderful insight into the living conditions of Indo-Trinidadians.His younger brother Shiva Naipaul's underrated novels Fireflies and The Chip-Chip Gatherers provide a similar view of Trinidad, and will encourage teachers and trainees to discuss how an Indian family in diaspora works.For Sri Lanka, novels by Carl Muller, Shyam Selvadurai, Romesh Gunasekera and Michael Ondaatje (especially Anil's Ghost) help in understanding contemporary urban and rural concerns.

Using films
Some mainstream and independent films offer an excellent introduction to other cultures and cultural norms.
Although films have been used in the USA for teaching various aspects of psychiatry their use in training in cultural competence is more recent.As the characters carry on their activities in the broader context of their society, friendships and culture, the viewer is helped to identify with the story and its protagonists.Even old films that portray different prevailing social, political and economic mores can help trainees identify current pressures and responses to them.

Goals
. Ask trainees to identify differences and similarities between the culture in the film and their own.This can prompt them to consider what influences cultural differences have in their interactions with people from different cultures. .Ask trainees to identify issues relevant to psychiatry and to the delivery of services. .Ask trainees to describe any insights they have gained into the culture portrayed, and how this affects their own cultural values.

Examples
A number of films have been used for teaching psychiatry and psychology (Fleming et al, 1990), some of which can be used for cultural awareness.These authors also suggest that the older, silent films are particularly suitable for handling intimate psychological subjects.Other more recent examples are given in Box 1.

Conclusion
Both novels and films can be a powerful teaching resource for students learning about cultural norms and nuances in an individual's development.Trainees can learn about how people from specific cultures think and behave, and how this knowledge can be used to develop treatment plans.Of course, novels and films can only give some direction; further insight will come from discussion with communities and community leaders.
To learn more about Chinese culture, Amy Tan's novel The Joy Luck Club and Farewell My Concubine by Lillian Lee refer to different eras, but are still interesting to discuss.Alan Duff's Once Bhugra Cultural competence trainingWere Warriors illustrates Maori culture in New Zealand.Toni Morrison and Alice Walker both provide an African American perspective.Walker's The Color Purple deals with issues of childhood sexual abuse and its impact on relationships, the addition of slavery creating an extra jeopardy.The novels of Isabel Allende and Mario Vargas Llosa are useful for learning about Latin American cultures.