Organizing a Program at Your Site

This part of the website guides site leaders in designing, organizing, and implementing their "Wit" programs. Because not all site leaders will require assistance with all stages of program planning, we have divided the section into discrete segments:

Brief Overview of Program Organization

The "Wit" program is intended to help your institution achieve a number of goals. First, the program hopes to introduce medical trainees to a range of competencies they will need in caring for dying patients. Specific competencies addressed in "Wit" include communicating difficult information, negotiating treatment decisions, and identifying physical, emotional, social, and existential needs of dying patients. Second, we hope to increase trainees' exposure to the humanistic elements end-of-life care, within a non-threatening forum that gives them a chance to reflect on their emotions and share them with others. A third goal is to stimulate discussion about challenges patients and providers face and how providers and the health care system can exacerbate or ameliorate those challenges. Finally, the program provides an alternative to traditional teaching methods (e.g. didactics) that may be better suited to the emotional content of end-of-life care.

The minimum recommended "Wit" educational program includes a viewing of the film supplemented by post-film facilitated small group discussions, often with a pre-film lecture to introduce the film’s end-of-life concepts. The facilitated discussions allow trainees the opportunity to react to the film and discuss important themes. We feel that a small group format is the best way increase trainees awareness of end-of-life issues, as well as trigger them to reflect upon and critically evaluate the care that they and their medical centers give to dying persons. Please see our program materials section to get more detail about recommended supplemental activities and how to incorporate them into your "Wit" program.

Developing an overall structure for your "Wit" program

The film version of "Wit" is not intended as a stand-alone educational program - it is the centerpiece of a variety of educational activities designed to help medical trainees gain insight into the personal experience of dying.

Selecting when to implement "Wit" into medical training

Selecting a group of trainees

Deciding which group of trainees to target with your "Wit" program depends on several factors, often the most important of which relates to which group you can get a commitment of curriculum time. However, if you have the flexibility to implement the program either for pre-clinical (e.g. MSI and MSII) or for clinical (e.g. MSIII and MSIV) students, it might be helpful for you to know the results of focus group pilots we have done using "Wit" with medical trainees at different stages of their medical training. We have found that trainees at all stages of their training, from early medical school to senior medical resident, feel that "Wit" is a valuable educational experience. Students earlier in their training, who have not yet had clinical experiences with dying patients, identify strongly with the patient's experience of illness. They often reflect on their desire to maintain their humanistic values through their medical careers and wonder whether medical training will impact on those values. An example of a quote made by one of the pre-clinical students after seeing "Wit": "I just kind of cringed you know, thinking of being in that situation just seemed so solitary, so lonely. And there was not friendship, I mean nothing, no family, there's nothing, no support except for Suzie and that is what stuck out most for me. I thought, wow, I might have to care for someone who is in this situation where they have no one – it's pretty sad."

Students in their clinical years as well as interns and residents have had increased exposure to demands on physicians in contemporary hospitals, and they identify most strongly with the physicians in "Wit." Many of these trainees, particularly interns and residents, struggle with the loss of their own idealism and their desire to retain compassion in the face of those demands. These themes are excellent opportunities for open-ended discussions following the screening of the film. An example of a quote made by one of the medical residents after seeing "Wit": "sometimes all they [the nurses] are doing is basic scrubbing patients' backs, they can be who they are and they don't have to be objective. It's hard being a resident 'cause you do have to be objective and have to be able to think clearly and you're terrified of what happens when you don't think clearly because you haven't had enough sleep because it's four o'clock in the morning . . . and you're always sort of haunted by the mistakes that you make, by how human you are on that level, you're terrified though by the fact that you're human."

Based on our experience with "Wit", we would recommend that schools consider 3rd and 4th year of medical school as the best opportunity for using the film to teach the humanistic elements of end-of-life care, as these students maintain the connection with their pre-clinical idealism but have been touched by the cognitive and workload demands of the clinical years. If it is not possible to incorporate "Wit" into the 3rd or 4th year, using it during the 1st or 2nd year is another good alternative. Some schools have even expressed a desire to show the film twice – once during the pre-clinical years and once during the clinical years.

How much curriculum time to commit?

The range of educational activities that can be incorporated into the "Wit" program at your site is quite wide, and have typically been limited by the amount of curriculum time available for the program. At a minimum, we recommend that every site include at least a full screening of the film (about 1 hour and 30 minutes) and a post-film discussion. The discussion can take a variety of forms (discussed in a separate section on the website), but should take at a minimum 30 minutes and more typically 60 to 90 minutes. Thus, including time for set-up and transitions between activities we recommend a minimum of about 2 1/2 hours although a 3-hour slot is recommended. Many schools chose to devote a half-day to their program. If your site has additional curriculum time to devote, we recommend any of a number of additional activities ranging from didactic lectures to role-plays to student-led readings of scenes from the play. For more information you may wish to consult our website's section on Additional Educational Activities.

Garnering institutional support for your program

As the organizer of the "Wit" program at your institution, you may have control over curriculum time for your trainees, or you may already have gotten a commitment from someone in your organization that controls curriculum time. In either case, you may already be in a position to place the program in your institution's curriculum. On the other hand, if neither of these is true, it is likely that you will need to enlist support for curriculum time from key individuals in your organization. During our work with institutions we have found a wide range of committed individuals who are effective mobilizers of curriculum time for "Wit." These individuals can also help to organize other "Wit" related activities and publicity for your program. We strongly suggest that you collaborate with one or more of these individuals to assist your program planning:

In enlisting program support, you can point out that "Wit" can help your organization to address the expectations of the AAMC with regard to curricular elements in end-of-life care. A letter of support from an AAMC executive will be available on our website.

Prior to the program – scheduling necessities

Scheduling a venue for watching the film.

Similar to the experience you have when going to see a movie in the theater, the quality of the projection system, audio, and seating has a large impact on the viewer's experience of the film (and what they will take away from it). Therefore, we recommend that the program organizer arrange for the highest-quality equipment available, preferably including a large-screen projector and excellent audio support, in a viewing area with comfortable seating for trainees. Although the film only lasts about 1 1/2 hours, we recommend reserving the room for at least 2 hours.

Scheduling a time for your program.

Together with the recommended post-viewing small group discussions, you should set aside a minimum of 3 hours for the entire "Wit" program. Our most successful programs have chosen to devote a full half-day to the program, which allows for some pre-viewing discussion as well as unhurried small group discussion. This arrangement is often possible if the program is scheduled as part of your institution's "Introduction to Clinical Medicine" or "Doctoring" course. Institutions that have been unable to set aside a half-day often have scheduled their programs over the noontime hour, often providing lunch to students as an added incentive for program participation. This arrangement permitted site leaders at these institutions to limit the program's time requirements to 2 hours of actual curriculum time.

Scheduling other educational activities in conjunction with "Wit"

As discussed above, "Wit" is not intended as a stand-alone film – educating medical trainees through the film requires supplementing the viewing with other activities that extend the film's technical and humanistic themes, including communicating bad news and negotiating treatment decisions, managing pain and other symptoms, supporting patients' emotional and spiritual needs, and organizing medical care for patients who are dying. There is a virtually limitless range of educational activities you may choose to pursue these themes. This website offers specific guides for post-performance discussion groups and talk-backs, as well as one sample pre-viewing lecture. Beyond these activities, however, we suggest that you supplement your students' film experience with intensified interactions with seriously ill patients, family caregivers and bereaved loved ones, and palliative care professional's through your institution's affiliated medical centers, veterans affairs facilities, cancer institutes, hospice, or other professional organizations. As with all activities involving patients and/or caregivers, it is important that you receive appropriate authorization from them beforehand, and to make available appropriate aftercare as requested. For trainees it may also be important to provide supportive guidance and mentorship in conjunction with all palliative educational activities.

Our experience in the "Wit" Educational Initiative led us to recommend post-performance small-group discussions as the minimum recommended supplemental activity. In addition, sites have been successful with a range of additional activities:

Including other healthcare trainees/providers/professionals

Although the "Wit" Film Project is targeted primarily for medical students, the lessons of "Wit" are broadly applicable across a range of disciplines including nursing, social work, pastoral care, mental health, and others. The "Wit" Film Project recognizes that the fundamental inter-professional grounding of palliative care requires integrating these diverse disciplines within a collaborative framework. In this spirit, we encourage you to consider including other training programs and disciplines in your "Wit" program. The addition of providers from these disciplines offers the opportunity to introduce a wide range of perspectives on the film, and may help medical students gain greater appreciation for the important contribution of inter-professional support services to patients' end-of-life care.

The conceptual model of the "Wit" Film Project is easily adaptable and can be integrated into a broad range of medical educational programs. Before you begin the detailed planning of the program it is most important that you enlist the support of key individuals within your institution. Once the program has been approved, the next step is to carefully consider the educational needs of your trainees and the amount of time to allot for educational activities. Depending on the size of your trainee group and institutional mandates, you may choose to integrate the program as a regular part of instructional activities or as an extracurricular training opportunity. The amount and extent of supplemental educational activities may depend on whether or not you choose to include allied healthcare professionals in the "Wit" Film Program at your facility.

Once the conceptual model has been adapted to suit the needs of your trainees within the structure of your institution, the detailed planning can begin. This includes reserving the auditorium or viewing space, considering the best time of day to capture your intended trainees, and other venue details that enhance the educational experience.

Wit Film Project : Site Map : Organizing a Program at Your Site