Insights
Role-play without humiliation: is it possible? Nicola Stobbs Department of Otolaryngology, Head and Neck Surgery, Blackpool Victoria Hospital, Lancashire, UK I was mortified, so much so that I did not attend any more of the sessions by this lecturer
T
he idea of role-play, in its simplest form, is asking someone to imagine that they are either themselves or another person in a particular situation,1 and within a medical education context it is practising dealing with real-life situations without the limitations imposed by real patients.2 My most memorable experience of role-play was as a student: in a packed auditorium the lecturer announced we were going to do some role-play and I was chosen, and was horrified at the thought of having to perform in front of
my peers. I was told that I was a patient and the lecturer was the general practitioner. He gave me a list of several medications, doses and times to memorise, and I was told at the end of the lecture I would need to recall them. Obviously, when my moment to shine came I was unable to remember the details and it was at this point the lecturer exclaimed ‘If this student is supposed to be in the top 2 per cent of the population and can’t do it, then how on earth is a little old lady going to remember her medications?’ He
was using me to illustrate a point and my colleagues were amused, but I was mortified, so much so that I did not attend any more of the sessions by this lecturer. Teaching by humiliation is a phrase that conjures up feelings of dread, even in the most confident amongst us, and although this style of education is thought of as old-fashioned, this practice still occurs. Wilkinson et al. conducted a survey of 1334 New Zealandbased medical students in 2006, and found that two-thirds had suffered an adverse experience
128 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 128–130
tct_12295.indd 128
3/11/2015 12:55:10 PM
Students find [these sessions] extremely useful when preparing for exams and clinical placements
at medical school, most commonly reporting being humiliated by a senior colleague.3 Similarly to my experience the students then attempted to avoid the perpetrator, which had an impact on their training, and a number of the respondents felt that their experience had made them consider leaving medical school. My role-play encounter was not an effective tool for teaching and improving skills. Instead, this on-the-spot style caused me stress, embarrassment and an
Box 1. The Trio role-play method Split the learners into groups of three: Learner One: Has the role of being the student or doctor taking the history or undertaking the communication task Learner Two: Has the role of the patient or family member with ready prepared information and a script Learner Three: Has the role of the observer and contributes constructive feedback to their colleague
Box 2. How to facilitate role-play without humiliation 1) Be prepared a. Organise the relevant scripts and scenarios beforehand b. Consider sending out the scenarios and material before the session so students can adequately practise and mentally prepare c. Know your audience and tailor the scripts appropriately d. Ensure the venue is suitable for the learning session 2) Be fair a. Create a “safe space” and set ground rules prior to the sessions so learners feel secure b. Allow students to opt-out of roles if it may cause them upset or distress c. Rather than dictate roles and groups, allow learners to choose these themselves d. Ensure the trio groups are running simultaneously so no learner feels singled out or exposed 3) Be approachable a. Be available during the role-play to troubleshoot any issues b. Conduct a thorough debrief for students after the scenarios c. Facilitate group discussion and reflection about the learning activity d. Listen to student feedback to improve future sessions
aversion to role-play. These situations can have a detrimental effect on learning and can lead to poor confidence levels. This is a view shared by Mansfield, who comments that a disadvantage of using role-play in teaching is that the concept can be met with initial resistance by some students, either because of shyness or because of a fear of self-exposure.4 In the right context, however, role-play is an excellent way to hone the proficiency of counselling, communicating and historytaking, by requiring students to use what they know and apply these skills. This is a powerful form of active learning and consolidates knowledge, and Joyner and Young state that role-play ‘is a continuous, interactive, dynamic teaching approach that engages students in meaningful learning’.2 When I started undertaking regular undergraduate teaching sessions I wanted to incorporate different styles of teaching. As part of my MSc in medical education I was observed teaching on several occasions, and wanted to try something new and be out of my comfort zone. I decided to use role-play and see whether this could be a useful learning tool; however, after my bad experiences I wanted this to be used in safer, less pressurised situations that were more
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 128–130 129
tct_12295.indd 129
3/11/2015 12:55:11 PM
I wanted [role-play] to be used in safer, less pressurised situations
realistic to clinical practice. I decided to trial scenarios in which student groups were split into groups of three. One of the participants had the role of being the student or doctor taking the history or undertaking the communication task. Another was the patient with ready prepared information. The third observed the interaction and gave constructive feedback to their colleague. This style of role-play has been previously investigated (see Box 1), and one particular study found that the percentage of students that thought role-play was a beneficial tool for education rose from 77.8 per cent of students, prior to a trio role-play scenario, to 96.5 per cent of students after the session.1 After carrying out many of these sessions, students have
appeared to enjoy them and find them extremely useful when preparing for exams and clinical placements. Additionally, I have received positive verbal and written feedback from students and examiners about the teaching sessions. Wearne states that ‘Neutral reactions to role-play are rare – you either love it or hate it’,5 and it seems that as a result of my incorporation of trio-style role-play into teaching sessions, my feelings have gone from the latter, and are starting to lean towards the former! In my experience, role-play sessions in which the students are forewarned, and that are organised and nonconfrontational (see Box 2), are an excellent opportunity to not only practise and get feedback about history-taking,
information-providing or counselling, but also to improve and be critiqued on communication skills. REFERENCES 1.
Nestel D, Tierney T. Role play for medical students learning about communication: Guidelines for maximising benefits. BMC Med Educ 2007;2:3.
2.
Joyner B, Young L. Teaching medical students using role play: twelve tips for successful role plays. Med Teach 2006;28:225–229.
3.
Wilkinson T, Gill D, Fitzjohn J, Palmer C, Mulder R. The impact on students of adverse experiences during medical school. Med Teach 2006;28:129–135.
4.
Mansfield F. Supervised role-play in the teaching of the process of consultation. Med Educ 1991;25:485–490.
5.
Wearne S. Role play and medical education. Australian Family Physician 2004;33:858.
Corresponding author’s contact details: Nicola Stobbs, c/o ENT Secretaries, Royal Albert Edward Infirmary, Wigan Lane, WN1 2NN, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgements: None. Ethical approval: Not required. doi: 10.1111/tct.12295
130 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 128–130
tct_12295.indd 130
3/11/2015 12:55:12 PM
Role-play without humiliation: is it possible? Nicola Stobbs Department of Otolaryngology, Head and Neck Surgery, Blackpool Victoria Hospital, Lancashire, UK I was mortified, so much so that I did not attend any more of the sessions by this lecturer
T
he idea of role-play, in its simplest form, is asking someone to imagine that they are either themselves or another person in a particular situation,1 and within a medical education context it is practising dealing with real-life situations without the limitations imposed by real patients.2 My most memorable experience of role-play was as a student: in a packed auditorium the lecturer announced we were going to do some role-play and I was chosen, and was horrified at the thought of having to perform in front of
my peers. I was told that I was a patient and the lecturer was the general practitioner. He gave me a list of several medications, doses and times to memorise, and I was told at the end of the lecture I would need to recall them. Obviously, when my moment to shine came I was unable to remember the details and it was at this point the lecturer exclaimed ‘If this student is supposed to be in the top 2 per cent of the population and can’t do it, then how on earth is a little old lady going to remember her medications?’ He
was using me to illustrate a point and my colleagues were amused, but I was mortified, so much so that I did not attend any more of the sessions by this lecturer. Teaching by humiliation is a phrase that conjures up feelings of dread, even in the most confident amongst us, and although this style of education is thought of as old-fashioned, this practice still occurs. Wilkinson et al. conducted a survey of 1334 New Zealandbased medical students in 2006, and found that two-thirds had suffered an adverse experience
128 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 128–130
tct_12295.indd 128
3/11/2015 12:55:10 PM
Students find [these sessions] extremely useful when preparing for exams and clinical placements
at medical school, most commonly reporting being humiliated by a senior colleague.3 Similarly to my experience the students then attempted to avoid the perpetrator, which had an impact on their training, and a number of the respondents felt that their experience had made them consider leaving medical school. My role-play encounter was not an effective tool for teaching and improving skills. Instead, this on-the-spot style caused me stress, embarrassment and an
Box 1. The Trio role-play method Split the learners into groups of three: Learner One: Has the role of being the student or doctor taking the history or undertaking the communication task Learner Two: Has the role of the patient or family member with ready prepared information and a script Learner Three: Has the role of the observer and contributes constructive feedback to their colleague
Box 2. How to facilitate role-play without humiliation 1) Be prepared a. Organise the relevant scripts and scenarios beforehand b. Consider sending out the scenarios and material before the session so students can adequately practise and mentally prepare c. Know your audience and tailor the scripts appropriately d. Ensure the venue is suitable for the learning session 2) Be fair a. Create a “safe space” and set ground rules prior to the sessions so learners feel secure b. Allow students to opt-out of roles if it may cause them upset or distress c. Rather than dictate roles and groups, allow learners to choose these themselves d. Ensure the trio groups are running simultaneously so no learner feels singled out or exposed 3) Be approachable a. Be available during the role-play to troubleshoot any issues b. Conduct a thorough debrief for students after the scenarios c. Facilitate group discussion and reflection about the learning activity d. Listen to student feedback to improve future sessions
aversion to role-play. These situations can have a detrimental effect on learning and can lead to poor confidence levels. This is a view shared by Mansfield, who comments that a disadvantage of using role-play in teaching is that the concept can be met with initial resistance by some students, either because of shyness or because of a fear of self-exposure.4 In the right context, however, role-play is an excellent way to hone the proficiency of counselling, communicating and historytaking, by requiring students to use what they know and apply these skills. This is a powerful form of active learning and consolidates knowledge, and Joyner and Young state that role-play ‘is a continuous, interactive, dynamic teaching approach that engages students in meaningful learning’.2 When I started undertaking regular undergraduate teaching sessions I wanted to incorporate different styles of teaching. As part of my MSc in medical education I was observed teaching on several occasions, and wanted to try something new and be out of my comfort zone. I decided to use role-play and see whether this could be a useful learning tool; however, after my bad experiences I wanted this to be used in safer, less pressurised situations that were more
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 128–130 129
tct_12295.indd 129
3/11/2015 12:55:11 PM
I wanted [role-play] to be used in safer, less pressurised situations
realistic to clinical practice. I decided to trial scenarios in which student groups were split into groups of three. One of the participants had the role of being the student or doctor taking the history or undertaking the communication task. Another was the patient with ready prepared information. The third observed the interaction and gave constructive feedback to their colleague. This style of role-play has been previously investigated (see Box 1), and one particular study found that the percentage of students that thought role-play was a beneficial tool for education rose from 77.8 per cent of students, prior to a trio role-play scenario, to 96.5 per cent of students after the session.1 After carrying out many of these sessions, students have
appeared to enjoy them and find them extremely useful when preparing for exams and clinical placements. Additionally, I have received positive verbal and written feedback from students and examiners about the teaching sessions. Wearne states that ‘Neutral reactions to role-play are rare – you either love it or hate it’,5 and it seems that as a result of my incorporation of trio-style role-play into teaching sessions, my feelings have gone from the latter, and are starting to lean towards the former! In my experience, role-play sessions in which the students are forewarned, and that are organised and nonconfrontational (see Box 2), are an excellent opportunity to not only practise and get feedback about history-taking,
information-providing or counselling, but also to improve and be critiqued on communication skills. REFERENCES 1.
Nestel D, Tierney T. Role play for medical students learning about communication: Guidelines for maximising benefits. BMC Med Educ 2007;2:3.
2.
Joyner B, Young L. Teaching medical students using role play: twelve tips for successful role plays. Med Teach 2006;28:225–229.
3.
Wilkinson T, Gill D, Fitzjohn J, Palmer C, Mulder R. The impact on students of adverse experiences during medical school. Med Teach 2006;28:129–135.
4.
Mansfield F. Supervised role-play in the teaching of the process of consultation. Med Educ 1991;25:485–490.
5.
Wearne S. Role play and medical education. Australian Family Physician 2004;33:858.
Corresponding author’s contact details: Nicola Stobbs, c/o ENT Secretaries, Royal Albert Edward Infirmary, Wigan Lane, WN1 2NN, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgements: None. Ethical approval: Not required. doi: 10.1111/tct.12295
130 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 128–130
tct_12295.indd 130
3/11/2015 12:55:12 PM
