Analysis of role-play in medical communication training using a theatrical device the fourth wall

BACKGROUND: Communication training is a central part of medical education. The aim of this article is to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance. METHOD: The empirical data stem from a communication training model demonstrated at an international workshop for medical teachers and course organizers. The model involves an actress playing a patient, students alternating in the role of the doctor, and a teacher who moderates. The workshop was videotaped and analyzed qualitatively. RESULTS: The analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction. 2) A "timeout/reflection" location, where the wall was doubly opaque, for the patient on the one side and the moderator, the doctor and the audience on the other side and 3) an "interviewing the character" location where the wall enclosed everybody in the room. All three locations may contribute to the learning process. CONCLUSION: The theatrical concept 'the fourth wall' may present an additional tool for new understanding of fiction based communication training. Increased understanding of such an activity may help medical teachers/course organizers in planning and evaluating communication training courses

Fiksjonsbasert kommunikasjonstrening i medisinsk utdannelse - med bruk av teaterfaglige virkemidler

Simulated patients are today used world wide in clinical communication training. Using simulated patients will imply the use of theatrical fiction. Basic elements of a theatrical fiction are relocation of time and space in addition to character(s) in some degree of acting/simulation and text. The main aim of this thesis was to elucidate and describe fiction based medical communication training with devices from the art of theatre with special focus on art didactical elements as the fourth wall's didactical function, the believability of the simulation and the importance of the in situ building of the simulated patient's character in elucidation of culture theory. The thesis consists of four sub-studies (Article I – IV). Sub-studies 1, 2 and 4 are based on recently developed communication training model aiming at training individuals in greater groups (Model 1). In this model students are stimulated to define own context-based learning goals. Sub-study 3 is based on a conventional training model used in most North-American medical schools (Model 2). This model is based on individual encounters, and the student gets feed-back from the simulated patient based on pre-defined learning goals. Sub-study 1 describes how theatrical tools mainly, as described by Stanislavskij, were utilised in Model 1. Through participation and reflection we stimulated the students to collectively develop a consultation with a simulated patient. The students reported learning outcomes in terms of mastering difficult consultations. In sub-study 2 close-reading was used as methodological tool in the analysis of a video-recording from a session of Model 1. The aim was to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance. Three different positions were identified, all depending on the direction of the ongoing communication. In sub-study 3 we let the three central aspects of Bakhtin’s dialogical theory interplay with data from training students by Model 2 in an abductive process. The aim was to explore the impromptu interaction between the medical student and the simulated patient with a specific focus on the in situ building of the SP’s character. Three features from Bakhtin’s theory of the utterance were applied in an abductive processinvestigate the impromptu interaction between the student and the simulated patient with a focus on the in situ building of the simulated patient's character. We derived, through examples, how Bakhtin’s theory may contribute to the impromptu building of the simulated character. In sub-study 4 the students evaluate their learning outcome in Model 1. The analysis is based on field notes, the students’ free-text evaluations, and two group interviews. Analysis was done by Systematic text condensation, inspired by Giorgi's method, with focus on students’ learning experiences. Utilising theatrical tools in clinical communication training is challenging, and made me adopt various methodologies. My research may be regarded as a contribution to increased focus on the qualitative and humanistic aspects of fiction based communication training

Creating the Simulated Patient Through Dialogue: An Approach Based on Bakhtin’s Dialogical Thinking

Simulated patients (SP) are being used in medical communication training worldwide. The character of an SP will be trained in advance. However, the dialogue with the student is never fully predictable. The aim of this study was to explore the impromptu interaction between the student and the SP with a focus on the in situ building of the SP’s character. Three features from Bakhtin’s theory of the utterance — addressivity, change of speaking subjects and finalisation — were applied in an abductive analytic approach. We found that the impromptu dialogue between the SP and the student provided different possibilities that may stimulate the creative process in SP character-building. The appliance of the dialogue as part of the simulated character-building may strengthen the simulation and thereby increases students’ learning outcomes

Researcher-researched relationship in qualitative research: Shifts in positions and researcher vulnerability

Background: The researcher role is highly debated in qualitative research. This article concerns the researcher-researched relationship. Methods: A group of health science researchers anchored in various qualitative research traditions gathered in reflective group discussions over a period of two years. Results: Efforts to establish an anti-authoritarian relationship between researcher and researched, negotiation of who actually ‘‘rules’’ the research agenda, and experiences of shifts in ‘‘inferior’’ and ‘‘superior’’ knowledge positions emerged as central and intertwined themes throughout the discussions. The dual role as both insider and outsider, characteristic of qualitative approaches, seemed to lead to power relations and researcher vulnerability which manifested in tangible ways. Conclusion: Shifting positions and vulnerability surfaced in various ways in the projects. They nonetheless indicated a number of similar experiences which can shed light on the researcher-researched relationship. These issues could benefit from further discussion in the qualitative health research literature

Researcher–researched relationship in qualitative research: Shifts in positions and researcher vulnerability

Background: The researcher role is highly debated in qualitative research. This article concerns the researcher-researched relationship. Methods: A group of health science researchers anchored in various qualitative research traditions gathered in reflective group discussions over a period of two years. Results: Efforts to establish an anti-authoritarian relationship between researcher and researched, negotiation of who actually “rules” the research agenda, and experiences of shifts in “inferior” and “superior” knowledge positions emerged as central and intertwined themes throughout the discussions. The dual role as both insider and outsider, characteristic of qualitative approaches, seemed to lead to power relations and researcher vulnerability which manifested in tangible ways. Conclusion: Shifting positions and vulnerability surfaced in various ways in the projects. They nonetheless indicated a number of similar experiences which can shed light on the researcher-researched relationship. These issues could benefit from further discussion in the qualitative health research literature