Role-Play Techniques Help Doctors Break Bad News

Structured action methods borrowed from psychodrama and sociodrama can substantially enhance the effectiveness of teaching physicians communication skills.

In an article by researchers at the University of Texas MD Anderson Cancer Center (Houston, TX, USA), an experimental approach that is learner-centered and case-based was used to select challenging scenarios in giving bad news, by attending to underlying emotion and by using reflection to anchor new learning using techniques such as warm-ups, role-creation, doubling, and role reversal. The researchers named the approach SPIKES (Setting, Perception, Invitation, Knowledge, Emotions, Strategy, and Summary).

According to the authors, a particularly effective method in creating empathy and involvement is doubling, where participants watching a role-play are invited to stand behind the chair occupied by the learner playing a character, imagine what the learner might be feeling or thinking, and speak their thoughts in the first person as if they were a voice-over or the learner's alter-ego. The authors found that this technique and the others they used can also reveal important unspoken thoughts and emotions. The study was published in the August 2014 issue of Simulation in Healthcare.

“Attending to hidden feelings and thoughts and using self-reflection to anchor new learning can, for example, raise awareness of how a doctor's own anxiety can lead them to avoid end-of-life discussions with patients and families or to be overly optimistic about available treatments,” concluded study authors Walter Baile, MD and Adam Blatner, MD.

“People often think about simulation in terms of teaching the clinical and technical skills in healthcare, but it is increasingly being used to teach a variety of nontechnical skills,” added Simulation in Healthcare editor-in-chief, David Gaba, MD, of Stanford University School of Medicine (CA, USA). “While many of us use role-play in our simulation teaching, the additional techniques presented may greatly enhance our work.”

Psychodrama is an action method, often used for psychotherapy, in which clients use spontaneous dramatization, role playing, and dramatic self-presentation to investigate and gain insight into their lives. Developed by Jacob Moreno, MD, psychodrama includes elements of theater, and is often conducted on a stage where props can be used. By closely recreating real-life situations, and acting them out in the present, people can evaluate their behavior and more deeply understand a particular situation in their lives.

Related Links:
University of Texas MD Anderson Cancer Center
Stanford University School of Medicine