Stanford University Geriatric Education Resource Center  

HB60: Who Will Teach Geriatrics? A Faculty Development Program for Internists

Table of Contents.

I. Vocabulary of Clinical Teaching 5
II. Role Play in Medical Education 7
III. Problem Based Learning 21
IV. Patient Management Problems 29
V. Video Trigger Tapes 45
VI. Effective Slide Presentations 72
VII. Standardized Patient 79
VIII. Evaluation in Medical Education 103
IX. Reviewing Videotaped Encounters 119
X. Strategies in Writing for Publication 127

VOCABULARY OF CLINICAL TEACHING
This module is designed to introduce participants to the clinical teaching concepts developed by the Stanford Faculty Development Program (SFDP). Most faculty have not had formal instruction in clinical teaching skills, and don't have a vocabulary with which to describe the different components of their teaching. The full SFDP is an intensive, month long program held at Stanford. In addition to developing their own clinical teaching skills, individuals who attend the full program are also trained to conduct abbreviated workshops for interested faculty in their own or nearby institutions.

Two Stanford faculty came to the University of Chicago during the first year of our faculty development program and led a two day workshop introducing the SFDP vocabulary and teaching methods. We then chose to introduce the vocabulary to subsequent groups of trainees in a single didactic session. This is not equivalent to having a Stanford trained person conduct an abbreviated workshop or attending a month long program. We did, however, find it sufficient to meet the goals described below.

The module consists of one 60-90 minute lecture/discussion of the seven components of clinical teaching skills, as described by SFDP: setting the learning climate, control of session, communication of goals, promoting understanding and retention, feedback, evaluation, and promoting self-directed learning. The overall goal of this module is to give participants a vocabulary with which they can self-assess their clinical teaching.

At the end of the module, participants are expected to be able to:

  1. Understand the vocabulary developed by Stanford to describe clinical teaching activities.
  2. Begin to think about their own clinical teaching using these terms.
Module activities include the following: ROLE PLAY IN MEDICAL EDUCATION MODULE
This module is designed to introduce participants to the uses of role play in medical education. Many participants have had little or no experience with role play as a teaching tool, and they feel uncomfortable using the technique in their own teaching. The module is conducted in two sessions. The first session begins with a discussion of participants' own experiences with role play, focusing on strengths and barriers to the technique. After a discussion of techniques for facilitating role plays, one of the leaders suggests a role play scenario to the participants, and demonstrates how to facilitate the process. The faculty development participants do the role play and discuss the strengths and weaknesses of the technique and of the facilitation. During the second session, participants facilitate role play scenarios which they have written during the previous week, and the discussion centers around the content of the role plays as well as the process of teaching using the technique. At the end of the two-part module, participants are expected to be able to:
  1. Identify the instructional uses of role play.
  2. Understand strengths and weaknesses of the technique in medical education.
  3. Feel comfortable facilitating a role play scenario.
  4. Understand how to develop an effective role play scenario.
Activities of this module include the following:
Session 1:
Group discussion about strengths and weaknesses of role play and about participants' previous experiences with role play.
Mini-lecture on Role Play in Medical Education.
Participation in a Role Play exercise facilitated by the module leader.
Participants are assigned a project of writing a role play scenario related to a geriatrics topic.
Session 2:
Each participant facilitates the role play which they wrote the week before. The other group members are the role players.
Group discussion of success or weaknesses of the day's role play experience.
ROLE PLAY IN MEDICAL EDUCATION
Halina Brukner, MD
  1. OVERVIEW
    • A learning method in which participants take on a particular role, emulating a true-life setting, in order to achieve certain educational objectives. Examples of such objectives:
    • to illustrate an important or difficult scenario..
    • to promote acquisition of specific skills.
    • To practice newly-learned techniques, especially in the realm of interviewing and interpersonal interactions.
    • To increase understanding of situations of others. (Patients, providers, family members)
    • to explore attitudes towards specific towards situations or scenarios.
    • To provide opportunity for immediate feedback on interactions.
    • To "stimulate realism when discussion of important topics seems stilted, stale or over-intellectualized."3
    • Role play, if set up properly, provides a safe environment for practice and exploration of difficult-to-learn skills.
    • Role play does not necessarily have to be "acting": the participant can be him/herself and experience the situation as such, learning from that experience, rather than trying to simulate a prepackaged scenario.
    • Role play is particularly effective for teaching communication skills, since these specific skills can be highlighted, practiced and repeated after feedback.
  2. PROBLEMS AND BARRIERS WITH ROLE PLAY
    • Performance anxiety of trainees.
    • Role players may "stall" during role play to avoid difficult situations.
    • Behavior during role play is not the same as behavior during live encounters.
    • Disruption of role play (e.g. laughter, asides).
    • Intellectual discussions may substitute for actual practice.
    • Facilitator needs to be well-trained and understand technique.
    • May undermine goals and usefulness of technique in the future if experience is negative.
    • May be time-consuming.
  3. THE TEN-STEP APPROACH TO TEACHING ROLE PLAY
    Cohen-Cole et al. have constructed a straightforward structured approach to teaching with role play. The following is a brief synthesis of their ten-step method that guides you through the various phases of a role-play session. I have also included some strategies that Steinert suggests and added a few recommendations based on my own experiences.
    1. Clarify the objectives of role play
      • Should be articulated as SPECIFICALLY as possible.
      • The goals can be articulated by the facilitator or by the participants.
      • The environment should be as relaxed and supportive as possible. Personal anecdotes by the instructor are often helpful.
      • The advantages of role-play in the particular situation should be made explicit.
      • Acknowledge potential resistance to the role play.
    2. Demonstrate relevant techniques
      • May use videotape, live demonstration, discussion of cases.
      • Use of live demonstration may allay some anxiety on the part of participants.
    3. Define the Clinical Situation:
      Spontaneous Role Play Approaches vs. Prearranged Scripts
      • Spontaneous role play
      • often the most powerful and influential role plays.
      • build on participants' own experiences and needs and encourages a more
      • self-directed approach to the exercise.
      • participants are asked to think of a situation that meets the goals of the session.
      • after hearing the various scenarios, the instructor and participants negotiate which case to role play first.
      Prearranged script
      • useful if a more directed approach is chosen.
      • often less stressful for participants.
      • useful to prompt learners who have difficulty coming up with their own cases.
      • disadvantages include perpetuation of feeling that participants are "acting" and suggestion of scenarios with which participants not comfortable.
      Include brief but sufficient explanation of situation:
      • setting
      • issues for each role-taker (including emotional status)
      • "interpersonal" information for group
      • "intrapersonal" information for role player only
      • May include instructions for specific reactions in response to certain stimuli.
      • Role players may be instructed to make up what they don't know or to use their own experiences during the role play.
    4. Rehearse patient role
      • Instructor "invites" someone to play patient role.
      • giving out roles at random may be necessary to avoid stunning silence.
      • The selected participant sets up the seating to his/her liking.
      • The trainee is asked to explain who he or she is and to describe the interview situation in the first person. The trainee should not use his/her real name.
      • Use of nametags may be helpful.
      • The other participant(s) in the role play may be asked to leave the room during rehearsal.
    5. Rehearse doctor role
      • Instructor "invites" someone to play the doctor role.
      • Instructor might use this opportunity to demonstrate and discuss the skill to be practiced.
      • The group further discusses and defines the strategies to be practiced.
      • The selected participant is asked to rehearse in the first person the role to be assumed.
    6. Proceed with Role Play
      • Agree in advance on a time expectation or on means of ending the role play.
      • Give role players freedom to take "time out" if necessary.
      • Two to three minutes is usually sufficient for learning basic skills. Five to ten minutes is usually sufficient for more advanced skills. Longer role plays may get too complicated for meaningful discussion.
      • Attempt to make the situation as realistic as possible (e.g. proper introductions, entering the office if appropriate, props if appropriate).
      • Stop at agreed-upon signal.
    7. Feedback I: Doctor's Analysis
      • The doctor is asked to comment on what he/she did well.
      • The doctor discusses other aspects of the interview that were more difficult or that he/she did not think went well.
      • The doctor may replay the same situation at this point if appropriate.
    8. Feedback II: The Patient's Response
      • The patient tells the doctor how he/she felt about the interaction and how he/she felt during the interaction.
      • Encourage the patient to start with positives.
      • The patient might suggest ways to improve the interaction.
    9. Feedback III: The Instructor and Audience Response
      • Instructor's feedback often integrated into steps 7 and 8.
      • Open-ended questions are most useful.
      • Especially valuable if each audience member is looking at a specific aspect of patient or doctor behavior.
      • Instructor may summarize teaching points.
    10. Repeat Role Play
      • Steps 1-5 can be done very quickly.
      • Allow as many repeats as necessary to achieve confidence in skill development.
      • Consider repeating the role play with different members of the group.
    11. Summarize and evaluate
      • Summarize goals and discus newly learned points.
      • Evaluate effectiveness of role play technique in meeting objectives.
  4. OTHER TECHNIQUES IN ROLE-PLAY
    • Role reversal during encounter
    • Role sequencing to allow for greater participation of group
    • Doubling
    • Third trainee stands behind role players and articulates their feelings as the role play progresses.
    • Instructor's role play of role play facilitation
    • Practice by faculty of teaching techniques.
    • Videotapes to review session or to observe progress.

References

Cohen-Cole SA et al. Teaching with Role Play: A Structured Approach; in Lipkin M, Putnam, S, Lazare A (eds): The Medical Interview. New York, Springer-Verlag NY, Inc.

Simpson MA. How to use Role-Play in Medical Teaching. Medical Teacher. 7(1):75, 1985.

Steinert Y. Twelve Tips for Using Role-Plays in Clinical Teaching. Medical Teacher. 15(4):283, 1993.

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