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 Table of Contents    
RESEARCH ARTICLE
Year : 2016  |  Volume : 48  |  Issue : 7  |  Page : 33-36
 

Role-play as an educational tool in medication communication skills: Students’ perspectives


Department of Pharmacology, BGSGIMS, Bengaluru, Karnataka, India

Date of Submission02-Jul-2016
Date of Acceptance07-Oct-2016
Date of Web Publication2-Nov-2016

Correspondence Address:
S H Lavanya
Department of Pharmacology, BGSGIMS, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7613.193311

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 » Abstract 


Objectives: Medication communication skills are vital aspects of patient care that may influence treatment outcomes. However, traditional pharmacology curriculum deals with imparting factual information, with little emphasis on patient communication. The current study aims to explore students’ perceptions of role-play as an educational tool in acquiring communication skills and to ascertain the need of role-play for their future clinical practice.
Materials and Methods: This questionnaire-based study was done in 2nd professional MBBS students. A consolidated concept of six training cases, focusing on major communication issues related to medication prescription in pharmacology, were developed for peer-role-play sessions for 2nd professional MBBS (n = 122) students. Structured scripts with specific emphasis on prescription medication communication and checklists for feedback were developed. Prevalidated questionnaires measured the quantitative aspects of role-plays in relation to their relevance as teaching–learning tool, perceived benefits of sessions, and their importance for future use.
Statistical Analysis: Data analysis was performed using descriptive statistics.
Results: The role-play concept was well appreciated and considered an effective means for acquiring medication communication skills. The structured feedback by peers and faculty was well received by many. Over 90% of the students reported immense confidence in communicating therapy details, namely, drug name, purpose, mechanism, dosing details, and precautions. Majority reported a better retention of pharmacology concepts and preferred more such sessions.
Conclusions: Most students consider peer-role-play as an indispensable tool to acquire effective communication skills regarding drug therapy. By virtue of providing experiential learning opportunities and its feasibility of implementation, role-play sessions justify inclusion in undergraduate medical curricula.
Key message:
Peer-role play as a teaching learning method to teach medication-communication skills to undergraduate pharmacology students needs to be explored. Students' perspectives of the positive impact of these sessions in acquiring counselling skills may guide future educational interventions in this regard.


Keywords: Medication communication, peer-role-play, perceptions, pharmacology, undergraduate students


How to cite this article:
Lavanya S H, Kalpana L, Veena R M, Bharath Kumar V D. Role-play as an educational tool in medication communication skills: Students’ perspectives. Indian J Pharmacol 2016;48, Suppl S1:33-6

How to cite this URL:
Lavanya S H, Kalpana L, Veena R M, Bharath Kumar V D. Role-play as an educational tool in medication communication skills: Students’ perspectives. Indian J Pharmacol [serial online] 2016 [cited 2020 Apr 7];48, Suppl S1:33-6. Available from: http://www.ijp-online.com/text.asp?2016/48/7/33/193311




“Medication communication is a vital component of patient safety, quality of care, and patient and family engagement,” stated Manias.[1] The direct correlation of good communication skills to better medication adherence and improved patient outcomes has been documented by numerous studies.[2],[3] However, according to the data available, the common fallacies on the physician’s part include missing the medications’ name (26%), the reason for prescribing (13%), dosing details (42%–45%), and the possible side effects (65%).[4] The process of medication communication is a rigorous one, which involves a lot of prior planning regarding the delivery of prioritized information. These skills need not be always innate; they can be acquired and enhanced.[5] Despite this fact, communication skills’ training happens to be an area that is often neglected.[6] It is therefore the need of the hour to invest in resources to enhance the “communication skills bank” of the medical graduates.

Conventional undergraduate pharmacology teaching has primarily focused on teaching the “theoretical” aspects of medications, rather than the pharmacotherapeutic skills.[7] Students are taught how to successfully write prescriptions for a medical ailment, but they are not adequately trained to counsel or educate patients regarding their proper use, which in turn may affect treatment outcomes. For imbibing and enhancing communication skills, interactive and innovative tools are preferred over pure didactic methods.[5] Peer-role-play is one such low-cost tool that allows students to comprehend the complexities of patient–physician interaction in a “safe and professional” setting.[5],[8]

A pilot study was conducted in twenty 2nd year medical students in the department of pharmacology to evaluate the effectiveness of peer-role-play as a teaching–learning (T–L) tool in improving communication skills with relation to patient education regarding medication prescription for ischemic heart disease. The students were trained and then evaluated using an objective structured practical examination method. The evaluation, which was based on a checklist prepared, using the modified Calgary-Cambridge guide, showed a significant improvement in the posttraining scores. In view of these and findings of other studies,[5],[6],[7] the researchers planned the current study to explore the students’ view points of the role-play and also to ascertain if learning communication skills was a felt need by students for their future clinical practice.


 » Participants and Methods Top


Study Setting

This observational, questionnaire-based study was conducted in the Department of Pharmacology, during the academic year 2015–2016. Students in second professional MBBS, 5th term (n = 122), were invited to participate in the peer-role-play sessions on medication communication.

Training Tools

Common medical problems encountered on an everyday basis by an Indian medical graduate and the major communication issues related to medication prescription were discussed and finalized by the department subject experts. Six training cases were designed keeping in mind the learning objectives [Table 1]. The Calgary-Cambridge guide to the medical interview for communication process was considered the reference for preparing training material for faculty and students.[9],[10]
Table 1: Training cases for role-play sessions

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A structured script for students that included concise patient and physician briefing sheets were designed for each of the training cases with specific emphasis on explanation and planning sections of the Calgary-Cambridge guide, for example, providing information on treatment offered and encouraging shared decision-making.[9],[10] All the training materials were subjected to peer-review within the institution, and the suggestions were incorporated after thorough discussions. The faculty were provided with a training manual containing case-briefing sheets and specific instructions regarding points on effective feedback for each of the cases.

Ethical Approval

Ethical clearance was obtained from the Institutional Ethics Committee. Following a written, informed consent, students were briefed about the role-play sessions, in which each one takes an active part in at least one role-play and witnesses the rest.

Methodology

Each role-play session required a minimum of three students, a physician, a patient, and an observer (additional student for the case of bronchial asthma). The students were allowed to choose their training cases and their roles. The role-plays were held during regular pharmacology practical classes. Prior to this, students attended a lecture class on the general aspects of communication skills (both verbal and nonverbal), along with the technical aspects of medication counseling (problem-oriented learning). The students playing the roles of physician and patients received their role sets which included all necessary medical information and the case descriptions, respectively, so as to concentrate on communication. The students were at liberty to include the emotional aspects into the sessions, if required. The student observers were provided a structured feedback based on a checklist that included components for both observation and reflection. The faculty moderated the discussions and provided the concluding critical, constructive feedback addressing the medical- and communication-related issues of the respective case.

Outcomes’ Assessment

At the end of six sessions, students who attended a minimum of four training sessions and played at least one active role were handed over a prevalidated questionnaire which included the students’ perspectives on (a) role-play as a T–L tool (b) benefits of medication communication training sessions that had to be answered on a 5-point Likert scale with the categories “agree completely” – (score 5) to “do not agree at all” – (score 1). In addition, students were asked as to how they perceived the importance of medication communication skills before and after role-play sessions.

Statistical Analysis

Data were entered into Microsoft excel data sheet and were analyzed using SPSS 22 version software. Categorical data were represented as frequencies and proportions.


 » Results Top


Out of 122 students attending pharmacology classes, a total of 96 students (78.7%) attended a minimum of four of the six training sessions and completed the questionnaires. Of these, majority were females accounting to 56.3% (n = 54) and males constituted 43.7% (n = 42). The findings are as follows.

General Perceptions about Role-play

Over 90% of the students agreed completely/partly that role-play concept was innovative and it was worthwhile taking part in them. There was a common consensus among students about role-play being an effective T–L tool, with majority of students agreeing that such sessions were indeed useful for learning medication communication skills and may be a part of regular pharmacology curriculum. A majority preferred more such sessions for further enhancement of skills and only a meager number felt that role-plays were a waste of time [Figure 1].
Figure 1: Role-play as a teaching–learning tool – general perceptions

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Perceived Benefits of Medication Communication Training Sessions

Majority of students (>80%) reported that this intervention helped them acquire doctor–patient interaction skills and also appreciate the vitality of such skills in preventing medication mishaps. The results were overwhelming in terms of confidence about conveying the details of drug therapy and also better retention of pharmacology concepts; with more than 90% of the students completely or partly agreeing about the benefits of training sessions. The feedback provided by both the moderators and observers was highly appreciated [Figure 2].
Figure 2: Students' perceptions of the benefits of medication communication role-play sessions

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Perceived Importance of Acquiring Medication Communication Skills

A positive response was obtained from students with a complete majority appreciating the significance of skills acquisition for future clinical practice [Table 2].
Table 2: Students' view of the importance of communication skills before and after role-play sessions

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 » Discussion Top


Communication about prescription medications forms a vital aspect of every physician–patient counseling session. Good communication skills can be taught to students through simulation which facilitate the combination of theory and practice.[8] We created a few hypothetical situations addressing these issues and chose the peer-role-play sessions as an educational tool to meet the specified learning objectives. As per the educational theory, role-play models are considered superior as they provide platform for students to be constructive and play active role in improvising professional and interpersonal behaviors, rather than being just passive bystanders.[11]

From the students’ perspective, the role-play concept was very much appreciated and was considered to be an effective means for learning communication skills. Similar findings were reported by Bosse et al. in their study on peer-role-play.[5] These results may be attributed to the positive traits of role-play methodology, namely, coming togetherness of individuals of varied mindsets, learning through experience and shared understanding, thinking out of the box, and developing creative ways to solve problems.[8]

Pharmacology is a dynamic science that follows students into their clinical years and beyond. According to Flexner’s principles, an approach to learning this science is to provide the fundamental concepts and then invite students to apply the same in clinical environment.[12] It was heartening to see that role-plays were perceived as a vital T–L tool in understanding and retaining pharmacological concepts by majority of students. Manzoor et al. recommended that by engaging students in role-plays, the components of both basic and clinical components of a medical curriculum can be delivered.[13] In addition, role-plays offer dual advantages of fostering skill development and empathy toward patients and thus warrant inclusion in medical curriculum.[5]

It is evident that patients who had adequate discussions with their physicians about prescription drugs had high adherence rates.[14] One of the objectives of this study was to train students to communicate the drug-related information to patients. This provides the backbone over which treatment outcomes rest upon. Students reported immense confidence while counseling the patients regarding drug therapy, with specific emphasis on drug name, purpose, mechanism, dosing details, precautions, and importantly follow-up details. Such an effort improves students’ confidence of minimizing medication errors in future; a fact reiterated by a similar study on medication communication.[15]

Despite its popularity for promoting active learning, role-play has its own challenges.[8] Few of the challenges faced by us were the initial reluctance among a few students toward participation and constraints of time. Integrating sessions during regular practical hours solved the issues of time. Allowing students to choose cases of their interests, witnessing enthusiasm exuberated by fellow students, and a bit of counseling from faculty rekindled the interests in reluctant students. By encouraging the students to play at least one role in the sessions, even the introverts and low achievers were given ample opportunity to perform and learn. Eventually, most of them reported that the skills they acquired through these sessions would be useful in their future clinical practice, which was comparable to the study findings by Shankar.[16]

Observational learning is a key aspect of behavioral science. Researchers have suggested that “behavioral change can and does occur through observation, even when such observation is incidental, occurring in the context of other activities.”[17] By providing a checklist with components for both observation and reflection, even the observers had the opportunity for planned, active learning. Structured feedback by the moderator and peers prompted students to analyze their performance and also reflect-on action. This was widely appreciated by most of the students.

Strengths and Limitations

Numerous studies have favored role-play approach for general communication skills training.[5],[13],[18] However, there is a paucity of data with respect to its usefulness in teaching medication communication skills, in particular, in the Indian medical scenario. The present study used hypothetical scenarios that were designed in accordance to the must-know portions of pharmacology for the role-play series. In addition, attempts were made to provide a structured feedback process along with scope for reflection to maximize the benefits of role-play.

Since only quantitative data were analyzed, inclusion of a few open-ended questions to analyze the qualitative aspects would have explored students’ perceptions in depth. A focused group discussion on faculty perspectives about the sessions would have added significant information too.

The effects of medication counseling skills training can be tested in real patient encounters in the clinical setting using assessment methods such as mini-clinical evaluation exercise or objective structured clinical examination. The long-term impact of role-play sessions in bringing around behavioral changes may be further investigated.


 » Conclusions Top


From the medical students’ point of view, peer-role-play sessions had a positive impact in improving medication communication skills for their future clinical practice. This study offers a realistic basis for the use of role-play in undergraduate pharmacology students for acquisition of communication skills regarding drug therapy. It is time to seriously consider incorporation of role-play in the current medical curriculum to foster active learning.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
 » References Top

1.
Manias E. Medication communication: A concept analysis. J Adv Nurs 2010;66:933-43.  Back to cited text no. 1
[PUBMED]    
2.
Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Med Care 2009;47:826-34.  Back to cited text no. 2
[PUBMED]    
3.
Street RL Jr., Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns 2009;74:295-301.  Back to cited text no. 3
    
4.
Kripalani S, Osborn CY, Vaccarino V, Jacobson TA. Development and evaluation of a medication counseling workshop for physicians: Can we improve on ‘take two pills and call me in the morning’? Med Educ Online 2011;16: doi: 10.3402/meo.v16i0.7133. [Epub ahead of print Sep 08].  Back to cited text no. 4
    
5.
Bosse HM, Nickel M, Huwendiek S, Jünger J, Schultz JH, Nikendei C. Peer role-play and standardised patients in communication training: A comparative study on the student perspective on acceptability, realism, and perceived effect. BMC Med Educ 2010;10:27.  Back to cited text no. 5
    
6.
Choudhary A, Gupta V. Teaching communications skills to medical students: Introducing the fine art of medical practice. Int J Appl Basic Med Res 2015;5 Suppl 1:S41-4.  Back to cited text no. 6
    
7.
Tripathi RK, Sarkate PV, Jalgaonkar SV, Rege NN. Development of active learning modules in pharmacology for small group teaching. Educ Health (Abingdon) 2015;28:46-51.  Back to cited text no. 7
[PUBMED]    
8.
Mogra I. Role play in teacher education: Is there still a place for it? Teach Educ Adv Netw J 2012;4:4-15.  Back to cited text no. 8
    
9.
Kurtz SM, Silverman JD, Draper J. Teaching and Learning Communication. Skills in Medicine. Oxford: Radcliffe Medical Press; 1998.  Back to cited text no. 9
    
10.
Silverman JD, Kurtz SM, Draper J. Skills for Communicating with Patients. Oxford: Radcliffe Medical Press; 1998.  Back to cited text no. 10
    
11.
Joyner B, Young L. Teaching medical students using role play: Twelve tips for successful role plays. Med Teach 2006;28:225-9.  Back to cited text no. 11
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12.
Jefferies WB, McMahon KK, Rosenfeld GC, Strandhoy JW, Szarek J, Wilson-Delfosse A. Pharmacology – In the face of revisiting Flexner’s view of medical education. Med Sci Educ 2010;20:288-92.  Back to cited text no. 12
    
13.
Manzoor I, Mukhtar F, Hashmi NR. Medical students’ perspective about role-plays as a teaching strategy in community medicine. J Coll Physicians Surg Pak 2012;22:222-5.  Back to cited text no. 13
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14.
Bull SA, Hu XH, Hunkeler EM, Lee JY, Ming EE, Markson LE, et al. Discontinuation of use and switching of antidepressants: Influence of patient-physician communication. JAMA 2002;288:1403-9.  Back to cited text no. 14
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15.
Tayem YI, Altabtabaei AS, Mohamed MW, Arrfedi MM, Aljawder HS, Aldebous FA, et al. Competence of medical students in communicating drug therapy: Value of role-play demonstrations. Indian J Pharmacol 2016;48:37-41.  Back to cited text no. 15
[PUBMED]  Medknow Journal  
16.
Shankar PR. Using case scenarios and role plays to explore issues of human sexuality. Educ Health (Abingdon) 2008;21:108.  Back to cited text no. 16
[PUBMED]    
17.
Fryling MJ, Johnston C, Hayes LJ. Understanding observational learning: An interbehavioral approach. Anal Verbal Behav 2011;27:191-203.  Back to cited text no. 17
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Luttenberger K, Graessel E, Simon C, Donath C. From board to bedside – Training the communication competences of medical students with role plays. BMC Med Educ 2014;14:135.  Back to cited text no. 18
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

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