by Ijeoma
Ekeocha, Pharm.D., PGY1 Pharmacy Practice Resident, the Johns Hopkins Hospital
Cultural competence is the capacity and awareness to care for a
diverse patient population. Such awareness often requires being respectful and
sensitive to the cultural differences of patients.1 In a world where
patients may come from all walks of life, cultural competence is an essential skill
that must be taught in curriculums intended to equip learners with the necessary
tools to interact with people. One method that instructors can use to develop
cultural competence is role play, which can be particularly useful in patient
care settings. Role play encourages
learners to express their feelings and portray individuals from various
backgrounds. There are few opportunities
for learners to do so in traditional teaching settings.2 In one
study where role play was used in an industrial psychology course, students
reported that role play was more valuable than conventional teaching approaches.3
Role play has been around for decades, and was originally developed to
effect attitudinal changes during psychotherapy. In 1956, Moreno, founder of psychodrama,
utilized players to recite pre-defined lines. This became the basis for role play in
educational settings today.1 The
definition of role play has since evolved.
It is a tool that promotes active learning and cultivates learner knowledge,
skills, and attitudes.4 Role
play entails the “acting-out of a specific situation based on the adopting of
another character ‘role’.”5 An
in depth look at the technique unveils questions to ponder. Are the roles
actual, imitational, or fictional? Are they spontaneous or scripted? How
structured and extensive should the role be?2
Using role play to teach cultural competence gives learners the
opportunity to learn the material from a different perspective. When learners
engage in role play, they take on a new persona. This provides
students with deeper insights into the responsibilities of members of the
healthcare team, such as the role of the nurse, dietitian, or patient. While
every role on the healthcare team is important, the patient’s role is at the
center. Therefore, when using role play to teach cultural competence, students
should assume the role of a patient. In so doing, it cultivates the student's interpersonal abilities.
Participating in role play allows learners to practice and develop
skills and techniques that would be useful when encountering patients in real
life. As learners get more exposure through these constructed exercises, it
gradually increases their understanding of other cultures. This, in turn, translates into increased
respect for other cultures. Respect of others is a critical component of cultural competence that must
be cultivated in school and necessary for success in clinical practice today.3
To successfully implement role play exercises, instructors must
deliberately bring to light various issues that students may face in practice.
Specific items that instructors should consider when developing role playing activities
include: 3
- Objectives
- Time frame for the activity
- Role specifications
- Monitoring the role play process
- Relating role play to theory
- Delineating criteria to grade performance
- Indicating the role of observers
- Facilitating constructive analysis
When designing a role play exercise, instructors must consider the
type of role play and clinical content to include. There are five types of role
play, all of which can be employed depending on the anticipated outcome. The
first type of role play is “Role-play as a creativity technique.” This type of
role play is designed to elicit ideas from the role play experience. Learners
must “bodystorm,” meaning they take part in a staged situation, which allows
them to empathize with the character in the given situation. The actors
transform into the characters which offers insight into the specific role.6
Another type of design is “role play as a research method.” This type
of role play is most often use in settings to trial software in scenarios which
can be useful in determining the success of marketed products. In these simulated
scenarios, designers use role play to analyze feelings and insights of the end
users while operating their product.6 This form of role play is
often created for testing in a predetermined environment to identify how
individuals will react in the real world.
While role-play can evoke ideas from the individual involved, it can
also serve as a valuable tool for spectators.6 By incorporating concrete
and intangible ideas, role-play can reveal important messages to the audience. This
type of role play may be recorded so that students are able to replay the
scenario and watch themselves through a recording. This role play is often used
in schools so that students can learn from and evaluate their own performances.
“Role play as an artifact” is the result of a user experience.5
In this case, the role play is a product of the experiment. For example, this type
of role play can be used to highlight a specific failure mode seen in the
medication use system. A medication safety officer may design a role that
includes an insulin pen that is verified appropriately by the Pharmacist,
filled incorrectly by the technician, and is incorrectly checked by the
checking pharmacist. This scenario allows pharmacy personnel to explore
different failure modes of the medication use system through the use of role
play drawn from a previous experience.
Lastly, role play can be used as a training method.6 This
type of role play is often utilized in classrooms to help learners safely
practice appropriate actions in simulation environments.6 Examples
of this type of role play can be seen in mock code situations intended to
prepare practitioners for real world emergencies.
In order to equip students with skills necessary to achieve the
intended outcome of the role play, instructors must methodically develop a
design that is tailored appropriately to their learners, which means
considering the proficiency level of the learners. Once a design has been
selected, teachers must incorporate a narrative that reflects the environment
being portrayed. This step includes providing students with a clear and
detailed description of the role in addition to information about the
environment.3
Because role-playing may be carried out by different people, it can be
difficult to reproduce. Therefore, instructors must provide materials such as a
scripted dialogue(s), prop(s), and detailed setting description to help create
an authentic scenario.6 In addition, the instructor must be
cognizant of gender identification, race, and other demographics which will
help bring the role to life.
During the final step, instructors should focus on debriefing with
learners. This step is extremely important as it allows the students to reflect
and evaluate the role portrayed. Instructors must encourage students to debrief
after each role play and to analyze key issues that occurred during the activity.2
It is through reflection that new
knowledge is generated.6
While all the steps outlined are important in creating a successful
role play, I believe the most critical steps include the narrative and
debriefing. In the narrative, instructors choose a role play type that will
allow him/her to achieve the learning outcome.
Just as it is important for learners to debrief following a role-play
activity, instructors must assess the learner’s performance during the
activity. To assess the role play activity, instructors can use rubrics designed
to assess oral communication. Rubrics contain the framework of expectations
for a specific learning exercise. The instructor’s assessment
coupled with the learners self-evaluation will help maximize learning. In
addition, role play may be assessed by students’ reaction to the simulation.3
Role play can be a useful learning tool that allows students to
creatively develop and practice skills needed in various clinical settings. Role
play is a useful and unique technique to teach cultural competence as it drives
students to develop interpersonal skills required to communicate with patients
from different backgrounds.
References:
- Shearer R, Davidhizar R. Using Role play to develop cultural competence. Educational Innovations. 2003;53(6):273-76.
- Kodotchigova MA.Role Play in Teaching Culture: Six Quick Steps for Classroom Implementation. Identity, Culture and Language Teaching.2002:1-7.
- DeNeve KM, Heppner MJ. Role Play Simulations: The Assessment of an Active Learning Technique and Comparisons with Traditional Lectures. Innovate Higher Education.1993;21(3):231-56.
- McIlvired DE, Prucka SK, Herbst M, Barger C. The use of role-play to enhance medical student understanding of genetic counseling. Genet Med. 2008;10(10):739-55.
- Shapiro S, Leopold L. A Critical Role for Role-Playing Pedagogy. Perspectives. 2012;29(2):120-30.
- Thoring K, Mueller RM. The Role of Role-play: Intangible Systems Representation for Business Innovations. International Design Management Research Conference. 2012 Aug 8-9; Boston, MA.
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