Background: An important goal in mental health education is for students to develop their ability to provide care and help to people with different degrees of mental problems. Positive experiences with the use of clinical role-play and subsequent reflection inspired us to investigate whether previous empirical studies had evaluated similar methods of teaching and to scrutinize the effects on students’ development of therapeutic skills and clinical reflection.
Method: An integrative review was conducted to search the literature for findings from both qualitative and quantitative research. Systematic searches of literature were done in Ovid (MEDLINE, PsycInfo), Cinahl, Cochrane, ScienceDirect, SweMed, Norart, ProQuest, and Google Scholar.
Results: The systematic literature search provided 42 full-text articles and four articles met the inclusion criteria. The results suggest that role-play in health education enhances students’ therapeutic and communicative skills. Nevertheless, there is limited research on the use of role-play in teaching therapeutic skills, and few studies that investigate how role-play affects students’ reflections on own practice. The literature search did not discover studies investigating whether practicing role-play in educational settings has consequences for clinical practice.
Conclusion: Based on this current review, role-playing in supervised groups seems to promote reflection and insight not only for students in the patient and therapist roles, but also for peers observing the group sessions. According to the included studies, clinical role-play facilitates helper–user equality and increases students’ involvement, self-efficacy, and empathic abilities in mental health practice.
Keywords: review, education, nursing, role-play, reflection, therapeutic communication
In mental health education students practice skills in a safe environment in order to become safe, predictable and competent practitioners. However, students are likely to have conflicting experiences as they move between the classroom and practice in terms of understanding the user’s experience and trying out skills they have learned.1–3 It has been emphasized for decades that the development of phenomenological understanding and therapeutic attitude is best achieved through practice-based training in groups, eg, Rogers.4 Group-based reflection in learning therapeutic communication skills may be implemented through teaching formats, such as simulation techniques, role-play and reflective practice. Below we discuss briefly some aspects of these formats with emphasis on hallmarks and differences.
Simulation involves performing a role in an interaction, either through roleplaying or by using a professional, trained standardized patient.5 The idea of using standardized and simulated patients originally came from the neurologist Howard Barrows.5,6 Barrows defined a “simulated patient” as a regular person who has been trained to present symptoms and signs of a particular diagnosis.5,7 The Researchers in Clinical Skills Assessment defined a “standardized patient” as a person with or without a certain disease who has been trained to describe either their own problems or those based on observations of other patients.5,8 In role-plays, students play the role of a patient they have met, thus exploring attitudes and feelings as part of professional development.5 At the part-time continuous education program of mental health care at Molde University College, supervised reflection groups, which include clinical role-play and joint clinical reflections on the actual role-play, have been an important part of the education for 20 years. Students bring anonymized case descriptions of patients from their daily work in mental health care to their reflection group and practice psychotherapeutic communication approaches by the use of clinical role-play, clinical reflection and supervision. The student who brings the case role-plays the patient, and fellow students role-play the therapist and other members of the patient’s social network (Table 1).
Simulation techniques
| Students role-play the clinician/therapist | Students role-play the patient | Other than students role-play the patienta | Subsequent reflection used as means | The use of psychotherapeutic communication approaches in the role-play | |
|---|---|---|---|---|---|
| Standardized patient | X | X | |||
| Simulated patient | X | X | |||
| Role-play | X | X | |||
| Reflection groups at Molde University College | X | X | X | X |
Note: aPerson trained to describe own problems or problems based on observations of others role-play the patient (standardized patient) or person trained to present symptoms of particular diagnosis role-play the patient (simulated patient).
These simulation techniques share important similarities, but there are also major differences. The main differences are the role the student takes in the interaction, whether reflection is used as a significant part of the simulation, and whether practicing psychotherapeutic communication approaches are essential in the role-play.
As mentioned before, students are likely to have conflicting experiences as they move between class and practice.1,9 This study will focus on role-play, which is one of the most established forms of simulation and has been used for decades in teaching students clinical skills.1,3,10 For almost 100 years, reflective thinking has been described as a continuous assessment of knowledge.11 Yet, there seem to be few studies that investigate methods combining reflection and role-play in teaching mental health, and whether doing so, bridges the gap between knowledge from class and practice.