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Analysis of role-play in medical communication training using a theatrical device the fourth wall.

Jacobsen T, Baerheim A, Lepp MR, Schei E - BMC Med Educ (2006)

Bottom Line: The analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction. 2) A "timeout/reflection" location, where the wall was doubly opaque, for the patient on the one side and the moderator, the doctor and the audience on the other side and 3) an "interviewing the character" location where the wall enclosed everybody in the room.The theatrical concept 'the fourth wall' may present an additional tool for new understanding of fiction based communication training.Increased understanding of such an activity may help medical teachers/course organizers in planning and evaluating communication training courses.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Bergen, Norway. torild.jacobsen@isf.uib.no

ABSTRACT

Background: Communication training is a central part of medical education. The aim of this article is to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance.

Method: The empirical data stem from a communication training model demonstrated at an international workshop for medical teachers and course organizers. The model involves an actress playing a patient, students alternating in the role of the doctor, and a teacher who moderates. The workshop was videotaped and analyzed qualitatively.

Results: The analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction. 2) A "timeout/reflection" location, where the wall was doubly opaque, for the patient on the one side and the moderator, the doctor and the audience on the other side and 3) an "interviewing the character" location where the wall enclosed everybody in the room. All three locations may contribute to the learning process.

Conclusion: The theatrical concept 'the fourth wall' may present an additional tool for new understanding of fiction based communication training. Increased understanding of such an activity may help medical teachers/course organizers in planning and evaluating communication training courses.

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Location 2. The fourth wall enables a discussion about the patient between the doctor, the audience and the moderator.
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Figure 2: Location 2. The fourth wall enables a discussion about the patient between the doctor, the audience and the moderator.

Mentions: At the first critical incident of the consultation between the doctor and the patient/actress, the moderator stopped the ongoing dialogue by taking a timeout. The doctor stopped the interaction with the patient and the patient minimized her response to the situation (not by going into a "freeze position" but by taking a general non-responsive position). The moderator addressed both the doctor and the audience and asked for possible options onwards. When moderator took timeout, the wall moved from the traditional theatre position, where the wall was transparent for the audience, to a totally new position where the wall functioned as a soundproof and opaque wall between the patient/actress on the one side and all the others in the room on the other side (Figure 2). In that situation the doctor, the audience and the moderator could discuss the patient as if she were not present. One might even say that the wall, in this situation, was doubly opaque because the patient was non-responsive to the options being discussed and because the moderator communicated with everyone in the room except the patient.


Analysis of role-play in medical communication training using a theatrical device the fourth wall.

Jacobsen T, Baerheim A, Lepp MR, Schei E - BMC Med Educ (2006)

Location 2. The fourth wall enables a discussion about the patient between the doctor, the audience and the moderator.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1621062&req=5

Figure 2: Location 2. The fourth wall enables a discussion about the patient between the doctor, the audience and the moderator.
Mentions: At the first critical incident of the consultation between the doctor and the patient/actress, the moderator stopped the ongoing dialogue by taking a timeout. The doctor stopped the interaction with the patient and the patient minimized her response to the situation (not by going into a "freeze position" but by taking a general non-responsive position). The moderator addressed both the doctor and the audience and asked for possible options onwards. When moderator took timeout, the wall moved from the traditional theatre position, where the wall was transparent for the audience, to a totally new position where the wall functioned as a soundproof and opaque wall between the patient/actress on the one side and all the others in the room on the other side (Figure 2). In that situation the doctor, the audience and the moderator could discuss the patient as if she were not present. One might even say that the wall, in this situation, was doubly opaque because the patient was non-responsive to the options being discussed and because the moderator communicated with everyone in the room except the patient.

Bottom Line: The analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction. 2) A "timeout/reflection" location, where the wall was doubly opaque, for the patient on the one side and the moderator, the doctor and the audience on the other side and 3) an "interviewing the character" location where the wall enclosed everybody in the room.The theatrical concept 'the fourth wall' may present an additional tool for new understanding of fiction based communication training.Increased understanding of such an activity may help medical teachers/course organizers in planning and evaluating communication training courses.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Bergen, Norway. torild.jacobsen@isf.uib.no

ABSTRACT

Background: Communication training is a central part of medical education. The aim of this article is to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance.

Method: The empirical data stem from a communication training model demonstrated at an international workshop for medical teachers and course organizers. The model involves an actress playing a patient, students alternating in the role of the doctor, and a teacher who moderates. The workshop was videotaped and analyzed qualitatively.

Results: The analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction. 2) A "timeout/reflection" location, where the wall was doubly opaque, for the patient on the one side and the moderator, the doctor and the audience on the other side and 3) an "interviewing the character" location where the wall enclosed everybody in the room. All three locations may contribute to the learning process.

Conclusion: The theatrical concept 'the fourth wall' may present an additional tool for new understanding of fiction based communication training. Increased understanding of such an activity may help medical teachers/course organizers in planning and evaluating communication training courses.

Show MeSH