Introducing new teaching methods – putting research into

practice

The use of video role play in undergraduate medical education

Barry Peters & Francia Kinchington

A tutorial prepared by

• Dr Barry S Peters, Senior Lecturer STDs St Thomas’ Campus of Kings College and

• Francia Kinchington, Senior Lecturer, School of Education, University of Greenwich

Based on an article to be published in October 2001 Edition of Sexually Transmitted Infections:

“A randomized controlled trial of the effectiveness of combining video role play with traditional methods of delivering undergraduate medical education”

Authored by: Clare Knowles, Francia Kinchington, Jo Erwin, Barry Peters

Why was a study needed into new forms of undergraduate education?

• New approaches are needed to address the lack of relevance (What do we mean by lack of relevance?) and lack of student involvement of traditional teaching methods (this notion is supported by reports such as “Tomorrow’s Doctors”, and the Calman report)

• Access to patients can be difficult for undergraduates, due to numbers of students, and aspects of patient sensitivity and preference especially in areas such as GUM

Summary of study

Subjects & Setting

4th year medical students at Guy’s & St Thomas’ Hospitals

During academic year 1996-1997

Methods (1)

• Assignment: Students were assigned in groups to have either traditional teaching alone, or traditional teaching plus the intervention [see slide Methods (2)]

• Masking: The assignment of students to groups was performed by staff not directly involved in the study

Figure 3 - Participant Flow and Follow-up  

141 Students eligible for the study  

133 students randomised

132 students entered the study

  92 Students received 40 Students received conventional both conventional

  85 students attended all, 37 Students attended or >85% of teaching all or >85% of sessions conventional teaching ie. 7 protocol violations sessions ie. 3 protocol

   All 92 Students attended All 40 students attended The OSCE examination the OSCE examination

   

Methods (2)Actor played either a patient with an STI, or a patient

requesting an HIV test & the interview was videoed

Assessment was as follows:• The actor assessed the performance of the student• The student evaluated his/her performance• Structured feedback and assessment by GU

Physician and educationalist

Methods (3)• The following week, the videos were

viewed by the student, the GU Physician and the educationalist

• The student was asked to give a verbal report of their perceived performance based on the assessment sheet completed after their interview

• The GU Physician and educationalist each gave a structured assessment

Methods (4)

• One week later all students, both those who received and those who did not receive the intervention, underwent an end of module OSCE

• The GU Medicine stations of the OSCE encompassed a range of activities including simulated scenarios involving actors reflecting the intervention

Results

• There were 40 students in the sample group and 92 in the control group

• The OSCE results were higher in the sample group than control group – p<0.001

(see paper)

How to introduce this approach to your teaching practise

We have broken down the process into the following:

• Identifying the need

• Identifying the benefits for the teachers

• Issues

• Building an enthusiastic team

• Providing the resources

• Running this teaching method

Identifying the need The clinicians involved with teaching need to assess

whether this approach will fill an identified unmet pedagogical need:

• Are students adequately exposed to clinical situations? (at least one department, UCL at Mortimer Market, has a

“teaching clinic” which meets the need this way)• Are students actively engaged in learning and given the

opportunity to reflect on learning that has taken place, so developing reflective practitioners? (Shoen, D.A. 1987 Educatiing the Reflective Professional Practitioner)

• Do students have the opportunity to learn in situations which closely resemble situations where they will eventually be required to to apply their knowledge?(Situated Learning) Kolb,D.A 1984 Experiential Learning

Identifying the benefits for teaching staff

• Improve quality of learning and the learning experience for students which should be reflected in student evaluations of courses

• Engage teachers in re-examining the learning experiences that they offer, developing them as reflective practitioners

• Teachers actively contribute to creating proactive independent learners who are reflective practitioners and engage in critical thinking

• Teacher takes on a different role from that of a traditional teacher i.e. that of a facilitator or consultant

Issues

There are additional logistic/time demands, therefore staff involved in the project need:

• departmental support for their willingness to engage with changes in the way they teach (“pedagogical innovation”)

• to be recognised appropriately for their contribution

Building an enthusiastic team

• When first setting this up, an enthusiastic team of at least 3 members are required

• Shared commitment to exploring this type of “pedagogy” and sharing in the teaching experience

Providing the resources

• Designated room, video equipment and office support are required

• (Apart from the video equipment, the other resources are the same type as required for any teaching project)

• Actor able to role play designated senarios• Resources can be obtained centrally through the

Medical School (ideal) or through soft/charitable funding (a compromise source)

Running this teaching method (1i)Stage 1: Setting it up• Initial discussion to clarify aims, objectives, process,

anticipated value added benefits and procedure must take place.

• Clarification of staff roles, rooming, organising of actors, briefing them about their scenarios and parameters of behaviour, ethical considerations

• Identification of monitoring and final evaluation procedures

• Clarification and writing of the assessment criteria • i. for teaching staff • ii. for student self-evaluation

Running this teaching method (1ii) • Timetabling and organising anticipated student rota of

interviews• Arrangements for briefing students about the intended

intervention and ensuring compliance• Negotiating with any other relevant staff who may be

affected by the interviews• Identification of costs and sources of funding• Timescale of carrying out interviews, feedback to student

cohort in relation to final exam such as OSCEs• Identification of contingency plans eg. Students unable to

attend interviews, Actors or staff absence, running over time

Running this teaching method 2• Stage 2: Making it happen

• Students briefed about the experience and the time of their ‘appointment’, that it is a learning experience (not a test situation), the role that they will play, crucial issue of timing(10 mins), and the time that they are booked in for their individual feedback session. Any questions?

• The videoed role play takes place, with a member of the team knocking on the door when the 10 mins. is up so that the interview can be terminated. Student is thanked and reminded of the time of of their personal feedback session.

• The Actor gives their response of the experience with the student straight on to the video, prior to preparations for the next student. The process is repeated.

Running this teaching method 3• Stage 3: Giving Feedback

• The student is welcomed and introductions made. They are asked to give a verbal summary of their self-evaluation, which is collected by the GU physician

• The video is viewed by the student, the GU physician and the educationalist. All three parties view the video for the first time at the same time

• The GU physician and the educationalist give their feedback in turn to the student. The student is then asked to give their overall perception of their performance and to reflect on the interview process as a learning experience. Learning needs are identified in relation to existing skills and knowledge, together with how this can be achieved

Running this teaching method 4

Stage 4 “Research informing practise”

• Students are evaluated on the basis of their OSCE performance

• The process is evaluated and presented as a piece of research/audit which is then used to inform practise

Acknowledgements

• The co-researchers on the original project:

Clare Knowles, Jo Erwin