Professor Raj Ariyaratnam (SFHEA, NTF) is Chair in Dental Education and Global Oral Health and Dr Eleni Deligianni is a Clinical Lecturer in Oral Medicine in the Division of Dentistry, School of Medical Sciences. In the second instalment of this 2–part post, they discuss dramatic enactment as a teaching tool in the “I am your patient today!“ clinical education programme.

Drama in education is not a new idea. It has been explored in the UK since the beginning of the 20th century. The major promoters of drama in education were Dorothy Heathcote and Gavin Bolton who evolved their theories later, in the 60’s and 70’s (Kolovou and Kim 2020). According to them, “educational drama is being anything which involves people in active role-taking situations in which attitudes, not characters, are the chief concern” and “drama as an art form establishes a connection to knowing, without defining what that knowing entails” (Allern 2008). Moreover, Heathcote illustrated interventions such as “dramatic role-play” and “teacher in role” and her methods were used to create “Drama in Education” (Kolovou and Kim 2020).  

In the medical sciences Drama in Higher Education was introduced as early as the 1960’s, when Howard Barrows established the ‘Standardized Patients’ that would later evolve to ‘Standardized Patient Educators’ and turn into “one of the most prominent evolving methodologies in medical education”, adopted in Medical Schools throughout the world. Moreover, this method influenced greatly the development of the OSCE as an examination form (Ryan et al 2010).  

Following the above innovations, programmes in the US have utilised for many years “Patient instructor” techniques – mostly in Medical but also Dental Schools – where non-medically trained people act as patients and offer feedback, in order to simulate a clinical environment for training purposes. The results are promising, indicating that students attain and enhance the desired skills (Broder et al 2015).  

It has been shown that students in health-related subjects have found that part of their training through drama and role-play has been helpful and gave them a better understanding of how to approach a patient whilst enhancing their diligence (Ryan et al 2010). Little, though, is known for the use of drama, role-play and its possible benefits in dental schools and traditional subjects such as Oral Medicine. Most of the time the application of drama in education in schools providing training in Medicine, Dentistry and Health Sciences is performed by professionals with a drama rather than a dental background, and trained individuals are being used systematically to ‘represent’ patients in SPEs and OSCEs (Ryan et al 2010).  

In our case we have implemented role-play guided by the tutor, acting as a patient (See Part 1: I am your patient today! Taking clinical education online). Our aim was to engage the students and provide an experience as similar as possible to the one in the clinic. Our groups consisted by a maximum of four to five students at a time, thus enabling better engagement as all the students had the chance to participate in the given time of the session which was two hours. Based on the feedback we got, the attempt was overall a success. Feedback from the two tutors was also positive, and it was mentioned that after the initial ‘breaking of the ice’ the students appeared to participate collectively and successfully in interviewing the tutor-patient and acted as if they were in clinic. Moreover, this teaching method was found to be more engaging and quite enjoyable from the tutor’s side as well. 

Of course, our method was not without limitations and those were acknowledged from the beginning. It was implemented as an ‘emergency’ tool, and planning was complicated due to the sudden changes in lockdown rules under the ongoing pandemic. None of the two tutors involved in this way of teaching had any background or training in drama or drama in education, so the teaching very much depended on the tutor’s professional experience and performing ability.  

Results of other programmes in the UK implementing drama in dental education have been published and seem to agree with our own.  “Performing Medicine” was shown to “increase empathy” and “reduce performance anxiety” for students (De la Croix et al 2011). A pilot programme run in the Dental Institute at King’s College London, with one component including role-play guided by a drama qualified individual, was also a success. The pilot group achieved higher scores in that year’s OSCEs (Objective Structured Clinical Exams) that followed by at least 4% when compared with their fellow peers (Zahra and Dunton 2017).  

‘Mask-Ed’, a novel method used in a nursing school in Australia, has shown that training the tutor health care professional in drama, so that he or she can implement the role-play in their teaching, benefits the students more as the depth and breadth of the health care professional’s knowledge is facilitated (Reid-Searl et al 2014).  

To our knowledge, this is the first time that a role-play teaching method based on the tutor’s skills and his/her clinical experience has been successfully explored on a synchronous platform, and our innovation won the Faculty of Biology, Medicine and Health (FBMH) Pandemic Pedagogy Teaching Award. We are more than happy to share our experiences and this model with our colleagues from other similar clinical T&L courses. As this turned out to be a successful pedagogy, we plan to continue to use this as an additional synchronous teaching and learning tool even after Covid-19. 

References 

1. Rogers, H., Sollecito, T.P., Felix, D.H., Yepes, J.F., Williams, M., and D’Ambrosio, J.A., Hodgson, T.A., Prescott-Clements, L., Wray, D., Kerr, A.R. (2011) An international survey in postgraduate training in Oral Medicine. Oral Diseases 17 (Suppl. 1), pp95–98.  

1. Kolovou, M. and Kim, N.J. (2020) Effects of implementing an integrative drama-inquiry learning model in a science classroom. The Journal of Educational Research, 113(3), pp 191-203.  

1. Allern, T-H. (2008). A comparative analysis of the relationship between dramaturgy and epistemology in the praxis of Gavin Bolton and Dorothy Heathcote. Research in Drama Education, 13(3), pp 321-335.  

1. Ryan, A., Walshe, N., Gaffney, R., Shanks, A., Burgoyne, L., Wiskin C.M. (2010) Using standardized patients to assess communication skills in medical and nursing Students, BMC Medical Education, 10(24), pp1-8.  

1. Broder, H.L., Janal, M., Mitnick, D.M., Rodriguez, J.Y., Sischo, L. (2015). Communication Skills in Dental Students: New Data Regarding Retention and Generalization of Training Effects. Journal of Dental Education, 79(8), pp940-948.  

1. De la Croix, A., Rose, C., Wildig, E., and Willson, S. (2011). Arts-based learning in medical education: the students’ perspective. Medical Education, 45, pp 1090–1100.  

1. Zahra, F. Smyth and Dunton, K. (2017). Learning to look from different perspectives – what can dental undergraduates learn from an arts and humanities-based teaching approach? British Dental Journal, 222(3), pp147-150. 

1. Reid-Searl, K.,Levett-Jones, T., Cooper, S., and Happell, B. (2014). The implementation of Mask-Ed: Reflections of academic participants. Nurse Education in Practice, 14, pp485-490.

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