Role-Play: A Healthcare Simulation Strategy for Teaching Problem-Solving, Communication, & Self-Awareness

The word “pretend” does NOT have to be perceived negatively across healthcare simulation. Asking learners to make-believe or act a part can lead to the acquisition of knowledge, skills, and attitudes. This practice, otherwise known as role-playing, can ultimately help produce desired outcomes in three major learning domains: affective, cognitive, and behavioral. Thus, role-play has become a healthcare simulation strategy that increases learner engagement and fosters knowledge retention. In this HealthySimulation.com article, author Jeanne Carey explains how role-play can be used as a type of clinical simulation methodology, and shares five reasons medical simulation educators and learners should add role-play to their healthcare simulation repertoire.

Role-Play as a Simulation Methodology

Role-play takes place between two or more people, who act out roles to explore a particular scenario. It is an experiential learning method designed to build first-person experience in a safe and supportive environment. Role-play is widely acknowledged as a powerful technique across multiple disciplines of training and education. Role-play is a pedagogy that has been used in a wide variety of contexts and content areas. Essentially, it is the practice of having students take on specific roles and act them out in a case-based scenario for the purpose of learning course content or understanding complex concepts.

Role-play simulation is sometimes referred to as peer simulation. And while this method of simulation may resemble Standardized/Simulated Patient (SP) simulation, there are key differences. In role-play or peer simulation, learners assume the role of the patient, as well as the role of the healthcare provider. This allows participants to explore the diversity of patient responses and gain insight into patient perspectives and motivations. These experiences promote empathy and a more patient-centered approach to care (Dalwood et al., 2020).

Role-play is designed primarily to build first-person experience in a safe and supportive environment. Role-play is effective in achieving a broad range of learning outcomes and is able to address cognitive, affective, and psychomotor domains of learning as described in Bloom’s Taxonomy. In role-play, students apply their knowledge to a given problem, reflect on issues and the views of others, while considering the relevance of theoretical ideas by placing them in a real-world context (Rowson, 2019). There may be no better way to illustrate the complexity of decision-making.

As is the case with all clinical simulation-based learning, role-play provides the student a structured setting that can be manipulated to meet the learner’s needs. Whereas in the traditional clinical setting, trainee encounters are random and the available opportunities may or may not address the stated learning objectives.

Role-play simulation engages learners in real-life situations or scenarios that can be stressful, unfamiliar, complex, or controversial, requiring them to examine personal feelings toward others and their circumstances. This type of simulation encourages students to think more critically about complex and controversial subjects and to see situations from different perspectives. Role-play simulation provides a safe environment to encounter different scenarios for the first time, which builds confidence in participants (Rønning & Bjørkly, 2019).

Five Reasons to Add Role-Play to Your Healthcare Simulation Repertoire

1. Role-Play Provides Opportunities for Perspective-Taking: Role-play allows students to explore various “perceptual positions” to increase self-awareness and understanding of one’s own perception of the world. Role-play also builds empathy and appreciation for other perspectives.

There are three basic positions of perception that individuals can take in any situation: first position (one’s own shoes, seeing the world through our own eyes), second position (standing in another person’s shoes), or third position (a neutral observer). Role-play develops the ability to shift between these three distinct perceptual positions in any given situation. In the first position, participants are looking at the world through their own eyes and processing the situation through their own values, beliefs, emotions, and needs. The first position is the direct experience of the situation.

The second position is the position of empathy. Participants stand in another person’s shoes and perceive the world through their needs, desires, emotions, and perceptions. The second position is the position for learning and modeling; it accelerates and deepens the learning process. The third position is one of the neutral observers. This position is all about noticing other people involved but looking at all that is going on from a neutral stand, without much emotional involvement and without being tangled in one’s own needs, or those of another.

The third position allows a bit of distance and clarity, helping maintain objectivity to better understand the relationship that is playing out between the people involved. This third position is useful for stepping back and getting insights into situations and seeing and hearing the bigger picture (Rowson, 2019).

2. Role-Play Simulation Brings Learning to Life: When students take the skills they learned in theory and put them into practice, this creates a deeper cognitive link to the material. Learning through role-playing has the potential to be transformative, exposing participants to new insights beyond their own experience. Role-play has been successfully used in the construction of knowledge and to aid conceptual understanding of complex concepts (Chen et al., 2020; Dorri et al., 2019).

3. Good Role-Playing Requires Good Listening Skills: In addition to understanding the words the other person is saying, it’s important to pay attention to body language and non-verbal clues. Participants must focus and pay attention to each answer given by the other actor, so they can relate and respond appropriately. It is better to have learners develop these skills while role-playing than when they are trying to perform in the real world (Joyner & Young, 2006).

4. Role-Playing is Simple and Safe: Role-playing provides a safe and supportive environment in which to encounter these situations for the first time, which builds confidence in team members that can help them in the field. No matter how outlandish the situation created in this controlled environment, something even more bizarre is bound to happen in real life. Role-playing helps learners develop creative problem-solving skills as they navigate challenging situations. Role-play is most useful in preparing for unfamiliar or difficult situations.

5. Role-Play Builds Confidence: Also, by preparing for a situation using role-play, you build up experience and self-confidence with handling the situation in real life, and you can develop quick and instinctively correct reactions to situations. This means that you’ll react effectively as situations evolve, rather than making mistakes or becoming overwhelmed by events (Dorri et al., 2019).

Top 10 Tips for Facilitating an Effective Role-Play Simulation:

10. Be prepared: Best practices standards apply to role-play simulation, just as in any other simulation method. The instructor should determine the learning goals of the role-play and choose a case that facilitates reaching those goals. It is also important to ensure all participants are adequately prepared with case materials and familiar with the role-play pedagogy.

9. Make it as real as possible: The more real the role-playing experience, the greater its value. If possible, put participants in the actual locations where they would experience the scenarios being replicated. Make sure the participants have enough information to play their roles effectively.

8. Clarify expectations and stay focused on time and benchmarks: Make role-plays concise and high-impact by sticking to specific objectives and schedules. Keep the objectives simple and specific. Be clear with participants upfront and stay focused on the primary goal when providing feedback. To help students understand the use of role-playing sessions, role-plays should be content-focused and relevant to real-world situations.

7. Make it safe: For some people, role-playing can feel threatening and embarrassing. To raise the “safety” level, emphasize that learning by making mistakes is part of the process. Make the first role-play an experiment. Foster a safe environment. Role-play by its nature is experimentation in a new behavior. Provide participants room to experiment and try out new behaviors and skills without judgment.

Let them know they are allowed to take risks and make mistakes. Some people feel threatened or nervous when asked to role-play because it involves acting. This can make them feel silly, or that they’ve been put on the spot. Humans find it hard to create things from scratch, but they love to edit and improve what already exists. Therefore, it may be helpful to start with a demonstration. This gives participants an opportunity to edit and improve the script (Kettula & Berghäll, 2013).

6. Determine how the role play will be assessed: If you plan to use role-play simulation as a graded exercise, introduce small, non-graded role-plays early in and during the semester to help students prepare for a larger role play which will be assessed (Rønning & Bjørkly, 2019).

5. Be specific: Do not make the scenario too broad. Identify the skills to be practiced during the role-playing and create the potential for small wins. Those small wins create momentum which propels learners to engage more deeply in the role-play (Rønning & Bjørkly, 2019).

4. Allow time for participants to get into a role: Actors need a moment to “get into role” and so do role-play participants. Give them a few minutes to focus on the scenario circumstances and the objective of the role-play. Ask participants to imagine what happened just prior to the start of the role-play scenario; this is extremely helpful in giving participants confidence and getting the role-play off to a more natural start (Kettula & Berghäll, 2013; Rao & Stupans, 2012).

3. Be sure to debrief the role-play: There might be some emotion or confusion left from the exercise, so start by asking participants to spend some time in quiet reflection considering the following questions: How did you feel during that scene? When were you most comfortable and why do you think that was so? When were you most uncomfortable and why do you think that was so? Did anything surprise you? Would you say or do anything differently the next time you are in a similar situation? Reinforce the positives during the debrief – confidence and learning go hand-in-hand. Highlight specific steps or actions that are strong; role-plays are about improvement, but making this an intentional effort helps guard against only highlighting areas to improve.

Allow the participants and observers to share their thoughts and feelings first, before providing feedback – invite active participants to share a few positive and negative reactions to their own performance. Then ask observers to share their observations. Keep critiques constructive. Make feedback actionable. The only way constructive role play feedback is valuable is if it is actionable. Participants should know exactly what to do to perform better in the real world. Be sure the feedback provided during the debriefing does not stray too far from the objectives of the role-play (Rønning & Bjørkly, 2019).

2.  Consider recording the role-play scenarios: This allows participants to see themselves in action, identifying their own strengths and weaknesses. If time permits, repeat the same scenarios with the same or different role-players; different approaches can be tested (Kettula & Berghäll, 2013; Rao & Stupans, 2012).

1.  Make it fun. Role-play simulation should be fun and enjoyable: Creating a fun environment with laughter and humor makes participants more likely to step out of their comfort zone and be fully engaged (Joyner & Young, 2006). It is possible to laugh and learn at the same time!

Learn More About Role-Play Simulation

About the Author: Jeanne Carey, RN, CHSE-A

Jeanne Carey is the Director of Simulation at Baylor University Louise Herrington School of Nursing in Dallas, Texas. She holds advanced certification as a simulation educator and has 10 years of experience in all aspects of simulation, including the development and implementation of new simulation-based learning activities, training of simulation facilitators, and recruitment and management of standardized patients. Carey and the LHSON Simulation Team created the Two-Heads-Are-Better-Than-One (2HeadsR>1) strategy for role assignment in simulation. She is active in several simulation organizations and currently serves as an INACSL Nurse Planner.