John Launer: Reinventing role play

A while ago I was on my way with colleagues to run a residential session for GP trainees when we got caught up in appalling traffic. The topic for the event was “living with uncertainty,” so there was some irony in this. We were going to arrive too late for the opening activities we’d planned, but we now had lots of time in the car to think about what else we might do. One of my colleagues described a case she hoped to bring for group discussion: it involved a patient who presented with a longstanding but very rare condition she’d never heard of. He seemed affronted by her ignorance of it.

After we’d finally arrived at the venue and done some ice breaking, I suggested improvising a role play exercise based on my colleague’s case. I invited her to take on the role of her patient in a consultation while I acted as the GP and explored how I might manage this tricky situation. I also found a volunteer from the trainee group who was willing to join me so that I could share aloud my own thoughts during the conversation as it progressed.

I’ve often done role play but never in quite this way. It turned out to be a surprisingly useful teaching strategy. I was able to behave in a reasonably respectful way with the “patient,” while pausing from time to time to explain to my silent supporter some of the less polite things that were going through my mind. These included thoughts such as, “Crikey, this is hard work,” or “I don’t think I’ve won her over yet,” and eventually, “Oh my God, she just smiled!”

I hoped that this would give the trainees licence to recognise the negative ideas that generally go through all our minds in difficult consultations. I also wanted to demonstrate how acknowledging this can help us to turn our thoughts into productive questions for the patient, rather than blurting out things that are likely to escalate conflict. The exercise also turned out to be fun, with a great deal of laughter.

This role play led me to think about how we usually teach consultation skills and reflective practice to medical students and GP trainees—and what may be missing. We give learners guidance on how to think about problems and to deal with challenging consultations, but we’re probably not clear enough about how to make use of the ideas that pass through our heads from moment to moment: often strong feelings, vague intuitions, and imaginary conversations rather than clinical reasoning.

Doing that exercise also led me to wonder whether any educator might be brave enough to make a consultation video using the Woody Allen comedy technique of showing someone talking with apparent equanimity while their private thoughts are shown in lurid detail as subtitles. Like the role play exercise, it might be a good way of teaching how we really manage uncertainty in our daily work.