Training nurses in an international emergency medical team using a serious role-playing game: a retrospective comparative analysis.

BACKGROUND: Although game-based applications have been used in disaster medicine education, no serious computer games have been designed specifically for training these nurses in an IEMT setting. To address this need, we developed a serious computer game called the IEMTtraining game. In this game, players assume the roles of IEMT nurses, assess patient injuries in a virtual environment, and provide suitable treatment options. METHODS: The design of this study is a retrospective comparative analysis. The research was conducted with 209 nurses in a hospital. The data collection process of this study was conducted at the 2019-2020 academic year. A retrospective comparative analysis was conducted on the pre-, post-, and final test scores of nurses in the IEMT. Additionally, a survey questionnaire was distributed to trainees to gather insights into teaching methods that were subsequently analyzed. RESULTS: There was a significant difference in the overall test scores between the two groups, with the game group demonstrating superior performance compared to the control group (odds ratio = 1.363, p value = 0.010). The survey results indicated that the game group exhibited higher learning motivation scores and lower cognitive load compared with the lecture group. CONCLUSIONS: The IEMT training game developed by the instructor team is a promising and effective method for training nurses in disaster rescue within IEMTs. The game equips the trainees with the necessary skills and knowledge to respond effectively to emergencies. It is easily comprehended, enhances knowledge retention and motivation to learn, and reduces cognitive load.

Role playing and interdependence among husbands of Iranian women after a mastectomy.

BACKGROUND: Breast cancer is the most prevalent cancer among women. AIM: To investigate the impact of breast cancer on the husbands of Iranian women. METHODS: A content analysis based on a Callista-Roy adaptation model was conducted on 23 patients with breast cancer and their husbands and therapists. After asking questions about coping with cancer through telephone interviews, the following subcategories were obtained: role play and interdependence. Data analysis was completed via the Elo and Kyngas approach. RESULTS: Data analysis led to the production of 51 initial codes from participants' experiences. The category role-playing included three further sub-categories: primary role, secondary role and tertiary role. Independence/dependence problems included seven sub-categories: personal beliefs, love and heartfelt attachment, organised support, non-organised support, support failure, economic problems and dependence problems/independence. CONCLUSIONS: Husbands of women who have had a mastectomy have to take on new roles in their life in order to care for their wife. Also, despite the financial, spiritual, psychological, and medical support that they receive, husbands still felt that the support was insufficient.

The Use of Simulated Patients Is more Effective than Student Role Playing in Fostering Patient-Centred Attitudes during Communication Skills Training: A Mixed Method Study.

Objective: While simulated patients (SPs) are considered a standard tool in communication skills training, there is no evidence thus far of their comparative benefit to the more cost-effective option of student role playing. We compared the effectiveness of both approaches in developing patient-centred attitudes in students. Methods: We retrospectively compared students who participated in the clinical communication course (CCC), based on student role playing (CCCsp-, n = 160), to students who participated in the CCC with SPs (CCCsp+, n = 146), and students with no formal CCC (CCC-, n = 122). We used validated questionnaires to assess patient centredness. We also conducted focus group interviews (FGI) to better understand the impact of CCC with sp. Results: Students after the CCC with simulated patients achieved a significantly higher score in the patient-practitioner orientation scale than other groups (p < 0.001). Conclusions: There is a strong positive correlation between the implementation of simulated patients and patient-centred attitudes among students. Data from the FGI revealed that students perceived training with SP as more realistic, safe, and engaging than student role playing. Practice Implications. Our research provides evidence to justify costs and resources invested in simulated patient programs.

Digital joint action: Avatar-mediated social interaction in digital spaces.

This article proposes a framework to characterize joint action in digital spaces. "Digital joint action" maintains many known elements from physical, real-world joint action including representations relating to joint goals and individual subgoals, processes such as predicting and monitoring own and others' actions, and supporting coordination through signaling and direct communication. In contrast to social interaction in the real world, joint action performed online comes with a unique additional feature: Digital joint action is mediated through (more or less vividly visualized) avatars that are controlled by the individual users but also imply particular personas that come with their own skills and acting abilities. This makes digital joint action a highly interesting research field as it allows to investigate the cognitive principles of joint action that lie outside of the constraints of human physicality but are nevertheless embodied (i.e., in a virtual body). The aim of this article is two-fold: First, we introduce digital joint action as joint action between avatars in a digital environment, and we specify commonalities and differences between joint actions in the real world and in digital spaces to provide a framework for further research. Second, using a survey study among users of the popular massively multiplayer online role-playing game (MMORPG) Final Fantasy XIV, we provide empirical validation for our approach.

The role-playing game to increase students' activity and engagement in the teaching process - A pilot study of research & development campaign.

BACKGROUND AND PURPOSE: The purpose of the study was to develop and test a simple role-playing game (RPG) dedicated to the generic drug product research and development (R&D) process and evaluate the level of acceptance of this teaching method among pharmacy students. EDUCATIONAL ACTIVITY AND SETTING: Students were divided into small groups and participated in the RPG adventures, which led to descriptive characteristics of the development process of the fictional drug product. The depiction of the process in the adventure considered the milestones and obligatory actions to achieve the R&D goal. FINDINGS: The voluntary survey was completed by 59% (n = 72) of participants. Over 90% of the respondents stated that the game helped them better understand generic drug development. The RPG application allowed a narrative description of the process with the possibility of students' involvement in drug development that mixed regulatory, analytical, and technological issues. SUMMARY: The application of the RPG allowed the creation of a narrative description of the process with the possibility of involving students in complicated problematics concerning drug development that mixed regulatory, analytical, and technological aspects of this process.

Predictors of Gaming Disorder or Protective from It, in a French Sample: A Symptomatic Approach to Self-Regulation and Pursued Rewards, Providing Insights for Clinical Practice.

Gaming disorder (GD) is a new health condition still requiring a lot of evidence established around its underlying and related psychological mechanisms. In our study we focused on Massively Multiplayer Online Role Playing Games (MMORPGs), a specific very popular and engaging game genre, to determine that benefit, motivation and control aspects could be predictive of a dysfunctional engagement in gaming. In total, 313 participants were recruited from private forums of gamers between May 2009 and March 2010. They filled out a questionnaire on their socio-demographic data and their weekly gaming time. They also completed different psychometric assessments such as the DSM IV-TR criteria for substance dependence adapted to gaming such as the Dependence Adapted Scale (DAS), the external rewards they expected from gaming (External Motives), the expected internal reward they expected from gaming (Internal Motives), the Zuckerman Sensation Seeking Scale (ZSSS), and the Barratt impulsiveness Scale (BIS-10). Results showed that some psychological factors related to online gaming represented risk factors for GD in participants (i.e., competition and advancement motives, reduced anxiety, solace, greater personal satisfaction, and sense of power), whereas some others were found to be protective factors from GD (i.e., recreation, enjoyment and experience seeking) in participants. Additionally, the study found that disinhibition, boredom susceptibility, thrill and adventure seeking, and high impulsivity were correlated to GD in participants. In conclusion, not only motives for gaming and impulsivity could be predictors for GD, but maladaptive coping strategies based on experienced relief in-game from negative feelings (anxiety and boredom) or experienced improvement in-game of self-perception (personal satisfaction, sense of power) could play as well a role of negative reinforcers for GD. Some benefits from gaming, typically entertainment and enjoyment, are shown to be protective factors from GD, playing the role of positive reinforcing factors. They are worthy of being identified and promoted as functional gaming habits. These findings can feed the clinical and health promotion fields, with a more in-depth understanding of diverse psychological factors in gamers, identifying those at risk for GD and those protective from it. The current work can foster a more balanced approach towards gaming activities, taking their opportunities for mankind and controlling for their adverse effects in some individuals.

Role-playing games in leadership learning.

This article describes a developmental framework for the application of role-playing games (RPGs) in leadership learning. RPGs relate to leadership learning on a range of levels from individual development, to team building, to parallel group processes. The variety and depth of learning and development potential in RPGs is very exciting, particularly the potential for collective creativity associated with the need for leadership that transforms communities. Many established learning frameworks used for leadership/adult learning are included and an original framework for adopting a developmental understanding is explained.

Live-Action Role Playing for Safety Training: Effectiveness Evaluation in two Italian Companies.

Researchers, corporate decision-makers, government agencies, and international bodies want to know how to improve safety and limit the serious social and economic consequences of occupational injuries. Understanding how to deliver effective training is important to achieving this aim. Gamification is considered a new frontier in effective safety training. This study tested the use of gamification in safety training, considering two Italian companies that used a live-action role-play methodology called "PratiCARE la Sicurezza." Workers who were required by Italian law to receive safety training or retraining participated in a pre-post study. Collection of measures relating to knowledge, attitudes, behaviors, and perception of the health and safety climate took place at baseline and immediately after the intervention. Participants' average safety knowledge at the end of the training was significantly better than the initial level, indicating that the training improved workers' knowledge level.

Sex Differences in Competitiveness in Massively Multiplayer Online Role-Playing Games (MMORPGs).

Sex differences in the use of competitive tactics have been well established. Although many factors may contribute to these sex differences, according to social role theory (SRT), stereotypes and expectations about men's and women's typical social roles are crucial. We addressed the potential impact of social roles by studying massively multiplayer online role-playing games (MMORPGs), a setting where individuals represent themselves with avatars and thus enjoy the opportunity to compete without regard to the typical expectations and behaviors associated with men's and women's roles. We surveyed players via MTurk (63 women, 191 men) and Reddit (166 women, 1,326 men) regarding their frequency of engaging in five competitive behaviors and the sex and role of their primary avatar. As expected, there were reliable sex differences in competitiveness: men were more likely than women to engage in player-versus-player duels (MTurk d = 0.19; Reddit d = 0.51), do solo runs of difficult content (0.30, 0.35), and work to acquire expensive items (0.32, 0.19); women were more likely than men to seek in-game awards (-0.38, -0.36) and spend real-world money on expensive microtransactions (-0.16, -0.27). Contrary to SRT, these sex differences in forms of competitive behavior were generally unrelated to players' chosen avatar sex or avatar role. These results instead indicate that sex differences in competitiveness largely reflect evolved predispositions.

Educating ethics codes by lecture or role-play; which one improves nursing students' ethical sensitivity and ethical performance more? A quasi-experimental study.

BACKGROUND: Promoting ethical and professional principles through education is the major way to build and maintain people's trust in the nursing. However, despite remarkable efforts in this area, sensitivity to these principles and their application in clinical practice remain low. PURPOSE: This study aimed to compare the effect of educating codes of nursing ethics through methods of role-playing and lecture on the Ethical Sensitivity and Ethical Performance of nursing students. METHODS: A single-blinded quasi-experimental study conducted on 114 nursing students of Urmia University of medical sciences, which recruited using convenience sampling and assigned to two groups of intervention (role-paly and lecture) and one group of control, so that the sixth-, seventh- and eighth-semester nursing students were allocated to the control, role-play and lecture groups, respectively. Data were collected using the Nurses' Ethical Performance Questionnaire (EPQ) and the Lutzen's Moral Sensitivity Questionnaire (MSQ) at three time-points of before, immediately after, and two months after the intervention. The same educational content was provided for both intervention groups, so that the role-play group received the intervention over an eight-day period and the lecture group received it in five sessions. RESULTS: The results showed there was a significant difference in the mean scores of ethical sensitivity and ethical performance between the three groups immediately (p < .001) and two months after the intervention (p < .001), so the mean scores were significantly higher in the role-play and lecture groups compared to the control group after the intervention (p < .001). In addition, after the intervention, the mean scores of ethical sensitivity and ethical performance in the role-play group were higher than the lecture group (p < .001). CONCLUSION: Educating codes of ethics by role-playing method had a greater positive effect on the promotion of the ethical sensitivity and ethical performance compared to the lecture.

Developing an innovative medical ethics and law curriculum-constructing a situation-based, interdisciplinary, court-based learning course: a mixed methods study.

BACKGROUND: Traditional lecture-based medical ethics and law courses deliver knowledge but may not improve students' learning motivation. To bridge this theory-to-practice gap and facilitate students' learning effectiveness, we applied situated-learning theory to design an interdisciplinary court-based learning (CBL) component within the curriculum. Our study aimed to investigate students' learning feedbacks and propose a creative course design. METHODS: A total of 135 fourth-year medical students participated in this course. The CBL component included 1 h of introduction, 1 h of court attendance, and 2 h of interdisciplinary discussion with senior physicians, judges, and prosecutors. After the class, we conducted a survey using a mixed-methods approach to gauge students' perceptions of engagement, performance, and satisfaction. RESULTS: A total of 97 questionnaires were received (72% response rate). Over 70% of respondents were satisfied and felt that the class was useful except for role-playing activities (60%). More than 60% reported a better understanding of the practical applications of medical law. Approximately half (54%) reported less anxiety about medical disputes. 73% reported that the lecture provided awareness of potential medical disputes, and most respondents expressed an interest in medical law courses after the court visit (78%). 80% of the respondents were able to display empathy and apply mediation skills. Qualitative analyses showed that students demonstrated new knowledge, including recognizing the significance of the medical profession, distinguishing the importance of physician-patient communication, having confidence in the fairness of the justice system, and being willing to increase their legal knowledge. CONCLUSIONS: CBL curriculum increases students' learning motivation in strengthening medical professionalism and medical law, develops students' empathy for patients and communication skills, as well as builds up students' trust in the justice system. This novel course design can be applied to teach medical ethics and law.

Can We Be at Peace With Unsolvable Suffering? A Qualitative Study Exploring the Effectiveness of Supportive Communication and Resilience Building.

The authors provided six 180-minute interpersonal assistance workshops using teaching materials from the End-of-Life Care Association: 90 minutes each on supportive communication and role-playing. The content included the following: ・ Suffering people are "at peace" with someone who understands their suffering, which starts with building a relationship through empathetic listening. The goal is not to "understand them" but for them to "feel understood." ・ Realizing the suffering of others and recognizing the internal moral and emotional strength of those who live with suffering. ・ Resilience building: helping caregivers face difficulties even when helpless; remembering one's support networks and valuing oneself. Participants (n = 114) wrote reflective journals after each session. Two domains and 10 key themes were identified through thematic analysis. The domains comprised topics on the importance of using listening techniques, such as repetition, waiting in silence, and asking questions (not to understand but for dialogue). The 3-month postinterviews revealed that participants could ease their sense of weakness by helping suffering people, which is relevant to work, grief care, and daily life. Changes in relationships between participants and patients were also identified. Role-playing can teach supportive communication, such as listening attentively and accepting others, which may help supporters engage with people experiencing incurable suffering.

Medical students' learning processes the first time they role-play in psychiatry: A grounded theory study.

BACKGROUND: Recent changes in psychiatric care and teaching that limit patient contact for medical students can be overcome in part by simulation-based education. Understanding the learning processes of medical students involved in psychiatric simulation-based programmes could usefully inform efforts to improve this teaching. This study explored the learning processes of medical students the first time they role-play in psychiatry. METHODS: We used constructivist grounded theory to analyse semi-structured interviews of 13 purposively sampled medical students and the six psychiatrists who trained them. To improve the triangulation process, the results of this analysis were compared with those of the analyses of the role-play video and the debriefing audio-tapes. RESULTS: Five organising themes emerged: improving the students' immediate perception of patients with mental disorders; cultivating clinical reasoning; managing affect; enhancing skills and attitudes and fostering involvement in learning psychiatry. CONCLUSION: Results suggest that psychiatric role-playing can improve students' progressive understanding of psychiatry through the development of intuition and by allaying affects. Emotional elaboration and student involvement appear to be key features.

Nuevo índice de desempeño global de una prueba diagnóstica: el índice T / New global performance index of a diagnostic test: the T index

Introducción. En el presente artículo se propone un nuevo índice de desempeño global de una prueba diagnóstica: el índice T, que corresponde a la proporción de aciertos (Pa) menos la proporción de error (Pe) dividido entre la proporción de aciertos (Pa). Métodos. Describir los fundamentos teóricos y prácticos del índice T. Comparar el índice T frente al índice de Youden para poder establecer si dos o más modalidades diagnósticas difieren en su capacidad de discriminar, correctamente, entre los individuos verdaderamente enfermos de los sanos. Comparar el índice T frente al índice de Youden para poder establecer si el índice T puede ser utilizado para escoger "el mejor punto de corte" cuando la prueba diagnóstica de interés expresa sus resultados en forma cuantitativa continua.Resultados. Comparado frente al índice de Youden, el índice T permite distinguir entre las pruebas diagnósticas con alto desempeño diagnóstico de aquellas con pobre desempeño diagnóstico. Además, el índice T, de manera confiable, permite escoger "el mejor punto de corte" cuando una prueba diagnóstica utiliza una variable cuantitativa continua para expresar sus resultados.Conclusiones. Al contrastar los resultados del índice T versusel índice de Youden y los resultados del índice T versus la curva COR, podemos afirmar que el índice T es un índice exacto y eficiente.

Introduction. In this article, a new global performance index of a diagnostic test is proposed: the T Index, which corresponds to the proportion of the hit ratio (Hr) minus the error ratio (Er) divided by the hit ratio (Hr).Methods. To describe the theoretical and practical foundations of the T index; to compare the T index against the Youden index in order to establish whether two or more diagnostic modalities differ in their ability to correctly discriminate between truly ill and healthy individuals; and to compare the T index with the Youden index in order to establish whether the T index can be used to choose the "best cut-off point" when the diagnostic test of interest expresses its results in a continuous quantitative way.Results. Compared with the Youden index, the T index allows us to differentiate between diagnostic tests with high diagnostic performance and those with poor diagnostic performance. In addition, the T index, reliably, allows choosing "the best cut-off point" when a diagnostic test uses a continuous quantitative variable to express its results.Conclusions. By contrasting the results of the T index versus the Youden index and the results of the T index versus the COR curve, we can affirm that the T index is an accurate and efficient index.

Improving delirium detection in intensive care units: Multicomponent education and training program.

BACKGROUND: Delirium is a common, devastating, and underrecognized syndrome in the intensive care unit (ICU). The study aimed to describe and evaluate a multicomponent education and training program utilizing a "Train-The-Trainer" (TTT) model, to improve delirium detection across a large health system. METHODS: Fourteen ICUs across nine hospitals participated in a multicomponent delirium program consisting of a 1-day workshop that included: (1) patient testimonials, (2) small group discussions, (3) didactics, and (4) role-playing. Additionally, four ICUs received direct observation/training via telehealth (tele-delirium training). The Kirkpatrick model was used for program evaluation in a pre/post-test design. RESULTS: A 1-day delirium workshop was held at two time points and included 73 ICU nurses. Of the 65 nurses completing the post-workshop satisfaction survey, most (46.2) had >10 years of clinical experience, and no or minimal delirium training (69.2%). All nurses (100%) identified lack of knowledge as a barrier to delirium detection, while time constraints and lack of importance accounted for only 25%. Overall, nurses rated the workshop positively (excellent 66.7%, and very good 23.3%), and likely to change practice (definitely 73.3% and very likely 15.0%). All validated Confusion Assessment Method for the ICU (CAM-ICU) cases demonstrated improvement in number of correct responses. Delirium detection across the health system improved from 9.1% at baseline to 21.2% in ICUs that participated in the workshop and 30.1% in those ICUs that also participated in the tele-delirium training (p = 0.005). CONCLUSION: A multicomponent delirium education and training program using a TTT model was rated positively, improved CAM-ICU knowledge, and increased delirium detection.

Simulation in physiotherapy students for clinical decisions during interaction with people with low back pain: randomised controlled trial.

BACKGROUND: Low back pain (LBP) is a condition with a high global prevalence, which is getting health professionals' attention, including physiotherapists as they must have the skills to provide treatment that increases the patient's quality of life. Clinical simulations could be a pedagogic strategy that facilitates adequate training for students to acquire skills to improve their professional reasoning in this clinical situation. OBJECTIVE: This study sought to determine the effects of clinical simulations with simulated patients (SP) on the physiotherapy students' clinical decision-making within a role-playing (RP) scenario while caring of LBP patients. METHODS: This experimental study included 42 participants from two Colombian universities, randomized into two groups (SP, n = 21; RP, n = 21). The clinical skill of performing the Objective Structured Clinical Examination (OSCE-LBP) was evaluated while students cared for patients with LBP; after that, a pedagogical method was conducted that included clinical simulation and, finally, the OSCE-LBP was applied again to compare both groups. RESULTS: Changes occurred in the OSCE-LBP among both groups of students: the scores increased (0.66 and 0.59 in RP and SP, respectively), and neither of the two was superior (p value 0.01; 95%CI - 0.21 to 0.23). CONCLUSION: Both types of simulation favor decision-making in professional reasoning in physiotherapy students during interactions with individuals with LBP. Trial registration https://clinicaltrials.gov/ct2/show/NCT04428892 Identifying number: NCT04428892. It was retrospectively registered.

Player-avatar interactions in habitual and problematic gaming: A qualitative investigation.

BACKGROUND AND AIMS: Previous studies have reported that stronger avatar identification and negative self-concept are associated with gaming disorder (GD). This study aimed to examine the value and significance of avatars based on firsthand accounts from regular and problematic gamers, and to identify any potential links between avatar-related experiences and excessive gaming. METHODS: An online survey of 993 adult gamers yielded 3,972 text responses. Qualitative analysis of 59,059 words extracted 10 categories of avatar-related perspectives. RESULTS: Some problem and non-problem gamers employed sentimental language (e.g., 'dear friend', 'like a child', 'part of my soul') to refer to their avatar. However, most participants perceived avatars as a means of achieving in-game goals and enabling greater interactivity (e.g., socializing). When asked to reflect on hypothetically losing their avatar, participants generally anticipated feeling temporary frustration or annoyance due to lost time and effort invested into the avatar. Although some participants reported that their avatar 'mattered', avatars were often considered as superficial ('just pixels') and peripheral to the primary reinforcement of achieving in-game rewards and objectives. Some broader psychological and identity issues such as gender dysphoria, rather than 'addiction', were cited as motivating persistent avatar-related interactions and attachment. DISCUSSION AND CONCLUSIONS: Participants reported diverse views on the psychological value and function of avatars, but the relationship between avatars and problematic gaming or GD was largely unclear or inconsistent, and refuted by some participants. Future research with clinical samples may lead to a better understanding of player-avatar processes, including whether avatar-stimuli facilitate the development of maladaptive gaming habits, particularly among psychologically vulnerable players. Future investigations should be mindful of 'overpathologizing' avatar-related phenomena and recognize their important role in socializing, storytelling, and creative expression among gamers.

The structural characteristics of esports gaming and their behavioral implications for high engagement: A competition perspective and a cross-cultural examination.

Esports has become one of the major online entertainment activities around the globe. Different from the previously dominant massively multiplayer online role-playing games, esports gaming has its unique structural characteristics, which substantially reshape the motivations, experiences, and behaviors of game users while raising new questions for research on Internet gaming disorder. In addition to identifying four structural characteristics of esports, the present study analyzed their implications from both theoretical and practical perspectives and conducted a cross-cultural examination by utilizing accurate and objective match history data of esports gamers in five different geographic regions (countries). Several findings of interest were obtained in this study. First, having in-game friend(s) in a premade team significantly increased gamers' propensity to play consecutive matches. Second, whereas Nordic and Eastern European gamers tended to play additional matches following wins, Japanese gamers were inclined to do so after experiencing losses. Third, low and high-skilled gamers were more likely to engage in consecutive play than their middle-skilled counterparts. With a focus on the competitive nature of esports, this study demonstrated that the presence of friend(s), the outcome of the previous match, and the level of gaming skill can significantly influence esports gamers' involvement.

Using peer role-playing to improve students' clinical skills for musculoskeletal physical examinations.

BACKGROUND: The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX). METHODS: Participants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants' performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis. RESULTS: The mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p < .05, physical examination: p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters. CONCLUSIONS: Through a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.

Psicodrama como terapia en trauma y estrés postraumático / Psychodrama as a Therapy in Trauma and Posttraumatic Stress

Resumen Objetivo: Evaluar la evidencia disponible de la eficacia del psicodrama como terapia para el manejo del trauma psicológico, trastorno por estrés agudo y postraumático. Método: Se realizó una búsqueda sistemática de la literatura en MEDLINE, EMBASE, Cochrane Central, Scopus, LILACS y Ovid hasta abril de 2019. Se incluyeron los términos: (1)Psychodrama, (2)Role-playing, (3)Stress disorders, Acute, posttraumatic, y (4)Psychological trauma (MeSH). Se seleccionaron revisiones sistemáticas de la literatura, metaanálisis, ensayos clínicos aleatorios, cuasi aleatorios y estudios observacionales en inglés y español. Se seleccionaron los trabajos que incluyeran una descripción de las intervenciones con técnicas del psicodrama. Resultados: 14 trabajos cumplieron criterios de inclusión. Conclusión: No se encontró una asociación fuerte de la eficacia del psicodrama ante los síntomas de estrés postraumático. Se requieren más investigaciones con diseño metodológico ajustado para este tipo de intervenciones.

Abstract Objective: To evaluate the available evidence in regarding the efficacy of psychodrama in patients with acute and posttraumatic stress disorder and psychological trauma- Methods: Systematic review. Terms: (1)Psychodrama, (2)Role-playing, (3)Stress disorders, Acute, posttraumatic, and (4)Psychological trauma (Mesh), were searched in Pubmed, EMBASE, Cochrane Central, Scopus, Lillacs and OVID, until April 2019. Systematic reviews of the literature, meta-analysis, randomized clinical trials, quasi-randomized and observational studies in English and Spanish were selected. The works should have described interventions with psychodrama techniques. Results: 14 papers met the inclusion criteria. Conclusions: There is no evidence of the psychodrama response to the symptoms after traumatic stress. Research should be carried out with a more rigorous methodological design.