Evaluation of a workshop using verbatim theatre stimuli to address challenging workplace situations: a pilot study.

BACKGROUND: Challenging workplace situations such as bullying, harassment, depression, suicide and fatigue exist in health care. The performing arts can generate dialogue and engagement with these difficult issues. This study evaluates a workshop for health care students that used filmed vignettes from a verbatim theatre play that used real stories of such situations. The workshop aimed to improve health professional students' confidence in seeking help for depression, addressing mistreatment, understanding mandatory reporting laws and the impact of driver fatigue. METHODS: Two workshops were held: one with a mixture of professions, including nursing, medical and allied health students, and the other with medical students only. Participants completed questionnaires before and after each workshop, responding to four Likert questions on understanding and confidence about the issues discussed and free-text responses about the perceived value of the workshop. RESULTS: Sixty-five people took part in the workshops, with a 100% response rate to the pre-workshop survey and a 98% response rate (n = 64) to the post workshop survey. Students most frequently reported an improvement in understanding mandatory reporting laws (57%), followed by an increase in confidence in dealing with bullying and harassment (44%). Students in the workshop with a mix of professions noted the benefit of learning about these challenging issues alongside students from other health professions. DISCUSSION: Students valued the facilitated discussion of sensitive issues. Although many respondents increased their understanding or confidence in the four topics, a smaller proportion reported a reduction after the workshop. Perhaps this resulted from greater appreciation of the complexities of these issues. Health care students valued hearing from other professional groups in the mixed professions workshop.

Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change.

Problem: The mistreatment of medical and nursing students and junior health professionals has been reported internationally in research and the media. Mistreatment can be embedded and normalized in hierarchical healthcare workplaces, limiting the effectiveness of policies and reporting tools to generate change; as a result, some of those who experience mistreatment later perpetuate it. We used a novel, creative approach, verbatim theater, to highlight the complexity of healthcare workplaces, encourage critical reflection, and support long-term culture change. Intervention: Verbatim theater is a theater-for-change documentary genre in which a playscript is devised using only the words spoken by informants. In 2017, 30 healthcare students and health professionals were recruited and interviewed about their experience of work and training by the multidisciplinary Sydney Arts and Health Collective using semi-structured interviews. Interview transcripts became the primary material from which the script for the verbatim theater play 'Grace Under Pressure' was developed. The performing arts have previously been used to develop the communication skills of health professional students; this esthetic expression of the real-life effects of healthcare workplace culture on trainees and students was implemented to stimulate consciousness of, and dialogue about, workplace mistreatment in healthcare work and training. Context: The play premiered at a major Sydney theater in October 2017, attended by the lay public and student and practicing health professionals. In November 2017, three focus groups were held with a sample of audience members comprising healthcare professionals and students. These focus groups explored the impact of the play on reflection and discussion of healthcare culture and/or promoting culture change in the health workplace. We analyzed the focus group data using theoretical thematic analysis, informed by Turner's theory of the relation between 'social' and 'esthetic' drama to understand the impact of the play on its audience. Impact: Focus group members recognized aspects of their personal experience of professionalism, training, and workplace culture in the play, Grace Under Pressure. They reported that the play's use of real-life stories and authentic language facilitated their critical reflection. Participants constructed some learning as 'revelation,' in which the play enabled them to gain significant new insight into the culture of health care and opened up discussions with colleagues. As a result, participants suggested possible remedies for unhealthy aspects of the culture, including systemic issues of bullying and harassment. A small number of participants critiqued aspects of the play they believed did not adequately reflect their experience, with some believing that the play over-emphasized workplace mistreatment. Lessons Learned: Verbatim theater is a potent method for making personal experiences of healthcare workplace and training culture more visible to lay and health professional audiences. In line with Turner's theory, the play's use of real-life stories and authentic language enabled recognition of systemic challenges in healthcare workplaces by training and practicing health professionals in the audience. Verbatim theater provides a means to promote awareness and discussion of difficult social issues and potential means of addressing them.

Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students.

A positive and respectful learning environment is fundamental to the development of professional identities in healthcare. Yet medical students report poor behaviour from healthcare professionals that contradict professionalism teaching. An interdisciplinary group designed and implemented a drama-based workshop series, based on applied theatre techniques, to help students develop positive professional qualities and interpersonal skills to deal with challenges in the healthcare setting. We piloted the workshops at the University of Sydney in 2015. Attendees completed evaluation questionnaires and participated in a focus group or interview. Of 30 workshop attendances, there were 29 completed questionnaires and three participants attended a focus group or interview. Workshop activities were rated as 'very good' or 'good' by 21/22 (95.5%). Thematic analysis of qualitative data highlighted the rationale for participation (to deal with bullying, prevent becoming a bully, learn social skills), workshop benefits (express emotions, learn about status dynamics and deconstructing personalities, empathy, fun), challenges (meeting participants' expectations, participants' need for further practice) and implications for medical education (need to develop awareness of others' perspectives). Our research has shown that there is momentum to challenge mistreatment in medical education. While a multipronged approach is needed to generate systemic change, this pilot offers a positive and creative innovation. It helps students improve their interpersonal skills and sense of self to deal with challenges in the healthcare setting, including mistreatment.

"Thank You for Giving Me a Voice!" A Longitudinal Evaluation of Patients' Experience of Partnering With Students in an Australian Medical School.

BACKGROUND: We evaluated the patient-partner experience in a longitudinal program called Integrated Population Medicine in the Sydney Medical School to assess its acceptability. The program exposed senior medical students to the lived experience of chronic disease. METHODS: We surveyed 267 people with chronic conditions recruited as patient-partners by the 2012 student cohort in a mixed-methods longitudinal cohort study. Surveys were administered 'over' 18 months: before, during, and after the program. RESULTS: A total of 155 (58%) patient-partners completed the baseline survey; 52 patients returned all 3 surveys. Patient-partners remained very positive about the program across all surveys. More than 95% of respondents enjoyed interacting with the student, and most were very positive about their role in teaching the student. Three major themes emerged: willingness to help, a sense of gratitude and enjoyment, and a chance to teach and learn. Participants were willing to discuss their illness experiences and were keen to spend more time with students. CONCLUSIONS: Patients are willing participants in longitudinal patient-partner programs. They perceive benefits for themselves and others, for the health system, and for students and would like to become more actively involved in medical education.

Reactions to Diversity: Using Theater to Teach Medical Students about Cultural Diversity.

Training medical students to understand the effects of culture and marginalization on health outcomes is important to the future health of increasingly diverse populations. We devised and evaluated a short training module on working with diversity to challenge students' thinking about the role of both patient and practitioner culture in health outcomes. The workshop combined didactic teaching about culture as a social determinant of health using the cultural humility model, interactive exercises, and applied theater techniques. We evaluated changes in the students' perceptions and attitudes over time using the Reaction to Diversity Inventory. There was initial significant improvement. Women and students with no past diversity training responded best. However, scores largely reverted to baseline over 12 months.

A clinical approach to population medicine.

BACKGROUND: An epidemic of chronic disease in an ageing population obliges us to train medical students to participate in patient and population-centred health systems as members of connected teams with the skills to work in an increasingly pluralistic cultural environment. CONTEXT: Like many others, the graduate-entry Sydney Medical Program struggles with teaching population medicine to students who often perceive it to be less relevant than clinical studies. Evaluation found that although students were aware of the importance of population medicine to clinical practice, they felt the existing programme lacked integration with their clinical education and did not develop professional skills. INNOVATION: Experience told us that clinicians apply the principles of population medicine in every consultation, understanding that individual health outcomes are moderated by the social determinants of health. We applied this knowledge to develop an integrated, community-engaged population medicine curriculum for our students in their final two clinical years. Each student will follow a patient with a chronic health condition in the community over 14 months. They will consider their patient's experience with chronic disease and its management through a population medicine lens. Students share their learning in tutorial sessions and through online assessment tasks. IMPLICATION: A comprehensive evaluation of patient, faculty and student experiences of the programme will allow us to assess whether we have achieved our goal of revealing to students how the application of the principles of population medicine is essential to excellence in daily clinical practice. Early data suggest that students feel positive and excited about this curriculum innovation.