Forum theater staging of difficult encounters with patients to increase empathy in students: evaluation of efficacy at The University of Angers Medical School

Abstract

Background: Physician empathy has been associated with improved clinical outcomes and lower physician burnout. We evaluated whether forum theater (FT), a form of applied drama that allows participants to enter the performance and represent the actions associated with emotions, would foster empathy in medical students, and which underlying variables would be associated to empathy scores. Methods: Three classes totaling 488 fourth-year medical students participated in the study. Forum theater was used to explore difficult encounters with patients and family members: announcement of cancer, fall at home of an elderly person requiring hospitalization, appointment with a patient suffering from depression, announcement of diabetes in an adolescent. The first scene was played by actors in front of a group of students, then audience members were asked to enter the performance and, by taking over the role of the "physician-actor," to explore alternative interactions. All the students followed two sessions as actors and observers in random order and were randomly assigned to FT sessions after 36 or 56 weeks of clinical rotations. They completed the Jefferson Scale of Physician Empathy (JFSE) anonymously. Results: Students were 22.1 ± 1.5 years old (43% males). Empathy scores increased after each session: 102.0 ± 9.8 before the sessions, 106.3 ± 9.8 after session 1 and 107.8 ± 11.5 after session 2 (p < 0.05). In regression models, gender (F vs. M, + 3.0 ± 1.0, p < 0.001) and position in the session (actor vs. observer, + 2.1 ± 1.0, p < 0.05) were significant determinants of JFSE scores, whereas age, session theme, and duration of clinical rotation were not. Conclusion: Being an actor in forum theater was a valuable tool for enhancing empathy scores in medical students.

Counteracting Abuse in Health Care: Evaluating a One-Year Drama Intervention with Staff in Sweden

“…Additionally, the participants in FP workshops had experienced more often that they were able to act according to their own moral beliefs. Our results are consistent with research confirming that role-playing is an effective way to enhance empathy and to improve the communication skills of health professionals [ 29 , 30 ]. They also support the findings that showed that participants in FP workshops had experienced a change in their motivation and perceived ability to act in situations of AHC [ 31 , 32 , 33 ].…”

Does nonviolent communication education improve empathy in French medical students?

“…Our 1 point gain for five items matches the 4 points gain out of 20 items (4/20) which were observed in 488 French medical students trained via forum theatre and tested after the training sessions. 39 Using another communication skill training in India, D'Souza showed that a single training session transiently but significantly improved the JSPE score by 4.5/20. 34 One of the main concerns for both adaptation 87 and readaptation 75 programs is the duration of the effects.…”

“…This is important in order to improve the patient-caregiver relationship as well as to achieve better adherence to treatment and better health outcomes. 7,18 A variety of interventions have taken this need into account: visiting patients at home, 19,20 writing about the patient's point of view, 21 student inpatient hospitalization, 22 mindfulness skills training, 23,24 communication skills training, [25][26][27][28][29][30][31][32][33][34] simulated experiential learning, 35,36 perspective taking training, 37,38 theater improvisation teaching, 39 role playing, 40,41 and Balìnt group training. 42,43 In the following paragraph, we shall see that several intervention types are likely to increase empathy skills among medical students.…”

Acting to teach communication skills to nurses

“…Several educational principles underlie our initiative. Our workshops were inspired by the well‐studied concept of forum theatre—which embraces experience sharing to foster connection 12 —in that group debrief and verbal self‐reflections strategically follow each exercise. Participants are encouraged to share difficult interpersonal and interprofessional encounters they have experienced and brainstorm how they might implement the workshop tools in their clinical practice when navigating future challenging patient encounters.…”