The use of clinical role-play and reflection in learning therapeutic communication skills in mental health education: an integrative review

Figures & data

Table 1 Simulation techniques

	Students role-play the clinician/therapist	Students role-play the patient	Other than students role-play the patient^a	Subsequent reflection used as means	The use of psychotherapeutic communication approaches in the role-play
Standardized patient	X		X
Simulated patient	X		X
Role-play	X	X
Reflection groups at Molde University College	X	X		X	X

Note: ^aPerson trained to describe own problems or problems based on observations of others role-play the patient (standardized patient) or person trained to present symptoms of particular diagnosis role-play the patient (simulated patient).

Figure 1 Literature search^a

Notes: ^aExample on search done in Ovid. Limits: peer-reviewed; 1860 to current; English or Scandinavian language.

Table 2 Number and reason for excluded full-text articles

Investigated standardized patients, not role-play	Did not address teaching mental health	Not research	Investigated simulation using manikins or avatars	Did not investigate clinical role-play	Investigated reflection, not role-play	Others^a
4	2	9	3	12	5	3

Note: ^aStudied simulation to recognize physical symptoms, did not investigate role-play, investigated role-play with students’ role-playing patient role, but failed to include its impact on clinical reflection.

Table 3 Included studies^a

Reference (year)	Country	Aim	Method	Participants	Results	Conclusion
Fossen and Stoeckel (2016)^Citation23	USA	The aim was to gain understanding of bachelor nursing students’ personal thoughts of experiencing auditory hallucinations in role-play activities before mental health clinical studies.	Qualitative interpretive phenomenological method with written surveys.	40 Baccalaureate nursing degree students	In advance of the study, the students reported that they were anxious and unsure of communicating with people hearing voices. After the simulation and role-plays, they felt safer and gained new understandings and attitudes about communicating with patients who hear voices.	The hearing voices simulation increased the students’ understanding of the experience of hearing voices. Role-plays helped the students to practice skills.
Guttormsen et al (2003)^Citation21	Norway	Investigated whether the course “first aid in case of suicide,” where role-play was an important method of teaching, was suitable for medical students.	Qualitative method/focus group interview	47 medical students (62% of participants of the course)	Students reported it was useful to practice specific situations and receive direct feedback on their skills. They experienced important learning both when practicing helping a person in danger of suicide and when role-playing the person in suicidal danger. They said it was useful going into the patient’s situation getting familiar with emotional reactions that occurred in the situation of the role-play.	The course can provide important knowledge and skills in dealing with suicidal patients.
King et al (2015)^Citation22	Australia	Evaluate a new role-play based approach for teaching mental health to medical students.	Quantitative method with questionnaire.	107 (of 130) medical students from three clinical schools	The results showed that students gained better involvement, self-esteem and empathy as well as increased learning. This was also good for preparation for practice and exams.	Role-play-based learning is unique and flexible and can be used in other disciplines as well. In addition, it is cost-effective and safe.
Wolff and Miller (1993)^Citation24	USA	To describe and discuss role-playing techniques to teach psychiatric interviews where students perform different roles including the patient role.	Quantitative method with survey.	31 of 46 medical students	71% felt that the experience made them more aware of patient’s feelings and 90% indicated that the role-play made them more aware of their own feelings. 84% felt that the experience could be used in other rotations. The students were better at understanding their own and the patient feelings, and were able to recognize discrete emotional states for the different roles.	The use of role-playing challenges students to study the frustrations of the interviewer and the worries of the patient. In overcoming their anxiety of the interview, it helped students to become more empathic and effective in facilitating the doctor–patient relationship.

Note: ^aStudies that met the following inclusion criteria: pedagogical clinical role-play students played both client and clinician, clinical reflection, training therapeutic skills, university students.

Figure 2 Identification and selection process based on the PRISMA flow chart. Adapted from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7).20

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