Peer Role-Play in a College of Korean Medicine to Improve Senior Students’ Competencies in Patient Care and Communication: A Case Analysis and Proposal for a Model

Eunbyul Cho; Hyun-Jong Jung; Jungtae Leem; Cho, Eunbyul; Jung, Hyun-Jong; Leem, Jungtae

doi:10.13048/jkm.22030

JKM > Volume 43(3); 2022 > Article

Cho, Jung, and Leem: Peer Role-Play in a College of Korean Medicine to Improve Senior Students’ Competencies in Patient Care and Communication: A Case Analysis and Proposal for a Model

Original Article

The Journal of Korean Medicine 2022; 43(3): 49-64.

Published online: September 1, 2022

DOI: https://doi.org/10.13048/jkm.22030

Peer Role-Play in a College of Korean Medicine to Improve Senior Students’ Competencies in Patient Care and Communication: A Case Analysis and Proposal for a Model

Eunbyul Cho¹

, Hyun-Jong Jung²^{, *}

, Jungtae Leem²^{, 3}^{, *}

¹Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea

²Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea

³Clinical Skills Center, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea

Correspondence to: Hyun-Jong Jung, Department of Diagnostics, College of Korean Medicine, Wonkwang University, #460 Iksan-daero, Iksan 54538, Republic of Korea, Tel: +82-63-8506978, Fax : +82-63-8507324, E-mail: kendu@wonkwang.ac.kr

Correspondence to: Jungtae Leem, College of Korean Medicine, Wonkwang University, #460 Iksan-daero, Iksan 54538, Republic of Korea, Tel: +82-63-8506914, Fax : +82-63-8507324, E-mail: julcho@naver.com

Received May 8, 2022 Revised July 25, 2022 Accepted August 16, 2022

Abstract

Objectives

Peer role-play (PRP) has been used in health care training simulations because standardized patient training requires considerable time and expense. This study described the implementation of clinical simulation using PRP and examined the effect.

Methods

Final year students from a single college of Korean medicine engaged in PRP as part of clinical skills practice. Education tools from clinical practice guidelines were used to structure the PRP. Communication competency was assessed with the Korean Version of the Self-Efficacy Questionnaire (KSE-12). Whether this training helped to achieve graduate outcomes was evaluated on a five-point scale.

Results

Fifty-nine students (53.2%) participated in the survey. Among 12 items on the KSE-12, the score for “How certain are you that you are able to successfully listen attentively to the patient?” was the highest. Further, PRP was found to be helpful for self-directed learning, establishment of one’s professional identity, and the ability to communicate and manage patients. Three themes (“Benefits of role-play”, “The importance of positive feedback”, “Limitations and problems of role-play”), 15 categories, and 16 central meanings were derived by categorizing learners’ subjective opinions about PRP.

Conclusions

Study findings indicate that PRP may contribute to improving communication skills and establishing a professional identity for future Korean medicine doctors. We suggest using PRP in clinical education in colleges of Korean Medicine.

Keywords: Communication, Debriefing, Patient care, Peer role-play, Professional identity, Simulation

Notes

Conflict of interest

The authors declare that they have no competing interests.

Ethical statement

This study was approved by the Institutional Review Board (Consent No.: WKIRB-202109-SB-069). The survey was conducted on a voluntary basis, with informed consent.

Data availability

The data of this study are available upon reasonable request.

Table 1

Clinical Presentation Topics Covered in Peer Role-play

Group 1	Group 2	Group 3
Weight loss	Weight gain	Tremor
Abnormal bowel	Dysmenorrhea	Dizziness
Paruria	Palpitation	Cough
Anxiety	Headache	Dyspepsia
Fainting	Runny nose, stuffy nose	Insomnia
Paresthesia in the arms and legs	Vomiting	Cervical pain
Muscle weakness in arms and legs	Shoulder pain	Low back pain
Fatigue	Finger joint pain	Knee pain

Table 2

Mean, Standard Deviation of Total and Each Item of the Korean Version of Self-efficacy Questionnaire(KSE-12)

Survey items	Mean±SD
1. How certain are you that you are able to successfully identify the issues the patient wishes to address during the conversation?	6.90±1.78
2. How certain are you that you are able to successfully make an agenda/plan for the conversation with the patient?	7.24±1.72
3. How certain are you that you are able to successfully urge the patient to expand on his or her problems/worries?	7.63±1.57
4. How certain are you that you are able to successfully listen attentively to the patient?	8.73±1.22
5. How certain are you that you are able to successfully encourage the patient to express thoughts and feelings?	7.71±1.52
6. How certain are you that you are able to successfully structure the conversation with the patient?	7.19±1.75
7. How certain are you that you are able to successfully demonstrate appropriate nonverbal behaviors (eye contact, facial expression, placement, posture, and voicing)?	7.63±1.81
8. How certain are you that you are able to successfully show empathy (acknowledge the patient’s views and feelings)?	7.78±1.72
9. How certain are you that you are able to successfully clarify what the patient knows in order to communicate the right amount of information?	6.93±1.73
10. How certain are you that you are able to successfully check patient’s understanding of the information given?	7.25±1.66
11. How certain are you that you are able to successfully make a plan based on shared decisions between you and the patient?	7.08±1.71
12. How certain are you that you are able to successfully close the conversation by assuring, that the patient’s questions have been answered?	7.31±1.73
Total	89.37±15.22

Table 3

Mean, Standard Deviation, and Positive Rate of Achievement of Learning Outcomes Through Peer Role–play

Learning outcomes	Meani±SD	Positive rate (%)
1. A DKM^* with medical skills	4.03±0.77	79.5
(1) Knowledge system and clinical skills related to treatment	4.06±0.73	80.7
1) Organize basic Korean medicine, biomedical sciences and clinical Korean medicine to understand patients' symptoms	4.08±0.73	84.7
2) Collect and systematically organize the symptoms and signs of patients with the ability of history taking and physical examination	4.03±0.72	79.7
3) Have knowledge related to patient care or treatment, and be able to properly implement related clinical skills	4.10±0.69	81.4
4) Select treatment plan based on knowledge, clinical skills, and relevant data related to symptoms or diseases	4.07±0.72	81.4
5) Record and manage the process of diagnosis and treatment, according to related laws and moral standards	4.02±0.80	76.3
(2) Knowledge of medicines and medical devices	3.82±0.89	68.9
1) Have enough knowledge about medicines, and properly apply them to treatment	3.76±0.93	66.1
2) Select, refer to, and utilize knowledge of medical devices for diagnosis and treatment	3.93±0.76	74.6
3) Manage medical devices and medicines efficiently in clinical practice	3.78±0.97	66.1
(3) Ability to communicate and manage patients	4.17±0.71	86.4
1) Form a desirable patient-doctor relationship through an attitude of consideration and respect for patients	4.31±0.59	93.2
2) Explain and confirm the patients' condition and prognosis in an easy-to-understand manner for the patients	4.22±0.65	88.1
3) Manage patient information and records in accordance with relevant laws and regulations, and providing necessary information to patients	3.98±0.84	78.0
(4) Integrative care and communication skills for it	4.06±0.70	82.2
1) Understand medical competency and solving the patients' problems by collaborating with other experts	4.12±0.59	88.1
2) Be well-informed of how to exchange information through standardized and accurate expressions in the process of integrated treatment or collaboration	4.00±0.79	76.3

2. A DKM with medical ethics and morality	4.18±0.72	88.1
(1) Establishment of professional identity for DKM	4.22±0.63	90.7
1) Recognize and continuously introspect responsibilities as DKM to improve the public health	4.19±0.71	86.4
2) Endeavor to maintain the knowledge, abilities, attitudes, literacy and values necessary to fulfill the duties of DKM	4.25±0.54	94.9
(2) Establishing awareness of medical research ethics	4.15±0.77	86.4
1) Adopt appropriate moral attitudes and behaviors that respect human dignity in the course of diagnosis and treatment	4.25±0.58	93.2
2) Be well-informed of relevant laws and examples of illegal acts such as overtreatment and false/exaggerated advertisements	4.08±0.93	81.4
3) Be well-informed of research ethics necessary for academic activities such as case reports and clinical trials	4.12±0.77	84.7

3. DKM who succeeds and develops national Korean medicine and contributes to society	4.01±0.86	78.4
(1) Self-directed learning ability	4.25±0.58	92.4
1) Have lifelong learning attitude to self-directly acquire the liberal arts and basic knowledge required as DKM	4.20±0.64	88.1
2) Learn, criticize, acquire changing and evolving professional knowledge and skills to apply in clinical practice	4.29±0.53	96.6
(2) Ability to discuss and present papers	4.15±0.74	84.7
1) Understand and be well-informed of the methods and process of organizing, analyzing experience and knowledge through objective indicators to acquire basic competencies to conduct medical research	4.12±0.72	83.1
2) Understand and be well-informed of the process of sharing research results and opinions with each other through presentations and discussions	4.19±0.75	86.4
(3) Knowledge of relevant laws and regulations	3.87±1.01	70.3
1) Be well-informed of laws, policies, systems related to Korean medicine, and participate actively with interest in their improvement and change	4.02±0.94	76.3
2) Accurately understand and manage financial systems such as insurance claims and taxation	3.73±1.06	64.4
(4) Knowledge of public health and international cooperation	3.77±0.96	66.1
1) Have the knowledge and abilities to actively participate in a variety of activities required by community health and public health care	3.97±0.81	76.3
2) Identify and take interest in ways to respond to various demands for international cooperation in the health field	3.58±1.05	55.9

* DKM=Doctor of Korean Medicine

Table 4

Analysis of Learners’ Comments on Peer Role-play

Theme	Category	Meaning unit
Benefits of role-play	Limitations of existing CPX classes	“Clinical reasoning in this role-play is more helpful than other CPX in which the disease is presented.”
	Benefits of practical class	“I was able to practice applying the knowledge I’ve learned.”
	Clinical topics	“It was very good to have an experience similar to the actual clinical situation.”
	Clinical topics	“It was a valuable opportunity to practice on the disease groups that I will see encounter the future.”
	Team discussion time	“It was nice to have time to discuss with my teammates.”
	Benefits of debriefing	“It was good to organize.”
	Setting learning directions	“It was very helpful in focusing on clinical tasks and procedures.”
The importance of positive feedback	Supportive climate	“During the CPX preparation and role-play process, the professor commented on what I was lacking and gave a lot of praise for what I did well.”
The importance of positive feedback	Facilitator	“The professor’s advice and encouragement will be of great help to senior students in deciding their own path and moving forward.”
Limitations and problems of role-play	Lack of communication with the patient	“The doctor role only asked questions for diagnosis, and non-verbal expressions for empathy and listening were a little lacking.”
	Concentration	“Needs attention from students who are not participating in the role play.”
	Class preparation	“Needs a method that encourages students to prepare diligently for role-play.”
	Excessive range of disease	“Too many diseases have to be considered for a given clinical presentation.”
	Infrastructure	“The quality of video and sound needs to be improved.”
	Lack of class hours	“Each group experienced doctor/patient role only once, due to the lack of class hours.”
	Difficulty in preparation	“I wish the CPX manual was sinqilified.”

참고문헌

1. Park Y.-H., Huang D.-S., Shin H.-K.2011; A survey of the medical treatment environment in traditional Korean medicine clinics. Journal of Korean Oriental Medicine. 32:4. 25–36.

2. Lim C., Han H., Hong J., Kang Y.2016; 2016 Competency Modeling for Doctor of Korean Medicine & Application Plans. Journal of Korean Medicine. 37:1. 101–113. https://doi.org/10.13048/jkm.16010

3. Huggett K.N., Jeffries W.2019. An introduction to medical teaching. 2nd ed. Gyeongsan (Korea): Yeungnam University Press.

4. Harden R.M., Laidlaw J.M.2017. Essential skills for a medical teacher: An introduction to teaching and learning in medicine. Paju (Korea): Academypress.

5. Jo H., Min S.2020; The current status and future operations of Clinical Performance Evaluation (CPX) in the nationwide colleges (graduate schools) of Traditional Korean Medicine. The Journal of Korean Medical History. 33:2. 9–21. https://doi.org/10.15521/JKMH.2020.33.2.009

6. Collins J.P., Harden R.M.1998; AMEE Medical Education Guide No.13: Real patients, simulated patients and simulators in clinical examinations. Medical Teacher. 20:6. 508–521. https://doi.org/10.1080/01421599880210

7. Bosse H.M., Nickel M., Huwendiek S., Jünger J., Schultz J.H., Nikendei C.2010; Peer role-play and standardised patients in communication training: A comparative study on the student perspective on acceptability, realism, and perceived effect. BMC Medical Education. 10:1. 27 https://doi.org/10.1186/1472-6920-10-27

8. Harden R.M., Lilley P., Patricio M.2016. The definitive guide to the OSCE: The Objective Structured Clinical Examination as a performance assessment. Edinburgh (UK): Elsevier.

9. Gelis A., Cervello S., Rey R., Llorca G., Lambert P., Franck N., Dupeyron A., Delpont M., Rolland B.2020; Peer Role-Play for Training Communication Skills in Medical Students: A Systematic Review. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 15:2. 106–111. https://doi.org/10.1097/SIH.0000000000000412

10. Song M.-K., Hong S.-U.2012; A survey of students’ satisfaction on participation learning using role-play in clerkship. The Journal of Korean Oriental Medical Ophthalmology & Otolaryngology & Dermatology. 25:3. 65–77. https://doi.Org/10.6114/JKOOD.2012.25.3.065

11. Baile W.F., Blatner A.2014; Teaching communications skills: Using action methods to enhance role-play in problem-based learning. Simulation in Healthcare. 9:4. 220–227. https://doi.org/10.1097/SIH.0000000000000019

12. Kim K.-S., Jeong S.-Y., Kim K.-O.2019; A study on the level of communication and clinical skills of Korean medical students by the participatory method of role playing. Journal of Oriental Neuropsychiatry. 30:3. 177–184. https://doi.org/10.7231/JON.2019.30.3.177

13. Kim K.-O., Kim H.-K., An H.-J., Shin H.-T.2013; A study about the medical communication proficiency of Korean traditional medical students using standardized patients with Hwa-Byoung. Korean Journal of Oriental Preventive Medical Society. 17:1. 163–179.

14. Cho C.S.2015; Student Satisfaction Study and Interrater Comparative Study on Patient-Physician Interaction Score of Clinical Performance Examination in Korean Medical Education. Korean Journal of Oriental Physiology & Pathology. 29:2. 152 http://doi.org/10.15188/kjopp.2015.04.29.2.152

15. Kweon J.H., Sim S.B., Kim E.J., Hong J.W., Shin S.W.2018; Evaluation of the Implementation of Clinical Performance Examination in Korean Medicine Education. Journal of Physiology & Pathology in Korean Medicine. 32:1. 51–61. https://doi.org/10.15188/kjopp.2018.02.32.1.51

16. Park K.-M., Cho S.-H., Yang S.-J., Shin H.-T., Choi Y.-J.2019; A Study about the Medical Communication Proficiency of Korean Traditional Medical Students Using Standardized Patients of Menopausal Disorder. The Journal of Korean Obstetrics and Gynecology. 32:2. 100–118. https://doi.org/10.15204/JKOBGY.2019.32.2.100

17. Han C.-Y., Kang D.-W., Park J.-G., Kim B.-H., Kim K.-S., Kim Y.-B., Nam H.-J.2020; An analysis of clerkship satisfaction in college of Korean medicine. J Korean Med Ophthalmol Otolaryngol Dermatol. 33:1. 12–24. https://doi.org/10.6114/JKOOD.2020.33.1.012

18. Jo H.-J., Park J.-S., Roh J.D., Sung H.K.2020; A Survey on Students’ Perception of Clinical Performance Examination (CPX) in College of Korean Medicine Using Student Standardized Patients. Society of Preventive Korean Medicine. 24:3. 1–13. https://doi.org/10.25153/SPKOM.2020.24.3.001

19. Jo H.-J., Jo N.-Y., Roh J.-D., Park J.-S.2021; A survey on clinical practice students’ perception of clinical performance examination in a college of Korean medicine using the actor standardized patient and student standardized patient. Society of Preventive Korean Medicine. 25:3. 101–115. https://doi.org/10.25153/SPKOM.2021.25.3.008

20. Tierney L.M., Henderson M.C.2010. (The)patient history: Evidence-based approach. Seoul (Korea): Korean medical books.

21. Koonja Publish Academic Bureau. 2013. Must have items of CPX+OSCE. Paju (Korea): Koonja Publish Company.

22. Globooks Academic Bureau. 2012. REAL CPX Guide Book. Paju (Korea): Globooks.

23. National Institute for Korean Medicine Development. Introduction of Clinical Performance examination. National Clearinghouse for Korean Medicine. [serial online]. [cited 2022 Feb 28]; Available from: URL:https://nikom.or.kr/nckm/html.do?menu_idx=123

24. Axboe M.K., Christensen K.S., Kofoed P.-E., Ammentorp J.2016; Development and validation of a self-efficacy questionnaire (SE-12) measuring the clinical communication skills of health care professionals. BMC Medical Education. 16:1. 272 https://doi.org/10.1186/s12909-016-0798-7

25. Gil C.-R., Sung K.-M.2020; Validity and reliability of the Korean version of self-efficacy questionnaire (KSE-12). Journal of Digital Convergence. 18:5. 337–345. https://doi.org/10.14400/JDC.2020.18.5.337

26. Mata Á.N.D.S., de Azevedo K.P.M., Braga L.P., de Medeiros G.C.B.S., de Oliveira Segundo V.H., Bezerra I.N.M., Piuvezam G.2021; Training in communication skills for self-efficacy of health professionals: a systematic review. Human resources for health. 19:1. 1–9. https://doi.org/10.1186/s12960-021-00574-3

27. Escribano S., Juliá-Sanchis R., García-Sanjuán S., Congost-Maestre N., Cabañero-Martínez M.J.2021; Psychometric properties of the Attitudes towards Medical Communication Scale in nursing students. PeerJ. 9:e11034 https://doi.org/10.7717/peerj.11034

28. Wolderslund M., Kofoed P.-E., Ammentorp J.2021; The effectiveness of a person-centred communication skills training programme for the health care professionals of a large hospital in Denmark. Patient Education and Counseling. 104:6. 1423–1430. https://doi.org/10.1016/j.pec.2020.11.018

29. Ha E.-H., Song H.-S.2015; The Effects of Structured Self-Debriefing Using on the Clinical Competency, Self-Efficacy, and Educational Satisfaction in Nursing Students after Simulation. The Journal of Korean Academic Society of Nursing Education. 21:4. 445–454. https://doi.org/10.5977/jkasne.2015.21.4.445

30. Fanning R.M., Gaba D.M.2007; The Role of Debriefing in Simulation-Based Learning. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2:2. 115–125. https://doi.org/10.1097/SIH.0b013e3180315539

31. Decker S., Fey M., Sideras S., Caballero S., Rockstraw L., Rocky Boese T., Frankhn A.E., Gloe D., Lioce L., Sando C.R., Meakim C., Borum J.C.2013; Standards of Best Practice: Simulation Standard VI: The Debriefing Process. Clinical Simulation in Nursing. 9:6. S26–S29. https://doi.org/10.1016/j.ecns.2013.04.008

32. Radziej K., Loechner J., Engerer C., Niglio de Figueiredo M., Freund J., Sattel H., Bachmann C., Berberat P.O., Dinkel A., Wuensch A.2017; How to assess communication skills? Development of the rating scale ComOn Check: Evaluation of communication skills. Medical Education Online. 22:1. 1392823 https://doi.org/10.1080/10872981.2017.1392823

33. Kramer G.A., Albino J.E.N., Andrieu S.C., Hendricson W.D., Henson L., Horn B.D., Neumann L.M., Young S.K.2009; Dental Student Assessment Toolbox. Journal of Dental Education. 73:1. 12–35. https://doi.org/10.1002/j.0022-0337.2009.73.1.tb04636.x