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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

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.

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
jkm-43-3-49f1.gif
Limitations of existing CPX classes
jkm-43-3-49f2.gif
“Clinical reasoning in this role-play is more helpful than other CPX in which the disease is presented.”
jkm-43-3-49f3.gif
Benefits of practical class
jkm-43-3-49f4.gif
“I was able to practice applying the knowledge I’ve learned.”
jkm-43-3-49f5.gif
Clinical topics
jkm-43-3-49f6.gif
“It was very good to have an experience similar to the actual clinical situation.”
jkm-43-3-49f7.gif
“It was a valuable opportunity to practice on the disease groups that I will see encounter the future.”
jkm-43-3-49f8.gif
Team discussion time
jkm-43-3-49f9.gif
“It was nice to have time to discuss with my teammates.”
jkm-43-3-49f10.gif
Benefits of debriefing
jkm-43-3-49f11.gif
“It was good to organize.”
jkm-43-3-49f12.gif
Setting learning directions
jkm-43-3-49f13.gif
“It was very helpful in focusing on clinical tasks and procedures.”
jkm-43-3-49f14.gif
The importance of positive feedback
jkm-43-3-49f15.gif
Supportive climate
jkm-43-3-49f16.gif
“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.”
jkm-43-3-49f17.gif
Facilitator
jkm-43-3-49f18.gif
“The professor’s advice and encouragement will be of great help to senior students in deciding their own path and moving forward.”
jkm-43-3-49f19.gif
Limitations and problems of role-play
jkm-43-3-49f20.gif
Lack of communication with the patient
jkm-43-3-49f21.gif
“The doctor role only asked questions for diagnosis, and non-verbal expressions for empathy and listening were a little lacking.”
jkm-43-3-49f22.gif
Concentration
jkm-43-3-49f23.gif
“Needs attention from students who are not participating in the role play.”
jkm-43-3-49f24.gif
Class preparation
jkm-43-3-49f25.gif
“Needs a method that encourages students to prepare diligently for role-play.”
jkm-43-3-49f26.gif
Excessive range of disease
jkm-43-3-49f27.gif
“Too many diseases have to be considered for a given clinical presentation.”
jkm-43-3-49f28.gif
Infrastructure
jkm-43-3-49f29.gif
“The quality of video and sound needs to be improved.”
jkm-43-3-49f30.gif
Lack of class hours
jkm-43-3-49f31.gif
“Each group experienced doctor/patient role only once, due to the lack of class hours.”
jkm-43-3-49f32.gif
Difficulty in preparation
jkm-43-3-49f33.gif
“I wish the CPX manual was sinqilified.”
jkm-43-3-49f34.gif

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