Structured, three-way, role-play activity for improving history-taking skills


  • Luiz E A Troncon

Luiz E A Troncon, Departamento de Clínica Médica, Hospital das Clínicas, Campus da USP (5º Andar, Sala 533), Ribeirão Preto, São Paulo CEP 14048-900, Brazil. Tel: 00 55 16 3602 2457; Fax: 00 55 16 3633 6695; E-mail:

Context and setting History-taking skills have undisputable relevance in medical student education. Experiential methods, such as videotaped interviews and simulated patient encounters with feedback, have been shown in evidence-based reviews to be effective for communication skills learning.

Why the idea was necessary Many medical schools lack resources such as videotaping facilities and access to standardised patients, and history-taking skills are taught using lectures and practice sessions with real patients. Although students may enjoy practising with real patients, encounters are usually unobserved and may cause discomfort to both participants.

What was done With the aim of enhancing active learning on history taking, a structured, three-way, role-play activity was devised and is being successfully utilised within an elective course. This course is offered to junior medical students who have just completed a compulsory course on basic clinical skills. The course programme consists of selected readings and discussions on factors affecting doctor–patient communication, as well as practical activities consisting mainly of real patient interviews followed by group discussions. The role-play activity starts with the teacher explaining the activity and emphasising the three different roles of doctor, patient and observer. Special attention is given to the observer role as this person is in charge of delivering structured feedback based on checklist-documented behaviours. Students then memorise individually the features of a common case from a series of previously constructed baseline patients. Groups of nine to 12 students are split into subgroups of three students, who rotate in the roles of doctor, patient and observer. Observed patient–doctor encounters then take place for 5–10 minutes. Thereafter, the observer delivers feedback on the doctor role-player performance, which is followed by comments from the patient and doctor players. Roles are rotated and, after three interviews, individual members successively rotate through the different subgroups, so that each student can play each role and obtain the relevant feedback. The final part of the session includes comments and feedback from the teacher to the players, as well as a general discussion on what was learned. For three consecutive years, students (n = 21) evaluated the role-play activity and various aspects of course using a 5-point scale (1 = poor, 5 = excellent) and open questions.

Evaluation of results and impact All students gave the course an overall grade of 4 or 5. Although 20 of 21 students reported that both the role-play activity and real patient interviews were good or excellent, the proportion of students who rated the role-play activity as excellent was significantly greater than the proportion of those who rated the interviews with real patients as excellent (18/21 versus 10/21; = 0.02). Narrative evaluations highlighted the perceived advantages afforded by the opportunity for extensive practice with common cases and the receipt of immediate feedback from both patient and observer players. Comments on patient and observer role-playing indicate that this may also contribute to reflection on the learning process. Finally, students indicated in a nearly unanimous manner that the role-play activity should be introduced as compulsory for all students. Further systematic utilisation and evaluation of this structured educational activity may provide evidence of a positive impact on student performance in history taking.