Hi all - role play troubles.

[AtxSi]

Hi all. Not sure if this where I post my troubles or just the intro, but here goes.

I'm a 28yo male medical student from Australia. I'm usually a very sociable and friendly guy, I used to run and own a small business and did all of my own quotes, meetings etc.

But since starting med school, there have been a tonne of role play scenarios (you are a patient interested in vaccines/you are a doctor, how would you discuss vaccines with a patient etc.) and for whatever reason I cannot put myself in the role, it brings out my inner neurotic traits or something.

The situation gets worse with simulated patients (actors with fake relevant symptoms). To the point I sometimes can't even speak. There is a very rigid structure to what we're required to say, and I struggle at role playing, remembering my lines (and I've read them 1000's of times) and listening to the patient.

It's gotten so bad I just cut some compulsory classes which will have be sent to a disciplinary board. I'm here now looking for anyone who has ever experienced this before.

I'm fine on hospital placements with interactions with real patients. The problem seems to be with 'acting' in front of others, Imo. And that's a big problem as it is a barrier to graduating.

Thanks in advance for any help you can give me 🙂

[romantic_thi3f]

Hi AtxSi,

Welcome to the forums and thanks for reaching out.

You did great with your post by the way! That's exactly how people do it 🙂

I've been on BeyondBlue for a little while now and I haven't quite seen a post like yours but hopefully I can help you anyway!

So I understand that even though you're doing fine interacting with real patients, you're struggling with acting with simulated patients. You mentioned that it brings out your 'inner neurotic traits'. Can you tell us more about that?

I think in order to try and help it would be great to get a bit of an idea of what's going through your mind or what might be blocking you from being able to role play affectively. It's really clear to me that you have the skills but I'm just curious about what it is about the acting that's throwing you off.

Oh, and even though I'm not a medical student I am a student and doing a lot of role plays; so from that aspect I do understand how different it can be in pretending that it's a real story and real situation.

Would love to hear back from you if you're willing to share more about what's going on. I hope that you enjoy being about of the forums.

[Mathy]

Hi AtxSi and welcome 🙂

I know exactly how you feel, fortunately I don’t get impeded from graduating from anything. It’s a shame that there aren’t other options, because I don’t know why everybody should be expected to be good at role playing and able to “act”. After all you’re training to become a doctor, not an actor.

When I have to do this sort of thing, I feel awkward, stilted and unable to express myself, fake, nervous and have just become speechless/frozen. Is this sort of what happens to you?

I don’t have to resolve my feelings about this, but for you it’s pretty important. I believe it’s similar to being anxious about public speaking or stage fright. Perhaps look for some strategies around that topic. Rehearsing multiple times?

I feel for you, the fact that graduation depends on this places a lot of pressure on you, which is only going to rev up the anxiety. Is there someone you can speak to a Med school (Counsellor perhaps) who could assist you helping wise but also gain you some extra time to overcome the issue? In most forms of education, there are usually alternate assessment options for students with disabilities. Disabilities include mental health illnesses. Is this an option for you?

I hope you can find an answer and come back and share how you’re going, cheers M 🙂

[AtxSi]

Hey, sorry for the late reply!

Thank-you for the warm welcome and well thought out reply 🙂

I guess interaction feels very different when you're in normal conversation compared to when you're being assessed on what you are saying specifically. I'm not especially sure how to describe the 'inner neurotic traits' except to say that I become hyper critical of needing to say the right thing, to the point where I suddenly lack the confidence to say anything at all. This has become exacerbated over the weeks as I see my classmates pick up the skills and readily switch between normal and acting seamlessly.

As it has gone on over the weeks, there has definitely been a lot of negative self talk, telling myself I can't do it for X reason - and that is creating a whole new problem on its own for sure.

When I'm in the moment, and the other actor is looking at me waiting for me to start/continue, I try to imagine what I am supposed to say, but I can't imagine it, my mind just draws a complete blank or maybe a single word prompt. When asked directly, I can tell them what needs to be checked at that stage of the simulation (scars, swelling, erythema, muscle wasting etc.) but it feels like that method of communication is using a different, more natural part of my mind. Whereas trying to keep to the script requires something else entirely, more like trying to remember something for an exam.

I've chat to a few friends of mine who say they imagine themselves as different characters "be a doctor in your head, and go from there", but I can honestly say I don't understand how to do that. I only really know how to be me.

When all the eyes are on me, I can feel myself constantly checking everyone's facial expressions and body language to see how I am doing as well. Even with one observer this usually overwhelmingly distracting, when its the whole class then I really can't focus. This doesn't happen with actual patients.

I'm not sure I elaborated much further, but it still feels nice to type out.

[AtxSi]

Hey Mathy, thanks for the welcome too. 🙂

I definitely feel fake and unable to express myself. It feels like when you know someone is lying to you, but you have to just go with it, except its you who is lying. The constant part of my brain that is saying 'that wasn't very convincing' is always ringing alarm bells. After a while of that my mind will either go blank, or a headache will start. It feels like really forcing something that isn't there.

I tried rehearsing a bunch with some fellow students, and rote learning the scripts but it then it feels like im reciting a script and I'm not really 'present' in the moment. Kind of a catch 22.

There are counsellors and I've spent a bit of time trying to explain my situation. So far nothing too useful has come from it but I'll keep trying. Unfortunately there is no special consideration for this part of the course.

[Mathy]

Hey AtxSi,

Wow, that’s difficult - meaning no other options for that part of your course. I know why they’ve implemented this piece of assessment. A few years ago there were issues around Med Students who had very high entrance scores, but were basically zero in Emotional IQ (I guess that means lack empathy). I’m guessing that this is what these role plays are all about. But seriously, following a script????

I bet if you were told expect a patient with one of 5 conditions, and they observed your interaction without a script you would do just fine?

If you didn’t have to follow a script, do you feel that you could confidently relate to, assess and diagnose a “fake” patient? Because if you do, I would be asking for your assessment to follow this format.

I’m seriously annoyed on your behalf, but I’m also seriously annoyed on my behalf - like most people, I’d like an educated doctor, who has some empathy and who can competently do their job. I’m not at all convinced that being able to role play and “pretend” their way through a script is a “plus” factor in whether they should graduate or not. Really, they could be at the bottom of the class in proper doctoring and graduate because they can act well? Give me strength (I’m being polite 😊)!!

I’m running out of ideas, but I do have one more. Forget about talking to counsellors or whatever in the Medical School and go to someone like Dean of Learning - there should be someone like that who facilitates student learning, course structure etc. Students with disabilities (including anxiety) have to have an alternative method of assessment. There’s a young man in QLD (I think) who became a quadriplegic (whilst a Med student), who graduated from Med School, and is now doing his Residency.

Keep trying, you may have to be a “squeaky wheel” and find the right person. As a last resort, take you case to your local MP - show them these posts.

Do not give up, please let me know how you’re going, best Mathy 😊

[romantic_thi3f]

Hi AtxSi,

Thanks for your post.

I appreciate you talking again and elaborating about some of these 'inner neurotic traits'; it really helps me gain a good sense of where you're at and what you're going through.

Honestly I can completely understand and I'm going through the same thing myself; when it's an assessment the aim is that you're highly critiqued and judged for every tiny little detail, but in reality, it's just about being a good doctor; helping the patient feel heard, good communication and of course - medical treatment/management.

I probably have to disagree a little (sorry Mathy!) because I can understand where the script comes from and why it's being implemented. There are a lot of people in the same boat (whether they appear confident or not!) so the script becomes a bit of a guideline for you to start to get used to what you'll be saying and how you'll be interacting. I imagine and assume that over time they'll drop the script because you'll be so used to it and not forget the important stuff and be able to interact more naturally as you would with actual patients.

All that aside though, the one thing you can control is your self-confidence. You did mention how you said 'can't do it for x reason'. What reason is that? It sounds like a lot of this role play kind of stems from your self-esteem and some of that negative self-talk that's going on. One of the best ways to deal with this is to try to challenge it; where's the evidence that you can't do it?

You also mentioned that your friends told you they were 'being a doctor in their head' and how you can't do that. It sounds like that bothers you a bit. The way I see it though is that is actually a good thing. I know for me personally, it's not a 'hat' that I take on and off, even though I respect that for some people it is. It's a real part of me; the authentic part, and I believe that's probably the same as for you.

This has been a bit of a long post but I hope that it's been helpful!

[Mathy]

Hey AtxSi,

It’s probably a busy time of year, approaching end of academic year. I just wondered how you are doing.

cheers M 🙂

[Mathy]

Hi romantic_thi3f,

No need to apologise, multiple points of view are useful 🙂

I’ve worked in tertiary education as a lecturer and a tutor, so that’s the direction I come from. I, like you, have also been a student. I wouldn’t have expressed those thoughts if I didn’t have an understanding of the “system”. It is the case, that alternative forms of assessment exist, otherwise one of the various discrimination acts/laws would be broken.

Anyways, I hope AtxSi has managed to resolve this problem. All the best, cheers M 🙂

romantic_thi3f said:

Hi AtxSi,

.....

I probably have to disagree a little (sorry Mathy!) because I can understand where the script comes from and why it's being implemented. There are a lot of people in the same boat (whether they appear confident or not!) so the script becomes a bit of a guideline for you to start to get used to what you'll be saying and how you'll be interacting. I imagine and assume that over time they'll drop the script because you'll be so used to it and not forget the important stuff and be able to interact more naturally as you would with actual patients.

......