Innovation
Our innovation is using a theatrical method called ‘forum theatre’ which we have specifically tailored for enhancing the teaching and learning experience for students in health and social care. Forum theatre is a theatrical game in which a problem from clinical practice is shown to students in the form of a play in an unsolved form. The session requires a minimum of two actors and a skilled forum theatre facilitator who ensures the smooth running of the session. After one showing of a scenario from practice, (it can be a full-length play), it is shown again and follows exactly the same course until a student shouts ‘Stop!’. At this point, the action on stage is paused and the student is invited up on to the stage to take the place of one of the actors, enact their solution and alter the course of the original play. Forum theatre in essence is a form of contest between the students who are challenged to bring the play to a different more palatable end (in which the cycle of poor care is broken) and the actors ostensibly making every possible effort to bring it to its original ending (in which the poor care is unchallenged).
What prompted innovation?
We were motivated to develop this method in order to complement traditional methods of teaching and to maintain and improve the quality of professional practice by people who work in health care. Forum theatre’s ability to provide a visual working and moving model for students to engage with facilitates a diverse educational dialogue in the lecture theatre. It was our intention to carefully prepare forum theatre sessions that provided students with the ability to recognise how situations can be inflamed and grow to become critical incidents and/or complaints. We recognise the difficulties that exist in a large hall lecture when attempting to fully explore the depth of practical complexities that clinical practice presents. Forum theatre prompted the ability to be able to explore the nuances of professional communication such as use of voice, power, proximity, relationships, motivations, behaviours and action in the safety of the teaching space.
What makes innovation different?
The emotional burden placed on healthcare staff is well recognised yet often absent from curriculum design. The use of forum theatre provides a platform to let students learn by being able to ‘feel’ the emotions of a situation while being removed from the instantaneous nature and severity of the realities of clinical practice. This form of theatrical debating presents students with the opportunity to critically explore their own values as well as scrutinise the actions of others to gain a better wider understanding of a scenarios. Through the use of this approach, students are given exposure to the consequences that can occur in the absence of the chief nursing officers 6 C’s (care, compassion, communication, courage, commitment and competence). The ideas for the scenarios can come directly from the students themselves which facilitates a student centred approach by delivering a session where they themselves decide what learning is important to them. Our forum theatre sessions aim to stimulate dialogue and praxis in the form of action, not just words. The students are able to pool their knowledge, tactics and experience and demonstrate to each other that alternatives are possible. The human interactive component of forum theatre affords students the opportunity to rehearse and prepare for the heightened range of senses, emotions, behaviour, stress and thoughts they will have exposure to in the reality of the clinical situation. Forum theatre does not, nor intends to, replicate reality. However, in the classroom setting we can recreate and sanitise scenarios using this theatrical approach which aims to inform students about the difficulties that can be faced in practice and move them from being passive recipients of knowledge into active transformers of their own lives.
Changes in practice
- Forum theatre sessions are memorable long after the event. Students who return on postgraduate courses (sometimes years later) are able to recall moments that resonated with them during our sessions. Individual students have recalled their experiences and state how their own personal practice has been changed. An example of this is during a practical moment in care when they have procedurally changed the way they have engaged with a patient/relative/colleague in that they have placed more considered thought into the intervention and the effects of their own actions. In essence it challenged ‘task orientated working’ and their ‘internal handbook of clinical phrases’ they often used in practice.
- Our emphasis on the chief nursing officers 6 C’s has allowed the students to carefully reflect on their own practice by observing and internalising the fatal flaws of our actors.
- Students often comment that they have either identified with the main character, or they have witnessed similar behaviours in others.
Impact
- 2010 – Received a Vice Chancellors Teaching Award
- 2012 – Finalist in the national Student Nursing Times Awards for ‘Best Innovation in Teaching’
- 2013 – Faculty winner for ‘innovative teaching’
- Student feedback has been consistently high over the six years we have been using this method.
- The reputation has led to being approached by external agencies such as local NHS providers to deliver teaching packages.
Dissemination
- 2013 (Sept) Nurse Education Today conference: core paper leading on student engagement
- 2013 (June) Perinatal mental health maternity conference: keynote session
- 2012 (Dec) RAISE: new researchers conference
- 2012 (Nov) Service user and carer conference: Keynote session
- 2011 (Nov) Service user and carer conference: Keynote session
- 2011 (June) International Learning differences conference: Keynote session
- 2011 (Jan) Time to change ‘whose aspirations’ conference: workshop session
- 2010 (April) Royal College of Nursing education forum conference: workshop session
- 2010 (March) Mental health in higher education academy conference: workshop session
- Article: Middlewick, Y., et al., (2011) Curtains up! Using forum theatre to rehearse the art of communication in healthcare education, Nurse Education in Practice doi: 10.1016/j.nepr.2011.10.010
- Website: www.southampton.ac.uk/heat
- Within the Faculty of Health Sciences at the University of Southampton this approach is used frequently in the undergraduate and postgraduate delivery of education.