Using role-play to assess and enhance the integration of learning
in first year physiotherapy students

by

Robyn CUPIT
and
Rosemary ISLES

Department of Physiotherapy
The University of Queensland

 

Introduction

Assessment is a necessity in a system that requires evidence that students achieve standards in order to progress to the next level. It reveals to us the "changes brought about in the knowledge and understanding abilities and attitudes of our students. " (Rowntree 1978, p.7). Assessment drives learning, so for learning objectives to be met, assessment must reflect those objectives to allow students to demonstrate the nature of their learning (Gibbs 1995). Where integration of various aspects of learning is important, a challenge exists to find ways of teaching and assessing which provide opportunity for that integration to occur and its importance and relevance to be appreciated. A further challenge is then to find a way of assessing students, which is in itself a continuation of learning and an enjoyable experience. A possible solution can be found in the concept of "performance" in the form of role-play.

 

Background to the Course

In 1998, one hundred and twenty students enrolled in PT 104 - Professional Studies One. This is an introductory subject for physiotherapy students and is considered to be the start of professional socialization. Objectives for the course suggest that by its completion students would have developed an awareness of:

The main themes are therefore, understanding patient/human rights, the nature of caring and the development of effective communication methods. Two further objectives focus on the learning processes to be used. They are stated as developing an awareness of:

The course is structured to rely heavily on small group discussion. Because of student numbers, classes are usually subdivided into four groups of approximately ten students. This means that with only two facilitators in the room two groups work independently or as leaderless groups for part of the class time.

Students are able to initially have some self-selection for groups (dependent on where they are seated) but after the first session they are encouraged to maintain the same group membership. This is so students can develop some knowledge and respect for the contributions from their peers and so that they can come to know what they can rely on as group skills.

 

The role-play group assessment

The initial working groups were subdivided when the " role-play group assessment" was assigned. For the most part the groups of five students were of mixed gender and students with English as a second language were not placed together. The teaching staff undertook some "orchestration" of the initial groups, based on prior experience of problems, which can develop in small groups. This orchestration was seen as important in the integration of Asian students into the groups and to ensure that they were encouraged and supported as group members, particularly in the development of their communication skills. Students were provided with a written handout outlining objectives of the exercise, its format and timing as well as the criteria for assessment. Staff wrote eight"trigger" scenarios primarily involving a physiotherapist and a client. The following example illustrates the nature of the scenarios.

"A 23 year old male footballer sustained a significant ankle injury in last Saturday's game. He has come to the club physiotherapist demanding intensive treatment in an effort to play this week and maintain his eligibility for selection in a representative team. You believe that playing will be detrimental to his long-term recovery and that he would not be ready to play in less than three weeks".

All scenarios were reviewed to ensure they provided equally good opportunities to showcase knowledge and understanding. Agreement was reached regarding the fundamental issues that could be developed from each scenario. For their allotted scenario, students were asked to develop a role play of four minutes duration, to illustrate their understanding of human/patient rights, their communication skills and their ability to make explicit their caring attitudes. Learning from all three areas was required to be integrated since it is the integration of knowledge ,skills and attitudes which is fundamental to becoming a physiotherapist.

A verbal report analyzing the role-play was to be presented at its conclusion and the group was then to answer questions from the class about the issues raised by their presentation. Each presentation was to take ten minutes in total. Students were able to request basic props, eg a walking stick or crutches, to be made available.

Since this was a group exercise and a group mark was awarded, students were asked to sign a declaration about the equity of contribution of members. Students were told to see the Lecturer as early as possible if there was any perceived concern with signing the declaration. A group mark was considered appropriate since students entering the particular course are known to be high achievers and unlikely to be poor or lazy students. Consistent with Gibb's suggestion for allocating such a mark, it was considered that students would learn that the effectiveness of the group would depend on co-operation (Gibbs 1992). Staff who had conducted the classes throughout the semester simultaneously but independently marked the presentations against criteria. The marks were subsequently aggregated. As this was an initial experiment in assessment, the presentations were videotaped. This was to ensure that if there was any major discrepancy in the marking, the work could be revisited.

 

Criteria

The criteria and standards developed were divided into two sections. The initial criteria focussed on what happened within the role-play and were nominated as:

understanding rights,communication skills and making caring explicit. A second set of criteria was based on the overall management of the task. These included the capacity of the verbal presentation to clarify content, group cooperation, commitment to the task, verbal skills and question answering ability.

 

Outcomes

The level of commitment to the exercise was high. Most students had been assigned an obvious role or responsibility and no groups seemed to have members who were being obviously carried by the group. It would appear that groups sorted people out very early. This was part of the inherent communication exercise with its focus in negotiation or dispute resolution. The two groups who could not accomplish a resolution of their problem sought help from the Lecturer. In both cases, a student allocated to the group had a record of poor attendance and was not attending group meetings either. The non-contributing members were withdrawn from the groups and were asked to complete independent work to accrue the credit. They were encouraged to attend the group presentations. It was noted that they did so and participated in the questioning.

The overall standard was very high with most groups scoring strongly in the area of understanding of rights issues involved in the scenario. The use of specific communication skills was strong with most groups relying on material delivered through the course. Where groups had gone further into the literature they were often able to extend either the skills or the commentary on them. Dialogue was well developed to illustrate points and students generally made a good attempt at using non- verbal communication.

The verbal presentations illustrated that sometimes intent was not actioned by the performers. These presentations were also useful to highlight errors or gaps in theoretical understanding particularly related to response modes in communication.

Group cooperation was highlighted in those groups who wrote dialogue that assigned everybody a role. Despite dialogue having been learned, the examiners believed it should have been possible to identify hesitant or incompetent users of the English language. No obvious problems were seen indicating that on this occasion there was probably a different year mix to that which is often seen.

A question may be raised as to whether in a spontaneous situation, responses would be as good. An avenue exists to go further and test student individual responses in a real time situation using video. The ebb and flow of interaction is lost and providing a live co-participant able to manipulate the conversation would be a resource expensive exercise.

The exercise as presented has a strong feature to recommend it. Each group, tackling a different scenario, was able to continue and extend the learning and experience of all other students in the total class group. The exercise offered an opportunity to practically apply skills, to demonstrate confidence in doing it and to show that understanding of relevance had been achieved. Students used humor in an effective way and overall gave the impression that this learning had been enjoyable.

Where learning is driven by assessment it is critical that the assessment relates well to the objectives of the course and students can see relevance in it. The use of "performance" in the form of role-play has been seen to provide integration and extension of learning in an enjoyable and maximal participatory context.

 

References:

Gibbs G (1992): Assessing More Students, Book 4 in The Teaching More Students Project. Oxford: The Oxford Centre for Staff Development.

Gibbs G ( 1995): Assessing Student Centred Courses. Oxford: The Oxford Centre for Staff Development

Rowntree D ( 1987) Assessing Students:How Shall We Know Them? London:Kogan Page.

 

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