Interactive drama: teaching aboriginal health medical education

Abstract

Context and setting Approximately 100 students attended this attitudinal learning activity designed for a Year 1 undergraduate medical education course on cultural diversity. The learning activity took place in an urban community with approximately 30 000 aboriginal people. Why the idea was necessary While lip-service is often given to the proverbial 3-legged stool in medical education (attitudes, knowledge and skills), most medical teaching institutions are perched precariously on a wobbly 2 legs at best. Attitude-oriented courses are typically perceived as being ‘soft’ and unimportant compared to more science-oriented courses. Most curricula squeeze in a mere hour or so for introspection and self-reflection, leaving students unaware of the importance that their attitudes have on their clinical interaction. Learning about aboriginal people's health tends to be limited to a knowledge-focused approach. Learning must illustrate the complex interaction of cultures (aboriginal, learner's natal and medical) and then offer tools to help negotiate and bridge the complexities. This learning activity was designed to provide an opportunity for students to explore cultural perspectives, reflect on attitudes toward aboriginal people, and learn ideational frameworks through which local aboriginal people experience health care. What was done An interactive genre called Forum Theatre encouraged students to move from being passive observers to active participants within a play consisting of a series of scenarios between an aboriginal elder, her granddaughter, her doctor and a medical student. The play wove together themes of relationship, culture and conflict within a health care setting. Students observed the play once. Following this, the play was run through a second time; however, this time students were instructed to shout out ‘Stop!’ when they felt that the medical student could engage with her preceptor or aboriginal patient differently. The audience member who shouted ‘Stop!’ would then take the place of the actor in the play and attempt to mitigate the conflict scenario. Thus, the students could practise and learn from alternative interventions. The activity created space for discussion around intervention effectiveness and diversity of cultural perspectives and preferences. Key issues that arose were: accepting gifts and conflict of interest, negotiating student−preceptor disagreements, intergenerational conflict, the role of the chart, medical professionalism, racism, gaining trust, and eliciting the patient's worldview without imposing assumptions based on ethnicity. Evaluation of results and impact Following this activity, students were asked to complete a mixed qualitative and quantitative evaluation. Student feedback included: ‘It made me realise how many issues I wouldn’t have answers for.' Students expressed their particular enjoyment in being involved and participating in ‘real life examples’: ‘It was fantastic to be able to “test out” alternate approaches or tactics and see how they work.’ The play fostered exploration of vital covert and overt issues, rarely dealt with in a traditional teaching setting. It was apparent that this activity enabled students to connect mentally, physically, spiritually and emotionally with the content and begin to develop an appropriate approach towards interacting with aboriginal patients.