Analysis of Role-play in Medical Communication Training Using a Theatrical Device the Fourth Wall

This study describes research on a theatrical training technique for physicians called 'the fourth wall,' which is a fiction-based medical communication training technique. Though educational drama is recognised and practiced in medical training, this training differs from the normal role play format in that while a student doctor interacts with an actor/patient in a consultation situation, the performance is interrupted in various stages while students and their moderator reflect on ways to proceed.

Employing video analysis methodology, the researchers examine the nature of 'the
fourth wall' concept as a communication tool. Their intent was to explore both how and where the fourth wall exists in the communication model. They found that it exists in three locations: between the patient-doctor scenario on one side and the student audience on the other; between the patient, excluded from the discussion, and the moderator with the audience and doctor; and, in the session where the patient stepped into the discussion, virtually outside the training.

The authors analyse the quality of interactions based on the location and transparent or opaque nature of the wall. According to their research findings:

• All three locations may contribute to the
  learning process.
• The theatrical concept 'the fourth wall' may present an
  additional tool for new understanding of fiction-based communication
  training.
• Increased understanding of such an activity may help medical
  teachers/course organisers in planning and evaluating communication training
  courses.