A step-wise role playing approach for teaching patient counseling skills to medical students.

We describe a step-wise role playing approach to bedside teaching during the clinical training of medical students. The objective of this approach is to teach them the skills which are required to practice patient-centered medicine. "Patient-centered medicine" refers to a style of practice which relates to patients' needs rather than to the doctor's own plan, and which moves from professional control to patient empowerment. Our approach is based on: (a) interviews with real patients, and (b) re-play of doctor--patient encounters in small group teaching sessions using the instructor (a physician) as a simulated patient, while a student assumes the role of the physician. The objective of the simulation is to assess the student's ability to provide health-related information, involve patients in making clinical decisions and plan their management in a manner which suits their preferences and lifestyle. The medical background of the instructor who simulates the patient eliminates barriers in communication and allows these objectives to be easily accomplished. The discussion which follows, attempts to: (a) identify discrepancies between the optimal counseling which was offered to the simulated patient and that offered to the real patient; and (b) show that although inevitable, these discrepancies are not irreducible. We have no formal evaluation of our approach in terms of whether it achieved its objective, produced changes in students' attitudes and bedside manners, or in terms of students' ratings of the teaching approach. However, student participation and occasional verbal feedback have indicated that the teaching intervention may be a valid contribution to the clinical training of medical students and that it may be of use for other clinical instructors.