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Healthcare Theatre Actor Zachary Jackson sits on the bed while
Andrew Jones talks to him and speech language pathologist Julie McCauley
watches during a class to simulate interaction between patients, nurses
the textbooks, lectures and study sessions, future health professionals
can face many unknowns during their first interactions with patients.
Will they ask the right questions? Will they know the right answers? How
will they connect with their patients?
For the past 12 years, students at the University of Delaware have
been able to safely practice their technical and interpersonal skills in
a safe environment through the Healthcare Theatre
program. Healthcare Theatre trains students to portray patients and
family members for interactive, high-fidelity, simulation-based
Founded by a team from the College of Arts and Sciences' Department of Theatre and the College of Health Sciences, it is a unique interdisciplinary education program that helps healthcare professionals develop
communication skills through interactive scenarios presented by theatre
The program transitioned from in-person simulations to telehealth,
tweaking some of its scenarios to better fit a virtual setting while
still giving students the chance to practice their skills and perhaps
pick up a few more through the use of telehealth.
Move this whole section up, swapping places with the section above it.
Healthcare Theatre actor Heather Mekulski portrays the mother of a
child with a feeding disorder during a simulation scenario with Teresa
Highberger, a graduate student from the speech-language pathology
program, while classmate Andrew Jones looks on.
Now, as healthcare professionals around the globe navigate the return
of in-person visits, Healthcare Theatre has pivoted again to help UD
students interact face-to-face with patients despite social distancing,
personal protective equipment and other challenges brought on by the
Regardless of whether its done in person or virtually, these
learning experiences are going to carry our students into their
professional lives, said Amy Cowperthwait, a co-founder of Healthcare
Theatre. This is a unique opportunity to practice direct care and learn
how your patients are thinking and feeling.
Simulation-based education integrates trained participants to
portray the roles of patients and family members in a standardized way
so healthcare professionals can practice important interpersonal and
technical skills, such as taking a patient history.
At UD, students are trained to portray simulated patients and family
members experiencing depression, pregnancy, drug use, cystic fibrosis
and other patient presentations. Actors use disease details and their
own research to deepen the characters they are portraying.
As an aspiring healthcare worker, I was immediately drawn to the
chance to be in the patients shoes., said Zoe Jacobson, who has spent
four semesters with Healthcare Theatre, most recently as an intern.
Its something that has reshaped the way I communicate with others.
Faculty and clinicians watch the simulated scenarios from the control room on the fourth floor of the Tower at STAR.
Heather Mekulski, program coordinator for Healthcare Theatre, said
the authenticity created in the simulations gives students insight into
the patients that they might not otherwise get in a clinical
Its really the biggest opportunity for the healthcare learner to be
able to hear from the patient, family member, or provider they are
interacting with, said Mekulski, who portrayed the mother of a child
with a swallowing disorder during a recent simulation at UDs Science,
Technology and Advanced Research (STAR) Campus. Youre not going to
stop in a session and say, How am I doing? Its really the only
opportunity they will get to practice and hear from someone who is
totally emotionally attached to the patient they are portraying.
In addition to developing scenarios for UD students studying nursing,
physical therapy, health coaching, nutrition and business, Healthcare
Theatre also works with healthcare professionals from several regional
healthcare systems, including ChristianaCare, Nemours/Alfred I. duPont
Hospital for Children, Sidney Kimmel Medical College at Thomas Jefferson
University, Beebe Medical Center and the Wilmington VA Medical Center.
Although the program has grown in recent years adding classes
and working with departments in four UD colleges the coronavirus
(COVID-19) pandemic has created the biggest opportunity for Healthcare
Theatre to expand its offerings, said Allan Carlsen, co-founder of the
program and an assistant professor of theatre.
Working with faculty, Healthcare Theatre rewrote in-person patient
scenarios so simulated participants could participate in virtual
simulations using Zoom. Doing so has allowed participants to explore
some of the challenges of telehealth, such as lighting, poor internet
connection and sound quality. Some obstacles remain the same being
able to emotionally connect with a patient, asking the relevant
questions, and confirming patient understanding.
We had to teach simulated participants how to appropriately portray
their character in a virtual setting, Mekulski said. This includes
lighting, scenery, attire and even how technologically savvy the patient
Simulated patients and family members continue to play their part
online. For example, a hungover student still slumps in a chair with an
oversized sweatshirt. Non-verbal gestures like twiddling thumbs or
wringing hands are exaggerated. Tissues are placed by the computer
screen so a practitioner can virtually offer one to a patient, who in
turn, shows one on their screen.
Putting it in a virtual COVID world teaches them to work in a telehealth setting, Carlsen said.
Healthcare Theatre has partnered with the Clinical Health Coaching
certificate program for seven years to help health coaching students
better understand what its like to coach a patient in real time. In
addition to simulated participant integration for their final exam,
Healthcare Theatre actors are used for a master class that allows
beginning students to stop in the middle of the simulation to ask for
advice or help.
My students will always say it was the thing they were most nervous
about, but they got the most out of the master class, said Tara
Leonard, director of the Clinical Health Coaching Research and Training
Center. In the middle of it you can say, Wait a minute, I feel lost
here so what do I say? Allan can offer advice, we can offer advice,
another student can pop in and say, How about trying it this way? Its
a really safe space to fall forward.
Transitioning the master class to telehealth meant reworking the
simulation which featured a 23-year-old woman with unhealthy eating
habits and limited exercise to include her reasons for reaching out
for a telehealth visit. To further amplify the development of the
virtual scene and reinforce their role as a provider, health coaching
students were encouraged to dress professionally. Just as in the
in-person simulation, students received feedback from others in the
class, including the actor portraying the patient.
Leonard said the pivot to online simulation allowed the students to
get the coaching experience they needed while also picking up additional
skills in telehealth. Ive had six finals since COVID, she added.
Weve had our foot on the gas working with Healthcare Theatre. We never
In early August, graduate students in the Communication Science and
Disorders speech language pathology program donned surgical gowns,
goggles, masks and other personal protective equipment. They stood
socially distanced across the fourth floor of the Tower at STAR, waiting
for their turn in the first face-to-face simulations in nearly five
months. The day-long simulations had been planned weeks in advance with
extra attention focused on safety protocols that were embedded into the
Walking into the Visualization Lab for Interprofessional Education
and Research, students found themselves immersed in simulated hospital
and outpatient rooms. They met Healthcare Theatre actors portraying
patients and family members needing assessment and treatment of
swallowing disorders known as dysphagia.
On one side of the partitioned room, Mekulski sat with a realistic
child mannequin operated by a staff member in the adjacent control room.
Mekulski portrayed, Amber, the mother of Andrew, a 3-year-old boy
with Down syndrome and feeding problems. On the other side, actor
Zachary Jackson sat in a bed as Paul, someone waiting to talk with
someone about liquids he could drink following his discharge from the
Clinicians and faculty watched from the control room as the students,
covered nearly head to toe with protective equipment, asked the
patients about their swallowing problems. In addition to navigating the
technical challenges of the diagnosis, students also had to figure out
the best ways to interact with the patients, like speaking louder to
make up for the muffled effect of the masks or offering feeding
techniques while keeping social distancing in mind.
Afterward, simulated participants and faculty offered their feedback
to the students, many of whom were sweating while wearing the extra
protective layers. In one simulation, Jackson speaking as Paul
noted the student didnt introduce himself when coming into the room,
which initially made him feel uncomfortable. But the students recap of
the visit at the end of the appointment helped ease the tension.
How is it talking through a mask? Carlsen asked. Its hard when you cant show half your face.
Everyone in the room nodded.
Julie McCauley, a lead master clinician in the UD
Speech-Language-Hearing Clinic who oversaw students in the simulation,
said the face-to-face experience was an eye-opener for many students.
These students definitely left with a new respect for what
healthcare workers are going through right now, she said. And, I think
they learned an unexpected lesson in how to be an empathetic
practitioner, talking about ways to build rapport with a patient amidst
layers of PPE.
These kinds of experiences will lead to better healthcare providers, said Cowperthwait.
Healthcare is pretty inflexible, but with the addition of the
theatre perspective, thats where we can be flexible and stretch
learners of all kinds to the edges of their ability, she said.
Article by Kelly Bothum; photos by Ashley Barnas
Published Sept. 23, 2020