Teachers often find it difficult to explain and convince first-year medical students about the different features and mannerisms associated with neurological disorders. For students, it's hard to visualize clinical cases without seeing the real patients in a clinical setup. Medical students here at our institute are not exposed to clinics during their first year of Bachelor of Medicine and Bachelor of Surgery courses. We at Melaka-Manipal Medical College adopted an effective and innovative teaching method to make our students better understand the concepts and features of various neurological abnormalities relating to different parts of the brain by incorporating role-playing sessions in our lectures.
One hundred thirty first-year medical students of Melaka-Manipal Medical College were involved in this study. All students had been exposed to regular didactic lectures in neuroscience in anatomy, physiology, and biochemistry in detail. This helped them to integrate various topics from different subjects. Clinical cases in neurophysiology were discussed during the physiology lecture. After teaching students about the possible causes for each disorder, we introduced some role-playing sessions on disorders that had been discussed in the lecture. All role-playing sessions were conducted toward the end of each lecture. The respective faculty members acted like patients with specific neurological disorders. The neurological cases that were discussed in our lectures included the symptoms, features, and mannerisms of patients with cerebellar lesion, Parkinson's disease, hemiballism, aphasia, etc. Different cases of cerebellar lesion were discussed, which was followed by a demonstration where the lecturer tried to walk in a typical wide-based gait (drunken gait), as shown in Fig. 1A. A patient with cerebellar lesion also finds it difficult to maintain body equilibrium and often loses balance, which was also acted out in our role play. Features of Parkinson's disease were explained, and the characteristic shuffling gait with very short steps, an expressionless face, and loss of associated movement (all typical features of Parkinson's disease) were shown. The actor (faculty member) who was demonstrating symptoms of Parkinson's disease tried to attain the stooped posture (Fig. 1B) that is one of the classical features of Parkinson's disease. We also tried to mimic the speech abnormalities in nonfluent aphasia (Broca's aphasia) and fluent aphasia (Wernicke's aphasia) using a conversational role play between two faculty members, where one faculty member acted as a doctor interviewing a patient while the other acted as a patient with aphasia. Conversations were initiated by the doctor asking the patient about his name, occupation, family details, etc. The faculty member mimicked a patient with nonfluent aphasia (Broca's aphasia) who was finding it difficult to speak, one whose speech was slow and hard to come. The patient was restricted to using two to three words to express his feelings and emotions (2). In a patient with fluent aphasia (Wernicke's aphasia), speech is normal but the patient speaks about unrelated things that have not been not asked to him. He also tries to talk excessively, which makes very little sense (2).
In another role-playing session, we divided the students into smaller groups and tried to imitate the characteristic movements of the fingers and hands in chorea. Irregular, rapid, uncontrolled, and involuntary, movements of fingers and an irregular gait (Fig. 1C) were also attempted, as in Sydenham's chorea. Symptoms of athetosis were shown to the students with slow, writhing movements of flexion and extension of the wrist and shoulder, etc. (1). We tried to act out the involuntary movements as seen in hemiballism, where the actor was seated on a chair and a sudden flailing ballistic movement was performed on one-half of the body (Fig. 1D). We tried to demonstrate in our role play the different types of tremors, namely, intentional tremor and resting tremor, associated with cerebellar lesion and Parkinsonism, respectively. Intentional tremor was demonstrated in a role play where two faculty members were involved. One faculty member offered a cup of tea to the other, who was acting as the patient with cerebellar lesion. In such patients, the tremors become more evident when the patient tries to perform some voluntary task; in the role play, when the tea cup reached near the mouth of the patient, the tremor became more prominent. Once the motor act is over and when the patient is at rest he doesn't seem to have the tremor, which is the characteristic of intentional tremor.
The resting tremor of Parkinson's disease was demonstrated, where the subject was seated on a chair with both hands resting on his lap, where the tremor was very evident. When the individual was asked to lift both upper limbs and hold them there for some time, the tremor disappeared, which clearly indicated that the tremor was present only during rest.
At the end of the role-playing series, the students of the entire batch (n = 130) were divided into small groups consisting 20 students/group. We asked them to explain the site of lesion and the pathways and areas involved in various disorders that might have resulted in the disorders that were represented by each of the characters in what they saw during their role-playing sessions. Four to five students from each group took up the responsibility as team leaders to explain the possible site of lesion that could result in the abnormal symptoms. There were active discussions among the students. They responded well to the questions by explaining to us the neural pathways involved, the site of lesion, and the normal functions of each brain structure. A summary of the type of questions that were asked to the students and the expected answers are shown in Table 1.
The majority of students gave a very clear explanation; this shows the effectiveness of the role-play lecture.
To document the effectiveness of the role-play lecture, a questionnaire was given to all students (n = 130) in the classroom during their lecture hour, asking them about the effectiveness of the role-play lecture in learning neuroscience. Their responses are shown in Table 2. It can be understood from the results shown in Table 2 that the overall response of the students toward the role-play lecture was positive, which once again proves the effectiveness of the role-play lecture. The students found this method of teaching to be very effective and interesting, unlike the usual theory classes in physiology, where they learn only the theoretical aspects with out any visual impact. Students responded in their feedback that the role-playing sessions helped them to better visualize the disorders and to retrieve the most important features seen in specific neurological abnormalities. This method made students very active and made the lecture more meaningful. It has been reported that lengthy lectures are less beneficial for students (3). This study supports the previous study, which reported that active involvement of students in a lecture helps them to understand the subject better (4). Moreover, audiovisual aids, such as video CDs on different neuronal abnormalities, are expensive and might require publisher's permission to use because of copyright restrictions. Therefore, we decided that role-play lectures were an effective, economical, and easily reproducible method for making our students better understand the core concepts and features involved in different neurological diseases.
- © 2008 American Physiological Society