title: Analysis of role-play in medical communication training using a theatrical device the fourth wall.
abstract: BACKGROUND
  Communication training is a central part of medical education. The aim of this article is to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance.
  
  
  METHODS
  The empirical data stem from a communication training model demonstrated at an international workshop for medical teachers and course organizers. The model involves an actress playing a patient, students alternating in the role of the doctor, and a teacher who moderates. The workshop was videotaped and analyzed qualitatively.
  
  
  RESULTS
  The analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction. 2) A "timeout/reflection" location, where the wall was doubly opaque, for the patient on the one side and the moderator, the doctor and the audience on the other side and 3) an "interviewing the character" location where the wall enclosed everybody in the room. All three locations may contribute to the learning process.
  
  
  CONCLUSIONS
  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 organizers in planning and evaluating communication training courses.
authors.affiliation: Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Bergen, Norway. torild.jacobsen@isf.uib.no
authors.forename: Torild
authors.initials: T
authors.lastname: Jacobsen
authors.forename: Anders
authors.initials: A
authors.lastname: Baerheim
authors.forename: Margret Rose
authors.initials: MR
authors.lastname: Lepp
authors.forename: Edvin
authors.initials: E
authors.lastname: Schei
mesh_terms: D000328:Adult; D003142:Communication; D004324:Drama; D004504:Education, Medical, Undergraduate / Q000379:methods*; D036262:Empirical Research; D006126:Group Processes; D006801:Humans; D007858:Learning; D019365:Metaphor; D008875:Middle Aged; D017145:Models, Educational; D009664:Norway; D016544:Patient Simulation; D010550:Personal Space; D010817:Physician-Patient Relations; D012381:Role Playing; D013663:Teaching / Q000379:methods