Interactive training in managing aggression using forum theatre

During the COVID-19 pandemic, we were unable to deliver our usual small group face to face training in managing aggression for final-year medical students, due to restrictions on in-person contact and a reduction in available clinical faculty. We needed to shift this vital teaching online and reach large groups of students, some of whom were overseas, whilst still encouraging student engagement, interaction and stimulating critical reflection.

We co-designed a novel online session with an arts organisation [Performing Medicine], about managing aggression. We used forum theatre, an interactive theatrical method rooted in critical pedagogy.¹ In forum theatre, audience members become active participants in the performance; a scenario is presented, which is then discussed and debated, followed by a replay with audience members invited to intervene and change the outcome. First, in a series of developmental workshops with a clinician and artists, we developed an authentic scenario of a junior doctor dealing with angry patients and relatives. Then, in a 1-hour live-streamed forum theatre session, more than a hundred students were invited by expert artist-facilitators to stop the action, hear the characters' perspectives, discuss and then modify the characters' behaviours in a series of re-runs of the scenario. The forum theatre session was followed by an introduction to a five-step model for thinking about the key skills and approaches in managing aggression, illustrative stories of dealing with aggression and violence from clinical practice, and 20 minutes reflecting on self-care following such incidents, including a brief guided meditation. The session was co-facilitated by artists, the communication skills faculty and clinical education teaching fellows training in psychiatry.

Survey feedback was positive with 98% of respondents saying they would recommend the session to fellow students and 82% rating the session as enjoyable or very enjoyable. The text comments highlighted the value of active involvement in the forum theatre (‘I really liked being able to tweak things and then see it happen again in real life. I feel like I've lived the experience …’) and that this interactive process was much more engaging than traditional large group online formats. Students welcomed the opportunity for meditation and self-care and the reflection on learning through the five-step model.

High-quality technical support was critical to the online delivery of this session—without a skilled audio-visual technician and high-quality cameras, lighting and audio equipment, it would not have been such a smooth experience for students or faculty. We also learned the importance of a dedicated facilitator to monitor the online chat and gather feedback for characters performed by the artist-facilitators and to manage breakout rooms for brief student discussions. The scenario can be upsetting for students, so we give a trigger warning and offer support during and after the session.

We can now deliver the same session in person that allows for more instant feedback for the characters and livelier interactions between students and with facilitators. But we also now have the option of running an effective, interactive online session for overseas students or to support future blended learning.