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I use this scripted role play in registrar sessions I facilitate on infertility to illustrate how emotionally charged and difficult consultations relating to infertility can be, and how easy it is to “put your foot in it”.
Why scripted role plays? It is well established that the use of role plays in communication skills training can be of great value, however unscripted role plays in group settings can be terrifying for participants. Some will disengage and/or use avoidance strategies, impeding their access to learning opportunities.
Scripted and semi-scripted role plays (where dialogue is initially read rather than improvised) can be less threatening. They provide most of the educational advantages of traditional role plays (e.g. experiential learning, development of empathy) while eliminating or reducing many of the limitations (e.g. lack of control over subject matter, quality of information imparted, performance anxiety), making them a more accessible and palatable option.
1) Prior to the session, two volunteers are sought for reading role play (and permission is obtained – no one is ever pressured to read)
2) Introduction to session which starts with this clip…
…and includes a discussion on while a lot of us spend a good deal of our reproductive aged lives trying NOT to get pregnant, there often there comes a time when the tables turn and pregnancy becomes the goal, not the mistake, and that unfortunately, for many, their plans don’t go to plan.
3) Definitions, statistics and the role of the GP in diagnosing/ managing the infertile patient.
4) Discussion on the psychological aspects of infertility.
4) Reading of dialogue by volunteers
5) Facilitator-led Q and A “in role” – which may involve some “re-winding” / additional role play by same or new volunteers.
6) Exercise to “de-role” readers
7) Group discussion
Scripted role play on the psychological aspects of Infertility.
Patient: Robyn, 40 year old female
GP registrar: Jeff Larson, aged 25 – 40
Jeff: Hi Robyn, I’m Jeff Larson, what can I do for you today?
Robyn: I was hoping to see Dr Kate again but the receptionist said that she’s left and you’ve taken her place.
Jeff: Yes, Kate has moved to another practice but I have access to her very thorough notes and will help you as best I can.
Robyn: That’s always happening here. I just get used to someone and they up and leave. Is it that bad a place to work?
Jeff: Not at all. It’s great. The reason that doctors come and go here is because it’s a training practice. Kate and I are registrars – GPs in training. We’re required to work at different places to improve our breadth of experience and get moved around periodically.
Robyn: I think you’re wrong about Kate – she’s no student doctor. She’s the most knowledgeable and caring doctor I’ve ever had.
Jeff: (under his breath) So her patients keep telling me. (to Robyn) GP registrars are not student doctors – we’re fully qualified doctors doing extra training in general practice. But let’s get back to why you’ve come along today…
Stop for Q and A in role, and discussion.
How are you feeling right now Jeff / Robyn? Who has had patients complain that doctors don’t stay? Who has had patients try to make you feel guilty for leaving? How do you think Jeff handled it? What would you have done differently? Do you tell patients you’re in training? How do you explain the concept of GP registrar?
Jeff: So how can I help you today?
Robyn: I need another referral to Dr Orford.
Jeff: The gynaecologist?
Robyn: Yes. I have an appointment next week and my last referral has run out.
Jeff: Sure, I can write you one. I see from your chart that you’ve been seeing him for fertility issues. Is this what the referral is for?
Robyn: Yes. I can’t get pregnant.
Jeff: I’m sorry to hear that. It’s really common in women your age. Fertility rates drop off a lot after 35.
Robyn: I’ve been trying to get pregnant since I was 29… 11 years ago. Isn’t that in my chart?
Jeff: Probably. I’m sorry, I didn’t have a chance to read it fully before you came in. Sounds like you’ve had a really difficult time of it. (pause… then trying to make a joke to lighten the mood). Well, at least you have a good excuse to get in lots of practice.
Jeff: (embarrassed) I just mean that you have an excellent reason to have regular sex which will umm… help strengthen your marriage.
Robyn: (incredulous) You think not being able to have kids helps relationships?
Jeff: No, no I didn’t mean that.
Robyn: And that business-like sex on an ovulation-centred schedule is fun?
Jeff: Well maybe not always but…
Robyn: Not that our attempts to get pregnant involve sex anymore… which is one small mercy.
Jeff: Been having IVF?
Robyn: IVF, AI, DI, IUI, ICSI, donor eggs… you name it, we’ve tried it.
Jeff: So what exactly is the nature of your problem, if you don’t mind me asking?
Robyn: I have endometriosis which Dr Orford said has also affected the quality of my eggs, and my husband has a low sperm count. Triple whammy – bad pipes, bad eggs and bad sperm. We’ve just had our 14th IVF attempt.
Jeff: 14! You must be very… umm… dedicated.
Robyn: Obsessed you mean.
(Jeff tries to protest)
Robyn: No, it’s alright, I am obsessed. I have wanted nothing in life except to be a mother. Dr Orford encouraged me to stop after 8 IVF cycles, my husband drew the line at 10, but each time I said ‘just one more try” and they caved in. It’s not going to work again though. It’s the end. That’s why Dr Orford has asked me to see him next week, I need to get a referral for him to tell me he can’t see me anymore. Talk about ironic.
Jeff: So about that referral…
Robyn: I’m not ready to give up on my dream of having a family though. What can I do?
Jeff: What about surrogacy?
Robyn: There’s no one close that I can ask to do it for me and paying someone is illegal, even if you do it overseas. Besides, bad eggs, bad sperm, remember? Surrogacy is unlikely to work for us.
Jeff: Have you considered adoption?
Robyn: We’re too old- they won’t accept us. George, my husband, is 48.
Robyn: They turned us down for that too. Long story.
Jeff: How about coaching a kids’ sporting team or doing some babysitting?
Robyn: Do you really think that’s anything like being a parent?
Jeff: In many ways, it’s better. You can give then back at the end and have a free and independent life.
Robyn: Do you have kids?
Jeff: Yes. 3 under 5.
Robyn: And how would feel if you had to ‘give them back at the end’?
Jeff: Sometimes I wish I could, believe me.
Robyn: You regret having them?
Jeff: Of course not! They’re the best things that have ever happened to me. It’s just that…you know… kids can be a bit…annoying sometimes.
Robyn: No I don’t know, that’s the problem. Sure, parents often complain that their kids are frustrating and restrict their lives but also say that having children is the most rewarding and fulfilling accomplishment in life. Can you honestly tell me that this is just a myth designed to help tired and stressed parents cope?
Jeff: No… maybe… I don’t know.
Robyn: I can’t help but think that I’m missing out on the best thing a person can do in life.
Jeff: (awkward pause) I’m really sorry you can’t have kids. I just don’t know what to say.
Robyn: Dr Kate would’ve.
Jeff: Shall I do that referral for you?
Q and A in role then group discussion
Where did Jeff run into trouble?
What could have he have done differently?
What do you do when patients ask you personal questions?