A trans patient waits to be called for a routine consultation in the corridor of a basic health unit. When it’s your turn, the doctor loudly calls out the name recorded on the birth certificate, instead of the social name. The scene is an example of a simulation that uses theater to form more humanized medical teams.
Other challenging situations addressed by these programs are caring for patients with aggressive behavior and communicating difficult diagnoses and deaths.
The realistic simulation methodology uses specialized actors to work on issues that are part of routine clinical care. The scenario scripts are based on real experiences and are often written together with professors in the area and hospital employees. But improvisation is also part of the interaction between the group in training and the actors.
The Center for Realistic Simulation at the Instituto Israelita de Ensino e Pesquisa Albert Einstein, in São Paulo, has been using the methodology since 2007. The activity allows the development of both technical and behavioral skills. “In addition to knowing what to do, we were able to simulate how to do it”, says Thomaz Bittencourt Couto, a physician at the center and professor at the Albert Einstein Israeli Faculty of Health Sciences.
In a training held by the institute, two actress nurses led a discussion about failures in procedures committed by one of them. When the debate gets heated, the team supervisor –a health professional in training– calls the employees for a conversation and then has to mediate the misunderstanding.
The activity, contracted by a health cooperative, aimed to work on skills necessary for conflict management. During the simulation, the participants reflected on which behaviors can reduce the group’s motivation and hinder productivity.
Joyce Barreto, the Center’s teaching manager, highlights the possibility of training in a safe environment as a positive point of the methodology. “You can learn from possible mistakes without causing harm to the patient”, she says.
The institution’s training programs work behavioral skills in conjunction with techniques. On average, 15,000 people per year are trained by these programs in face-to-face and online formats. Participants come from different levels of education, from high school to MBA.
Einstein studies in the finalization phase indicate the relationship between training and the reduction of unnecessary cesarean sections and with a lower rate of Covid infection among trained professionals.
Another institution that has a realistic simulation center is the UFF (Fluminense Federal University), in Rio de Janeiro. There, medical and nursing students acquire technical knowledge and develop interpersonal skills to deal with different situations during care.
In a simulated office, there are interactions between actors, who represent patients, and students, the doctors. The scenes reproduce everyday situations, according to Ronaldo Gismond, responsible for the medical clinic area. “We focus on difficult news, how to convey to someone that they have cancer, and how the doctor should behave when the patient has a change in behavior.”
The actors who participate in the UFF simulations belong to the TransParente Collective, a group that transforms the experiences of LGBTQIA+ people into theatrical representations. The collective performs at least one simulation related to diversity per semester at the university.
Marcos Campello, founder and coordinator of the collective, says that it all started in June 2019, with a simulation that involved screening an LGBT patient. To work on different scenarios, since then transvestite, gay, lesbian and non-binary, black and white actors and actresses have been cast.
University students have to deal with a group that many were unaware of. After the training, the students reported having observed prejudices in their behavior that they had not been aware of until then, says Campello.
Actress Marina, an 18-year-old transvestite, found in the collective a place of comfort to share experiences. She has already experienced constraints in health units that today serve as learning situations for future doctors and nurses. “It’s effective for an LGBT person to be there acting as a patient, face to face with doctors,” she says.
This report was produced as part of Folha’s 7th Science and Health Journalism Program, which was supported by the Serrapilheira Institute, Roche Laboratory and the Albert Einstein Beneficent Society.
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