Exercise #28
Patient – I Don’t Understand
Authors: Magdalena Stankiewicz, PUM Szczecin
30 minutes
Description
A practical communication skills workshop using the role-play game “Patient – I Don’t Understand.” Students practise culturally sensitive communication through reflection, role-play, and the rephrasing of poor communication examples into constructive responses.
Methodological Guide
Objectives
After completing this exercise, students will be able to:
• Recognise culturally insensitive or dismissive communication patterns.
• Rephrase poor statements using I-messages, empathy, and paraphrasing.
• Apply conflict resolution strategies in clinical communication.
• Identify shared goals to de-escalate tension with patients.
• Recognise culturally insensitive or dismissive communication patterns.
• Rephrase poor statements using I-messages, empathy, and paraphrasing.
• Apply conflict resolution strategies in clinical communication.
• Identify shared goals to de-escalate tension with patients.
Expected Outcomes
After the exercise students can:
• Identify emotional and cognitive reactions to culturally challenging patient choices.
• Recognise how cultural assumptions influence communication.
• Use culturally sensitive communication strategies.
• Increase confidence in managing intercultural challenges.
• Identify emotional and cognitive reactions to culturally challenging patient choices.
• Recognise how cultural assumptions influence communication.
• Use culturally sensitive communication strategies.
• Increase confidence in managing intercultural challenges.
Exercise Procedure
1. Introduction (2 min): Explain the goal is reflection, not judgment.
2. Emotion mapping (5 min): Complete the segmented circle.
3. Role-play encounter (15 min): Work through the branching scenario.
4. Written reflection (10 min): Complete the reflection field.
5. Plenary debrief (optional): Share key insights with the group.
2. Emotion mapping (5 min): Complete the segmented circle.
3. Role-play encounter (15 min): Work through the branching scenario.
4. Written reflection (10 min): Complete the reflection field.
5. Plenary debrief (optional): Share key insights with the group.
Mode of Implementation
Stage 1 – Individual: emotion mapping (segmented circle).
Stage 2 – Individual/pair: branching scenario role-play.
Stage 3 – Individual: written reflection.
Stage 2 – Individual/pair: branching scenario role-play.
Stage 3 – Individual: written reflection.
Role of the Teacher
Guide/moderator: creates a safe space and clarifies the reflective purpose. Provoker of reflection: asks deepening questions. Facilitator: ensures trust, respect, and diverse perspectives.
Theoretical Basis
Grounded in transformative learning principles: disorienting dilemma (patient refusing treatment challenges student assumptions), critical reflection (identifying personal cultural filters), and dialogue and action (exchanging perspectives through role-play). Draws on assertive communication, active listening, and culturally sensitive practice frameworks.
Practical Application
Students practise role-play (patient vs. healthcare professional), complete structured reflection tasks, and apply active listening, paraphrasing, and negotiation strategies directly relevant to clinical encounters with patients whose cultural or religious beliefs influence health decisions.
Knowledge Transfer
Students learn to recognise personal biases, understand cultural influences on healthcare decisions, and apply culturally sensitive strategies to build collaboration with patients and families.
Reinforcement & Reflection
360° feedback from peers and observer. Self-reflection through structured worksheets covering emotions, assumptions, and communication strategies. Teacher reinforcement of good practices such as empathy and openness.
Required Resources
Case description handout; worksheets (reflection + feedback); whiteboard or Mentimeter; optional: video from Living Library.
Assessment / Evaluation
Self-assessment: reflective journal entry. Peer assessment: observer feedback during simulations. Teacher observation: quality of participation, depth of reflection, communication strategies applied.
Practical Tips
Encourage pauses and open-ended questions. Use teach-back to check understanding. Provide clear, behaviour-based feedback. Adaptable to online delivery.
Discussion Topics
When does patient autonomy end and physician responsibility begin? How does the law support or limit patient subjectivity? What biases influence whether we listen to patients?
Further Resources
Reading recommendations on shared decision-making. Follow-up journal assignment: analyse one real clinical situation focusing on patient subjectivity.
Additional Remarks
Easy to adapt for online simulation. Video examples may be added in extended versions.