OPEN ACCESS | Research Report | Published Online: 15^th  July 2026                                                                             

EFFECTIVENESS OF VIDEO-BASED LEARNING VERSUS ROLE PLAY FOR TEACHING FAMILY EDUCATION IN DEPRESSION TO PHASE III MEDICAL STUDENTS 

Harish M Tharayil^1*, Anu Padmanabhan², Nishanth J Haridas³, Tom Varghese³, Afeefa Moidu⁴, Varsha Vidyadharan⁵

1. Professor, 2. Assistant Professor, Department of Psychiatry, KMCT Medical College, Kozhikode, Kerala, 3. Assistant Professor, 5. Associate. Professor, Department of Psychiatry, Government Medical College, Kozhikode. Kerala. 4. Assistant Professor, Department of Psychiatry, Government Medical College, Konni, Kerala.

*Corresponding Author: Professor, Department of Psychiatry, KMCT Medical College, Kozhikode. Kerala.

Email: drharishmt@gmail.com

INTRODUCTION

Communication skills are one of the very important soft skills medical students have to acquire during training. Effective communication helps doctors accurately understand their patients’ symptoms, concerns, and medical history. This, in turn, helps make accurate diagnoses and effective treatment plans. Effective communication ensures smooth collaboration with patients and their family, leading to better health outcomes. It also helps patients to make informed decisions about their health. Teaching medical students communication skills was never given much importance in our earlier medical curriculum; these soft skills were considered to be imbibed by the students during the years of medical education. A study conducted by Choudhary and Gupta found an improvement in patient satisfaction after providing basic training in communication skills and counseling to medical students.1 Communication skills are all the more important in a psychiatry setting due to the complexity of symptoms, etiology, and prognostic factors. Explaining to the patient and their family members regarding serious mental illness like schizophrenia or any other psychotic disorder becomes very difficult. Medical graduates should have good communication skills while educating family members regarding treatment and prognosis due to the stigma associated with psychiatric conditions.¹

The National Medical Commission (NMC) has introduced Competency-based Medical Education (CBME) for the MBBS course in India. They have published documents outlining the topics, competencies to be acquired, and Teaching-Learning Methods (TLMs) for all subjects taught in the course. The Curriculum in Psychiatry has been revised by extending clinical postings from two to six weeks. 19 topics and 117 outcomes are specified in Psychiatry. Several topics in the Communication / Attitudes aspects have been included in the curriculum, in addition to the cognitive outcomes. Family Education in all major psychiatric disorders is one such skill included in Volume II of the Competency-Based Medical Education (CBME) Curriculum document. ² These are core skills to be demonstrated at the “Shows How (SH)”. Communication skills acquired by these sessions can get generalized and help the students to improve their ability to engage with patients and counsel them about many conditions. This approach takes a more active role in teaching communication skills to MBBS students.

Family Education, which is usually referred to as psychoeducation by psychiatrists, is a specific form of communication or counseling in which the therapist engages in a discussion about the illness, its causes, treatments, prognosis, and complications in a supportive and empathetic environment. This is an important part of the training of a young doctor. The skills gained here can be generalized to many situations in which a doctor must provide information, communication, and education to patients and their family members. The curriculum did not give much importance to such skills, but this is being drastically changed with the advent of the CBME curriculum. But still, there is a lack of clarity about which TLMs are best, and balancing outcomes with time constraints and a shortage of faculty is a real challenge. Using pre-recorded videos is one method that can be helpful in this context.

Bedside clinics and DOAP (demonstrate-observe-assist-perform) sessions are the suggested Teaching/Learning methods (TLM) for acquiring this skill and outcome, to be assessed through skills assessment according to the guidelines in the National Medical Commission (NMC) document. Integration with the Attitude, Ethics and communication (AETCOM) module is also suggested; other options include role-plays and video demonstrations of such sessions.³ Peer–assisted role-plays can be done by students based on a guide, and watching their own friends doing it makes them more involved. Video demonstrations could also help achieve these outcomes. There is evidence that these methods can provide health education in various health and mental health-related conditions. Role-plays have also been found to be an effective tool for teaching communication skills to medical students across various settings.
Ahsen et al. used videos and role-plays to teach communication skills to 4th-year medical students in Pakistan regarding health conditions.⁴ An OSCE conducted six months later also showed continued benefits, but it did not include a comparator group. Bhattacharyya D et al have used role-plays and DOAP sessions to teach screening and brief interventions to persons with alcohol dependence. However, they used only a pre-post comparison with a two-group parallel design to compare two different interventions.⁵ Volabailu R et al. have shown that role-play can be successfully used in pharmacology to teach prescription-related communication skills to MBBS students.⁶ Baes Saab and colleagues have reported that video-based learning is a useful method to teach counseling skills to medical students to interact with psychologically distressed individuals.⁷ A systematic review and meta-analysis done in 2018 “found low-quality evidence showing that digital education is as effective as traditional learning in medical students’ communication skills training.^8,9Another study from Karnataka by Holla and Geetha found that role-play is better than traditional methods to teach medical students.¹⁰ There is a lack of clarity in this study, as they used role-plays and lectures in the two study groups. One group received traditional lectures, and role-plays were added for the other group. Outcome assessment was using MCQs, and thus it appears that they were trying to impart knowledge in the cognitive domain using role-play as a supplement to lectures. However, no studies comparing video-based learning with role-plays for teaching family education to medical students on psychiatric disorders were found. Therefore, this study was planned to compare the effectiveness of – peer-assisted role-play based or Video-demonstration-based sessions, in teaching Family Education to Phase III medical students by comparing the two groups a) on the marks obtained in OSCE and b) the proportion of students who were able to score pass marks in the OSCE and to compare student’s perception regarding both the teaching/learning methods and their confidence in doing the task.

MATERIALS AND METHODS

This comparative study on two TLMs was conducted at the Department of Psychiatry, Government Medical College, Kozhikode, from March to June 2024. The study commenced after getting institutional ethics committee approval. Phase III Part I MBBS students posted to Psychiatry during the months of April and May 2024 were included in the study. Each batch of around 44–52 students was posted for about 14 days. Those who were unable to attend on the study days and those who refused consent were excluded.
Sample size was calculated using the formula: N = 2 *SD2 (Z α/2 + Z β) 2 / D2; where Standard Deviation (pooled SD) = (1.28+2.62) ÷ 2 =1.95and D = expected mean difference = 1 form earlier studies.^7,8 Calculated sample size was 59 per group, so at least 118 students were required. The study included127 MBBS students from Phase III.
Students who were posted for 2 weeks in the psychiatry department during Phase III were divided into two groups by using random numbers, and written consent was obtained. A brief lecture on the symptoms, diagnosis, and management of Depression at the level of a general practitioner was delivered to the entire cohort by a faculty member on all study days before randomization into two groups. An introduction to the study was given, and the procedure was detailed to them.
Group 1-video-based learning: Group 1 was shown a pre-recorded video covering details about depression and family education. This video was prepared by the investigator and validated through peer review from colleagues. The video has a doctor psycho educating the bystander of a patient diagnosed of depression. A psychiatry resident played the role of the doctor, and an intern played the role of a family member of the patient. In the video, the doctor establishes rapport and discusses the symptoms and management of the patient. The doctor also clarifies all the doubts at the end and concludes the session. The video briefly covered all aspects of a family education session at the level of an undergraduate medical student. This helped to acquire knowledge about communication skills, establish rapport, and develop therapeutic alliances.
Group 2 - Peer-assisted role-play. Role-play is a Teaching/Learning Method in which participants are presented with a situation and encouraged to act out the roles of the characters involved, thereby exploring the emotional and experiential aspects of the situation.¹¹ Group 2 was made to do peer-assisted role-play sessions based on a role-play guide on family education and counseling in depression. This guide was prepared by the first author, reviewed by faculty in the department, and found to be adequate in content. The guide outlined the points to include in the role-play. The role-play guide also includes essential information on depression, including its symptoms, causes, treatment options, and prognosis. The role-play guide contained instructions on building rapport and concluding the session. One student acted as a doctor and another as a family member while the rest of the group watched. The role-play was done under the supervision of a faculty member. Both groups had role-play and video sessions on the same day simultaneously; each group got approximately 20 to 25 minutes for the session.
The study tools were all peer-reviewed. They included a video, role-play handouts, an OSCE checklist, and a Likert-type scale (scoring from 1 to 5) for assessing their liking of the method and their confidence in conducting family education.
Assessment of outcomes was conducted using the Objective Structured Clinical Examination (OSCE).¹² This is a well-established and accepted method for assessing clinical or procedural skills of a student.13 The checklist for use in the OSCE was prepared by the principal investigator. It was circulated among the other investigators and selected faculty members in the department; all the suggestions and comments received were again reviewed by the team of investigators to prepare the final checklist. A total of 15 domains were included, which included mutual self-introduction, asking about family background, asking about symptoms, especially mood symptoms, biological symptoms, cognitive symptoms, asking about energy and activity levels, asking about past episodes, explaining the biopsychosocial basis of etiology, discussing drugs and side effects, and emphasizing follow-up. The above-mentioned domains were rated 0 or 1. Key points such as establishing good rapport, stating the name of the disease, informing about the prognosis and treatment options, and giving reassurance were rated on a 0, 1, 2 scale. Total marks in the OSCE were 20, and 10 or above was required for a pass.
OSCEs were administered the same day as the video and role-play session to evaluate their ability to perform tasks. An intern was given a class on major depressive disorder, and training was given regarding acting like a family member. Each student got a maximum of 15 minutes to complete the OSCE session. The instructions about the OSCE were given to students before the assessment. A faculty member sat as an observer and scored this using a checklist. The assessors were blinded to the students' exposure. A total of 6 exposures were done. Each batch had around 40 students, and all were assessed on a single day. Proficiency in Malayalam was assessed by self-report from the students. Soon after the sessions, feedback was collected from the students. A Likert scale with three questions and five anchor points for each was used for the feedback. The video was shown to Group 2 after this.
Comparison of OSCE marks between the two groups of students exposed to the two T/L methods was performed using an unpaired t-test. Comparison of the proportion of students who got pass marks was done using the chi-square test. The Likert-type scale for perception of students and their confidence regarding both methods were analyzed using Fisher's exact test. Analysis was done using SPSS version 16.

RESULTS                        

A total of 127 Phase III Part I MBBS students were included in the study; 66 in Group 1 and 61 in Group 2. No student refused consent to participate in the study, though a few were absent on the study days. They were divided into two subgroups using random numbers. All participants (including three non-Malayalam students) reported good proficiency in Malayalam, the language used for the study's intervention. All participants, except for three students, were Malayalam-speaking natives of Kerala. The other three participants were non-Keralites, but could communicate in Malayalam.
The video-based group had 66 students (52%), while the role-play group had 61 (48%). Both groups were comparable on age and gender. (Table 1)

Table 1: Comparison of Age and Gender Across the Two Groups

The Video group fared marginally better both in terms of marks obtained in OSCE and percentage of pass, but it did not reach the level of statistical significance. Pass percentage was 47(71.2%) and 39(63.9%) in the respective groups. (Table 2)

Table 2: Comparison of OSCE marks and pass percentage among the 2 groups

Both groups were comparable in terms of level of acceptance of the TLM and their confidence in doing the task. (Table 3)

Table 3: Liking and Confidence of TLM across the Two Groups

  DISCUSSION