Role Play Vs. Standardized Actor: A Quasi-Experimental Examination into Teaching Clinical Skills

Students training to be social workers are dependent on human interactions, where providing opportunities to develop clinical skills is essential to preparing students for engaging in successful therapeutic relationships.  To date, the field has relied mostly on role-playing and the use of standardized actors to provide realistic clinical simulations to students. While using standardized actors has been known as the gold standard for teaching clinical skills, this realization comes mostly from the medical field and has yet to be studied empirically. The purpose of this study was to test the efficacy of the training models of peer-to-peer role play (RP) and standardized actor patients (SAP) in training MSW students to work with military clients.

A quasi-experimental non-equivalent groups study design was employed to examine differences in clinical skills between the training conditions of RP and SAP training. The sample population consisted of students enrolled in a masters of social work program. Pretests were completed after recruitment (study week 1) and consisted of a self-report online survey (demographics and self-efficacy) and an in-person clinical skill assessment. Participants were placed in either RP or SAP training groups and completed three 90 minute trainings over three weeks, focused on clinical engagement (study week 2), recognizing and response to symptoms of PTSD (study week 3) and recognizing and response to suicide (study week 4). The final week consisted of a post-test self-report online survey and an in-person clinical skill assessment (study week 5). Pre/posttest clinical skill examinations were rated by skilled clinicians using the Military Objective Structured Clinical Examination scale (MOSCE).

In total, 156 participants completed the study procedures. For self-efficacy, there was a main effect of time (p<0.001) with participants in both the SAP and RP groups reporting greater self-efficacy from pretest to posttest. Closer examination did not reveal significant differences between the SAP and RP groups on pretest (p=0.498) and posttest (p=0.908) scores, and the group by time interaction (p=0.438). Regarding clinical skills, although the interaction between group (SAP vs. RP) and time (pretest, posttest) was not significant for the MOSCE subscale and overall scores (p=0.165 for engagement, p=0.504 for PTSD, p=0.850 for suicide, p=0.927 for military competence, and p=0.3956 for overall), several main effects of time were observed. Participants in both the SAP and RP groups were observed to have improved from pretest to posttest on all three modules. Closer examination between SAP and RP groups did not reveal significant differences on recognizing PTSD (p=0.075 for pretest and p=0.239 recognizing suicidal symptoms (p=0.964 for pretest and p=0.817), and overall performance (p=0.368 for pretest and p=0.118).  

The results show that SAP and RP appear to be equally effective training modalities. While SAP has been thought to be the gold standard in the development of clinical skills, findings demonstrate no difference between the RP and SAP groups. This has important implications for social work education as the development of clinical skills is an essential element of MSW programs. However, many schools do not have the resources to use SAP in their classrooms.