How to...
Learn the Craft of Acting for Patient Simulation
This section has 3 activities:
Activity 1: Read and consider the article
Activity 2: Watch the video Kramer as a Standardized Patient (1:01)
Activity 3: Watch the video How to Master Method Acting (1:44)
Activity 1: Read and consider the article
Activity 2: Watch the video Kramer as a Standardized Patient (1:01)
Activity 3: Watch the video How to Master Method Acting (1:44)
Acting is the art of performing a role or character. As with all art, acting involves a creative process. The aim of this process is to achieve a truthful portrayal. We know it’s truthful, if it is believable. In this sense, acting is playing make-believe. Just as children do all the time, an actor must be willing to drop self-consciousness and fully surrender to the world of make-believe. Thus a purely intellectual, detached comprehension of the acting process will not suffice.
A personal connection is required. The more personally an actor can relate to their given character, the more believable they will be. This is important because when someone believes us, we have the ability to affect change in them. This is particularly relevant to patient simulation where the main goal is for the health professional to learn through first-hand, lived experience (where it is safe to fail). The simulation is precisely that - a simulation. It is not real, but it should feel real. The more realistic the simulation is, the more effective the learning outcome is.
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Watch Kramer expertly playing a simulated patient and fully committing to the world of make-believe. Although a parody, this amusing scene highlights how making a personal connection to the simulated patient role can benefit the doctors learning. In the video Kramer begins by telling the student doctors what his symptom is, but it is not until he draws the interview into details around his personal life that the symptom links to a potential diagnosis for the student doctors. Without the personal story, the symptom lacks context making it harder for the student doctor to determine a diagnosis.
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Acting is something all humans are already doing every day. We are constantly playing different ‘roles’; unwittingly adapting our behaviour according to who we are interacting with.
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When you speak to your Mum on the phone, you are playing the role of daughter or son and you act accordingly. When you are treating a patient you are playing the role of health professional, speaking and behaving in a very different way to how you did to your mother. Even within the role of health professional, you will play a variety of sub-roles, as you adjust to different patients’ needs. In this sense, we are full of many different versions of ourselves which we unconsciously call upon to help us get what we want from day to day.
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This is what acting is. It is not being someone else. Quite the opposite, it is drawing on parts which already exist within oneself and relating them to the given circumstances of the character in the script. As acting great Meryl Streep puts it, “Acting is not about being someone different. It's finding the similarity in what is apparently different, then finding myself in there.” [Barranger, 2014]. Of course, despite our natural day-to-day ‘acting’, the ability to seamlessly shift into a different role on demand is where the real art lies. As actors, we can call upon whichever part(s) of ourselves best align with the character we are portraying. As health professionals, we can also implement this strategy to accommodate patients’ needs.
The techniques an actor may use to achieve this are varied. Some actors follow one methodology only, while others combine different teachings to form their own go-to guide. However, the root of many modern day acting techniques can be found in Stanislavsky’s System. Konstantin Sergeievich Stanislavsky (1863-1938) was a Russian theatre practitioner who dedicated his entire life to developing a practicable actor training system which fostered a realistic performance. He never sought to codify acting in a strict, inflexible way, instead opting for a series of methods which came about through his own trial-and-error as an actor and director. He co-founded the famous Moscow Art Theatre in 1898, which toured the world and brought his teachings to the attention of American theatre practitioners who would go on to adopt some key elements of his System and themselves become famous teachers in their own right. Overall, Stanislavsky was interested in harnessing an actor’s conscious mind to unlock subconscious, and therefore, authentic behaviour.
The techniques an actor may use to achieve this are varied. Some actors follow one methodology only, while others combine different teachings to form their own go-to guide. However, the root of many modern day acting techniques can be found in Stanislavsky’s System. Konstantin Sergeievich Stanislavsky (1863-1938) was a Russian theatre practitioner who dedicated his entire life to developing a practicable actor training system which fostered a realistic performance. He never sought to codify acting in a strict, inflexible way, instead opting for a series of methods which came about through his own trial-and-error as an actor and director. He co-founded the famous Moscow Art Theatre in 1898, which toured the world and brought his teachings to the attention of American theatre practitioners who would go on to adopt some key elements of his System and themselves become famous teachers in their own right. Overall, Stanislavsky was interested in harnessing an actor’s conscious mind to unlock subconscious, and therefore, authentic behaviour.
Emotional Memory
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Emotional Memory is the most well known example of this. It is sometimes referred to as; Emotion Memory, Affective Memory, Emotional Recall or Sense Memory. Stanislavsky discovered that when an actor successfully recalls a real life past experience, they can ‘borrow’ the feelings conjured by this to align them with the emotion being demanded of them by the role they are playing. Emotional Memory can be used by an actor to relive the past emotions of a memory in the present. This is useful in patient simulation.
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Although the System comprises many elements, Emotional Memory is the most recognised due to its links with the popular Method technique. The Method was created by American Lee Strasberg (1901-1982) who was inspired by the teachings of Stanislavsky. Throughout the 1940s and 50s, Strasberg developed this rigorous technique which has produced some of the most famous actors of our time.
In short, The Method works in three parts [Bartow, 2008];
In short, The Method works in three parts [Bartow, 2008];
- The actor learns to trust their own instincts through sensory exercises which encourage Affective Memory by recalling the senses attached to the memory;
- The actor inserts the sensory work and affective memories into the relevant scene to see if they translate appropriately;
- The actor engages in character work which deals with the physicality of the role.
- the room they were in at the time;
- its smells,
- its colours,
- the texture of the wallpaper,
- the feel of the coffee cup, etc.
Imagination
Both the Adler and Meisner techniques prefer the use of imagination. They argue it is easier to access, is not restricted by the life experiences of the actor, and hence, is limitless in its ability to be specific to the circumstances of the character. It may be useful to think of this form of emotional preparation for a role as similar to daydreaming. When we daydream, we see a whole other world in our mind’s eye which can truly transport us emotionally, even though the entire experience is invented. This is how powerful the imagination is. Returning to the earlier weeping scenario, in this instance, an actor may imagine someone they deeply love has just died. If executed accurately, upon entering such a daydream, the actor would be reduced to tears over the planted belief that their loved one is no longer with them. When the scene is over, the actor knows that it was just make-believe, and that their loved one is in fact still alive and thus they can safely drop the daydream.
Expanding on this, anything at all may be used to stimulate such emotion in the actor. Often, the most simple and specific stimulus works the most effectively. Merely thinking of a particular song may suffice to trigger sadness in the actor. The possibilities are endless and entirely unique to the individual actor. As Meisner taught his students, “You’ve got to find the things that stimulate you and no-one else.” [Longwell & Meisner, 1987] In any case, whether an actor chooses to use Affective Memory or imagination-based triggers, a solid understanding of the actor’s instrument - the self - and a strong personal connection to this, is required.
If...
The remaining elements of Stanislavsky’s System, which have also influenced the above practitioners’ methodologies, are: Method of Physical Actions, Subtext, “If”, Given Circumstances, Objective, Super-Objective and Throughline. Simplistically put, these areas propose an actor study who their character is, what situation they find themselves in, what their objectives are and what actions they will take in order to achieve these within the context of the storyline. The actor then arms him or her self with personal motives fuelled by their own life and imagination, which propel them into truthful behaviour.
Magic If or As If
A useful tool in finding a personal motivation is applying the “If” hypothesis (sometimes called the “Magic If” or “As If”). The “If” gets the actor to ask, “What would I do if I were in this situation?” If the answer does not align with what the character in the scene does, then the actor must ask, “What would make me do what the character does?” For example, let’s say the medical scenario outlines a patient who avoids answering questions about her dislocated shoulder. The actor playing the patient would ask, “What would I do if I were in this situation?” Perhaps the actor may realise they would be happy to talk openly about the dislocated shoulder with the health professional, therefore they cannot yet relate to the character in the scenario. They would need to ask the second question, “What would make me want to avoid discussing the dislocated shoulder?” This is where the actor must invent a reason from their real life which would genuinely motivate them to avoid all questions regarding the dislocated shoulder. Perhaps, the actor coaxes a motivation by proposing, “What if I had a really embarrassing tattoo right where the dislocated shoulder is and I was horrified by the thought of the health professional seeing it?” If that works, then the job is done. But maybe this does not work for a different actor, so that actor needs to find something specific to them that they can believe. Perhaps this actor has a criminal record in real life and avoids discussing it at any cost. In this case, all this actor has to do is treat the dislocated shoulder as if it is her criminal record being mentioned. Now the actor can not only relate to the character, but she can even empathise with the character because she has bridged the gap between the character’s circumstances and her own. In this way, self-identification with the character results not only in a more realistic performance, but one which is more fun to do because the actor has created very personal reasons for doing it. Likewise, as a health professional, you will find your work far more rewarding when you are able to self-identify and hence, empathise with a patient.
When an actor bridges the gap between the character’s life and their own life, they discover the character was within them all along.
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Once the actor has completed their initial preparation for the role, and learnt their lines, they are ready to start playing the scene. The key here is to let go of all the homework done and trust it will appear when it needs to:
If any doubts or distractions occur during the scene, a good trick is to simply place your focus back onto the actor opposite you and take everything they say for real. If in doubt during a medical scenario, the actor playing the patient need only re-focus their attention on the health professional opposite them and play it moment by moment.
- Our actor who has translated the dislocated shoulder into her criminal record will not be up in her head pondering this. Equally, the actor who has revisited the funeral of their mother to induce tears for the top of the scene, should now no longer be thinking about the funeral.
- All of the attention should now be on the other actor, which, in patient simulation, is the health professional.
- Just as in real life, we play it moment to moment, with no idea of what will happen next.
- We may begin weeping because that is what the scenario demands of us, but if the health professional enters and is able to soothe us, we can stop weeping and go with how we are genuinely feeling.
- If, however, the health professional enters and ignores our weeping and fires off their own agenda, we may continue to weep because we feel ignored.
If any doubts or distractions occur during the scene, a good trick is to simply place your focus back onto the actor opposite you and take everything they say for real. If in doubt during a medical scenario, the actor playing the patient need only re-focus their attention on the health professional opposite them and play it moment by moment.
In Summary
We can deduce that:
- Acting involves a highly personal process which is unique to each individual preparing for a role.
- The more an actor can use their own imagination and life experiences to justify the behaviour of the character they are playing, the more believable they will be.
- In the case of the student performing the role of the simulated patient, this has the added benefit of giving them insight and therefore empathy towards patients who they may otherwise have judged or misunderstood – an experience which will no doubt leave them well placed to practise in the future.
