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The e ec o blended ole-playing and e lec i e aining on
nu sing s uden s’ communica ion skills wi h dep essed pa ien s
Fa eme Fa ahi1, Zah a Amouzeshi1, Hamid Naza i1, Da ood Oudi1*
1Depa men o Nu sing, School o Nu sing and Midwi e y, Bi jand Uni e si y o Medical Sciences, Bi jand, I an
A icle in o Abs ac
In oduc ion
E ec i e communica ion is a i al elemen and an
in eg al pa o quali y ca e in he nu sing p o ession [1].
Communica ion is he p ocess o ansmi ing messages
in a planned and pu pose ul way o collec da a, suppo
he pa ien , c ea e a collabo a i e space o de elop a ca e
plan and each basic ips o imp o e he heal h le el [2].
Gi en he unique na u e o men al illnesses and he
psychological symp oms expe ienced by hese pa ien s,
es ablishing e ec i e communica ion in he nu sing ca e
o indi iduals wi h men al heal h issues becomes
pa icula ly impo an [3]. Conside ing men al illnesses,
using e ec i e communica ion skills is a c ucial ool o
heal hca e wo ke s om diagnosis o ea men . In mos
cases, he signs and symp oms o men al illnesses can
only be assessed h ough e ec i e communica ion and
he applica ion o app op ia e communica ion echniques
and skills [4]. Communica ing wi h a pa ien wi h men al
diso de s can be associa ed wi h challenges ha a e
ba ely isible in o he pa ien s and needs enough skills
[5]. The psychological aspec s o hese illnesses, along
wi h he social s igma ela ed o men al heal h diagnoses,
necessi a e he use o speci ic communica ion skills
when in o ming indi iduals and hei amilies abou
men al illnesses—pa icula ly when hey may lack
su icien unde s anding o li e acy [6]. In o he wo ds,
one o he mos impo an dimensions o quali y ca e in
A icle his o y:
Recei ed 16 Sep. 2024
Accep ed 21 May. 2025
Published 13 Jul. 2025
Fa ahi e al. J Med Edu De . 2025; 18(2): 36-45 Jou nal o Medical Educa ion De elopmen
Backg ound & Objec i e: Communica ing wi h dep essed pa ien s is a c ucial p o essional
skill o nu sing s uden s, which hey mus lea n du ing hei s udies. This s udy aimed o assess
he e ec i eness o blended aining—inco po a ing bo h ole-playing and e lec i e p ac ice—
on nu sing s uden s' communica ion skills in hei in e ac ions wi h dep essed pa ien s.
Ma e ials & Me hods: The p esen semi-expe imen al s udy was conduc ed in 2023 wi h a
be o e and a e wo-g oup design. All six h-semes e nu sing s uden s a To ba Jam Facul y
o Medical Sciences we e andomly selec ed and di ided in o wo g oups: an expe imen al
g oup and a con ol g oup. The in e en ion included he apeu ic communica ion skill aining
sessions wi h he ole-playing and e lec ion blended me hod. The con ol g oup ecei ed he
s anda d aining me hod. The apeu ic communica ion skills in dealing wi h dep essed pa ien s
be o e and a e he in e en ion we e e alua ed by a communica ion skills ques ionnai e. Da a
we e analyzed using he s a is ical so wa e SPSS e sion 20, desc ip i e s a is ical es s and
in e en ial es s ( - es , analysis o a iance, and pai ed- ) a a signi icance le el 0.05.
Resul s: The a e age communica ion skills sco es be o e he in e en ion showed no
s a is ically signi ican di e ence be ween he in e en ion and con ol g oups (p > 0.05).
Howe e , he mean sco e o communica ion skills a e he in e en ion was signi ican ly
di e en in he wo g oups (p < 0.05). The esul s also indica ed ha he mean communica ion
skill sco e a e he in e en ion signi ican ly imp o ed in he expe imen al g oup compa ed o
be o e he in e en ion (p < 0.05). Howe e , he e was no s a is ically signi ican change in he
mean communica ion skill sco e in he con ol g oup be o e and a e he in e en ion (p > 0.05).
Conclusion: Educa ional sys em manage s and planne s a e sugges ed o use a blend o hese
wo me hods o ain nu sing s uden s' communica ion skills, especially in he psychia ic
depa men and when dealing wi h dep essed pa ien s.
Keywo ds: ole-playing, e lec ion, communica ion skill, s uden , nu sing, dep essed pa ien
*Co esponding au ho :
Da ood Oudi, Depa men o
Nu sing, School o Nu sing and
Midwi e y, Bi jand Uni e si y o
Medical Sciences, Bi jand, I an.
Email: da [email protected]
O iginal A icle
How o ci e his a icle:
Fa ahi F, Amouzeshi Z, Naza i H,
Oudi D. The e ec o blended ole-
playing and e lec i e aining on
nu sing s uden s’ communica ion
skills wi h dep essed pa ien s. J Med
Edu De . 2025; 18(2): 36-45.
[ DOI: 10.61882/edcj.18.2.36 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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: E ec o Blended T aining o Role-Playing and Re lec ion on he Communica ion Skills
Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 37
nu sing is he abili y o es ablish a p ope ela ionship
wi h he pa ien . This issue is pa icula ly impo an and
necessa y in dealing wi h people wi h a men al heal h
condi ion, such as dep essed pa ien s, who ha e a weake
abili y o communica e han o he pa ien s [4].
Dep ession has se ious consequences o people's heal h,
and he ea men eam aces many challenges when
communica ing wi h a dep essed pa ien . These pa ien s
p o ide less eedback du ing communica ion and
pa icipa e less han o he pa ien s.
Following he educ ion o he pa icipa ion o hese
pa ien s du ing communica ion, hei adhe ence o he
ea men egimen may also be a ec ed, which h ea ens
hei heal h [7]. Thus, in dealing wi h hese pa ien s,
using e ec i e communica ion echniques o he
ea men eam membe s is especially impo an [8].
Also, e ec i e communica ion be ween nu ses and
nu sing s uden s wi h dep essed pa ien s plays an
impo an ole in educing s ess and c ea ing elaxa ion
o hem. The p o essional pa ien -s uden ela ionship as
a sou ce o suppo can a ec he p og ess and
de elopmen o an o iginal and pa ien -cen ed
he apeu ic app oach o be e ca e o people wi h a
men al heal h condi ion among s uden s [9].
Recognizing ha e ec i e e bal and non- e bal
communica ion skills a e i al o enhancing ea men
ou comes, os e ing ela ionships wi h colleagues,
pa ien s, and hei amilies, and na iga ing complex
ea men si ua ions o nu ses and nu sing s uden s as a
po en ial wo k o ce o he u u e [10], eaching
communica ion skills has become a key componen o
nu sing educa ion in ecen yea s. Nu sing s uden s
should be able o p o ide app op ia e communica ion in
he pa ien -ca ing p ocess [11, 12].
S udies indica ed ha nu sing s uden s a e unable o
communica e e ec i ely wi h pa ien s, and many
s uden s a e a aid o encoun e ing pa ien s and ela i es
wi h di e en backg ounds and pe sonali ies in men al
heal h [13]. Addi ionally, communica ion skills a e a
i al ye o en o e looked educa ional need o s uden s
in nu sing p og ams. The esea ch esul s emphasize ha
ine icien aining leads o a de ici in communica ion
skills in heal hca e p o ide s [13, 15] and holding
app op ia e aining cou ses o de elop he
communica ion skills o heal hca e p o ide s is an
impo an s ep owa d imp o ing hese skills [14, 13].
Role-playing is one o he e ec i e me hods o eaching
communica ion and social skills [16]. Role-playing is a
o m o simula ion in which pa icipan s in e ac wi h a
pa ien wi hou he app ehension o po en ial isks
associa ed wi h hei ca e me hods. In his me hod, a
pu pose ul show is pe o med, and by discussing i ,
people can discuss hei eelings, a i udes, and p oblem-
sol ing s a egies ega ding he si ua ion [17]. The
educ ion o ime and cos equi ed o aining,
imp o emen o decision-making and c i ical hinking
skills, and inc ease o comp ehensi e sel -con idence a e
among he ad an ages o his aining me hod [16].
Despi e he bene i s o his me hod, in ou coun y, ole-
playing is a ely used in medical science educa ion, and
in o ma ion on he e ec i eness o his me hod in
eaching nu sing s uden s in I an is limi ed [18, 19].
Ano he way o imp o e lea ning is e lec i e hinking.
Re lec i e hinking is a ho ough, ongoing, and ac i e
examina ion o one's belie s and knowledge, u ilizing
pe sonal jus i ica ions and in e ences ha help ein o ce
and solidi y hose opinions o belie s [20]. The p ocess
o e lec i e hinking allows people o ecall and e iew
he expe ience and encou ages hem o sea ch o and
e alua e solu ions in complex si ua ions [16]. Re lec ion
can lead o imp o ing clinical easoning skills and deep
lea ning; hus, i is conside ed an impo an educa ional
ool in he nu sing p o ession [21].
In addi ion o imp o ing knowledge and skills, e lec ion
eaches lea ne s he habi o c i ical hinking and
lea ning, and he e o e, i is conside ed an e ec i e
educa ion me hod [22]. Re lec i e hinking helps
s uden s o imp o e hei lea ning expe iences du ing
and a e pe o ming clinical skills and o ealize hei
lea ning de iciencies h ough sel -c i icism [24, 23]. The
nume ous bene icial e ec s o ole-playing and
e lec i e hinking educa ional me hods ha e been
demons a ed indi idually.
Some esea ch has conside ed hese wo educa ional
me hods complemen a y and concluded ha combining
hem in eaching skills esul s in syne gis ic lea ning in
he indi idual [24-26]. Despi e nume ous s udies on each
o hese educa ional models and hei e ec s, e y li le
esea ch has been conduc ed on he e ec o blended
aining wi h ole-playing and e lec ion me hods on he
communica ion skills o nu sing s uden s in dealing wi h
dep essed pa ien s.
Ma e ials & Me hods
Design and se ing(s)
This semi-expe imen al esea ch uses a wo-g oup
design (in e en ion and con ol) wi h p e- es and pos -
es assessmen s. I began on July 16, 2023, and
concluded on Sep embe 20, 2024.
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Fa ahi e al
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38 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
Pa icipan s and sampling
The esea ch popula ion consis ed o all six h-semes e
nu sing s uden s a To ba Jam Facul y o Medical
Sciences, who we e included in he s udy h ough a
con enience non- andom sampling me hod based on
speci ic inclusion and exclusion c i e ia. The inclusion
c i e ia included being a six h-semes e nu sing s uden ,
passing he ele an heo e ical and p ac ical uni s so a ,
and no passing he in e nship uni in psychology. The
exclusion c i e ia included being ans e s uden s o he
acul y and pa icipa ing in communica ion skills
aining wo kshops. A o al o 44 s uden s pa icipa ed in
he s udy (Figu e 1).
Figu e 1. Flow cha o he s udy
Tools/Ins umen s
Da a we e collec ed using a demog aphic in o ma ion
ques ionnai e (age, gende , do mi o y s a us, ma i al
s a us, and na i eness) and a s anda d In e pe sonal
Communica ion Skills Scale (ASMA). This
ques ionnai e was de eloped by Vakili e al. The ini ial
ques ionnai e con ains 43 i ems ha all in o se en
dimensions, including public communica ion skills,
speaking skills, lis ening skills, in e p e a ion and
cla i ica ion skills, ques ioning skills, encou agemen
skills, and eedback skills. The op ions o his
ques ionnai e a e g aded acco ding o a 5-poin Like
scale o 1 ( e y weak), 2 (weak), 3 (mode a e), 4 (good)
and 5 ( e y good). Vakili and his colleagues
psychome ically e alua ed his ques ionnai e in a s udy
on he popula ion o heal h wo ke s in Zanjan. Based on
he esul s o explo a o y ac o analysis, 30 i ems om
his ques ionnai e we e con i med and placed in 7 a eas
o gene al communica ion skills (6 i ems), speaking
skills (4), lis ening skills (4), in e p e a ion and
cla i ica ion skills (4), and ques ioning skills (4),
encou agemen and p aise skill (4) and eedback skill (4).
The eliabili y o he en i e ques ionnai e in his s udy
was epo ed using C onbach's alpha 0.91 [27].
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Da a collec ion me hods
Six h-semes e nu sing s uden s wi h bachelo 's deg ees
we e assigned in o wo expe imen al and con ol g oups
using a simple andom me hod o conduc he s udy.
Communica ion skills we e e alua ed in bo h
expe imen al and con ol g oups be o e he in e en ion
by comple ing a ques ionnai e. The con ol g oup
ecei ed he usual heo e ical and p ac ical me hod o
aining communica ion skills wi h dep essed pa ien s.
Fo he in e en ion g oup, he aining was implemen ed
in combina ion wi h ole-playing and e lec i e hinking
skills o communica ion skills wi h dep essed pa ien s.
A e he in e en ion, he communica ion skills o bo h
he expe imen al and con ol g oups we e e-e alua ed
using he same measu emen ins umen . The
in e en ion included aining in he blended me hod o
ole-playing and e lec i e hinking. The ole-playing
aining me hod was done in he o m o a heo e ical
explana ion o he p oblem, and hen he oles and
pe o ming he ole we e de e mined by he s uden s and
eedback was p o ided o hem. The me hod consis ed o
se en s eps: he i s s ep in ol ed wa ming up he g oup
by in oducing he p oblem, explaining he si ua ion,
discussing he con ex ual s o y, highligh ing key issues,
and ou lining he ole-playing ac i i ies. The second s ep
is selec ing he pa icipan s by analyzing he oles and
selec ing he ole playe s. The hi d s ep is p ocessing he
scene by adjus ing he p inciples o beha iou in he ole,
es a ing he oles and acing he p oblem si ua ion. The
ou h s age p epa es he obse e s by de e mining he
subjec o he sea ch and explaining he obse a ion
asks. The i h s age is discussion and e alua ion, which
in ol es e iewing ole-playing beha iou (inciden s,
issues, ealism), discussing cases, and c ea ing he nex
s age. six h s age, e-playing by playing he modi ied
oles and sugges ing he ollowing s ages wi h mo e
app op ia e beha iou s) [28]. A e eaching
communica ion skills o he s uden s using he ole-
playing me hod, hey we e asked o e lec on hei
expe iences based on he 6-s ep e lec ion model
de eloped by Mezi ow and Taylo (2009). The s eps
included: 1) emo ional eac ion, 2) explana ion and
desc ip ion, 3) in e nal e iew, 4) c i ical analysis, 5)
e alua ion, and 6) new ac ion planning. S uden s
e lec ed on how o communica e wi h pa ien s, he
ele an in o ma ion ega ding pa ien in e ac ions, hei
communica ion skills, and he ou comes o using hese
skills. They documen ed hei e lec ions on a shee
o ganized acco ding o Mezi ow and Taylo 's e lec ion
model [29]. The esea che s udied he s uden s' w i ings,
and app op ia e eedback was p o ided o imp o e hei
lea ning (Table 1). All e hical conside a ions we e
conside ed when conduc ing he s udy. Ob aining
pe mission om he Uni e si y o Medical Sciences and
he Ins i u e o Medical Educa ion o pa icipa e in he
s udy, ob aining w i en in o med consen om he
esea ch uni s o pa icipa e in he s udy, eedom o en e
and exi he s udy, he anonymi y o he ques ionnai es,
and he emphasis on he con iden iali y o in o ma ion
we e aken in o conside a ion.
Table 1. Mezi ow and Taylo ole play s eps
Implemen a ion plan
S eps o conduc ing educa ional sessions
Wa ming up he g oup by in oducing he p oblem, explaining he
p oblem, explaining he s o y o he p oblem, showing he impo an
issues and explaining he ole-playing
Fi s s ep
Role-playing me hod
selec ing he pa icipan s by analyzing he oles, and selec ing he ole
playe s
Second s ep
p ocessing he scene by adjus ing he p inciples o beha io in he ole,
es a ing he oles and acing he p oblem si ua ion
Thi d s ep
p epa ing he obse e s by de e mining he subjec o he sea ch and
explaining he obse a ion asks
Fou h s age
discussion and e alua ion by e iewing ole-playing beha io (inciden s,
issues, ealism
Fi h s age
Replaying he modi ied oles and sugges ing imp o ed beha io al
esponses o u u e si ua ions
Six h s age
A e eaching communica ion skills o he s uden s using he ole-
playing me hod, he s uden s we e asked o e lec based on he 6-s ep
e lec ion model o Mezi ow and Taylo (1, emo ional eac ion, 2,
explana ion and desc ip ion, 3, in e nal e iew, 4, c i ical analysis, 5,
e alua ion, 6, new ac ion planning) [29].
Re lec ion
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Da a analysis
The da a we e analyzed using SPSS e sion 20 wi h
desc ip i e s a is ics ( equency, pe cen age, mean, and
s anda d de ia ion) and in e en ial es s (pai ed - es , -
es , chi-squa e, and ANOVA).
Resul s
All s uden s pa icipa ed in he s udy, and he e was no
sample a i ion. The Kolmogo o –Smi no es esul s
indica ed ha he s udy a iables ha e a no mal
dis ibu ion (p > 0.05). Fo y-eigh pe cen o he
pa icipan s in his s udy we e male. The ages o he
esea ch subjec s anged om 23 o 51 yea s. The
dis ibu ion o pa icipan s based on demog aphic
a iables is p esen ed in Table 2. Addi ionally, he
ANOVA and chi-squa e indica ed no signi ican
di e ences in demog aphic a iables be ween he wo
g oups (p > 0.05). The mean dis ibu ion o
communica ion skills abou demog aphic cha ac e is ics
among he s uden s also showed no signi icance (p >
0.05), as de ailed in Table 3. Fu he mo e, he e was no
signi ican di e ence in he mean communica ion skills
o s uden s be ween he expe imen al and con ol g oups
be o e he in e en ion (p = 0.16). The e was a
signi ican di e ence be ween he cases and con ols in
he mean communica ion skills a e he in e en ion (p
= 0.04). The e was a signi ican di e ence in he mean
communica ion skills o s uden s in he expe imen al
g oup be o e and a e he in e en ion (p = 0.04). In
con as , no signi ican di e ence was obse ed in he
mean communica ion skills o he con ol g oup be o e
and a e he in e en ion (p = 0.065) (Table 4).
Table 2. F equency, mean, and s anda d de ia ion o demog aphic cha ac e is ics o pa icipan s in he in e en ion and
con ol g oups
Indi idual speci ica ions
In e en ion n (%)
Con ol n (%)
Sig.
Indi idual speci ica ions
Age
19-21
5 (22.72)
4 (18.19)
F = 1.056
p = 0.631
22-24
14 (63.64)
16 (72.72)
25-27
3 (13.64)
2 (9.09)
Gende
Male
4 (18.18)
7 (31.82)
X2 = 1.011
p = 0.262
Female
18 (81.82)
15 (68.18)
Do mi o y s a us
Do mi o y
17 (77.27)
19 (86.36)
X2 = 1.112
p = 0.090
Non-do mi o y
5 (22.73)
3 (13.64)
Ma i al s a us
Ma ied
2 (9.1)
1 (4.55)
X2 = 0.198
p = 0.124
Single
20 (90.9)
21 (95.45)
Na i eness
Na i e
7 (31.81)
3 (13.63)
X2 = 0.054
p = 0.263
Non-na i e
15 (68.19)
19 (13.63)
No e: ANOVA was used o compa e quan i a i e demog aphic a iables be ween g oups, while he Chi-squa e es was used o compa e quali a i e a iables.
Abb e ia ions: n, numbe o pa icipan s; SD, s anda d de ia ion; X2, Chi-squa e es ; Sig., s a is ical signi icance; p, p obabili y- alue.
Table 3. Mean and s anda d de ia ion o s uden s’ communica ion skills by demog aphic a iables
eibai aV
N e Vb
PVbaVnei V
lcee naaieacn umaaa
Mean ± SD
eibai aV
GVndVb
Male
11
25
119.13 ± 27.16
Female
33
75
109.7 ± 18.06
= 1.03 , p = 0.066
Mibaeia ueie u
Mdii a
3
6.82
121.13 ± 23.66
S lgn
41
93.18
118.16 ± 13.27
= 1.91, p = 0.0712
A V (sVibu)
19-21
9
20.45
111.9 ± 24.12
22-24
30
83.63
102.10 ± 13.12
25-27
5
63.18
112.11 ± 23.11
F = 2.54, p = 0.191
scbeaecbs ueie u
Dmio imio
36
81.81
123.11±28.22
Nml-amio imio
8
18.19
119.16±18.82
= 1.51, p = 0.301
Niea Vness
Ndi
10
22.72
98.16 ± 15.12
Nml-ldi
34
77.28
102.11 ± 24.22
= 1.03, p = 0.621
No e: ANOVA es was used o compa e pa icipan s based on quan i a i e demog aphic a iables o g oups. es was employed o compa e pa icipan s
based on quali a i e a iables
Abb e ia ions: n, numbe o pa icipan s; SD, s anda d de ia ion; F, analysis o a iance es ; Sig, s a is ical signi icance; p, p obabili y- alue
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Table 4. Compa ison o mean communica ion skills be ween in e en ion and con ol g oups be o e and a e he in e en ion
lcee naaieacn umaaas
In e en ion g oup
Mean ± SD
Con ol g oup
Mean ± SD
Sa .
nVicbV aneVb Vneacn
69.25 ± 8.14
68.65 ± 11.48
= 1.06
p = 0.166
nieVb e V aneVb Vneacn
112.35 ± 12.21
73.15 ± 6.51
= 1.02
p = 0.043
ua .
= 1.001
p = 0.043
= 1.006
p = 0.065
-
No e: Independen - es was used o compa e communica ion skills be ween g oups, and pai ed - es was used o wi hin-g oup compa isons.
Abb e ia ions: SD, s anda d de ia ion; p, p obabili y- alue.
Discussion
The p esen s udy's esul s indica ed ha eaching
nu sing s uden s communica ion skills by blending ole-
playing and e lec ion, compa ed o he usual me hod,
imp o ed hei communica ion skills in dealing wi h
dep essed pa ien s. Huang e al. conduc ed a s udy o
de e mine he e ec o eco ded ideo ole-playing and
guided e lec ion on empa hy, ca ing beha io and
compe ence o 72 i s -yea nu sing s uden s o medical
acul ies in Taiwan. The con ol g oup ecei ed he
adi ional me hod o educa ion. The esul s indica ed
ha aining based on eco ded ideo ole-playing and
guided e lec ion imp o ed s uden s' empa hy, ca ing
beha io and compe ence [30]. The indings o his s udy
a e consis en wi h he esul s o he p esen s udy.
Al hough he dependen a iables, as well as he s udied
g oups, a e di e en in he cu en s udy and ou s udy,
in bo h s udies, he blend o wo me hods o ole-playing
and e lec ion was able o c ea e posi i e e ec s on he
s uden s' desi ed a iables. In a s udy, Sho ey e al.
in es iga ed he e ec i eness o blended lea ning based
on a communica ion module designed based on lea ning
sa is ac ion, a i ude owa d communica ion skills, and
sel -e icacy o Bachelo nu sing s uden s in es ablishing
communica ion. In designing he educa ional p og am o
his s udy, in addi ion o using mul imedia ools and
i ual eali y o inc ease s uden s' pa icipa ion in
lea ning, ole-playing and e lec ion exe cises we e used.
The s udy's esul s indica ed ha all h ee a iables o
sa is ac ion wi h lea ning, a i ude owa ds
communica ion skills, and sel -e icacy in
communica ing signi ican ly di e ed a e he s udy han
be o e [31]. The esul s o his s udy we e also consis en
wi h ou esul s. In bo h s udies, ole-playing and
e lec ion in e en ions signi ican ly inc eased s uden s'
communica ion skills. In hei s udy, Chung e al.
in es iga ed he e ec i eness o a blended aining
p og am consis ing o an online module and a s uc u ed
eedback sys em on senio nu sing s uden s' communica ion
skills and sel -e icacy in a local college in Hong Kong.
The aining p og am in he in e en ion g oup was
in-pe son and as an online module. In he con ol g oup,
only in-pe son aining was done. The esul s o his
s udy indica ed he e ec i eness o he blended lea ning
app oach in imp o ing he compe ency o
communica ion skills and sel -e icacy o senio nu sing
s uden s in clinical deli e y [32]. The esul s o his s udy
we e also consis en wi h ou s udy. Al hough he ype o
in e en ion in ou s udy and his s udy was di e en , in
bo h s udies, he me hod o blending wo educa ional
me hods was used, signi ican ly imp o ing nu sing
s uden s' communica ion skills. In hei s udy,
Sadhuwong e al. explo ed he impac o a blended
aining model ha combined mul imedia ools wi h
cogni i e lea ning me hods on he clinical easoning
skills o 56 junio nu sing s uden s a he Royal Thai
Na al Academy. The pa icipan s engaged in his
blended mul imedia and cogni i e app oach o e 10
days. In he con ols, hese wo me hods we e p esen ed
wi hou blending. The esul s indica ed ha a hyb id
lea ning model by blending si ua ional mul imedia
lessons and cogni i e in e nship me hods could enhance
he clinical easoning skills o nu sing s uden s.
Howe e , implemen ing he model should in ol e
p epa ing lea ne s in e ms o hei lea ning skills and
sel -di ec ed hinking, as hese a e ounda ional o
de eloping clinical easoning skills [33]. The s udy's
esul s, simila o ou s, indica ed ha he blended
app oach can e ec i ely enhance he skills o nu sing
s uden s. In analyzing he esul s o his s udy wi h ou
s udy, bo h he ype o blended aining and he
dependen a iable we e di e en in bo h s udies.
Howe e , in he men ioned s udy, p epa ing s uden s o
communica ion skills was emphasized be o e s a ing he
s udy. In hei s udy, Hojja i e al. in es iga ed he
e ec i eness o a blended clinical educa ion model on
nu sing s uden s' a i udes owa d pa ien s in he
psychia ic depa men o Za e Hospi al in Sa i. Eigh y-
i e s uden s we e included in he s udy, and he
educa ional con en o he in e en ion g oup and he
men ioned i ems included ilm sc eening, g oup
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42 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025
discussion, and pa ien educa ion. Among cases, blended
aining was also gi en in addi ion o ou ine aining.
Fo con ols, he usual clinical aining such as d ug
he apy skills, pa icipa ion in daily psychia ic isi s and
pa icipa ion in daily ounds o he psychia ic
depa men we e implemen ed. The s udy's esul s
indica ed ha blended aining signi ican ly imp o ed
s uden s' a i udes owa d homewo k in he men al
depa men [34]. The esul s o his s udy a e consis en
wi h ou s udy in e ms o he e ec o he blended
me hod on nu sing s uden s in he psychological lea ning
en i onmen . Howe e , he blended me hod used, as well
as he dependen a iable in he wo s udies, we e
di e en . In any case, ega dless o he ype o me hod,
blended aining can posi i ely a ec he a i ude o
nu sing s uden s in he psychia ic depa men and on
homewo k in he psychia ic depa men . In a s udy,
Shahsa a i Es ahani in es iga ed he e ec i eness o he
blended aining me hod wi h he p oblem-sol ing
me hod and ole-playing on he sa is ac ion o lea ning
he p ac ical skill o pa ien educa ion among i s -yea
nu sing s uden s a Jah om Uni e si y. The indings
indica ed ha s uden s' sa is ac ion wi h he blended
me hod inc eased signi ican ly a e he in e en ion.
Also, he ole-playing me hod inc eased s uden s'
emo ional exci emen by 85%, making hem eel close
o he s age and use all hei senses o obse e (87%). In
addi ion, he p oblem-based lea ning me hod leads o he
imp o emen o s uden s' skills (90%) and mo i a ion
managemen (92%), and he blended aining me hod
leads o high sel -es eem (95%). Thei p ac ical lea ning
inc eased by 89% [35]. The esul s o his s udy we e
consis en wi h ha o ou s udy in e ms o he posi i e
e ec s o he blended me hod. Al hough he dependen
a iables in his s udy di e ed om ou s, he common
poin be ween hese s udies can be exp essed as a
signi ican inc ease in hei p ac ical lea ning. Also, he
blended aining me hod in his s udy was ole-playing,
which is he same as ou s. In a s udy, Ilic e al.
in es iga ed he e ec i eness o eaching he basics o
e idence-based medicine in a blended me hod compa ed
o lec u e me hod educa ion on compe ence, sel -
e icacy, a i ude and beha io owa d e idence-based
medicine in medical s uden s in hei i s yea o clinical
educa ion. The con en o he aining wi h a blended
app oach, in addi ion o using he lec u e me hod,
included online and mobile phone-based lea ning,
showing an educa ional ideo, communica ing wi h he
pa ien and p o iding him wi h he necessa y aining by
he s uden . The indings showed no signi ican
di e ence in he knowledge and skills o s uden s
be ween he wo g oups. Howe e , he s uden s' a i ude
in he blended aining g oup was signi ican ly highe
[36]. Pe haps he lack o e ec i eness o his me hod in
s uden s' knowledge and skills can be a ibu ed o
a ious easons, including he i s expe ience o s uden s
who a e mo e ocused on heo e ical basis and me hods
such as lec u es. Howe e , his blended me hod
signi ican ly a ec ed he s uden s' a i udes. In a s udy,
Pa anda a e al. in es iga ed he e ec o designing a
blended aining p og am on he pe o mance and
clinical easoning o midwi e y s uden s o Azad
Uni e si y, Jah om B anch. The educa ional p og am
implemen ed o he in e en ion g oup included ilm
showing, g oup discussion abou eal scena ios, use o a
simula ion model and clinical decision-making exe cise,
and he con ol g oup ecei ed lec u e-s yle aining.
Acco ding o he indings o he s udy, al hough in he
in e en ion g oup, he a e age sco e o pe o mance and
clinical easoning a e he in e en ion was signi ican ly
highe han be o e, he e was no s a is ically signi ican
di e ence in he mean sco e o pe o mance and clinical
easoning a e he implemen a ion o he in e en ion
be ween he wo g oups [37]. The e o e, he esul s o
his s udy con as wi h hose o he p esen s udy. The e
is a need o wide in e en ions o clinical easoning.
In his s udy, su icien ime was no alloca ed o p o ide
blended aining. The e o e, no signi ican di e ence
was obse ed be ween he sco es o he wo g oups a e
implemen ing he in e en ion. In a s udy, Choi e al.
in es iga ed he e ec i eness o lea ning based on he
p oblem-sol ing model compa ed o lec u e-based
eaching on c i ical hinking, p oblem-sol ing, and sel -
di ec ed lea ning in i s -yea nu sing s uden s in Ko ea.
Based on he s udy's indings, he wo g oups had no
signi ican di e ence in c i ical hinking, p oblem-
sol ing and sel -di ec ed lea ning [38]. The esul s o his
s udy a e inconsis en wi h he indings o he p esen
esea ch.
The small size o he sample and he lack o use o he
blended app oach in aining based on he p oblem-
sol ing model led o he absence o a signi ican
di e ence be ween he wo g oups in his s udy. One
limi a ion o ou s udy was he use o a non- andom
sampling me hod, which es ic s he gene alizabili y o
he indings o he b oade popula ion. The e o e, i is
ecommended ha a s udy be conduc ed using a andom
sample. Ano he o he limi a ions o he p esen s udy is
he indi idual cha ac e is ics and pe sonali y di e ences
among s uden s ega ding hei willingness o lea n
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: E ec o Blended T aining o Role-Playing and Re lec ion on he Communica ion Skills
Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 43
p o essional skills, which ha e in luenced he esea ch
and a e beyond he esea che 's con ol.
Conclusion
Based on he esul s o he p esen s udy, i seems ha
blended aining o ole-playing and e lec ion is
e ec i e in imp o ing he communica ion skills o
nu sing s uden s in dealing wi h dep essed pa ien s. In
ligh o he indings om he p esen s udy and he
posi i e impac o he blended me hod compa ed o
adi ional app oaches, i is ecommended ha
educa ional sys em manage s conside inco po a ing his
me hod in o bo h heo e ical and p ac ical aining
cou ses o s uden s.
Addi ionally, p o esso s in he psychia ic nu sing
depa men should adop his app oach o enhance
s uden s' communica ion skills wi h a ious pa ien s in
he psychia ic uni and solici eedback on i s
e ec i eness om he s uden s.
Nu sing s uden s a e encou aged o sha e hei
expe iences wi h new eaching me hods, such as his
blended app oach, wi h educa ional adminis a o s and
acul y membe s. Sha ing hese expe iences can help
iden i y po en ial obs acles and weaknesses in
implemen ing hese me hods. Fu he mo e, u u e
s udies should explo e his skill ac oss di e en
academic p og ams o unco e he long- e m e ec s o
his me hod on s uden s' communica ion skills.
E hical conside a ions
The esea ch p oposal was app o ed by he Resea ch
Depa men o Bi jand Uni e si y o Medical Sciences
unde he iden i ie IR.BUMS.REC.1402.478. The s udy
objec i es we e explained o pa icipan s, and in o med
consen was ob ained. Pa icipan s we e also assu ed ha
he da a was con iden ial and ha hey could wi hd aw
om he s udy a any ime.
A i icial in elligence u iliza ion o a icle
w i ing
The au ho s con i m ha gene a i e a i icial in elligence
(AI) and AI-assis ed echnologies we e no u ilized in he
w i ing p ocess o his pape .
Acknowledgmen
The au ho s hank he Vice Chancello o To ba Jam
Facul y o Nu sing and Midwi e y and nu sing s uden s
o hei coope a ion in his esea ch.
Con lic o in e es s a emen
The au ho s decla e no con lic o in e es .
Au ho con ibu ions
DO designed he s udy, collec ed da a, pe o med he
s a is ical analysis, and d a ed he manusc ip . ZA
concei ed he ini ial idea o he s udy, assis ed wi h he
s udy design, and con ibu ed o he inal edi ing o he
a icle. FF also collec ed da a and conduc ed he
s a is ical analysis while d a ing he manusc ip . HN
con ibu ed o he in e en ion design and helped d a
he manusc ip . All au ho s e iewed and app o ed he
inal e sion o he manusc ip .
Funding
This esea ch ecei ed no speci ic unding om public,
comme cial, o non-p o i agencies.
Da a a ailabili y s a emen
The da ase s used and/o analyzed du ing he cu en
s udy a e a ailable om he co esponding au ho upon
easonable eques .
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