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Several studies suggest the relevance of healthcare simulation to prepare future doctors to deliver bad news. A such, we designed a role-play workshop to train first-year residents enrolled in Lille University School of Medicine to break bad news. The objective of this work is to report on our experience of this training and to assess its educational value through its capacity to satisfy residents' expectations, to induce a feeling of ease towards bad news disclosure, and to change trainees' preconceptions regarding these situations. The training consisted of a 45-minute heuristic reflective activity, aimed at identifying residents' preconceptions regarding bad news disclosure, followed by 4 30-min role-plays in which they played the parts of the physician, the patient and/or their relatives. Trainees were asked to answer 2 questionnaires (pre- and post-training), exploring previous experiences, preconceived ideas regarding bad news disclosure and workshop satisfaction. Almost all residents felt very satisfied with the workshop, which they regarded as formative (91%) and not too stressful (89%). The majority felt "more capable" (53% vs. 83%) and "more comfortable" (27% vs. 62%) to deliver bad news, especially regarding "finding the right words" (12% vs. 22%). Trainees tended to overestimate their skills before the workshop and lowered their assessment of their performance after attending the training, especially when they played the role of a patient in the simulation. Healthcare role-play seems an interesting technique for training to breaking bad news. Placing residents in the role of patients or relatives is an active approach that encourages reflexivity. [ABSTRACT FROM AUTHOR]

Le personnage du clown a fait sa première apparition à l'hôpital au sein des unités pédiatriques où les effets positifs de son action sont largement reconnus. Cette « activité clown » est néanmoins encore très peu répandue dans les services de psychiatrie où les patients, qui parfois ont du mal à accéder à l'humour, ou qui sont aux prises avec des émotions fortes qu'ils ne parviennent pas à exprimer, pourraient bénéficier de ses vertus cathartiques. Dans cet article, nous présentons dans un premier temps les résultats d'une mini-revue de la littérature portant sur la place et le rôle du clown dans la démarche de soins en psychiatrie. Dans la seconde partie de l'article, nous présentons les résultats de notre étude dont l'objectif était de mesurer le sentiment de bien-être des patients psychiatriques par une échelle visuelle analogique (EVA) après deux semaines de participation à l'atelier clown. Il s'agit d'une étude pilote de faisabilité ouverte, prospective et monocentrique qui s'est déroulée de juin 2015 à décembre 2016 à l'Unité d'Hospitalisation Temps Plein (UHTP) du site de l'EPS Ville-Évrard à Saint-Denis, Pôle 93G03. Cinquante-neuf patients ont été inclus dans l'étude après recrutement par un médecin investigateur chargé de vérifier les critères d'inclusion et de non-inclusion. L'analyse des articles recensés dans la mini-revue souligne les gains des patients en termes de capacité de communication et de gestion des émotions. Par ailleurs, les résultats de notre étude n'ont pas montré de différence statistiquement significative (p < 0,7). Bien que notre étude n'ait pas montré de différence significative, elle a mis en évidence la faisabilité de ce type d'atelier au sein d'un service de psychiatrie et fournit des arguments en faveur de la poursuite de cette activité sur une plus longue période et au sein de structures telles que l'HDJ ou le CATTP. In psychiatry, we often talk about therapeutic mediation, used in many group and individual therapies. We use a wide variety of mediating objects, cultural means and even people, their roles and the image they project, including the character of the clown. The word clown immediately sends us back the image of a comedian working in the circus world or in the royal courts. Yet, modern clowns are now taking different places. The 1980s marked the beginning of the era of "Doctor Clowns" in hospitals. The character of the clown made his first appearance in hospital in pediatric units where the positive effects of his action are widely recognized. This "clown activity" is nevertheless still not very widespread in psychiatric services where patients, who sometimes have difficulty accessing humor, or who are struggling with strong emotions that they cannot express, could benefit from its cathartic virtues. In this article, we first present the results of a mini-literature review on the place and role of the clown in the psychiatric care process. In the second part of the article, we present the results of our study whose objective was to measure the feeling of well-being of psychiatric patients by a visual analog scale (VAS) after two weeks of participation in the clown workshop. For the conduct of the research of scientific articles, we have chosen the databases according to their relevance in scientific, psychiatric and psychological research. These are the following areas: PubMed, PsycInfo, ScienceDirect, LiSSa... No time limit has been set given the low availability of articles in this area and its recent development. For the same reason, all types of scientific papers, as well as some books have been considered. We have selected the articles in French and English. Furthermore, our study is an open, prospective and monocenter pilot feasibility study that took place from June 2015 to December 2016 at the Full Time Hospitalization Unit of the EPS Ville-Évrard site in Saint-Denis, pole 93G03. Fifty-nine patients were included in the study after recruitment by an investigating physician responsible for verifying the inclusion and non-inclusion criteria. The aim was to offer hospital patients in psychiatry a group activity around the theme of humor. This mediation was coordinated by a professional clown with previous experience of hospitalized patients. The activity was 2 hours long, with 8 participants maximum. Description of a session: 1/Time to put on the "clown's outfit" (hat, red nose, wigs...). 2/Relaxation with breathing exercises. 3/Self-presentation through games. 4/The "clown" time which is articulated in two passages on stage, one individual and the other with several people. 5/The conclusion when everyone expresses their feelings about what they have experienced. The main endpoint, namely the participants' sense of well-being, was measured by a Visual Analogue State (VAS) before and after each clown workshop (D0 and D15), i.e. after two weeks of participation in the clown workshop. Analysis of the articles reviewed highlights patients' gains in terms of communication skills and emotion management. Furthermore, the results of our study did not show a statistically significant difference (P < 0.7). Although the results did not show a statistically significant difference, this study highlighted the feasibility of this type of workshop within a psychiatric department. There was no worsening of the clinical condition of the patients during the protocol and no behavioral disorder caused a disruption of the sessions or their premature termination. In fact, all the sessions could be carried out. The patients who participated in the first session were also present during the second one 15 days later. It can be noted that in terms of feasibility, the patients were complacent and joined the group well. They cooperated in this foray into the imagination created by the character of the clown, allowed emotions to be expressed that they did not show during formal interviews. In conclusion, this study provides arguments in favor of the continuation of this activity over a longer period and within structures such as day hospital or part-time therapeutic activity center. [ABSTRACT FROM AUTHOR]

Abstract: Drawing on the story of events surrounding the hospitalization of a patient named Mr. B., the authors try to reconstruct what, from the non-symbolized past of this patient, is going to be replayed during this regressive period. Observation and decoding of the institutional mise-en-scene that the patient evokes in the hospital environment do reveal him as a “user” of the place he uses, often without him knowing, by producing a singular reconfiguration of what is established and constituted as a template for welcome and care. Consequently, the authors review this reconfiguration of the medical institution through observation of various times when a specific interactive dynamics is put into effect between the patient and the other patients but also with the nursing body and its hierarchy. They suggest the idea of deploying a primary fantasy scenario peculiar to the patient and perceptible in the movements and feelings of the professionals, in the actions of this patient and in his statements during dual conversations. The known traumatic elements of the patient''s life are put into correspondence with the scenes produced in the institutional space. These mappings show how the hospital can be the theater of a simple repetition of the traumatisms or become a convenient space for their partial elaboration. [Copyright &y& Elsevier]