Forum Theatre, developed by Brazilian theatre practitioner Augusto Boal in the 1970s as part of his ‘Theatre of the Oppressed’ methodology, is a dynamic form of participatory theatre that can be adapted for simulation-based learning. It serves as a powerful tool to explore social issues, foster dialogue and evoke exploratory debate; it promotes social learning (Middlewick et al, 2012) while encouraging community-driven solutions.
Often employed to address topics such as racism, gender inequality, workplace exploitation and managing difficult conversations, this approach is particularly valuable in healthcare education. It empowers health professionals to think critically about complex and challenging situations, allowing them to explore and practise actionable solutions for real-world applications.
This active learning pedagogy is supported by rigorous research in science-based education (Michael, 2006).
To integrate the principles of Forum Theatre into nursing education and enhance simulation pedagogy use the following simple rules.
Principle 1.
Devise a short scenario
The scenario should highlight a problem requiring resolution, such as oppression, conflict, or a dilemma; the scenario itself should last no longer than 15 minutes. It should involve controversy or challenges to maximise learning opportunities for students, promoting critical thinking and engagement.
Instead of being overly prescriptive, focus on key elements such as the background of the scenario, the setting, and the reasons for a patient's anger and frustration. Consider the patient's values, beliefs, past experiences or prejudices that may be influencing their behaviour. Simulation, as an educational tool, offers the flexibility and fluidity to adjust certain aspects of the scenario in real time, enabling participants to practise techniques and problem-solving skills in a controlled environment (Chernikova et al, 2020). The scenario should remain realistic, yet provide opportunities for repetition, allowing learners to refine their approaches and build confidence.
Principle 2.
Room set-up
The room set-up is essential for creating an immersive and effective learning experience. A thoughtfully designed space can simulate real-life environments, enhancing authenticity and participant engagement. Arranging the room in a horseshoe configuration and removing barriers such as tables or equipment encourages interaction, collaboration and clear communication, while ensuring that all participants have an unobstructed view of the action.
Minimising distractions is crucial, so the room should ideally be located away from noise. To avoid disruptions, latecomers should not be allowed into the session after 15 minutes, as they will lack the necessary context to participate effectively.
Principle 3.
Identify the aims and learning outcomes
The aims and objectives of simulations are generally built around participants applying theoretical knowledge, practising decision-making and developing problem-solving skills in a controlled setting.
The aim should centre around enhancing experiential learning by immersing participants in scenarios that mimic real-world challenges, encouraging active engagement and reflection. Objectives include fostering collaboration, critical thinking and communication skills, as well as providing opportunities to test various strategies and receive feedback.
Ultimately, simulations seek to bridge the gap between theory and practice, promoting deeper understanding and preparing participants for real-life situations.
Principle 4.
Set expectations
Set ground rules at the start of the session, emphasising that participants will play themselves in their professional roles, not act out as characters. Ensure a safe environment where participants feel comfortable asking questions, expressing uncertainties and sharing past experiences.
Explain the rules, including safety protocols, expectations for behaviour, and the importance of respect and confidentiality. Stress the need for active engagement, open dialogue, and attentive listening to all contributions and viewpoints, which are crucial for effective learning and development.
Principle 5.
Pre-briefing
Brief the participants at the start of the session. Outline the objectives for the simulation, clarify the roles of participants and provide any necessary context or background information about the scenario.
The briefing helps participants understand the purpose of the exercise and how it connects to broader learning goals, allowing them to engage more confidently and meaningfully in the simulation. Clear instructions reduce confusion and help ensure that the simulation runs smoothly and achieves its intended outcomes.
Principle 6.
Set the scene
Begin the scenario by having the facilitator take on the role of the problem solver. This approach helps students grasp the structure of the session and understand their expected involvement.
Use this initial phase to clearly define the key issue of the scenario and encourage participants to contribute their suggestions for addressing the unfolding situation. As participants become more comfortable with the simulation, invite one of them to step in and assume the facilitator role, allowing them to guide the scenario and apply their own strategies. This transition fosters active involvement and gives participants a practical understanding of the dynamics involved.
Principle 7.
The importance of the facilitator role
The process is guided by a facilitator, who helps mediate the interaction between the actors and the audience. The facilitator ensures that the dialogue remains constructive and encourages critical thinking and reflection on the issues being addressed. The aim is to keep encouraging participants to offer solutions and try different approaches.
Forum Theatre appeals to a wide range of learning styles. The experiential approach allows participants to pose and test questions in real situations that deviate from expectations based on theory and principles (Middlewick et al, 2012). It is the facilitator's responsibility to get everyone to take part. This requires close observation of the participants, the use of silence and gentle encouragement.
Principle 8.
Participants as spect-actors
In this approach, participants are not passive spectators but they become ‘spect-actors,’ engaging actively with the scene (Boal, 2019). They are invited to step into the role of the problem solver and experiment with different actions and strategies to alter the outcome.
This method encourages multiple participants to attempt various interventions, with the ‘audience’ offering alternative solutions to test. Forum Theatre provides a tangible experience, either through physical participation or by mentally engaging with the unfolding scenario. This enables participants to explore the situation and reflect on how different interventions impact the scene (reflective observation). Additionally, it encourages them to connect theoretical concepts with practical applications (abstract conceptualisation). The process is guided by a facilitator, who helps mediate the interaction between the actors and the participants.
Principle 9.
Stop, start and reflect
Use the ‘Stop, Start, Reflect’ approach to enhance learning during the simulation. Pause the scenario to discuss and evaluate the current interaction, allowing participants to suggest alternative strategies or techniques.
Facilitate role exchanges among participants to enable different approaches and perspectives. Use these pauses to stimulate discussion, reflect on the scenario's dynamics, and identify ways to improve outcomes. This method encourages participants to rethink and refine their actions, fostering a reflective practice environment that emphasises shared curiosity and best practices (Middlewick et al, 2012).
Principle 10.
Debrief
Debrief the session using the Plus-Delta debrief model. This is a structured reflection tool used to evaluate experiences by identifying strengths (Plus) and areas for improvement (Delta). In this approach, participants first highlight what went well, reinforcing positive behaviours and successful strategies. Then, they identify aspects that could be improved or adjusted, fostering a growth mindset and continuous learning. This simple yet effective model encourages constructive feedback, promotes self-assessment, and supports team development by focusing on actionable changes rather than just critique (Kainth, 2021).
Ask the participants to consider what went well and what could be improved. Start by highlighting the ‘Plus’ aspects, such as successful interventions, active participation, clear communication, and how the simulation effectively mirrored real-world challenges. Then, address the ‘Delta’ areas by discussing any strategies that were less effective, engagement issues, communication barriers, and any needed adjustments to the scenario.
Conclude with a summary of key insights, encouraging participants to reflect on these points and consider how they can apply the lessons learnt to real-life situations and future simulations.