PRPlayers

Challenge

People with learning disabilities (LD) continue to face significant inequalities in healthcare. The Confidential Inquiry into Premature Deaths of People with Learning Disabilities (CIPOLD, 2013) revealed that 37% of deaths in this group were potentially avoidable. Earlier, Mencap’s Death by Indifference (2007) exposed the widespread institutional discrimination faced by people with learning disabilities in the NHS.

In response to these findings, PRP partnered with medical educators to pilot and implement OSCE (Objective Structured Clinical Examination) stations using actors with learning disabilities.

The goal: to help assess trainee psychiatrists' ability to communicate appropriately, ethically, and confidently with people with LD.

Many doctors report a lack of confidence and appropriate training in treating patients with learning disabilities. According to a General Medical Council (GMC) poll, over half of doctors felt patients with learning disabilities receive a poorer standard of care. The GMC has since developed a dedicated interactive module to help address this gap.

Project Requirements

• Recruit and train actors with learning disabilities through a bespoke PRP+ LD Course

• Pilot the OSCE station before integration into the Clinical Assessment of Skills and Competencies (CASC)

• Ensure quality assurance and role consistency across all exam stations

Solution

PRP recruited actors with learning disabilities and delivered a tailored PRP+ Induction and LD Course in London. This course introduced the core principles of professional role play vs acting, using our four-stage standardisation model, multiple rehearsals, and guidance on:

• The exam structure and environment

• Character briefs

• Professional expectations

• Time management during OSCEs

The pilot station, designed under the “treatment explanation” category, included a boundary challenge in which the actor asks the candidate a personal question — a test of professional boundaries. The pilot was run six times at Barts Hospital, observed by a panel of psychiatrists who assessed consistency, realism, and performance quality. Their feedback validated that actors with learning disabilities could deliver high-quality, calibrated performances.

Following the successful pilot, the station was introduced in the January 2013 MRCPsych CASC exam, requiring 14 actors to run 8 parallel circuits. PRP delivered additional training sessions in London, Leicester, and Bradford, using peer-paired mock interviews to help actors understand the pressure candidates face, and how to maintain character integrity and timing.

Results

The initial CASC exam implementation was a success. PRP role players arrived early for a pre-exam rehearsal, where they refined their performances alongside volunteer psychiatrists under the supervision of a PRP facilitator. This ensured calibration and consistency across all circuits.

Positive Outcomes:

• Examiners praised the realism and effectiveness of the station in testing communication skills

• Lay Observers commended PRP’s care for the role players and the thoroughness of pre-exam briefings

• The success led to continued use and expansion of LD role player stations in psychiatric assessments

This initiative has been recognised as groundbreaking in the assessment of psychiatry trainees, setting a new benchmark for inclusive, realistic, and fair OSCE design.

Read the full report:

S. Soni, I. Hall, P. Doulton, and P. Bowie "Involving people with intellectual disabilities in the formal assessment of psychiatrists’ skills"

References

CIPOLD (2013) “Confidential Inquiry into premature deaths of people with learning disabilities final report”, University of Bristol

Mencap (2007) “Death by indifference”