Through collaboration with the NCDHR and the Deaf community volunteers, Deaf Strong Hospital was conducted at the Wegmans School of Pharmacy at St. John Fisher College. Conducting the program required coordination between the school, NCDHR, and the deaf community. For effective execution, we appointed 4 program leaders (2 from NCDHR and 2 from the deaf community) who wrote all of the scenarios, assisted in organizing materials, ensured there was a sufficient number of volunteers, organized the panel discussion, and oversaw the flow of the program. On the day of the role-reversal exercise, 17 deaf community facilitators (including the 4 leaders) participated in both the DSH exercise and the small-group debriefings. Eight interpreters also were present to assist “patients” at Deaf Strong Hospital. The program was conducted at the college using the atrium, classroom, and study rooms.
Two days prior to the program, the college provided pharmacy students with instructions for fingerspelling the alphabet and a few basic signs in ASL, as well as reading materials on deafness as culture13
and learning objectives for the exercise (Table ). To make the experience more authentic, students were not given specific instruction on the use of ASL. On the day Deaf Strong Hospital was conducted, program leaders provided students with basic information for navigating the “hospital,” including that they could not use their voices during the exercise. Program leaders also instructed the community volunteers to communicate with students in fluent ASL and to limit their use of spoken words and lip reading.
Pharmacy Students' Agreement With Statements Reflecting Learning Objectives for the Role-Reversal Exercise After Participating in the Deaf Strong Hospital
Program leaders provided each student with a color-coded sticker and a card for “step 1” that contained the information on where to go first. After completing the interaction at each station, a “hospital worker” gave the students an instruction card for the next step. Several scenarios were used for the exercise so the instructions on the cards varied. Which scenario a student followed was determined by the color of the sticker he/she had been given.
All students were directed through the waiting area, doctor's office, emergency room, and pharmacy during the activity. Additionally, many students encountered a specialist, such as a psychiatrist, dentist, or gastroenterologist. One sample scenario is provided (Table ). Interpreters were provided only at select sites within the hospital as a demonstration of how interactions with medical personnel could be positively affected if they, as the patient, could communicate and understand the information being provided.
Sample Role-Reversal Scenario for the Deaf Strong Hospital Program
As students began the role-reversal exercise, they were again reminded that they were not allowed to use their voices, and signs stating this were posted throughout the “hospital.” Students were encouraged to use alternative methods of communication (writing, pantomiming, etc).
The benefit of role play exercises is that they allow students to experience the patient's perspective by feeling firsthand the effect of specific interactions.14
Additionally, role play exercises teach students to integrate their past knowledge and experiences to a novel situation in order to arrive at a creative solution.15
Students waited for receptionists who took their name, complaint, and insurance information. They were required to wait for their name to be “called” using fingerspelling. This mimics the experiences that many deaf and hard-of-hearing patients have in the health care system when they are forced to watch the receptionist's lips, waiting for their names to be spoken. Students who were in the waiting room for a prolonged time were given assistance by the volunteers so they could proceed to the next station.
The Deaf Strong Hospital exercise was initially designed so that the medical students had the longest interaction with the volunteers who were acting as either emergency or primary care physicians. When the program was adapted for pharmacy students, the prolonged interaction with the physician no longer became a point of emphasis. Pharmacy students spent equal amounts of time with each of the heath care providers. Students were instructed to communicate symptoms such as nausea, headache, or stomach pain without speaking. The volunteers often would make the students try several methods of explaining a symptom before acknowledging comprehension. The volunteer would then explain the diagnosis to the student in ASL, along with important instructions.
To illustrate the dangers associated with patients not understanding their prescriptions or the pharmacist's instructions, prescription bottles in the “pharmacy” were filled with a variety of different colored M&Ms as many medications come in various colors. Upon filling the student's “prescription,” the “pharmacist” instructed the “patient” about the number of tablets to take, how many times a day, and which color to take, and explained any expected side effects. In an extreme example, the student was told that taking the wrong colored M&M could be life-threatening. As in the interactions with the volunteer “physicians,” the inability to communicate concerns to the “pharmacist” was designed to elicit feelings of disempowerment and frustration in the students.
All students were instructed to ask for interpreter services at the reception desk, but most of these initial requests were denied and the student was told that the reason was he/she had not requested the interpreter service in advance. However, an interpreter was available to assist each student at 1 of the stations during the exercise so that students could understand the advantages and importance of providing this service to patients. The obvious change in the quality of care when an interpreter was present was purposeful and designed to highlight the importance of interpreting services in promoting improved cross-linguistic communication.
All students were required to sign their name to a surgical consent form before leaving the exercise. The form consisted of excerpts taken from an actual document used routinely at a local hospital for outpatient surgeries and procedures. Due to the complex nature of these forms, they are difficult for many patients to understand. For deaf patients the consent form can be particularly daunting because English may be their second language and they may have only a fourth- or fifth-grade English reading level. To demonstrate to the students this literacy and language barrier to receiving health care, the consent form was provided in Albanian, a language to which few if any students would have had exposure. Students were instructed to sign and present the form to their “healthcare provider.” The English translation of the form was:
I agree to other operations or treatments. My doctors may learn more in surgery. They may think I need other treatments. My doctors will decide in surgery. I agree to let them do the things they think are necessary. If I understand this form I will sign it using only my last name.
At the conclusion of the role-reversal exercise, students participated in a panel discussion. Included on the panel were community members who were hard of hearing (had a cochlear implant), early deaf, deaf and blind, or late deafened. Each panelist gave a brief introduction and described some of their personal interactions and frustrations with their pharmacists. Students were given an opportunity to ask questions throughout the presentation. During the discussion, the panelists gave students suggestions on how to make interactions with deaf or hard-of-hearing patients more productive. Alternate forms of communication also were encouraged because not all deaf and hard-of-hearing patients lip-read or read written English.
Prior to the student debriefing sessions, the 12 faculty facilitators, representing both pharmacy practice and pharmaceutical sciences, met with a NCDHR facilitator. This informational session provided faculty members with tips on communicating through an interpreter and with suggested topics for the small group discussion, including the program learning outcomes (Table ).
The debriefing session was primarily an opportunity for the students to reflect on the experience. Students were encouraged to share their reactions to, frustrations with, and experiences at Deaf Strong Hospital with each other. Within the student debriefing groups a deaf community member and interpreter also were present to encourage additional student questions and reflection.