Professional role players are increasingly being employed in psychiatric training. There have been several studies of their experience. A Dutch study showed an ‘unexpectedly high’ rate of reported mild stress in those playing psychiatric roles. ^{Reference Bokken, Van Dalen and Jan-Joost1} An American study found that role playing mania and depression could be exhausting and that being more than 40 minutes in role with more than three or four repetitions was stressful. ^{Reference McNaughton, Tiberius and Hodges2}

We were interested in the experience of UK professional role players. We conducted semi-structured interviews with ten professional role players, six women and four men, followed by two focus groups with the same individuals. They were taking part in local mock Objective Structured Clinical Examinations (OSCEs) and had between 5 and 10 years' experience of simulating patients with psychiatric disorders several times a year. They were recruited and trained by a professional trainer with a background in psychiatry.

Generally, the role players we interviewed felt appreciated and well looked-after at psychiatric OSCEs. They emphasised the value of seeing the full scenarios beforehand, including the instructions to candidates and examiners as well as examiners' score sheets. These inform their training sessions. Guided, collective training is crucial; they prefer not to rely on their imaginations to work out how a particular patient would behave. Role players' instructions should include directions on how to act the role; they felt that portraying the appropriate affect is important. Too long a history can make them anxious lest they forget bits; this detracts from their capacity to think and feel themselves into role.

Thinking and feeling oneself into role is a key aspect of method acting. The researchers in the Dutch study thought that method acting may have contributed to their role players' reported stress. They played ‘emotionally and psychologically complex roles’ only occasionally. Another study reported that role players find it difficult to ‘turn off characterisation’. ^{Reference Naftulin and Andrew3} However, an experienced UK role player has argued strongly in favour of method acting in order to give convincing performances. She considers these simulations appropriate even for amateur actors so long as they have a sense of humour and the capacity to ‘switch off’ afterwards. ^{Reference Davies4}

In keeping with American professional role players, ^{Reference Davies4} ours liked their work and felt it had allowed them to develop greater empathy towards people with mental illness. They said they had come to appreciate the human exchange that seemed to them central to a psychiatric consultation and felt more able to deal with psychiatric problems experienced by friends and family. They felt that psychiatric role playing can be physically demanding, much of the simulation being non-verbal. They found some very intense scenarios distressing, disturbing and draining, but they did not find the work disturbing overall; they felt they could shrug their roles off afterwards. They regarded psychiatric role playing as interesting and satisfying. Although they reported no continuing stress or adverse consequences from their work, they agreed collectively that only experienced role players should undertake psychiatric roles. So whether a role player is stressed or distressed by simulating may reflect his or her experience. The individual's emotional stability and buoyancy may also be important. Their trainer writes that ‘an individual with baggage from personal experience may need more support when de-roling and, in our experience, may be unsuitable’. ^{Reference Spence and Dales5}

Ours is the first study of the experience of UK role players. Its main limitation is that it draws on a small number of role players from only one programme and may therefore not be representative of the UK as a whole. Also, OSCEs have now been replaced by Clinical Assessment of Skills and Competencies (CASCs) in the Royal College of Psychiatrists examinations. Nonetheless, there are sufficient similarities between OSCEs and CASCs to render our study still relevant.