Theater based Learning - TBL

A unique and innovative methodology to learn and understand educational material

Medical Theater

Medical Theatre is the use of TBL for medical and healthcare topics.

Soft Skill Stories for Medical Representatives of AstraZeneca

July 2011

In the process of acquiring sponsorship for a workshop, we were introduced to AstraZeneca, a well-established pharmaceutical company. They were impressed with the whole idea of medical theatre and saw potential in it being utilised for training medical representatives. They immediately requested for a workshop to be conducted for their new scientific task force team that was being created in the field of their cardiac medication division. The intention was to help this new scientific task force team to be well versed with certain attributes that a medical representative requires to possess as a quality in his/her career. This was a three day workshop planned 3 hours every day. There was a competitive performance at the end of their third day during their symposium.

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Objectives – 1. To introduce an innovative methodology by which certain soft skill attributes can be learnt and understood.

Body – For these group of pharmaceutical companies we mainly concentrated on soft skills that they require when dealing with doctors and hospital staff from various institutions. Medical representatives need to have certain qualities which can help them be more efficient in their responsibilities. For this we conducted a three day intervention where we worked on certain attributes such as Influencer, Negotiator, Multi-Tasker, Alliance Builder, Partnership Manager, Strategist, Planner and New Account acquirer. Along with theatrical games and group building exercise’s we brought a varied group of professionals from different backgrounds and experiences out from their comfort zones. They were divided into groups based on the attributes assigned to them  and each group was facilitated to create a story plot for a short performance highlighting that particular attribute. We noticed that after a while all of them were extremely focussed to give their best performance and enjoyed the process by experiencing these attributes for themselves.

Conclusion- At the end of these workshops we concluded that this process can be utilised to emphasize the importance of certain qualities that any profession might require. Even though no elaborate medical content was communicated, even something as simple as soft skills was learnt effectively through this methodology. We learnt that it is the group that experiences the process actually decides the structure and outcome of this methodology.

Institution: AstraZeneca

Subject: Attributes for medical representatives

Topic: Influencer, Negotiator, Multi-Tasker, Alliance Builder, Partnership Manager,Strategist, Planner and New Account acquirer.

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Options for Script Framework-

  1. An old lady (Remains common throughout all stories) narrates to a small boy who wants to become someone useful in life so that every human being can benefit from his work.

            She narrates to him the story of “The man who wore a tie”. (Remains common throughout all stories- but makes presence to the audience only after the last story is narrated)

Each story will site an example of the following attributes (These examples will be different from a doctor – Medical representative scenario)–

Influencer

Negotiator

Multi-Tasker

Alliance Builder

Partnership Manager

Strategist

Planner

New Account acquirer.

There is a problem depicted in each scenario and at the end of each story the “Man in the red tie” solves their problems. In the end, (after the 8th theatrical presentation) the boy asks his grandmother as to who the man in the red tie was? – she calmly replies – A medical Representative, as he has all these qualities , which makes him make the difference to the world because of this. If there were no Medical Representatives, A doctor would never know what type of medication should be prescribed to what kind of patients.

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  1. OR , ANOTHER STYLE OF PRESENTATION ALONG THE SAME LINES COULD BE

A vikram and Betaal scene at the beginning of the first performance, where Betaal narrates these 8 stories to vikram , and at the end questions to vikram “ who the man in the red tie was?, vikram smartly replies – all these qualities can be present only in a Medical Representative. Betaal says- correct answer, and flies away.

  1. THE SAME FRAMEWORK can apply to a KBC situation, here the additional point that can be made is – a question at the end of each story where the answer can be the moral understood in the story or an answer like an influencer, negotiator etc. At the end of the 8th scenario the question for 1 crore can be- who was the man in the red tie? And the correct answer can be a medical representative.

Basic understanding of a medical representative (for facilitators only) –

A medical representative is an important person for a pharmaceutical company as he promotes a medicine to the doctor who prescribes these medicines to the end user- the patients.

A medical representative (MR) usually spends his entire day marketing and promoting the product he has been asked to promote. For instance if a pharmaceutical company like AstraZeneca has a wide range of products, each MR would be allotted various segments to promote at different hospitals and doctors( for eg, only cardiology, only respiratory medications etc). It’s a stressful and demanding Job as the sales of a product reflects on the abilities of a MR.

On a typical day, the MR awaits at the doctors OPD (Out Patient Department) till he finishes seeing all his patients. The MR then enters the already exhausted doctor’s chambers to promote the medications. This is usually done by showing charts, Placards and nowadays even on laptops etc. Many MR’S also distribute gifts, pens, pads, and also medicine samples to the doctors for trying the medications and to remember the brand names. They also organize CME’s (Continuing Medical Education) , Organize and sponsor Conferences, Symposiums, Talks and host dinner/lunch parties.

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In spite of all this, and the increasing competition between companies, the doctor usually prescribes a medicine at his own discretion. There could be many reasons for this – if the patient is poor, an affordable brand is prescribed. If the patient has many complaints, a medicine which has combinations of two or three drugs is used so that the patient does not have to take too many pills. Sometimes the doctor might be receiving profits or benefits by prescribing a particular brand etc etc.

So, to conclude, it’s a tough occupation which is usually underrated – but the entire therapeutic team relies on these medications and their availability which an MR does efficiently by bringing to the doctor’s notice the benefits of various medications.

Stories for each attribute-

  1. Influencer: What are the influencers for the utilization for a particular medication?

At a corporate hospital like Fortis- the Doctor at the emergency medicine or casualty usually follows strict hospital protocols for any patient that enters the casualty. If a patient enters with chest pain, there is a protocol for what the next steps are and what medications to give. Here this casualty doctor does influence the use of this medication in the casualty, whereas it is the cardiologist who has made this protocol for the duty doctor to follow in his absence or until it comes mainly influences the medications after his arrival.  When the patient is in the ICU, the ICU doctor is the influencer and when patient is getting discharged the treating doctor again is the influencer. At a government set up the duty doctor, nurses and technicians all have the ability to influence the use of a medication. On many occasions the nurses can alter charts and the technicians can promote the benefits of a medication to the doctor at a government set up. A chemist can also alter the brand by simply saying that a particular brand is unavailable at his shop and replace it with a similar brand.

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Main objective- The participants must know that it is just not one doctor that influences, but many others like doctors at various stages of the flow of patient in a hospital influence the usage of medications. From Emergency room – to Cath lab- to ICU – to ward- to discharge.

Story – In the royal Mughal era, a small businessman is caught for parking his bullock cart in the no parking area. The royal soldier who identified this mistake asks for the bullock cart to be towed. The small business man begs and pleads for forgiveness but the royal soldier does not listen to his pleas and tows the bullock cart away to the royal barricade. The business man then goes to the chief sultan who was in charge of controlling crime in the Mughal city; he was a loyal warrior to the king. He asks for forgiveness and the release of his bullock cart but the sultan is stern –“your offence has no forgiveness, your bullocks will be sacrificed”. Disheartened he goes to seek the advice of “the man who wore the red tie”

         After meeting the “man who wore the red tie”, the business man enters the royal palace. He meets the maids, the cleaners, the ministers and the royal chefs. He tells them that there shall no more be delivery of the special rice to the royal palace as his bullock cart had been towed away. If they wanted that rice to be delivered again, they would have to convince the king to release his cart. Soon the king questioned why his special rice was not served and the queens, maids and chefs explained to him the reason. The next day the sultan was called and asked to release the bullock cart to the business man after charging him a fine instead.

       Moral – it’s not only the main persons who are always important, lots of others can play a role in influencing an outcome.

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  1. Negotiator + Alliance builder

Negotiator- In an institution there is a purchase committee meeting at fixed intervals usually at 2 months) durations to decide what medications should the hospital pharmacy purchase? This committee usually comprises of a group of doctors and administrative faculty. The MR keeps a track of these meetings and influences these committee members to promote his companies brand in the next forth coming meeting. At the same time applies the medication proposal to the institution for the next committee meeting so that the brand is accepted.

Alliance builder- This is to describe how he has to bring various stakeholders across departments including doctors and pharmacists on the same table. Example could be him conducting an activity across 2-3 departments i.e getting speakers from diabetology to speak to cardiologists about holistic treatment and dealing with co-morbidities.

Story- In the land of the jungle ruled by a lion king, there lived a horse that was struggling to make a living. The horse would mainly run in search throughout the day to bring a rare breed of hairy rabbits into the forest for the wild animals to hunt. This was for his own survival, as the horses would be the next targets once the deer and cows are finished. This rule was followed in the jungle and only when a particular species is eaten to fulfilment, then only the next in line would be hunted. There were very few deer’s and cows left, which made the horse worry even more. He goes to the tiger and says why you consider eating these rabbits next. The tiger smirks, “rabbits? I thought we ate them all”. The horse explains that these are a rare breed that has survived and there are lots of them. The tiger is not pleased – “why run behind rabbits when fine meat like your self is next in serving”. The horse is dismayed and goes to the “man who wore the red tie”. After receiving the advice the horse asks the tiger, who takes the decision on these rules of which animal gets eaten next. The tiger replies” the lion, the elephant and the peacock. don’t worry, they would never agree to include your hairy rabbits for hunting anyways”.

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The horse then organises a fitness meeting where all the animals from different domains are invited to check if they were overweight. The lion, elephant and the peacock were also present. the horse invited a doctor cheetah to give a talk who reported that 80 per cent of the animals were turning fat and are at risk for heart disease. He advised them lots of exercise and high fibre in diet. The horse then mentions to everyone that these hairy rabbits were high in fibre and tough to catch, so would be great exercise while hunting. In the next committee meeting the rabbits were decided as next on target.

  1. Negotiator + planner

A MR strategizes how a medical product / medicine can be sold in large numbers. So in addition to marketing it to individual doctors, the MR tries to sell the medication to the pharmacy. The pharmacy usually requires some number of prescriptions( 20 -30/month) to come from the doctor in order to procure a particular drug into the pharmacy. Therefore even though that particular brand is unavailable in the pharmacy, the MR asks the doctors to prescribe that same brand, just so that it bounces of the pharmacy counters and the pharmacy then decides to procure these medications.

             Story- The fashion industry was at its peak, when a crazy fashion designer came up with the     idea of creating a furry tail out of animal fur. He was very proud of his creation and was certain this would make a fashion breakthrough. He calls his marketing team and asked them to have these tails sold at traffic signals. They all thought he had lost his mind but reluctantly agreed to do what he ordered. The sales were zero and no body wanted to buy a tail that they could attach to their bottoms. The sales men were frightened that they might get fired if they do not sell any tails. They then go to the “man who wore a red tie.” Soon after this they all head out a clothes showroom all dressed as normal civilians. Each of them goes to the shopkeeper and asks for a tail that matches their clothes. Initially the shopkeeper finds it amusing, but as more and more of these “civilians” ask for such tails he begins to think it can make a good profit. After a while a sales man dressed as himself enters the showroom and asks if they were interested in purchasing the latest hit in the fashion industry- tails for clothes. The showroom executive places a big order and the sales men sell their quota for the day.

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  1. Multi-tasker + partnership manager:

Multi-tasker : This is to bring out how he plans his tasks and balances multiple priorities. For example, he would have clashing appointments with doctors, doctors requesting reps to sponsor meetings, respond to data requests from his line managers, wait for a doctor and hence miss calls and sometimes not fulfil his day’s call quota.

Partnership Manager : This is to describe how he has to bring various stakeholders across departments including doctors and pharmacists on the same table. Example could be him conducting an activity across 2-3 departments i.e getting speakers from diabetology to speak to cardiologists about holistic treatment and dealing with co-morbidities.

Story- A 35 year old happily married man was living with his lovely wife and 2 children in a 2 bedroom flat in Bangalore. He was a successful businessman with a flourishing business. He had 3 relationships with three other women apart from his wife. Typically he would spend 3 months with each of them, claiming to tour the rest of the year for business, but to his surprise he was told that all the three are arriving to Bangalore to meet him for one day, each unaware of his other existing commitments. He could manage all of them when they stayed in their own cities but had no clue how he would manage them together. He then went to the “man who wore a red tie” and took his advice.

In a days time he organized an “employees reunion party” event where all the old employees would meet for a get together. In a short notice many of his friends, colleagues and employees turned up. He told his other relationships individually to meet him in the party as he has organised it. In this party he brought along his wife and openly met and greeted his other three relationships one at a time. Each woman thinking that he is meeting an old colleague. After spending time with each of them, they all left back to their cities again.

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  1. Strategist + new business acquirer – Understanding where the prescription is getting switched/substituted and taking action accordingly; understanding what is the drug policy/protocol of the hospital; understanding who are the doctors who could give you more business & how to get new departments to give the rep business.

Nurses and technicians are also useful influencers. This means that If the MR is in good terms with these nurses and technicians, he can basically monitor whether the doctor is prescribing that particular brand or not. If not, then what is the reason and how to tackle it.

Story- This is the first day of a hard working Medical representative, who tries really hard to impress the doctors to prescribe his companies medications. But when he checks at the pharmacy he realises that there have been no prescriptions for his brand medication. He continues to work hard day and night, yet no prescriptions. He seeks the advice of “ the man who wore the red tie” and takes his advice.

The next day the MR be friends the nurses and technician and asks them to find out whether the doctor is prescribing his brand name. To his surprise he finds out the the doctor has been prescribing only his brand name. But why are there no sales of the medications.              He then convinces the technician to pretend that he is a patient and takes his brand prescription to the chemist; the chemist says no stock for that medication and prescribes him a similar brand. That’s when the MR realises that the switch was occurring at the chemists shop. He makes a deal with the chemist to give him a share for issuing the drug mentioned. The MR also finds out from the nurses and post graduate students, who is the doctor who makes the medicine protocol and specifically promotes the medications to him. Soon the sale of his brand increases.

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