Students gain confidence and speed in accessing information on the spot

While acting out a two-person scene during a course in medical improvisational theater, second-year medical student Owaiz Ansari deliberately waited several seconds before responding to his classmate.

“We had to process what they were saying before responding to them. The scene became very in-depth and emotional when people had time to think about what they were going to say,” Ansari said.

Ansari said he chose to take the seminar to improve his communication skills. As part of Feinberg’s curriculum, medical students are required to take a five-week seminar in medical humanities during their first and second years through the Center for Bioethics and Medical Humanities.

“This type of activity will help me not just in patient interactions, but also when I start working with attendings. I’ll be able to digest what I’m hearing better and take a second to think about it. And, hopefully, be able to create a clear mindset and have a goal in mind when I respond,” Ansari said.

Katie Watson, JD, associate professor of Medical Education, is the director of the course, called “Playing Doctor: Improving Doctor-Patient Communication Through Improvisational Theater.”

“I’m hoping students will identify, reinforce and retain the communication strengths they bring, and also identify communication challenges they may have, and start improving them,” Watson said.

While the seminar is focused on doctor-patient communication skills, there are no specifically medical scenarios or prompts. Watson creates or modifies theatrical improv exercises that correlate with general skill sets medical students will need to use in their profession.

“I think of it as cross-training. Why does the runner do sit-ups? It doesn’t look like it makes sense, but you’re building a muscle in a different way,” Watson said.

During each two-hour session, students perform a few exercises around a theme, then after completing the exercises, they debrief and discuss how they can apply what they learned in medicine. In an article recently published in Annals of Internal Medicine, Watson discusses the educational benefits of the medical improv course, which including adaptability, spontaneity, deep listening, building trust and teamwork.

Medical students cultivate skills like adaptability, spontaneity, deep listening, building trust and teamwork while performing improv exercises.

Medical students cultivate skills like adaptability, spontaneity, deep listening, building trust and teamwork while performing improv exercises.

“When reflecting on an activity, we would say this is a situation that would make sense if you were with a patient and have to think on the spot, or when you are explaining a diagnosis — it was nice to see those parallels,” Ansari said.

As the course progresses, Watson said, “I see the students becoming more confident, more relaxed and more quickly accessing all the information and skills they possess.”

Connection Between Improv and Medical Practice

While completing her fellowship at Northwestern in bioethics and performing improv on the weekends, Watson noticed overlaps between the skills required of improvisers and of physicians. So she tested the idea of an improv theater seminar for medical students. After receiving positive feedback, she started the course in 2002.

Since then, Watson has refined the curricula through trial and error.

When Watson tried more traditional medical scenarios in past versions of the course, she watched the medical students turn into “robots.”

“Sometimes these warm, eloquent and insightful young people suddenly become very awkward when you put them in the doctor role,” she said. “When I see the struggle like that with this new persona, it looks like they are trying to be someone else’s character of the doctor.”

By focusing the course on recognizing their own strengths and weaknesses, Watson can encourage students to think how they can develop their own professional identities as physicians.

For example, students in one exercise practiced recognizing power dynamics in talking to different audiences and through role-playing.

“I’m definitely going to be more aware of how I compartmentalize my emotions between different encounters, or when I’m in a conversation with patients or physicians, knowing when I should introduce new information and when I should lay back and allow other people to contribute,” said Philip Dinh, a second-year medical student.

Watson has also developed a course to train others nationally to teach the course and implement it at their own institutions.

Tailoring Improv Skills to Physician Needs

While Watson originally designed medical improv for undergraduate medical students, over the years she has created additional workshops for graduate and continuing medical education audiences.

Watson has developed new exercises for these specialized workshops using the principles of improv to target specific medical communication goals, such as teamwork between different medical professionals.

Watson said she plans to continue training more instructors nationally, advancing the work through new applications and conducting outcomes research.

“To take on the intellectual and emotional challenge of providing healthcare, physicians need all of their personal and emotional resources to meet the needs of their patients,” Watson said.