“Yes, and…”: How Improv Techniques Enhance Medical Training

From the 4/9/2021 newsletter

Medical Humanities Perspective/Opinion

“Yes, and…”: How Improv Techniques Enhance Medical Training

Erica Chou, MD and Sara Lauck, MD

Drs. Chou and Lauck discuss the parallels between interpersonal interactions in theater improv and at the bedside. Improv offers a way to hone critical clinical skills …

Attunement, affirmation, and advancement. These are the core skills of improv, and of all interpersonal interactions. Attunement means to be present and focused, deeply listening. Affirmation is to acknowledge the other person's truth and to find common ground, even at times of disagreement. Advancement uses that common ground to move the conversation and interaction forward. In short, these skills embody the “yes, and” tenant of improv. 

These same skills are essential in the practice of medicine. Good communication with patients, families and healthcare team members requires active listening and adaptability. A quality of empathy is recognizing others’ perspectives as their truths. Listening, acknowledging, and responding productively are the foundation of creating psychological safety on a team. The relevancy and applicability of improv in healthcare is where medical improv comes into play. 

Here’s an example of Medical Improv

Medical improv is the adaptation of theater improv skills and principles to the healthcare setting. It is a type of experiential learning, where learners participate in improv exercises and then debrief afterwards. While the exercises themselves teach learners to be spontaneous and think on their feet, it is the unpacking of their actions, behaviors and feelings during the exercises that allows learners to reflect and make connections to medicine and other aspects of their lives. 

An example is an exercise called Word at a Time Story. In this exercise five to six people stand in a line. They are given the title of a story and asked to make up a story together where each person says one word at a time. This exercise is incredibly challenging. The natural tendency is for everyone to think of their own story and to try to plan what word they are going to say when it is their turn. But then the sentences that are created make no sense grammatically and the story does not come together. To be successful with this exercise, participants need to focus, be present and listen intently; and if they do these things, then they can trust that when it is their turn to speak, they will say a word that aligns and advances the story.  

How does this relate to medicine?

These same skills can be applied when obtaining a patient history. Rather than approaching the patient encounter with a list of pre-prepared questions to ask, students learn with medical improv to listen and respond to their patients, and to embrace the path the conversation takes.

After attending the 5th International Medical Improv Train-the-Trainer Workshop in 2018, we developed a two hour-long medical improv workshop based on Katie Watson’s Playing Doctor course at Northwestern University Feinberg School of Medicine.2 Our workshop includes the above exercise, as well as several other improv exercises that explore the concept of “yes, and,” emotions, leading/following, and status. We have presented our workshop for a variety of different audiences, including high school, undergraduate and medical students, residents, faculty, staff and interprofessional teams. 

Please contact Erica Chou echou@mcw.edu or Sara Lauck slauck@mcw.edu if you are interested in having a medical improv workshop for your learners, section or team. 

For more reading

Belinda Fu (2019) Common Ground: Frameworks for Teaching Improvisational Ability in Medical Education, Teaching and Learning in Medicine, 31:3, 342- 355, DOI: 10.1080/10401334.2018.1537880 

Katie Watson (2011) Perspective: Serious Play: Teaching Medical Skills with Improvisational Theater Techniques, Academic Medicine, 86:10, 1260-1265, DOI: 10.1097/ACM.0b013e31822cf858

Erica Chou, MD is an Assistant Professor of Pediatrics (Hospital Medicine) at MCW. She is a member of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Sara Lauck, MD is an Assistant Professor of Pediatrics (Hospital Medicine) at MCW and the Pediatrics Clerkship Director.