Using improvisation to enhance communication skills in 4th year medical students

In healthcare settings, effective communication between clinicians and patients is a critical skill that promotes optimal care and health outcomes. However, in medical education, there has been relatively little emphasis on developing students' skills to deal with a variety of communication scenarios they may experience in their practice. These early encounters in medical education are critical, as they shape behaviour patterns that can continue into residency and beyond. As a result, there is a need to develop innovative pedagogical approaches that help students gain self-confidence in their communication skills and cultivate empathy in their interactions with patients, families and colleagues. Medical improvisation offers promise as an adaptation of improvisational theatre principles and role play to improve communication and teamwork in medical practice.¹

To address the challenge of effective clinical communications with patients, families and co-workers, our health humanities faculty implemented an innovative course entitled ‘Medical Improv’ as a selection for the required MS4 elective. The course offers medical students an introduction to the basic skills of improvisation and an understanding of how they can be used in a variety of clinical settings. This approach has been shown to help students respond to unexpected events, address patient concerns and communicate more confidently.¹ Examples of course activities include: warm-up exercises involving teamwork, storytelling, body movement and mirroring; structured role playing to explore the non-verbal aspects of patient-clinician communication; and writing about how a challenging medical school situation could be addressed with improv techniques. The course includes eight 2.5-hour sessions within one semester.

Over the past year, the Medical Improv course has consistently resulted in nearly full enrollment (24 students). In both written course evaluations and oral feedback, students described how the use of improvisation in their class activities could improve their communication skills in their clinical practice. Students also developed insight into how medical improv training can enhance awareness of environmental factors such as the room set-up, which may influence the clinical encounter.

Students kept a reflective journal that indicated a progressive development of understanding the interrelations between communication skills, mindfulness, empathy, teamwork and patient care. The course helps students develop communication, listening and observational skills that can contribute to a more grounded and robust professional identity as well as more effective and empathic interactions with both patients and co-workers. Future studies will examine how this training might help to mitigate stress and burnout in the clinical setting.

This project has been approved by institutional review boards at Penn State College of Medicine.