The core principles of improvisation—equality, collaboration, flexibility, responsiveness, differing perspectives—can be applied to anything from comedic theater to a hospital room.
Dr. Carolyn Chan, a first-year resident at University Hospitals, was looking for a research project last fall when a mentor suggested she combine her long-time hobby of improv with her medical work—something she hadn't thought to do before. Soon, she began using improv as a tool when something was going wrong in a conversation with a patient.
“With patients who are really angry at me for whatever reason, I'll try to calm them down by trying to find something to actually agree on,” Chan said. “So that's the first rule of improv: 'yes, and.' It's hard to argue with someone if you find something to agree on.”
She worked to develop a curriculum and in February began teaching her fellow residents how to apply improv to their work. So far, she's trained about 30 of her peers at UH and Louis Stokes Cleveland VA Medical Center.
The Cleveland Clinic has also incorporated “medical improv” into its communication training. The Clinic created sustainment courses to build upon an initial eight-hour communication course all physicians take. In order to practice and expand on those skills, the Clinic wanted to offer a fresh, engaging and fun course that was also highly educational, said Katie Neuendorf, director of the Clinic's Center for Excellence in Healthcare Communication.
Improv fit the bill and is now incorporated as a part of those refresher courses, including the “yes, and” exercise, in which participants have three conversations, each with a rule of starting every sentence with either “yes, but,” “no” or “yes, and.”
It gets people thinking about what it feels like if every time they say something, they're met with a “no” or “yes, but” response, which can feel adversarial and dismissive. The alternative “yes, and,” feels collaborative.
Staff brought these techniques back to the Clinic to teach others after attending a workshop led by Katie Watson, an assistant professor in the medical humanities and bioethics program in Northwestern University's Feinberg School of Medicine. Watson coined the term “medical improv” in 2002 when she created a seminar to combine those two parts of her life.
“I realized that in many ways, physicians are being asked to do some similar things that improvisers have to do,” said Watson, who is also an adjunct faculty member of Chicago's Second City Training Center, a school specializing in improv and sketch comedy. “A patient comes in, (physicians) don't know who that 'character' is or what they're going to say, and they have to collaborate to create a shared story and direction for that encounter.”
Seeing her students struggle to do that, Watson brought in some of the principles and training techniques of improv theater: affirming your scene partner's reality; seeing each other as equals in collaboration; recognizing each has something different to offer; and understanding a joint responsibility for the outcome.
Learning to listen is just as important as the core communication skills, said Chan, who hopes to continue teaching improv to more residents and possibly med students. The techniques encourage physicians to think about whether they're really listening with their body and to the patient's words and body language, she said.
“All the clues are right there, but sometimes when our pager's going off, we just don't have time,” Chan said. “So it's a nice reminder to just sit back and listen to your patients or your teammates or your nurse.”
Dr. Jane Wey, assistant professor in surgery at the Clinic, has taken a couple of the refresher courses the Clinic offers. When working on the improv part of that course, there were some puzzled looks in the class as people wondered where the exercises were going, she said, but it becomes clearer.
The class paired up for one exercise, in which one person was of present times and the other played the role of a Rip Van Winkle character who was waking up after being asleep for 200 years.
“So we had to put ourselves in that position of someone who had no comprehension of cell phones, for example, or televisions,” Wey said. “The analogy then would be trying to put yourself in the position of a person with no medical experience and trying to explain a complex procedure or a complex diagnosis.”
Plus, she said, taking yourself completely out of the medical world adds some new perspective.
Watson said this new angle combined with the simple fact that it's a fun activity makes improv an effective teaching tool. It also helps break down communication and allows people to focus and hone skills in small pieces.
“I think of it as working muscle by muscle, like today we're doing biceps. Tomorrow we're doing glutes,” Watson said. “We're going to isolate muscle groups and make sure each is strong before we're going to put the body in motion.”
"Medical improv putting physicians to the test" originally appeared in Crain's Cleveland Business.