Exploring the Value of Improvisational Theater in Medical Education for Advancing the Doctor-Patient Relationship and Health Equity

Jennifer M Rusiecki; Nicola M Orlov; James A Dolan; Michael P Smith; Mengqi Zhu; Marshall H Chin

doi:10.1097/ACM.0000000000005183

Exploring the Value of Improvisational Theater in Medical Education for Advancing the Doctor-Patient Relationship and Health Equity

Acad Med. 2023 Jun 1;98(6S):S46-S53. doi: 10.1097/ACM.0000000000005183. Epub 2023 May 23.

Authors

Jennifer M Rusiecki¹, Nicola M Orlov², James A Dolan³, Michael P Smith⁴, Mengqi Zhu⁵, Marshall H Chin⁶

Affiliations

¹ J.M. Rusiecki is assistant professor of medicine, Department of Medicine, and Women's Health Track Director, Internal Medicine Residency, University of Chicago, Chicago, Illinois.
² N.M. Orlov is associate professor of pediatrics, Department of Pediatrics, associate program director, Pediatric Residency Training Program, clerkship director for pediatrics, Pritzker School of Medicine, and junior faculty scholar, Bucksbaum Institute for Clinical Excellence, University of Chicago, Chicago, Illinois.
³ J.A. Dolan is a research fellow in science communication, King's College, Cambridge, assistant teaching professor, Engineering and Physical Sciences Research Council (EPSRC) Centre for Doctoral Training in Nanoscience and Nanotechnology (NanoDTC), Department of Physics, and improv performer and instructor, Cambridge University Science Improv, University of Cambridge, Cambridge, United KingdomORCID: https://orcid.org/0000-0001-5019-1544 .
⁴ M.P. Smith is assistant professor of medicine, Department of Internal Medicine, University of Nebraska Medical Center, Division of Hospital Medicine, and improv performer and instructor, The Backline Theater, Omaha, Nebraska.
⁵ M. Zhu is a statistician, Department of Medicine, University of Chicago, and a PhD student in biostatistics, University of Illinois Chicago, Chicago, Illinois.
⁶ M.H. Chin is Richard Parrillo Family Distinguished Service Professor of Healthcare Ethics, Department of Medicine, University of Chicago, senior faculty scholar, Bucksbaum Institute for Clinical Excellence, co-director, Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation National Program Office, co-director, Merck Foundation Bridging the Gap: Reducing Disparities in Diabetes Care National Program Office, and member, Excited State improv troupe, The Revival Theater, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1924-5641 .

Abstract

Purpose: Health care inequities persist, and it is difficult to teach health professions students effectively about implicit bias, structural inequities, and caring for patients from underrepresented or minoritized backgrounds. Improvisational theater (improv), where performers create everything in a spontaneous and unplanned manner, may help teach health professions trainees about advancing health equity. Core improv skills, discussion, and self-reflection can help improve communication; build trustworthy relationships with patients; and address bias, racism, oppressive systems, and structural inequities.

Method: Authors integrated a 90-minute virtual improv workshop using basic exercises into a required course for first-year medical students at University of Chicago in 2020. Sixty randomly chosen students took the workshop and 37 (62%) responded to Likert-scale and open-ended questions about strengths, impact, and areas for improvement. Eleven students participated in structured interviews about their experience.

Results: Twenty-eight (76%) of 37 students rated the workshop as very good or excellent, and 31 (84%) would recommend it to others. Over 80% of students perceived their listening and observation skills improved, and that the workshop would help them take better care of patients with experiences different than their own. Six (16%) students experienced stress during the workshop but 36 (97%) felt safe. Eleven (30%) students agreed there were meaningful discussions about systemic inequities. Qualitative interview analysis showed that students thought the workshop helped develop interpersonal skills (communication, relationship building, empathy); helped personal growth (insights into perception of self and others, ability to adapt to unexpected situations); and felt safe. Students noted the workshop helped them to be in the moment with patients and respond to the unexpected in ways more traditional communication curricula have not. The authors developed a conceptual model relating improv skills and equity teaching methods to advancing health equity.

Conclusions: Improv theater exercises can complement traditional communication curricula to advance health equity.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Communication
Curriculum
Education, Medical*
Health Equity*
Humans
Physician-Patient Relations
Students, Health Occupations*
Students, Medical*

Grants and funding

P30 DK092949/DK/NIDDK NIH HHS/United States