Common Ground: Frameworks for Teaching Improvisational Ability in Medical Education

Abstract

Issue: The practice of medicine is intrinsically unpredictable. Clinicians must respond skillfully to this uncertainty; therefore, medical educators are using improvisational theater training methods to teach improvisational ability in areas such as communication and professionalism. This teaching approach is called “medical improv.” Although early reports of medical improv suggest promise, the collective descriptions of curricular content lack consistency. This ambiguity creates impediments for further implementation and research of this new educational technique. To address this challenge, the author presents two unifying conceptual frameworks for medical improv curricula. Evidence: Medical improv evolved from previous work done in improvisational (improv) theater and “applied improv,” which is the broader category of improv-based training in nontheater environments. The author synthesized curricular elements from all three fields of improv into two conceptual frameworks: core curricular components (skills, principles, and exercises) and core skill groups (attunement, affirmation, and advancement). The curricular component framework simplifies terminology and clarifies a previously vague distinction between skills and principles. The skill group framework harnesses a redundant and wide-ranging list of improv skills into three categories. Together, the frameworks provide a simple structure that encompasses and organizes the core concepts of medical improv. Implications: These curricular frameworks enable educators and learners to more easily understand the scope and depth of medical improv concepts and to identify areas where medical improv could enhance existing medical education strategies. For example, there is substantial overlap between improvisation skills and current curricular objectives for communication skills, as outlined by Accreditation Council for Graduate Medical Education benchmarks (e.g., Milestones, Competencies, Entrustable Professional Activities). Medical improv courses could be an efficient way to achieve many of these objectives. In addition, improv-based exercises represent an experiential learning modality that is underutilized in communication skills training; therefore, exercises could be integrated into existing coursework to bridge the learning pathway between texts and simulation. Furthermore, the deliberate cultivation of affirmation skills could enhance resilience and wellness in clinical and learning environments. In summary, through their conceptual simplicity, these curricular frameworks for medical improv can help educators understand, study, and optimize teaching of improvisation in medical education.

Keywords:

• improvisation
• adaptive expertise
• uncertainty training
• communication skills
• medical improv

Acknowledgments

I thank Byron Joyner, Lynne Robins, Amy Windover, Alex Reed, Winslow Gerrish, Lindsay Grimm, Andrea Creel, and Paul Fu, Jr. for their generous assistance in reviewing this article, and Katie Watson for her mentorship, guidance, and enduring support.

Selected themes expressed in this article have been presented at individual academic institutions as invited seminars.

Declaration of interest

The author is founder and director of the Mayutica Institute, an independent educational entity. She is also a professional improvisational theater performer at Unexpected Productions (Seattle, WA). The author received no financial resources or compensation for development of this manuscript from her affiliated institutions. The author has disclosed these interests fully to Taylor & Francis and has in place an approved plan for managing any potential conflicts arising from these involvements.