IMPROV AND HEALTHCARE: THE GROWING FIELD OF MEDICAL IMPROV
Medicine and improv. You’re thinking, “Maybe let’s not mix those? I don’t want my surgeon improvising.”
I am sorry to tell you, but medicine and improv have already begun to mix, and by the time you finish this article, you’re going to have no other choice but to throw your phone to the floor and passionately scream, “I want my doctor to be an improviser! Someone call Justin Trudeau for me because my screen is cracked!”
WHY ARE MORE MEDICAL PROFESSIONALS IMPROVISING?
The growing field of medical improv brings the tools of theatrical improvisation to the world of medicine to improve clinician cognition, communication, teamwork and ultimately patient-care.
Improvisers are required to listen deeply and react productively in the moment. Similarly, physicians, nurses and other clinicians use mental agility to react to new and rapidly changing situations with the added pressure of time constraints and life-and-death moments, all the while maintaining professional composure.
Physician-patient communication may be structured to some degree, but is rarely scripted - making it in part, if not entirely, improvised. The practice of preparing for inherent unpredictability in medicine, makes improv training a value-add. In fact, 95% of medical students who attended a improv seminar between 2002-2010 at Northwestern University Feinberg School of Medicine, agreed that “studying improv could make me a better doctor,” and 100% agreed with the statement of “I would recommend this class to other medical students.”
You may have caught wind of this idea from the press surrounding Alan Alda’s new book If I Understood You, Would I Have This Look on My Face?: My Adventures in the Art and Science of Relating and Communicating. The book documents Alda’s journey from a TV actor to using improv techniques with engineers, doctors and scientists and the subsequent creation of The Alan Alda Institute for Communicating Science at Stony Brook University in New York. The book highlights empathy as the secret-sauce of effective communication (whether in medical, academic, or personal relationships) and suggests that improv exercises are one way to improve empathy scores.
Programs from The Alan Alda Institute for Communicating Science, focusing on human connection and communication, are now being taught at 17 medical schools and universities worldwide. Similarly, Katie Watson, an Assistant Professor of Medical Education and Bioethics & Medical Humanities at Feinberg School of Medicine, offers a 10-hour selective course on ‘medical improv’ - a term they coined. Additionally, they offer an annual five-day Train The Trainer course to prepare medical professionals to bring the teachings back to their home institutions.
THE CANADIAN SIDE:
On our side of the border, a prominent figure in the medical improv field is Hartley Jafine.
Hartley is a professor at McMaster University teaching theatre-based courses within the undergraduate health science program. Hartley also facilitates a medical improv curriculum with the Department of Family and Community Medicine at Sunnybrook Health Sciences, and hopes to expand the program to hospitals across Toronto. I spoke with Hartley in late October:
“Within medicine there is such an to appetite to engage with improv and play. While some groups I work with are initially skeptical, once they do the work, and they really engage, they all have that experiential ‘ah-ha’ moment and there is a release of value and joy in it.”
However, this wasn’t always the case.
“When I first started working at McMaster in 2008, the response I got from Medicine was initially, ‘Don’t have time'. Part of this is because medicine is a very evidence-based discipline and there was limited evidence. Now there’s a lot research that’s being published that highlights how improv and theatre can have impact on the training of health care professionals and all seventeen Canadian medical schools have some sort of humanities component within their curriculum.”
Hartley explained that this component is elective in most Canadian medical schools. However there is at least one medical school in the United Kingdom where it is core curriculum.
“The other piece I am often amazed by is, while theatre and improv are fairly new within educational health sciences settings, the medical school musicals are not. U of T’s annual medical school musical started in 1911 [...] and Western’s in 1956. The shows are entirely written, produced, choreographed and performed by medical students. The shows are spectacular in terms of their artistic quality...”
“...First of all it’s amazing to see there’s so much talent, and also to have so much history it’s got be ‘doing something’ and I started applying the applied theatre lens to it. The medical school musicals often highlight the current anxiety and fears students experience at the time. So, it’s very much being used as a vehicle to subvert the cultural norms through humour and chaos.”
Hartley’s focus goes beyond just health practitioner skills development and also addresses burnout and compassion fatigue (which is also becoming an increasing concern in Canadian Medical Schools). Hartley is a mainstay at the Ontario Medical Schools Association’s Wellness Retreat, an annual weekend program designed to help medical students focus on their personal wellness.
Kayla Simms, attended this conference in 2015. Presently, Kayla is now an MD specializing in psychiatry and a Level Four Improv Student at The Making-Box. Here’s what Kayla had to say:
"Good medicine is undoubtedly more than a set of technical decisions, pharmaceutical therapies, or surgical interventions. Good medicine demands empathy, insight, trust, and an understanding of the human experience of suffering. For me, doing improv with the Making-Box promotes these attributes. It encourages reflective, empathetic, and analytical skills while also prioritizing my own wellness and healing. Medicine presents demanding levels of responsibility, environments of genuine human emotion, and exceptional standards of professional conduct. Without an outlet for creative and authentic expression, health care practitioners run the risk of shutting down as a protective response to the emotional labours of bearing witness to suffering. Improv not only informs medicine through unique insights into the clinical encounter, but also encourages the development of healthcare workers who will better serve their patients by also taking care of themselves. Improv reminds us that we are human beings."
We all want a doctor who is an empathic, active listener, willing to provide spontaneous individualized care. We want them to communicate a path to wellness that is jargon-free and connects with us at our level. It seems health-care may well need improv.
We at The Making-Box are doing our part to help. Our staff team does not yet include a medical professional - maybe Kayla will fill that role someday - however, we do know a thing or three about achieving better listening and collaboration using the tools of applied improv.
Over the next few months we are delighted to be bringing improv training to teams at McMaster University’s Postgraduate Medical Education Office and the Region of Waterloo’s Public Health.
SOMETHING TO TRY:
Want to try to boost your own empathy score? Try this practice borrowed from Alan Alda’s aforementioned book:
Empathy is about understanding how others are feeling. This simple practice can guide you in the direction of connection. For one full week, whenever you interact with someone for more than 5-seconds, take a moment to note the emotion they are presenting. Say you’re checking-out at the grocery store, you note the cashiers name tag, their quiet hello and inside your head you could say, ‘Marsaye is worn-out’. Or maybe you’re arriving at The Making-Box and Hayley greets you cheerily at the door. You might note that, ‘Hayley is giggly’. Noting what someone is feeling is the first step to understanding how they are feeling. Try this for a full week. Let us know how it goes.