I get nervous…
I don’t feel I had enough training in counselling skills.
You’re not alone.
Listen to the content of this page here:
Traditional teachings in client counselling, using assessment forms and checklists, can promote rigid and “one size fits all” treatment plans, which takes the client’s experiences out of their care.
The tools of improv differ from simulation and offer a creative skill set you can use immediately to provide person-centred care that is truly intuitive, individualized, non-judgemental and collaborative for diverse populations.
But don’t just take my word for it…
Publications have shown improv training builds skills in healthcare related to active listening, communication, teamwork, collaboration, receiving feedback, handling unexpected situations and supporting mental well-being.
How does this relate to healthcare delivery outcomes?
Inter-professional collaboration and patient-centred care is at the forefront of organizational remodelling in healthcare (Health Force Ontario, 2007; TOH, Inter-professional Model of Patient Care, 2009). Organizations work with limited budgets. Healthcare professionals need to work creatively and collaboratively with their patients, clients and peers to deliver effective care that maximizes limited resources.
Existing theory and training in communication may miss the mark when it comes to training intuitive interpersonal responses or working with unexpected issues. As stated by Shochet et al. (2013), “One could argue that existing approaches in teaching medical learners communication skills may promote rigid and stereotyped responses.” Case and Brauner (2010) state that there is a “pressing need for teaching methods that encourage empathy in both undergraduate and postgraduate medical curricula.”
Improv in medical curricula
In 2005, the University of Arizona College of Pharmacy introduced improv training into their Counselling Skills course (Boesen et al., 2009). In 2004, standardized patient examination scores demonstrated students were failing to recognize initial cues from patients. Performance in this area, overall scores and the number of perfect scores all increased after improv was introduced into the curriculum.
The Mayo Medical School and the Mayo Clinic Centre for Humanities in Medicine also piloted a program using theatre training called “Telling the Patient’s Story.” (Hammer et al., 2011). All the students agreed that the course helped them to be better listeners and improved their delivery of patient histories. Another study reported the same improvement in active listening (Hoffman et al., 2008). As Watson (2011) puts it:
“some medical students are comfortable speaking up but are poor listeners because their minds are racing to compose the next thing they will say.”– Katie Watson, JD, Assistant Professor of Medical Education and Bioethics & Medical Humanities at Feinberg School of Medicine, Northwestern University
In qualitative reports from Boesen et al. (2009), students reported being better able to deal with unexpected situations. Of medical students taking an improv class at Chicago’s Northwestern Feinberg School of Medicine, 93% of students agreed that “this class helped me to be a more flexible and resourceful person.” (Watson, 2011)
Improved teamwork, collaboration, ability to receive feedback, support for mental health and the ability to deal with stressful and ambiguous situations are other outcomes of improv training in healthcare discussed in publications.
Why we need to practice creativity
Being creative is finding the solution that no one else has thought of before (Watson in Second City Works, 2017). We need creative healthcare professionals. Each patient presents a unique set of issues and determining factors for success. Yet, traditional didactic teachings only give us the tools for part of the solution. When we learn solutions by rote and repeatedly make the same recommendations (as if by a script), we have taken the patient’s experiences out of their care (Case and Brauner, 2010).
To avoid stereotyped delivery of patient care, more is needed to increase confidence, compassion, collaboration and creativity to roll with the unexpected in healthcare settings. Healthcare professionals must own a creative skill set to provide patients and clients solutions that fit.
How does improv offer this solution?
When we work with patients and clients, we may have a template for how to assess and manage their health concern. However, we never have a complete script, and patients certainly don’t want us to always read from one.
Improv training teaches us how to really listen and connect with our patients and clients. Improv helps us to become comfortable working with unexpected moments, and to turn these moments into great opportunities. Improv shows us ways we can collaborate to find solutions no one’s thought of before.
By default, practicing improv also supports public speaking skills, empathy, compassion, and taking a non-judgemental stance in our work. These skills align with organizational models of care that are patient-centred and inter-professional.
Finally, improv training has been previously evaluated and recommended for use in health care training (Boesen et al., 2009; Hammer et al., 2011; Watson, 2011; Case and Brauner, 2010). Indeed, 95% of students who took an improv class as part of their medical school training agreed that “studying improv could make me a better doctor.” (Watson, 2011)
Boesen, K., Herrier, RN., Apgar, DA., Jackowski, RM. Improvisational exercises to improve pharmacy students’ professional communication skills. American Journal of Pharmaceutical Education 2009;73: Article 35.
Case, GA., Brauner, DJ. Perspective: The Doctor as Performer: A Proposal for Change Based on a Performance Studies Paradigm. Acad Med 2010;85:159-63.
Hammer, R., Rian, JD., Gregory, JK., Bostwick, JM., Birk, CB., Chalfant, L., Scanlon, PD., Hall-Flavin, DK. Telling the Patient’s Story: using theatre training to improve case presentation skills. J Med Ethics; Medical Humanities 2011;37:18-22.
Health Force Ontario, Interprofessional Care Steering Committee. Interprofessional Care: A Blueprint for Action in Ontario. July 2007.
Hoffman A., Utley, B., Ciccarone, D. Improving medical student communication skills through improvisational theatre. Medical Education 2008;42:513-43.
Podcast by Second City Works “Getting to Yes, And,” hosted by Kelly Leonard, April 10 2017. Katie Watson, Northwestern University – Medical Improv. Accessed online secondcityworks.com Jan 2018.
Shochet R, King J, Levine R, Clever S, Wright S. “Thinking on my feet”: an improvisation course to enhance students’ confidence and responsiveness in the medical interview. Educ Prim Care. Feb 2013;24(2):119-24.
The Ottawa Hospital/L’Hôpital d’Ottawa Inter-Professional Model of Patient Care© TOH IPMPC© Manual: Implementation and Tools 1.3.1 TOH IPMPC Guiding Principles, Revised October 2009 accessed onlineottawahospital.on.ca January 2018.
Watson, Katie. Perspective: Serious Play: Teaching Medical Skills With Improvisational Theater Techniques. Academic Medicine October 2011;86(10):1260-5.