Improv to improve medical student communication.

BACKGROUND: Effective patient provider communication skills can be difficult and time-consuming to teach. Deliberate practice of communication skills through improvisational theatre exercises, with structured debriefing, can provide a solution for teaching patient-centred communication skills in time-limited settings. The objective of this study was to determine if improvisational theatre exercises improved the ratings of patient satisfaction and empathetic communication by standardised patients. METHODS: This was a randomised controlled trial looking at the effect of improvisational theatre exercises on ratings of patient satisfaction and empathetic communication. Third-year medical students (n = 188) participated in a formative team-based standardised patient (SP) experience. Prior to the SP experience, teams of students were randomly assigned to receive a 45-minute communication-focused improvisation intervention (immediately before the SP experience) or to a control arm without intervention. All teams then participated in the SP experience; the SPs (blinded to team randomisation assignment) then assessed each team's empathetic communication and completed patient satisfaction questions focused on physician behaviours derived from Press GaneyTM and the Hospital Consumer Assessment of Healthcare Providers and System SurveysTM . Fifty teams of three or four students participated; 20 teams in the intervention arm and 30 teams in the control arm. RESULTS: Student teams in the improvisation intervention group had increased measures of empathetic communication (p = 0.04) compared to the control group. The intervention group had increased patient satisfaction survey ratings of 'ability to listen carefully' (p = 0.001) and of 'physician skills' compared to control groups (p = 0.03). DISCUSSION: Improv exercises with students increased students' empathetic communication and patient satisfaction as assessed by standardised patients.

Writing Well: The Long-Term Effect on Empathy, Observation, and Physician Writing Through a Residency Writers' Workshop.

BACKGROUND: Writing narratives during medical training can provide a way to derive meaning from challenging experiences, enhance reflection, and combat burnout. The Yale Internal Medicine Residency Writers' Workshop, an annual 2-day intensive workshop followed by faculty-guided writing revision and publication, has been training resident physicians in the craft of writing since 2003. OBJECTIVE: The study aimed to assess the long-term effects of a craft-focused writers' workshop for residents on empathy, observation skills, and future writing. METHODS: A survey of closed and open-ended questions was sent to former workshop participants (2003-2013), who rated and described the workshop's influence on their observation skills, empathy, improvement in writing, and continued informal and formal writing. A total of 89 of 130 participants (68%) completed the online survey. We identified key themes in written responses and collected quantitative ratings on a 5-point Likert scale of self-reported influence on these factors. Simple statistics and narrative analysis were used to derive results. RESULTS: Most participants agreed or strongly agreed that the workshop influenced their ability for careful observation (72 of 85, 85%); ability to be empathic with patients or colleagues (51 of 77, 66%); quality of writing (69 of 77, 90%); and continued formal or informal writing (52 of 77 [68%] and 41 of 77 [53%], respectively). Participants felt the workshop improved their attention to detail, provided a deeper understanding of others' experiences, and improved their writing. CONCLUSIONS: Participants in a residency writers' workshop experienced lasting effects on observation, empathy, and writing skills.