What does improv comedy have to do with medicine?
September 22, 2020
A group of first-year Pritzker School of Medicine students are lined up inside Ida B. Noyes Hall, doing an activity called “One Word Story.”
They’ve been given three random words – banana, Hawaii and sleeping. One by one, they go down the line, and each person says a single word. The goal is to build a story centered on those words.
“The,” the first student says, turning toward the next person in line.
“Banana,” says the next student, turning.
“Started,” says the next.
The fourth student in the line pauses. He looks nervous. His mind is obviously racing to come up with a word.
“Dancing!” he finally blurts out, as the room erupts in laughter.
It’s a fun activity, but it serves an important purpose for these future doctors. It forces them to listen. This exercise, like the many others they engage in, makes them realize they don’t know where the story is going to go, so they must pay attention to verbal and non-verbal cues.
Such skills will be critically important when communicating with patients or colleagues, and working on research teams, says University of Chicago Medicine pediatrician Nikki Orlov, MD, a Junior Faculty Scholar working on the second year of a pilot grant to incorporate improv into medical student communications training. The grant is funded by the The Bucksbaum Institute for Clinical Excellence at the University of Chicago.
“This has nothing to do with comedy,” says Orlov, who expects to publish her findings by the end of the year. “It’s all about improving advanced communication skills.”
Orlov developed the program with help from a facilitator at Chicago’s famed Second City to build a curriculum for first-year Pritzker students with the goal of objectively measuring whether this training will impact communication skills.
Improv is now a trendy topic in medical education, as more schools and teaching hospitals recognize the potential benefits. So far, research shows improv classes improve physician-patient care, diagnostic accuracy, reduce potential litigation, and make it more likely that patients will adhere to treatment. They also can help boost empathy, teamwork, quick thinking, and a hospital’s patient satisfaction scores, resulting in better insurance coverage.
University of Chicago Medicine internist Marshall Chin, MD, MPH, recently published a paper that went so far as to say doing improv and stand-up comedy can help reduce health disparities (see sidebar).
Even actor Alan Alda is on board. In 2009, he launched the Alan Alda Center for Communicating Science, which has provided communications and improv training to 15,000 scientists at more than a dozen medical schools and universities, including some half-day workshops at the University of Chicago.
Yet, despite the increased awareness, improv remains an elective for most medical schools, including Pritzker. Sometimes it’s offered as a one-day workshop.
Medical schools don’t ignore the importance of communication skills. There’s the Objective Structure Clinical Exam (OSCE), which tests doctor-patient interaction. And pediatric doctors learn how to do a comprehensive and thorough HEADSS assessment, where they talk with adolescents about list of sensitive topics like drugs, sex and depression. But improv classes can help a doctor listen to what the patient is saying (or not saying), rather than just go through a checklist.
“A big misperception in the medical profession is that when we teach improv, we’re teaching jokes and punchlines. It has nothing to do with that. It’s about listening and collaborating. It’s like ‘listening school’,” says John Stoops, owner and founder of The Revival, a Hyde Park theater where some Pritzker students take improv classes.
“Medicine can be a one-way street – eat these foods, take this medicine. Improv helps change that. But it takes practice to put these communication skills into practice,” Stoops added.
Some of that practice takes place at The Revival, which is also home to the university’s 1 ½-year-old improv troupe, The Excited State. Named after a quantum physics phenomenon of high-energy levels of atoms, it’s made up of a dozen U of C staff of all ages and specialties, including professors, physicians, post-docs and graduate students.
Their monthly shows are similar in format to what you’d see at Second City (which – fun fact - actually grew out of UChicago’s late 1950s theater troupe, The Compass Players), except there’s a heavy science emphasis. They might play games with the audience like, “Centrifuge,” or ask “What’s your favorite chemical element?” when seeking a word on which to build a skit.
Every show includes a 10-minute presentation from a “guest scientist.” During a recent show, University of Chicago molecular biologist Allan Drummond, PhD, spoke in a light-hearted and conversational way about how cells sense temperature, using funny references to scrambled eggs and pooping birds. He communicated in a way that made his lesson understandable to non-science audience members – an important skill for scientists and doctors.
“Fundamentally, improv is about human communication and interaction,” says The Excited State cast member Yeva Shan, a post-doc in biomedical research at University of Chicago’s Department of Medicine. “It helps you learn the best way to communicate an idea, and helps you communicate scientific information to the public.”
Shan says she uses her improv skills daily in staff meetings, or in communications with donors. It’s even improved her English, another benefit for the large number of foreign-born post docs.
Improv puts clinicians in uncomfortable situations they’re not used to, forcing them to be nimble and aware of where a patient is at, says Chin. He was resistant and intimidated to try improve at first. Now, he likes it so much, he now does both The Excited State and stand-up comedy in his free time.
Surprising or useful information can surface at every patient appointment, Chin says. That’s where the classic improv exercise “Yes, and” comes in. By listening and saying “Yes, and,” instead of “Yes, but” you show you’re listening and acknowledging the patient’s reality. You may disagree with it, but it begins a discussion.
“The reality is, there’s a limited amount of time for a patient visit. The easy thing is to default to the medical script and slam through it in 10 or 15 minutes. But there’s a danger of not really addressing or hearing the patient’s true issue,” Chin says.
Another big upside to improv: it’s fun. Orlov doesn’t like to use that descriptive. When people think it’s fun, that somehow undermines its value and makes medical schools take it less seriously, she says. But Orlov has already seen it help student and doctor burnout. It gives people a break from their serious, science-focused work, and loosen up, laugh and connect with colleagues.
“When you come out of medical school, your mind is so cluttered from learning medical facts, that the humanism thing gets crowded out,” Chin says. “Improv is not the first thing you associate with doctors and medicine, but putting us in this environment has some amazing potential benefits."
Chin’s JAMA Internal Medicine says improv can help reduce health disparities
Much has been written how improv comedy skills can improve doctor-patient relations. But can it help doctors reduce health disparities? It can, says University of Chicago Medicine’s Marshall Chin, MD, MPH.
In his recently published perspective piece, “Lessons from Improv Comedy to Reduce Health Disparities” in JAMA Internal Medicine, Chin identifies four skills he uses while doing improv and stand-up comedy that help him as a doctor. They can be used to communicate with marginalized patients at risk for poor outcomes due to their race, ethnicity, socioeconomic status, sexual orientation or gender identity.
The skills are: listening, building relationships, recognizing how you are perceived, and making strong and bold choices.
“While these lessons may not seem new, many care teams have not fully practiced them,” Chin said in his article.
In the article, Chin notes that there tends to be more distrust between racial minority and LGBTQ patients and their doctors, making communication more challenging. They’re sizing up the physicians, wondering, “Is this someone I feel safe to confide in?” And that’s where improv skills come in: they can help a doctor listen, meet a patient where they’re at, and build a trusting relationship.
“Once you have trust, you can do a lot more to help them,” Chin said. “Facts without the trust between a clinician and a patient means they’re not as likely to do what you recommend. Being a good listener, you can provide a safe space for them.”
As for the skill of making strong and bold choices, that’s Chin’s way of saying that the medical profession can do more to stand up against injustices they see in the healthcare system and for policies to help marginalized patients.
“Doctors tend to advocate for individual patients, but overall, as a profession, we don’t advocate enough for improving the system,” he said. “If we do that, it will enable all of our patients to do well.”