Medical Improvisation: Impact of Training on Medical Students’ Experience with Communication on Clinical Rotations - A Single-Center Mixed-Methods Study

Abstract

Abstract Background: Effectively preparing medical students to communicate with patients, families, and teams remains a challenge in medical education. Although techniques from medical improvisation have been introduced to teach communication skills in this context, limited evidence exists regarding how such training elicits student involvement, impacts clinical students’ communication skills, and affects medical students’ authentic clinical care interactions. Objective: To implement a medical improvisation-based educational training in the pre-clinical year and gather medical students’ reflections following one year of clinical rotations. Methods: We recruited medical student volunteers to participate in an established medical improvisation curriculum, complete course evaluations, and provide progressive reflections as they began and continued their clinical medical training. Course duration was 2 hours per week for 5 weeks, prior to beginning clinical rotations. Participants completed anonymous, electronic evaluations via Qualtrics software before and after the course, which included structured (closed-ended) and open-ended questions. One year later, after students completed core clinical rotations, we conducted semi-structured interviews and performed thematic analysis on transcripts. Results: 23 of 24 recruited students completed the course and surveys. Pre/post-course comparison survey data show significant improvements in reported comfort with different communication situations. 11 students (48%) participated in follow-up interviews. All interviewees reported they found the course valuable and, universally, would recommend it. In interviews, students noted that skills improved by medical improvisation included flexibility, “yes, and” approach, accepting mistakes, listening, and confidence in unknown situations. Many interviewees felt medical improvisation was helpful to their professional development, gave them strategies for challenging conversations in real-life practice, and supported personal growth and wellness and building friendships. Conclusion: Medical students exposed to medical improvisation prior to clinical rotations noted both immediate benefits in communication skills and long-lasting improvement in specific domains of communication.