A novel approach to enhanced communication confidence: Utilizing improv as skill development

Background and Hypothesis: Communication is vitally important to the doctor-patient relationship and delivering effective, patient-centered care. Physicians often overestimate their ability to connect with patients; most patient complaints are related to the doctor-patient relationship rather than medical competence. Further, the proliferation of telemedicine adds another layer of complexity to effective doctor-patient communication. Our study investigated whether improvisation workshops enhance communication skills and confidence. We believe these workshops can then be used to aid physicians in their medical practice and build more trusting, connected, and equitable doctor-patient relationships. This study implemented a unique design to further assess the association between improv training and the ability to build strong, trusting relationships with patients.

Methods: In September 2022, a cohort of 58 Master of Science in Biomedical Science students at Rocky Vista University-Colorado participated in an IRB-exempt study. The 90-minute improv workshop was conducted by Brian Schwartz, PhD, a faculty member with improv training experience. The session included a series of communication-based improv activities. We used a survey to assess the effect of the workshop on students’ confidence levels regarding their verbal and non-verbal communication skills. Survey questions were synthesized from seven validated communication instruments consisting of five major themes: adopting a logical approach, building rapport, active listening using nonverbal and verbal skills, acknowledging another’s viewpoint, and adapting to one’s level of understanding. A pre-survey (T0) and post-survey (T1) were conducted immediately before and after the workshop. T0 and T1 consisted of identical questionnaires and maintained participants’ anonymity.

Results: Survey responses were reported on a 4-point Likert scale (not at all confident; somewhat confident; confident; extremely confident) and were converted to numerical values (1-4, respectively) for statistical analysis. Paired t-tests were used to assess statistical significance between pre- and post- survey responses. The analysis showed statistically significant improvement (p < 0.05) in confidence levels post-improv workshop on each of the 18 survey questions. Additionally, a statistically significant increase (p < 0.05) in confidence was noted when comparing the averages of all pre- to post-survey responses.

Conclusion: Improvisational techniques and exercises are effective in the enhancement of communication confidence and skills. This is a fact gleaned from the literature on the topic, and was also shown to be present in this study. The improv exercises undertaken with the participants created an environment in which the importance of agreement and lack of denial, as well as encouragement, active listening, and creating a partnership for effective communication were instilled in the students. They were given instructions for the improv exercises, and were able, with guidance and repetition, to foster an atmosphere of listening and active participation. This atmosphere was hypothesized by the investigators to be conducive to increased confidence in communication. The statistical analyses and anecdotal observations of the investigative team supported that hypothesis, further encouraging the efforts to utilize improvisation in training to strengthen communication skills. We believe strong communication deepens the doctor-patient relationship and amplifies an osteopathic physician’s ability to treat patients holistically– mind, body, and spirit.

Acknowledgement of Research Study Sponsors and IRB: This study (#2022-070) was approved for exemption by Rocky Vista University’s IRB.