I’m happy to see a change in his demeanor, to see him less guarded, more at ease. I’m glad there is no misinterpretation.
I’m glad that only he heard me.
Doctors in training are still judged first on memorization—of anatomy, physiology, pathology, and pharmacology. During clinical rotations, we become hoarders of checklists, templates, and algorithms to be recalled at a moment's notice. There’s still no algorithm for patient interaction, but medical educators have attempted to create one with the aid of standardized patients (SPs): actors trained to portray "classic" patient types with common chief complaints—the angry patient with back pain, for example.
Medical students are critiqued on posture, eye contact, and use of strategic pauses. We learn to avoid potentially bothersome habits and disfluencies, such as saying “uh” and “um.” Discussion arises around the categories of human touch—a supportive hand on a patient's arm is appropriate but the same gesture on a patient's thigh may not be. We are coached to acknowledge feelings with "I understand" or "I am sorry to hear that."
The use of standardized patients began in the early 1960s, with the primary goal of evaluating physical-exam maneuvers that students perform. Over 90 percent of U.S. medical schools now use SPs to broadly assess students’ communication skills, often as preparation for the now controversial clinical skills licensing exam. Although SP encounters encourage students to reflect on their interpersonal skills, many experts worry that this training doesn’t translate into effective clinical practice.
In medical school, interpersonal skills are de-personalized. Students are taught structure and essentially given a script. Traditional educators view improvisation as a risk.
Yet, the practice of medicine is spontaneous and, often times, risky. And, if educators teach students to tread carefully even in simulated encounters, how can physicians be expected to form genuine relationships with their patients?
In undergrad, I enrolled in an improvisational acting class that taught the “Meisner” technique—to “live truthfully under imaginary circumstances” and to be “firmly rooted in the instinctive.” Through this and subsequent experiences with sketch and standup comedy, I came to appreciate that improvisation is less about acting and more about reacting—to others in a scene, to the audience, to the present. I discovered that skilled improvisation is merely the interpersonal equivalent of having insight and being adaptable.
A few thought leaders have started to see the potential value of such improvisational techniques in medical education. At Northwestern University's Feinberg School of Medicine, for example, one seminar utilizes improvisational theater practices to improve communication, cognition, and teamwork. Katie Watson—an assistant professor of medical education at Northwestern, a faculty member at Chicago’s famed comedy theater Second City, and the medical improv seminar's founder—contends that while physician-patient encounters may be structured, every interaction is, to some extent, improvised.