Improv courses help University of Arizona medical students become better doctors

Medical students at the University of Arizona have lots of mandatory courses to complete. Many of them are similar to what you’d find at other medical schools, but one of them is a bit unique: improv.

Over the course of four intensive three-hour sessions, aspiring doctors gather with instructors to perform theater games, free associate and just generally play. For a cohort of students that tends to be fairly serious and practical in their thinking, it’s not always comfortable.

Instructor Jacque Arend conceived the program with UA faculty member Dr. Howard Silverman, based on what he saw as a mental health crisis. Arend joined The Show to explain what the program does for students’ development.

Full conversation

JACQUE AREND: (Silverman) had been really sort of processing and thinking about the burnout rate of doctors and especially the suicide rate, because doctors are not given skillsets to cope. They’re sort of just given this idea that they have to sort of repress or put this cold layer over their emotions so that they’re not as affected.

But that result is that they then don’t know how to process any of it, and it becomes too big, and it’s very sad. And he’s like, how do we fix this? Like, how do we fix this problem?

And he was like, improv could be the key. Improv could easily be the key. Because what we’re doing is we’re asking folks to play, and we’re asking folks to be imaginative and to really practice their critical thinking and their creative problem solving skills to create positive communication skills that allow for deeper connections.

DINGMAN: Yeah.

AREND: Self awareness and the ability to self evaluate and check in.

DINGMAN: So tell me a little bit about what it was like for you getting in a room with med students for the first time.

AREND: We walked into that space the first day and had hoped they would buy in.

DINGMAN: Right.

AREND: But I think the hard thing, especially in a high-stakes environment like the first year of med school.

DINGMAN: Oh boy.

AREND: We know that in applied improv spaces, when you walk into a business and you introduce improvisation to business-minded folks, you are certainly going to get right and wrong answer paralysis. But they have even more rigidity in there just because they have to know the right and wrong answers.

DINGMAN: Yeah. Because the stakes in business are not necessarily life or death or wellness or unwellness. And if you’re a first-year med student, you’re coming in with that as your kind of benchmark, I would think.

AREND: Right. For sure. And sort of what we were trying to say to them all at that time is like, we’re introducing this at the same time that you’re going through that, because we think it’s important that you’re exercising this muscle simultaneously, so that you’re not getting too rigid and then we’re having to sort of unpack all of it later.

Like, you can come in with this plasticity. So there were lots of groups that sort of went on and had a lot of challenge just because they didn’t feel safe.

DINGMAN: Yeah.

AREND: And a lot of that was our learning curve of like, “OK, well, we’re gonna have to, like, really come at them with their language, with what they’re wanting out of this. We have to unlock the doors that they’re wanting to open right now.”

DINGMAN: So can you give me an example of what an early exercise with a med student looks like as you’re beginning to work with them in one of these first sessions?

AREND: Yeah, like on that first day — and this is similar to all applied improv experiences — you were sort of just trying to acknowledge the nerves. You really have to be very clear that this is about repping and about strengthening and not about being funny. Like, you really have to take that aspect of this being comedy out of the way.

And so you’re saying that’s not what this is about. It’s not about showing up and being funny. It’s just about showing up.

DINGMAN: Right.

AREND: It’s just about showing up and listening and listening well and responding honestly with how the moment is impacting you. And so then you get them up on their feet and you do really simple, like, word association exercises or just name game of moving their body and matching energies.

It’s very important, too, in this first part that you really have the conversation about mistakes and about that they don’t exist in improv, that we have guidelines to make strong choices over choices that aren’t going to maybe get us as far or get us as connected.

Those are the things that we’re strengthening is stronger skills. But ultimately, there’s no wrong answer. So you’re getting people comfortable with just making a choice and getting through the fear.

DINGMAN: Like, move your body in this way, and then your partner is like, “How does that make you want to move your body?”

AREND: Yeah. Or just make a sound and I’ll match that sound, you know? And so it’s like immediate choice making and affirmation of the choice.

DINGMAN: Yes, right.

AREND: Because you’re saying, “Yes, I love that choice. So I’m going to match it, and I’m going to push it this much further.”

DINGMAN: Right. I’ll make the sound louder.

AREND: And so they do word association, which is just like getting them out of the habit of thinking about the choices before choosing them. Like, the word association stuff is, “OK, well, I hear mall. Mall makes me think girls.”

So now we’ve created the idea of mall girls. Mall by itself is its one own thing. Girls by itself is one thing. Mall girls is like a group of teenage girls who hang out in the food court.

DINGMAN: Right, right. So when you get to the end of, like, the fourth session, what have you seen transform in the students? At this point, are they, like, improvising full shows? Or do you find that their comfort level evolves?

AREND: Yeah, I think so. I think that it’s tough because each time we sort of have to go through the process of reminding them: Remember, this was fun. What we were experiencing was, OK, first session, we’re going to be excited if we can just get them at least all to agree on the same emotion and physicalize it for five seconds.

By the second week, we’re gonna just be happy if they can just find some joy in a lot of the discomfort of the exercises. By week three, we just want them to be feeling confident.

And on the fourth session, we sort of do it more as a celebratory, like, hey, you came this far, let’s get you on your feet playing and sort of think about, would you have ever imagined that you could do that and create in this way and collaborate in this way and connect in this way when we first started? And now we can all take just a bigger breath around how heavy this thing is.

DINGMAN: And it’s OK, it seems like to come together and experience this. Maybe you’re laughing at it, maybe you’re just kind of marveling at it, but it’s maybe not something you have to — to go back to the origin story of the program, it doesn’t have to be a crisis.

AREND: Yeah, right. For sure. A lot of things that we’re talking about with the medical doctors is like, you’re gonna have pieces of information, but you’re not gonna have the whole puzzle. You have to decide: What roads am I gonna take to fill in the puzzle? And that’s what improv is.

You’ve got one piece of information at the start. “Oh, my scene partner’s happy.” My second piece of information is, “Oh, I’m feeling a little nervous.” If they’re happy and I’m nervous, we’re cliff diving. It’s my first time, and they’re telling me it’s gonna be awesome. And so we’re telling them that the skill set of taking an A and a very divergent M in the alphabet and finding the middle.

DINGMAN: Right. B through L.

AREND: Yeah, exactly.