By: Carolyn A. Chan, MD, MHS, Nicole Damari, MD, MS
Improvisational theater, or “improv”, is a live performance in which scenes are developed spontaneously rather than being pre-determined in a script. The two most common types of improv are “short form” and “long form”. Short-form improv is structured around 2-3-minute improv games (e.g., the TV show Whose Line is it Anyway?), while long-form improv is when audiences provide a suggestion and actors create an entire show lasting 20-60 minutes. While many people’s primary touch point with this style of performance is improv comedy, improv theater does not need to be comedic, and the tools of improv do not always need to be used for entertainment. The concept of applied improv describes leveraging the many games and exercises of improvisational theater for a secondary goal, which is often non-theatrical and skill-based. When we consider that improv theater techniques offer opportunities for skill development in areas such as communication, creativity, navigating uncertainty, and team building, the application of improv games to medical education feels like a natural fit.
In fact, the origins of improv theater are more aligned with applied improv than one might imagine. Improv theater as we understand it today was developed in the 1940’s by Viola Spolin, an actor, director, and educator. Grounded in her belief that children learn through interactive play, she initially developed these games to help immigrant children in Chicago overcome language, cultural, and social barriers. Improv games were created with simple, specific objectives to encourage participants to focus on in-the-moment spontaneity rather than self-judgement or self-editing.
Among the many applications of improv games since that time was the development of Medical Improv. The term was coined in a 2011 paper by Katie Watson, “Serious Play: teaching medical skills with improvisational theater techniques,” which described how the use of improv theater techniques can improve skills such as communication, cognition, and teamwork in medicine. To better understand how improvisational theater exercises (sometimes called games) can help participants develop these skills, we consider here the key principles of improv and their relevance in medical and medical education contexts.
1. Yes, And.
The most well-known principle of improv theater is “Yes, and”. This creates a mutual understanding that anything said on stage will be accepted through “yes’ing”, and that, through “and,” improvisers will build on each other’s ideas. For example, if one person on stage started a conversation with, “What a great day on the moon”, and their scene partner responded with denial by stating, “No, we are under the ocean”, it would not make for a very engaging scene to watch. If instead their scene partner accepts and builds upon their statement by saying something like, “Yes, the weather in our space habitat is well curated today”, the scene is able to move forward.
“Yes, and” can be taught as a tool to promote listening and co-creating plans. It may be used during shared decision-making in patient encounters. For example, if a patient states that they “will absolutely not take any medications requiring injections for their diabetes”, a clinician could respond with, “Yes, and let’s talk through the pros and limitations of medication options so you can make a decision that works for you.” The use of “yes, and” allows for collaborative dialogue with patients. This could be in contrast to a clinician responding with, “No, insulin is the only treatment that will help you”, or “Yes, but nothing will help you as much as insulin,” which may result in a lack of patient engagement.
2. Active Listening.
Another key improv principle is for improvisers to engage in active listening. They must pay close attention to their scene partner to respond, because one cannot build upon an idea if they are not listening. It can be tempting to try to pre-plan lines, though this is rarely effective because it often results in not hearing what a scene partner is saying. This often causes the performer to contradict something already stated, creating confusion among the audience.
Active listening is a skill that is critical to the practice of comprehensive care. In some cases, clinicians and learners may prematurely stop listening to a patient’s history, instead focusing internally on developing a treatment plan. In doing so, they may miss key clinical or contextual factors needed to develop a comprehensive care plan for the patient or to respond authentically and empathetically within the patient encounter.
3. Make each other look good.
The final principle we will discuss here is that the actors should aim to support their scene partner and make them look good in the scene. The goal is to support the entire ensemble. The emphasis is on collaboration over competition, which fosters a psychologically safe environment. If an individual is working to make their scene partner appear brilliant, they will also look good, and the performance will succeed. Actors are discouraged from taking an action that may make another performer uncomfortable, sometimes referred to as “pimping out”.
Healthcare professionals often need to work in high-stress, interprofessional teams. This principle encourages healthcare members to recognize care team members as equal partners and creates a mindset that we are all there to improve patient care. Adopting this mindset and communication style fosters a psychologically safe environment.
While this is a non-comprehensive list of improv principles, there are many others that instructors can leverage depending on a session’s goals and objectives. There are a vast number of ways that these principles can be applied to medical improv, in particular to help health care professionals. Medical improv adapts improvisation games and exercises for learning through experience. A structured framework for developing medical improv curricula has been described (Fu, 2019) and includes two key components:
- Core curricular components including skills, principles, and exercises
- Core skill groups, including attunement, affirmation, and advancement.
Through this framework, educators can intentionally align improv techniques with their educational goals in health professions settings. To date, medical improv has been used to develop curricula on multiple topics such as motivational interviewing, breaking bad news, empathy, advocacy, resilience, and many other topics.
The most unique aspect of this framework is the exercises (also called improv games), which are key to experiential learning. During medical improv in action, the facilitator provides instructions for a game, after which the learners perform the exercise. During their performance, they may receive formative feedback through side coaching, direct observation, and peer observation. After the exercise is complete, they debrief on their experience and discuss how it relates to clinical care (Figure 1).
If you would like to see an example, play this video to see a medical improv game in action.
Figure 1: Overview of the steps of medical improv in action
Medical Improv is an emerging teaching pedagogy, with strong potential for use in health professions education. Although best practices are still evolving and research questions remain, it offers broad opportunities for application in health professions. For those looking to learn more or have faculty development on medical improv, Medical Improv runs a yearly train-the-trainer course for those interested. The Medical Improv Collaborative is a community of educators that can be a resource for those already practicing. We hope to see more research on this teaching pedagogy in the years to come.
Photo courtesy of istock
References
- WTTW. “Free to Experience: Viola Spolin and the Invention of Improvisation.” WTTW Chicago Stories. Accessed February 15, 2026. https://www.wttw.com/chicago-stories/inventing-improv/free-to-experience-viola-spolin-and-the-invention-of-improvisation
- Katie Watson, Perspective: Serious Play: Teaching Medical Skills With Improvisational Theater Techniques, Academic Medicine, Volume 86, Issue 10, October 2011, Pages 1260–1265, https://doi.org/10.1097/ACM.0b013e31822cf858
- Chan, Carolyn A., et al. “Medical improvisation-based motivational interviewing for internal medicine residents: Mixed-methods evaluation of a novel course.” Medical Teacher 45.12 (2023): 1411-1418.
- Kukora, Stephanie K., et al. “Hilariously bad news: Medical improv as a novel approach to teach communication skills for bad news disclosure.” Academic Pediatrics 20.6 (2020): 879-881.
- Hoffmann-Longtin, Krista, et al. “Teaching advocacy communication to pediatric residents: the efficacy of applied improvisational theater (AIT) as an instructional tool.” Communication in Instruction. Routledge, 2021. 30-51.
- Zelenski, Amy B., et al. “Interprofessional improv: Using theater techniques to teach health professions students empathy in teams.” Academic Medicine 95.8 (2020): 1210-1214.
- Mehta, Ankit, et al. “Impact of Improvisational Theater Training on the Resiliency of Medical Students: A Mixed-Methods Study.” Academic Medicine (2025): wvaf079.
- Chan, Carolyn A., et al. “State-of-the-art review of medical improvisation curricula to teach health professional learners communication.” Advances in Health Sciences Education 29.3 (2024): 1025-1046.
- Fu B. Common Ground: Frameworks for Teaching Improvisational Ability in Medical Education. Teach Learn Med. 2019 Jun-Jul;31(3):342-355. doi: 10.1080/10401334.2018.1537880. Epub 2018 Dec 31. PMID: 30596300.
- Mehta A, Yanez-Fox L, Shah N, Katzman J, Garcia-Filion P, Silverman H. Impact of improvisational theater training on the resiliency of medical students: a mixed-methods study. Acad Med. 2025 Dec 6:wvaf079. doi: 10.1093/acamed/wvaf079. Epub ahead of print. PMID: 41712552.
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