48.8 Improv-ing Teaching: An Online Improvisational Theater Pilot Program to Teach Child and Adolescent Psychiatry Clinical Skills

Abstract

The psychiatric interview is the cornerstone of developing mental health diagnoses and treatments for children and adolescents. Interviewers must navigate layers of complexity including consideration for development and inclusion of patient and family for case formulation and treatment planning. Improv is a form of improvisational theater in which actors perform unscripted to generate dialogue, action, and story in real time. Few studies have assessed the potential of improv as a tool to teach psychiatry clinical skills to trainees and, to the best of our knowledge, none have looked specifically in the realm of child and adolescent psychiatry. We aimed to design an improv program and examine its effectiveness at teaching child and adolescent psychiatry clinical skills. We designed a 45-minute monthly online improv curriculum that focuses on a variety of topics in child and adolescent psychiatry to provide exposure in a low-stakes environment to both pediatric and psychiatry trainees. Pre- and postsession surveys were sent to participants to assess perceived confidence (100-point scale) in: 1) interviewing skills; 2) assessment and treatment planning; and 3) improv efficacy in improving clinical skills. Trainees perceived a statistically significant improvement in confidence among all 3 domains even after a single 45-minute session. On subgroup analysis, this effect is largely driven by pediatric trainees (n = 28), with no significant perceived benefits from psychiatry trainees (n = 7) likely due to higher pretest scores and a lower number of participants. Trainees' overall perceived confidence rose by 25.3% (p = 0.004) interviewing family, 20.3% (p = 0.006) interviewing children, 21.4% (p = 0.006) interviewing both, and 12.7% (p = 0.006) discussing difficult topics. Additionally, there was a 27% (p = 0.006) improvement in confidence with formulating the assessment and plan. The online improv program is a time-efficient and effective strategy to facilitate learning of child and adolescent psychiatric clinical skills. Pediatric residents reported higher overall confidence from even one 45-minute improv session. Recruitment of additional psychiatry trainees is needed to evaluate the effectiveness of improv in escalating clinical confidence among this group.