Medical improvisation helps speech therapists to improve their communication skills.

Abstract

Speech therapists are supposed to be experts in communication, but communication teaching remains uncommon in their curricula. Despite the well-documented benefits of effective and empathetic communication, there is a lack of available resources, and communication training remains challenging. While medical improvisation training grows in health student curricula to develop communication skills, it has not been extended to speech therapy. Medical improvisation is a practice based on non-scripted theatre, using theatrical improvisation tools to train health professionals and help them develop specific skills.1 It allows a safe space and experiential learning to develop effective and empathetic communication (i.e. to listen actively, express clear messages and appropriate emotions) through exercises involving all communication dimensions (verbal, para and non-verbal). Students can fail and try multiple times within this safe space. We explored speech therapists' experience with and interest in medical improvisation training for communication skills. Since 2018, speech therapist students (fourth year) at out institution had a non-mandatory medical improvisation training within their curriculum, and 21 of them attended ten 2-hour sessions weekly with a professional improv facilitator. The first course focused on improv general rules (listen actively, accept proposition: say ‘yes, and…’ instead of ‘yes, but…’). The following courses improved the basic skills (speak in public) with various exercises focusing on the following: voice, posture, proxemics and leading to embody other person's perspective and emotions (empathy). Then, these skills were used to train speech therapist students within inspired-by-real-life-experience clinical situations. For example, the speech therapist students enacted ‘the worst way to’ deal with a patient or a rude colleague. Debriefing allowed faculty to illustrate behaviours to avoid in clinical situations and how to improve them. Then, students had to play the same scenario using ‘the best way to…’ to improve their self-personal efficiency. Unlike classical role play, medical improvisation training encouraged learners to fail and then try to improve. We explored speech therapist students' experience and interest through post-improv questionnaires and their verbal feedback. This effort supports the need for communication training (‘I need to be more comfortable for speaking (....) control my voice’) with feedback about medical improvisation training being broadly positive (‘I retained exercises that could be useful in my future professional practice’). Most students (67%) re-used the improv exercises and strategies (breathing) in a professional context: during their oral examinations and internships (e.g. to explore child's imagination, make the exercises enjoyable). The first students who attended these classes, now clinicians, started to use improv techniques with patients as part of therapy (e.g. work on prosody and facial expression with a parkinsonian syndrome patient), with positive anecdotal feedback (relaxation, pleasure and subtle gestures improvement). Medical improvisation appears valuable to speech therapist students and could, thus, lead to development of new rehabilitation strategies in the future. Beyond communication skills, it also could be beneficial to deal with uncertainty. JDW designed the work, analysed and interpreted the data and drafted the word. MH designed the work, analysed the data, revised the work and gave its final approval and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of the work are appropriate. MG contributed to the concept the work, revised the work and gave its final approval and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of the work are appropriate.