Improvisational and Standup Comedy, Graphic Medicine, and Theatre of the Oppressed to Teach Advancing Health Equity

Abstract

Ninety-minute virtual workshops that used improvisational comedy, standup comedy, graphic medicine, and Theatre of the Oppressed were implemented in 2020 within a required health equity course at the University of Chicago Pritzker School of Medicine to train 90 first-year medical students in advancing health equity. Learning objectives were to (1) deepen understanding of diverse human experiences by developing relationship skills, such as empathy, active listening, engagement, and observation; (2) recognize how diverse patients perceive students and how students perceive them to gain insight into one’s identity and how intersectional systems of oppression can stigmatize and marginalize different identities; and (3) engage in free, frank, fearless, and safe conversations about structural racism, colonialism, White and other social privileges, and systemic factors that lead to health inequities. With a 61% (109/180 [90 students × 2 workshops per student]) survey response rate, 72% of respondents thought workshops were very good or excellent, and 83% agreed or strongly agreed they would recommend workshops to others. Key recommendations are to (1) incorporate experiential storytelling and discussion; (2) define clear learning goals for each workshop, map exercises to these goals, and explain their relevance to students; and (3) create a safe, courageous, brave space for exploration and discussion. For health equity, transformation happens as students share their perspectives of curriculum content from their intersectional identities, experiences, and varied privileges; are challenged by others’ perspectives; and attempt to understand how others can experience the same content differently. The arts create a powerful form of sharing beyond routine conversations or discussions, which is critical for honest dialogue on difficult topics, such as racism, homophobia, and White privilege and other social privileges. Educators should enable students to have the space, time, and courage to share their true perspectives and engage in authentic discussions that may be uncomfortable but transformative.

Exploring the Value of Improvisational Theater in Medical Education for Advancing the Doctor–Patient Relationship and Health Equity

“…The third category is based on our discussions about how future improv workshops could more effectively address bias and systems of oppression: improv scenarios raising issues of status, power, bias, and culture, combined with discussion, personal storytelling, and self-reflection within safe, brave spaces. 15…”

“…Curricula need to meet the needs of all these trainees. 15 All too often clinicians, patients, and trainees feel like they are speaking different languages or not discussing difficult issues that are submerged yet salient.…”

“…Each student was randomly assigned to participate in 2 out of 4 possible health humanities sessions: improv, stand-up comedy, 26 graphic medicine, and Theatre of the Oppressed. 15 Sixty students participated in the 90-minute improv sessions, which were held via Zoom, a video conferencing platform. These students were randomly assigned to 1 of 6 small groups that were led by a physician (J.M.R.…”

“…Clinicians can leverage these skills to similarly connect with patients, colleagues, and leaders from different backgrounds to move health equity forward. We believe that principles of improv comedy can be harnessed productively to teach about advancing health equity in safe, brave, respectful ways, 15 as we have seen for a separate workshop taken by the medical students that used principles of standup comedy and was highly rated. In addition, robust evaluation techniques using a variety of mixed quantitative and qualitative methods and experimental designs would be helpful to test outcomes along the spectrum of the Kirkpatrick model of training evaluation levels including reaction, learning, behavior, and results.…”

“…The third category is based on our discussions about how future improv workshops could more effectively address bias and systems of oppression: improv scenarios raising issues of status, power, bias, and culture, combined with discussion, personal storytelling, and self-reflection within safe, brave spaces. 15 Our pilot focused on the first 2 pillars, patient-clinician communication and trustworthy relationships. Improv focuses on many key skills for building an iterative communication style such as active listening, observation, and nonverbal cues.…”