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Chan CA, Windish DM, Spak JM, Makansi N. State-of-the-art review of medical improvisation curricula to teach health professional learners communication. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1025-1046. [PMID: 37921903 DOI: 10.1007/s10459-023-10296-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/08/2023] [Indexed: 11/05/2023]
Abstract
Medical improvisation (improv) applies theater principles and techniques to improve communication and teamwork with health professionals (HP). Improv curricula have increased over time, but little is known about best practices in curricula development, implementation, and assessment. We sought to complete a state-of-the-art review of medical improv curricula to teach HP learners communication skills. A literature search of MEDLINE and 8 other databases on HP medical education and medical improv communication curricula occurred. We screened 1869 articles published from 2012 to 2022. Seventeen articles were selected for extraction and synthesis. Common curricular goals included improving interprofessional, interpersonal, and empathetic communication. Curricula often lacked alignment between learning objectives and improv exercises. Sessions occurred once (65%) or were longitudinal (35%). Only 24% reported a full description of their intervention. Few reported details on the content of curricula. Evaluations often focused on feasibility and acceptability. Heterogeneity exists in the development, implementation, and assessment of improv curricula. Low-quality evidence was provided to support the use of medical improv to teach communication skills to HP learners. Improv curricula were feasible, and acceptable to learners. We offer recommendations to guide future medical improv curricula development.
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Affiliation(s)
- Carolyn A Chan
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, 3131 Harvey Ave, Suite 104, Cincinnati, OH, 45224, USA.
| | - Donna M Windish
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Judy M Spak
- Academic Research and Education, Cushing/Whitney Medical Library, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Nora Makansi
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, H3A1G1, Canada
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Chan CA, Chou E, LaDisa AG, Mehta A, Zelenski A, Longtin K. Using nominal group technique to determine skills that applied improvisation can teach health profession education learners. PEC INNOVATION 2023; 3:100194. [PMID: 37576803 PMCID: PMC10415759 DOI: 10.1016/j.pecinn.2023.100194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Objective Applied improvisation (AI) is an approach used in health professions (HP) education to teach skills essential for clinical practice such as communication, teamwork, and empathy. Little is known about which skills can be developed using AI, or those which an AI should prioritize. Our research aims to identify skills essential to include in an AI curriculum for HP learners. Methods A modified nominal group technique (NGT) was conducted to identify and prioritize specific skills which can be taught using AI. This involved silent generation of ideas, round robin, discussions, 2-rounds of preliminary voting, and a final ranking survey to determine a prioritized list of skills to include in an AI curriculum for HP learners. Results Six content experts participated in the NGT meeting. Initially, 83 skills were identified, and through NGT, a final list of 11 skills essential to an AI curriculum were determined including: adaptability, affirmation of others, acceptance, active listening, being present, cooperation, collaboration with other, advancement, compassionate communication, sharpened non-verbal communication, resilience. Conclusion Essential skills for an AI curriculum relate to adaptability, attunement, collaboration, affirmation, and advancement. Innovation This study is a novel application of NGT as a strategy to organize an approach to curriculum innovations.
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Affiliation(s)
- Carolyn A. Chan
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, USA
| | - Erica Chou
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Anne Graff LaDisa
- Department of Pharmacy Practice, Concordia University Wisconsin School of Pharmacy, Mequon, USA
| | - Ankit Mehta
- Department of Internal Medicine, University of Minnesota, Minneapolis, USA
| | - Amy Zelenski
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Krista Longtin
- Department of Communication Studies, IUPUI, USA
- Indiana University School of Medicine, Indianapolis, USA
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De Wever J, Hainselin M, Gignon M. Applied improvisation and transdisciplinary simulation: a necessity for any health curriculum? Front Med (Lausanne) 2023; 10:1237126. [PMID: 38105900 PMCID: PMC10722906 DOI: 10.3389/fmed.2023.1237126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/26/2023] [Indexed: 12/19/2023] Open
Abstract
From practising a procedure, such as a lumbar puncture, to explaining the aim and method and listening to concerns, the practice of health professionals requires a range of skills, often classified into technical and non-technical skills. Just as gestures and procedures can be taught, so can empathy and communication skills. This article introduces an innovative approach that unites both necessary types of skills. The specific framework of improvisational theatre ("improv") has widespread application, including the training of health professionals (health training improv). By sharing close contexts and skills, health training improv provides a valuable, safe, and effective learning environment that allows practitioners to practice exercises and situations that align with particular objectives. We created a transdisciplinary team to develop a programme of Health Professional Training Improv (HPTI), bringing together the fields of health, psychology, simulation, and arts. Since 2019, various health student groups (nurses, midwives, medical doctors, and speech therapists) have participated in a 16-h applied improv training workshop under the supervision of a professional improv facilitator. Additionally, drama students completed applied improv for health courses, which trained them to act as simulated patients, with a view to the implementation of transdisciplinary improv simulation sessions at SimUSanté (a multidisciplinary health simulation facility located in France). Students' feedback emphasized their interest in HPTI, the realism of the simulation sessions, and the skills they felt had improved. This feedback needs to be supplemented with quantitative data from standardised assessments. The development of this rich pedagogical and research framework, based on a transdisciplinary approach, has brought different fields together to prepare students for real patient encounters. It is essential to continue this training and conduct research to evaluate the curricula developed.
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Affiliation(s)
- Julie De Wever
- CRP-CPO, UR UPJV 7273, Université de Picardie Jules Verne, Amiens, France
- Simulation Center, SimUSanté Epione, CHU Amiens-Picardie, Amiens, France
| | - Mathieu Hainselin
- CRP-CPO, UR UPJV 7273, Université de Picardie Jules Verne, Amiens, France
| | - Maxime Gignon
- CRP-CPO, UR UPJV 7273, Université de Picardie Jules Verne, Amiens, France
- Simulation Center, SimUSanté Epione, CHU Amiens-Picardie, Amiens, France
- Department of Preventions, Risks, Medical Information and Epidemiology, CHU Amiens-Picardie, Amiens, France
- Health Education and Practices Laboratory (LEPS EA3412), University Paris 13, Sorbonne Paris Cité, Bobigny, France
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Tranberg M, Brodin EM. Physicians' Lived Experience of Breaking Bad News in Clinical Practice: Five Essentials of a Relational Process. QUALITATIVE HEALTH RESEARCH 2023; 33:1349-1359. [PMID: 37793062 PMCID: PMC10666517 DOI: 10.1177/10497323231197534] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The purpose of this study was to develop deeper knowledge about physicians' lived experiences of breaking bad news by identifying their common meanings and interrelatedness along with their potential alignment with process-oriented and relational aspects. Based on the methodology of descriptive phenomenology, in-depth interviews were conducted with 22 physicians from a wide variety of specialties. The participants were invited to freely reflect upon their experiences of breaking bad news by describing situations that had worked well and less well. Results showed that breaking bad news was fundamentally experienced as a relational process constituted by the five essentials of Becoming the bad messenger, Expecting the unpredictable, Being on stage, Professionally managing hope, and Mindfulness of the emotional relationship. In line with recent research, this study confirms that clinical communication involves much more than just delivering the message. However, it also contributes to existing knowledge by focusing on the phenomenology of physicians' experiences, which enables deeper understanding of the medical profession and the relational process of breaking bad news. As such, our findings are important to enable broader learning in, for example, medical education and continuing courses for clinical staff.
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Affiliation(s)
- Mattias Tranberg
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- The Institute for Palliative Care at Lund University and Region Skåne, Lund, Sweden
| | - Eva M. Brodin
- Department of Educational Sciences, Lund University, Lund, Sweden
- Centre for Higher and Adult Education (CHAE), Stellenbosch University, Stellenbosch, South Africa
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Chan CA, Cabaniss P, Morford KL, Martino S, Martin A, Windish DM. Medical improvisation-based motivational interviewing for internal medicine residents: Mixed-methods evaluation of a novel course. MEDICAL TEACHER 2023; 45:1411-1418. [PMID: 37378496 DOI: 10.1080/0142159x.2023.2225725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE Develop and assess a novel medical improvisation-based motivational interviewing (MI) curriculum for residents. MATERIALS AND METHODS A 6-h medical improv-based MI curriculum occurred in 2022 for internal medicine residents. A mixed-methods evaluation included: pre- and post-role plays using the Motivational Interviewing Treatment Integrity Score (MITI) to assess MI competency, a post-course survey assessing confidence, and focus groups to understand learning through improvisation. RESULTS Participants increased their confidence in applying MI skills after the curriculum in responding to a patient's argument against change (29% pre vs. 72% post, p < 0.001), eliciting change talk (21% vs. 86%, p < 0.001), and providing information in an MI-centric way (39% vs. 86%, p < 0.001). All role-play participants achieved at least beginning proficiency on MITI technical and relational global summary scores post-course. MI-adherent behaviors increased, and MI-non-adherent behaviors decreased in post-course role plays. Themes on learning through improvisation included: (1) improvisation can enhance the learning of MI skills, (2) using non-medical scenarios in improvisation exercises has benefits, and (3) trying improvisation had positive effects on the learning environment. DISCUSSION A medical improvisation-based course is a promising, engaging way to teach residents MI skills and can improve competence and confidence with MI.
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Affiliation(s)
- Carolyn A Chan
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Kenneth L Morford
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Donna M Windish
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Abstract
Communication skills training is a core competency for neonatal-perinatal medicine (NPM) fellows, yet many neonatology fellowship programs do not have formal communication skills curricula. Since the late 1990s, experiential learning that includes role-play and simulation has become the standard for communication training. NPM fellows who receive simulation-based communication skills training report greater comfort with difficult conversations in the NICU. Most communication skills studies in neonatology focus on antenatal counseling, with some studies regarding family meetings and end of life conversations. Published examples for simulation-based communication skills curricula exist, with ideas for adapting them to meet the needs of local resources.
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Affiliation(s)
- Sara Munoz-Blanco
- Department of Pediatrics, Division of Neonatology and Pediatric Palliative Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Renee Boss
- Department of Pediatrics, Division of Neonatology and Pediatric Palliative Medicine, Berman Institute of Bioethics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Landry-Wegener BA, Kaniecki T, Gips J, Lebo R, Levine RB. Drama Training as a Tool to Teach Medical Trainees Communication Skills: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:851-860. [PMID: 36538658 DOI: 10.1097/acm.0000000000005121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Recognizing the similarities between the skills an actor needs and those required of a physician in clinical communication, medical educators have begun to create drama-based interventions to teach communication skills. The purpose of this scoping review was to summarize existing educational interventions that use drama training to teach medical trainees communication skills. METHOD The authors searched PubMed, CINAHL Plus, Embase, ERIC, and Web of Science Core Collection multiple times beginning in March 2020 through March 2022. Articles were included if they (1) described components of an educational intervention, (2) used an active intervention based on drama training, (3) stated a curricular goal of improving learners' communication skills, and (4) included medical trainee learners. Data extracted included the details of the targeted learners and educational interventions, assessment tools, and outcomes. The quality of each study was assessed. RESULTS Thirty articles met the inclusion criteria. Twenty-five (83%) articles included acting and improvisation exercises, 9 (30%) used some or all of the conventions of forum theater, and 3 (10%) used dramatic performance. The interventions included undergraduate, graduate, and continuing medical education learners. Most were elective and involved a member of the theatrical community. Although low overall study quality (average MERSQI score was 8.5) limited the strength of the evidence, of the 8 articles that evaluated learners' knowledge, skills, and/or behaviors, the majority showed an initial improvement in communication skills post-intervention. CONCLUSIONS This review is the first, to the authors' knowledge, to focus on the curricular goal of improving communication skills and to include a broader scope (beyond medical improv) of drama trainings. While the included articles represent a diverse group of interventions, generally they reported an outcome of improved communication skills in their learners. More high-quality studies are needed to determine best practices and the generalizability of drama-based initiatives.
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Affiliation(s)
- Bernard A Landry-Wegener
- B.A. Landry-Wegener is assistant professor, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy Kaniecki
- T. Kaniecki is a rheumatology fellow, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Gips
- J. Gips is a resident physician, Osler Medical Residency, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachael Lebo
- R. Lebo is clinical services librarian, Wegner Health Sciences Library, University of South Dakota, Sioux Falls, South Dakota
| | - Rachel B Levine
- R.B. Levine is professor and associate dean for faculty educational development, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Li W, Scherr CL, Fenter RB, Watson KL, Wicklund CA. Exploring a brief medical improvisational performing arts intervention for genetic counseling graduate students. J Genet Couns 2022; 31:1193-1205. [PMID: 35617028 PMCID: PMC9795887 DOI: 10.1002/jgc4.1590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 12/30/2022]
Abstract
Psychosocial counseling is the foundation of genetic counseling. Genetic counseling students are required to receive in-depth training on psychosocial counseling techniques. In other medical disciplines, "medical improv," an educational method derived from improvisational theatre, has been used to allow trainees to practice clinical skills without also having to focus on medical knowledge they've not yet mastered. The present study aims to investigate the acceptability of medical improv as an educational tool for genetic counseling students. Fourteen genetic counseling students and new genetic counselors completed a 2-hr medical improv workshop and participated in follow-up interviews to discuss the workshop. Participants' responses to the intervention were positive, with 92.9% of participants responding that they would recommend medical improv training to other genetic counseling students. Participants described the medical improv workshop as helping build psychosocial skills in a safe environment, which may facilitate the use of more advanced counseling skills in clinical situations. By training students to practice psychosocial skills and building students' confidence, medical improv may help genetic counseling students and genetic counselors be more effective in challenging clinical situations, and to feel more comfortable in experimenting with new ideas and psychosocial techniques in their clinical practice.
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Affiliation(s)
- Weilong Li
- Graduate Program in Genetic CounselingNorthwestern UniversityChicagoIllinoisUSA
- Physician Assistant Studies ProgramSalus UniversityElkins ParkPennsylvaniaUSA
| | - Courtney L. Scherr
- Department of Communication StudiesNorthwestern UniversityChicagoIllinoisUSA
| | | | - Katie L. Watson
- Departments of Medical Social SciencesMedical Education and Obstetrics & GynecologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
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Karnieli-Miller O, Pelles S, Meitar D. Position paper: Teaching breaking bad news (BBN) to undergraduate medical students. PATIENT EDUCATION AND COUNSELING 2022; 105:2899-2904. [PMID: 35710469 DOI: 10.1016/j.pec.2022.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
Sharing new medical information that is perceived as seriously effecting people's lives, i.e., breaking bad news (BBN) is important in caring for patients and relatives and is challenging for healthcare professionals. Optimal BBN requires incorporation and implementation of multiple professional competencies acquired gradually throughout years of training. The BBN encounter has implications for all participants: the patient, family members, their close social environments, and the deliverer of the news. Due to these implications and the accountability involved, medical schools invest educational resources in helping medical students develop this competency. The current paper summarizes literature, research, and teaching experiences while suggesting practical guidelines for designing and teaching a BBN course to undergraduate students. The following principles lie behind the recommendations: stepwise spiral continuity of exposure to and teaching of communication skills in various contexts while focusing on BBN in the advanced clinical years; relating the developing skills to broader humanistic studies; enhancing awareness of self-perspectives and beliefs regarding BBN; connecting to patients' and family members experiences and needs; providing a BBN protocol and opportunities for structured experiential learning followed by reflection and feedback; using observation and reflection to address gaps between theory and real-life practice; and creating continuity of learning about BBN through undergraduate, graduate, and continuing medical education. Applying this learning process can help enhance the management of these difficult conversations to improve patients' care during these difficult, life-changing encounters, and physicians' well-being.
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Affiliation(s)
- Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sharon Pelles
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Dafna Meitar
- Mandel School for Educational Leadership, Jerusalem, Israel; Medical College of Wisconsin, Wisconsin, USA
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Abstract
Decision-making at extreme prematurity remains ethically and practically challenging and can result in parental and clinician distress. It is vital that clinicians learn the necessary skills integral to counseling and decision-making with families in these situations. A pedagogical approach to teaching counseling should incorporate adult learning theory, emphasize multidisciplinary team in-situ simulation that links to counseling clinicians' daily practice, and includes critical reflection, debriefing, and program assessment. Multiple educational strategies that train clinicians in advanced communication and decision-making offer promising results to optimize antenatal counseling and shared decision-making for families facing possible delivery at extreme prematurity. Continued process evaluation and innovation in these educational domains are needed while also assessing the effect on patient-centered outcomes.
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Affiliation(s)
- Anne Sullivan
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Center for Bioethics, Harvard Medical School, Boston, MA, USA.
| | - Christy L. Cummings
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA,Center for Bioethics, Harvard Medical School, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
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Affiliation(s)
- Ankit Mehta
- Ankit Mehta, MD, FHM, FACP, is a Hospitalist, HealthPartners, and Assistant Professor, Department of Internal Medicine, University of Minnesota
| | - David Fessell
- David Fessell, MD, is a Retired Professor of Radiology, and Faculty Associate, Ross School of Business, University of Michigan
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Lindquist LA, Liggett A, Muhammad R, Seltzer A, Kim KYA, Barish B, Wagner A, Ramirez-Zohfeld V. Effects of Improv Training on Older Adults in a Long Term Care Facility. Gerontol Geriatr Med 2021; 7:23337214211016111. [PMID: 34104682 PMCID: PMC8155780 DOI: 10.1177/23337214211016111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 11/15/2022] Open
Abstract
Adjusting to life in a long term care facility (LTCF) can be challenging for older adults. Improvisation (shortened to improv) is a unique activity that encourages creativity and adaptive cognitive stimulation, through performing short scenes with content suggestions. We sought to assess whether improv training, in the form of a course entitled Humor Doesn't Retire (HDR), could impact patient-centered outcomes in a LTCF. About 15 adults (mean age 83.6 years) living in a LTCF participated in the 8-week HDR course with pre and 1-month post mixed method surveys assessing validated Patient Reported Outcomes Measurement Information System (PROMIS) measures and qualitative open-ended responses. Participants experienced significant improvements in social isolation and perceived stress (p < .05), and trend improvements in positive affect, self-efficacy, and anxiety. Participants described themes of increased attentiveness, becoming more relaxed, increased cognitive stimulation, and improved communication skills. In conclusion, LTCFs may want to consider offering improv training to positively improve the lives of older adult residents.
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