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{ "pk": 52345, "title": "Enhancing Relationship-Centered Communication and Feedback in Emergency Medicine Through Applied Improvisation (EM-PROV)", "subtitle": null, "abstract": "<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">Audience:<span class=\"Apple-converted-space\"> </span></span></strong><span style=\"font-family: Calibri, sans-serif;\">This small group session is intended for emergency medicine residents, medical students, and faculty.</span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">Introduction:</span></strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"><span class=\"Apple-converted-space\"> </span>Improvisational techniques offer a novel and effective approach to teaching relationship-centered communication (RCC) and enhancing learner feedback in emergency medicine (EM).<sup>1</sup><span class=\"Apple-converted-space\"> </span>Improvisational theater (improv) is a form of spontaneous performance where all things or most things are made up on the spot. The “yes, and” principle—accepting a partner’s idea (\"yes\") and building upon it (\"and\")—reflects core improv values such as affirmation, spontaneity, active listening, and empathy, all of which contribute to psychologically safe learning environments.<sup>1</sup><span class=\"Apple-converted-space\"> </span>It is an engaging practice that can foster creativity, build confidence, and enhance communication and social skills. Improv helps participants become more adaptable, attuned to emotional tone, and comfortable with uncertainty. These are critical elements of high-quality interpersonal feedback.<sup>2,3,4</sup></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> </span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">In the fast-paced EM setting, where teaching and supervision often occur in real time, the ability to deliver concise, respectful, and actionable feedback is essential. Improv-based learning provides a low-stakes space to explore tone, content, and delivery without fear of error. Prior studies demonstrate that improv improves communication performance, team collaboration, and confidence in difficult conversations.<sup>5,6</sup><span class=\"Apple-converted-space\"> </span>This module builds on that foundation by integrating structured feedback models and core RCC principles with improvisational exercises, allowing participants to refine skills through play, reflection, and peer interaction. As EM continues to emphasize communication and professionalism milestones, improv offers a compelling adjunct to traditional faculty or resident development by combining emotional literacy, interpersonal skills, and educational theory in a single interactive format.</span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">Educational Objectives:<span class=\"Apple-converted-space\"> </span></span></strong><span style=\"font-family: Calibri, sans-serif;\">By the end of this session, learners will be able to<u><span style=\"color: rgb(33, 33, 33);\"><span class=\"Apple-converted-space\"> </span>improve relationship-centered communication (RCC</span></u><span style=\"color: rgb(33, 33, 33);\">): 1) define “yes, and” and its role in RCC, and 2) demonstrate active listening and responsiveness using improvisational techniques such as “yes, and,” gift-giving, establishing scene, and callbacks. They will also be able to improve<u><span class=\"Apple-converted-space\"> </span>learner feedback</u>: 1) define “yes, and” and its role in learner feedback, 2) review three evidence-based feedback models through a “yes, and” lens, <span class=\"Apple-converted-space\"> </span>and 3)<span class=\"Apple-converted-space\"> </span><u>p</u>ractice improv techniques and deliver structured feedback in real-time peer scenarios using improvisational techniques such as “yes, and,” gift-giving, establishing scenes, and callbacks.</span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">Educational Methods:</span></strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"><span class=\"Apple-converted-space\"> </span>Using Kern’s six-step approach, this curriculum was designed to address gaps in relationship-centered communication (RCC) and feedback skills among emergency medicine residents.<sup>7,8,9,10</sup><span class=\"Apple-converted-space\"> </span>The first two workshops focused on RCC, linking improvisational principles to patient communication through the Three-Function Model, which emphasizes building relationships, understanding the patient’s perspective, and collaborating on care decisions. Sessions incorporated facilitator discussions, a video clip from Whose Line Is It Anyway? and small-group improv exercises. The third workshop targeted feedback skills for Graduate Medical Education (GME) leadership, introducing concepts such as “yes, and,” credible feedback, and evidence-based models, and included interactive activities like the “Red Ball” exercise and improv-based learner scenarios to reinforce effective communication and feedback practices.<span class=\"Apple-converted-space\"> </span><strong> </strong></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">Research Methods:</span></strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"><span class=\"Apple-converted-space\"> </span>A post-intervention survey with a 5-point Likert scale was administered immediately after all three sessions via Google Forms. Participants were asked about the structure of the activity, length, engagement, relevance to practice, and the facilitator's skill. Open-response questions included:</span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">“Describe a specific moment during the improv session that stood out to you.”<span class=\"Apple-converted-space\"> </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">“How did it impact your understanding or approach to feedback or communication?”<span class=\"Apple-converted-space\"> </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">“How do you see the skills learned today translating to your future clinical practice?”<span class=\"Apple-converted-space\"> </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">“How likely are you to use “yes, and” in your communication with colleagues and patients?”<span class=\"Apple-converted-space\"> </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> “What challenges did you encounter when applying improv techniques during this session?” Thematic analysis of reflective prompts was performed.<span class=\"Apple-converted-space\"> </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">Results:<span class=\"Apple-converted-space\"> </span></span></strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> Fifty-two learners participated and responded to the post-intervention survey. This included<span class=\"Apple-converted-space\"> </span></span><span style=\"font-family: Calibri, sans-serif;\">a<span style=\"color: rgb(19, 115, 51);\"><span class=\"Apple-converted-space\"> </span></span><span style=\"color: rgb(33, 33, 33);\">5-point Likert scale and open-response questions administered for all three sessions. Respondents rated highly (4 or 5 on Likert scale) the activity structure (96.1%), length (84.3%), engagement (100%), relevance to practice (92.3%), and facilitator skill (88.5%). Thematic analysis of free-text answers revealed themes of “enjoyment/engagement,” “connection to patient care,” “applying improv to feedback,” and “openness to future application.” </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> </span></strong></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; break-after: avoid;'><strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\">Discussion:<span class=\"Apple-converted-space\"> </span></span></strong><span style=\"font-family: Calibri, sans-serif; color: rgb(33, 33, 33);\"> This applied improvisation curriculum provided an effective modality to practice RCC and feedback skills among EM learners and faculty. High engagement, relevance to practice, and strong facilitator impact highlight this effectiveness. The thematic analysis findings underscore the value of connecting improv techniques to patient care and feedback delivery.<span class=\"Apple-converted-space\"> </span></span></p>\n<p class=\"MsoNormal\" style='margin: 0in; font-size: medium; font-family: \"Times New Roman\", serif; border: medium; color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-style: solid; text-align: justify;'><em><span style=\"font-family: Calibri, sans-serif; color: black;\"> </span></em></p>", "language": "eng", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Relationship-centered communication" }, { "word": "feedback" }, { "word": "applied improvisation" } ], "section": "Small Groups", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/99n4w2r3", "frozenauthors": [ { "first_name": "Jordan", "middle_name": "", "last_name": "Valentin", "name_suffix": "DO", "institution": "Northwell Health & Staten Island University Hospital", "department": "Department of Emergency Medicine" }, { "first_name": "Abbas", "middle_name": "", "last_name": "Husain", "name_suffix": "MD", "institution": "Northwell Health & Staten Island University Hospital", "department": "Department of Emergency Medicine" }, { "first_name": "Brendan", "middle_name": "", "last_name": "Freeman", "name_suffix": "DO, MHPE", "institution": "Northwell Health & Staten Island University Hospital", "department": "Department of Emergency Medicine" } ], "date_submitted": "2025-06-29T16:32:01-07:00", "date_accepted": "2026-03-23T10:52:02.324216-07:00", "date_published": "2026-04-30T21:25:00-07:00", "render_galley": { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/uciem_jetem/article/52345/galley/49531/download/" }, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/uciem_jetem/article/52345/galley/49531/download/" } ] }