Enhancing Relationship-Centered Communication and Feedback in Emergency Medicine Through Applied Improvisation (EM-PROV)

Audience: This small group session is intended for emergency medicine residents, medical students, and faculty. Introduction: Improvisational techniques offer a novel and effective approach to teaching relationship-centered communication (RCC) and enhancing learner feedback in emergency medicine (EM).1 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.1 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.2,3,4In 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.5,6 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. Educational Objectives: By the end of this session, learners will be able to improve relationship-centered communication (RCC): 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 learner feedback: 1) define "yes, and" and its role in learner feedback, 2) review three evidence-based feedback models through a "yes, and" lens, and 3) practice improv techniques and deliver structured feedback in real-time peer scenarios using improvisational techniques such as "yes, and," gift-giving, establishing scenes, and callbacks. Educational Methods: 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.7,8,9,10 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. Research Methods: 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: "Describe a specific moment during the improv session that stood out to you." "How did it impact your understanding or approach to feedback or communication?" "How do you see the skills learned today translating to your future clinical practice?" "How likely are you to use "yes, and" in your communication with colleagues and patients?" "What challenges did you encounter when applying improv techniques during this session?" Thematic analysis of reflective prompts was performed. Results: Fifty-two learners participated and responded to the post-intervention survey. This included a 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." Discussion: 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. Topics: Relationship-centered communication, feedback, applied improvisation.