State-of-the-art review of medical improvisation curricula to teach health professional learners communication.

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.

Using nominal group technique to determine skills that applied improvisation can teach health profession education learners.

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.

Medical improvisation-based motivational interviewing for internal medicine residents: Mixed-methods evaluation of a novel course.

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.

A survey of motivational interviewing training experiences among internal medicine residents.

OBJECTIVE: Assess resident physicians' training experiences and self-reported application of motivational interviewing (MI) skills. METHODS: A cross-sectional nationally representative survey of internal medicine and medicine/pediatric residents from October 2021 - May 2022. Residents reported their MI skill training settings: lectures, standardized patients, role plays, group exercises, direct observation of patient encounters, and a full day or more course. Respondents reported frequency of using specific MI skills in the prior six months during behavior change conversations with patients. RESULTS: The response rate 71.2% (202/281). Respondents received MI training in medical school (67.7%), residency (27.2%), both (22.7%), or none (23.5%). Respondents reported MI training through formal lectures/information discussion (77.5%), MI exercises (77.5%), direct observation of a real patient encounter (38.7%), and one or more full-day workshops (8.5%). Most respondents never or only sometimes elicited change talk statements (73.2%), responded to a patient's sustain talk (64.3%), and developed discrepancies in behavior between individuals' current actions and desired behaviors (75%). CONCLUSIONS: Significant training gaps exist within resident MI education, which may reduce the application of MI skills. PRACTICAL IMPLICATIONS: Behavior change is crucial to many aspects of patient health outcomes. This lack of knowledge may impact future physicians' ability to comprehensively care for patients.

Response to "Education Solutions to the Medical-Dental Divide." A Novel Approach to Creating Unifying Organizational Cultures in Medicine and Dentistry.

No abstract available.

SOAPs and SUDs: Patients With Substance Use Disorders and What Clinicians Should Know About the Cures Act.

The 21st Century Cures Act of 2016 mandates that patients have access to their clinical notes, labs, and imaging through electronic portals and requires information sharing among healthcare entities. We provide practical tips to healthcare professionals on best practices in documenting substance use in the era of transparent electronic medical records, as well as provide guidance on the application of the Cures Act information blocking exceptions for their patients who use substances.

Harm Reduction in Health Care Settings.

Harm reduction is an approach to reduce the risk of harms to an individual using substances without requiring abstinence. This review discusses substance-specific interventions for opioids, alcohol, and stimulants that can minimize harms for individuals who use these substances. Topics discussed include overdose prevention, infection prevention, and low-barrier substance use disorder treatment.