New horizon in improving ageing with improvisational theatre.

Cognitive decline, mental health and mindset factors can all affect the autonomy and well-being of older adults. As the number of older adults across the globe increases, interventions to improve well-being are urgently needed. Improvisational theatre (improv) and improv-based interventions are well-suited to address this need. Studies have shown that participation in improv-based interventions has a positive impact on mental health indicators, including depressive symptoms, well-being and social connectedness, as well as cognitive skills such as attention and memory. In addition, improv-based interventions have been beneficial for people with dementia, improving positive affect, self-esteem and communication. In this article, we describe improvisational theatre, or improv, and the reasons it has emerged from a form of spontaneous theatre that involves playfulness and creativity to an important tool to effect behavioural change in individuals and groups. We then review the literature on the effects of improv in ageing populations, with a focus on social, emotional and cognitive functioning. Finally, we make recommendations on designing improv-based interventions so that future research, using rigorous quantitative methods, larger sample sizes and randomised controlled trials, can expand the use of improv in addressing important factors related to autonomy and well-being in older adults.

Applied improvisation and transdisciplinary simulation: a necessity for any health curriculum?

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.

Off-Script, Online: Virtual Medical Improv Pilot Program for Enhancing Well-being and Clinical Skills among Psychiatry Residents.

OBJECTIVE: Clinical interactions demand a balance of structure and flexibility in response to unpredictable situations. Medical improv is a form of experiential learning that applies techniques from improvisational theater to the healthcare setting, deliberately targeting clinical skills of communication, teamwork, and cognitive abilities. Psychiatry Education through Play and Talk (PEP Talks) is a novel medical improv program designed specifically for psychiatry residents with the goal of improving communication, teamwork, and conflict resolution skills, as well as enhancing residents' well-being and capacity for self-reflection. METHODS: PEP Talks was delivered virtually by an experienced medical improv facilitator in spring 2021 to a self-selected group of psychiatry residents at a Canadian university. Aligned with the context-input-process-product (CIPP) evaluation model, outcomes were assessed through mixed methods surveys, recorded debriefings, and a focus group. RESULTS: PEP Talks enhanced residents' self-reported well-being, reflective capacity, and communication skills. Participants made qualitative connections between PEP Talks and their well-being, inter- and intra-personal skills, and clinical experiences in psychiatry. Processes in PEP Talks that led to these outcomes included the following: joy, building community, personal reflection and discovery, going off-script, immersion, and virtual engagement. CONCLUSIONS: Virtual medical improv offers an innovative solution to the pedagogical challenges of training psychiatrists to be proficient communicators, collaborators, and professionals capable of reflective practice. Additionally, this innovation demonstrates that medical improv can be delivered in a virtual format and may offer a unique solution to support resident well-being and foster connection amid remote learning during a global pandemic.

Connecting improvisational exercises and pharmacy communication skills: A how-to guide.

BACKGROUND AND PURPOSE: Medical improvisation (improv) is increasingly being used to teach physicians, nurses, and other caregivers how to better communicate with patients and other members of the healthcare team. This article describes how improvisational activities were incorporated within an existing pharmacy practice lab course and how to implement improv games targeting specific communication skills. EDUCATIONAL ACTIVITY AND SETTING: Three hours of improvisational activities were incorporated into a semester-long pharmacy practice lab course. Partner games such as "the mirror" and group games such as "out-of-order story" were played and connected to communication skills related to counseling or taking a patient's history. Additional activities were introduced targeting specific areas of weakness identified in a formative assessment. FINDINGS: A survey was used to assess student perceptions of the improv activities. Students were largely able to connect the skills learned in improv to pharmacy, and some provided examples of how they were already implementing these skills in practice. SUMMARY: This article provides a user manual so that faculty with little to no improv experience can include these activities in their communications courses.

"Young Women My Age Really Need Boosts Like This": Exploring Improv as a Facilitator of Wellness Among Young Women of Color.

This project qualitatively examined the potential of scenic improvisation ("improv") for engaging young women of color as a possible means of promoting and enhancing health and wellness outcomes in this often-overlooked population. Seven young women of color (ages 15-18), accessing virtual after-school programming, participated in a three-session professionally facilitated improv workshop series. Participants provided insights through in-depth pre- and postproject qualitative interviews about their experiences. Participants indicated that improv boosted their self-esteem and strengthened their social connections. Participants were enthusiastic about accessing further improv opportunities, noting that improv should be embedded into other youth-serving programs and health-promotion efforts, as such approaches were deemed as particularly needed among young women of color. Inclusion of improv activities in intervention and prevention efforts would benefit from additional exploration as ways by which health and wellness programs and supports might be innovated and tailored to the specific needs and preferences of young women of color.

Exploring a brief medical improvisational performing arts intervention for genetic counseling graduate students.

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.

IMPROVing communication about diversity, equity, and inclusion in health professions education.

There has never been a stronger call for authenticity in health professions education than this moment in time. The health inequities laid bare by the COVID-19 syndemic (a concept that describes the clustering of SARS-CoV-2 infection and disease by political, social, and economic factors) compels health professions educators to learn how to best engage in, sustain, and deepen conversations on diversity, equity, and inclusion (DEI) within our learning environments. Health professions curricula should address such concerns through explicit faculty training programs in dialogue models of communication. In this commentary, I propose that medical improv can help refocus health professions training to the humanistic values of empathy for others and respect for multiple viewpoints. Medical improv refers to teaching methods that adapt improvisation principles and exercises to enhance professional competencies in the health professions, such as communication. I describe a training series implemented at one institution to prepare faculty facilitators to engage in conversations about DEI in a discussion-based core course on the social determinants of health for first year medical students called "Humanity in Medicine." Key elements of dialogue training, including examinations of identity and positionality, caretaking and team-making, and conversations with a skeptic, are viewed through the lens of improv exercises as a pedagogy in communication. I report on facilitator and medical students' positive response to facilitator training and the Humanity in Medicine course. Potential next steps towards a formal evaluation of the method, and outcomes assessments of the use of improv in health professions training are discussed.

Imposter phenomenon in radiology: incidence, intervention, and impact on wellness.

PURPOSE: Imposter phenomenon refers to feelings of inadequacy due to inability to internalize evident success. While high achievers such as physicians have been known to exhibit imposter phenomenon, there is limited literature specific to radiologists. Our purpose was to (1) investigate imposter phenomenon in radiologists and assess correlation with burnout, and (2) pilot an intervention aimed at addressing imposter phenomenon through improvisational theater techniques. METHODS: Part 1 - Clinical radiology faculty at a single large academic medical center completed an anonymous survey with questions related to demographics, burnout (derived from the validated Mini-Z assessment tool), and imposter phenomenon. Part 2 - A one-hour interactive workshop on imposter phenomenon was organized for the radiology department at the same institution. The workshop included the Clance Imposter Phenomenon Scale (CIPS). A post-workshop survey rating was also performed. RESULTS: Part 1 - Of 30 clinical radiology faculty who participated in the survey, 83% reported feelings of imposter phenomenon during their career. There was significant (p = 0.024) correlation between imposter phenomenon and burnout. Part 2 - Of 21 members of the Department of Radiology who completed the CIPS in the interactive workshop, 71% exhibited frequent or intense symptoms of imposter phenomenon. On the post-workshop survey asking participants to rate the workshop, the mean score was 4.4 and the mode score was 5 on a scale of 1 (poor) to 5 (excellent). CONCLUSION: Imposter phenomenon affects radiologists and is correlated with burnout. Innovative interventions to address imposter phenomenon such as workshops utilizing medical improvisational techniques are well-received.

Applied Improvisation Enhances the Effects of Behavioral Activation on Symptoms of Depression and PTSD in High School Students Affected by the Great East Japan Earthquake.

BACKGROUND: The education system can serve as a community-based resource to support the provision of long-term follow-up care after large-scale disasters. While school-based interventions conducted after a disaster have been confirmed to reduce symptoms of depression and posttraumatic stress disorder (PTSD), adolescents often exhibit low treatment motivation. Traditional methods used to encourage treatment motivation include fun activities, such as applied improv (AIM). This study evaluated the intervention effects and improved motivation of an intervention program combining AIM with the behavioral activation approach (BAA). METHODS: Participants were 253 tenth graders, who were in fifth grade at the time the Great East Japan Earthquake of 2011, and 239 students were included in the analyses. Participants were divided into two groups: the BAA and AIM + BAA groups. Students in each group participated in one class-wide intervention session, which lasted 60 min. Depression, PTSD symptoms, behavioral activation, avoidance, and resilience were evaluated using psychological scales. A participant's evaluations of the intervention were confirmed using the impression sheet consisting of six items that measure comprehension, difficulty, efficacy, generalization, confirmation of a specific situation, and motivation. RESULTS: A two-way analysis of variance (ANOVA) conducted using data from the psychological scale did not reveal a significant effect from the intervention program. However, the Mann-Whitney U-test, which used data from the impression sheet, showed a significant effect on comprehension (p = 0.001), generalization (p = 0.023), and motivation (p = 0.025). CONCLUSION: This study did not confirm the effectiveness of the BAA in reducing symptoms of depression and PTSD in adolescents. Regarding treatment motivation, the AIM + BAA group reported higher motivation than the BAA group. Thus, one session of AIM may contribute to improved treatment motivation in adolescents. AIM creates a safe environment and encourages engagement and participation in interventions. Treatment motivation is an important issue in adolescent therapy, and AIM may help solve this problem.

The impact of a medical improv curriculum on wellbeing and professional development among pre-clinical medical students.

Medical students experience rising rates of burnout throughout their training. Efforts have been made to not only mitigate its negative effects, but also prevent its development. Medical improv takes the basic ideas of improvisational theatre and applies them to clinical situations. Given improv's focus on self-awareness and reflection, in addition to its spontaneous nature, we hypothesized it had the potential to serve as a creative outlet, a way to prevent and/or mitigate the negative effects of stress, burnout, and fatigue, and provide a learning environment to develop skills necessary to succeed as a physician. University of California (UC) San Diego School of Medicine developed a medical improv elective for pre-clinical students and assessed its effects on student development and wellbeing. Students enrolled in the elective between Fall 2019 and Fall 2020 at UC San Diego School of Medicine were surveyed pre- and post- course completion using both qualitative and quantitative methods. Students noted significant improvement in domains related to proactivity in their professional career (3.15 to 4.00, p = 0.02), wellbeing (3.0 to 4.4, p < 0.001), engagement with their studies (3.85 to 4.52, p = 0.02), and communication (3.75 to 4.3, p = 0.04) after completion of the medical improv elective. We describe a pilot-study demonstrating the positive effects of improv on medical student wellbeing and professional development, laying the groundwork for both future study of improv on student wellness and its implementation in the pre-clinical curriculum.

Conscious dance: Perceived benefits and psychological well-being of participants.

BACKGROUND: Meta-analyses suggest that dance has potential to decrease psychological distress, increase trait mindfulness, and enhance quality of life. Conscious dance can be defined as unchoreographed, intentionally nonevaluative mindful movement commonly practiced in a group setting for purposes of authentic self-expression, self-discovery, interpersonal connectedness, and personal healing or growth. OBJECTIVE: To assess perceived effects of conscious dance practice (e.g., Ecstatic Dance, 5Rhythms) and examine associations between frequency/duration of practice and psychological well-being among participants. METHODS: Self-identifying adult conscious dancers completed a survey (N = 1003; mean age = 47 years; 52% from the U.S; 78% White; 73% female). RESULTS: Conscious dancers with ≥5 years of practice had significantly higher trait mindfulness and life satisfaction compared to newer practitioners. More frequent practice (≥once per week) was associated with higher trait mindfulness. A strong majority of participants endorsed experiences consistent with mindfulness (i.e., feeling "more present in my body"; 99% of the sample) and psychological flow ("I felt like I was 'in the zone' or 'in the flow' of things"; 93% of the sample) during conscious dance. Among participants endorsing any of five stress-related health conditions, the majority reported therapeutic effects (i.e., that conscious dance "helped them cope" with the condition). Therapeutic effects were most consistently reported by individuals with depression or anxiety (96% endorsement), followed by those with a trauma history (95%), chronic pain (89%), and history of substance abuse or addiction (88%). For all conditions except addiction, therapeutic effects were associated with greater experiences of psychological flow during dance, and the magnitude of these effects was large (Cohen's d range: 1.0-2.3). CONCLUSION: Individuals who engage in conscious dance report that these practices help them to cope with stress-related health conditions. Participants reporting longer duration or greater frequency of practice scored higher on measures of psychological well-being. The feasibility and efficacy of conscious dance for improving well-being among individuals naïve to these approaches will be important to determine in future research.

Teenagers Tell Better Stories After Improvisational Theater Courses.

Improvisational theater (improv) is a booming theatrical practice, applying in many fields (teaching, medicine or entrepreneurship). Its effects on cognitive and behavioral processes are beginning to be demonstrated, despite scientific publications that are still rare, particularly about language. This study aimed to evaluate the effects of improv on adolescent narrative skills. Twenty-seven middle school students were recruited and divided into two groups: an IMPRO group (n = 13), composed of novice and intermediate improvisers, and a CONTROL group (n = 14), composed of middle school students doing theater. The evaluation took place in two experimental times spaces 3 months apart (11 sessions). It consisted in the creation of a written narrative resulting from previously observed images. We used quantitative criteria to carry out the analysis of this story (coherence, cohesion, lexicon, and syntax), according to the methodologies of PELEA and EVALEO. We showed an effect of the improv on coherence, which suggests that the practice of improv introduces teenagers to improve the narrative skills and the planification of a story, unlike written theater.

An Applied Improvisational Pharmacy Communication Workshop Implemented During Orientation for First-Year Pharmacy Students.

Objective. To deliver a brief, applied workshop in improvisational communication skills during the new student orientation for first-year Doctor of Pharmacy students and to assess students' perceptions about the experience. Methods. Communication instructors developed a two-hour communication "boot camp" based on established principles of clear, responsive, flexible communication. They taught core skills through interactive applied improvisational exercises and facilitated debriefings. A questionnaire was administered following the workshop that asked students to rate the quality of the session and comment on its strengths and weaknesses. Results. Of the 124 students who participated in the workshop, 95 (77%) completed evaluations at the end. Their feedback was generally favorable: 90% of participants indicated that the boot camp improved their communication skills and 92% agreed that the activities were realistic and relevant to real-life scenarios. The students reported that they valued the chance to connect with classmates, learn how to adapt to different audiences, and explore how communication skills would be useful in professional settings. Conclusion. This interactive program delivered valuable content in a short period of time. Student feedback suggested that they valued the expertise of communication instructors and the playful, active method of learning. The creation of the workshop was labor-intensive because of the formative research that guided it.

Active Learning on Center Stage: Theater as a Tool for Medical Education.

Introduction: Knowledge and skill development related to communication must incorporate both affective and behavioral components, which are often difficult to deliver in a learning activity. Using theater techniques and principles can provide medical educators with tools to teach communication concepts. Methods: This 75-minute faculty development workshop presents a variety of techniques from theater and adapts them for use in medical education. Using examples related to diversity and inclusion, this session addresses general educational and theater principles, role-play, sociodrama, applied improvisation, and practical aspects of involving theater partners. The session materials include a PowerPoint presentation with facilitator notes, interactive activities to demonstrate each modality, and an evaluation. The sessions can be extended to longer formats as needed. Results: Forty-five participants at Learn Serve Lead 2016: The AAMC Annual Meeting attended the 75-minute session. We emailed 32 participants 5 months after the conference, and eight responded. Participants reported that their confidence level in using theater techniques as a tool for medical education increased from low-to-medium confidence presession to high confidence postsession. All survey respondents who were actively teaching said they had made changes to their teaching based on the workshop. All commented that they appreciated the active learning in the session. Many indicated they would appreciate video or other follow-up resources. Discussion: Principles and techniques from theater are effective tools to convey difficult-to-teach concepts related to communication. This workshop presents tools to implement activities in teaching these difficult concepts.

Common Ground: Frameworks for Teaching Improvisational Ability in Medical Education.

Issue: The practice of medicine is intrinsically unpredictable. Clinicians must respond skillfully to this uncertainty; therefore, medical educators are using improvisational theater training methods to teach improvisational ability in areas such as communication and professionalism. This teaching approach is called "medical improv." Although early reports of medical improv suggest promise, the collective descriptions of curricular content lack consistency. This ambiguity creates impediments for further implementation and research of this new educational technique. To address this challenge, the author presents two unifying conceptual frameworks for medical improv curricula. Evidence: Medical improv evolved from previous work done in improvisational (improv) theater and "applied improv," which is the broader category of improv-based training in nontheater environments. The author synthesized curricular elements from all three fields of improv into two conceptual frameworks: core curricular components (skills, principles, and exercises) and core skill groups (attunement, affirmation, and advancement). The curricular component framework simplifies terminology and clarifies a previously vague distinction between skills and principles. The skill group framework harnesses a redundant and wide-ranging list of improv skills into three categories. Together, the frameworks provide a simple structure that encompasses and organizes the core concepts of medical improv. Implications: These curricular frameworks enable educators and learners to more easily understand the scope and depth of medical improv concepts and to identify areas where medical improv could enhance existing medical education strategies. For example, there is substantial overlap between improvisation skills and current curricular objectives for communication skills, as outlined by Accreditation Council for Graduate Medical Education benchmarks (e.g., Milestones, Competencies, Entrustable Professional Activities). Medical improv courses could be an efficient way to achieve many of these objectives. In addition, improv-based exercises represent an experiential learning modality that is underutilized in communication skills training; therefore, exercises could be integrated into existing coursework to bridge the learning pathway between texts and simulation. Furthermore, the deliberate cultivation of affirmation skills could enhance resilience and wellness in clinical and learning environments. In summary, through their conceptual simplicity, these curricular frameworks for medical improv can help educators understand, study, and optimize teaching of improvisation in medical education.

Thera-prov: a pilot study of improv used to treat anxiety and depression.

Background: Improvisational theater exercises (improv) are used in various settings to improve mental health and medical outcomes. However, there is little documented evidence of the effectiveness of these interventions.Aims: We developed a short-term, group intervention that used improv exercises in a therapeutic manner to treat psychiatric patients.Methods: We evaluated the feasibility, acceptability and five clinical outcomes (depressive symptoms, anxious symptoms, self-esteem, perfectionism and satisfaction with social roles) of this intervention in an outpatient setting. Participants were 32 patients with symptoms of anxiety and depression and who had variable exposure to psychiatric treatment.Results: In paired samples t-tests, participants demonstrated reduced symptoms of anxiety (t(31) = 4.67, p < 0.001) and depression (t(31) = 3.78, p = 0.001), and improved self-esteem (t(31)= -3.31, p = 0.002) following the intervention. There was a trend towards reduction of perfectionism (t(31) = 1.77, p = 0.087), but no substantial change in rated satisfaction with social roles. Effect sizes were medium for reduction in symptoms of depression and anxiety.Conclusions: The results of this study indicate that a brief intervention based on improv exercises may provide a strong and efficient treatment for patients with anxiety and depression.

Improving Teenagers' Divergent Thinking With Improvisational Theater.

Improvisational theater (improv) is supposed to have an impact on cognitive processes (divergent thinking, flexibility, language, memory, problem solving, and co-construction), academic performance, and everyday life in many ways. However, little research studied on the psychological impact of improv, with some results highlighting a divergent thinking enhancement in children and adults, but not with teenagers, one of the most important age groups to practice improv. Therefore, this study aims to assess divergent thinking for middle school students before and after an 11-weeks session compared to a control group with a sport practice. The Alternative Uses Task (AUT) was used before and after the session for both groups to evaluate divergent thinking. The improv group had better performance in originality, flexibility and gave less prototypical items after the improv sessions compared to before, while the control group performance was similar before and after. Our results suggest that improv helps teenagers' divergent thinking to improve, not only with experimental games in the lab context but also after ecological sessions. We urge scientists to study in depth psychological impacts of improvisational theater and applied improvisation, for a better understanding of improv and as a model to study embodied cognition.

Scripted-IMPROV: Interactive Improvisational Drama With Persons With Dementia-Effects on Engagement, Affect, Depression, and Quality of Life.

Scripted-IMPROV (SI) is a nonpharmacological (ecopsychosocial) intervention that consists of semi-improvised drama performances specifically designed for persons with dementia (PWD). In this 12-site study, 178 PWD took part in the SI intervention. Levels of engagement/affect were assessed at baseline and again during SI performances; quality of life (via the Dementia Quality of Life scale) and depression (via the Geriatric Depression Scale-Short Form [GDS-SF]) were assessed at baseline and post-treatment. Positive forms of engagement/affect increased, while negative forms of engagement decreased. Regarding depression, for a subsample of 29 participants who scored in the depressed range on the GDS-SF at baseline, depressive symptoms were reduced at post-treatment. Although overall quality of life did not change, the increase in positive affect during SI suggests that quality of life was higher during the intervention itself. In conclusion, SI possesses the characteristics of a high-quality intervention for PWD and seems worthy of further investigation in future research.

Laughter is the best medicine: The Second City® improvisation as an intervention for Parkinson's disease.

BACKGROUND: Expressive therapies are increasingly incorporated into the management of Parkinson's disease (PD), although there are little objective data assessing their benefits. OBJECTIVE: Develop and study a novel community Improvisation Theater (IT) program for PD in order to improve quality of life. METHODS: A prospective, rater-blinded, modified cross-over design study of IT for PD. 22 subjects were randomized 1:1 to active-start (AS) or control-start (CS) groups, controlling for age and Hoehn and Yahr stage. Participants were recruited from the Northwestern PD and Movement Disorders Center. 60 min IT sessions were led by The Second City® faculty weekly for 12 weeks. The primary aim was to assess feasibility, determined as 70% of participants attending at least 75% of the classes. Exploratory data were obtained comparing pre- and post-intervention outcomes using Wilcoxon signed rank test for UPDRS parts I-IV, PDQ-39, and 5 neuro-QoL measures (communication, anxiety, stigma, depression, and wellbeing). RESULTS: All 22 participants completed the study. 21/22 (95%) participants attended at least 80% of the classes. All participants indicated that they would recommend the class to others with PD. 21/22 participants enjoyed the class and felt it was beneficial for their symptoms. A significant improvement pre-to-post intervention was seen with the UPDRS part II ADL measure (mean -1.5, p = 0.019). CONCLUSION: A novel improvisation program can be well-attended, enjoyable, and improve ADL measures among patients with PD of varying ages and disease severity.

Medical improvisation training to enhance the antenatal counseling skills of neonatologists and neonatal fellows: a pilot study.

INTRODUCTION: Neonatologists must be skilled at providing antenatal counseling to expectant parents of premature infants at the limits of viability. We conducted a medical improvisation workshop with the objective of enhancing antenatal counseling skills. METHODS: Pre- and postworkshop questionnaires were collected to examine the impact of the training. A follow-up survey was distributed 3 months after the workshop to examine the impact of the training on antenatal counseling skills. RESULTS: Nine neonatologists and three neonatal fellows participated in the workshop. Participants reported the skills learned in the workshop could enhance the quality of antenatal counseling. On follow-up survey, 90% of subjects reported improvements in the quality of their antenatal counseling. DISCUSSION: Participation in a medical improvisation workshop resulted in enhancements of self-perceived antenatal counseling skills. Medical improvisation training may provide a feasible and effective method of communication training for neonatologists. Further research into this innovative method are needed.