Purpose: Rates of burnout are high during medical training including psychiatric residency. This study examined the impact of improvisational theater training on psychiatry residents’ experiences of burnout and on several outcomes associated with improv training: tolerance of uncertainty, playfulness, and self-compassion. Methods: Fourteen psychiatry residents with minimal background in improvisational theater participated either in an improv (N = 9) or comparison group (N = 5). The improv group met weekly in 2020 for four weeks in person and two additional weeks online. Surveys were administered before the program, after the first four weeks, and following the complete program. Results: Nine residents participated in the improv program. Eight completed all follow up surveys (100%) as did all five non-participants (100%). Initial results indicated that improv contributed to residents’ self experienced well-being, either through reduced burnout or tolerance of uncertainty, increased playfulness, self-compassion, or some combination thereof. Residents reported that improv affected their work and life in general and that it differed substantially from other types of coursework in their psychiatric curriculum. Conclusions: This study, utilizing a relatively low-cost six-week program, suggests that improv can help psychiatry residents overcome burnout, increase tolerance of uncertainty, and enhance their playfulness, self- compassion, sense of joy, and connection to others.
KeywordsBurnoutImprovisationPsychiatryEducationResidency Training
Alkhamees, A. A., Assiri, H., Alharbi, H. Y., Nasser, A., & Alkhamees, M. A. (2021). Burnout and Depression among Psychiatry Residents during COVID-19 Pandemic. Human Resources for Health, 19, Article No. 46. https://doi.org/10.1186/s12960-021-00584-1
Barnett, L. A. (2007). The Nature of Playfulness in Young Adults. Personality and Individual Differences, 43, 949-958. https://doi.org/10.1016/j.paid.2007.02.018
Blanchard, A. K., Podczerwinski, J., Twiss, M. F., Norcott, C., Lee, R., & Pincavage, A. T. (2021). Resident Well-Being before and during the COVID-19 Pandemic. Journal of Graduate Medical Education, 13, 858-862. https://doi.org/10.4300/JGME-D-21-00325.1
Burchiel, R. N., & King, C. A. (1999). Incorporating Fun into the Business of Serious Work: The Use of Humor in Group Process. Seminars in Perioperative Nursing, 8, 60-70.
Bykov, K. V., Zrazhevskaya, I. A., Topka, E. O., Peshkin, V. N., Dobrovolsky, A. P., Isaev, R. N., & Orlov, A. M. (2022). Prevalence of Burnout among Psychiatrists: A Systematic Review and Meta-Analysis. Journal of Affective Disorders, 308, 47-64. https://doi.org/10.1016/j.jad.2022.04.005
Cai, F., Ruhotina, M., Bowler, M., Howard, E., Has, P., Frishman, G. N., & Wohlrab, K. (2019). Can I Get a Suggestion? Medical Improv as a Tool for Empathy Training in Obstetrics and Gynecology Residents. Journal of Graduate Medical Education, 11, 597-600. https://doi.org/10.4300/JGME-D-19-00185.1
Carleton, R. N., Norton, M. P., & Asmundson, G. J. (2007). Fearing the Unknown: A Short Version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21, 105-117. https://doi.org/10.1016/j.janxdis.2006.03.014
Chan, M. K., Chew, Q. H., & Sim, K. (2019). Burnout and Associated Factors in Psychiatry Residents: A Systematic Review. International Journal of Medical Education, 10, 149-160. https://doi.org/10.5116/ijme.5d21.b621
Coverdale, J., Balon, R., Beresin, E. V., Brenner, A. M., Guerrero, A. P. S., Louie, A. K., & Roberts, L. W. (2019). What Are Some Stressful Adversities in Psychiatry Residency Training, and How Should They Be Managed Professionally? Academic Psychiatry, 43, 145-150. https://doi.org/10.1007/s40596-019-01026-w
Dyrbye, L. N., Thomas, M. R., Massie, F. S., Power, D. V., Eacker, A., Harper, W., Durning, S., Moutier, C., Szydlo, D. W., Novotny, P. J., Sloan, J. A., & Shanafelt, T. D. (2008). Burnout and Suicidal Ideation among U.S. Medical Students. Annals of Internal Medicine, 149, 334-341. https://doi.org/10.7326/0003-4819-149-5-200809020-00008
Felsman, P., Gunawardena, S., & Seifert, C. M. (2020). Improv Experience Promotes Divergent Thinking, Uncertainty Tolerance, and Affective Well-Being. Thinking Skills and Creativity, 35, Article ID: 100632. https://doi.org/10.1016/j.tsc.2020.100632
Fessell, D., McKean, E., Wagenschutz, H., Cole, M., Santen, S. A., Cermak, R., Zurales, K., Kukora, S., Lantz-Gefroh, V., Kaplan-Liss, E., & Alda, A. (2019). Medical Improvisation Training for All Medical Students: 3-Year Experience. Medical Science Educator, 30, 87-90. https://doi.org/10.1007/s40670-019-00885-0
Fidler, D., Trumbull, D., Ballon, B., Peterkin, A., Averbuch, R., & Katzman, J. (2011). Vignettes for Teaching Psychiatry with the Arts. Academic Psychiatry, 35, 293-297. https://doi.org/10.1176/appi.ap.35.5.293
Fu, B. (2019). Common Ground: Frameworks for Teaching Improvisational Ability in Medical Education. Teaching and Learning in Medicine, 31, 342-355. https://doi.org/10.1080/10401334.2018.1537880
Gao, L., Peranson, J., Nyhof-Young, J., Kapoor, E., & Rezmovitz, J. (2018). The Role of “Improv” in Health Professional Learning: A Scoping Review. Medical Teacher, 41, 561-568. https://doi.org/10.1080/0142159X.2018.1505033
Glaser, B. G., & Strauss, A. L. (2017). Discovery of Grounded Theory: Strategies for Qualitative Research. Routledge. https://doi.org/10.4324/9780203793206
Harendza, S. (2020). Improvisation—A New Strategy in Medical Education? GMS Journal for Medical Education, 37, Doc44.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research Electronic Data Capture (REDCap)—A Metadata-Driven Methodology and Workflow Process for Providing Translational Research Informatics Support. Journal of Biomedical Informatics, 42, 377-381. https://doi.org/10.1016/j.jbi.2008.08.010
Hoffmann-Longtin, K., Rossing, J. P., & Weinstein, E. (2018). Twelve Tips for Using Applied Improvisation in Medical Education. Medical Teacher, 40, 351-356. https://doi.org/10.1080/0142159X.2017.1387239
Ishak, W., Nikravesh, R., Lederer, S., Perry, R., Ogunyemi, D., & Bernstein, C. (2013). Burnout in Medical Students: A Systematic Review. Clinical Teacher, 10, 242-245. https://doi.org/10.1111/tct.12014
Kumar, S. (2011). Burnout and Psychiatrists: What Do We Know and Where to From Here? Epidemiology and Psychiatric Sciences, 20, 295-301. https://doi.org/10.1017/S204579601100059X
Lacy, B. E., & Chan, J. L. (2018). Physician Burnout: The Hidden Health Care Crisis. Clinical Gastroenterology and Hepatology, 16, 311-317. https://doi.org/10.1016/j.cgh.2017.06.043
McHugh, M. L. (2012). Interrater Reliability: The Kappa Statistic. Biochemia Medica, 22, 276-282. https://doi.org/10.11613/BM.2012.031
Mehta, A., & Fessell, D. (2022). Improvisation in the Time of a Pandemic: Field Notes on Resilience. Journal of Graduate Medical Education, 14, 13-17. https://doi.org/10.4300/JGME-D-21-00663.1
Montero-Marin, J., Zubiaga, F., Cereceda, M., Piva Demarzo, M. M., Trenc, P., & Garcia-Campayo, J. (2016). Burnout Subtypes and Absence of Self-Compassion in Primary Healthcare Professionals: A Cross-Sectional Study. PLOS ONE, 11, e0157499. https://doi.org/10.1371/journal.pone.0157499
Ogütlü, H., McNicholas, F., & Türkcapar, H. (2021). Stress and Burnout in Psychiatrists in Turkey during COVID-19 Pandemic. Psychiatria Danubina, 33, 225-230. https://doi.org/10.24869/psyd.2021.225
Patel, R. S., Sekhri, S., Bhimanadham, N. N., Imran, S., & Hossain, S. (2019). A Review on Strategies to Manage Physician Burnout. Cureus, 11, e4805. https://doi.org/10.7759/cureus.4805
Patton, M. Q. (1990). Qualitative Evaluation and Research Methods. SAGE Publications, Inc.
Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and Factorial Validation of a Short Form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy, 18, 250-255. https://doi.org/10.1002/cpp.702
Rodrigues, H., Cobucci, R., Oliveira, A., Cabral, J. V., Medeiros, L., Gurgel, K., Souza, T., & Goncalves, A. K. (2018). Burnout Syndrome among Medical Residents: A Systematic Review and Meta-Analysis. PLOS ONE, 13, e0206840. https://doi.org/10.1371/journal.pone.0206840
Romani, M., & Ashkar, K. (2014). Burnout among Physicians. Libyan Journal of Medicine, 9, Article No. 23556. https://doi.org/10.3402/ljm.v9.23556
Shapiro, J., Zhang, N., & Warm, E. (2015). MD Residency as a Social Network: Burnout, Loneliness, and Social Network Centrality. Journal of Graduate Medical Education, 7, 617-623. https://doi.org/10.4300/JGME-D-15-00038.1
Simpkin, A. L., & Arabella, L. (2016). Stress from Uncertainty and Resilience among Depressed and Burnt out Residents: Cross-Sectional Study. Master’s Thesis, Harvard Medical School.
Sincsky, C. A., Brown, R. L., & Stillman, M. L. (2021). COVID-Related Stress and Work Intentions in a Sample of US Health Care Workers. Mayo Clinic Proceedings: Innovations, Quality Outcomes, 5, 1165-1173. https://doi.org/10.1016/j.mayocpiqo.2021.08.007
Stacey, A., D’Eon, M., & Madojemu, G. (2020). Medical Student Stress and Burnout: Before and after COVID-19. Canadian Medical Education Journal, 11, e204-e205. https://doi.org/10.36834/cmej.70305
Tawfik, D. S., Scheid, A., Profit, J., Shanafelt, T., Trockel, M., Adair, K. C., Sexton, J. B., & Ioannidis, J. P. A. (2019). Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-Analysis. Annals of Internal Medicine, 171, 555-567. https://doi.org/10.7326/M19-1152
Trockel, M., Bohman, B., Lesure, E., Hamidi, M. S., Welle, D., Roberts, L., & Shanafelt, T. (2018). A Brief Instrument to Assess both Burnout and Professional Fulfillment in Physicians: Reliability and Validity, Including Correlation with Self-Reported Medical Errors, in a Sample of Resident and Practicing Physicians. Academic Psychiatry, 42, 11-24. https://doi.org/10.1007/s40596-017-0849-3
Watson, K. (2011). Perspective: Serious Play: Teaching Medical Students with Improvisational Theater Techniques. Academic Medicine, 86, 1260-1265. https://doi.org/10.1097/ACM.0b013e31822cf858
West, C. P., Dyrbye, L. N., Sinsky, C., Trockel, M., Tutty, M., Nedelec, L., Carlasare, L. E., & Shanafelt, T. D. (2020). Resilience and Burnout among Physicians and the General US Working Population. JAMA Network Open, 3, e209385. https://doi.org/10.1001/jamanetworkopen.2020.9385