Improv Empowers Med Students to Navigate Racial Bias

A novel training program that uses theater and improv can help empower Asian American, Native Hawaiian, and Pacific Islander (AANHPI) medical students faced with racial bias in clinical settings, new findings suggest.

The webinar-based program uses skits inspired by real experiences of AANHPI students to teach participants how to recognize and respond to prejudice, implicit bias, microaggressions, and cultural conflict.

Students who completed the program said that it was easy to adapt to their own training programs, helped improve their communication skills, and increased recognition of implicit bias. 

“Participants felt excited to have built a community of solidarity and allyship with each other and we believe that this is the first step to collective healing and nurturing a sense of belonging among interprofessional trainees,” Elizabeth Li, MD, psychiatry resident at Stanford University, Stanford, California, said during a press briefing. 

Li presented the findings on May 4 at the American Psychiatric Association (APA) 2024 Annual Meeting. 

Navigating Microaggressions 

“Historically, we have lacked systematized curricula addressing how to support ethnic and racial minority students facing microaggressions and structural racism in the clinical environment,” Li explained. 

To address this gap, Li and her colleagues developed and piloted Acting Together, a webinar-based curriculum that teaches AANHPI medical students how to navigate bias, prejudice, and stereotyping. 

Each webinar consists of three modules: (1) improvisation to create a sharing and nonjudgmental framework, (2) interactive theater to act out a cultural dilemma, and (3) a post-webinar panel discussion. 

“We developed skits inspired by lived experiences of AANHPI trainees, which depict the cultural conflict, implicit biases, and racial microaggressions faced in the clinical training environment,” Li said. 

Creating a space for make-believe “imparted a sense of psychological safety, which provided trainees with the freedom to explore responses, make mistakes, and identify solutions to challenging situations,” Li added.

The researchers recruited 112 self-identified AANHPI healthcare trainees through word-of-mouth, university listservs, and professional organization newsletters, indicating a clear and widespread interest in the topic, Li said. 

Pre- and post-surveys were used to assess program acceptability, feasibility, students’ perceived impact on implicit bias, and their understanding of navigating cultural dilemmas. 

“Overwhelmingly,” students felt that Acting Together was easy to adapt to their respective training program, and 90% would recommend it to their peers, Li reported.

In addition, 81% of trainees reported enhanced engagement and proactivity in their professional career; 68% reported enhanced wellness, peer connection, confidence, ability to seek support when faced with cultural dilemmas, and ability to recognize implicit bias; and 71% felt that their communication skills improved. 

“I was so surprised to find that so many others had also experienced situations like mine in the past and that was so reassuring,” one trainee commented.

“We see endless applications for using improv and theater in diversity, equity, and inclusion education,” Li added. 

Innovative Curriculum 

Briefing moderator Howard Liu, MD, MBA, chair of the Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, said, “This work is really fundamental because we all know the importance of a diverse and inclusive workforce.”

This is particularly true for the AAPI community, which has a “lower degree of health seeking than other populations, so we really need to have a linguistically and culturally diverse workforce that is comfortable dealing with some of these microaggressions so that they don’t drop out during training but really feel welcome,” Liu said. 

“This is an innovative and creative curriculum and I do think it has widespread adaptability across different training programs both in psychiatry, and more broadly in the school of medicine,” he added. 

The Josiah Macy Jr. Foundation provided grant support for this project. Li and Liu have no relevant disclosures. 

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