Medical Improv Teaching Sample: Core Principle-“Yes and…”

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This Medical Improv core principle can be taught by using an activity called, “Yes and…., Yes but, … and No.”  It is very effective for raising awareness about what it sounds and feels like to validate, invalidate, be validated, and be invalidated in a safe (and fun) way.  It also serves as a beginning to practicing listening and assertiveness skills necessary for increasingly more difficult improv activities.

To teach this activity, the group breaks up into pairs taking on the numbers 1 and 2.  The pairs are instructed to have a conversation about a topic, for instance, ‘sports’.  They must alternate one sentence at a time and with the exception of the very first one, all sentences must begin with “Yes and…”.  They are coached to make up whatever they want and that being factual isn’t important.  Conversations like these emerge as the instructor(s) walks around the room to coach or answer questions and although a bit awkward for some is usually punctuated with laughter:

Surgeon:  I’m excited for football season to begin.  The New England Patriots have a super strong team this year.

Nurse manager:  Yes and the team has a wonderful new manager who I’ve heard great things about. 

Surgeon:  Yes and the new manager is moving into my neighborhood so I’m hoping to get to meet him. 

Nurse manager:  Yes and I would love to have you invite him to my big BBQ Tailgate party I’m having next week.

Surgeon:  Yes and, I’d like to bring my old football outfit and through a few passes with him.

Nurse manager:  Yes and I’ll be sure to bring my camera for some great moments with you and him!


doctor listeningA couple of minutes to debrief e.g invite feedback, how would you describe the quality of the conversation, what did you notice about saying “Yes and…”, was any part of it harder or easier?               `

Part of the magic of Medical Improv is that these two participants can play the same activity together and learn different things.  It might be harder for the nurse to bring new information to the dialogue and for the surgeon to take ideas in from a nurse and build on it.  Yet with the structure provided there is a low risk and clear expectation for both.  In addition, these few moments of ‘serious play’ allow for the nurse manager and surgeon to see each other as human beings working together for a common, albeit silly goal.  This creates an excellent opportunity for collaboration and starts to build a new way of relating to each other.

The next part of the activity is called, “Yes, but…” and is similar to the first level, except this time all sentences after the first must begin with “Yes, but…”.  A new topic such as, “pets” is provided and having the other person go first might be suggested.

Nurse manager:  I’m getting a new puppy today and I’m going to name her Goldie after my great grandmother!

Surgeon: Yes, but, your new puppy’s name shouldn’t be associated with a human relative.

Nurse manager:  Yes, but….my grandmother loved puppies and  we’re really close.  She wants me to use her nickname.

Surgeon: Yes, but your new puppy will probably be confused when your grandmother visits.

This conversation doesn’t have to continue for very long before participants realize how defensive and uncooperative they are being together.  Again in a safe and silly way, they gain awareness of how if feels, looks, and sounds like to 482px-Krankenschwester_Janine01have a conversation with a colleague that is not very supportive.  With this group and many others, it is a familiar feeling and the opportunity to acknowledge that,  even very briefly raises awareness and commitment to behaving differently together.  Feedback and debriefing is similar and followed by a quick opportunity to play the 3rd level with “No”.  This time the topic might be “travel”.

Surgeon:  I’m very excited to leave for my vacation to Aruba tomorrow.

Nurse Manager: No.  Your vacation was canceled.

Participants realize pretty quickly they are polarized and the conversation comes to an abrupt halt.

Again a quick debrief and depending on time one more round of “Yes and…” to end on a positive note and remind the group that “Yes and…” is the golden rule in improv.

Beth Boynton, RN, MS

Medical Improv Brings out the BEST in PEOPLE!

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