Gabby Mullally (right) improvises a scene with a fellow medical student.
An innovative approach borrowed from the performing arts is helping medical students at the University of Wisconsin School of Medicine and Public Health strengthen their ability to engage in active listening and think on their feet, which are key skills they will need throughout their careers.
For more than a decade, students have been offered an elective class in improvisational theater, or improv, taught by medical education researcher Amy Zelenski, associate professor of medicine, UW School of Medicine and Public Health, who herself has a background in theater.
Zelenski’s initial work on leveraging improv for deepening empathetic behaviors in health care professionals involved teaching internal medicine residents how to give bad news. In this work, she realized the residents’ ability to connect well with patients was still emerging and needed more guidance.
“They could say the words, and with practice do the right thing, but they were really struggling with the connection piece,” Zelenski said.
At the same time, she was working with a medical student who learned of an improv class at Northwestern University being used to help medical students develop interpersonal skills. Zelenksi saw the potential in the student’s idea and with encouragement from Dr. Elizabeth Petty, senior associate dean for academic affairs, they brought the innovative idea to life at UW–Madison in 2015.
“It all really came together to create this class, now 10 years ago,” Zelenski said.
The magic that makes improv successful in teaching interpersonal skills, including empathy, are referred to as “the three As:” attunement, affirming and advancing with other people and the environment around them, a model created by Dr. Belinda Fu, a family physician based in Seattle.
“You affirm what the other person is feeling or bringing to the situation, and then advance the conversation,” Zelenski said.
By building these skills in a low-stakes and purposefully uncomfortable environment in the class, Zelenski helps engrain skillful behavior so students can become comfortable applying these lessons in patient settings. The same capabilities also build success for active listening and teamwork between medical colleagues working side by side in fast-paced clinical settings.
“I feel like there is some muscle memory we’re building so that when they are in that patient care scenario, they can remember what that was like to attune, affirm and advance when they are in that really high-pressure situation,” Zelenski said.
Gabriella Mullally, a fourth-year medical student at the UW School of Medicine and Public Health, learned of the class from a classmate who had already taken the elective. As Mullally prepared to graduate and move on to her residency training, the ability to communicate effectively in the professional world with colleagues and patients will be critical, she said.
“This class has already been going on for three weeks and I’ve already seen changes in the clinical setting,” Mullaly said. “When you are meeting a patient, you are meeting them for the first time on the spot, and I already feel much more comfortable.”
There is evidence to support the approach. In 2020 and 2025, Zelenski published papers detailing its success. The initial study, published in Academic Medicine showed that the students who participated in the class improved their ability to make others feel at ease, show care and compassion, communicate clearly, help others contribute, and create a consensus plan of action. The students also described improved interactions with patients and people outside of work.
The 2025 study, published in BMC Medical Education, showed similar results, but with the use of a virtual meeting platform to conduct the class, demonstrating that the benefits were not limited to in-person learning modality.
Anna Kreynin, another fourth-year medical student at the school, decided to take the course to challenge her own comfort level in the hope that it might improve her ability to manage stressful interactions with patients or colleagues.
Currently, much of Kreynin’s time is spent interviewing with residency programs around the country, and she has found that training offered through the improv course is also aiding her interview techniques.
“I’m in deep with interview season and I can definitely tell I feel a little bit less shy or not overthinking what I’m saying,” she said. “I can definitely see this being helpful when I go back to the clinical setting.”
As the students practice their newfound improv skills, spontaneity rules the moment and laughter often rings out. These moments of levity are welcome for students who have spent years studying and preparing for challenging, often serious clinical situations.
“There’s been a lot of laughter, and I’ve been really surprised how good some of my classmates are, not that we are in this to be professional improvisers,” Kreynin said.
