Wax On Wax Off

starJon Trevor introduced himself as the “Improv Evangelist” to the GP trainees. As one of the Training Program Directors for North Birmingham General Practice Vocational Training Scheme I could sense that many of the Trainee GPs were slightly bemused and apprehensive what this all meant……. To be fair so was I!

I was slightly intrigued and soon realised that Evangelist phrase referred to Jon’s infectious enthusiasm to the art of Applied Improvisation.

As GPs, we believe that effective communication is the cornerstone of an effective doctor patient relationship. Jon explained that we need to be full engaged with active listening and that there was nothing clever about looking good at improvisation other then keeping things simple. Of course I thought this would be no problem for us GPs who are reputedly good listeners, but it proved to be far more challenging then I expected . The games we were tasked to perform might appear silly and woolly they subsequently proved to highlight some important skills. Though we commonly perform “role playing” in training to be a GP we were gently persuaded to abandon our comfort zones and embrace the challenges of the afternoon.

The first exercise was to “man up” and admit to be “proud” of our mistakes. The culture of good clinical governance often expects us to be open and divulge errors. What was novel ,was Jon gave us “permission” to own up to nonclinical mistakes. He encouraged us to applaud and strut with our chests out, proud and blaze in the glory of our mistakes! This was somewhat incongruous to the mind-­‐set of our group GP trainees ,where making the wrong decisions could be potentially life threatening! The importance of this lesson was not to be to harsh and self critical, we are all human after all.

We then proceeded to perform a series of group games that were simple, such as Zip, Zap, Boing. Surprisingly this was initially quite competitive but we quickly realised how easy it was to make a mistake despite relatively easy instructions. One of the trainees pointed out that it was easier to blame Juniors in real clinical practice but when the Senior doctors also made mistakes and there wasn’t such a big deal made of this. However it was soon apparent that we were all liable and equally prone to making errors (including myself on more then several occasions! ). We were encouraged to reflect on these mistakes. Through practice, teamwork and being more vigilant we realised as a group how to become slicker by being more considerate and not just trying to make ourselves as individuals look good or more witty and inventive!

We have previously discussed the concepts of “Win-­‐Win” from the Seven Habits of Highly Effective People. Some of the games prompted us into doing what was right for the team and not trying to inflate our egos They also encouraged active listening and would enable us to understand and anticipate narratives. This skill is very applicable to our models of patient consultation. The other games of the day also taught us about keeping things simple and whilst it is great to encourage blue sky thinking the simpler we kept things, the easier it was to construct more realistic and effective improvisations. We soon abandoned fantastical thinking and proceeded with a more grounded approach.

We realised the importance of mirroring and tried to gain a shared perspective by keeping things simple so concepts and trains of thought could be easily followed and interpreted. On reflection this is valuable in helping us to view things from somebody else perspective, especially patients and I hoped this could improved the trainees skills of negotiation and sharing decision making.

The art of General Practice is more then just knowing guidelines and diseases. It is also about understanding the human condition as well as how we interact with individuals. This is not always apparent on first glance and I think the lessons of the day will be realised not immediately but in years to come as the trainees mature, they will realise the benefits and lessons of the day. Just like Mr Miyagi from the original Karate Kid film where his student performed mundane chores such as cleaning a car with “Wax on, Wax off” and was secretly preparing him with this unorthodox method. Likewise, with Applied Improvisation the lessons are immediately less tangible, but the skills elicited will prove to being applicable to our clinical work as well as having potential benefits for our personal relationships with colleagues, families and spouses.

Dr Sarby Soorae

North Birmingham Training Program Director

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