ADAPTing to participant distress: A protocol for applied improvisation in healthcare

Introduction: Applied improvisation (improv) is an emerging innovative approach to clinical education and requires the cultivation of a highly engaged learning environment. With highly interactive and engaging forms of learning, it is critical to address participant distress and psychological safety in an improv learning environment in order to prevent damage to the learning capacities of individual participants as well as the group as a whole. However, little is available to guide applied improv practitioners to navigate the socially complex dynamics of participant distress during an improv session. The purpose of this project was to develop a distress protocol, tailored for improvisation-based interprofessional clinical communication training curricula, aiming to characterise, anticipate, prevent and address participant distress during sessions. Methods: Using an interpretive descriptive approach, we analysed qualitative data including previously collected interview data and primary field notes taken during improv simulations in order to develop the Addressing Distress in Applied Improvisation Participants Tool (ADAPT). Results: Analysis revealed two key distress manifestations (resistant distress and reactive distress) as well as three distress profiles (primary distress, secondary distal distress and secondary proximal distress) that may occur during an improv session. The ADAPT guides facilitators through four phases of attending to participant distress during applied improvisation sessions. These four phases include Redirecting the Spotlight, Responding to Distress, Reintegrating the Group and Reflecting on the Distress. Discussion: The ADAPT is the first of its kind as a general guide for addressing participant distress and can be customised and tailored to other applied improv curricula and experiential learning activities. Future inquiry should evaluate the utility and effectiveness of the ADAPT for responding to in situ participant distress in applied improv or other similar active learning environments.