Dr Amy B. Zelenski | Can Digital Tools Effectively Teach Medical Students Clinical Skills?

Medical students often experience a decline in empathy as they progress through their training, an issue with real consequences for patient care. A new study from the University of Wisconsin explores an unexpected remedy: Zoom-based improvisational theatre. In the first randomized controlled trial of its kind, researchers found that short online improv sessions helped students improve perspective-taking, reduce emotional distress, and deeply reflect on patient relationships and power dynamics. As telemedicine becomes increasingly common, this approach to teaching empathy could offer a timely, effective, and engaging tool to help future doctors more meaningfully connect with their patients.

Reimagining Clinical Skills Education in a Digital Era

Medical students face the immense challenge of absorbing vast amounts of information in a high-pressure learning environment, often at the expense of developing essential interpersonal skills such as empathy. Despite empathy being critical for effective patient care and physician well-being, research shows it tends to decline during medical training. Empathy encompasses both cognitive understanding and emotional resonance with others, and its erosion can lead to communication breakdowns, medical errors, and burnout.

To address this, an educational approach using improvisational theatre techniques called medical improv, has emerged as a promising tool to enhance communication, emotional intelligence, and professional competencies among healthcare trainees. Improvisational theatre, or ‘improv’, is typically associated with comedy stages, not medical schools. But it turns out that the skills actors practice in improv – like listening, responding in the moment, and showing vulnerability – are exactly the same skills doctors need to connect meaningfully with patients.

While in-person improv sessions have shown benefits in mastering these skills, the COVID-19 pandemic disrupted this model almost overnight and forced medical schools around the globe to explore digital alternatives to traditional teaching methods. The result was a massive shift toward virtual learning, including online simulations, instructional videos, interactive platforms, and more, offering flexibility and continued skill development. While some viewed these adaptations as temporary stopgaps, others saw them as opportunities to innovate. But the central question persisted: can digital learning methods effectively teach clinical skills, traditionally reliant on physical interaction and immediate feedback?

This question carries profound implications not only for the future of medical education but also for patient safety and healthcare system readiness. If digital tools can deliver training that is equivalent or superior, then they could help overcome geographical barriers, ease faculty workloads, and create more flexible learning environments. However, if they fall short, over-reliance on them could compromise educational outcomes and, ultimately, patient care.

Although virtual improv has been linked to improved listening, well-being, and engagement, its impact specifically on empathy remains unstudied. Recognizing this, Dr Amy B. Zelenski and colleagues conducted a pilot study to examine whether a Zoom-based medical improv intervention could positively influence medical student empathy. The study was conducted by a multidisciplinary team based at the University of Wisconsin, with expertise in medical education, empathy research, and applied improvisational techniques. Using a concurrent mixed methods design and building on their prior empathy/improv framework, they aimed to explore how such virtual experiences might support the cultivation of empathy during medical training.

From Stage to Screen

For this study, the research team adapted a well-established, in-person medical improv curriculum for Zoom. They invited 51 medical students to participate in a month-long pilot study. These students were randomised into two groups, with half joining five 90-minute improv workshops online and the other half continuing with their regular training.

The teams central aim was to evaluate the impact of a Zoom-delivered medical improv intervention on multiple domains of empathy – cognitive, affective, and behavioural – using validated measurement tools like the Jefferson Scale of Empathy (JSE), the Interpersonal Reactivity Index (IRI), and the Consultative and Relational Empathy (CARE) measure. Before and after the program, both groups completed previously validated surveys, which applied these measurement tools to examine levels of empathy, stress, and the students’ self-perception of communication skills.

More Than Just Fun and Games: What the Students Gained

The results were striking. Students who participated in Zoom improv sessions showed clear improvements compared to their peers:

• They improved their ability to take others’ perspectives, a key aspect of empathy.

• They reported less emotional fatigue, even as their workload increased, suggesting increased resilience.
• They demonstrated greater imaginative thinking, especially in navigating unfamiliar roles and scenarios, helping them connect with patients on a deeper level.
• They became more aware of power dynamics in healthcare, such as the way authority can affect doctor-patient communication.

Interestingly, students rated themselves more critically on some empathy-related behaviours after the sessions, but this was interpreted as a sign of increased self-awareness as they better understood the challenges involved in showing compassion and sharing control with patients.

What’s more, the format worked particularly well for students in the later stages of training, in particular those already working directly with patients, suggesting that the benefits of improv may grow as clinical experience deepens. Zoom, too, seemed to add unexpected value. Students appreciated the convenience and comfort of learning from home, and many noted that performing improv through a screen pushed them to be more imaginative. In fact, this virtual format may have strengthened one often-overlooked aspect of empathy: the ability to creatively ‘step into someone else’s shoes’.

Reimagining Medical Training

This study is the first randomized controlled trial to evaluate Zoom-based medical improv as a tool for teaching empathy. Unlike previous work, which mostly involved voluntary workshops, this research compared a randomly assigned control group and measured specific aspects of empathy through multiple lenses.

The team found that even a short virtual intervention can help counteract the empathy decline that too often occurs in medical education. It also showed that Zoom improv isn’t just a workaround for in-person sessions, it may offer unique advantages. Students felt more at ease participating from home, and learned to connect and communicate through a screen, an increasingly vital skill in the era of telemedicine.

Going forward, the researchers hope to build on this promising pilot by expanding the study size and including more diverse participant groups, as well as comparisons between virtual and in-person formats, alongside extending the intervention to other healthcare fields such as nursing, pharmacy, and social work.

The Bottom Line: Empathy Can Be Taught—and It Might Even Be Fun

In a high-pressure, high-stakes field like medicine, empathy can sometimes feel like a luxury. But this study demonstrates that Zoom-based medical improv not only enhances empathy among medical students but also counters the typical empathy decline seen during training. By fostering skills such as perspective-taking, emotional awareness, and reflective practice, virtual improv may become a valuable tool in medical education, equipping future clinicians to build stronger, more empathetic relationships with patients and colleagues.

In an era where empathy is both more needed and more at risk than ever in healthcare, this study offers a hopeful message: cultivating emotional intelligence doesn’t have to come at the cost of academic rigor. It can be fun, flexible, and done on Zoom. As healthcare increasingly moves online, Zoom improv may be just what the doctor ordered, for both patients and providers.