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Playback Theatre as a tool to
enhance communication in medical
education
Ramiro Salas
1
*, Kenya Steele
2
, Amy Lin
3
, Claire Loe
4
,
Leslie Gauna
5
and Paymaan Jafar-Nejad
6
1
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston,
TX, USA;
2
Department of Family and Community Medicine, Baylor College of Medicine, Houston,
TX, USA;
3
Houston Playback Theatre, Houston, TX;
4
School of Biomedical Informatics, University
of Texas Health Science Center at Houston, Houston, TX, USA;
5
Department of Curriculum &
Instruction, College of Education, University of Houston, Houston, TX, USA;
6
Jan and Dan Duncan
Neurological Research Institute, Department of Molecular and Human Genetics, Baylor College of
Medicine, Houston, TX, USA
Playback Theatre (PT) is an improvisational form of theatre in which a group of actors ‘‘play back’’ real life
stories told by audience members. In PT, a conductor elicits moments, feelings and stories from audience
members, and conducts mini-interviews with those who volunteer a moment of their lives to be re-enacted or
‘‘played’’ for the audience. A musician plays music according to the theme of each story, and 45 actors listen
to the interview and perform the story that has just been told. PT has been used in a large number of settings
as a tool to share stories in an artistic manner. Despite its similarities to psychodrama, PT does not claim to
be a form of therapy.
We offered two PT performances to first year medical students at Baylor College of Medicine in Houston,
Texas, to bring the students a safe and fun environment, conducive to sharing feelings and moments related to
being a medical student. Through the moments and stories shared by students, we conclude that there is an
enormous need in this population for opportunities to communicate the many emotions associated with
medical school and with healthcare-related personal experiences, such as anxiety, pride, or anger. PT proved a
powerful tool to help students communicate.
Keywords: Playback Theatre;medical education;stress;improvisation;arts
Received: 15 August 2013; Revised: 22 October 2013; Accepted: 23 October 2013; Published: 23 December 2013
The first year of medical school is both a daunting
and a defining time for future physicians. In the
United States, many medical programs tend to be
somewhat sequestered, high-pressure environments (1, 2)
that allow students only limited time for ‘‘extracurricular’’
activities to offset the demands of professional training.
Toward this end, we offered first-year students at Baylor
College of Medicine the opportunity to participate in
Playback Theatre (PT) performances in which they could
share personal stories and experiences.
The PT activities were offered as part of Compassion
and the Art of Medicine, a first-year elective course at
Baylor that explores the roles of art in the healing process
and the development of compassion in the medical edu-
cation setting. The typical course enrollment is 5075
students, and topics discussed include 1) international
health, 2) patients’ or family members’ experiences with
illness and doctors, 3) medical education as an art form,
4) compassionate physician role models and their experi-
ences, and 5) balance of career with personal and family life.
In this setting, we sought to explore PT as a means
of enhancing communication among students. We be-
lieve PT is intrinsically different from other extracurri-
cular stress-reducing activities (e.g., playing sports or
singing in a choir), as the primary goal is to facilitate the
sharing (and receiving) of personally relevant, real-life
experiences.
Playback Theatre was created in the 1970s by Jonathan
Fox, a therapist and theatre performer in New York,
as a way to explore personal stories through the art of
theatre (3). In most improvisational theatres, the goal is
to provoke laughter through witty remarks and physicality,
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æ
SHORT COMMUNICATION
Medical Education Online 2013. #2013 Ramiro Salas et al. This is an Open Access article distri buted under the terms of the Creative Commons Attribution
3.0 Unported (CC BY 3.0) License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.
1
Citation: Med Educ Online 2013, 18: 22622 - http://dx.doi.org/10.3402/meo.v18i0.22622
often using offensive or pejorative remarks to create
humorous situations. In PT, the goal is the opposite:
The troupe works to create an environment based on trust
where everyone feels safe and comfortable enough to tell a
story from their lives honoring and respecting tellers’
experiences no matter how silly, sad, joyful, or embarras-
sing they may be. When done successfully, this creates a
channel of communication among PT audience members
on a level that is difficult to achieve by any other means.
Houston Playback Theatre (HPT) was formed in 1996
and has performed in a wide array of venues such
as schools, churches, community centers, museums, and
theatres. The performance themes have ranged from the
most sensitive (e.g., stories from Alzheimer’s patients and
their relatives, cancer survival, and death) to the relatively
light (e.g., stories of summer vacations). Over two years,
HPT has provided two one-hour performances for the
Compassion and the Art of Medicine course.
PT performances are designed and structured to
ease the audience into sharing and thoughtful participa-
tion. At the beginning of a performance, actors introduce
themselves by sharing moments from their lives which
are then immediately ‘‘played back’’ by the other actors.
This models what is expected from the audience, and the
tone of the performance is set by these introductions.
For the Compassion and the Art of Medicine perfor-
mances, the HPT actors introduce themselves with perso-
nal experiences related to medicine. In PT, it is crucial that
performers form ‘‘connections’’ with the audience; thus, it
is helpful that several of the HPT actors are involved in
health care as researchers, providers, or educators. As a
result, it was possible to have a broad range of introductory
moments that helped the actors bond with the audience of
medical students.
After introductions, a PT performance moves to ‘‘short
forms’’ in which the conductor elicits moments or feelings
from audience members, and the actors play these on the
spot, using various improvisational techniques. The third
and usually major part of a PT performance is ‘‘stories.’’
Once audience members have warmed up to the idea of
sharing a personal story, volunteers from the audience are
invited to come to the stage, sit by the conductor, and tell
their stories. After a brief interview, the conductor tran-
sitions the focus to the actors, who play the story on
the spot. A typical performance has 34 stories told by
different volunteers.
Lastly, the PT performance closes with a sharing
of feelings elicited by the performance. This tends to
reinforce the commonality of life experience and gives
everyone time to reflect on the themes of the perfor-
mance. Audience members often feel that the stories
shared onstage resonate with their own stories, even if
they did not volunteer to share theirs aloud during the
performance.
In PT, the success of a performance is reflected in the
range of stories told by the audience. Although funny
stories are appreciated, a truly successful PT performance
should include stories that elicit various emotions. In a
medical education context, we expect PT to have three
positive effects: First, it should offer a meaningful but
entertaining experience, filled with laughter and emo-
tion, which, in and of itself, is a welcome break from the
stresses of academic study. Second, reflecting upon life
through art should add meaning to personal stories
such as enriching or reinforcing students’ motivations
to pursue medical careers (see comments 1 and 2, below).
Lastly, telling personal stories could be therapeutic,
as demonstrated in written and oral recounts of past
traumatic events (4).
As a cursory means of exploring the positive impacts
of communication among medical students, we reviewed
the stories shared as well as students’ reactions to the
performance. From this, is seemed apparent that PT
offered a safe place to freely share personal experiences
something visibly lacking in the medical curriculum.
Below are selected ‘‘moments’’ shared by first-year
medical students:
1) One student told about her first stethoscope
experience and the feeling of ‘‘Now I am a real
doctor’’ once she clearly identified a heartbeat.
2) Another student ‘‘responded’’ with his own first
stethoscope experience: not being able to find a
pulse. The ensuing enactment was humorous, but it
relayed an underlying sentiment of failure that the
actors captured and played back.
3) A student told of witnessing a physician listing
an array of physical problems to an elderly woman
(e.g., her knee arthritis, other test results, etc.), who
responded by repeatedly complaining of her hair
loss suggesting that the doctor was not really
‘‘listening’’ and was downplaying the patients’ con-
cern for her changing image.
4) A student recounted how her grandfather was so
proud about her being a medical student that he
changed his mind about being buried deciding
instead (despite some religious doubts) to bequeath
his body to a medical school. Her grandfather’s
decision, in turn, gave her an added respect for the
cadavers in the dissection lab. She was better able to
‘‘humanize’’ who this person may have been, includ-
ing his or her stories and the fact that someone must
have loved him or her.
5) A student told of a trip to his home country when
he was 10 years old, including feeling sick and ex-
periencing a different health care system. Despite a
humorous undertone, it relayed the importance of
family heritage to him. More importantly, the story
illustrated cultural differences in the health care
Ramiro Salas et al.
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system, but also similarities in the caring attitudes of
medical personnel.
6) One student shared how she had conflicting emo-
tions about becoming a doctor: She was very excited
but was forced to leave her job as a teacher where
she was making a difference in the community. So,
when the time comes to apply for off-site rotations,
she planned to request placement in this same com-
munity. After the performance, an academic admin-
istrator confessed to one of the actors, ‘‘When that
student shared this moment, I saw her in a new light.
I didn’t know she was a teacher before. I always try
to place students where they request to be, but I can
see now why being in that particular community
would be especially important to her.’’
The following are comments from students who
attended the HPT performances:
1) ‘‘The performers of this lecture showed me that
the means of healing or of encouraging healing
does not necessarily need to be solely derived from
pills and ointments, but can also incorporate the
arts.’’
2) ‘‘I gained some insights into how some non-
medicinal practices could have a significant impact
on the well-being of an individual, and possibly on
the doctorpatient relationship.’’
3) ‘‘It was absolutely amazing to see the actors, di-
rected only by spoken words, accurately capture the
feelings embedded in each story.’’
Conclusions
The stories freely shared by participating audience mem-
bers, we believe, reflected a welcomed enhancement in
both reflection and personal communication among these
students. Given the high-stress environment in which
medical students are immersed, PT shows promise in eas-
ing some of the pressure and providing a semblance of
balance to students’ lives. By sharing their experiences,
students may feel less isolated and better able to recog-
nize their reactions and feelings in others. Perhaps more
importantly, PT provides a venue for the nourishment of a
student community and, specifically, a student community
based on mutual respect.
Strategic placement of PT performances within the
medical curricula might foster students’ compassion and
understanding. For example, an emerging part of modern
medical training is early clinical experience including
empathy, an understanding of the impact of disease on
patients, more confidence when talking to patients, and
the development of communication skills (5). We believe
that PT may offer a way to increase the value of those
experiences by providing a structured way to discuss these
topics.
Lastly, sharing a personal experience and witnessing
others’ experiences through art can solidify meaning in a
manner that is completely contrary to the memorization
of ‘‘factoids.’’ Thus, PT could become a mechanism to aid
in medical students’ professional identity development.
Although we believe that offering such opportunities
early is important, perhaps having a PT experience closer
to graduation would be equally beneficial to revisit and
reinforce students’ personal values and beliefs about
medicine.
Acknowledgments
The author thanks the Houston Playback Theatre (HPT) company,
the Baylor College of Medicine, and all first-year students who
shared their personal stories.
Conflict of interest and funding
The authors report no conflicts of interest.
References
1. Firth J. Levels and sources of stress in medical students. Br Med J
(Clin Res Ed) 1986; 292: 117780.
2. Dyrbye LN, Szydlo DW, Downing, Sloan JA, Shanafelt TD.
Development and preliminary psychometric properties of a well-
being index for medical students. BMC Med Educ 2010; 10: 8.
3. Salas J. Improvising real life. Personal story in Playback Theatre.
New Paltz: Tusitala; 1993.
4. Pennebaker JW. Writing to heal: a guided journal for
recovering from trauma & emotional upheaval. Oakland, CA:
New Harbinger; 2004.
5. Littlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J,
Dornan T. Early practical experience and the social responsive-
ness of clinical education: systematic review. BMJ 2005; 331:
38791.
*Ramiro Salas
Menninger Department of Psychiatry and Behavioral Sciences
Baylor College of Medicine
S104, Houston, TX 77030
USA
Email: rsalas@bcm.edu
Playback Theatre as a tool to enhance communication
Citation: Med Educ Online 2013, 18: 22622 - http://dx.doi.org/10.3402/meo.v18i0.22622 3
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