Visualize this: a group of residents standing in a circle, waving their hands, making faces at each other, and speaking in gibberish.

That's just one of the many unorthodox techniques used in programs conducted by Performance of a Lifetime, a training and organizational development company in New York City. Drawing from their expertise in education and psychology as well as theater, POAL trainers employ improvisation and theater games to teach doctors how to build better relationships with patients. If you think your doctors would stomp out of the room if anyone tried to make them speak nonsense, think again. While “touchy-feely” communication skills training is usually a tough sell, in the aftermath of 9/11, residents, at least, are asking for help in dealing with traumatized patients.

Creating Therapeutic Conversation

The subject of 9/11 has come up continuously in the training sessions Susan Massad, MD, conducts with second- and third-year medical residents at Long Island College Hospital. To help them, Massad uses techniques she learned from POAL. One of the most powerful instances, she says, was a conversation between a doctor — who had been through POAL training — and a woman who had fled one of the Twin Towers and was suffering from post-traumatic stress disorder.

“It was so creative. One of the lovely things was the way the doctor moved out of the medical inquiry mode and was able to have a therapeutic conversation with this person as another human being,” says Massad. “Why can't we create that interaction more often?” she asks.

Lose the Linear Approach

One reason why not is because of doctors' training. “Doctors are trained to get the medical history,” Massad says, “but that's not a good way to build a relationship, and it's in the relationship that healing takes place. This performance approach really enables physicians to break out of that scientific, linear way they've learned.”

But convincing docs to break out of the mode is not easy. “The medical industry is the most resistant one we encounter. Medical residents don't think that what we do applies to them, because we're not dealing with hard science,” says David Nackman, director of POAL. “People don't always understand that “in playing, they learn.”

One such activity is storytelling. Using a topic suggested by a participant, Nackman creates the first sentence of the story. Each person in turn adds just one sentence. The inflexible rule: Each sentence must begin with the words “Yes, and,” as acknowledgement of what the previous person said.

“The ‘Yes, and’ activity is fundamental for medical residents,” says Nackman. “They're good at pulling out clinical cues, but they miss the big cues — mood, discomfort, fear. If a doctor doesn't hear those, that seriously colors the therapeutic relationship.”

Next, volunteers perform 60-second solo improvisations. Finally, the entire group is divided into teams and given 10 minutes to create and rehearse a three-minute play that each team will perform.

Says Cathy Rose Salit, president and CEO of POAL, “As scared as people are, as hard as this may seem, people are excited at the opportunity to be human beings together. And we learn that even though we're uncomfortable, we can take risks.”

One technique that POAL uses is videotaping a conversation between a resident and a patient — with the patient's approval, of course. When the group watches the videotape, “They're instructed to observe the characters as if they were watching a TV show, to look for improvisational cues,” says Nackman.

This training, Nackman explains, “gives residents the skills needed to build a therapeutic relationship.” And that increases the likelihood that patients will comply with treatment recommendations. Another very practical benefit: “When doctors listen better, patients don't sue.”

For Massad, the bottom line is more basic. “Why do we need a September 11 to teach us how to relate to each other as human beings?”

POAL conducts training programs worldwide. Contact them at (212) 343-2884, or visit