LAUSR

I read with great interest a recent article by van Ark and Wijnen-Meijer (2018) concerning the parallels between jazz improvization and clinical medicine. Whilst improvization is often unavoidable across myriad domains of medical practice, it may be argued that a greater degree of structure and reproducibility (likened metaphorically to classical music) serves to produce more consistently reliable patient outcomes. Given that practising improvization skills instills structure to any improvization undertaken, it seems rational that we practise said skills in order to maximize structure, thereby optimizing the so-called “structure-improvization spectrum”. Increasingly sophisticated technologies such as immersive virtual reality (VR) may prove fruitful in enabling the practise of such skills, providing a metaphorical “rehearsal space” for practising prior to performing “on stage”. Improvization is intrinsic to surgery, wherein complex procedures, variable anatomy, and unfamiliar technology demand the adaptation of rehearsed steps. “Deliberate practise” – i.e. focused and structured activity explicitly intended to improve performance – is frequently adopted by jazz musicians and has been discussed by Dearani et al. (2017) as a method of mastering surgical improvization skills. VR technology, already well established in surgery as a means of simulating specific procedures, facilitates “deliberate practise” of technically challenging aspects of specific operations. Such use of VR likely results in reduced surgical error rate by applying structure to situations requiring improvization. van Ark and Wijnen-Meijer (2018) further discuss the metaphor as it applies to patient–doctor interactions, in which the foundation for improvization (provided by the rhythm section in jazz) is provided by knowledge, evidence, and clinical experience. Communication skills teaching is commonplace at medical schools, providing students with the opportunity to experiment with phraseology and listening in a safe environment. In future, institutions may provide such sessions by means of VR, which offers an interesting avenue for exploration with respect to honing improvization skills. Furthermore, virtual standardized patients – for instance, those enabling students to practise history-taking – might offer a financially appealing alternative to employing actors. However, whilst VR offers an increasingly attractive option for refining one’s improvizational capabilities, simulated scenarios prepare only in part for the complexity and adaptable nature of surgical operations and patient–doctor interactions. As such, emphasis ought also be placed on applying virtually gained improvization skills in real clinical settings – taking to the stage, as it were – so as to approach perfection in clinical improvization.