When was the last time you played? Was it a board game? Your daily Wordle? A pickleball match? A tea party with your kids? For me, regardless of when you read this, it was probably pretty recently at the improv theater where I perform (more on that later). Play lets us suspend the "real world" for a precious few moments and, whether we're on a literal or figurative playground, we might take chances, make mistakes, and get messy, learning something new about the world and ourselves along the way. But is there any room for play in medicine?
Even though play has its earliest roots in the development of human society, in modern times, play seems kind of indulgent. Especially after the devastation of a global pandemic, it can be particularly jarring to believe there's any overlap between the worlds of play and high-stakes decisions in health care.
And yet, simulation — a close cousin of play — has long been a cornerstone of surgical training. The ancient Indian surgeon Sushruta urged his students to practice procedures on gourds and fruits; the modern surgical resident must pass simulation exams for board certification. Research even shows that trainees who play video games have greater dexterity in video-based surgical techniques.
Case-based learning, the now-preferred approach to medical education, is itself a form of imaginative play, asking the learner to pretend that they are face-to-face with a hypothetical patient. It requires the learner to venture beyond rote memorization into the realm of knowledge application. Case-based learning can be richly illustrated or completely dependent on the learner's imagination, and can be high tech or analog.
In my role as a medical educator/clerkship director, I have observed two trends in undergraduate medical education that unintentionally seem to undermine each other: As we have moved toward flipped-classroom case-based preclinical learning, we have also allowed for increased optional in-person attendance. While the flexibility has helped open medical education to a more diverse student body (e.g., people with children, those who cannot afford to live close to campus, etc.), it has also shifted a lot of responsibility for learning onto the student. By reducing the need to interact in-person, we have effectively created a pre-clinical environment that is simultaneously self-sufficient and isolating. When students finally do enter clinical rotations, the gulf between trainees and faculty/residents feels particularly vast: a new third-year medical student is not fluent in collaboration and risk-taking is infrequent. Learning how to function on a team in a way that allows a student to "take ownership" of a patient is an opaque process that can take months to grasp. In short, between preclinical and clinical environments, students find themselves on a steep and slippery slope on which the stakes and expectations to perform escalate quickly. It's like playing tennis against a wall for two years and suddenly being forced to rally with Serena Williams — sure, she'll be kind to you, but her expectations on the court are, correctly, astronomically high.
The problem with case-based learning in the preclinical years is that frankly, no one likes a group project. So what if we reframe the delivery of "case-based instruction" by adopting concepts behind tabletop games like Dungeons & Dragons? Imagine that the teacher is the "dungeon master" (DM) and the students merely need to show up prepared as their characters (though they're doctors instead of mages and rogues). The DM has omniscient knowledge of the case (example: a young female presenting with right lower quadrant abdominal pain), while the players come prepared with some background knowledge (the appropriate workup and management of abdominal pain in general). As the players work their way collaboratively through the challenge, sharing bits of their knowledge and learning from each other, they earn more "skills points" that give them the ability to further treat the patient, and more case scenario details, including twists and red herrings, are revealed. Unlike an oral board exam or observed structured clinical examination (OSCE) with a standardized patient, a D&D-style case-based instruction would be low-stakes, low-cost, collaborative, and intentionally playful.
Perhaps the most valuable element of play is spontaneity, which is also the most disorienting concept for us to wrap our minds around. To accept uncertainty, to think on your feet and make decisions with most but not all the information, to have the courage to sometimes go off-script, is one of the most difficult aspects of medicine. I remember being the critical care fellow leading rounds in the ICU, my desire to make the right decision paralyzing me as I asked for more and more tests. My attending pulled me aside and gently said, "Sometimes, you need to make decisions with incomplete information. Practice becoming comfortable with that uncomfortable feeling." But how can we possibly practice feeling the discomfort of that liminal space, particularly when the entirety of evidence-based medical education is built on pattern recognition?
The answer (as I previously alluded to) might be found in the world of improv comedy. In improv, entire stage shows are created on the spot by people who are essentially playing imagination games with each other. Everything is unscripted, and the actors must simply trust each other to build relationships and explore scenarios that materialize out of thin air. The world of “yes, and” is silly, magical, profound, and a space of infinite possibilities. The smallest gesture, word choice, or mistake can inspire hilarity. Improv is like exposure therapy for uncertainty, and many industries, from major league sports teams to multinational financial firms, have turned to improv games to build soft skills such as creative problem solving, listening, collaboration, communication, resilience, and confidence. As an improviser myself, the stage is more than a creative outlet: it is a laboratory for me to work on communication skills with patients, to practice not panicking when faced with an unexpected situation in the OR, to develop situational awareness by learning to listen carefully to everyone on my team. During a recent interaction in which the patient asked me about "laser surgery," I was reminded of the time I had to react quickly to my improv scene partner deciding to slip into an extraterrestrial language with me as his UN translator.
At our institution, improv sessions are woven into the preclinical curriculum. It's admittedly uncomfortable at first, but by the end of the longitudinal experience, many students will jump up on stage with our group of improv teachers for our final show. Watching students step out of their comfort zone is genuinely inspiring. In surveys, students express surprise at their peers' creativity, and even more surprise at their own ability to be spontaneous. In a practical sense, improv games that take place in wacky alternate realities (think talking animals and anthropomorphized inanimate objects) also help students practice asking themselves, "If this is true, what else is true?" As in: if a patient presents with fevers and jaundice, what else is likely true about this situation?
The teamwork and collaboration required of most games — whether it's D&D, improv, or pickup basketball — mirrors real-world scenarios, such as the collaborative, multidisciplinary care required for patients with complex medical needs. In the OR, it's not a stretch to see how each “player” — surgeon, anesthesiologist, circulating nurse, scrub tech — must fully inhabit their role to complete the case safely.
So why don't we play more? Maybe it's because games can have a way of revealing our authentic, vulnerable selves, the hidden parts of our personalities we keep hidden away until we are in a zero-consequences space. Some months ago, I went to a birthday party for one of my friends' children. As I sipped on lemonade, making serious but distracted conversation with the grown-ups, my heart felt a pull toward the game the kids were making up on the periphery of the backyard, something loosely resembling a wild combination of golf, basketball, and tag. The alacrity with which I dropped all adult conversation when I heard, "Auntie Priya, can you play with us?" was gleefully rude. I spent the rest of the afternoon practicing mental (and physical) agility, trying to keep a group of 6-year-olds from seriously injuring themselves, all while having the time of my life. Days later, it was this same playful spirit I had in mind when I excitedly welcomed a group of wide-eyed (and terrified) third-years to the surgery clerkship. Yes, it's safer and easier to follow the script and stay inside the box, where most of our day-to-day lives take place. But if we choose to step outside the box, we can use play to heighten and explore our world, to interact with each other with more authenticity, to find the fun in the very serious work we do.
What's the last game you played? Share in the comments.
Dr. Priya Rajdev is a surgeon specializing in minimally invasive abdominal wall reconstruction and benign foregut surgery in Phoenix, AZ. She is passionate about medical education, health literacy, and the importance of play in daily life. She enjoys gardening, reading, celebrating everyday absurdities and serendipities, and improv comedy. Dr. Rajdev is a 2024-2025 Doximity Op-Med Fellow.
Image by Elena Chernykh / Getty Images
