Improv classes have been a welcome diversion from my daily clinical and academic activities — a place to unplug, be spontaneous, and even (occasionally) be funny. The theater became a sanctuary, a stark contrast to the high-stakes surgical environment where precision and control are paramount. Over the years, taking dozens of classes and performing in just as many shows has brought me immense joy, laughter, and a much-needed creative outlet.
As I now transition into the role of a senior surgeon, I find myself frequently asked to provide surgical coaching — a role I've embraced as an opportunity to help others avoid the mistakes I've made. Recently completing formal training in surgical coaching has deepened my appreciation for the craft, and surprisingly, has illuminated striking parallels between the principles of improv and the art of coaching.
In improv, performers practice deep listening, not just hearing their scene partners' words but fully absorbing tone, intent, and nuance. This creates a foundation for guided inquiry, where questions and responses build the narrative without forcing a predetermined outcome. Specificity is key to making the scene resonate, while performers must also trust their team members to choose how to respond and guide the story in unexpected directions. A good improvisor will listen for the "unusual thing" and seek out more details. Importantly, the scene unfolds spontaneously, shaped by creativity and presence of the group. In improv, the joy and successes of a performance lie in the process of this collaboration, and not just the punchline.
Surgical coaching, like improv, centers on collaboration and an individualized process. Coaches listen actively to surgeons' goals and challenges, offering reflective questioning and constructive feedback to help them gain deeper insight into their practices. Just as improv encourages performers to respond authentically to the unexpected, surgical coaching helps surgeons adapt to the ever-changing dynamics of the OR. Psychological safety is a shared principle, ensuring that surgeons, like improvisers, feel supported in exploring their vulnerabilities, mistakes, and potential areas of growth, without judgment. A surgical coach will listen for the unusual thing like "feeling words" and seek out more detail. Just as an improv actor must say “yes, and” to build on their scene partner's ideas, surgical coaches must remain open to the learning goals of the surgeon and not the coach. This vulnerability fosters mutual growth and trust. Specificity also plays a critical role, as precise feedback and goal-setting are essential to improving technical and cognitive skills. Both improv and coaching reward creative problem-solving. Creativity within improv can move a scene in an exciting new direction, while innovation within surgery can result in enhanced techniques for elevated patient care.
Both disciplines embrace the unpredictable. Whether crafting a scene or coaching a surgeon through a complex procedure, success lies in the ability to respond fluidly to emerging challenges while maintaining focus on the overarching goals. Improv and surgical coaching have both taught me that excellence isn't about rigid control but about cultivating the skills to listen deeply, reflect, respond, and draw insight. Nonverbal communication with an attention to detail and true presence becomes paramount. Just as improv actors rely on body language and facial expressions to support their partners, surgical coaching relies on nonverbal cues such as observing posture and hand movements. By embracing these shared principles, I hope to catalyze surgical excellence with the creativity, resilience, and humanity that define the improvisational art.
Dr. Magdy Milad is the Albert B. Gerbie Professor of Obstetrics and Gynecology at Northwestern Medicine in Chicago, Division Chief for Minimally Invasive Gynecologic Surgery and Medical Director for the Center for Complex Gynecology. He recently completed his certification at The Academy for Surgical Coaching.
Illustration by April Brust
