Safe and Sound: An Improvisational Theater-Based Curriculum and Behavioral Intervention to Address Violence in the Emergency Department

Published:November 13, 2022DOI:



      Emergency Department (ED) workplace violence has become increasingly prevalent in the United States, warranting the development of legislation, policy, and advocacy to protect healthcare workers. Solutions to address ED violence remain limited, and staff-oriented trainings often exist as short, one-time didactic sessions which are not practical nor often applicable to the ED setting. There is a paucity of evidence-based interventions that incorporate behavioral-based training to adequately prepare staff for the complicated, multifactorial presentation of violence in the ED.


      This pilot study sought to assess the feasibility of an improvisational theater-based, simulation intervention for healthcare professionals to address ED violence.


      A longitudinal curriculum for ED violence was developed in collaboration with a committee of emergency medicine (EM) faculty, EM simulation experts, hospital security and police personnel, professional theater and improvisational performers, resident physicians, and medical students. This pilot intervention was tailored to new EM residents (n=25) at a large, urban, academic medical center. Sessions were led by facilitators trained in group facilitation, simulation, and improvisation.


      Participants felt the curriculum was helpful (82.6%), engaging (91.3%), applicable (73.9%), and enjoyable (82.6%). Participation primarily by residents identifying as female and people of color suggested the efficacy of creative expression and nontraditional modalities in engaging diverse learners. 95% of participants expressed interest in future sessions.


      A multidisciplinary workplace violence intervention leveraging principles of improvisational theater, health equity, organizational psychology, and EM simulation may prove useful in preparing healthcare professionals for violence in the ED.


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