Otolaryngology Residents taking Improvisation Training

This control group of OHNS residents continues their standard medical education.

3 Online Group Improvisation Training classes led by a professional is offered every other week for 1 hour to the experimental cohort.

Team dynamics and interpersonal connectedness are assessed using the Social Connectedness Scale. This is a custom survey developed specifically for this study to measure participants' sense of belonging and connection within the residency program. The scale consists of 5 items rated on a 5-point Likert scale. Total scores range from 0 to 25, with higher scores indicating a greater sense of connectedness (better outcome).

Clinical decision-making under pressure is assessed using the "Intraoperative Vignettes" assessment. This is a computer-based cognitive test comprising 20 Otolaryngology-Head and Neck Surgery (OHNS) case scenarios. Participants are presented with clinical scenarios and must select the correct management decision. The outcome is reported as a composite of accuracy (total number of correct responses) and response time (time taken to select an answer). Accuracy is scored from 0 to 20, with higher scores indicating better clinical decision-making.

Mood is assessed using the Positive and Negative Affect Schedule (PANAS). This is a validated 20-item self-report questionnaire that measures two distinct dimensions of emotion: Positive Affect (10 items) and Negative Affect (10 items). Participants rate items on a 5-point scale ranging from 1 (Very slightly or not at all) to 5 (Extremely). Scores for each subscale range from 10 to 50.

• Positive Affect: Higher scores represent higher levels of enthusiasm and energy (better outcome).
• Negative Affect: Higher scores represent higher levels of subjective distress and unpleasurable engagement (worse outcome).