Medical Improvisation Study

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).

Psychological distress is measured using the Depression, Anxiety, and Stress Scale-21 (DASS-21). This is a validated 21-item self-report instrument containing three subscales: Depression, Anxiety, and Stress (7 items per subscale). Participants rate how much each statement applied to them over the past week on a 4-point scale ranging from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). Subscale scores are calculated by summing the scores for the relevant items and multiplying by 2.

• Range: Each subscale ranges from 0 to 42.
• Interpretation: Higher scores indicate greater severity of symptoms (worse outcome).

Participants in the intervention group complete an Intervention Satisfaction Survey to evaluate the curriculum and learner experience. This measure utilizes a Likert scale to assess participant feedback. Items are rated on a 5-point scale from 1 (Not true at all) to 5 (Completely true), with higher scores indicating higher satisfaction (better outcome).