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INTRODUCTION: Effective communication has been shown to improve patients’ health outcomes. This study utilizes medical improvisation techniques to teach communication skills to an entire medical school class. METHODS: Required workshops were held for entering third-year students from 2005 to 2017. Workshop evaluations were obtained immediately following each session and at 3 months post-workshop for one cohort. RESULTS: Four hundred ninety-four medical students participated in the improvisation workshops. Over 90% of students rated the workshops as above average or excellent. Students reported a gain in insights regarding their role as a physician (≥ 90%), an improvement in their ability to demonstrate effective communication (80–87%), and a positive impact on teamwork (91–93%). At 3 months post-workshop, 84% of students reported they had used at least 1 improvisation skill on their clinical wards (50% response rate). CONCLUSIONS: This study demonstrates that medical improvisation exercises can be scaled to an entire class of medical students versus a self-selected group of students. Further, we found that students felt that it improved their communication. This study also provides new insights regarding specific improvisation exercises that are most useful for the clinical environment.