11-17: YES!: Leveraging the Group’s Power: Leading Engaging Workshops
November 17, 2023ID10990
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- 00:04Able to opt out if you for some
- 00:07reason don't want to be part of the
- 00:10recording where you can opt in,
- 00:12as you probably see on
- 00:13your screen at the moment.
- 00:15So I'd like to get started by
- 00:18just welcoming you on behalf of
- 00:20the Center for Medical Education,
- 00:23formally thought of as the T to the the
- 00:27Teaching and Learning Center or the TLC.
- 00:30So the center is now has now expanded to
- 00:34include continuing medical education as well.
- 00:36So Andrea has just reminded you that
- 00:39you can also get continuing medical
- 00:42education credit for attending this
- 00:45session if you go to the link.
- 00:48So the YES series or the Yale Medical
- 00:52Education series, Yes for sure.
- 00:54That occurs every other Friday
- 00:57approximately each month.
- 00:59Sometimes when there's a lot
- 01:01of holidays as coming up soon,
- 01:04we may not present in that particular month,
- 01:07but you'll be able to figure that
- 01:10out by looking at the calendar
- 01:12at the centre's website.
- 01:13We also sponsor a meta discussion
- 01:16group monthly,
- 01:16so we invite you to check all of our
- 01:20faculty development opportunities
- 01:21out at the centre's website,
- 01:24and maybe Ed can also put the
- 01:26link in in the chat as well.
- 01:28The Doctor Andres Martin from the
- 01:30Child Study Center and Doctor Dana
- 01:33Dunn from Internal Medicine are the
- 01:35Co directors of the Yas series,
- 01:36and Doctor Martin happens to
- 01:38be our presenter today.
- 01:40Most of you know, but in case you don't,
- 01:43Doctor Martin is the Riva
- 01:46Ariella Rifa Professor.
- 01:48It's a tongue tie,
- 01:50a tongue twister in the Child Study
- 01:53Center and is professor of psychiatry.
- 01:55He also facilitates a discussion series
- 01:57on qualitative research methods,
- 01:59so some of you may also want
- 02:01to check that out with him.
- 02:03So rather than taking more time,
- 02:05I I want to turn the rest of the
- 02:08afternoon session over to Doctor
- 02:10Martin and to give him a break.
- 02:12I'll also monitor the chat as we go.
- 02:15Thank you, John,
- 02:16and thank you all for coming
- 02:18here on this Friday afternoon.
- 02:20I'm excited to share some stuff today.
- 02:24So we're going to talk about
- 02:26teaching in small groups,
- 02:27something that is very useful
- 02:29when it comes to workshops and
- 02:32many other formats that we
- 02:34that we that we use. Oops,
- 02:39yeah. So I have nothing to
- 02:43disclose there. You have that.
- 02:45And to get your CME credits,
- 02:48we'll remind you a couple
- 02:49of times during the talk.
- 02:50But you can text that number,
- 02:5439539 to that other
- 02:55number and we have a beast
- 02:57in one Merit. Lava
- 03:00the Left. So we encourage you
- 03:03to get those credits. OK, first
- 03:10quiz here. Can anyone tell me,
- 03:13does anyone know recognize
- 03:15where my pointer is pointing?
- 03:17Does anyone know what that means?
- 03:23No. So so this means that this image was
- 03:29created with artificial intelligence and
- 03:31specifically with a program called Dali
- 03:36DADAL EE. And what I did is that I
- 03:39knowing that I was going to come here,
- 03:41I said give me an image in watercolours
- 03:44about medical students solving
- 03:47problems together and this is what
- 03:49artificial intelligence spit out.
- 03:51Pretty cool, right?
- 03:53Now I I start with with this
- 03:55image and with the idea of AI.
- 03:58To make the point that in in
- 03:59my comments today I'm going
- 04:01to try to bring technology,
- 04:02not as ******** technology as AI,
- 04:06but some technology,
- 04:07to the teaching.
- 04:10OK, so a couple of core
- 04:15points to start off with.
- 04:17This is how teaching unfortunately
- 04:19traditionally happens.
- 04:20There's an orange person pontificating
- 04:23on a bunch of blue people,
- 04:26and the information exchange is limited.
- 04:31The fun is very minimal,
- 04:33and not a whole lot happens.
- 04:35And yet this is historically how teaching
- 04:37has been done and how most most of us,
- 04:39certainly I learned when we were
- 04:41in medical school and other places.
- 04:43But fortunately things have changed.
- 04:45And here at Yale,
- 04:46we are in an environment of a
- 04:48lot of innovation and teaching,
- 04:49which is very exciting.
- 04:52And after whoops,
- 04:53after these innovations,
- 04:54what we hope for is something more like this,
- 04:57that there's very active
- 04:59iterative interaction between
- 05:01all the participants .1 and .2.
- 05:03That it doesn't have this verticality
- 05:05and this hierarchy of the left image,
- 05:08but rather it's a more horizontal
- 05:11everybody can learn from each other.
- 05:14In so doing,
- 05:15the number of arrows increase and the
- 05:18number of teaching moments per hour,
- 05:21if you will,
- 05:22increase,
- 05:22and that's what we're going to
- 05:24be aiming for today.
- 05:25How can we unleash those educational units?
- 05:33Those images, by the way,
- 05:34come from this very nice reviewed
- 05:36paper by Burgess on how to facilitate
- 05:39small groups if anyone is interested.
- 05:42And another image that I sort of like, but
- 05:44not fully like from that paper is this one.
- 05:47I think that the starting
- 05:48premise is a good one.
- 05:49When you are teaching in a small group,
- 05:51you have three tasks at hand.
- 05:53You have to manage the learning, the
- 05:55content of what it is that you are sharing.
- 05:59You need to manage the group,
- 06:02those who talk too much,
- 06:03those who talk too little,
- 06:04those who, this, those who, that,
- 06:05and you need to manage the activities.
- 06:08Whatever those activities are.
- 06:09We're going to see examples of those.
- 06:12So far, so good.
- 06:13But what I think is missing from this
- 06:17paper from the ancient year 2020 is this,
- 06:21that you also have to manage the
- 06:25technology and its discontents.
- 06:28You need to be really ready to do that.
- 06:30Even as I speak to you,
- 06:32you're not seeing this.
- 06:33But in my I,
- 06:34I have to be dealing not just with
- 06:36a PowerPoint and with my screen,
- 06:39but also with a zoom screen which happens
- 06:41to interfere with my PowerPoint screen.
- 06:43And this is just a very basic task.
- 06:45As you start including other things,
- 06:47it gets complex.
- 06:48And many of these things really love
- 06:51to crash and breakdown and you need
- 06:53to know how to March on and not be,
- 06:56you know, taken down by that.
- 06:59And the third image from that paper,
- 07:01which I also sort of but not
- 07:03really agree with, is this.
- 07:05For a long time,
- 07:06the idea of small groups has
- 07:08been this 3P approach.
- 07:10You pose a question to the whole group,
- 07:13You pause, you allow them to think.
- 07:16And then like a tiger,
- 07:17you pounce on some unsuspecting person
- 07:20and you tell them by their name and
- 07:23they feel humiliated and frozen.
- 07:24And it's not a particularly
- 07:27good learning environment.
- 07:28But I invite you as we go on to
- 07:32think of this third P instead
- 07:34of pouncing as an invitation to
- 07:36playing because there can be
- 07:39these very playful elements.
- 07:41I think particularly when we bring
- 07:43technology and we bring some
- 07:45of these things that that make
- 07:46the the learning different.
- 07:52OK,
- 07:55one final thought on background and theory.
- 07:59Ish is about small groups,
- 08:02small group learning in TBL,
- 08:04and team based learning,
- 08:05which is the classic way of doing this.
- 08:11I think that there's a lot to be said
- 08:13for TBLS, but it's rare in this day and
- 08:16age that they're done in the absolute
- 08:19classic way that they were described.
- 08:21And yet, there are elements of TBS.
- 08:27There are elements of TBL that
- 08:31can be maintained and be useful.
- 08:33So in TBL, for those of you
- 08:35who have or have not tried it,
- 08:36the idea is that the learning
- 08:39starts before the class.
- 08:41It starts in home based preparation,
- 08:45at home in the library individually
- 08:49and that's an important precondition.
- 08:52Without which it is very hard to do
- 08:55what follows because what follows
- 08:57is the content at the class.
- 09:00Don't pay too much attention
- 09:02to the to these little arrows.
- 09:04Let's let's look above.
- 09:07Here the second phase of TBL is what's
- 09:11called readiness and and and assurance.
- 09:16And the idea is that during some
- 09:17period of time it says here 40 minutes,
- 09:19but it can be 20 minutes, it can be brief.
- 09:22You do some test in which you
- 09:25assess how much the learners took
- 09:27in and what questions they have.
- 09:30Traditionally there's an individual test,
- 09:32then a team test.
- 09:33There can be,
- 09:34which again doesn't sound
- 09:35very nice written appeals,
- 09:36which is more like clarifying questions.
- 09:40And this part is done in
- 09:43with the knowledge that the
- 09:45students should really have.
- 09:47But the really fun part comes in the end.
- 09:49You see the much longer,
- 09:50longer piece which is application
- 09:53oriented in which you apply everything
- 09:56that came here and in which for optimal
- 10:01results there isn't 1 correct answer.
- 10:04We're going to come back to that.
- 10:09So when we have both the individual
- 10:14work that happened at home and in the
- 10:18readiness in the classroom and then
- 10:20small groups coming together and total
- 10:22discussion that what has the the big,
- 10:24the big impact on learning
- 10:26what we're going after,
- 10:30I don't know how to get rid of this.
- 10:33OK. So what we're going to do now
- 10:36is I'm going to do a little bit of
- 10:39an exercise with you guys and rest
- 10:42assured that we're not going to go
- 10:44into breakout rooms because my in my
- 10:47experience whenever we go into breakout
- 10:49rooms we lose half of the people
- 10:51and that can be awkward if you're
- 10:52you're not in a group that you know.
- 10:54I also assure you there's going to
- 10:56be no assessment in it of any time.
- 10:58And very importantly,
- 10:59it doesn't matter what your area
- 11:01is of expertise, what specialty of
- 11:03your physician or what whatever.
- 11:05If you're not a physician,
- 11:06it doesn't matter.
- 11:08I'm going to ask you for this to be
- 11:10a general is not an expert and we'll
- 11:14assess some general breadth of of knowledge.
- 11:19So you're in luck today because I think
- 11:21John mentioned I'm a psychiatrist,
- 11:23a child psychiatrist.
- 11:24So because of that,
- 11:25I guess that my default is that
- 11:27we're going to have a little bit
- 11:28of a psychiatry refresher.
- 11:29So sit far away from Doctor Wilkins,
- 11:33who I saw my fellow psychiatrist here,
- 11:36so she will know some of these answers.
- 11:38But it doesn't matter.
- 11:39It doesn't matter.
- 11:40It's more about the process
- 11:41that we're going after.
- 11:42So let's start with some
- 11:45basic facts about depression.
- 11:47It's a worldwide hidden burden.
- 11:51It's a disorder that affects over
- 11:55350 million people in the world,
- 11:57and that's dated by now.
- 12:01Almost one people,
- 12:0211 million people,
- 12:03take their own lives every year.
- 12:05This is a disorder that disproportionately
- 12:08effects women in general and women during the
- 12:11childbearing years of life in particular.
- 12:13So that's just to Orient us to the
- 12:19the severity of this condition.
- 12:22Now I want you to now take,
- 12:24I don't know,
- 12:26a minute and just think in
- 12:29your own mind's eye what your
- 12:31understanding is of depression.
- 12:32What are some of the symptoms of depression,
- 12:34What it looks like you can think about
- 12:38it if you want to jot it down South.
- 12:41Clinically, what does it look like next?
- 12:44What are some of the causes of
- 12:46depression that you can come up with?
- 12:48And finally, what treatments do you know of?
- 12:50Have you heard from a patient?
- 12:53From a relative?
- 12:54From a loved one?
- 12:56From oneself?
- 12:56What are some of the treatments
- 12:59of depression?
- 12:59So let's just give you a
- 13:01few seconds to do that.
- 13:12Doctor Wilkins, I'm so happy to see
- 13:14you here. May I give you a task?
- 13:17Yes. Your task is going
- 13:18to be to take the most contrarian
- 13:21responses and answers that you
- 13:22can think of. OK OK OK All right.
- 13:29All right. So let's move on.
- 13:34And what I'm going to do now is show
- 13:36you a clip. It's a 2 minute clip,
- 13:412 minute and 22nd clip.
- 13:43And I'll just let the tape roll.
- 13:45And you've thought a little
- 13:47bit about depression.
- 13:48Let's see how your thoughts
- 13:50change after you do this.
- 13:55By the way, if we had been in a
- 13:57classroom rather than zoom at this point,
- 14:00I might have given you some initial
- 14:01assessments, some little paper and pencil,
- 14:03something to write along
- 14:05the lines that I asked you.
- 14:07But here we're going to,
- 14:07we're going to move on. OK.
- 14:10So let's, let's meet this pair. I
- 14:14I've had depression on and off my whole life,
- 14:19but I've I've never had anything like this.
- 14:23This is worse than anything.
- 14:25This is the worst that I've
- 14:26seen her in my entire life,
- 14:29and I'm honestly really scared by it.
- 14:34I yeah, it's terrifying me
- 14:36to be completely honest.
- 14:38Depression can look like a lot of
- 14:40different things for different people.
- 14:41Can you maybe describe to me what your
- 14:43depression has looked like recently?
- 14:45I just don't have any energy,
- 14:50no energy to do anything.
- 14:52I just want to.
- 14:55I want to sleep.
- 14:56I can't sleep.
- 14:59Every time I come over to come see her,
- 15:01I I'm there every day now because she
- 15:05just doesn't have the energy to get out
- 15:07of bed or just take care of her cat.
- 15:10Or she used to help me with my sons,
- 15:13help them come up from daycare and from
- 15:15school, and she just doesn't have the
- 15:18energy to leave her apartment anymore.
- 15:21Are you able to do things like pay your
- 15:24bills on time? No, I help her with that.
- 15:27OK. And has that always been the case?
- 15:29No. No, that's been recently.
- 15:31How about things as simple as getting
- 15:33out of bed to brush your teeth,
- 15:35take a shower in the morning?
- 15:37I mean eventually.
- 15:39Have there been days this week for example,
- 15:41that you were unable to do any
- 15:44of those things?
- 15:45I had to call her and remind her.
- 15:49When you're in low energy,
- 15:51sleep is not great.
- 15:54Difficulty falling asleep.
- 15:56Difficulty falling asleep,
- 15:59difficulty staying asleep,
- 16:01Waking up in the morning
- 16:04earlier than usual.
- 16:05I don't want to get out of bed.
- 16:07Like wake up.
- 16:11Have you been feeling sad? I
- 16:15don't
- 16:19know if I can
- 16:19even really like describe
- 16:22exactly how I feel. Kind of numb.
- 16:27Does that sound like being numb?
- 16:29She's just like she doesn't.
- 16:32I don't want to say care, but that's
- 16:34probably the best word I can find.
- 16:47OK, so again, I want you in your
- 16:50mind site to to put that together
- 16:53and what I'm going to ask you now,
- 16:55you only need to do this once
- 16:57but it would be great if you all
- 17:01could log on to pull everywhere.
- 17:03Some of you I know have used it,
- 17:06but these there are three ways,
- 17:07whatever all of them are the same.
- 17:09The easiest one is take your your cell
- 17:11phone and aim it at that QR code and
- 17:14it'll take exactly where you need to be.
- 17:16You can also do it through the
- 17:18website and Linda if you're kind
- 17:19enough to also put it on the
- 17:23on the on the chat. And if for some
- 17:27reason you you lose it, it will be
- 17:29in all all the relevant slides. So
- 17:33by the way, it'll ask you
- 17:34for your for your name.
- 17:35You don't need to put your name, so
- 17:39you can just move on.
- 17:45OK, so let's get started
- 17:48and let's start with this.
- 17:51Let's start with, we're going to
- 17:52have four questions, by the way.
- 17:54It's not going to be 100 questions,
- 17:55but each one is going to have
- 17:57a different goal. So this one,
- 18:01what lab abnormality is most
- 18:04commonly associated with depression?
- 18:05Vitamin B12, hematocrit,
- 18:11thyroid hormone,
- 18:12warfarin or VDRL for syphilis.
- 18:16So you can just.
- 18:18I see that five of you,
- 18:19six of you have already voted.
- 18:21So people are getting it.
- 18:22That's great.
- 18:27Oh, 15 good. OK,
- 18:31so let's see, let's see
- 18:33people's thoughts about this.
- 18:36All right,
- 18:39once I found, oh, there we go.
- 18:42OK, we have 17 responses,
- 18:45and this is what it looks like.
- 18:48So TSH was a big winner.
- 18:51Thyroid. The DRL was a big loser.
- 18:57OK, does anyone want to just
- 18:59talk about what they voted for?
- 19:02We we know who's going to be
- 19:03the contrarian in the group.
- 19:04But does anyone want to?
- 19:09Kristen, you're you're you as a
- 19:10contrarian and my fellow psychiatrist,
- 19:12do you want to break the ice here
- 19:14with why you decided the VDRL?
- 19:16Look, look at that.
- 19:17No one else voted with you.
- 19:18Kristen, why did you do that?
- 19:20Well, I just, I think I remember
- 19:23reading somewhere that people
- 19:24with depression had risk taking
- 19:26behaviors or something like that.
- 19:28And so I figured if they were maybe
- 19:31sexually promiscuous that they might
- 19:32be likely to contract syphilis.
- 19:34That's great. That's great.
- 19:35And you know, let me add to that
- 19:37very good thought that 100 years ago,
- 19:40the number one leading cause of
- 19:42mental illness of all types was
- 19:44syphilis through tertiary syphilis.
- 19:45So for those of you lovers of history,
- 19:49if you went to an asylum 150 years ago,
- 19:51you would have seen a
- 19:52lot of tertiary syphilis.
- 19:54But yeah, I think that the most of
- 19:56you didn't go for it and I understand.
- 19:58So do we have anyone for porphyrin?
- 20:05All right. You're going to, you're shy.
- 20:06So I'm going to,
- 20:07I'm going to speak for porphyrin.
- 20:08So, you know, porphyrin is there
- 20:10because it always has to be in the
- 20:12differential and it never happens.
- 20:13And it was invented only for the boards.
- 20:16But you know, we put it there.
- 20:17It's a rare thing.
- 20:18It's a classic zebra.
- 20:19But yeah, could it relate to depression?
- 20:22Sure. It can't.
- 20:23And you know,
- 20:24there was that famous movie of King
- 20:25George the Third who had some psychotic
- 20:28disorder related to porphyrin.
- 20:30So very, very rare, but there you go.
- 20:33I'm curious about those of you who
- 20:36talked about hematocrit and blood.
- 20:38Can anyone speak to that?
- 20:46I can do it. Go
- 20:48for it, go for it can't
- 20:50be on for you right now.
- 20:51But I put H&H just because
- 20:55women of childbearing age are
- 20:57commonly anemic and they're
- 20:59commonly affected by depression.
- 21:00And that's really it. Well,
- 21:03I think that that's great.
- 21:04I think that that's great.
- 21:05Certainly a high risk population
- 21:07and when we do Routine Labs,
- 21:09that's one place where we can
- 21:11commonly find abnormality.
- 21:12So I think that you're thinking
- 21:14is spot on and that's great B12.
- 21:24So again not not common, not very common,
- 21:27but it's something that can happen
- 21:28and we don't routinely test for it,
- 21:30but you know it can happen.
- 21:31And and it sounds like TCTSH is
- 21:34something that many of you thought
- 21:35about and I think that that's right.
- 21:37Does anyone want to speak
- 21:38on behalf of the thyroid?
- 21:44Great, I will. OK.
- 21:46So hypothyroidism is very common
- 21:48as we know and it can be related to
- 21:51subclinical or clinical depression.
- 21:54So it's a wise thing to check it out.
- 21:56Good, good, good, good.
- 21:57Now you maybe had some of the tools
- 22:00to answer this, maybe you didn't.
- 22:02So that was entirely fair.
- 22:04But we'll we'll come back to that.
- 22:07OK. Now
- 22:12what I want you to do now is you
- 22:13you've already been thinking
- 22:15about symptoms of depression.
- 22:17It'd be great if you could just jot
- 22:19down the symptoms that you can remember.
- 22:20And to help you remember,
- 22:22some of you may have heard of
- 22:25this acronym called CIGGY CAPS.
- 22:27It's common for depressive symptoms.
- 22:29So try to name as many symptoms as you can
- 22:31and if they fit within that acronym, great.
- 22:33If not, just put down whatever.
- 22:36We all know what depression
- 22:38is in the vernacular,
- 22:39so I think it's, you know,
- 22:41perfectly fine too.
- 22:44So let's see
- 23:16Very good. So we have well 1314 of
- 23:20you have responded. So let let's
- 23:22see what you what you thought.
- 23:27OK. Sleep disturbance. Sleep OK
- 23:32Sleep is going strong. Sleep sadness.
- 23:40Interest Decrease Insomnia,
- 23:47Comorbidities.
- 23:51Sleep,
- 23:55Don't eat even when hungry.
- 23:57Change an appetite.
- 24:02Appetite.
- 24:08OK, so it sounds that that you as a
- 24:12as a group are adding some stuff.
- 24:16Sleeplessness, crying energy, low anhedonia,
- 24:19which is inability to enjoy things.
- 24:24Sadness. Irritability. Lethargy.
- 24:26Sadness. Homniacs asleep. Great.
- 24:29So I think that the the picture is,
- 24:30is is is thickening.
- 24:32You're doing a great job force happiness.
- 24:35That's that's very interesting.
- 24:38Crankiness. Terrific.
- 24:40So let's now move to this because I
- 24:44think that you hit most of the symptoms.
- 24:48Everybody talked about sleep.
- 24:51I think that interests were mentioned
- 24:53both by you and in the video.
- 24:54Guilt. I can't remember if it
- 24:57was mentioned or put in there,
- 24:59but this refers to feeling like a burden
- 25:02on the other, especially on loved ones.
- 25:05Low energy for sure.
- 25:07Appetite was mentioned.
- 25:09Suicide, suicidality was mentioned.
- 25:11Perhaps Les mentioned was psychomotor
- 25:14agitation and retardation.
- 25:16Feeling shaky, feeling very slowed down.
- 25:19Concentration.
- 25:20But this is a way of remembering
- 25:24these symptoms.
- 25:25So This is why I'm giving you this acronym,
- 25:28and this is the same acronym and
- 25:30some of the same things that we
- 25:32use with our medical students.
- 25:33So today you're pretending
- 25:36to be a medical student.
- 25:40Now, now that we know what depression
- 25:43is a little bit what it looks like,
- 25:47the news is not all bad.
- 25:48Because once we recognize depression,
- 25:49there's a lot that we can do to help.
- 25:52Now, fortunately, yesterday you
- 25:57we're going to start with this.
- 25:59Let's start with any antidepressant
- 26:01that you can mention and you can
- 26:04put more than one in the in the
- 26:06field but but let's see how many
- 26:08antidepressants you can name
- 26:11if any antidepressant treatments you can name
- 26:17doesn't have to just be a medication.
- 26:41OK, so let's let's see
- 26:44what you what you answered
- 26:50Prosaic
- 26:53ethics or
- 27:01CBT. So cognitive behavioral therapy good.
- 27:03So a non medication meditation good.
- 27:09Excise the depression through exercise.
- 27:11Exercise problem. Raw cookie dough.
- 27:13I like that. I like that.
- 27:14Although that may be more of
- 27:15the problem than the solution.
- 27:17Oh, we're getting fancy Lyrica Zoloft.
- 27:19Prozac, electrotherapy.
- 27:21Cognitive behavioral
- 27:22therapy exercise sertraline
- 27:28good. So what I'm seeing here is
- 27:30that most of you are familiar with at
- 27:32least some at least one medication,
- 27:35usually medication fewer of you are as
- 27:39familiar with non medication treatments.
- 27:41That's fine. And for those non
- 27:44medication treatments things like
- 27:46exercise and puppies are you know,
- 27:49common things that can that can help.
- 27:51OK, So what do we do with this information?
- 27:57So as you recall, you're part of this course
- 28:02and you got your homework and you were
- 28:04at home and you studied it very closely.
- 28:07And now you're going to use the
- 28:09information from your homework
- 28:10assignment to answer a question.
- 28:12Now I know that the dog ate your homework,
- 28:15so that's fine.
- 28:15So we're going to give it back to you.
- 28:17We're going to put it in the text.
- 28:18It's A1 pager, Linda, if you don't mind.
- 28:21And I'm also going to go over
- 28:22it on the screen.
- 28:23We're going to spend, you know,
- 28:25a minute or two or three going over this.
- 28:28And with the information
- 28:29that you're going to see,
- 28:31we're then going to ask you to put your
- 28:34heads together and come up with an answer.
- 28:37OK, Again, I'm not going to
- 28:38divide you into small groups,
- 28:40but we're going to do something
- 28:42quite similar to that.
- 28:43OK.
- 28:45So in this list of you know the
- 28:48notes that you took at home from the
- 28:50lectures and the podcasts and whatever,
- 28:53you have these five treatments
- 28:55that you remember.
- 28:56And you took some notes about aripiprazole
- 28:59or Abilify any typical antipsychotic.
- 29:03It acts on dopamine and serotonin,
- 29:05traditionally used for schizophrenia,
- 29:07but has also been used in
- 29:09treatment resistant depression,
- 29:11especially as a adjunct in
- 29:14addition to an antidepressant.
- 29:16Weight gain liability can
- 29:17be a common side effect.
- 29:19So that's one treatment,
- 29:21aripiprazole,
- 29:24very different treatment is non medication
- 29:28and they're organized alphabetically.
- 29:31Electroconvulsive therapy is
- 29:34an old treatment that goes back
- 29:36to the 1920s and it's the first
- 29:38effective antidepressant we had,
- 29:40can be safe and can have a rapid
- 29:43onset treatment of choice for
- 29:45depression with psychotic features
- 29:46and for severe depression including,
- 29:48which may sound really counterintuitive
- 29:51or depression during pregnancy,
- 29:52for example.
- 29:55And the electric stimuli stimuli are
- 29:58delivered either one side or both
- 30:00sides of the head, so that's ECT.
- 30:04And so that's the second one that
- 30:06you remember from your notes.
- 30:09Third one is ketamine,
- 30:11which is a very the new kid on the block,
- 30:14it's an NMDA receptor.
- 30:15It actually started in anaesthesia
- 30:18as a dissociative anaesthetic.
- 30:20It acts very quickly.
- 30:22Within the first dose you can
- 30:24see dramatic improvements.
- 30:25Unfortunately it has a very short half life.
- 30:28Unfortunately it has to
- 30:30be given intravenously.
- 30:31But in this day and age we're using
- 30:33more something called esketamine
- 30:35that's given as a nasal spray and
- 30:37this treatment can also be used in
- 30:39addition to others as a combination.
- 30:41But it's a very current treatment.
- 30:494th and and ultimate one is RTMS.
- 30:52Repetitive transcranial magnetic stimulation.
- 30:55Non invasive, it uses magnetic fields
- 30:58that are put surrounding the the head.
- 31:02The magnetic fields can go some 2
- 31:04inches into the cortex. Very safe.
- 31:08Does not require anaesthesia,
- 31:10essentially no side effects.
- 31:12One in a million people can have
- 31:14seizures is very rare and given
- 31:16its low side effect burden,
- 31:17it's it's often really liked and preferred
- 31:21by patients because it's so easy.
- 31:24And the final treatment is
- 31:26another medication, venlafaxine.
- 31:28It's an SNRI serotonin
- 31:32norepinephrine inhibitor.
- 31:34It's commonly used as a second line
- 31:36antidepressant when let's say the SSRI,
- 31:38the pro sex of the world haven't worked
- 31:43it. We use it in children.
- 31:46Duloxetine, which is a cousin is
- 31:49particularly used for patients
- 31:51who have Co occurring pain.
- 31:53OK, so now this was a reminder
- 31:56of your your homework.
- 31:58Again, you have it,
- 31:59it's a Word document if you
- 32:01want it for this next phase.
- 32:04So whoops. So the question is what
- 32:11treatment use for the patient that you saw.
- 32:13And don't don't rush it, just take your time.
- 32:16What I'm going to ask you is
- 32:18not just to put your vote down,
- 32:21but then it'll really help make all
- 32:25the teaching points if you then defend
- 32:27if you will, or justify your choice.
- 32:30OK. So
- 32:35you'll be able to pick just one.
- 32:37If we were in a room together,
- 32:39I would ask you to form little
- 32:43groups and it's less about the group.
- 32:46You know, we could do groups in in,
- 32:50in breakout rooms,
- 32:51but it's more about the continuity of groups.
- 32:54So I find that if it's a class where the same
- 32:56students are meeting and they form groups,
- 32:59then this really works very well.
- 33:01When the group is a 11 only
- 33:04time getting together,
- 33:05it doesn't work quite as well.
- 33:07But for now you're going
- 33:07to do it individually.
- 33:08And let me give you a minute
- 33:10and make up your mind
- 33:39now, Andrea says. As people
- 33:40are making up their minds,
- 33:42could I just remind people
- 33:44that with so many in the room,
- 33:45it's difficult to see hand hands raised.
- 33:48So just feel free to defend
- 33:52your answer orally by unmuting
- 33:54and defending your answer.
- 33:56Or you can also put information,
- 33:58questions, comments and chat
- 34:01and I'll monitor that.
- 34:03Thanks. Great.
- 34:33And remember, we're we're choosing
- 34:36treatment for the patient.
- 34:38We saw in the video, a woman
- 34:41probably in her early 60s, mid 60s,
- 34:46recurrent episodes of depression.
- 34:48But by far this is the worst and
- 34:50her usual treatment has not worked,
- 34:52and it's having an impact on
- 34:55her family life, taking care of
- 34:57her grandchildren and so forth.
- 35:05OK, let's let's see what what
- 35:09do you guys thought? OK,
- 35:18OK, very interesting. OK. So first of all,
- 35:31I I think it's important to say that
- 35:34none of the options are horrific.
- 35:37You know, no one would send you to psychiatry
- 35:39jail for doing any of the five things.
- 35:41I think that they're so and and
- 35:43that's why we want to hear.
- 35:45Now you're thinking, right,
- 35:46it's not about I won and you lost, but why?
- 35:49So it it's interesting and and curiously
- 35:51it's not what I would have predicted,
- 35:53which is what makes this always fun.
- 35:55So why don't we start with our contrarian?
- 36:01Kristen, Why, Kristen, why?
- 36:02Why did you pick erypiprazole augmentation?
- 36:08Well, just looking at the woman,
- 36:09I was concerned about psychosis and she
- 36:12just seemed so flat and so withdrawn.
- 36:15Although we didn't ask her about
- 36:16psychotic symptoms in the interview,
- 36:18I'm just I I worry that's
- 36:19the direction she's going.
- 36:20So I feel like she's going
- 36:21to need an antipsychotic.
- 36:22And it could help her depression too.
- 36:25Yeah. And can you tell us what made you
- 36:27think of the possibility of psychosis?
- 36:31Well, she just looked so, you know,
- 36:33just sort of flat and withdrawn and
- 36:34and was kind of slow to respond.
- 36:36I almost wondered if she was
- 36:37having some thought blocking.
- 36:38Maybe she was paranoid about the whole
- 36:40situation that was going on with her
- 36:42daughter there talking to the doctor.
- 36:44And I wondered if she
- 36:45might, you know, might be having
- 36:46some kind of violence and delusions,
- 36:48that sort of thing.
- 36:50No, that's good. And I would also add
- 36:52to your thinking that she had been on
- 36:55her previous medication for a while and
- 36:57she had been doing well for a while.
- 36:59So that's maybe the ideals
- 37:00of augmentation right?
- 37:01Now let's not take out something that
- 37:03was at least helpful for a long time.
- 37:05So, so thank you, but you know,
- 37:07unfortunately, you, you,
- 37:08you're you're alone on this one.
- 37:10Let's see what your buddies thought.
- 37:12OK, so ECT Does anyone?
- 37:16I'm going to go in in their
- 37:18order of frequency, ECT.
- 37:19Anyone.
- 37:29Come on, people. You. You know who you are.
- 37:38No, no, ECT.
- 37:42OK, well, I'll. I'll come to your
- 37:45rescue and maybe you'll pipe in.
- 37:47I actually think that ECT would be
- 37:49a really good option for this woman.
- 37:54As far as she we know she doesn't
- 37:55have a a complex medical history,
- 37:57but she does look a little bit frail.
- 38:00She has not responded.
- 38:01She has responded very well in the past,
- 38:04but now has had this very dramatic
- 38:07decrease in in her function.
- 38:12She is missing out on a lot of things
- 38:16and this could very quickly get worse,
- 38:20worse in the direction of
- 38:21depression as Kirsten mentioned,
- 38:23or worse in the depression of the
- 38:25depression getting really, really frozen.
- 38:27We already see some frozenness
- 38:29in her movement.
- 38:31She's very slowed down.
- 38:32We don't know her from before,
- 38:33but I would bet that that's not her baseline.
- 38:36So I think that ECT would be a very,
- 38:38very good option and I think that
- 38:40someone in this crowd might be
- 38:42with me because does anyone want to
- 38:44support that view and that vote.
- 38:50OK, OK. All right. So what about ketamine
- 38:55and venlafaxine seem to be tied.
- 38:57Anyone I want to speak for either one.
- 39:06Deb, I'm going to pick on you before
- 39:08because little earlier you had you
- 39:10were about to say something and
- 39:12and I think that I skipped it if
- 39:14I'm right, is that is that fair?
- 39:17I was going to say something
- 39:18when I was I can't even remember
- 39:20back that far now but yet I
- 39:23was oh, it was on anemia
- 39:25and B12 being leaked
- 39:28on the RTMS,
- 39:29on anything on whatever you
- 39:31voted or whatever you want. So I
- 39:35hooked, I choose RTMS and I
- 39:37happy to be picked on by the way.
- 39:40But no, I chose it because it's
- 39:42something that you introduced,
- 39:44something that I'm not familiar
- 39:46with and in my clinical setting
- 39:48it wouldn't be an option.
- 39:49So I was intrigued by the lower side effect
- 39:52profile for someone caring for children.
- 39:55And a lot of these other options
- 39:57would have a risk of either,
- 40:00you know, altering sedation level,
- 40:03either sedation or overstimulation
- 40:04kind of in either direction.
- 40:07And some might interact with her
- 40:10desire to say be independently caring
- 40:12for small children.
- 40:14Yeah no I'm I'm so,
- 40:15I'm so glad that you're thinking with
- 40:17with the children in mind, right.
- 40:19That's not typically how we think.
- 40:20We think just patient in mind.
- 40:21But I think that here thinking
- 40:22generationally is, is very important.
- 40:25So that's good, you know RTMS.
- 40:27The the advantage would be
- 40:28that it's non invasive,
- 40:29it's user friendly.
- 40:31She would go for it.
- 40:33I think that probably it wouldn't be my top,
- 40:36top, top choice because I don't
- 40:37know that it would take her out
- 40:39of this depth of depression.
- 40:40But if she is not as accepting or
- 40:44exciting about ECT for example,
- 40:46this could be a pathway to
- 40:48get her more comfortable with
- 40:50interventional approaches for example.
- 40:52So you know, thank you for that, William.
- 40:55Bill, did you do you want to defend a vote?
- 40:59Any vote.
- 41:01I I Full disclosure,
- 41:03not a psychiatrist. So no
- 41:06one's perfect, no one's perfect.
- 41:09But my my rationale was the
- 41:13non invasive aspect of it.
- 41:15I understand that previously
- 41:17she was on a medication,
- 41:18so this does represent a real change in
- 41:23therapy that might itself just give her
- 41:26some hope and positiveness about it.
- 41:28I worried maybe it won't be strong enough,
- 41:34but I thought it was a good
- 41:36first intervention as you said
- 41:38to get her used to the idea of
- 41:40something other than medication.
- 41:44And so those were those
- 41:46were my thoughts on that.
- 41:48Thank you. No, that's great.
- 41:50And venlafaxine could also
- 41:51be a very good choice.
- 41:53It would be a substitution of of the
- 41:56SSRI that she is on for venlafaxine.
- 41:59As I say any of the five options could be,
- 42:02could be a good one and that that was a
- 42:05point to start thinking about these these
- 42:06issues and we saw some nice examples
- 42:08thinking about the grandchildren.
- 42:09We typically don't do that thinking
- 42:11about the medical comorbidity,
- 42:13thinking about previous treatments.
- 42:14These are some of the things
- 42:16that as future physicians you're
- 42:17going to be thinking about.
- 42:18So, so good job with that.
- 42:21Now,
- 42:26I'm going to say that,
- 42:30well, I'm gonna ask beforehand how many
- 42:33of you have seen ECT, know what ECT is?
- 42:40And this time I probably
- 42:42anticipate a few hands will go up.
- 42:44Not even Kirsten.
- 42:45I I know Kirsten has seen it.
- 42:47So, Kirsten. OK, Deb.
- 42:49OK, so since we talked about ECT and
- 42:53there was so much discussion about it,
- 42:56I want you to see what it looks like and
- 42:58then give you an opportunity to ask any
- 43:00questions or thoughts that you might have.
- 43:02This is a video of this
- 43:04patient during one minute.
- 43:06It's a one minute video of ECT.
- 43:09And this is done with real doctors,
- 43:12real nurses and a non real patient.
- 43:16This is a simulated participant.
- 43:17We filmed this in the simulation center,
- 43:21so here we go.
- 43:22One minute
- 43:23I'm ready. Green light.
- 43:25It's been about 90 seconds.
- 43:27Treat delivering the stimulus.
- 44:11Looks like the convulsions have
- 44:12ended, but she's still seasoned
- 44:18all right and the seizure has stopped.
- 44:23OK, so
- 44:27does anyone have any thoughts,
- 44:29observations, reflections about the
- 44:31ECT or about the treatment in general?
- 44:38Yes Chelsea, I see.
- 44:39I see your your hand up.
- 44:40Tell him go ahead What what are?
- 44:42What are some of your thoughts?
- 44:43Please share with us.
- 44:47I was grabbing my water bottle.
- 44:49If you're talking to me
- 44:53and and any thoughts and
- 44:54and and any reflections
- 45:00I do not have any at this moment
- 45:03I'm just you're taking it all in
- 45:05not not coming from a clinical
- 45:08background so I'm just here
- 45:10but you know
- 45:11I I that's exactly why I wanted
- 45:13to reach out to you as a non.
- 45:15I know you're not a clinician
- 45:16and but just as a, you know,
- 45:18member of society what,
- 45:20what are your thoughts when you,
- 45:21you know, as you saw ECT,
- 45:23Did you have any idea in your
- 45:26mind's eye of what it was or not?
- 45:30I didn't exactly have anything in mind.
- 45:32I just wonder, I just had a question
- 45:34that I was questioning for myself.
- 45:36I was just wondering at what point do you
- 45:39know if ECT is is working for the patient is
- 45:42what I was was really reflecting on.
- 45:44Yeah. Yeah, yeah. No, so that's,
- 45:46I mean that that's a great question.
- 45:48And you know typically this treatment
- 45:51is done three times a week for the
- 45:53first week and then after twice a week
- 45:56usually it takes about eight or ten such
- 45:59treatments till we see full recovery.
- 46:02But as I had mentioned it's
- 46:03it's a very quick treatment.
- 46:04So sometimes after one or two treatments
- 46:06we already see the patient feeling better.
- 46:08And so yeah, no that that's great.
- 46:11That's a great question.
- 46:12And and again I was picking on you Chelsea,
- 46:15because as a non clinician I I
- 46:18think that it's very important to
- 46:20think about what are the perceptions
- 46:21of the public when they hear ECT.
- 46:23In general those perceptions are very bad.
- 46:25You know something terrible is
- 46:27going to happen.
- 46:28So part of what we're also doing is
- 46:31breaking that stigma a little bit
- 46:33that not all of you are going to be
- 46:35psychiatrists and for many of you doctors,
- 46:37non psychiatrists,
- 46:37it may elicit all sorts of things.
- 46:39So that's why I thought especially
- 46:42when you hear the Electro, you know
- 46:45again not being clinician, being
- 46:46from just the general public,
- 46:49if I was the patient
- 46:51and one of those treatment
- 46:52options were given to me,
- 46:53I might not go towards ECT because
- 46:59I would hear the word Electro
- 47:00and be like, oh, you know,
- 47:02the stigma around around it.
- 47:05Yeah. And that's why you,
- 47:06you voted for RTMS because you said,
- 47:08Oh well that sounds less invasive,
- 47:10maybe she'll go for it.
- 47:11These are the kind of clinical
- 47:12discussions that we have.
- 47:13So thank you. Thank you. So
- 47:18with with this, I'm gonna just about
- 47:22to close before a cameo appearance,
- 47:25but what we just went through
- 47:26let let's put this into a little
- 47:28bit of a meta level, right?
- 47:30I mean the purpose today was not
- 47:32to have a lecture on depression,
- 47:34but it was to exemplify how to
- 47:38use group based interventions.
- 47:40Now I I feel that having them on Zoom
- 47:45is not the same as doing them in person,
- 47:48you know, and we're going to
- 47:50comment more about that.
- 47:51But when we do it in Zoom,
- 47:53we can also use certain other skills
- 47:56or or tools or tricks like we saw
- 47:59with the electronic response system,
- 48:02ways of engaging students.
- 48:03I think that the more that we
- 48:06can make clinical cases be real,
- 48:09like we saw depression, we saw ECT,
- 48:12the better it's going to be.
- 48:13And sometimes we can bring real patients,
- 48:15sometimes we do that,
- 48:16sometimes videotape patients rich
- 48:19clinical vignettes and engaging as much
- 48:22as we can the participation of the group.
- 48:25Now what here is a little bit tough to do
- 48:28in ZOOM is the intergroup participation,
- 48:30right.
- 48:31Because if we had PODS that would
- 48:34have happened as I say and I
- 48:36learned this the the hard way.
- 48:38Sometimes when we do the breakout
- 48:40rooms in ZOOM rapidly in this context,
- 48:43we can rapidly lose most participants.
- 48:45So that's not good.
- 48:46So that's those are the,
- 48:47the choices.
- 48:48Last slide,
- 48:49I just want to put things into
- 48:52a little bit of a meta context
- 48:54and this is what we did.
- 48:57We start by defining the learning objectives.
- 48:58You got it in the invitation.
- 49:01You got it a little bit.
- 49:02As I describe,
- 49:03we're going to be learning about
- 49:06depression and then we had some silent
- 49:11reflection or individual reflection
- 49:15in which you started gelling the
- 49:17thoughts based on what you knew,
- 49:18based on your prior knowledge,
- 49:19maybe based on the homework you had done.
- 49:22The red letters here, by the way,
- 49:24are terms that Steve Holt in
- 49:26Internal Medicine came up with.
- 49:28I find them very helpful.
- 49:30And in the purple,
- 49:31these are the terms from a classic
- 49:34old paper from 1965 of Tuchman
- 49:37developmental sequence in small groups.
- 49:39So how do groups form?
- 49:41So during the silent reflection
- 49:43today was individual.
- 49:44But think that you were in a in
- 49:46a classroom with with a small
- 49:47group trying to form that group.
- 49:49And indeed we formed a kind of group,
- 49:51all of us together.
- 49:55Then there's this diagnosing learners.
- 49:58I really like this, not not diagnosing
- 50:00in the sense of do you have a pathology,
- 50:03but diagnosing in the sense of where
- 50:05are you in your knowledge about this.
- 50:07And and again, Chelsea, you were a
- 50:09very good sport when I picked on you.
- 50:11You know, that was part of diagnosing
- 50:13the learners and you started by saying,
- 50:15oh, but I'm not a clinician.
- 50:16I said that was a sin and I said no,
- 50:18that's a strength, that's great.
- 50:20But I need probably to pitch it differently
- 50:22to you than I would to someone else.
- 50:24So that's a diagnosing of the
- 50:26learners or let's norm so that we
- 50:28can get to a unified point.
- 50:32This is my favorite one,
- 50:34creating struggle or storming.
- 50:36And that's what was exemplified in the
- 50:40choose one of these five treatments.
- 50:43There isn't one that is right.
- 50:45And if you said, oh,
- 50:47this has all the right fills,
- 50:51all the right boxes,
- 50:53that's not the right approach.
- 50:54It's not a multiple question, yes no,
- 50:56you want to have some internal struggle ECT.
- 50:58Sounds great, but this lady won't go for it.
- 51:01RCT sounds user friendly,
- 51:03but it's probably vanilla etcetera,
- 51:05etcetera, etcetera.
- 51:06So that was a creating struggle.
- 51:08And then finally we can do it either breakout
- 51:11groups or individually the performing,
- 51:14you know the answering the getting
- 51:16in there and doing the task and
- 51:19finally what we're doing now which
- 51:21is the consolidation of the learning
- 51:25in this case less about depression.
- 51:28My heart won't be broken if you don't
- 51:30know these treatments of depression,
- 51:32but more about from a learning point of view,
- 51:34from a pedagogy point of view,
- 51:35what did we learn?
- 51:36And then we close this phase.
- 51:38If the group is a repeated group over time,
- 51:41the closure has a different meaning.
- 51:43You know,
- 51:44we've been together for 10
- 51:46sessions now we're coming apart,
- 51:47etcetera.
- 51:48Now in the last five minutes,
- 51:51I
- 51:52Andreas, could you do you have time to
- 51:55answer a quick question and chat with.
- 51:57So Deb had a question.
- 51:58Do you have thoughts on finding
- 52:01a balance in engaging students
- 52:03or participants and not focusing
- 52:05too much on what participants
- 52:07feel about being called upon?
- 52:09Yeah, no, it it it, it's a tricky one
- 52:12And and I think I also exemplified
- 52:15this year because I took some risks.
- 52:17I happened to know Chelsea,
- 52:19so I knew that she was would likely be OK,
- 52:22even though I totally caught her by surprise.
- 52:24I know Kirsten and again,
- 52:27I diagnosed Kirsten. I, you know,
- 52:28she's a very senior psychiatrist.
- 52:31I'm not going to ask her Prozac questions,
- 52:33but to kind of put it on its head.
- 52:37So it's always tricky because you don't
- 52:40want to make anyone feel uncomfortable or
- 52:43ashamed or anything other than positive.
- 52:46So it's a tricky balance.
- 52:48I wish I had more to say.
- 52:50Usually the challenge is one of two
- 52:53either people being quiet and today as
- 52:55a group you are a little bit quiet,
- 52:57or the monopolizer who takes
- 53:00it all right in in in.
- 53:02Trying to balance those is
- 53:04something that just takes time.
- 53:06And that is harder in zoom because
- 53:08I can't quite read your facial
- 53:10expressions as well and for some
- 53:12of you I can't read them at all.
- 53:13So it's tricky,
- 53:14but that's a that's a great
- 53:17question and a great challenge.
- 53:19Now I want to.
- 53:20Yeah,
- 53:21Deb,
- 53:21no,
- 53:24I was mouthing. Thanks.
- 53:25I should have just typed it.
- 53:29I'm going to. I do want to have the last
- 53:31couple of minutes for Ann Elizabeth.
- 53:34Now, I started with,
- 53:38I started by showing you an AI image.
- 53:42Right. So this is another AI image.
- 53:44I'm going to leave it up there
- 53:45as Ann Elizabeth comes on board
- 53:46and you see here created with AI.
- 53:48Again the same question, but this
- 53:49time I some other problem because AI.
- 53:52Elizabeth knows a lot about AI,
- 53:55but that's not the reason why she's here.
- 53:56The reason why she's here
- 53:57is that she has recently.
- 53:59Well, she'll tell you the story.
- 54:00And Elizabeth, who are you?
- 54:01Are you here?
- 54:01Come on.
- 54:02Wow us.
- 54:04Hi everyone.
- 54:05I'm a second year MDPHD student.
- 54:08I work with Andres and the child and
- 54:11adolescent psychiatry interest group.
- 54:13But that's actually not why I'm here.
- 54:16I'm here because I can speak to
- 54:18the student perspective of being
- 54:20in a small group workshop.
- 54:23And specifically, I had the pleasure of being
- 54:26in Dean and Luzzi's workshop last week.
- 54:29That was in OB Guine workshop
- 54:32about preeclampsia.
- 54:33And somehow news of this incredible
- 54:36workshop got all the way to
- 54:38Dean Hafler and then to Andres.
- 54:40And then I am Now here I am to explain
- 54:42a little bit about what what worked
- 54:45really well and talk a little bit about,
- 54:46I guess, how to do this in person.
- 54:50So the diagram that Andre showed
- 54:52at the beginning of trying to have
- 54:54as many connections and as much
- 54:56of a conversation as possible as
- 54:58opposed to the one person sort
- 55:00of lecturing at the others.
- 55:02I think it's a really important point.
- 55:06Dina Luzzi,
- 55:07when she started the workshop,
- 55:10said, you know,
- 55:11you all are going on to clerkships
- 55:13very soon and so I want you all to
- 55:16practice talking amongst a group and
- 55:18trying to figure out what's going on.
- 55:20I want you to ask me for
- 55:23additional information.
- 55:24So she gave us the first page,
- 55:26but then she said, OK,
- 55:27now what labs do you want?
- 55:29What physical exam maneuvers
- 55:30do you want to do?
- 55:33What other information would you want?
- 55:35She said use me as a consultant
- 55:37and feel free to ask questions
- 55:39about the pathophysiology.
- 55:41But I'm trying to help you all,
- 55:42like build a framework for being
- 55:46able to approach a patient where you
- 55:48don't really know what's going on,
- 55:49but you do know vaguely what
- 55:52field you're rotating in.
- 55:55And yeah,
- 55:56so I thought what worked really
- 55:58well about her workshop was that
- 56:00it was quite student driven and
- 56:03relied on our curiosity and gave
- 56:06us an opportunity to apply some
- 56:08of these skills that we've been
- 56:10working on for a while,
- 56:11like figuring identifying
- 56:13what the next step should be.
- 56:17And it ended up being a really
- 56:19great group conversation because
- 56:20everyone felt comfortable.
- 56:22And Elizabeth
- 56:24and by the way I placed the the
- 56:26information for the evaluation.
- 56:27We really, really appreciate
- 56:29your doing the evaluation.
- 56:31But and Elizabeth, can you comment
- 56:33on the difference between an in
- 56:35vivo experience like you just
- 56:37described in the online experience,
- 56:40getting it group engagement like this one?
- 56:43Definitely. I think it is easier for it
- 56:45to be more conversational when you're
- 56:48in person and as as you mentioned
- 56:50it's much easier to read each other's
- 56:53faces and so if someone was confused
- 56:56you know we as a group would be able
- 56:59to tell and then talk about it more,
- 57:01whereas that's harder here.
- 57:02What's useful though about Zoom I
- 57:05think is when you have technology like
- 57:07pull everywhere or if we in TBLS we
- 57:10fill out a self-assessment on our own,
- 57:12then you can really assess your
- 57:15individual understanding.
- 57:16Whereas in a more conversational,
- 57:19in person based group,
- 57:20each of us is bringing something
- 57:22a little bit different.
- 57:23And so it ends up being collaborative
- 57:26learning, which is very helpful.
- 57:27But it doesn't necessarily tell me,
- 57:28do I know the pathophysiology
- 57:30of preeclampsia,
- 57:31yes or no or do I need to
- 57:32study this when I get home?
- 57:35Yeah,
- 57:39right. Thank you. And Elizabeth any any
- 57:43last thoughts, questions, comments,
- 57:48Well thank you all for, for joining us.
- 57:51And I I think that here the slide
- 57:55of what's coming up our very
- 57:57own and Elizabeth is going to
- 58:00be talking about ChatGPT that's
- 58:02going to be on Thursday the 14th.
- 58:05So that would be great.
- 58:07And then in I think the last
- 58:09one of the year December 15th,
- 58:10we're going to, I'll be talking about
- 58:13how to put together an abstract.
- 58:15So hope to see some of you then.
- 58:18Thank you, everyone.
- 58:20Thanks everyone. Thanks
- 58:22Andreas and Elizabeth. Thanks.