All the (Medical) World’s a Stage: Human Simulation at Yale School of Medicine

Name: All the (Medical) World’s a Stage: Human Simulation at Yale School of Medicine
Uploaded: 2022-04-06T13:50:30.153Z
Duration: 1 h 15 min 5 s
Description: The Yale School of Medicine's “Innovation in Medical Education” series is a unique chance to meet faculty curriculum leaders and to learn how innovation is enhancing the student experience.

April 06, 2022

The Yale School of Medicine's “Innovation in Medical Education” series is a unique chance to meet faculty curriculum leaders and to learn how innovation is enhancing the student experience.

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00:09Welcome to all the medical
00:11world's a stage human simulation
00:13at Yale School of Medicine.
00:15There will be time for Q&amp;A
00:16at the end of the session.
00:18Please use the chat feature
00:19at the bottom of your screen
00:21to submit any questions.
00:23This session is being recorded.
00:28Hello and welcome
00:30to the third webinar in our New Girl series
00:34Innovation in medical education at YSM.
00:37I'm Jessica Lucy, the deputy Dean for
00:39education and I want to thank you for
00:41taking time out of your day to join us
00:44for a presentation and discussion of how,
00:46why ISM is advancing student learning
00:49in medicine in captivating and
00:52engaging ways through innovation.
00:54As noted, the title of today's
00:56session is all the world,
00:58all the medical world's a stage human
01:01simulation at Yale School of Medicine.
01:04I'd like to now introduce Michael Schwartz,
01:07our associate Dean,
01:08for curriculum and newly appointed Director
01:10of Innovation in Medical Education.
01:16Hello everybody, welcome to tonight's
01:19presentation in tonight's innovation
01:21in medical education webcast,
01:23we will highlight the Yale School of
01:26Medicine simulated participant program,
01:28which is designed to provide students at
01:31the Yale School of Medicine with a safe,
01:33effective space.
01:34In which to acquire, develop,
01:37and practice their clinical skills.
01:40This program has been an important
01:42and integral part of our pedagogical
01:45structure of the curriculum since 1993
01:48and is currently integrated with in all
01:51phases of the medical student training.
01:54It has evolved to meet the
01:56changing and evolving needs of our
01:59curriculum for the last 29 years.
02:01Tonight you will hear about this dynamic,
02:04creative and educational
02:06program from faculty,
02:08students and actors within the program.
02:11Leading tonight's webcast will
02:13be doctor Alan Grace Martin.
02:15Doctor Martin has been the director
02:17of the Simulated Participant program,
02:19which resides in the Yale School of Medicine
02:22teaching and Learning Center since 1980.
02:25Excuse me since 2018,
02:27Doctor Martin is a child in adolescent
02:30psychiatrist and a professor in
02:33the Yale Child Study Center.
02:35In his clinical work,
02:36Doctor Martin has served as the
02:38medical director of the Children's
02:40Psychiatric inpatient service at the
02:43Yale New Haven Hospital since 22,000
02:46and two and is active internationally,
02:48including as a visiting professor in
02:51medical education at Tel Aviv University,
02:54Faculty of Medicine,
02:55where he'll be teaching later this week.
02:58Doctor Martin is joining us tonight late
03:01in his evening from the Netherlands,
03:03where he is working as a PhD
03:06candidate in medical education
03:08at the University of Gronigen.
03:11I know we're all excited to
03:12hear about the creative,
03:13innovative and effective use of
03:15simulated patients within the
03:17ysm curriculum tonight,
03:19and I'd like to turn the webcast
03:20over to Doctor Martin now.
03:24Thank you so much, Doctor
03:27Schwartz and I put this background
03:30on a Van Gogh note to share that I
03:34am joining you from the Netherlands.
03:37I am delighted to be here, and,
03:39you know, wherever Yale goes,
03:41I go and I know that that is true for
03:44everybody who is joining me this evening.
03:46I am delighted to be sharing.
03:51Maybe showing off.
03:52I should say this wonderful program
03:55that I had the the real honor and
03:57privilege of being the director
03:59of together with I should mention
04:01her Barbara Hilderbrand who is
04:03always in the in the background
04:05but always leading everything.
04:06And I think that this evening you
04:08are in for a treat I think so I know
04:11that for me it has been wonderful
04:13to get to know one work with this
04:15extraordinary cast of characters.
04:17Literally you'll be meeting nine
04:20of them tonight.
04:22And let's get the show on the road.
04:25So let's put things into context.
04:28We will be talking this evening
04:31about human simulation.
04:32In the prior installment
04:34of this innovation series,
04:37you had heard of our simulation efforts,
04:40including. Combined machine.
04:45Dumb Gadget dolls, medical gizmo,
04:50simulations,
04:51and the sophistication in that program.
04:54There was a cameo appearance
04:56there about human simulation,
04:58but today's talk is all about
05:00human simulation.
05:01As Doctor Schwartz mentioned,
05:02I am a psychiatrist.
05:04I am a child psychiatrist.
05:05I am very interested in helping for
05:08all of my career in human interaction.
05:11And there is nothing that can ever
05:13substitute what a human can do.
05:15There will never be a machine, a computer.
05:20Zoom anything that has the
05:22sophistication of a human and that
05:24is what this program is all about.
05:25We're going to be seeing several
05:27examples of how do we do that?
05:30Let me give you 2 notes of background
05:32and then the menu for the evening.
05:35So the background human simulation
05:37is a fairly new endeavor.
05:39It started in 1963 with a neurologist,
05:43doctor Howard Barrows,
05:44who was at the time in UCLA.
05:47If memory serves,
05:48or University of South California.
05:51And he described in the Seminole
05:53paper called the programmed patient
05:55and actor who he worked with.
05:58Teaching him and I think it was
06:00a he the very first one.
06:01How to enact this and that?
06:05Neurological pathology, paralysis etc.
06:09And from there 1963 we're off to the
06:13races and all these years later the
06:16field of human simulation is an entire world.
06:19There are annual meetings.
06:20There are journals.
06:21There are anything that you can pick
06:24from any branch of medicine dedicated
06:26to human simulation that was in 1963.
06:3130 years later, Yale introduced
06:34its program of human simulation.
06:37It wasn't all that.
06:39Long after,
06:40even though they started in 1963,
06:43it took a while for the field of
06:46medicine broadly to uptake simulation
06:48and we did in 1993 with the appointment
06:52of Janet Heffler pictured here,
06:54who is our director of the
06:56Teaching and Learning Center.
06:58This was as doctor bullets.
07:00Key was ardyn preceding Dr.
07:03Lucy and you see their doctor Wick Hessler,
07:06who is my predecessor as the
07:08director of this program.
07:10He built this program and
07:12over many years led it to this
07:15wonderful foundation that we
07:16have now been able to build on.
07:21If you get the newsletter from
07:22the Yale School of Medicine,
07:24you may have noticed or not.
07:25But let me remind you,
07:26this is very recent. March 18th,
07:28we announced the change in name of the
07:31program from standardized patient program,
07:33which is what it has been called
07:35forever and what most programs
07:37across the country were called,
07:39standardized, patient.
07:41To what seems like a minor
07:45change simulated participant.
07:47The initials are the same as P,
07:49but the difference is quite
07:51intentional and important.
07:53All of the actors and all
07:54their roles are simulated.
07:56They always simulate something,
07:58but they don't always
08:00necessarily simulate a patient.
08:01Sometimes they simulate a doctor,
08:04a family member and attorney,
08:06a social worker.
08:07So they have all sorts of roles,
08:09not just patients.
08:10So that's what we change it to, participant.
08:12And simulate it is an umbrella term that
08:16includes both simulation and standardization.
08:20A standardized patient goes
08:21through a set number of steps.
08:23Imagine that you're learning
08:25how to dance the tango.
08:26You put your foot here.
08:27You put your foot there and you
08:29always give the same lesson to
08:30this person that you're teaching.
08:32How to dance a tango.
08:34That's what we do early on in
08:37medical education later on,
08:38as our medical students are housestaff,
08:41our faculty develop more complex activities.
08:44We go into simulation in which
08:46the actors have free reign.
08:49We give them a character to embody,
08:51and they go wherever the
08:53action will take them.
08:54So it's a subtle but
08:56important change in name.
08:57And here you see one of the many
08:59activities in which we are teaching
09:02some clinical skill with an actor here.
09:06This is a slide that's
09:08intentionally old by now.
09:09This is 2018 to 19,
09:11at which time we had 35 actors and
09:15124 educational activities per year.
09:18This last year, if memory serves,
09:20we're close to 40 actors and an
09:23astronomical over 200 activities and it
09:26just keeps getting bigger and bigger.
09:29There's great interest in using our
09:31services and really one of the rate
09:33limiting steps is how many actors we have
09:35and how many Barbara Hildebrand's we have.
09:37We have one Barbara Hilderbrand who is really
09:39a treasurer who makes all of this work.
09:42I I really am grateful to her so
09:45let's talk about this evening's menu.
09:48We're going to divide it into five parts.
09:50We're going to start start with
09:53Jaideep Talwalkar colleague of
09:54mine who will talk about clinical
09:57skills training in medical school.
09:59Throughout the years of training,
10:02then we're going to have two
10:05different yet related presentations.
10:07Both of them,
10:08and in fact all four of the next
10:10ones having to do with a minoritized
10:13or overlooked population.
10:15The first one,
10:16and one that I'm particularly proud of
10:18as a child and adolescent psychiatrist,
10:20is children.
10:22Children have not often been
10:24included in simulation.
10:26It is difficult to involve children
10:28for all sorts of legal, etc reasons.
10:30We're delighted that at Yale,
10:32we've been able to involve children and
10:34adolescents for the past two years.
10:36We're really excited about that.
10:38I should also add that this will be the
10:40first of two presentations this evening,
10:42led by a soon to be alum
10:44of Yale School of Medicine,
10:46we will have two such individuals who
10:49will introduce themselves in a second.
10:51The substance use disorder segment
10:53that we're going to talk about
10:55at Brian Foyer line and expert.
10:57In substance use,
10:58we'll talk about that and Betsy Beth Castro,
11:01one of our very talented actors,
11:03will tell us what it's all about
11:05to be an actor.
11:06In this program, you will see her in action,
11:09and then you will see her as a person.
11:12The last two presentations are going to
11:14be more on the research side of things,
11:16but it's clinical research.
11:18It's applied research and its
11:20research that has real life or death,
11:23and even I would say existential
11:26implications.
11:27The first one in which my colleague,
11:30Lilia Benoit from Paris, visiting scholar,
11:32will start and I will close.
11:34That part has to do with ecological anxiety.
11:38Small problem that we as physicians have
11:41been and will be dealing with. A lot.
11:44This is a real existential threat.
11:46How do we as individuals?
11:48How do our youth move from ecological
11:51anxiety to ecological action?
11:53And finally,
11:53we're going to close with transgender
11:55youth health for this segment,
11:57we're going to have three percenters.
11:59We are going to have the second soon to
12:02be alumni alumnus of Yale School of Medicine,
12:05so I'm delighted that we're going
12:07to have a medical student sharing.
12:10Justin Halloran is going to
12:11be accompanied by the second
12:14of our actors tonight.
12:15Jill Celentano and Jill after
12:18telling us about her experience and
12:21her role as a simulated participant
12:23will pass it on to the closer.
12:26Who's going to be?
12:27Carol Carol is what this is all about.
12:31Carol is the parent of a child of a patient
12:34of someone who has gone through this,
12:37and Carol will remind us that everything
12:39that we talk about. Is not theory.
12:41It's not, you know, thought, experiment.
12:44It is not theoretical physics.
12:46It is about lives, it's about children.
12:49It's about adults.
12:50It's about patience.
12:51It's about those we have trained and
12:54dedicated our professional lives too.
12:57So without further ado,
12:59let me introduce to a teacher of so many,
13:02certainly including myself.
13:04And this is JD Towcar Jaideep.
13:07Please take it away.
13:10Great
13:11thanks Andres, thanks for
13:12inviting me to highlight some of
13:14the work that we do together.
13:16So I'm a practicing internist and
13:18pediatrician so duly trained in medicine
13:20and Pediatrics at the medical school.
13:22As as you heard I run the clinical skills
13:24program so this is a four year program
13:26where students learn about the essential
13:28elements of doctoring things like history,
13:30physical point of care, ultrasound,
13:33clinical reasoning under can you.
13:36Can you get onto my first slide there.
13:37Thanks just 'cause you.
13:39Can see here some of the
13:40activities that we do in class.
13:42Students work with ESPYs at multiple
13:45touchpoints through this curriculum,
13:47primarily teaching communication skills,
13:49but over the years we've really
13:51tried to move away from lectures.
13:53The bulk of class time in clinical skills is
13:57spent with experiential hands on practice.
14:00We've practiced with the thank you
14:02with the ESPYs to help students learn
14:04the basics of medical interviewing.
14:06As you heard, dating back almost
14:0830 years for Kessler's tenure,
14:09long predating me,
14:10but a lot of changed over that time.
14:12Most notably,
14:13there is a real growing footprint of
14:15these sessions in the formal curriculum,
14:17since students keep asking for more,
14:19they recognize how amazing this is as
14:21an educational opportunity during these
14:23sessions for basic medical interviewing,
14:26students practice interviewing using Smits,
14:28patient centered interview model
14:29that's based on a textbook.
14:31Authored by our Director
14:32of Communication Skills,
14:34Dr Aug 14 and actors help the students
14:36flesh out not just the symptoms story,
14:38but we also really emphasize the
14:40importance of the personal context
14:42and the emotional impact that illness
14:44is having on their characters
14:46early in the first semester.
14:47Faculty observing give feedback.
14:49But as students get more experience,
14:51the mechanism really shifts to students
14:53giving each other feedback and ultimately
14:55the ESPYs driving the feedback.
14:57The wonderful one of many wonderful
14:59things about working with DSPS for these.
15:01Early sessions is the realism that
15:03they bring, combined with flexibility.
15:05Really, I would.
15:06I would even use the word permission
15:08for students to make mistakes.
15:09We encourage students to take
15:11timeouts literally.
15:12We have them or we do this if they're stuck,
15:14or if they need to collect their thoughts.
15:16And one of my favorite teaching techniques
15:18is to rewind and an example of this
15:20would be a student finishes the interview.
15:22We start doing feedback.
15:23We can go and rewind the interview back to a
15:26specific time point to try something again.
15:28Try a different approach.
15:29Or maybe, maybe the student mumbled
15:31their words the first time around.
15:33They get to do it over again.
15:34They they leave with a real,
15:35tangible sense that they've
15:37improved in real time.
15:38The actors are so versatile and
15:40and amazing in their abilities.
15:42To pause, shift,
15:43and rewind during these sessions.
15:46So I've got next slide please,
15:48so I've shown you about the
15:50introduction introductory sessions,
15:52but the curriculum with RSPS
15:54has blossomed well beyond that.
15:55In recent years,
15:56we've developed content that's
15:58really critical to
15:59students in their future patients,
16:00but really also highlight some of
16:02the range and skill of the actors.
16:04All of the students go through the
16:07advanced Communication Skills Workshop
16:08and it's part of the capstone course
16:10that occurs just before graduation.
16:12We just had it last week.
16:14Students work through five stations.
16:16On particularly emotionally
16:17related topics that they may or
16:19may not have actually encountered,
16:21or had any experience with
16:22on their clinical rotations.
16:23But as you can see from the
16:25list here on the screen,
16:26they certainly will experience these
16:28things during their residency,
16:29and the cases are really intense.
16:31We have created safeguards to be sure
16:33that both the students and the actors
16:35have opportunities to debrief and and
16:37process what they've just experienced,
16:40and there's a lot more that I
16:41could say about this workshop,
16:42but I'm going to direct you to
16:44some papers that our group has
16:45written about this exercise.
16:46As well as just working partnership
16:48between the clinical skills
16:50programs and the SP's in general,
16:51you see some of the references
16:54here on the slide.
16:55So the thanks,
16:56the bulk of our work with SPS and
16:58clinical skills relates to to
16:59communication skills which I've highlighted,
17:01but we've also worked with the
17:03program to create a series of
17:04videos related to physical exam.
17:06Here you see some photos of me and
17:07Doctor Joe done row who runs our
17:09physical exam curriculum with some of
17:11the ESPYs who helped us with these videos.
17:13There's a whole collection
17:14available on on this website.
17:16It's a procedural journal called
17:17Journal of Visualized Experience.
17:19If you're interested in seeing
17:20more of what we've done there,
17:22you can scan that QR code and it
17:24will take you to that journal.
17:25Website.
17:28Those videos got a lot unbeknownst
17:30as we've reported them pre pandemic.
17:32They got a lot of traction in
17:34the spring of 2020 when every
17:35medical school had to make rapid
17:37adjustments due to the pandemic.
17:38But the bigger adjustment we made
17:40was this new emphasis on telehealth.
17:42There was this long period of time
17:44when campus was closed to everyone
17:45other than students and faculty,
17:47and so the ESPYs couldn't join us in person.
17:49The positive aspect of this was really
17:51forced us to come up with creative
17:53solutions to teach about Tele health,
17:55some of which were still doing.
17:56Now that we're all back in person.
17:58At different stages of the pandemic,
18:00our teaching setup ranged from students
18:02in person with the ESPYs remotely
18:04connected on iPads to sessions
18:06where everybody was fully remote
18:08and everything happened on zoom.
18:10We did, of course do some catch up in
18:12person work with these students when
18:14we were all able to come back safely,
18:16but gosh,
18:17the ESPYs were just remarkably adaptable.
18:19Willing to adjust with us as our tech
18:22solutions change often on a weekly basis,
18:24and thankfully through both our anecdotal
18:27observations of our students and.
18:29Formal assessments,
18:29they're telling us that the affected
18:32students during that period are really
18:34still where they ought to be from
18:36a clinical still skill standpoint,
18:38in large part related to this
18:40partnership with the ESPYs.
18:42So finally,
18:42I'm going to talk about the role of SPS and
18:45performance improvement and remediation.
18:47We have various mechanisms to
18:49identify students who are struggling
18:50with their clinical skills.
18:52You saw a photo of Doctor Thielen big
18:54soccer on one of Andre slide earlier.
18:56He's a core member of our Skills team
18:58and he leads remediation efforts.
19:00Our team works with Andres to
19:02develop case scripts,
19:03to train the ESPYs to play these roles.
19:05These exercisers are often more
19:07customized than our typical
19:09scenarios since we really target.
19:11Targeting the specific needs of the
19:14individual student sessions are
19:16usually longer and often physical
19:18exam is part of these cases as well.
19:21So in summary,
19:22the faculty and the students are just
19:24we're so lucky to have such a close
19:26partnership between the SP program
19:27and the Clinical Skills program.
19:29The ESPYs allow us to come up with
19:31all sorts of creative and innovative
19:33ways to teach bedside medicine
19:34to Yale medical students and the
19:37students fully recognize this,
19:38routinely commenting on how they
19:40really can't tell the difference.
19:41That the SPS are actually acting
19:43when they're in character.
19:44They do their jobs so well.
19:45They S fees.
19:46Also have a remarkable ability
19:48to learn and adapt with us,
19:49and they give so much of themselves
19:51to student education.
19:52They really are our educational partners
19:54when it comes to teaching clinical skills.
19:58Thank you.
20:00And thank you jaydeep.
20:02We're gonna now pass it
20:05on to one of our very soon
20:07to be alumni Alex Kimmel.
20:09Alex take it away.
20:12Thank you so much.
20:13Hi everyone, my name is Alex.
20:15I'm currently a fourth year medical student,
20:17but soon to be resident in Pediatrics
20:19and I'm so thrilled to be here to
20:21talk to you about my thesis project,
20:24which was the development of a
20:26curriculum focused on teaching
20:28medical students and health care
20:29professional students in general.
20:31How to take care of children
20:32with physical disabilities.
20:34And I'll start with a little bit
20:36of the background on the project
20:37and and how I came to this.
20:39So I miss born from personal experience,
20:41my childhood best friend.
20:43Right after we graduated,
20:44college had a spinal stroke and has
20:46since that time been using a wheelchair.
20:48And as I learned a lot from watching
20:51her adjust to her new role as
20:53a a person with a disability,
20:56I was entering the yellow curriculum
20:57and felt that I wasn't actually being
21:00taught quite as much about how to be
21:02a good physician for patients like
21:04my friend and how to really care for
21:07patients with physical disabilities
21:09who have historically experienced
21:11inadequate and inequitable care.
21:13So I decided to change this and
21:14I came up with Doctor Martin,
21:16doctor Todd Walker and also
21:18Doctor Aaron knows it.
21:19So you'll meet in a moment to create
21:21a ultimately a 50 minute workshop
21:24that intersperses video clips of a
21:27simulated participant interaction with
21:29traditional lecture content and also
21:31discussion questions for students.
21:33So as you can see on this next slide,
21:35we filmed a video that is focused on a
21:40simulated participant interaction using.
21:43A the first ever actually at Yale
21:46Child simulated participants and
21:48the videos depict a well child
21:49visit at an outpatient clinical
21:51setting for a child in a wheelchair,
21:54and his mother and the physician in
21:56the video is played by Doctor Karen,
21:59knows it,
22:00and we filmed the videos in the simulated
22:04participant center and we really,
22:07we felt strongly from the beginning of
22:08this project and its inception that we
22:10really wanted to model for students,
22:12not just.
22:14What's the content should be and
22:15how we should approach things,
22:16but to really model the behaviors
22:18and the skills that we would like
22:20students to be able to develop in
22:22order to treat this population in
22:24an equitable way so we knew it
22:26would be important to use simulated
22:28participants and we're so glad we did.
22:31Need another important thing to
22:32highlight in this project and on
22:34this slide I'll talk about it a
22:36little bit is that we really met a
22:37set out to do this project in this
22:39period of participatory research
22:41and in the idea of nothing.
22:42About me without me.
22:43So when we started developing this project,
22:46we met with a group of multiple
22:48stakeholders in the disability community,
22:50including patients with
22:51disabilities such as my friend,
22:53whose name is actually
22:54highlighted here on this slide.
22:55Mary Salisbury,
22:56as well as several other
22:58patients with disabilities.
22:59Parents of children with
23:01physical disabilities.
23:01And also physicians
23:02who treat this population and are
23:04part of this population themselves,
23:06and we really wanted to highlight
23:08their experiences and ask them what
23:10they thought would be important
23:11for medical students to know.
23:12And we took the key points that
23:14they gave us and developed this
23:16script for the videos that I was
23:18just talking about and I I was so
23:20impressed with the way in which the
23:23simulated participants who played
23:25these roles really authentically
23:28represented my friends experience.
23:30Authentically represented the experience of.
23:33Many people in this population who
23:35we were really trying to improve the
23:37care for and increase the equity for,
23:39and I'm so thrilled that I was able
23:41to do this with the participant
23:43program and I'll pass the floor
23:45now to Doctor knows it to talk
23:46just a little bit before you.
23:47We show you some of the video
23:49clips that we developed.
23:57Thanks Alex. Hi everyone and uh,
24:00we really appreciate your time tonight.
24:03So the videos you're about
24:05to see are truly a powerful
24:07teaching tool. Of course I'm
24:09biased, but you know, I'm
24:11I've been the one kind of a
24:14leading the 50 minute workshops and
24:17receiving the student feedback.
24:19And it's really been very positive.
24:21As a faculty member and pediatrician
24:24who has the privilege of caring
24:26for patients with disabilities everyday.
24:29This simulated participant program
24:31has allowed us to create an archive,
24:34a direct observational
24:35experience for students on
24:38the gold standard
24:39of care for a child with a
24:42physical disability, and the
24:43advantage here is that students
24:45can process what they are seeing
24:46in a safe and comfortable space where
24:49they can absorb the content
24:51and then ask questions,
24:52and we do have deliberate prompts in
24:54there to help move conversation along.
24:59You know this isn't always possible
25:00when face to face with an actual patient.
25:03We know that patients with
25:05disabilities receive comparatively
25:06inadequate and insensitive care
25:08in this country, and these videos
25:10have helped us challenge the
25:12next generation of physicians
25:14to change the status quo for the better.
25:16So without further ado,
25:17we'll watch some of them.
25:24OK, so Jacob you know as you
25:27get older we want to kind
25:27of give you a chance.
25:28Like I was saying to you when your mom
25:31was here to talk without a parent.
25:34You know what we say here is between us.
25:36Unless you say something like
25:37I've been thinking of hurting
25:38myself or hurting someone else,
25:40and then I'd need to get extra help,
25:42but otherwise private, OK.
25:45So this is just
25:46meant to give you an opportunity
25:48to talk openly, maybe about things
25:49that have been on your mind.
25:51Some kids say you know, I've been
25:53thinking about this about my health,
25:54my physical health and mental
25:55health and other kids don't really
25:56have anything to talk about.
25:58So either one is fine.
26:02Is there anything that you wanted to bring
26:03up today that you were worried about?
26:05Not much. My physical health.
26:07Well, besides, this seems to be fine.
26:11It's mostly, but I had to adapt to a
26:13lot of things like using the bathroom,
26:16moving around and.
26:17At first my mom helped me out
26:20a lot 'cause I needed it.
26:22I was really having had to
26:24adapt to that change, but now.
26:26Like I'm pretty much got the hang of it.
26:29I can use the bathroom with no trouble,
26:31and especially with the catheter and
26:33everything is pretty much fine now and but.
26:36She still seems very like she's
26:39hovering over me all the time
26:41and like I feel like I've grown
26:43a bit more independent now,
26:44so I think it should be fine if
26:45she like laid off a little bit.
26:51OK, so Jacob.
26:57Erin, should I just go ahead?
27:01Sure, sure.
27:05OK, so we're nearing the end of our time
27:08together. For today we've
27:09talked about a lot of things,
27:10so I just wanted to kind of
27:12wrap up and make sure we we all
27:14felt good about everything.
27:16So Jacob will be coming
27:17here for his medical needs.
27:19Will be his medical home from now
27:21on and you can communicate with me
27:23using the Mychart app or calling.
27:27And then I'll provide you some
27:30pamphlets on the wheelchair
27:32basketball that we talked about.
27:34It looks like you may
27:35already have a basketball.
27:35Yeah, one of the nurses had a couple
27:38extra or something so this one's not mine.
27:40Wonderful thank you for that.
27:43Practicing early.
27:45And then like we talked about, we have
27:47the medical legal partnership available.
27:49If you need help with.
27:51Any kind of school advocacy and
27:54then some names of counselors
27:56that we talked about as well.
27:57Great, OK.
28:03OK.
28:07Alex, do you wanna wrap
28:08it up or Erin and Alex?
28:12Oh sure. So yeah. So as you can see,
28:15the videos depict really all parts
28:18of the outpatient visit and we
28:21really wanted to make a gold standard
28:23model of how to approach care of a
28:26child with a physical disability
28:27in a wheelchair in particular.
28:29And so you know,
28:31we're just extremely grateful to the
28:32simulated participant program for
28:34being part of this project and for
28:36really committing so to authentically
28:38representing the experience of
28:40this often underserved population.
28:42And all transition it now to some
28:46discussion of actually another stigmatized
28:48and often underserved population and
28:51past the the floor over to back to back.
28:54We're going to start with Doctor Brian
28:57Foyer line actually, and Alex Pre.
29:01Congratulations on something very important
29:03that's happening on May when we will
29:05start calling you doctor but not yet.
29:08Brian, you are a doctor. Take us away.
29:11Thank you Doctor Martin and everybody else.
29:14So I'm Brian for line.
29:15I am the director of the
29:17psychiatric emergency room at VA,
29:18Connecticut and I'm on the faculty
29:21in the Department of Psychiatry
29:22here at Yale and what I do is is
29:26the psychiatric emergency room.
29:27Primarily is take care of patients
29:29with substance use disorders,
29:30so of course we take care of
29:31her variety of patients here.
29:33But a lot of our patients have
29:34substance use disorders and there's
29:37an art to working with patients
29:40with substance use disorders.
29:42And when I rotate,
29:44I when resident students,
29:45fellows rotate with me,
29:46they have an opportunity to work
29:48with directly with patients with
29:50substance use disorders and get
29:52to see how I engage with them.
29:54Just like with surgery,
29:56there's an art to surgery, right?
29:57You can give a lecture about
29:59how to do a surgical procedure,
30:01but there's nothing like watching someone
30:04do it or practicing doing it yourself.
30:07So I give lectures all the time
30:09about alcohol use disorder,
30:10opiate use disorder, AA and NA,
30:12Alcoholics Anonymous, and other things,
30:14and I'm able to impart knowledge
30:16to people about these illnesses.
30:18But when the residents and the students
30:20rotate with me and their little watch
30:22me actually interact with these often
30:24challenging patients and how I would
30:26attempt to motivate patients for recovery,
30:27how I would attempt to convince the
30:29patient to attend Alcoholics Anonymous
30:31when maybe they didn't have the best
30:33track record with AA in the past,
30:35or how I might get it a history from.
30:37Involving a difficult topic
30:39such as injecting fentanyl,
30:40we're using cocaine,
30:42watching me interact with the patients
30:45and then discussing it afterward.
30:46Is really the best way to learn how to apply
30:49the knowledge to actual clinical care,
30:51particularly with the challenging
30:53patient population like this,
30:55and that's when I say there's an art to this.
30:57So I had the opportunity to work
31:00with Doctor Martin to work with
31:02the program to work with actors
31:04who were able to really expertly
31:06simulate some of these things that.
31:08I do every day in the emergency room,
31:11which is to develop a draft of a
31:13case that would really encapsulate
31:15how difficult it can be to work
31:18with a patient with an alcohol use
31:20disorder or how difficult it might
31:22be to motivate someone with an opiate
31:25use disorder to attend recovery.
31:26So with a A we think of the concept
31:29of hitting a rock bottom.
31:31We're trying to get people to motivate it.
31:34We're trying to motivate people to
31:35get into treatment before hitting
31:37that rock bottom occurs or trying
31:39to bring the bottom up.
31:40So for alcohol I had an opportunity
31:42to work with an actor named Johnny
31:44and he and I worked together in
31:46two different capacities.
31:47The first one was he came in.
31:49He wasn't particularly interested
31:51in going to treatment.
31:52His life wasn't going well,
31:54but things hadn't fallen apart yet.
31:56And I wasn't really able to motivate
31:59him to get better and then the
32:01actor sort of changed his clothes,
32:03redid how he looked, disheveled his hair,
32:06he had a cut on his face.
32:08Same day filming,
32:09but we then filmed it as if this was
32:11a little bit later and the actor was
32:14now doing much worse and a little
32:16bit more amenable to treatment.
32:17So we were able to film two different
32:19scenarios of me speaking to this patient.
32:21How I would approach it?
32:22And Doctor Martin,
32:23I think you want to show a video
32:25clip of of that interaction now.
32:29So hi again Steve. So tell me a
32:32little bit about what happened
32:33since the last time you were here
32:35since the last time I was here, yeah.
32:39Well, bottom line is.
32:43I screwed up,
32:45you know, things have just gotten
32:46really messed up in my life
32:47since since I was here last.
32:52Tell me a little more what happened.
32:55Well, I'll tell you
32:56when I left here. I was two weeks
32:59ago I was bound and determined
33:00that. I wasn't gonna drink again.
33:04You know, I was absolutely positive of it.
33:07And. How I even I even convinced
33:12my wife? I think she was half
33:13certain I wasn't. Wasn't
33:15going to. Drink again either,
33:18although she wouldn't let up with
33:20saying I should have. Stayed
33:22in longer, but
33:23anyway things were.
33:25Things were good for a few
33:27days. Things were fine.
33:31Never even had a. Thought to
33:33have a drink. I wasn't it just
33:35wasn't gonna do it anymore.
33:40So hi again, Steve.
33:43So I I can't emphasize enough how
33:46awesome he was when he came in the way
33:49he was dressed and the way he looked.
33:51It was just so perfect and
33:52having an opportunity.
33:53If you watched all the videos to see a
33:56progression of the actor was just phenomenal.
33:58Obviously another really important
34:00topic is opiates, and again,
34:02one of those really difficult things
34:04that we do when we're educating
34:06patients is how do you avoid dying?
34:09How can we get patients on Suboxone?
34:11How can we get null oxone available
34:12to all of our patients so they
34:14don't die of an overdose?
34:15How can we reduce the harm
34:17associated with opiates?
34:18These are all things that are are
34:20something we can lecture about.
34:21But if you really want to learn how to
34:23interact with patients you really want
34:24to learn how to deliver these types of
34:26of educational sessions to your patients.
34:28The best way to do it is through
34:31watching someone do it and and
34:32do it in a way that looks real.
34:34And if you can't bring everybody to the
34:36emergency room to observe me doing it
34:38down here and interact with real patients,
34:40what we're able to encapsulate
34:42in this program really captures
34:43exactly what we're doing here.
34:45So in the second case.
34:46Betsy Beth, who's with us today?
34:48Who's going to be speaking after this,
34:50played the role of the patient,
34:52and I was interviewing her a little
34:53bit and after this video I'm gonna
34:55turn it over to Betsy Beth to give her
34:57perspective on the program and what
34:59it was like for her to be a patient.
35:01If you will in this setting,
35:03but I just can't emphasize enough how
35:06professional and expert the actors were
35:08when given a case to really represent
35:11what we were looking for and to use
35:13this as a tool to be able to teach.
35:16People how to interact with patients in a
35:19real life way it is is such a useful thing.
35:22I can't overstate that.
35:23So, Doctor Martin,
35:24you can play this video and
35:25then I will turn the floor.
35:26But it Betsy Beth,
35:27who will then share her
35:28experience as you can see,
35:29Betsy Beth right here.
35:31That was overdose prevention.
35:33Do you? Do you have you heard of Narcan?
35:35Do you have any of that at home, yeah.
35:37OK, do you know how to use it?
35:39It probably be helpful if I got a refresher.
35:43OK, so there's two different
35:44main forms of Narcan
35:45that people can have, right?
35:46There's one that is like a nose spray.
35:48You squirt and it goes up
35:49the nose and it goes into the bloodstream.
35:51And another one is an injection.
35:53They usually goes
35:53into the muscle of the arm.
35:55Narcan reverses an overdose, right?
35:57So you really need to have
35:59someone with you, because if you
36:00overdose and you're by yourself,
36:02even if you have Narcan with you,
36:03there's no one there to administer it.
36:05So you have to have someone with you.
36:06And depending on which one you have,
36:08that person should know how to
36:09use it as you should for them.
36:10If you're using together.
36:11And you either depending you,
36:12just put it up the nose or you
36:14put it in the arm and you give
36:15the injection and that reverses
36:16the overdose. Does
36:18that? Does that make sense?
36:19If you heard of that,
36:20yeah, that makes sense, OK? So if
36:24there's no one around to administer
36:25that Narcan, it's really
36:26important that you know that you
36:27have someone around with you.
36:30About was.
36:33Bits of a please.
36:36Hello hi, my name is Castro
36:39with stated my pronouns,
36:40are she her hers?
36:42Uh my am in SP and I've been.
36:45Doing this for, I wanna say over
36:49two years now that video that you
36:52just saw was a little while ago.
36:54I did look a little different.
36:56My experience so far as a
36:59simulated participant has been.
37:01Very rewarding, UM,
37:03it's been so amazing to be a part
37:07of the process of helping you know
37:11future medical professionals. Hi in,
37:14in real life you know like I am an actress,
37:17a professional actress.
37:18I've been acting for about almost
37:2110 years now and so when I saw this
37:25opportunity to enhance my own skills
37:28and practice it more regularly and.
37:31Really practice some improv.
37:32Uhm, I had to jump on the opportunity.
37:36And it's been. Amazing, uh?
37:40I feel like this program in particular is
37:43not only so beneficial for the students,
37:47but I find it to be amazingly
37:50beneficial for actors in general.
37:53Because yes,
37:53we receive the information sometimes as
37:55who our character is and all that stuff,
37:58but we don't really receive a script,
38:00so it does give us an opportunity to.
38:04It's a really strengthen our skills to
38:07improv to just go with the flow and
38:10also really just live in the moment
38:13and live in someone elses story.
38:15And it really gives up.
38:16Gives us the perspective of those we may
38:20not encounter a lot for this specific.
38:23Uh, it's a video that you just saw, uh,
38:27I got to learn a lot about a person who.
38:31Was struggling with substance
38:32abuse and in that and I don't
38:36personally know anyone in that,
38:38but it did show me that there are
38:40people out there who who are struggling
38:42and sometimes they don't look what
38:44you think they're going to look like.
38:45But I am grateful for my time
38:47here and I'm hoping I can continue
38:50doing this for as long as I can,
38:52because again,
38:53it is so beneficial as an actress
38:56and I'll pass it on to Doctor Benoit.
39:01Thank you, Betsy Beth Lilia.
39:04Thank you very much.
39:06So I'm Lydia Benoit.
39:07I'm a French and Brazilian tile psychiatrist,
39:10so I I trained in in Paris.
39:12I did my MD, PhD in Paris and I have
39:16been working at Yale for one year.
39:19First on a on a Fulbright,
39:21and now as a associate research
39:26scientist with Andrews team.
39:29So I'm delighted to join a Yale community
39:31and I hope to stay as long as possible,
39:34but if I were to go back to France and if
39:38we're to bring back to France teaching tool,
39:41I think that it would be simulated
39:45patient participant program.
39:47Especially because in Paris
39:49we had something similar,
39:51but without professional actors.
39:53So we had to play the patient
39:57as a fellow or the resident.
39:59Would have to play the patient and I cannot
40:02emphasize enough how important it is.
40:04You have visual actors.
40:06This is crucial.
40:07This is like something totally
40:09different and I have been really
40:12thrilled to participate in the program.
40:15So we are trying to use it for
40:18research now on the product I'm
40:21conducting on ecological anxiety
40:24among children adolescent.
40:26So we started this project by
40:29reviewing what is being said in
40:33American newspapers about children
40:35and adolescent awareness and
40:38actions surrounding climate change.
40:42But this has been a very good start and
40:45with this review with Isaiah Thomas,
40:47who is a medical student at Yale and
40:51hopefully a future psychiatrist.
40:53What we've found in this study,
40:56the results that we can show you now,
40:59maybe yes,
41:00the results were that newspapers
41:04were innocence characterizing
41:08children adolescents involvement in
41:12in climate action by describing them
41:15as either fierce young activists
41:18being bold and demanding or as
41:21adult ified children taking on.
41:24The responsibilities that should
41:26be adults responsibilities such as
41:29taking care of their future so it
41:32is where narratives surrounding
41:33the idea that children cannot go to
41:36school because they have to go to protests,
41:38because if they were not going to protest,
41:40who would be taking care of that future?
41:44The third narrative was the one about,
41:46you know,
41:47some victims saying that children
41:50were going to die early of illnesses,
41:53that they were suffering from asthma
41:55and a lot of environmental health issues.
41:59And the last course that was in a
42:03sense positive towards children, adolescent.
42:06But at the same time still characterizing
42:10them was to depict them as ultimate savior.
42:13So this was a discourse.
42:14Around us saying oh,
42:16this new generation is really wonderful.
42:19They are doing so well and thanks
42:21God they're here because they are
42:23going to take care of the planet
42:25and we better than what we did.
42:28So this is positive.
42:30But this is still burdening
42:32for children and adolescents.
42:34So what we have been working on next is
42:38to try to build a positive narrative,
42:41one that can be empowering and move.
42:45Use from inklings. I teach weikal action.
42:48To work on that.
42:51We have been thinking what what
42:52would be a good narrative?
42:53Something that bring empowers adolescent,
42:57who would watch a video,
42:59who would listen to a message?
43:01So I'm going to to pass now to
43:04Doctor Martin because we have
43:06relied on on the research that
43:08you already did 2 to inspire us.
43:13Merci beaucoup bedankt as we would
43:15say here in the Netherlands.
43:17Thank you, Lilia, and I'm so
43:19delighted at the partnership that
43:20we have established with France.
43:22We now have the Qual app,
43:23which is a qualitative,
43:25qualitative and mixed methods lab,
43:26which is a partnership between the
43:29National Institute of Health and Paris.
43:31With Lilia and with us here at Yale.
43:33So this is also an aspect about
43:36our international collaborations.
43:37Before we show you the work that
43:39we're doing at echoing society,
43:41where we're going to feature another actor
43:43who unfortunately could not join us.
43:44Tonight I do want to say a note
43:47on methodology because the methods
43:49that I'm going to describe are
43:51relevant to the study in egg logical
43:53anxiety that we're doing with Lilia,
43:55but also to the next study that
43:57you will hear from medical student
43:59Justin Halloran and the next chapter.
44:02So if you will,
44:04this is as methodologically complex
44:05as this presentation gets.
44:07Tonight,
44:08we published a paper earlier this year
44:10with my colleague, Darren Amsalem.
44:13Originally from Israel,
44:14now at Columbia,
44:16in which we sought to reduce
44:18stigma related to depression among
44:21adolescents and to increase treatment
44:24seeking intentions among adolescents
44:27and the intervention that we did
44:29was through a randomized control
44:32trial using a very brief video
44:34under 100 seconds to show videos
44:37of adolescents in various roles.
44:39These were once again actors
44:42part of this youth.
44:44Acting group and this is what we did.
44:47We had in this case two siblings.
44:50Silvia is her alias.
44:52And Noah and you have the pink and the
44:56blue to emphasize female and a male.
44:59And what we did through crowd
45:01crowdsourcing was a pretty large sample
45:03size of over 1000 youth ages 14 to 18
45:07who were randomized to one of three groups.
45:10All of them got a short video.
45:13Either they saw the depressed girl.
45:16The depressed boy,
45:17or a control group,
45:18which was both of them talking about
45:22something unrelated to depression.
45:24We did this and we found very,
45:26very robust findings that even
45:28seeing 100 seconds worth of video
45:30made a big impact on perceptions
45:33about stigma about depression.
45:35About it's not my fault about
45:37I should get some help.
45:39This is a person I should
45:40go and get help with.
45:42Much stronger response when they
45:44could empathize to these characters
45:46to these individuals with.
45:47With whom they could really
45:50empathize in another study.
45:52We found that these professionally
45:54made videos of the quality of the
45:56videos that you have been seeing.
45:57They were in a non inferior
46:00non inferiority trial.
46:02We found that there were just as
46:04good as the kind of videos that kids
46:07are making 24/7 using Tik T.O.K.
46:09And in fact,
46:10not only were they justice efficient,
46:12but they certainly were much cheaper.
46:14We could have infinite variety of doing them,
46:17and the kids could literally do
46:19them in their bedroom and showing
46:21us what it was like.
46:23So what you're going to see next is
46:27102nd video of one of our very
46:30talented actors Camille Fortin,
46:32who unfortunately could not join us tonight.
46:35And this is a study we're about to
46:37launch with, Lilia, in which we're
46:38going to do something very similar here.
46:40To this study, but instead of
46:43showing depressed versus control,
46:45we're going to show two different ways for
46:48adolescents to deal with ecological anxiety.
46:50One of them is that, Oh my God,
46:52the world is coming to an end.
46:53There's nothing we can do.
46:54These adults have done terrible things.
46:56The world is over at Jeremiah
46:59versus a more we are the future.
47:01We can do it.
47:02We need to mobilize and we're going to
47:05see the kind of messaging that can be most
47:08helpful to move attitudes and behavior.
47:10You can imagine the potential of this if
47:13these videos can go viral as we know they do,
47:17and if they can go viral to quote UN quote,
47:20sell something like,
47:21let's fight ecological anxiety,
47:23or let's deal with stigma.
47:26That could be a wonderful thing.
47:28It's not just selling cars or video games,
47:31it's selling health related
47:32products that we're doing here.
47:35So let me introduce you
47:36to Camille 100 seconds,
47:38let me alert you.
47:39This is a high intensity video.
47:41So in case you were feeling sleepy,
47:43here we go.
47:46Hi, my name is Camille,
47:47I'm 16 and I'm sick and tired of
47:49people ignoring climate change and
47:51global warming to the point where
47:53it's really been messing with me.
47:55I've been so sad and depressed and just
47:58feeling so helpless but all that's
48:00changed now I'm gonna tell you how
48:02I went from frustrated and helpless
48:05to hopeful and full of purpose.
48:07I'm sure you don't need a reminder,
48:09but our world is rapidly warming,
48:11which leads to glacier melts and
48:14floods and hurricanes and fires.
48:18And after seeing all of this,
48:19I just felt so helpless and sad.
48:23'cause you see all these big
48:25corporations and politicians who have
48:27the power not doing anything to help.
48:29And after having maybe a little baby
48:33meltdown, I realized it has to be me.
48:35It has to be us, you and me.
48:39Gen Z baby.
48:41We gotta be the change and I
48:42know it's like what can little
48:44me who lives in my parents house?
48:45Do there's actually so many
48:47actionable things that we can do.
48:49First things first,
48:50a lot of our electricity uses coal
48:53gas oil which release CO2 into the
48:55environment and contribute to global warming.
48:56So to reduce our use of electricity,
48:59maybe try washing your laundry on cold.
49:02Or air dryer clothes instead of using
49:05the dryer and the things that I just
49:07mentioned are kind of solo things,
49:08but I realized that there must be
49:10people feeling the same way as me.
49:11So I started a group at my school and
49:13not only did I make a bunch of friends
49:15who have the same goals as I do,
49:16but together we were actually
49:18able to make visible changes.
49:20We got solar panels applied
49:21to my high school roof.
49:22We got the mayor to add more bike
49:24lanes to our town and plant more trees,
49:26and that's just the beginning and
49:28I just want you to know that it's
49:30possible we can make a change.
49:32I believe that you can be the change.
49:35You could do this.
49:38So hi, my name is Camille.
49:41This study is soon to be starting and I
49:44want to thank again the collaboration with
49:47Lilia across the ocean and with Camille.
49:52Let me now pass it to the last segment,
49:55and now that you understand a little
49:56bit of the methodology that we're
49:58using with videos to conduct these
50:00large randomized control trials,
50:02let me introduce you to the very soon
50:06to be doctor Justin Halloran. Thank
50:09you Doctor Martin as Doctor Martin
50:12mentioned 4th year student I
50:14guess 50 year if you count the
50:16extra research yard took we're as
50:18fortunate to work with Doctor Martin.
50:20Originally I started with the
50:21Yale Pediatric Gender Program,
50:22doing a survey data,
50:23and in the past year I've been
50:25able to work more closely with
50:27Doctor Martin's work with the
50:29standardized patient program.
50:30Contrast with my previous research
50:31is that now I'm actually able to
50:33engage a little bit more closely
50:34with the communities I'm hoping
50:35to serve that being transgender
50:37youth and non binary youth.
50:39And again this reflects Doctor Martin's
50:41philosophy that he mentioned earlier.
50:44Nothing about me without me,
50:45so really trying to engage in the
50:47communities that we're serving.
50:48Uhm, and so the first study that
50:51I'll discuss at the next slide
50:53might seem a little bit familiar.
50:55It's a similar project to what
50:57Doctor Martin highlighted earlier,
50:59essentially doing an arc to see
51:01if this social contact video can
51:04affect attitudes towards depression.
51:06And this is just published in JAMA
51:08and what we're looking at here was not
51:10just a question related stigma among
51:12adolescents but transphobia as well,
51:14and what we did was we had simulated
51:17participants Parker and Monica,
51:18who will be introducing shortly.
51:20My dad scripts identified themselves
51:21as transgender and related that
51:23to their experience,
51:24so seeking mental health care.
51:26Now these were scripts because we
51:27wanted to be able to correlate them
51:29with the experience that was highlighted
51:31by the cisgender simulated participants,
51:33but they were able to add some
51:35of their own flavor to it.
51:37We have a team member who has some
51:38lived experience and was able to
51:40write the scripts and so we were
51:41really able to try and bring in some
51:42of their actual genuine experiences
51:44as we introduced them and we had
51:47very encouraging data even though we
51:49weren't able to have them engage face
51:52to face with survey participants,
51:53we found that we were able to
51:55reduce transphobia.
51:56And also reducing the same process,
51:58depression related stigma and
52:00this was particularly true for
52:02heterosexual participants,
52:04whereas maybe we hit a little bit of
52:06a ceiling effect with patients who
52:07identified as part of the queer community.
52:10I think for me the take home message
52:11there is that this might provide
52:13a really effective Ave to have
52:15people work with people and get some
52:17contact with people in different
52:18communities from theirs and breakdown
52:20some of those barriers.
52:23In addition,
52:23we are also able to work with
52:25Parker and Monica on another study.
52:27In this one Parker and Monica,
52:28we're actually asked to give some of
52:30their own perspectives and experiences.
52:32Being trans teens not just about
52:34their own stories and lives,
52:36but also about their perspectives
52:37on some of these issues.
52:38More globally speaking,
52:39and what we use those videos for
52:41was a study in which we introduced
52:43those videos to trainees in the
52:45health professions to try and get
52:47a sense of how we can best bolster
52:50our education on
52:51these topics. The intervention there,
52:53plus inclusion or exclusion of
52:55videos of Parker and Monica.
52:57Uh, and while we're still completing
52:59our data analysis and doctor Martin,
53:00I have just met prior to this to discuss it,
53:03and we've gotten very encouraging results
53:04so far that seemed to indicate a long
53:06lasting benefit from the inclusion of
53:08those experiences in the didactic session.
53:10With surveys showing that trainees
53:12reported increased warmth,
53:13warmth towards trans and gender
53:15diverse people,
53:16even though again Parker Monica were
53:17not able to present live and in person
53:19and the benefit to that is pretty huge,
53:22given that that allows us to disseminate
53:25these materials much more widely.
53:26And and with that,
53:27I'd just like to take a moment to
53:29actually watch some videos of Parker
53:30Monica and have them introduce a
53:31little bit their own experience.
53:33Thanks, doctor Martin.
53:40I am a transgender male.
53:44And for the longest time.
53:48I felt like I was in the wrong
53:52body and that there was no escape.
53:56I felt trapped and like there was no way out.
54:00Honestly, I felt worthless.
54:01Yeah, kind of like a disappointment in ways.
54:05Once my grades started to drop especially.
54:09And my parents didn't know why,
54:11'cause I wouldn't tell them.
54:14That's when I started to have.
54:17Dark thoughts recital thoughts.
54:22And I knew.
54:24I had to tell my parents and so I did.
54:28And they took me to a pediatrician who
54:31referred me to a psychiatrist psychiatrist,
54:35diagnosed me with depression.
54:37Which came mostly from not being
54:40able to be my true self and not
54:43being able to express myself.
54:49Thank you know we have Monica you next.
54:56The feelings of guilt and fear have lifted.
55:00I've really started to find more
55:02joy in life again, and I've really
55:05begun to understand that there's
55:07nothing wrong with me expressing my
55:08true gender if I had to
55:10give a piece of advice
55:12to anyone who's going through something
55:15similar to what I went through and
55:17what I'm currently going through.
55:19It's that not only should
55:21you talk to a therapist and.
55:23Psychiatrist but I also highly encourage
55:26you to. Talk with your
55:28friends. There's nothing
55:30wrong with reaching out,
55:31and as a matter of fact,
55:32you're incredibly brave and strong
55:34for even taking those steps.
55:39Thank you Monica, and let me pass it now.
55:42Onto Jill, the second of our
55:45simulated participants who's joining
55:47us this evening. Jill take it away.
55:50Thanks Andre. So I'm sorry.
55:52I mean those videos make me cry.
55:55I promise I'm going to cry but hi everyone,
55:57I'm Jillian Celentano.
55:59She her pronouns.
56:01I am a transgender woman.
56:02I I transition started my transition in 2015.
56:07And that was an awakening.
56:09I went back to school.
56:11I'm right now earning my masters
56:13in social work and I will
56:16be graduating in five weeks.
56:17But what brought me here is why I did a
56:20two year internship at the agenda program.
56:23I'm an advocate.
56:24I'm a speaker and through all that I
56:27got the pleasure of meeting Andres
56:29and getting involved with the SP
56:31program because we are definitely
56:33under rated with the medical community
56:35and how we're treated and look.
56:37I never. I'm not an actor.
56:39I never acted a day in my life,
56:40but bringing my lived experience.
56:43It is what brought me here
56:44and I absolutely loved it.
56:46Then I heard this study I'm
56:47going out with these videos.
56:49And I know Andre was looking
56:51for some authentic,
56:52you know,
56:53people on some transgender youth
56:55and I run two youth groups and this
56:59is where it was great to introduce
57:02Parker and then Monica is also been
57:04a huge part of my youth group and so
57:09we are able to bring them in and look.
57:12They're not actors either.
57:13But you know what bringing in your
57:15life experience that that's all
57:17you need are your lived experience.
57:19And it was so amazing when the scripts
57:21were being written they kept were keep.
57:24We kept rewriting them because Monica
57:26and Parker were writing the scripts.
57:28You know, they started one and
57:30just by their experiences.
57:32So it was so powerful.
57:34And so I told them I coached him.
57:36Come on, just bring in,
57:37tell your stories and as you can see so
57:40authentic and again they are not actors,
57:43this they're just being themselves.
57:45So I was delighted to see that.
57:48You know being trans I I talked
57:52about yesterday versus today.
57:53You know, growing up as I couldn't
57:55say a word until along,
57:57you know, until I was later on.
57:58But I I'm gonna fight.
58:00This is why I'm going back to school.
58:01I'm being a therapist for the trans for
58:04trans youth and I'm going to fight for them.
58:06Everything I can do for them to make
58:09their lives a little bit easier.
58:11I hope you know hope too and I
58:13see a lot of improvements,
58:14but I also see a lot of scary
58:16things like these laws that are
58:18being introduced in Texas.
58:19In Florida,
58:20you know every time something
58:22like that happens,
58:23a little piece of me dies inside and
58:25probably for a lot of the trans population.
58:27That's what happens.
58:29So anyway,
58:30all this together I could talk all night,
58:32but I'm not going to,
58:34but I do want to say like this
58:37cannot be done.
58:39None of these kiddos can be part of this
58:42without a supportive parent or parents.
58:44So so important. And I I always
58:47emphasize this to everybody.
58:49So with that being said,
58:51I want to turn this right over to
58:54a supportive parent Carol who is.
58:56I cannot say enough words about
58:58her and absolutely amazing person.
59:02Oh, thank you. Thank you Jillian.
59:05I just wanted to describe
59:07how much my daughter Monica got out of
59:11participating in the research project.
59:13Destigmatizing transgender use.
59:16So she was nervous at first
59:19because she's not an actor,
59:21but the team really emphasized that they
59:24wanted somebody with lived experience.
59:26Someone who really understood what
59:28it's like to be a transgender girl,
59:31and they gave her the opportunity
59:33to collaborate with Jillian.
59:34And with Parker on the scripts,
59:37so they really reflected her feelings and
59:41her experiences as a transgender teen.
59:46She really talked about how she identified
59:48with the isolation that her character feels,
59:52and in another part of the
59:54video Monica talks about.
59:56She says, even when I approached teachers,
59:59they did not understand.
01:00:01I felt like nobody understood me and.
01:00:05My daughter realizes that she
01:00:07attends a supportive school and she
01:00:09lives in an accepting community,
01:00:12but so many transgender teens don't and I
01:00:16just want to echo Jillian in saying that,
01:00:19I think the trends in this
01:00:21country are alarming.
01:00:22It really breaks my heart that there are
01:00:26state legislatures pushing to classify
01:00:29gender affirming healthcare as child abuse.
01:00:32I I can't imagine what it would be like to
01:00:35be criminalized for helping my daughter.
01:00:38So I.
01:00:40Admire the team for doing this
01:00:44research and I admire Monica for
01:00:46stepping forward because she really
01:00:47wanted to help fight transphobia.
01:00:50And she really wanted to help
01:00:53humanize transgender youth and do
01:00:55that by describing their struggles
01:00:58and describing how they can get
01:01:01better and encouraging others to get
01:01:03treatment which is so important.
01:01:06And I'd also like to say that
01:01:08the shoot day itself was so.
01:01:11Exciting,
01:01:11she was thrilled to interact
01:01:14with the doctors.
01:01:15She was delighted to say her lines
01:01:18on camera and it actually ended up
01:01:22humanizing the doctors because I think
01:01:25we were expecting maybe cold clinicians.
01:01:29But the team was so warm and so effusive.
01:01:36By the end of the shoot,
01:01:37they were giving each other
01:01:40high fives and they thanked her
01:01:43profusely for participating.
01:01:45It was so validating for her she
01:01:49felt so valuable and it was so
01:01:52uplifting for her to know that she's
01:01:55helping other transgender youth.
01:01:58So I just want to thank
01:01:59the team for giving my daughter
01:02:03this opportunity to participate
01:02:06in such important research and to
01:02:09have a chance to to help and make
01:02:12a difference. Thank you so much.
01:02:16Carol, thank you so much and thank you
01:02:19for reminding us what it is that we do,
01:02:21what it's all about, it's families,
01:02:24it's children. It's patience.
01:02:25I wanna pass it on in the time
01:02:28that we have for Q&amp;A rather
01:02:30than me being the talking head.
01:02:32I want this two very soon to be
01:02:36doctors to take it from here.
01:02:38So please, Alex and Justin takes up,
01:02:42take us, take us from here.
01:02:46Sure, so I will start with the
01:02:49first comment that was actually
01:02:50posted in the chat,
01:02:52and it's referring actually to my
01:02:54project and one of the videos in my
01:02:57project in which we discussed puberty
01:03:00with our Jacob our simulated patient,
01:03:02and he mentions in the video feeling
01:03:05like his mother is hovering and that
01:03:08that was a difficult issue for him and
01:03:11it was mentioned in the comment that
01:03:12that we didn't address in the video.
01:03:14His concern about his hovering
01:03:16mother and I'd like to say thank
01:03:18you for pointing that out.
01:03:19Unfortunately,
01:03:19in the interest of time for this event,
01:03:21we had shortened all of the video
01:03:23clips that we showed you significantly,
01:03:25so in the full length video clip,
01:03:28which is for that section closer to
01:03:305 minutes instead of one minute.
01:03:32We really thoroughly explored those
01:03:34emotions for him and really explored
01:03:36his experience of obtaining new
01:03:39independence and how to really have
01:03:41conversations with his mom about his
01:03:43feelings of new independence and and really.
01:03:46You know,
01:03:46begin to advocate for himself as
01:03:48he's reaching that age of puberty.
01:03:50But I'll also open the Florida
01:03:51doctor knows it's too,
01:03:52and key to add anything you wanted to add
01:03:54about that comment as well.
01:03:59No, I think you explained that
01:04:00beautifully. Alex, thanks.
01:04:03Alex, before we go to the
01:04:05next question may I take.
01:04:07A moment to ask you what what has
01:04:08your education at Yale School of
01:04:10Medicine been like and would you
01:04:12do it again or tell us about that?
01:04:14Oh sure, I'm I'm happy to talk about
01:04:17this because my answer is 1000%.
01:04:19I would do it again.
01:04:20I have deeply loved
01:04:23dedication and I got here.
01:04:25I've felt that since the day
01:04:26I walked through the door,
01:04:27I've been met with educators throughout
01:04:29all four years who just care so deeply
01:04:32about my experience as a student.
01:04:34And I've felt very privileged to have
01:04:36been in that environment and to train in
01:04:39that environment from Doctor Talwalkar
01:04:40in year one to meeting Doctor Martin.
01:04:43More on the wards and in the clinical years.
01:04:45Conductor knows it's everyone has
01:04:46just cared so deeply about the
01:04:48experience of the student and on
01:04:50the topic of simulated participants.
01:04:52I've been part of many of the clinical
01:04:55skills workshops that involve those
01:04:56and have found every single one of
01:04:58those to be some of the most rich
01:05:00educational experiences I've had here.
01:05:02The the emotion that the simulated
01:05:05participants bring and the training that
01:05:07I get in the environment that it it
01:05:10happens in where I feel OK making mistakes.
01:05:12I've had many times where I've
01:05:14had to rewind or take a timeout.
01:05:15In process and really think about my
01:05:18words and and how to really go forth
01:05:20as hopefully a quality physician who
01:05:22will make my patients feel heard.
01:05:26Excellent. Justin yeah no.
01:05:30I definitely echo that.
01:05:32I feel very lucky to have come to
01:05:34yell anything globally and also in
01:05:36terms of the single inpatient program.
01:05:39I think it's been effusively warm and
01:05:42supportive community the entire time.
01:05:44I was recently part of the capstone
01:05:46course that Doctor Talwalkar mentioned,
01:05:48in which we had some recent
01:05:50simulated patient, sorry,
01:05:52simulated participant experiences.
01:05:56And similarly felt it to be an incredibly
01:05:57warm and supportive environment,
01:05:59despite the fact that now we're moving into
01:06:01discussing some more difficult topics.
01:06:02For example, my role was notifying
01:06:05a parent that their child had passed
01:06:07away in this same way to experience,
01:06:10which was a pretty emotionally
01:06:12embracing thing.
01:06:13Just because the actors again who
01:06:15participate in this program are so effective.
01:06:17But we still have the support of our
01:06:19classmates and our faculty to debrief
01:06:21afterwards and unpack that inside.
01:06:22I think it's been incredibly
01:06:23great experience
01:06:25well? Thank you both for sharing
01:06:27of your lived experience.
01:06:28I know that those of us who are in
01:06:30this line of business are largely
01:06:31because not only our patients
01:06:33but because of our students.
01:06:34You you bring so much life to what
01:06:37we do and I know Justin there's other
01:06:39questions that you have been collecting.
01:06:41Do you wanna take one more
01:06:43and then Doctor Schwartz?
01:06:44You will tell us when to
01:06:45pass it back on to you,
01:06:46but I think we may have
01:06:47a question or two more.
01:06:49Yep, absolutely.
01:06:50And again please feel free
01:06:51to add any questions in the
01:06:53chat that we're happy to read.
01:06:55I was hoping to hear a little bit
01:06:57about what the group feels like.
01:06:58Yale's SP program has over
01:07:00programs that maybe they had it
01:07:02seen at other peer institutions,
01:07:03or maybe even how it's changed
01:07:04in the past few years and what
01:07:06strengths you think it's gained.
01:07:10And I wonder, Betsy Beth,
01:07:13your your camera is off.
01:07:15I wonder if I could pass it on to
01:07:18you because you're an experienced
01:07:20actor and you've worked in
01:07:23some competing institutions,
01:07:24the name of which are going
01:07:26to be remain secret,
01:07:27but tell us, what do you think?
01:07:30I'm trying to gather my
01:07:31thoughts on that question.
01:07:32Uhm, well, let me give you a clue.
01:07:35Do you want to talk about your role
01:07:37as a simulated versus as standardized
01:07:39patient and some of the things
01:07:41that we've done there where you've
01:07:43taken some real interesting roles?
01:07:44Do you want to come and maybe on that?
01:07:45Or anything else?
01:07:48So you did? Sorry yeah so.
01:07:52I'm a simulated versus standardized
01:07:55stuff it to me my in my head.
01:07:57I'm still getting used
01:07:58to the language itself,
01:07:59but the experience of it is.
01:08:04Really I. Gather my words here.
01:08:08I appreciate the way that
01:08:11they prep us here at Yale.
01:08:15I really appreciate that we are given
01:08:18materials beforehand given the workshop
01:08:21beforehand and all that stuff and.
01:08:24They may they take the time to
01:08:26make sure that we understand what
01:08:27our role is for this for that
01:08:29specific workshop or specific event,
01:08:31because every workshop and event
01:08:33is very different and the role you
01:08:35might be taking on is very different,
01:08:37and I love the research they brought,
01:08:39they bring to it to help us
01:08:42understand what we're doing.
01:08:43And then I appreciate the day off as well.
01:08:46I feel like Yale specifically
01:08:49when it comes to.
01:08:51The way it functions the day of
01:08:55it just feels. Safe for everyone.
01:08:57I feel like everyone feels comfortable.
01:08:59Every like students patience
01:09:01organizers everyone involved.
01:09:03Feels like OK, we know what we're doing.
01:09:05We know the structure we know
01:09:07what's gonna happen and you know
01:09:09of course it's always going to
01:09:10be surprises and I feel like.
01:09:13It's always handled well and
01:09:16I feel like as the patient
01:09:18or as the participant.
01:09:21Even though we are given parameters,
01:09:24there is still some freedom.
01:09:27What we say and and in that encounter
01:09:29which I feel like is more realistic and
01:09:33other organizations that I work with.
01:09:34Sometimes it feels like it's a little bit
01:09:36too structured, which you know can't.
01:09:38There is there is some benefit to that as
01:09:40well, but I do appreciate that there is.
01:09:44Uh. The the balance of both where there is.
01:09:47There are some, some,
01:09:49some standardized situations,
01:09:50but also a lot of simulated
01:09:52situations where it allows for more.
01:09:56Uh, I guess freedom and also more
01:09:59realism or realistic situations.
01:10:01The language that comes out of us
01:10:03is going to, you know, be real.
01:10:06Thank you Betsy, Beth,
01:10:08and I see that we have on tap and I hope
01:10:11he will be OK with my reaching out to him,
01:10:14but someone who has taught all of us.
01:10:16I know one of my dear teachers and I
01:10:19think I speak for all of us is August
01:10:2114 and I see his name here and I'm
01:10:23hoping that August could turn his camera
01:10:25on and say a word or two because he
01:10:28has been part of this program in in
01:10:30many capacities for for a long time.
01:10:32August I see you there,
01:10:33but you're mute and I don't see your camera.
01:10:36Let's hope that he can join us.
01:10:40And while he gathers his thoughts
01:10:42and hopefully joins us,
01:10:44let me pass it to either Doctor
01:10:46Schwartz or Doctor Illuzzi if we can't.
01:10:49If we don't hear from August in
01:10:50a minute or two.
01:10:52Waiting for August, could you?
01:10:54There's a question in the chat about
01:10:56whether the actors are paid and do
01:10:59they only do in prompt to acting?
01:11:01And how are they taught to be a patient?
01:11:04Could you address that? No,
01:11:06absolutely. It's a great question.
01:11:08Yes, all of our actors are paid.
01:11:11We pay not only for the time on camera all
01:11:15the time during interactions disclosure, both
01:11:17Betsy Beth and Jillian are not doing this,
01:11:21just out of the goodness of their heart.
01:11:22They are. Getting paid now.
01:11:24They are getting paid
01:11:25for all their activities.
01:11:26We compensate them.
01:11:27We know that they're professionals
01:11:28and just like we're professionals.
01:11:30They are professionals.
01:11:31We always compensate them not only as
01:11:33they say for the time during the activity,
01:11:36but preparing for the activity
01:11:38which can take considerable time.
01:11:40And there's a whole process on
01:11:42training our actors who come to us
01:11:45as professionally trained actors.
01:11:47We make very few exceptions,
01:11:49most of them have a lot of experience
01:11:52already. And what we do is.
01:11:53Tweak some of their skills to the
01:11:56medical scenario and they are
01:11:57eminently brilliant and adaptable and
01:11:59it is just a joy to work with them.
01:12:05If I may, Andreas, I'd like to
01:12:08comment on a few of those items.
01:12:12You know, one of the things I'd
01:12:14like to point out is that one of our
01:12:17very innovative programs in using
01:12:20simulated participants is using.
01:12:24Actors it to teach our students
01:12:26how to engage and share decision
01:12:28making and that currently is
01:12:30located in the OB GYN clerkship.
01:12:32But as you can imagine,
01:12:33engaging with patients when they
01:12:37face very difficult decisions.
01:12:39Taking into account their values and
01:12:42preferences and what's important
01:12:44to them and helping them decide you
01:12:46know in certain cases whether to
01:12:48pursue surgery or medical therapy,
01:12:50or how to respond to challenging situations.
01:12:53You know it's a very special skill
01:12:55and our all of our Yale students are
01:12:58given the opportunity to practice that,
01:13:00and I would like to point out
01:13:02that the reason why we were able
01:13:04to begin that program now.
01:13:05I think over 10 years ago,
01:13:07was because of a donor.
01:13:11Alumni who came forward and you know,
01:13:15contributed funds for us to
01:13:16develop a program like that,
01:13:18and so that's how we were first able
01:13:21to begin to pay some of the actors.
01:13:23And now in the more recent past,
01:13:26we've developed a program to teach
01:13:29students how to take difficult histories.
01:13:32You know,
01:13:32potentially you know what about a patient?
01:13:34That may be a victim of sex
01:13:37trafficking or a patient who's
01:13:40experiencing domestic violence.
01:13:41We've set up scenarios like that in
01:13:44the clinical skills program with
01:13:45with Doctor Talacre and the students
01:13:48also talk about how formative
01:13:50those experiences have been.
01:13:56So I'd like to wrap up by thanking
01:14:00Andreas and all of the presenters for
01:14:03such an amazing glimpse into the program.
01:14:07I think this is really a remarkable
01:14:10effort that you all put on,
01:14:12and I think our students are
01:14:14appreciative as we can hear from the
01:14:15students who are part of this program,
01:14:17but also went through it.
01:14:20And so I I want to thank you
01:14:22all for giving us this glimpse.
01:14:24I also want to emphasize.
01:14:25And as we think about innovation,
01:14:27that Yale School of Medicine,
01:14:29but it's not always about technology.
01:14:31So there's clearly technology here.
01:14:33But but I think what an important
01:14:35part of our program is to think
01:14:38about innovations in pedagogy.
01:14:40How technology can support that or not.
01:14:43But I hope you see from this
01:14:45the technology isn't always the
01:14:47innovation that comes out to be the
01:14:49best educator for our students.
01:14:52So thank you again to everybody
01:14:54for participating tonight.
01:14:55And thank you to everybody.
01:14:57Who joined us in this webcast?
01:15:00Tonight.
01:15:02Goodnight