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

April 06, 2022

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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