11-15-24 YES!: Leveraging the Group's Power: Leading Engaging Workshops

Transcript

• 00:00To our our yes session
• 00:02today,
• 00:03Yale Medical Educator Series. I'm
• 00:05Dana Dunn. I co direct
• 00:08this series with Andreas Martin,
• 00:09who you're gonna hear from
• 00:10today.
• 00:11And,
• 00:12I just wanna take a
• 00:13moment to mention that this
• 00:15is gonna be recorded, and
• 00:16all of the recordings are
• 00:17available on the center for
• 00:18medical education website. If you
• 00:19go to educator development and
• 00:21recordings, you'll find them there
• 00:23if you miss any of
• 00:23these sessions.
• 00:25And I also want to
• 00:27introduce our speaker today, you
• 00:29know, him from,
• 00:31some of the sessions we've
• 00:32had already. And I think
• 00:34this is his final in
• 00:35the classroom teaching, but then
• 00:36he does have a few
• 00:37more this season talking more
• 00:39about manuscript, abstract, and
• 00:43posters
• 00:44posters as well. So kind
• 00:46of the professional
• 00:47continuing medical
• 00:49development as well. So Andreas
• 00:51Martin is a professor in
• 00:53the child psychiatry
• 00:54department. He's also one of
• 00:56our longitudinal coaches
• 00:58in for the medical students,
• 00:59and he also directs
• 01:01the new ish
• 01:03medical education concentration for the
• 01:05medical students. So
• 01:07he has
• 01:08tons of experience,
• 01:10and,
• 01:11this is a really
• 01:12useful session, I think, today
• 01:14for whether you're a classroom
• 01:15or
• 01:16somebody who does a workshop
• 01:17for a national meeting or
• 01:19does something for your residents.
• 01:22If you could go just
• 01:23maybe to that mapping slide
• 01:24before I stop talking, Andreas,
• 01:27to remind you that we
• 01:29shared in the beginning of
• 01:30the season, and they're available
• 01:32if you Google
• 01:33it. And then I'm sorry.
• 01:34And then we'll come back
• 01:35to the CME code in
• 01:36a minute that
• 01:37there are clinician educator milestones
• 01:39now written for faculty.
• 01:41So we had
• 01:43highlighted at the beginning of
• 01:44the season that we would,
• 01:46aim to try to cover
• 01:47a lot of the competencies,
• 01:50and highlight which ones we're
• 01:51covering at each session so
• 01:53that you can kind of
• 01:54follow along and tailor your
• 01:56experience recognizing what,
• 01:58competencies these sessions are focusing
• 02:00on. So now I'll stop
• 02:02messing up your slide order
• 02:04and turn it over to
• 02:05you, Andreas. And and and
• 02:07if people have any questions,
• 02:08put them in the chat.
• 02:09I'll monitor that, and there'll
• 02:10be time for questions at
• 02:11the end.
• 02:13Great. Thank you, Dana. And,
• 02:16you can mess up my
• 02:17slides any day. No problem.
• 02:19So this is for CME.
• 02:22All our all of our
• 02:23activities
• 02:24at Yes are,
• 02:26CME approved, so we encourage
• 02:28you to take a second
• 02:29and
• 02:30and claim your credit.
• 02:39Okay.
• 02:40So,
• 02:42what are we're gonna be
• 02:43talking about today is how
• 02:45to make the
• 02:47most of working with small
• 02:48groups.
• 02:50And,
• 02:51and, incidentally, we're also gonna
• 02:53be talking about how to
• 02:54incorporate a number of technologies
• 02:56into this.
• 02:57It's, nice to have this
• 02:59image which blends both. It's
• 03:00a bunch of medical students,
• 03:03and even though they're not
• 03:04using a technology,
• 03:06this image was created with,
• 03:07AI, with the program DALL
• 03:09E. And I just said
• 03:11create an image of medical
• 03:13students
• 03:14intensely concentrated in group work.
• 03:16So there you have it.
• 03:20So
• 03:21I I think that
• 03:22many of us, certainly myself,
• 03:25we're socialized
• 03:27and educated,
• 03:28and I really wanna emphasize
• 03:29that socialized
• 03:31by this model of learning
• 03:32in which we had the
• 03:33all knowing
• 03:34f
• 03:36and
• 03:38the mignon e blues.
• 03:40And
• 03:42the transfer of knowledge really
• 03:44went from top down. It
• 03:46was very linear by each
• 03:48student.
• 03:50That's unfortunately how I learned
• 03:51medicine,
• 03:52thirty five, forty years ago
• 03:53in in Mexico, but that's
• 03:55how it's taught in many
• 03:56parts most parts of the
• 03:57world.
• 03:58An alternative model and what
• 04:00we want to
• 04:01get to is a much
• 04:02more
• 04:03interactive fluid,
• 04:06model in which the arrows
• 04:07are not just between orange
• 04:09man and blue man,
• 04:10but between blue people and
• 04:12all sorts of,
• 04:14interactions that become not
• 04:17summative but exponentially,
• 04:19additive in some way, not
• 04:21to mention challenging
• 04:22and fun.
• 04:26In,
• 04:27this manuscript,
• 04:29Burgess and colleagues wrote
• 04:31the key tasks that we
• 04:33need to be aware of
• 04:34as facilitators
• 04:35of a small group.
• 04:37And it's, of course, to
• 04:39manage the learning, to manage
• 04:41the content,
• 04:42to manage whatever
• 04:44activities
• 04:45we we have. And the
• 04:46more
• 04:47active that we are, the
• 04:48more workshop y and less
• 04:50lecture y that we are,
• 04:51the more of these that
• 04:52we have. And, certainly, we
• 04:54need to manage the group.
• 04:57In,
• 04:58recent times, we also have
• 05:00this additional thing, which is
• 05:01we need to manage the
• 05:03technology.
• 05:04Much of the teaching that
• 05:06we do uses one or
• 05:07several technologies.
• 05:09When they work, they are
• 05:11absolutely marvelous.
• 05:13But, for some of you
• 05:14who may have joined me
• 05:15a couple of weeks ago,
• 05:17technology can just
• 05:19be very bad and kinda
• 05:21blow up in your face
• 05:21at the minute that you
• 05:23least expected, and you need
• 05:25to have some backup plan.
• 05:27So I think that these
• 05:27are the four key roles,
• 05:30that as a facilitator
• 05:31of a small group, you,
• 05:33can look forward to having
• 05:34or have had.
• 05:39One of the ways of
• 05:40engaging learners traditionally has been
• 05:43thought about in this three
• 05:45p model of,
• 05:46post where you pose a
• 05:48question to the whole group
• 05:49or to the subgroups.
• 05:52You pause and allow
• 05:54time for thinking. During this
• 05:56time, you can give,
• 05:58additional materials that the students
• 06:00and the learners can consult
• 06:02in before you pounce, before
• 06:04you select someone by name.
• 06:07Now I have a little
• 06:08bit of trouble with the
• 06:08pouncing, and, I don't think
• 06:10it's very,
• 06:12Yale friendly. It it sounds
• 06:13like a lion pouncing on
• 06:15on its prey, and it's,
• 06:17name calling. It's just not
• 06:19the best. So I've I've
• 06:20changed that for play,
• 06:22that you wanna remain
• 06:24playful. You wanna be reading
• 06:26the lessons of the
• 06:28group, the nonverbal
• 06:29signs, and that they're sending
• 06:30you to see how best
• 06:32to engage them
• 06:33rather than pointing your very
• 06:35scary finger at them and
• 06:37giving them a grade, and
• 06:38that's not so user friendly.
• 06:43One example
• 06:44of small,
• 06:46group teaching that some of
• 06:48you, perhaps all of you
• 06:49are familiar with, is team
• 06:51based learning, TBL.
• 06:54Now TBL,
• 06:55the term is used and
• 06:57misused and overused all the
• 06:59time, so we've kinda lost
• 07:01track of what it really
• 07:02originally meant. And this is
• 07:04a reminder that
• 07:06in a TVL,
• 07:07there's an obligatory
• 07:09preparation,
• 07:11pre class individual study.
• 07:15Then during this busy part,
• 07:19the things to,
• 07:21look at are the first
• 07:23number two and three. So
• 07:24the individual test and the
• 07:25team test. So in the
• 07:26individual test, after some prep,
• 07:29posting of questions, you ask
• 07:30a question that is filled
• 07:32in individually
• 07:33either on a piece of
• 07:34paper or on these cards
• 07:36that we used to have,
• 07:36or you can do it
• 07:37through one of the technologies
• 07:38that we'll talk about. But
• 07:40the key thing is that
• 07:41the answers are given by
• 07:42individual students.
• 07:44Then the students come back,
• 07:46discuss
• 07:47what they did, what they
• 07:48didn't do, what they thought,
• 07:50and they enter communally and
• 07:51answer the five or four
• 07:53or six of them
• 07:54as a team test.
• 07:57And what you wanna see
• 07:58and what you usually see
• 07:59is that
• 08:01grade go up, how many
• 08:03they got right once they
• 08:04collaborated.
• 08:06It's a fun and engaging
• 08:08way,
• 08:09that very concretely shows the
• 08:11value of collaboration.
• 08:13And then there's
• 08:15the the feedback from the
• 08:16instructor.
• 08:21The key thing also in
• 08:22TBL
• 08:24is that
• 08:25later after what really was
• 08:27just the the readiness making,
• 08:29there's an application
• 08:31that is done as a
• 08:32class
• 08:33where,
• 08:34questions that are more clinically
• 08:36sophisticated and complicated are posed.
• 08:39Those questions,
• 08:40I'm here in in, number
• 08:42six. Those questions are typically
• 08:44vague. They don't in in
• 08:45that they don't have a
• 08:46black and white yes or
• 08:47no answer, but any number
• 08:49of answers could be right.
• 08:50And the idea is to
• 08:51foster each group's thinking.
• 08:53So this is a a
• 08:54TBL.
• 08:56If we were to
• 08:57summarize this mathematically, this is
• 09:00the formula, and I think
• 09:01it's a good formula for
• 09:02us to think about
• 09:04in the context of today's
• 09:05topic, that individual
• 09:07work,
• 09:08multiplied by small group discussion
• 09:10and
• 09:11multiplied or exponentiated
• 09:13by total class discussion
• 09:15has a tremendous impact on
• 09:16learning as opposed to getting
• 09:18stuck on that first bubble,
• 09:20which is what most, classic,
• 09:22teaching usually does.
• 09:26So with with those concepts
• 09:29and with those models in
• 09:30mind, we're not gonna do
• 09:31any one of those exactly,
• 09:33but we're gonna do a
• 09:34variation of it. And I'm
• 09:35gonna do it in an
• 09:36experiential
• 09:37manner
• 09:38such that let's just think
• 09:40that you're coming into your
• 09:41mock board exam.
• 09:44In this mock board exam
• 09:45that I'm gonna be giving
• 09:46you,
• 09:47you will be a generalist.
• 09:49You're not a expert or
• 09:50a specialist in any given
• 09:52area. That's fine.
• 09:54It doesn't matter what level
• 09:55of training you're in or
• 09:57how senior or junior you
• 09:58are,
• 09:59and you're gonna be assessed
• 10:01really self assessed for,
• 10:03breadth and clinical relevance.
• 10:06And you are in luck
• 10:08as, in today's agenda, we
• 10:10have,
• 10:11I'm a psychiatrist,
• 10:12a refresher on some psychiatric
• 10:14diagnoses and treatments.
• 10:16K? So we're gonna
• 10:18review some stuff that,
• 10:20you know, let let's see
• 10:21how you guys do.
• 10:24So I'm gonna ask you
• 10:25to get your
• 10:27smartphone and point your camera
• 10:30to this QR code. You
• 10:31only need need to do
• 10:32that once,
• 10:34and it'll take you
• 10:47Dana, let me just ask.
• 10:49Are you, seeing the the
• 10:50screen? Yep. It's good. Okay.
• 10:53Good. So I see that
• 10:54one person has already
• 10:56voted. That's terrific.
• 10:58If you hadn't gotten the
• 10:59QR code on the first
• 11:00row around go around,
• 11:02it's up there on the
• 11:03right.
• 11:04But, you need to vote.
• 11:05There's only one voter so
• 11:06far. So You can skip
• 11:08just push skip if that's
• 11:09kinda There we go. Perfect.
• 11:10Oh, thank you for the
• 11:11reminder. Yeah. You can skip.
• 11:12No problem.
• 11:28That one is not showing
• 11:29the results for whatever reason.
• 11:30Wait. What what happened? Hold
• 11:32on.
• 11:34Uh-oh.
• 11:36Hold on.
• 11:39Okay. Only seven of you
• 11:41voted?
• 11:42Come on, people. You're strong
• 11:43voters.
• 11:45Eight.
• 11:47Let's crack at least ten.
• 11:48I'm at nine.
• 11:52Your votes count
• 11:53here. Your that's right. Your
• 11:55votes count here. Come on.
• 11:57One more person. Is anyone
• 11:59having difficulty logging on?
• 12:02Because we're gonna be using
• 12:03this several times, and, we
• 12:05really wanna hear from you.
• 12:06So if you're having
• 12:07difficulty, just,
• 12:09please let me know. You
• 12:10can I touched I I
• 12:12voted, but it didn't seem
• 12:13to move?
• 12:15I don't know if you
• 12:16got mine.
• 12:19I'm sure that it did.
• 12:20If you voted, it's it's
• 12:21there. It turned blue when
• 12:23I touched it. Yeah. It
• 12:24it did. Yep. He just
• 12:25hasn't shown the results, but
• 12:26it probably did. Yeah. Yeah.
• 12:27Yeah. So so let me
• 12:28so let's show the results
• 12:29now.
• 12:31Can you see it, Dana?
• 12:32Yep. Yep. Okay. So that's
• 12:34good. Alright.
• 12:36So, not surprisingly,
• 12:39most of you have,
• 12:40minimal or some basic knowledge
• 12:42of psychiatrists. Most of you
• 12:43are not psychiatrists, so that's
• 12:45that's great.
• 12:47A couple of you feel
• 12:48comfortable enough,
• 12:50because it's not your main
• 12:51area of work. So this
• 12:53is a little bit what
• 12:54I expected and hoped for.
• 12:56You know, I would be
• 12:56very nervous if all of
• 12:57you were professional psychiatrists, and
• 12:59it would be less interesting.
• 13:02Okay.
• 13:04So let's start with a
• 13:06micro lecture,
• 13:07to remind you that depression
• 13:09is a very common disorder.
• 13:11It's a hidden burden.
• 13:13Some of the key facts
• 13:15to know is that at
• 13:16least two two hundred and
• 13:17fifty million people live with
• 13:19depression worldwide,
• 13:21and it is the leading
• 13:22cause of disability
• 13:24worldwide more so than, any
• 13:26physical illness, which is remarkable.
• 13:29But it remains hidden, not
• 13:30treated, not talked about, stigmatized.
• 13:34Depression often starts at a
• 13:35young age and predominantly affects
• 13:37women and women of childbearing
• 13:39age,
• 13:41which leads to a secondary
• 13:43condition called
• 13:44postpartum depression or perinatal depression
• 13:46in which
• 13:48mothers are not the only
• 13:49ones who are affected, but
• 13:50their child as well.
• 13:52And at least one million
• 13:54people take their lives each
• 13:56year.
• 13:57So,
• 13:58this is just to put
• 13:59into context what we're talking
• 14:01about. It's a major public
• 14:02health problem.
• 14:04What I'm gonna do now
• 14:05is show you a video
• 14:07that's about a minute and
• 14:08a half long or thereabouts.
• 14:11And I want you to
• 14:13pay attention to some of
• 14:14the symptoms and the signs
• 14:17elicited here.
• 14:19And I want you to
• 14:20be intentional about it because
• 14:21I'm gonna be asking about
• 14:23it, in in a minute
• 14:24to make this exercise all
• 14:25the more,
• 14:27useful.
• 14:28So take a look at
• 14:29what she says, what she
• 14:30does, what she appears like,
• 14:32what her daughter,
• 14:33shares with us. So here
• 14:35we go.
• 14:40There's no sound.
• 14:43There's no sound.
• 14:45Hold on. Thank you.
• 14:47You can never
• 14:49be too careful with these
• 14:50things.
• 14:51Yeah. Yeah. To click that
• 14:52box, it says share.
• 14:54Yeah. Yeah.
• 14:56Share.
• 15:00It's not letting me share,
• 15:02Ed.
• 15:03I think, Andres, you have
• 15:05to unshare
• 15:06and then reshare. Oh, yeah.
• 15:08Got it. Got it. Got
• 15:09it. Yeah. Perfect. Thank you.
• 15:12That is my wing wingman
• 15:13wingwoman.
• 15:18Hold
• 15:19on. Hold
• 15:24on. Share.
• 15:26Share.
• 15:31I think that I got
• 15:33it now.
• 15:35UCL, if that's not the
• 15:36case.
• 15:43I I've had depression Good.
• 15:45On and off my whole
• 15:46life,
• 15:48but I've I've never had
• 15:49anything like this.
• 15:51This is worse than anything.
• 15:53This is the worst that
• 15:54I've seen her in my
• 15:56entire life, and
• 15:58I'm honestly really scared by
• 16:00it.
• 16:02I yeah. It's terrifying me
• 16:05to be completely honest. Depression
• 16:07can look like a lot
• 16:08of different things for different
• 16:09people. Can you maybe describe
• 16:10to me what your depression
• 16:12has looked like recently?
• 16:15I just
• 16:16don't have any energy, no
• 16:18energy to do anything. I
• 16:20just wanna
• 16:22I I wanna sleep, but
• 16:24I can't sleep.
• 16:27I I every time I
• 16:29come over to come see
• 16:29her, I I'm there every
• 16:31day now because
• 16:33she just doesn't
• 16:34have the energy to get
• 16:35out of bed or to
• 16:37take care of her cat,
• 16:38or she used to,
• 16:40help me with my sons,
• 16:42help them pick them up
• 16:43from day care and from
• 16:44school, and she just doesn't
• 16:45have the energy to leave
• 16:47her apartment anymore.
• 16:49Are you able to do
• 16:50things like pay your bills
• 16:53on time? No. I help
• 16:54her with that. Okay. And
• 16:56has that always been the
• 16:57case? No. No. That's been
• 16:59recently. Okay. How about things
• 17:01as simple as getting out
• 17:02of bed to brush her
• 17:03teeth, take a shower in
• 17:04the morning?
• 17:05I mean, eventually.
• 17:08Have there been days this
• 17:09week, for example, that you
• 17:10were unable to do any
• 17:11of those things?
• 17:13I had to call her
• 17:14and remind her.
• 17:16Okay. I'm hearing low energy,
• 17:19sleep is not great,
• 17:21difficulty falling asleep.
• 17:25Difficulty falling asleep, difficulty staying
• 17:28asleep.
• 17:29Waking up in the morning
• 17:31earlier than usual.
• 17:34I I don't wanna get
• 17:34out of bed. I
• 17:36I wake up.
• 17:39Have you been feeling sad?
• 17:45I
• 17:47I don't know if I
• 17:47can even really, like, describe
• 17:50exactly how I feel.
• 17:52How about numb?
• 17:55Does that sound right? You
• 17:57mean numb?
• 17:58She's like, she doesn't
• 18:00I I don't wanna say
• 18:01care, but that's probably
• 18:04the best word I can
• 18:05find.
• 18:11Okay.
• 18:14Oops.
• 18:16So
• 18:17what what we're gonna do
• 18:18next is reflect on depression.
• 18:20That's the illness that we're
• 18:23looking at and learning about.
• 18:25And we're gonna start thinking
• 18:26about symptoms, causes,
• 18:28and labs in in a
• 18:30first
• 18:32pass, and then we're gonna
• 18:33think about treatments.
• 18:35So
• 18:36for the first one, in
• 18:37terms of depression,
• 18:40can you,
• 18:41you know, go again
• 18:42to your screen?
• 18:44And
• 18:45you can put in as
• 18:46many
• 18:48different words or short phrases
• 18:50as you want.
• 18:56And, hopefully, everybody
• 19:00is able to do
• 19:01it now without a problem.
• 19:03I'm gonna do this so
• 19:04that you don't yet see
• 19:05the results. Let's just give
• 19:07you
• 19:08a few seconds. I see
• 19:09two of you have responded.
• 19:11Please. Please.
• 19:13More. That's great.
• 19:15It,
• 19:16it's it it allow it
• 19:18did not allow me to
• 19:19advance, so it seems as
• 19:20though I have to scan
• 19:21again
• 19:22because it's
• 19:23okay. Yep. Yep.
• 19:25Right. You can enter as
• 19:26many as you want. Yeah.
• 19:49Okay. So
• 19:51it's good. We have fifteen
• 19:53eighteen responses. That's great.
• 19:55Let's see what you guys,
• 19:57thought.
• 20:00Okay. Or the fifteen responses.
• 20:02Oh, there we go.
• 20:15And as you look at
• 20:16them scrolling down, think if,
• 20:19some of them surprise you
• 20:21or not.
• 21:14Right.
• 21:15So it sounds that the
• 21:17group saw the two that
• 21:19I see coming down,
• 21:21a lot
• 21:22are,
• 21:23energy and sleep.
• 21:25Those seem to be, pretty
• 21:27big ones.
• 21:29There's one that I actually
• 21:30didn't
• 21:31quite
• 21:32see.
• 21:33Although it's right. She didn't
• 21:35what would be a pertinent
• 21:36negative? That's a way of
• 21:37of asking it. What what
• 21:39relevant things in depression
• 21:41did she
• 21:42not show?
• 21:44And I think that the
• 21:44big big one is suicidality,
• 21:47suicide related thinking. You know,
• 21:48there was none of that,
• 21:49so so that's good. But
• 21:51I think that all your
• 21:52observations were good.
• 21:53Does anyone know, by the
• 21:55way, what this,
• 21:56acronym, SIGICAPS,
• 21:58means?
• 22:01I know part of it.
• 22:03Say that again? I know
• 22:05part of it.
• 22:06Ah, okay.
• 22:08Sleep s is sleep. Yeah.
• 22:11E is energy.
• 22:13Yeah. C is concentration.
• 22:15Yeah.
• 22:16S is suicide.
• 22:18Yeah.
• 22:19Not sure about the others.
• 22:21I I thought I might
• 22:22be insomnia, but that's sleep.
• 22:24Right. No. You you you
• 22:26did great. So the I,
• 22:29refers to interests, change of
• 22:31interests. Yeah.
• 22:32And the a is appetite
• 22:34dash weight,
• 22:36and the p is psychomotor
• 22:38retardation
• 22:39or agitation. So
• 22:41excellent. So John and Candela
• 22:43wins,
• 22:45wins extra points.
• 22:48Terrific.
• 22:49Okay. So let's keep on
• 22:51going here.
• 22:53Oops.
• 22:56Oh, there you go. So
• 22:58it's a silly mnemonic that
• 22:59we use, SIGI caps,
• 23:01that if it's helpful
• 23:02to you, the idea is
• 23:04SIG as in a prescription,
• 23:07sig, e as in vitamin,
• 23:08e capsules, so prescribed
• 23:10e capsules. Not that that's
• 23:12what we use for to
• 23:13treat depression, but it's a
• 23:14helpful,
• 23:16acronym that, John nailed for
• 23:18us here.
• 23:19So that's as a general
• 23:21physician,
• 23:22probably a good thing for
• 23:23you to know that in
• 23:24addition to low mood that
• 23:26goes for at least two
• 23:27weeks,
• 23:28a combination of these symptoms,
• 23:30typically
• 23:30five symptoms, is major depression.
• 23:34Now
• 23:35unless you get, sad or
• 23:37or depressed or deflated
• 23:38about, what we've covered so
• 23:40far, the good news is
• 23:41that depression is a, highly
• 23:44treatable disorder
• 23:46and that, getting help
• 23:48can really,
• 23:50lead to major changes.
• 23:52But,
• 23:52health is very
• 23:55distributed unequally across the globe.
• 23:57It's very available in some
• 23:58areas and not at all
• 23:59in large parts of the
• 24:01globe.
• 24:03So
• 24:04let now reflect a little
• 24:05bit on treatments.
• 24:08And
• 24:10let let's start with this
• 24:11question. You're again, you're a
• 24:13doctor. You're an intern. You're
• 24:14a resident. You're admitting a
• 24:15patient.
• 24:16Which lab abnormality
• 24:18is most commonly associated with
• 24:20major depression? If you were
• 24:21if you were gonna pick
• 24:22one
• 24:23to test, which which which
• 24:25one would you test?
• 24:51Linda and Sarah and Ed,
• 24:53are you voting?
• 24:55Come on. I'm going to
• 24:56the poll to make sure
• 24:57you're voting.
• 25:02K. So
• 25:05let's go and see the
• 25:07results. Would you
• 25:08oh, this is a group.
• 25:15Okay.
• 25:18And this is what you
• 25:19responded. So
• 25:21most of you responded TSH,
• 25:23thyroid hormone,
• 25:25and you are correct. It's
• 25:27the
• 25:28the the most likely, you
• 25:30know, not super commonly associated,
• 25:32but
• 25:33commonly enough associated. So sixty
• 25:35percent of you thought thyroid
• 25:37stimulating hormones, so that's great.
• 25:39And certainly in a lady
• 25:41of that age, you would
• 25:42be thinking
• 25:43strongly about TSH. She also
• 25:45looks quite
• 25:46quite small.
• 25:48I would be interested in,
• 25:50has she lost or gained
• 25:51weight or gained weight, etcetera.
• 25:53So TSH. So that's good.
• 25:56So the other ones are
• 25:58interesting.
• 25:59So no one wanted porphyrin.
• 26:01You break my heart.
• 26:03You're right. It's put there
• 26:04exclusively for Zebra reasons. You
• 26:06know? It's like that thing
• 26:08they say, go check for
• 26:08porphyrin. It's never positive. But
• 26:11there you have it. King
• 26:12George had a porphyrin problem,
• 26:14so that's at least one
• 26:15person who I know had
• 26:16a porphyrin problem, but it
• 26:17never happens.
• 26:20H and H would be
• 26:22probably my second
• 26:24guess.
• 26:26You know, chronic low grade
• 26:29anemia can lead to this,
• 26:30so it's not unreasonable.
• 26:33And certainly b twelve deficiency,
• 26:35not very common, but it
• 26:37can definitely lead to depression.
• 26:39It's highly treatable.
• 26:41It's something we don't think
• 26:42about very often.
• 26:44And then there was
• 26:45one of you who thought
• 26:47VDRL.
• 26:50If do you feel comfortable
• 26:51speaking up,
• 26:54whomever chose DVRL? If not,
• 26:56I'm happy to.
• 27:02Okay. That's fine.
• 27:03So it's, you know, it's
• 27:05highly, highly, highly, highly unlikely,
• 27:07but it's not an impossible
• 27:08thing. And I put it
• 27:09there
• 27:10for a didactic purpose.
• 27:12Doctor Dunn,
• 27:14can I ask you a
• 27:15question a medical question?
• 27:18Yeah. Especially if it has
• 27:19to do with VDRL.
• 27:21Exactly. So what was what
• 27:22was the leading
• 27:24cause of,
• 27:26major
• 27:27mental illness requiring
• 27:29hospitalization
• 27:30often for a lifetime
• 27:32in the nineteenth to eighteenth
• 27:34centuries?
• 27:35Yeah. In the pre antibiotic
• 27:36era, it was syphilis.
• 27:39Exactly.
• 27:40So in the pre antibiotic
• 27:41era, psychiatry was really,
• 27:44kind of the same specialty
• 27:46that that doctor Don does,
• 27:47which is venereal diseases and
• 27:49syphilis in particular.
• 27:51With the advent of antibiotics,
• 27:53not only do we not
• 27:54have those conditions,
• 27:56they're extraordinarily
• 27:57rare,
• 27:59but,
• 28:04But but they led not
• 28:05only to the elimination of
• 28:07the disorders, but they led
• 28:08to the elimination of something
• 28:09else,
• 28:10which is are you ready
• 28:11for part two for credit,
• 28:13doctor Dunn?
• 28:15Okay. Hit me.
• 28:17So in Middletown, Connecticut, there's
• 28:19a humongous hospital
• 28:21that is half fallen to
• 28:23the ground and covered by
• 28:24ivy leaves, and it's like
• 28:26a mess. It looks like
• 28:27something out of Edgar Allan
• 28:28Poe. Name that hospital.
• 28:33Correct. Connecticut Valley Hospital.
• 28:35Well, that's
• 28:36So c So
• 28:38Yeah. So CDH was the
• 28:40largest,
• 28:41psychiatric hospital in the state,
• 28:44and it housed the kind
• 28:45of, individuals we're talking about
• 28:47with,
• 28:48tertiary syphilis.
• 28:50Once the antibiotic era came
• 28:52up on board, the hospital
• 28:53was emptied essentially, and that
• 28:55happened across the country.
• 28:57So, again, even though VDRL
• 28:59is highly unlikely to read
• 29:01lead to depression, I inserted
• 29:03that there as a little
• 29:04historical tidbit,
• 29:06for us to be grateful
• 29:07for antibiotics and the doctors
• 29:09like doctor Dunne who prescribed
• 29:10them.
• 29:13Okay.
• 29:14Now let's
• 29:15keeping on treatments,
• 29:20go ahead and name any
• 29:21antidepressant treatment that you can
• 29:23think of. It and it
• 29:24it it can certainly be
• 29:25a a medication, but, don't
• 29:27feel like
• 29:29it has to be.
• 30:39Okay. So
• 30:40this is great. Let me
• 30:42pause it here.
• 30:46And
• 30:48I think that the,
• 30:50oh, good. We have some
• 30:52late entries,
• 30:53that I really like that
• 30:54are nonmedications.
• 30:55So
• 30:56exercise,
• 30:57light,
• 30:58various types of therapy.
• 31:00Terrific.
• 31:01And then we see several
• 31:02different types of,
• 31:05chocolate. Thank you very much.
• 31:06Helps me.
• 31:09And several different types of
• 31:10medication.
• 31:13Oh, I had missed this,
• 31:14but I'm very glad to
• 31:15see that someone mentioned ECT,
• 31:18because that usually is one
• 31:20that is missing. So I
• 31:21think that, collectively, you you
• 31:23addressed many of the common
• 31:25ones.
• 31:28But let's speaking of ECT,
• 31:30electroconvulsive
• 31:31treatment or what has been
• 31:33called
• 31:34electroshock or shock therapy,
• 31:36what are your thoughts,
• 31:38and and feelings? You know?
• 31:40This is a safe space.
• 31:41You can tell us your
• 31:42your feelings
• 31:43about,
• 31:44ECT.
• 32:52Okay. Let me
• 32:54lock it here.
• 32:56So
• 32:57I think that, you know,
• 32:59just getting a group temperature,
• 33:01we see,
• 33:02if I'm so bold,
• 33:04to see that probably
• 33:07there's more negative than positive
• 33:09views here.
• 33:11And,
• 33:13stigmatized, misunderstood,
• 33:15brutal,
• 33:18dangerous,
• 33:21harsh,
• 33:23extreme, unproven,
• 33:25scary,
• 33:26unavailable.
• 33:27It's not all negative.
• 33:29It it looks like, the
• 33:30second most common word is
• 33:32effective, which which is great.
• 33:34But I think what I'm
• 33:35showing here is an X-ray,
• 33:37if you will, of how
• 33:39you all we all as
• 33:40a group are feeling about
• 33:41this
• 33:42intervention.
• 33:44So let's just keep that
• 33:45in the back of our
• 33:46minds.
• 33:50And I would assume that
• 33:52few of you have actually
• 33:54seen what ECT looks like
• 33:56and probably
• 33:57have,
• 34:00an impression of it based
• 34:01on some media. The most
• 34:03common media is one flew
• 34:05over the cuckoo's nest.
• 34:07But whether you have seen
• 34:09it or not, I'm gonna
• 34:09show you a one minute
• 34:10of ECT.
• 34:12I don't really need to
• 34:13give you an advisory warning.
• 34:14You're not gonna see anything
• 34:16awful.
• 34:17You're gonna be seeing what
• 34:18ECT looks like.
• 34:20This is done in the
• 34:21simulation
• 34:22center, and,
• 34:25the doctor on the left
• 34:26is a real interventional psychiatrist.
• 34:29The nurse is a nurse
• 34:30who works at the the
• 34:32ECT center here,
• 34:34and the doctor on the
• 34:35right is, an anesthesiologist.
• 34:37So the three of them
• 34:37are very much real.
• 34:39The ECT machine and everything
• 34:41else is real. The only
• 34:42thing that is not real
• 34:43here is the patient who
• 34:45is a simulated actor
• 34:47who we worked,
• 34:49for a long time, including
• 34:50having her come to ECT
• 34:51to see what it looks
• 34:52like.
• 34:53So what you're gonna be
• 34:54seeing is really as real
• 34:56as real gets in ECT.
• 34:59Keep your eyes on it
• 35:00and see if any questions
• 35:02come up.
• 35:04I would hope that they
• 35:05do,
• 35:06and let's see. Here we
• 35:07go.
• 35:08I'm ready.
• 35:10Green light. It's been about
• 35:11ninety seconds. Treat. Okay. Delivering
• 35:14the stimulus.
• 35:54Okay.
• 35:56Looks like the convulsions have
• 35:57ended, but she's still seizing.
• 35:59Alright.
• 36:03And the seizure has stopped.
• 36:09Any any thoughts? Any questions?
• 36:17Let me then share just
• 36:18a couple of things that,
• 36:20I think were worth noticing.
• 36:22One is that
• 36:24the procedure is, if anything,
• 36:26I would say anticlimactic.
• 36:28You know, there's not a
• 36:29lot going on. There's minimal,
• 36:31shaking.
• 36:33Patient is partially paralyzed,
• 36:36number one.
• 36:38Number two, the intervention is
• 36:39very, very brief as you
• 36:41saw from the tracing.
• 36:43Here it was, I I
• 36:44think, twenty something seconds.
• 36:47Three, the patient is not
• 36:48intubated. There's an ambu bag
• 36:50to provide some extra support,
• 36:52but the patient can breathe
• 36:54and is not fully paralyzed
• 36:56as I said.
• 36:58And,
• 37:01yes, the maybe the the
• 37:03fourth point is that the
• 37:04only visible experience that she
• 37:06is undergoing a tonic clonic
• 37:08seizure is in her toes.
• 37:09That's where we see,
• 37:11that that she is having
• 37:12a seizure. So it's kind
• 37:13of a boring
• 37:14video, but a very realistic
• 37:16video.
• 37:24So let me ask again,
• 37:26is there anything that,
• 37:28may have surprised you or,
• 37:30anything that you wanna ask?
• 37:36A question that I had
• 37:37when I first saw this
• 37:39was why weren't the nurse
• 37:41and the doctor getting electrocuted?
• 37:44Why were you know? Because
• 37:46we have the
• 37:47emergency
• 37:48room shows where everybody clear
• 37:50and put your hands away.
• 37:52That doesn't happen.
• 37:54That doesn't happen. And including
• 37:56because the voltage used is
• 37:59quite small. That's one of
• 38:01the reasons. There's other physical
• 38:02reasons why. But, the patient
• 38:04can be held without a
• 38:05problem. There's no
• 38:06conduct
• 38:07conductance
• 38:09of,
• 38:10at the at at the
• 38:11time.
• 38:15Let me go back to
• 38:16my screen.
• 38:38Okay.
• 38:39So,
• 38:40and just a con consolidation
• 38:42of what we went through
• 38:43in the micro review of
• 38:45ECT, if you will,
• 38:47It was a very first
• 38:48effective antidepressant treatment to be
• 38:49discovered back in the twenties.
• 38:53It is extremely safe.
• 38:56It,
• 38:58there are very few counterindications
• 39:00to ECT. The only one
• 39:01that's an absolute contraindication
• 39:04is having an intraventricular
• 39:06shunt or lesion or something
• 39:07like that.
• 39:09It has very rapid onset.
• 39:11We typically give it three
• 39:12times a week for the
• 39:13first week and then every,
• 39:15twice a week for the
• 39:16next couple of weeks. And
• 39:18usually within two or three
• 39:19treatments, we see an effect.
• 39:20So within a week, week
• 39:21and a half, which is
• 39:23significantly
• 39:23faster than antidepressants,
• 39:25which typically take four to
• 39:26six weeks.
• 39:28It's a treatment of choice
• 39:29for depression with psychotic feature,
• 39:30very severe depression.
• 39:34And it is,
• 39:37also a treatment of choice
• 39:39for,
• 39:40pregnancy.
• 39:41If we have a patient
• 39:43with severe depression or some
• 39:44other psychiatric reasons,
• 39:47symptoms,
• 39:48ECT is very safe.
• 39:51Stimuli are delivered either unilaterally
• 39:53or bilaterally. Usually, we start
• 39:54with unilateral nondominant, but it
• 39:56can also be bilateral. So
• 39:58those are some of the
• 39:58facts that you need to
• 39:59know.
• 40:01Let me ask you now,
• 40:03to go back, and this
• 40:04will look very familiar.
• 40:06What are your
• 40:08what are your thoughts? What
• 40:09are your feelings about,
• 40:11ECT?
• 40:14Let's take a moment with
• 40:15that.
• 40:22The version that's showing is
• 40:24the one that doesn't show
• 40:26Yes. Correct.
• 40:27Correct. You should be able
• 40:29to see
• 40:30what are your thoughts and
• 40:31our feelings.
• 40:32Yep. But they're like, the
• 40:33QR code is not there
• 40:34anymore. It's not the check
• 40:35marks of how many are
• 40:36coming in. Right. Okay.
• 40:39Yep. Yep.
• 41:30Okay. So
• 41:32let's see,
• 41:33what you thought.
• 41:38Alright. So let
• 41:40me let's read the the
• 41:41more negative we valence ones.
• 41:44So we don't we
• 41:45don't receive results just to
• 41:47let you know. Oh, oh,
• 41:47oh, oh, I'm sorry about
• 41:49that.
• 41:50What about now? I think
• 41:51I have to read them
• 41:52if it went off if
• 41:53something went haywire, but that's
• 41:55fine.
• 41:56Oh,
• 41:57that's
• 41:59that's too bad.
• 42:01Let me see if I,
• 42:02stop share and share again,
• 42:03whether it won't come back.
• 42:04If not, I'll read them.
• 42:24Nope.
• 42:29Where did it go? Picture
• 42:30of before and after, but
• 42:31that might be something that
• 42:32came from something that was
• 42:34published.
• 42:35Yeah. No. That's separate.
• 42:37It says where we were.
• 42:44Okay. I found it, and,
• 42:45hopefully, now that I share
• 42:46it, it'll show.
• 42:51Share.
• 43:04Can you see it now?
• 43:07Yes.
• 43:08Oh, good. Good. Good. Okay.
• 43:09So let me start reading
• 43:11the more negative valence words,
• 43:12which are skeptical,
• 43:19risk benefit unclear,
• 43:21memory,
• 43:28and that's it
• 43:29because the rest of the
• 43:30words are fairly positive.
• 43:33Monitored, safe, helpful,
• 43:35psychotic depression,
• 43:40effective,
• 43:43painless, manageable,
• 43:45treat,
• 43:46quick, evidence based,
• 43:49etcetera. So this is the
• 43:51snapshot of this
• 43:54distinguished group of of you.
• 43:57And let me show you
• 43:58how you compare to a
• 43:59group of two hundred or
• 44:01something.
• 44:02These were nursing students
• 44:04in which we did something
• 44:05similar.
• 44:06And in this, the,
• 44:09the
• 44:11blue tones are positively valence
• 44:14words, very few of them.
• 44:18The warm colors are negatively
• 44:21valence terms,
• 44:22outdated, etcetera.
• 44:23And the gray terms are
• 44:25factual.
• 44:26So it's it's a pretty
• 44:28negative.
• 44:29And then we have
• 44:31after,
• 44:32you know, the the colors
• 44:33change. There's more blue, but,
• 44:35importantly, there's much more gray.
• 44:37There's much more
• 44:38factual basis.
• 44:40And what we did here
• 44:41was a variation of extensive
• 44:43variation of what we did
• 44:44here
• 44:45using education
• 44:46to these students on what
• 44:47ECT was and really changing
• 44:50views that were at times
• 44:51quite quite negative.
• 44:55We did it working with
• 44:57with YSN, working with, nurses
• 45:00in in that school.
• 45:03And we did it,
• 45:04through
• 45:05a video based educational resource.
• 45:07We have a whole range
• 45:08of videos. The two videos
• 45:09that you saw are part
• 45:10of this. So how we
• 45:12were able to change that
• 45:15knowledge.
• 45:17I think that this is
• 45:18a meta moment in which
• 45:19I'm sharing you
• 45:21what an actual teaching group
• 45:22did.
• 45:24And if you were the
• 45:24learners, we could have gone
• 45:26from x to y. And
• 45:28I'm,
• 45:29showing how this could be
• 45:31done as a and was
• 45:32done
• 45:33as a research intervention. So
• 45:34in any
• 45:36intervention that is stigmatized, I
• 45:38think that it's a welcome
• 45:39approach.
• 45:41And this is, us,
• 45:44taping it in my office.
• 45:47Okay. So a couple of
• 45:48further meta reflections, if you
• 45:50will.
• 45:52First, if we do
• 45:54analysis of what it is
• 45:55that we did in the
• 45:56last forty or so minutes,
• 45:58this is I consider a
• 45:59helpful way of thinking about
• 46:01it.
• 46:02First, we define the learning
• 46:03objectives. You got that, through
• 46:05your
• 46:06through the materials
• 46:08ahead of time.
• 46:10Then we kinda reflected. We
• 46:12didn't share a whole lot.
• 46:15The red labels
• 46:16come from Steve Holt from
• 46:18whom you're gonna be hearing
• 46:19in the next session or
• 46:20two,
• 46:21and they're very much
• 46:23informed by other terminology on
• 46:25the literature, what's called forming.
• 46:27You know, the the group
• 46:28is coming in just
• 46:30smelling things out. Is this
• 46:32gonna be a friendly group
• 46:33or not, etcetera?
• 46:36Then as your instructor, I
• 46:38needed to diagnose learners.
• 46:41Were you on the same
• 46:42page? Were you not? I
• 46:43did it here through a
• 46:45quick assessment of how much
• 46:46do you know about depression
• 46:47or psychiatry.
• 46:49I'm trying to norm
• 46:51to covary
• 46:52to where you are at
• 46:53as learners.
• 46:55Perhaps the best part is,
• 46:57creating struggle or what's called
• 46:59storming. You want differences of
• 47:01opinion
• 47:01to come to the fourth
• 47:03in a positive and constructive
• 47:05way, but you want that
• 47:06struggle. You want that stormy.
• 47:07That is a good thing.
• 47:10We didn't do breakout groups,
• 47:13today,
• 47:14just for the sake of
• 47:15time, But you can imagine
• 47:17that an exercise like this,
• 47:18we could have gone into
• 47:19small groups of two or
• 47:21three. What did you see
• 47:22about depression? What do you
• 47:23think about ECT?
• 47:25And have more of a
• 47:26group response and a group
• 47:27discussion. So this, we didn't
• 47:28do today.
• 47:31And we consolidate the learning,
• 47:33which is what I'm doing
• 47:34now and what what I
• 47:35did with the summary
• 47:37of what ECT is, etcetera.
• 47:43So just the last thing
• 47:44before we,
• 47:45wrap wrap up,
• 47:47it's unrelated, but
• 47:48have, you had any challenges
• 47:50using technology and teaching? Please
• 47:52please let us know. Is
• 47:53there a program that has
• 47:54driven you crazy?
• 47:56Is,
• 47:57have you never used it?
• 47:59Has it always been wonderful?
• 48:01Anything that you wanna
• 48:03share will be great.
• 48:34Anyone else?
• 49:05Okay.
• 49:06So let's just
• 49:07stop there. The the reason
• 49:09why I asked you this
• 49:10is, both personal and also
• 49:12seeking,
• 49:14I don't know,
• 49:15seeking reassurance that the world
• 49:17can be a better place
• 49:18or something.
• 49:20When I taught a couple
• 49:21of weeks ago, I had
• 49:22not one, not two, but
• 49:23three
• 49:24technologies
• 49:25crash on me.
• 49:27Zoom, Poll Everywhere, and Mentimeter.
• 49:31So I was very, very,
• 49:32very frustrated, and I thought
• 49:33that I'd come back today
• 49:34and just share one or
• 49:35two little pointers of what
• 49:37I have learned so that
• 49:38it doesn't happen
• 49:39to you.
• 49:42So
• 49:42the first one,
• 49:45and this took a lot
• 49:45of testing back and forth
• 49:47is about Zoom.
• 49:48So Zoom, as you may
• 49:50know,
• 49:51has a feature to do
• 49:53polls,
• 49:54and that would seem very
• 49:55easy and very user friendly
• 49:57to
• 49:59do. And yet I had
• 50:00created these beautiful polls, and
• 50:01then they didn't show up.
• 50:03And I couldn't figure it
• 50:04out, and it was only
• 50:05earlier today with, Ed who
• 50:07is, there. Hell, hello, Ed.
• 50:09Show you show your face.
• 50:10We don't see you.
• 50:12It was testing with Ed
• 50:13that we realized that you
• 50:14have to be the owner
• 50:15of the Zoom
• 50:17in order for the polls
• 50:18to work.
• 50:19You cannot co you know,
• 50:21assign it to a co
• 50:22facilitator or whatnot.
• 50:24And and these polls can
• 50:25be very helpful
• 50:27because you can create them
• 50:28on the fly
• 50:29as you're giving the talk
• 50:30if you you can insert
• 50:31something.
• 50:33But just be aware that
• 50:34you need to be the
• 50:35person doing it.
• 50:37Just to give you
• 50:39a sense, let me see
• 50:42if I can show you
• 50:43an old poll.
• 50:46So
• 50:48I just launched a poll.
• 50:49It's not my poll. It's
• 50:50not relevant to now, but
• 50:52just, you know, click in
• 50:53whatever thingy.
• 50:59Only two there we go.
• 51:00Okay. So
• 51:02there you see you can
• 51:03see the results there.
• 51:05So the the good news
• 51:06is that you can do
• 51:07it very quickly on the
• 51:09fly. But as I say,
• 51:10you must do it only
• 51:11if you own the Zoom,
• 51:12Not even being a a
• 51:14co facilitator
• 51:15or co whatever,
• 51:17helps.
• 51:17So that was the first
• 51:18pain point for me.
• 51:20The second one
• 51:26second one
• 51:30The second one was,
• 51:32Poll Everywhere.
• 51:33And and this really hurt
• 51:35because I have been using
• 51:37Poll Everywhere for years, and
• 51:38I have never had a
• 51:39problem.
• 51:40And then,
• 51:41two weeks ago, everything just
• 51:43fell apart.
• 51:44So what did I learn,
• 51:45and what do I want
• 51:46to
• 51:46remind you?
• 51:48It's not enough to have
• 51:49your slide deck
• 51:51and to have your website
• 51:52in order for Poll Everywhere
• 51:54to work. You
• 51:56have to have a third
• 51:57component, which is the Poll
• 51:59Everywhere app
• 52:00that's very easy to to
• 52:01download,
• 52:03and you need to keep
• 52:05it open while you present
• 52:07because this Poll Everywhere
• 52:10app is what's
• 52:11what the link between the
• 52:13web, where the questions are,
• 52:15and your PowerPoint or whatever
• 52:17application you're using.
• 52:19So,
• 52:20this is a relatively recent
• 52:22change. As far as I
• 52:23can tell, I didn't
• 52:24have it last week, and
• 52:25that's why things didn't work.
• 52:27Once you open the app,
• 52:29you get an interface that
• 52:30looks something like this. These
• 52:31are the questions that we
• 52:32saw today. You create your
• 52:34questions.
• 52:35You insert the slide into
• 52:37your PowerPoint
• 52:38very, very easy.
• 52:40You activate
• 52:42it very easy, and you're
• 52:43good to go.
• 52:46But if you don't have
• 52:46the app, it won't work.
• 52:49Finally, Mentimeter,
• 52:52the good news about Mentimeter
• 52:53is that it's very
• 52:55sharp looking, very pretty.
• 52:57The bad news is that
• 52:58it costs money,
• 52:59and, the even, badder news
• 53:02is that you
• 53:03have to create all your
• 53:04slides from within Mentimeter.
• 53:07You don't create them in
• 53:08PowerPoint and then insert your
• 53:10slides.
• 53:11You create everything from Mentimeter,
• 53:12and it doesn't have, obviously,
• 53:14all the flexibility
• 53:15of,
• 53:16PowerPoint or whatnot.
• 53:18So,
• 53:19that was a bonus teaching
• 53:20today. So the what we
• 53:22covered today, there's I hope
• 53:24you have seen there's power
• 53:26in small numbers and that
• 53:27the workshop format is an
• 53:28effective and clinically relevant way
• 53:30to unleash it. That potential,
• 53:32whether in person or through
• 53:34synchronized video conferencing.
• 53:37Some relevant,
• 53:39tools include
• 53:40the teaching,
• 53:41team based learning.
• 53:43We didn't cover the bus
• 53:44groups, but it's when you
• 53:44ask students to get together
• 53:46in the classroom physically and
• 53:47talk among themselves and then
• 53:48answer,
• 53:49flipped classroom, teaching, I think
• 53:51we're all familiar with.
• 53:54Welcoming and sharing uncertainty can
• 53:56help unlock the
• 53:57full group's potential,
• 53:59and and certainly incorporating
• 54:01some technology,
• 54:03can be very useful.
• 54:04So this is another AI
• 54:06created image of hard at
• 54:07work medical students in a
• 54:09group.
• 54:11And,
• 54:12if,
• 54:13I could ask you,
• 54:14just to take a minute
• 54:15to fill your evaluation,
• 54:17that's very valuable to us.
• 54:20And, certainly, if you have
• 54:21any questions in the meantime,
• 54:22feel feel free to
• 54:24speak up
• 54:26or put them on the
• 54:27chat.
• 54:31And, Linda, are you gonna
• 54:32put the link in the
• 54:33chat as well,
• 54:35the Qualtrics link?
• 54:43Potentially?
• 54:51For those who are not
• 54:53quick on the draw.
• 55:10Awesome.
• 55:12Okay. Let me it's in
• 55:13the chat. I can't quite
• 55:14see.
• 55:18The last thing is that
• 55:19we'll leave you with, what's
• 55:20coming up next. We have,
• 55:23Stephen Holt, who I had
• 55:24mentioned. He's gonna be here
• 55:25on December sixth talking again
• 55:27about optimizing,
• 55:28group learning.
• 55:30And then we have on
• 55:31a totally different track, but
• 55:32an important one,
• 55:34ladder tracks and how to
• 55:36climb them successfully, and that's
• 55:37by
• 55:38no other than Sam Bell
• 55:42Ball. I'm sorry. Sam Bell
• 55:43who,
• 55:44organizes
• 55:45that office.
• 55:47So with that, I am
• 55:48going to
• 55:50Yeah. A couple minutes to
• 55:52ask for questions if people
• 55:53have any.
• 56:05We know more about depression.
• 56:08We know more about depression.
• 56:09And then, hopefully, it was
• 56:10clear that this was not
• 56:11a talk about depression, but
• 56:13using
• 56:14depression as a model on,
• 56:16you know, how to engage
• 56:17teens.
• 56:22In in my mind, there's
• 56:23nothing like engaging teams in
• 56:25Vivo as compared to,
• 56:28on Zoom.
• 56:30But,
• 56:31in this a and h,
• 56:32we need to
• 56:33use that as well. So
• 56:41Thanks everybody for coming.
• 56:43Thank you, everyone. Have a
• 56:44good rest of your day.
• 56:45Bye bye.