Making it Real: From Telling to Showing, Sharing, and Doing in Medical Education

Transcript

• 00:03Yeah.
• 00:08Good afternoon.
• 00:08Let's go ahead and get started, please.
• 00:12I'm Laurie cardona.
• 00:13Today, it is a great,
• 00:14great privilege and an honor to
• 00:16present to you a dear colleague and friend,
• 00:19Doctor Andres Martin,
• 00:20who will be speaking to us today.
• 00:22I wanted to give you some background.
• 00:25Doctor Martin was born and raised in Mexico,
• 00:28and therein also obtained his medical degree.
• 00:32In 1990, he came to the US,
• 00:35where he completed his psychiatry
• 00:37residency training at the University of
• 00:39Miami and then Harvard Medical School.
• 00:42His.
• 00:42Education continued in New Haven,
• 00:44where he completed his Masters
• 00:46degree in public health from the Yale
• 00:49School of Public Health in 2002.
• 00:51Since his earliest days in New Haven at
• 00:53the child and at the Child Study Center,
• 00:56doctor Martin has dedicated his clinical
• 00:59career to serving our communities
• 01:01most vulnerable youth and families.
• 01:04So Doctor Martin has been the
• 01:06longest serving medical director
• 01:08on the Children Psychiatric Service
• 01:10at Yale New Haven Hospital,
• 01:12which he began in 2002.
• 01:14During the decades of his clinical
• 01:17leadership on when he won,
• 01:19Doctor Martin has transformed
• 01:21our clinical practices.
• 01:23By emphasizing the compassionate and
• 01:26culturally informed integration of
• 01:29evidence based care and principles
• 01:31into our daily work.
• 01:34Doctor Martin has been equally
• 01:36passionate about medical education
• 01:38throughout his entire career.
• 01:40For example,
• 01:41he's been a key leadership role here
• 01:43within the child Psychiatry Training program,
• 01:46as well as internationally,
• 01:48wherein he founded the Donald
• 01:50J Cohen Fellowship Program for
• 01:53International Scholars and Child
• 01:55and Adolescent Mental Health.
• 01:58Doctor Martin was promoted to
• 01:59a professor in the clinician
• 02:01educator track in 2007 and more.
• 02:04Recently, in 2018,
• 02:06he's become the director of the
• 02:08simulated Participant Training
• 02:10program here at the medical school
• 02:12at the teaching and Learning Center.
• 02:15Doctor Martin,
• 02:16ever thirsty to expand his training
• 02:18and his education,
• 02:19recently completed his PhD in medical
• 02:23education from the University
• 02:26of Groningen in 2002.
• 02:28Doctor Martins scholarly
• 02:30publications are vast.
• 02:32He's been especially prolific
• 02:34during the period of 1999 to 2002,
• 02:38during which time I counted
• 02:40at least 33 publications.
• 02:43That's right,
• 02:453333 publications and peer reviewed journals
• 02:48during that brief time period alone.
• 02:51So today,
• 02:52it's a great honor to be here with
• 02:54you as Doctor Martin reflects on just
• 02:56a small portion of the body of work.
• 02:59That he has authored in the
• 03:01area of medical education.
• 03:10Thank you, Lori.
• 03:11And I'm so glad that my wife and my
• 03:13daughter were here to hear those things.
• 03:15So, so thank you so. See, see. OK, OK.
• 03:21Anyway, it's wonderful to be here with,
• 03:24with friends, with family,
• 03:26literally and figuratively,
• 03:28and to talk about work that is so
• 03:31meaningful to me and what I'm going
• 03:34to be talking to you about today.
• 03:37Let me tell you why the title making it real.
• 03:39I think that we psychiatrists,
• 03:42and by the way,
• 03:42when I use a world word,
• 03:43psychiatrist, bear with me.
• 03:44I'm talking about all of us
• 03:45child mental health providers,
• 03:47regardless of our education.
• 03:49We mental health providers are very
• 03:51good about talking about what we do,
• 03:53but no one really knows what we do,
• 03:56and the work I'm going to be
• 03:58talking about is an effort to
• 04:00make it real and make it palpable.
• 04:02To others and to ourselves.
• 04:06What I'll talk about is the culmination.
• 04:10Mouse.
• 04:10OK,
• 04:11what I'm what I'm going to talk about
• 04:14today is a culmination of almost four
• 04:17years of work at the University of Groningen,
• 04:20way up in the north of the Netherlands,
• 04:22where I pursued my PhD in medical education.
• 04:26Because of the pandemic,
• 04:27I didn't get to go to the beautiful
• 04:29Netherlands as much as I would have,
• 04:31but I managed to go now and then.
• 04:34And the Netherlands has a very strong
• 04:36tradition of medical education,
• 04:38which is what drew me there.
• 04:44My mouse. My mouse.
• 04:48OK, this is the the cover of the thesis,
• 04:52making it real. And as you see,
• 04:55it's divided into 3 parts.
• 04:56It's a variation on the on that saying show,
• 05:00don't tell, show me the work,
• 05:01don't just tell me about it.
• 05:03And I took it further,
• 05:04moving from telling you about
• 05:06the work telling us about
• 05:08the work we do to showing,
• 05:10sharing and doing.
• 05:15My mouse is very unhappy with me today.
• 05:18OK, so let me try to walk you through
• 05:22in cartoons what it is in my thesis,
• 05:25and this work is all about.
• 05:27I'm a child and adolescent psychiatrist,
• 05:29and I wanted to wed this
• 05:31interest with medical education.
• 05:33Once I found that there's this world
• 05:35out there called medical education,
• 05:37a discipline I really didn't know anything
• 05:40about until four or five years ago,
• 05:42partly catalyzed by the wonderful
• 05:44friendship with Janet Heffler.
• 05:46I see my friend Dorothy de Bernardo there.
• 05:48And my colleagues in the teaching
• 05:50and Learning Center and other people
• 05:52started opening my eyes to this world.
• 05:54So I wanted to do something
• 05:56with medical education.
• 05:57I wasn't quite sure what,
• 05:58but I knew that I would find the what,
• 06:01and I did.
• 06:02I knew early on that one of the
• 06:04things I wanted to do in medical
• 06:07education was work with actors,
• 06:08because by that time I was fortunate enough,
• 06:11as Lori mentioned,
• 06:12to be the Director of the
• 06:14standardized at that time called
• 06:15standardized patient program,
• 06:17now the simulated participant program.
• 06:19I'll get to those terms later,
• 06:20working with professional actors
• 06:23who embody roles, medical roles,
• 06:26to learn different skills.
• 06:27So I knew I wanted to do that.
• 06:29I also knew that numbers are fun,
• 06:33they're interesting. We got an MPH.
• 06:35I'd like playing with numbers,
• 06:37but what I really like our words.
• 06:39I like stories.
• 06:41We're storytelling animals.
• 06:42And I wanted to go there.
• 06:44And when I learned that there was this
• 06:46whole world of qualitative medicine,
• 06:48qualitative analysis,
• 06:49I wanted to get in there.
• 06:52It really wasn't qualitative medicine.
• 06:54Medicine really imported
• 06:55it from anthropology.
• 06:57And where are you, Matt?
• 06:58We have a Matt who is doing his PhD and
• 07:00comes with a background in anthropology.
• 07:02It comes from sociology,
• 07:04comes more from psychology,
• 07:06not really medical, and within medicine,
• 07:09certainly not from psychiatry.
• 07:10That seem to be like a gaping hole.
• 07:13So that's what I knew I wanted to do.
• 07:16In the part of Psychiatry,
• 07:17I also knew that I wanted to work on two
• 07:19areas that were very near and dear to me.
• 07:22The upper panel is stigma.
• 07:24Why is it that one group is in and one
• 07:27individual or individuals are out?
• 07:29And specifically those with
• 07:32psychiatric illness?
• 07:33Even as a psychiatrist, I've been,
• 07:35I've felt stigmatized by other physicians.
• 07:38We've all felt it.
• 07:39There's stigma to physicians
• 07:40dedicated to this area.
• 07:41There's two patients.
• 07:42We could go on and on about stigma.
• 07:45Wanted to do something about stigma,
• 07:47and the lower panel was very personal.
• 07:49I had a feeling that it was important
• 07:52that there was something about sharing
• 07:54our personal stories of vulnerability in
• 07:57general and of mental illness in particular.
• 08:00I didn't know how,
• 08:01but I knew that there was something in there.
• 08:03So here I went,
• 08:042019 to get my PhD and then,
• 08:06just in case you didn't know,
• 08:08this thing happened called the pandemic.
• 08:11So the pandemic landed on my
• 08:12plate literally within three
• 08:14or four months of my starting my PhD.
• 08:16And that changed things
• 08:17in any number of ways.
• 08:18I thought it was going to be a PhD killer.
• 08:21In fact it was an enzyme.
• 08:23It make things quicker,
• 08:25faster, more efficient.
• 08:26And the vast majority of my work was done
• 08:29over zoom and other telephone platforms.
• 08:31So that was that lower panel.
• 08:34I knew that tell us something was important.
• 08:38But then there was the difficult side,
• 08:40seeing the racial revolution
• 08:44reawakening a heartache,
• 08:47whatever we want to call it,
• 08:49these issues that came to confront
• 08:51us in such a painful way and that
• 08:54we needed to do something about it.
• 08:56I didn't know what to do.
• 08:58I knew that it was no excuse
• 08:59that I came from Mexico,
• 09:01where we didn't have some of these stories.
• 09:03We had our own stories, but I knew that
• 09:05something was happening in this country,
• 09:07in this city, that we needed to address.
• 09:10So there I went.
• 09:11It seemed pretty easy.
• 09:13Just put all these guys into
• 09:15the blender and get a PhD.
• 09:16And that's kind of what I did.
• 09:18So I'm going to tell you about
• 09:21different pockets of these
• 09:22bubbles and how they connected.
• 09:25And I'm going to start with the first
• 09:27part of my thesis, which is showing.
• 09:29And as you see there,
• 09:30I use a plan.
• 09:31The word image,
• 09:32you're going to hear this term recurring.
• 09:35We're going to start with imaging.
• 09:38Mental illness and psychiatry
• 09:39how is it viewed by others?
• 09:44So your learning objective,
• 09:45our learning objective is to
• 09:47familiarize ourselves with simulation,
• 09:49with professional actors and to exemplify
• 09:52its use as a tool for education for
• 09:55destigmatization and research in
• 09:57child and adolescent mental health.
• 09:59And I'm going to start at a very,
• 10:01very clinical point because
• 10:02I'm a clinician at heart.
• 10:04That's what I've always been.
• 10:05And I see my dear friends
• 10:07Carol and Sarah there.
• 10:09Carol wasn't yet our nurse manager,
• 10:11but Sarah will remember we admitted a
• 10:14child on a wheelchair to when he won.
• 10:17And we had no clue what to do.
• 10:19We had no clue what to do.
• 10:21We knew how to freak out about it,
• 10:22but we didn't know what to do and it
• 10:25was very challenging and we did the
• 10:27best that we could by this child.
• 10:29And this medical student just happened
• 10:31to be rotating with us, Alex Kimmel.
• 10:34And for Alex,
• 10:35this was very personal because
• 10:36his her best friend from College,
• 10:38Mary,
• 10:39had suffered a cervical stroke
• 10:41soon after college and was now
• 10:44a quadriplegic in a wheelchair.
• 10:46And when Alex saw this,
• 10:48she said I got to do something.
• 10:50About this and boy did she
• 10:52do something about it.
• 10:53She has now gone to present
• 10:55about this nationally.
• 10:55Internationally she is now in Pediatrics
• 10:59at Children's Hospital Boston,
• 11:01and here you have a early
• 11:03in the pandemic filming.
• 11:06And encounter very simple encounter of how
• 11:08to interact with a child on a wheelchair.
• 11:11And this is just to give you this setup,
• 11:13just to show you that in this case
• 11:15the only actor here is a child.
• 11:17This,
• 11:18by the way,
• 11:18is the first child at Yale University
• 11:20who we've been able to hire as an actor.
• 11:22We needed to wait about a year and
• 11:24a half with legal counsel to make
• 11:26sure there wasn't child labor.
• 11:27And there were all these things that
• 11:29we need to be very careful about.
• 11:31This was our first child actor,
• 11:33the physician, the woman sitting down is.
• 11:36Karen knows it's a pediatrician with a
• 11:38lot of experience working with vulnerable,
• 11:41physically vulnerable kids.
• 11:42And you see Travis are
• 11:44professional videographer.
• 11:44We have two cameras.
• 11:45This is just to give you a sense of the
• 11:48kind of professional videos that we do.
• 11:51And this led to a publication just accepted.
• 11:54It took a long time,
• 11:55but it's now accepted with
• 11:57Alex as a lead author,
• 11:59for which she won three awards
• 12:01at graduation last year.
• 12:02It's a really very useful set of
• 12:05materials about how to deal with
• 12:07clinically with the child on a wheelchair,
• 12:10but also very personal, as I said.
• 12:13And something very important,
• 12:14two of our co-authors are on wheelchairs,
• 12:17something that I'll come back
• 12:19to both Mary and Doctor O.
• 12:21Are on wheelchairs.
• 12:23This is a very brief clip,
• 12:25less than a minute,
• 12:26just to give you a flavor of
• 12:27the kind of what do you do,
• 12:29physician 101,
• 12:30nurse 101 with a child on a wheelchair
• 12:33that says as a wrapping up their interview.
• 12:37OK. So we're nearing the end
• 12:39of our time together for today.
• 12:41We've talked about a lot of things.
• 12:43So I just wanted to kind of wrap up and make
• 12:45sure we we all felt good about everything.
• 12:48So Jacob will be coming
• 12:50here for his medical needs,
• 12:51will be his medical home from now on,
• 12:54and you can communicate with me
• 12:57using the Mychart app or calling.
• 12:59And then, uh, I'll provide you
• 13:01some pamphlets on the wheelchair
• 13:03basketball that we talked about.
• 13:05Umm, it looks like you may
• 13:07already have a basketball.
• 13:08Yeah, one of the nurses had
• 13:09a couple extra or something,
• 13:11so this ones not mine.
• 13:13Wonderful.
• 13:14Thank you for that.
• 13:16Practicing early and then
• 13:18like we talked about,
• 13:19we have the medical legal partnership
• 13:21available if you need help with.
• 13:24Any kind of school advocacy and
• 13:26then some names of counselors
• 13:29that we talked about as well.
• 13:30Great. OK. So very simple.
• 13:33This paper has 15 or 20 such videotapes,
• 13:37and the idea is that you,
• 13:39wherever you're in the world,
• 13:40you download the videos and you
• 13:41just go and teach at the bedside,
• 13:43what we didn't have at that time.
• 13:46Umm. When we did this study
• 13:47and this kind of studies,
• 13:49we are interested both in knowledge,
• 13:51can we increase knowledge through these
• 13:54interventions and attitudes and I
• 13:56won't show you the boring statistics,
• 13:58believe me they got better.
• 13:59You know people have better attitudes
• 14:02towards people with disabilities.
• 14:03But this one slide,
• 14:04this data slide will kind of give you
• 14:07kind of a gut feeling of the data.
• 14:09We ask our participants close to 100
• 14:11participants named the I can't remember
• 14:131-2 or three words that come to mind
• 14:15when you hear child on a wheelchair.
• 14:18And the words that you see in
• 14:20red and in white were mentioned
• 14:22more than X number of times.
• 14:24So those were the high number.
• 14:26And you see that the words are challenging,
• 14:28disability, difficult,
• 14:29different negative words.
• 14:30There's two neutral words,
• 14:32mobility and accessibility,
• 14:33but the big words are negative.
• 14:35This was before they saw anything
• 14:37and then after the intervention.
• 14:40You see that the story changes, right?
• 14:42Accommodations, normal,
• 14:43strong compassion, resilience,
• 14:45support, empathy.
• 14:46Person accessibility is still
• 14:48there as a neutral word.
• 14:50So even after brief interventions,
• 14:52we can make a big change.
• 14:55If we hit on the empathy gland,
• 14:57I think you know,
• 14:58that's what we're targeting,
• 14:59not not only the cognitive apparatus,
• 15:01but the empathic apparatus.
• 15:05I mentioned that in that study led by Alex.
• 15:11We worked very closely with two co-authors
• 15:14who are on wheelchairs and with a
• 15:17focus group of other stakeholders.
• 15:20Involved in issues related to disability.
• 15:24And this is part one of the threads that I
• 15:26hope you'll see through my presentation is
• 15:29this notion of participatory action research,
• 15:32which can be summarized as
• 15:34nothing about me without me.
• 15:36That if I'm going to study you Group XI,
• 15:40need you group XE to be part of what
• 15:43we're doing because ultimately the
• 15:45benefits are going to be towards you.
• 15:48And this next study is similar.
• 15:52We did it as participatory action research.
• 15:54You can see it even from the title.
• 15:56We collaborated with transgender youth in an
• 15:59effort to educate trainees and professionals.
• 16:03And we did a randomized
• 16:05control trial of didactics,
• 16:07once again enhanced by brief videos.
• 16:11Doctor Hafler,
• 16:12your ears must have been ringing.
• 16:13I already said nice things about you,
• 16:15so I'll repeat them later.
• 16:17So as and for those of
• 16:19many of you don't know her,
• 16:21but Janet Hafler is the associate
• 16:23Dean for medical education.
• 16:25She's the director of the teaching
• 16:26and Learning Center, and she's great.
• 16:29And so participatory action research,
• 16:32in this case with transgender youth
• 16:36and transgender adults coming up
• 16:38with a way to optimize teaching about
• 16:42very basic literacy, if you will,
• 16:45on transgender health.
• 16:46We were interested in a couple of things.
• 16:48The two things that we're always
• 16:50interested in these studies can
• 16:51we teach knowledge?
• 16:52Can we increase knowledge?
• 16:55Can we enhance attitudes and reduce stigma?
• 16:58So those are the things we always look at.
• 17:00But here there was a third thing
• 17:02that we were curious about,
• 17:03and that is does it make a difference
• 17:06if you yourself are transgender or
• 17:09cisgender as you're trying to educate others?
• 17:12And we didn't know.
• 17:13We didn't know which way that
• 17:15was going to go.
• 17:16And you can start thinking in your own head,
• 17:17does that make a difference or not?
• 17:19And what it would imply
• 17:21as you think about that,
• 17:22let me show you two very brief
• 17:24parts of these clips.
• 17:25These, by the way,
• 17:27are not professional actors.
• 17:28These are transgender youth who
• 17:31were using an alias for Parker and
• 17:34Monica's parents, very involved,
• 17:36very actively involved.
• 17:37They have since become adults.
• 17:41And they are talking.
• 17:42In the first case,
• 17:43Monica will talk about gender joy,
• 17:45and then Parker will talk about pronouns.
• 17:49These youth and these adults.
• 17:50They came up with the things that they
• 17:52thought were important for non trans
• 17:54people to know and these were two of them.
• 17:56So we're going to hear brief clips
• 17:58of how they define these terms.
• 18:01So this is Monica.
• 18:02Yes,
• 18:03I have experienced gender joy.
• 18:05The best way that I would describe
• 18:07it and the place where I've kind
• 18:09of experienced it most often
• 18:11is if I've done something with
• 18:13my hair, if I've tried out makeup, and
• 18:15you just. Take a brief look in the
• 18:18mirror and sometimes you know the
• 18:21gender joy isn't there, but when it is,
• 18:23for me anyway, it's just kind of a
• 18:26a brief flash of just happiness.
• 18:29Just going Yep, this looks correct to me.
• 18:32That doesn't always happen, but when it does,
• 18:34it's always very welcome. Yeah.
• 18:37You can hear in the background the voice
• 18:39of our colleague Christy all Accesskey,
• 18:40who's also a key partner in in this effort,
• 18:44and we're going to meet the
• 18:46Parker telling us about pronouns,
• 18:48something that I know I have
• 18:51more than once gotten wrong.
• 18:53So what happens when you get it wrong?
• 18:56I feel like that makes me
• 18:58like. Personally, it makes me feel like.
• 19:02Weird, not weirded out, but
• 19:03kind of like uncomfortable in a
• 19:05way. It just correct yourself.
• 19:09Like if somebody were to call me a she
• 19:12and they would be like he, just don't say
• 19:14the word sorry. But.
• 19:18And correcting yourself
• 19:20is never a problem.
• 19:22Especially like don't.
• 19:25I have people who will
• 19:26say the wrong pronouns,
• 19:28realize they say it and keep going,
• 19:30and then just fix it later
• 19:31and continue the rest of the
• 19:34sentence using proper pronouns.
• 19:35Don't be afraid to correct yourself.
• 19:39And be like, let's say somebody
• 19:40referred to me as she and just
• 19:42kept going and then said he later.
• 19:45Go ahead and correct yourself.
• 19:48So so these are two illustrative.
• 19:53Snippets and here you see Christy again,
• 19:56what did we learn?
• 19:58So if you see down there at the
• 20:00bottom that what is it the the dark
• 20:02line is the video condition and the
• 20:04blue line is a no video condition.
• 20:06Just to Orient you,
• 20:08this is the first panel and this is
• 20:10kind of the summary of what we found.
• 20:12We used an instrument called the TK AB,
• 20:15which is a transgender knowledge
• 20:17attitudes and behavior scale.
• 20:19It has a total,
• 20:20which is what you're seeing here and
• 20:23three subscales and two things to note.
• 20:25One is that now we have three time points.
• 20:28Most of the studies that I'm going
• 20:30to go on to tell you about done
• 20:32with youth only have two time
• 20:33points because for IRB reasons and
• 20:35identification and all sorts of things,
• 20:37that gets complicated.
• 20:38This particular study was done with adults,
• 20:41so these were college students,
• 20:42nursing students, medical students,
• 20:44trainees and the health professions,
• 20:46all of them adults.
• 20:48So we had a precondition.
• 20:49And you see that at the middle
• 20:51point of the post condition,
• 20:53the videos improved meaning that attitudes,
• 20:56behaviors less transphobic attitudes,
• 20:59everything up is good,
• 21:02things got really good.
• 21:04And then at the Third Point
• 21:05at the 30 day follow up,
• 21:07there was a slight decrease
• 21:09but there were still there,
• 21:10they still elevated.
• 21:11There was some regression to
• 21:12the mean but not quite.
• 21:13So the videos really helped and
• 21:16the effect lasted as opposed
• 21:18to the not no video condition.
• 21:20We saw this in the three subscales.
• 21:22Same story.
• 21:23The three subscales social tolerance,
• 21:26comfort, and contact.
• 21:27You know,
• 21:28how comfortable would you be
• 21:30if your neighbor was trans?
• 21:32And acceptance of the gender spectrum.
• 21:34Is there a spectrum or isn't there?
• 21:36So in all of these things,
• 21:38with the videos,
• 21:39the video condition improved
• 21:41the just teaching,
• 21:42teaching cognitively didn't
• 21:44do much of a difference.
• 21:47Now we had a second measure,
• 21:48which is a measure of temperature
• 21:50and you can do the the thought
• 21:52experiment in yourself,
• 21:53how warmly or coldly how positively or
• 21:56negatively you feel towards X group,
• 21:59in this case towards transgender people.
• 22:02You know 100 is I love them great.
• 22:04Fantastic zero.
• 22:05I want nothing to do so.
• 22:07It's a measure of warmth
• 22:09and what you see here.
• 22:11Is that again, warmth in general got better.
• 22:13It started pretty good.
• 22:14It started in the 90s.
• 22:15This was actually a pretty
• 22:17it was a select group,
• 22:18self identified group.
• 22:19So there were people who had some
• 22:21interest in transgender health,
• 22:22so probably not the representative
• 22:25of the mean population,
• 22:26but still they started the 90 fives,
• 22:28but they went almost up to 100 and
• 22:30then they went down a little bit.
• 22:32The exception,
• 22:32the thing that didn't that breaks
• 22:35the pattern here is this last mouse,
• 22:37this last panel.
• 22:38You can see my mouse there you see
• 22:41how this these two lines end up
• 22:43touching together at follow-up and
• 22:45there's no asterisk of significance.
• 22:48So these two lines really didn't differ.
• 22:50And that is, how comfortable would you be or?
• 22:54A warmly or coldly would you
• 22:56feel towards a daughter, a son,
• 22:58a cousin, a spouse who is trans.
• 23:00And what you see is that people in
• 23:02general say, well, fine, I feel fine,
• 23:04but not really at at 30 days at
• 23:07social desirability or whatever,
• 23:09the effect goes away.
• 23:11So this is, you know,
• 23:12it tells us that there's still more
• 23:15bias or transphobia, if you will,
• 23:18that then we'd like of course,
• 23:20that it reminds us that there's a ways to go.
• 23:23But I don't want to leave this study on a
• 23:25negative note because it was a very positive,
• 23:27encouraging study. Where what?
• 23:29I asked what do you think in terms
• 23:32of the gender of the instructor?
• 23:35We found it made no difference if
• 23:37the instructor was trans, persists,
• 23:39so long as they use these videos.
• 23:42It wasn't the presenter
• 23:43doing the presentation,
• 23:44it was a video doing the presentation.
• 23:46It was the kids who were selling,
• 23:47selling anti transphobia that was
• 23:49powerful and I find that very,
• 23:52very encouraging because we're very lucky
• 23:54here that we have a vibrant trans community.
• 23:58I'm very lucky that my friend Jill Solano
• 24:00is a gifted teacher who can come and teach.
• 24:03But if you're out in the boonies,
• 24:04out there in the boonies, most in the world,
• 24:06you might not have access to someone like
• 24:08that or someone who is willing to do it,
• 24:11who has the experience.
• 24:12And what this tells us is that anybody
• 24:15can use these videos with these children,
• 24:17telling the story of what it's
• 24:18like to be them.
• 24:19For some people, this was the first
• 24:21time they had ever seen someone trance.
• 24:22So I could go on and on.
• 24:25OK, so these two studies that I showed are
• 24:28examples of what we can do with videos.
• 24:30I'm now going to tell you a very different
• 24:33type of things we can do with videos,
• 24:35which is using crowdsourcing.
• 24:37Crowdsourcing is when we go
• 24:40to an outfit like Amazon.
• 24:43We pay, you know,
• 24:44a fee per participant and very quickly
• 24:47we can collect many many participants.
• 24:49Ford Motor Company goes to
• 24:51crowdsourcing to test,
• 24:52you know whatever advertisement
• 24:54you can pay for these things.
• 24:56And people volunteer.
• 24:57So very large sample sizes which
• 24:59then with our good old ball tricks,
• 25:02the panel on the right,
• 25:04the little hard to to see.
• 25:06I don't intend it.
• 25:07Could be legible.
• 25:08That just to show you the code in the
• 25:11background of Qualtrics that does,
• 25:13for example,
• 25:13a little pink boxes are randomization spots.
• 25:16You can do all sorts of very sophisticated
• 25:18randomized control trials using Qualtrics,
• 25:20which is what I'm going to show you.
• 25:23The first of these studies that we did
• 25:25was can we reduce the stigma related
• 25:28to depression in adolescence and
• 25:30increased treatment seeking intent.
• 25:32And the answer is yes,
• 25:34by using short video clips.
• 25:38This study, by the way,
• 25:39is the first of four that I'm
• 25:40going to show that I did with my
• 25:42good colleague Doron. I'm Salem,
• 25:43who from University of Tel Aviv,
• 25:45but now at Columbia University.
• 25:49And. What we did is that we had a girl.
• 25:54Depressed girl actor.
• 25:56Following a script of depression.
• 25:58We had a depressed boy,
• 26:00they happened to be siblings
• 26:02following a script and then we had
• 26:04a control condition in which they
• 26:05just talked about being kids and
• 26:07then the kind of numbers that we use.
• 26:10You see 1100 kids very quickly.
• 26:13We randomized,
• 26:14these are teenagers ages 14 to 18.
• 26:17And we saw what are the
• 26:20effects of of this so.
• 26:23We found, unlike what we we predicted
• 26:26that girls would respond more to the
• 26:28girl video and voice of the boy video.
• 26:30We didn't find that the the gender
• 26:32really didn't make a difference.
• 26:34What did surprise us is that
• 26:36race made a difference.
• 26:37So Black viewers responded,
• 26:39less than half as stronger as white viewers.
• 26:44And remember,
• 26:45these are white protagonists
• 26:47where they're seeing.
• 26:49So that, you know,
• 26:51we weren't expecting either of those findings
• 26:53and this propelled us to this next study,
• 26:56the second study.
• 26:57Done together with Jose Paez,
• 27:00maybe around here with Amanda Calhoun,
• 27:03where we try to destigmatize
• 27:05specifically for the needs,
• 27:06for the realities,
• 27:07for the lives of black youth.
• 27:10And what we did is that with our actor,
• 27:14we had the standard condition,
• 27:16meaning the same video we had
• 27:18done with the white kids,
• 27:19and then we had what we
• 27:22call an adjusted condition.
• 27:23For that adjusted condition,
• 27:25we did a focus group of six,
• 27:27if I recall,
• 27:28women,
• 27:29black women who got together in
• 27:30a room and talked about what
• 27:32is unique and different,
• 27:33about their experience of depression.
• 27:35And with that, we informed this video.
• 27:40There were two things that
• 27:42were unique among others.
• 27:43One that really struck me
• 27:45I would not have imagined.
• 27:47The one that I wouldn't have imagined,
• 27:50maybe because I have no hair.
• 27:52Is how important hair is in the black.
• 27:56Women depression experience.
• 27:57There were so many comments about this,
• 28:00the exotic isation,
• 28:02that isation touching lots of content
• 28:05about hair that I was not expecting
• 28:08and the other one which was not,
• 28:10you know,
• 28:10painfully not so surprising,
• 28:12but very real is what Jasmine will
• 28:14talk to us about in in a second.
• 28:20I was going through a lot.
• 28:21It was tough, like I
• 28:24go to school in the suburbs,
• 28:25so it was always people asking if
• 28:28my hair was real. They always were,
• 28:31considering that things I like or ghetto.
• 28:34And just all of the girls who were popular,
• 28:38who were considered the
• 28:40most beautiful in school,
• 28:42they never look like me. And just.
• 28:46I started to feel like I couldn't
• 28:49be beautiful unless I was like.
• 28:53So this very painful experience of racism,
• 28:57of internalized racism, all of these
• 29:01issues came about and we thought.
• 29:06Well, this is what we found we had.
• 29:09Our main outcome is a measure
• 29:11called depression stigma scale
• 29:13well validated instrument.
• 29:15And what we found is that
• 29:18among black viewers.
• 29:20Everybody, all the measures got better.
• 29:24What I mean by better is.
• 29:27Depression became less stigmatized,
• 29:29treatment seeking became more favored.
• 29:33So everything that goes up
• 29:35again is positive here.
• 29:36And we saw that among black viewers,
• 29:38whether they saw the regular video or
• 29:40the adjusted video, things got better.
• 29:42But you see there's there was no
• 29:44difference in these two groups.
• 29:46Oops. Which is up? Sorry.
• 29:48Which is in contrast to what
• 29:51happened among white participants.
• 29:53So in white participants again,
• 29:54everybody got better.
• 29:55But there was a stark difference
• 29:58in the response,
• 29:59and the response was much
• 30:01stronger to that adjusted video.
• 30:03And we couldn't quite understand why
• 30:06wouldn't black kids respond more.
• 30:08And the way that that we came to
• 30:10understand it is that for white viewers,
• 30:11and this certainly was true for me,
• 30:13not really knowing the experience of racism,
• 30:16not really living the experience of racism.
• 30:18This was a major news slash,
• 30:20whereas for black viewers,
• 30:22painfully, it was not a newsflash.
• 30:24They kind of knew.
• 30:25So maybe it was you couldn't distinguish
• 30:28depression with and without racism
• 30:31because it's always with racism,
• 30:32something along those lines.
• 30:33And we got more evidence of
• 30:35that in the secondary outcome,
• 30:37which is again, though,
• 30:38the warmth towards black people.
• 30:40No difference among blacks, no,
• 30:42no real change but among whites.
• 30:46When they saw this adjusted video,
• 30:48when they understood the
• 30:49experience of racism,
• 30:50they responded much more favorably.
• 30:52Again,
• 30:53they were getting an empathic flavor of what
• 30:56was happening in the life of these kids.
• 30:59We did a third study.
• 31:01I won't go into the results in detail
• 31:04because they're very different,
• 31:05but we did it again with transgender
• 31:08kids and looking at transphobia
• 31:10and depression related stigma.
• 31:12The findings were very similar.
• 31:15And what you see here, you know,
• 31:17perhaps the the the tallest column
• 31:19is transgender youth.
• 31:20You know,
• 31:20they started with very favorable views,
• 31:22even they got a little bit better.
• 31:25Girls had more favorable views.
• 31:27They accepted the transgender
• 31:30and gender norms more than boys.
• 31:34Boys had a a bigger room to grow, to go.
• 31:37But they've all improved after the
• 31:40after seeing these short videos.
• 31:43Same thing in terms of sexual orientation.
• 31:46Those who were LGBTQ, you know,
• 31:49they already had a positive favorable views,
• 31:51but they still improved after
• 31:53seeing the videos.
• 31:54But among straight youth,
• 31:56there was a a big jump.
• 31:59It helped a lot in.
• 32:01Improving views and acceptance both of
• 32:04seeking treatment and of depression.
• 32:10The last video I won't tell
• 32:12you other than the punchline.
• 32:14We started comparing these videos
• 32:16that were done with professional
• 32:18crews like I showed you. Expensive.
• 32:20Setups. We compare them to selfies
• 32:23done in the kids bedrooms.
• 32:26And we found that there were exactly.
• 32:28The same. They're completely comparable,
• 32:30which was very good news for many reasons.
• 32:33One is that a selfie costs nothing,
• 32:352 is that a selfie you can
• 32:37do as many as you want.
• 32:38Three, it's not,
• 32:39but it doesn't get any more
• 32:41naturalistic setting than that.
• 32:43And it's what kids see.
• 32:46So we showed in two randomized trials
• 32:48that selfies are the same and this will
• 32:51open a whole series of studies that
• 32:53the next time in a couple of years,
• 32:55I hope to tell you about we're
• 32:57about to launch with Doron,
• 32:59with Meta and with the Instagram
• 33:02large studies that are going to make
• 33:05our sample size of 1500 look heady.
• 33:08You know and you collect these
• 33:11samples within minutes.
• 33:12And so we're we're excited
• 33:13of where this is going.
• 33:15We just have the IRB approval and stay tuned.
• 33:19So in summary,
• 33:20can what can we do to target stigma
• 33:24with short videos using these
• 33:27social contact based interventions?
• 33:30We know from a long time ago this
• 33:31is a classic review by Corrigan that
• 33:34had empowered presenter who has
• 33:36lived experience and by empowered
• 33:37saying I did something about it.
• 33:39All of our videos don't just
• 33:41show the IT was terrible.
• 33:43They also show this is what I did
• 33:45this is how I got better and emphasis
• 33:47on recovery rather than on symptoms.
• 33:50They're important and we can tailor
• 33:53it to target specific audiences
• 33:55as I just showed so,
• 33:57so that's very exciting with the.
• 34:00Yeah.
• 34:01I had mentioned this empathy,
• 34:04I I think that part of the power
• 34:05of these videos and we see it,
• 34:07that's why we go to the movies
• 34:08and like TV and etcetera.
• 34:10We can gain an empathic foothold
• 34:12into the life of another person,
• 34:14another experience and part of this
• 34:16work is how can we Marshall that,
• 34:18leverage that towards the good.
• 34:22And we're very hopeful about how we can
• 34:24scale this big time through social media
• 34:27that's that's certainly the the hope.
• 34:29OK, so that was the first word showing.
• 34:32Imaging. We're going now to the third part.
• 34:36I'm going a little bit out of order.
• 34:37You'll see why. And we're going
• 34:38to the third part of my thesis,
• 34:40which is doing and it is
• 34:44imagining psychiatry anew.
• 34:48So what do I mean by this?
• 34:51So my goal here is to introduce
• 34:53you to a learner driven and
• 34:56simulation based training model
• 34:58to enhance reflective practice.
• 35:01Learner driven.
• 35:01It's the learner who guides this ship.
• 35:04Simulation based,
• 35:05you already saw what actors can do,
• 35:09and reflective practice,
• 35:10which you know theoretically is
• 35:11what we're doing all day long.
• 35:13But I would argue we could do better
• 35:15and we can always do better in.
• 35:18So what are some of the shortcomings
• 35:20of traditional education in children,
• 35:22Ellis and psychiatry?
• 35:23Psychiatry in general?
• 35:24Well, one of them,
• 35:25that to me is pretty obvious,
• 35:27is that supervision takes place
• 35:30after clinical encounters.
• 35:31Imagine if your surgeon practiced
• 35:34gallbladder surgery only after
• 35:35doing gallbladder surgeries.
• 35:37Imagine if you're a pilot.
• 35:39You know, simulated flying a
• 35:42plane only after flying a plane.
• 35:44I mean, it makes no sense, right?
• 35:46And yet, that's what that's what we do.
• 35:50Second thing,
• 35:51the goals are driven by us,
• 35:53the instructor,
• 35:53the instructors,
• 35:54rather than the learners.
• 35:58And I would argue that we have
• 36:01limited ability to reflect and act in
• 36:03real time as things are happening.
• 36:05Not when we're pondering, you know,
• 36:06a week later in supervision.
• 36:09And I know that however hard
• 36:12we try teaching a lesson,
• 36:14plans can become ossified.
• 36:15You know, you can't reinvent something
• 36:17every year or every six months or whatever.
• 36:19So things get awesome,
• 36:20but it's hard to keep it fresh. Umm.
• 36:23I'm not going to put the music here,
• 36:26but I had the room where it happens from
• 36:29Hamilton because I would argue that no
• 36:31one knows what happens in our rooms.
• 36:34And we want to open it.
• 36:36So that's what we try to do with this model.
• 36:40Called constructive patient simulation.
• 36:42So Co constructive means that it's not
• 36:45just the educator who's building it,
• 36:48it's the learner and the educator
• 36:50and the actors building it.
• 36:53And it is simulation. This is pretend.
• 36:58Learner centered. So let me walk
• 36:59you through what this model is.
• 37:01And this is a part of cartoons, so it's good.
• 37:03No words. Cartoons.
• 37:05Here you have Doctor,
• 37:07mustache psychiatrist or psychologist
• 37:08or social worker or any mental health
• 37:11clinician meeting with his patient.
• 37:13A very nice lady.
• 37:15After they are done. A day later.
• 37:18An hour later. A month later.
• 37:21Doctor Mustache is thinking as to what
• 37:23was the encounter about what happened.
• 37:26What did she say that?
• 37:27Blah, blah, blah. What did I say that?
• 37:29Blah, blah, blah.
• 37:30So thinking, thinking, thinking.
• 37:31Now,
• 37:32we encourage our learners who
• 37:34have been particularly fellows to
• 37:37think about difficult situations,
• 37:39difficult interactions,
• 37:40interactions where the affect was charged,
• 37:43not necessarily bad, maybe even good,
• 37:46where you got very excited when you got very,
• 37:50you know, confused.
• 37:51Anything that has a lot of effect.
• 37:53Take that case.
• 37:55And write a script.
• 37:57Become Steven Spielberg and write
• 38:00the script of that.
• 38:02Doctor glasses here,
• 38:03the supervisor will help you write that,
• 38:07and now the SP, the standardized patient,
• 38:10the actor.
• 38:11All of you are gonna write this script,
• 38:14and once the script is arrived at
• 38:16you were you're going to try it.
• 38:18You're going to role play it to
• 38:19see if it feels right.
• 38:20You know the actor is going to enact
• 38:22and bring alive your patient and you're
• 38:24going to see whether it feels right.
• 38:26So far so good.
• 38:28To give you an example,
• 38:30by the way,
• 38:31this is a drawings of one of
• 38:34our recent fellows.
• 38:36Mariam did us a patient she had seen up
• 38:39in the floor and consultation liaison.
• 38:41A girl who I can know the details,
• 38:43wasn't taking her insulin or took
• 38:45too much insulin or something.
• 38:47But for Mariam she made a big
• 38:49impression physically what she
• 38:50looked like and she drew it.
• 38:51And the actor we had looked
• 38:53exactly like this.
• 38:54And I mean the actor became the patient.
• 38:57So now that we have that,
• 38:58now that we have an avatar or an
• 39:02actor doing that. We come together.
• 39:06And we have.
• 39:09Here we have now the the actor.
• 39:12And up here, someone who doesn't know
• 39:14anything about the case, anything at all,
• 39:17he is meeting with that patient while all
• 39:20your other peers and the scriptwriter and
• 39:22the supervisor and everybody is watching.
• 39:25So we actually do it in George
• 39:27Street in the big classroom.
• 39:28It's like a little theater
• 39:30and you have an actor.
• 39:31In a role with a fellow who
• 39:34knows nothing about that case,
• 39:36like with any other patient and
• 39:37all the rest of us watching.
• 39:39And after we do that interaction,
• 39:42we come together to have a debriefing.
• 39:44In the debriefing, first the people
• 39:46who were in the quote UN quote,
• 39:47hot seat talk about their experience,
• 39:50their transference,
• 39:52countertransference.
• 39:54Then the peers.
• 39:55And finally, the scriptwriter.
• 39:57And at the very end,
• 39:58the actors share their experience.
• 40:01It's a very powerful method of bringing.
• 40:04Theater to life, if you will.
• 40:06I I we have a President and
• 40:08others who have been part of this.
• 40:11And based on this, we we did it with
• 40:15two cohorts of our fellows and.
• 40:18Came up with a model,
• 40:20came up with this very long,
• 40:22complicated qualitative paper from learning
• 40:26psychiatry to becoming psychiatrists,
• 40:28which is what we're trying to do,
• 40:29getting closer to the real deal.
• 40:33We do this experience shortly
• 40:35before our Fellows graduate.
• 40:38In this paper we came up with a very complex
• 40:409R model that would explode your head,
• 40:43so I'm not going to do that,
• 40:44but we adapted this model
• 40:47to veterinary medicine.
• 40:49We work with veterinarians in the
• 40:52University of Utrecht and we adapted it
• 40:55and this time the patient was the doggie.
• 40:59I love that about pediatricians,
• 41:00but the veterinarians, by the way,
• 41:01they call the animals their
• 41:04patients and the handlers,
• 41:05the owners are the clients.
• 41:07So I really like that they're.
• 41:10It was very fun working with veterinarians,
• 41:13but.
• 41:15What we what we did is just
• 41:17simplify the model to its core.
• 41:18And what you see here are the three things,
• 41:22one of the fathers of medical education,
• 41:25modern medical education,
• 41:27whatever foundation.
• 41:28One of the foundational books is Donald
• 41:31shuns the reflective practitioner,
• 41:33which he did at MIT,
• 41:35working not just with physicians but
• 41:37with all sorts of engineers and people.
• 41:39How do people become experts?
• 41:41And what he found is that a lot?
• 41:44Is learned as you do it.
• 41:48You know,
• 41:48and and he came up with this
• 41:50model of reflection in action,
• 41:52which is while you're doing the thing.
• 41:56We tend to think that that's
• 41:57not a moment to reflect,
• 41:58but that's the most valuable
• 42:00point to reflect.
• 42:01Then there's the reflection on action.
• 42:04I did it. What can I learn from it?
• 42:06And then reflection for action.
• 42:09What am I going to do the next time?
• 42:11So we slowed this down in the reflection.
• 42:14We go into this in in great
• 42:16detail and to give you an example
• 42:19from again veterinary medicine,
• 42:21we start by I'm going to show
• 42:23you four of
• 42:24the 9R's. Regulate or.
• 42:28Don't go limbic, you know.
• 42:29Don't lose it. The client is angry,
• 42:32but I will respond in kind.
• 42:34I'll keep it chill. Relate.
• 42:37Once the tempers are a little bit lower,
• 42:40I can relate. I can empathize.
• 42:42I can understand how upsetting
• 42:43it was for you to learn about the
• 42:46medicine side effect this way.
• 42:48Then we can reason keeping it frontal.
• 42:50Let's go into the cortical
• 42:52function now that I've,
• 42:54you know, turn off the limbic.
• 42:56I made a judgment call at the time
• 42:59thinking that, that, that, that.
• 43:01And finally.
• 43:02Reflect in an iterative fashion.
• 43:06In retrospect, I did the wrong thing and
• 43:08moving forward I'm going to do this.
• 43:10So this is a very summarized way of
• 43:15thinking at reflection in slowdown.
• 43:18How can we do that and overtime I
• 43:20think and the hope is that we get
• 43:23better at reflecting in real time.
• 43:25We don't need to wait a week
• 43:27to think back on what we did.
• 43:29Now this model CCPs code
• 43:33constructive patient simulation.
• 43:34And we've adapted it in a number of ways.
• 43:36And for the first adaptation,
• 43:38I need you to really pay
• 43:39attention to the words here. OK?
• 43:40The words are really important,
• 43:42and I know that at least one person
• 43:43in the audience will understand.
• 43:45OK, so pay attention.
• 43:48Everything. So did Nicola
• 43:50misses is going to only
• 43:52go to, I'm sure.
• 43:56If that was too if that was too fast
• 43:58for you, this is the second view
• 44:00and let's see if you can hear it.
• 44:06Yeah, so. I think you saw him one.
• 44:10Let me just show him because
• 44:11we have him here. Here he is.
• 44:13Look at him over here.
• 44:14This handsome young man,
• 44:16Yankee has gone here from Istanbul.
• 44:19And Yankee, we've been having the
• 44:22pleasure of doing CPS in Turkey.
• 44:24And it's wonderful to have you here and.
• 44:29You know, one of the things is that
• 44:31when things happen in real time,
• 44:33we adjust in real time.
• 44:34When we started CPS,
• 44:35the pandemic started and that's the
• 44:38first time that we went on on zoom
• 44:40and we needed to deal with anti Asian
• 44:42sentiment and you know the crisis
• 44:44that we were living then and now,
• 44:46you know, right in the middle
• 44:48of this experience in Turkey,
• 44:50we're dealing with this situation in Turkey.
• 44:52So thank you for being here.
• 44:53It's wonderfully Yankee and and
• 44:55we're doing a variation of this
• 44:58adaptation in the local language.
• 45:00In Turkey, and in June,
• 45:02we're going to be doing it in Israel.
• 45:04A slight variation on the theme in Hebrew.
• 45:09So there's many opportunities and
• 45:11adaptations that we can do from CPS.
• 45:14We are currently doing a collaboration
• 45:17across sites and indeed across countries.
• 45:20We're in the fourth of six of these
• 45:22sessions in partnership with France,
• 45:24the Netherlands, Canada,
• 45:25with Alberta and Ontario and in the
• 45:27US and I'm very excited that in the
• 45:29US we're working with Mississippi,
• 45:31with Central Florida,
• 45:32so we can reach all sorts of
• 45:35places and use their reality.
• 45:37It's not our realities.
• 45:39Learner centered.
• 45:43We started working on case
• 45:44development over time.
• 45:45What happens when the same patient
• 45:47comes two or three times over time?
• 45:49And one of our students, Isaiah Thomas,
• 45:52is doing his thesis on the emotional
• 45:55labor in a clinical encounter.
• 45:59We strengthen communities of practice,
• 46:01we're strengthening each of these sites,
• 46:02and we get strengthened
• 46:04as we learn from others.
• 46:06And in harnessing the regional realities,
• 46:09I hope that we're also doing something
• 46:12that is profoundly anti neocolonial,
• 46:14that rather than coming to Basra,
• 46:16Turkey to tell them this is what you need to
• 46:18do because this is what we do in New Haven,
• 46:20CT then we learn what they are struggling
• 46:23with, what they are dealing with.
• 46:25So I'm very excited about that.
• 46:28So in the last couple of minutes.
• 46:31I'm going to talk about sharing,
• 46:34which is addressing the image problem
• 46:37of mental illness and psychiatry.
• 46:40And since this is the more personal
• 46:43of the three parts.
• 46:44I'd love to tell the end.
• 46:47And so learning objectives to
• 46:48highlight the unique mental health
• 46:50needs of care providers and examine
• 46:52the role of professionals sharing
• 46:54their lived experiences as preventive
• 46:56and role modeling interventions.
• 47:00So this work started in 2019 in partnership
• 47:05with the University of Tel Aviv School
• 47:08of Medicine, where in the cohort of 2020.
• 47:14Two of us and my dear friend Julie,
• 47:16who I think is on Zoom Doron.
• 47:19I'm Salem, who I mentioned and I.
• 47:22We stood up and did something that
• 47:23was really quite novel at the time.
• 47:25We stood up in front of 70 medical students
• 47:28and we told them about our mental illness.
• 47:30In our mental struggles. And we didn't
• 47:34know where this was going to go.
• 47:36And the response was overwhelming.
• 47:37We measured it.
• 47:38That study was all numerical.
• 47:40We had very little qualitative data,
• 47:42but everybody loved it and learned about it.
• 47:45The measures of stigma went down.
• 47:47It was a very, very powerful experience.
• 47:50So we said, well, and surely it was wrong,
• 47:52let's do it again.
• 47:53And we did it next year
• 47:54with a different cohort,
• 47:55but this time with better psychometrics
• 47:58and with the qualitative component.
• 48:00We did a mixed method study and bingo.
• 48:03Even stronger.
• 48:04So we said, well, surely that was wrong.
• 48:06Let's do it again,
• 48:07this time with physician assistants
• 48:09and let's have the physician assistance
• 48:12be the ones revealing their story.
• 48:14Again, we're not going to,
• 48:16if it was going to be lawyers,
• 48:17we want the lawyers talking
• 48:18to the lawyers etcetera.
• 48:19And we found the same thing and we
• 48:21probably keep could keep on going.
• 48:23Now what I'm going to tell
• 48:25you about this study.
• 48:26These studies were done before
• 48:28the birth of the Kalab and
• 48:30shameless self promotional plug.
• 48:32The Quala the qualitative and mixed
• 48:34Methods Lab is a partnership between us,
• 48:36the Child Study Center and the center of
• 48:39Epidemiology of the National Institute
• 48:41of Health of France and Lily Epinoia.
• 48:44Over here say Hello Lilia is our recently
• 48:49matched fellow into the solid program and.
• 48:53So it's been just such a joy over
• 48:55the last two years with Lilia to to,
• 48:57you know, make this come alive.
• 49:00The results I'm going to show
• 49:01you are pre qualified,
• 49:02so sorry you don't get credit on these,
• 49:05but this is for those of you who
• 49:07don't know anything about qualitative.
• 49:08I just want to give you a little
• 49:10flavor of Genesis Aqua, OK.
• 49:14So 2 themes I'm going to share
• 49:16with you that we found here 1
• 49:19unexpected vulnerability.
• 49:19You know what happens when someone
• 49:22in a position of power gets up and
• 49:25I was personally just taken aback.
• 49:27I did not expect for something
• 49:28like that to happen.
• 49:29Something changed a lot real fast.
• 49:32It was unexpected because I had
• 49:34never experienced it in relation
• 49:36to someone in medicine.
• 49:37That's just not done in medicine.
• 49:41I was diagnosed with depression.
• 49:44Takes guts to talk about it.
• 49:46Makes you wonder about what our hangups
• 49:48still are about the power dynamics and
• 49:50the stigma of labeling people with
• 49:51certain diagnosis, especially when
• 49:53it comes to the mental health world.
• 49:56Or this third one.
• 49:58The honesty about things like
• 50:00failing the boards.
• 50:02I failed them twice.
• 50:05What's heartening?
• 50:06The fact that you can have issues,
• 50:08make mistakes,
• 50:08and still get to where you deserve to be
• 50:11or where you want to be in your career,
• 50:13even if you might be disadvantaged at
• 50:15certain points or things didn't work out
• 50:17exactly how you had planned them to be.
• 50:20This is the kind of stuff that you
• 50:21don't get from P values, right?
• 50:23I mean, this is qualitative.
• 50:25A second theme was unarmored mutuality.
• 50:29It's not a one way St.
• 50:32It wasn't a one way exchange where
• 50:33Professor shared their personal stories,
• 50:35which is admirable.
• 50:35What I particularly enjoyed was that
• 50:37they not only shared their personal
• 50:39stories but took time to listen to ours.
• 50:44There's this kind of invisible line
• 50:46between instructors and students,
• 50:47and it took a deliberate effort to
• 50:49break the barrier and engage with
• 50:51students on such a personal level,
• 50:53which made a real difference.
• 50:57And finally, their willingness
• 50:58to share these intimate details
• 51:00about their lives with us.
• 51:02It made me feel like they
• 51:04were both trusting me and
• 51:05putting me on the same level.
• 51:07And it made me want to listen
• 51:08to what they had to say because
• 51:10they were so willing to share.
• 51:13So. That's a taste from these studies.
• 51:17I will come to the final. Lines here.
• 51:25Oops, I forgot my disclosure slide.
• 51:27No. Oops. Doctor Kieran O'Donnell.
• 51:29It's all part of the plan.
• 51:31I I wanted to put my disclosure slide
• 51:34here because I have nothing to disclose.
• 51:37But I have much to share.
• 51:38I have come to really not like the term self
• 51:42disclosure and we moved away from that.
• 51:44Because self disclosure.
• 51:46You sound, you know,
• 51:48you disclose your taxes,
• 51:50you disclose the bodies of, you know,
• 51:52the jewels that you've stolen.
• 51:54But this is not disclosure,
• 51:55this is revealing, this is sharing.
• 51:57So we've moved in,
• 51:59in our writing from self disclosure to
• 52:02shared lived experience and even further
• 52:04I would say from shared lived experience,
• 52:07which is in the past to
• 52:09share living experience,
• 52:10because those of us who have experience
• 52:13with these issues know that, you know,
• 52:15you don't wrap them up with a little bow.
• 52:17And put them in the past.
• 52:19And in this spirit of sharing,
• 52:21I want to end by sharing.
• 52:23These are two short papers.
• 52:26That I published in the in the heat of
• 52:29the pandemic Healer revealed myself.
• 52:34Encouraging my colleagues,
• 52:36and not just.
• 52:37Any all of us are healers to
• 52:41share of ourselves.
• 52:43Obviously not in a narcissistic way,
• 52:46not in a mini me way,
• 52:49but I think the formula is that if
• 52:51you were thinking about the other,
• 52:53then you're sharing is good.
• 52:55If you're thinking just about you,
• 52:56the sharing is not good and
• 52:58you'd better not share.
• 52:59So since I'm in grand rounds surrounded
• 53:01by loved ones and people who I care
• 53:04about and who share this mission,
• 53:06I will share a little bit.
• 53:09And the segue to that is the
• 53:112nd paper that I wrote.
• 53:12I think that the title tells
• 53:14you already a lot.
• 53:16You're informed,
• 53:17uplifted and unaware psychiatrist list
• 53:19with a condition under his purview.
• 53:22So I will end by reading a few
• 53:25words from these two papers, and.
• 53:29And we'll end on that.
• 53:30So, so here it goes.
• 53:33So the most potent antidote to the.
• 53:38Exclusionary distancing and shaming
• 53:40ways of stigma is social contact with
• 53:43members of the ostracized group.
• 53:45It is we imperfect healers,
• 53:47the aching and the recovering among us.
• 53:50Those of us who have experienced
• 53:52mental illness while dedicating our
• 53:53professional lives to improving
• 53:55the lot of others.
• 53:56It is we who can do so much.
• 53:58As experts synergize by both
• 54:01professional and personal experience,
• 54:03we have an opportunity,
• 54:04if not a moral obligation,
• 54:06to bring us closer,
• 54:08to demonstrate that no one is truly alone.
• 54:11Every instance of genuine sharing
• 54:14is a generous offering that opens
• 54:17off relieving conversations.
• 54:19That gives permission to share in
• 54:21kind and that more often than not
• 54:24brings closeness and strengthens
• 54:25relationships,
• 54:26including relationships with our patients.
• 54:30Sharings reveals that we are
• 54:32not that different from they.
• 54:35Not all that removed and safely ensconced
• 54:38away on a higher doctorly plane.
• 54:40Sharing the trajectory of our
• 54:42psychopathology lays bare that this
• 54:44is personal, that it matters.
• 54:48And I will end.
• 54:50This other quote, little longer quote.
• 54:55Whether you have been depressed or not,
• 54:57whether you have been afflicted by
• 54:59any of the conditions we stray,
• 55:01we strive to treat every day.
• 55:03I encourage you, yes you,
• 55:07to take stock of your own
• 55:09mental health and well-being.
• 55:10The sobering statistics about physician
• 55:12burnout and suicide provides stark reminders
• 55:15that we ignore such matters at our own peril.
• 55:17They remind us that part of the good fight
• 55:19we put up every day is that against stigma.
• 55:22And how could we claim to be fighting
• 55:24the stigma of mental illness if not by
• 55:26opening and normalizing the experience,
• 55:27by coming out as afflicted,
• 55:29wounded warriors ourselves?
• 55:31Here it goes then.
• 55:34I have suffered at least five bouts of major
• 55:37depression in two episodes of mood disorder
• 55:39and two episodes of hypomania in my life.
• 55:42I proudly embrace my depressed persona
• 55:44and my mood disorder heritage.
• 55:46I'm observant of when personal demons
• 55:48may become more liability than asset,
• 55:51and I'm not shy to seek and
• 55:53receive treatment.
• 55:54I'm also becoming increasingly
• 55:55comfortable in sharing my experience,
• 55:57as I do hear and as I encourage you,
• 56:00yes, you again you.
• 56:02To consider doing as much.
• 56:05Not in the name of self centeredness.
• 56:07Certainly not of eliciting sympathy,
• 56:09not even of presuming to be able to
• 56:12better understand another's plight,
• 56:14but simply to become a better
• 56:16calibrated and humbler healer,
• 56:18one who recognizes commonality with
• 56:20those we are privileged to serve.
• 56:23Thank you.
• 56:36Project.
• 56:40Thank you Doctor Martin for that
• 56:42wonderful example of generous sharing.
• 56:44Questions for Doctor Martin.
• 56:50Hi Doctor Martin, thank you for that.
• 56:51It was all very interesting.
• 56:53I had a question specifically about the
• 56:55choice because I noticed in the for example,
• 56:58like the when you were destigmatizing
• 57:00mental health like seeking among like young
• 57:02black people how you chose to use like or
• 57:05the vignette almost painted depression
• 57:06is like a social experience right.
• 57:08Like the going to school I don't
• 57:09look as like the popular girls.
• 57:10I don't like the pretty girls.
• 57:11I'm like super interested in that choice
• 57:13to portray depression is like a social
• 57:15experience and that like there's a
• 57:16super common discourse right now like.
• 57:18Oh, I have a chemical imbalance.
• 57:19Oh, I have this that.
• 57:20And I'm like very confident.
• 57:21Like, I read other papers about how,
• 57:22like when people, people respond very
• 57:25differently to a person who says,
• 57:26I experience this traumatic event,
• 57:27therefore I'm depressed versus I have a
• 57:29chemical imbalance and therefore depressed.
• 57:30I'd be super curious.
• 57:31Like if you were to recreate the study
• 57:33with those two separate vignettes,
• 57:34what that would show in terms
• 57:36of destigmatization.
• 57:36I have a great answer for you,
• 57:37Matt.
• 57:38You're going to be here for eight years,
• 57:39right?
• 57:43You, you are recruited and and we
• 57:45will do all sorts of fun things
• 57:47because I think that those are very,
• 57:49very important questions and I I agree
• 57:51we we talked about it just yesterday,
• 57:52our kind of unhappiness with the
• 57:56biopsychosocial reductionism.
• 57:57So yeah we could talk more about it,
• 57:58but rather talk about it,
• 57:59let's plan the next step.
• 58:15Thanks, Andre. It was just a
• 58:16fabulous talk and I feel so proud.
• 58:18When you think of the work you've done
• 58:20with your PhD thesis, it's excellent.
• 58:22And when you think now, especially
• 58:25with working and having the Qual lab,
• 58:28what do you think some of the next
• 58:29steps are that we can be moving
• 58:30some of this excellent work forward?
• 58:32Because you've really started to
• 58:34uncover it for us, and it's tough.
• 58:36These are really tough conversations.
• 58:38And So what do you think some
• 58:39of the next steps
• 58:40will be? You know, I,
• 58:42I have been so excited with with the
• 58:45master students and medical education,
• 58:46the program that Doctor Heffler started,
• 58:49the tremendous interest
• 58:50in qualitative methods.
• 58:51I think that there's a laden hunger
• 58:54in medicine that people say, oh,
• 58:55I didn't know you can do that.
• 58:57I didn't know you know I
• 58:58thought you needed AP value.
• 59:00It's like well sometimes.
• 59:01So I think that if we could
• 59:03just continue building on that.
• 59:05I think the number of thesis in
• 59:07the short time that I've seen that
• 59:09are qualitative has been going up,
• 59:10these are you know.
• 59:12Fabulous folks in all sorts of specialties.
• 59:14So I think that would be great.
• 59:16I actually feel that in in psychiatry
• 59:18and child psychiatry we're a
• 59:19little behind the 8 ball that
• 59:20we're behind other specialties.
• 59:22So we have probably more
• 59:24paradoxically room to go.
• 59:25But I think that the future is
• 59:28very bright and and you know we
• 59:30look to you how we can get more
• 59:32involved in in bringing TLC.
• 59:34I I know the last point is that we
• 59:38now export our trainees to go do
• 59:40qualitative other parts of campus.
• 59:42I think that we have enough that
• 59:44we could start doing our own,
• 59:45and I think that that would be fabulous,
• 59:47you know,
• 59:48because there's some medical special stuff.
• 59:51I believe we have Doctor Chilton
• 59:52who's raised her hand.
• 59:57Can you hear me OK? Yeah. All right.
• 01:00:01Well, dear friend and mentor,
• 01:00:04that was wonderful.
• 01:00:06And I think. You know as the.
• 01:00:11As the grandfather to your grandchildren
• 01:00:15so famously said, life is with others.
• 01:00:19Or Donald Cohen and my.
• 01:00:22Own grandfather always said the
• 01:00:24meaning to life his relationships.
• 01:00:28And until Doctor Martin.
• 01:00:33Took the lead in reducing stigma
• 01:00:37and and sharing his experience.
• 01:00:40I felt so alone and.
• 01:00:45I think that.
• 01:00:47What you've done has been so helpful
• 01:00:50to make so many people not feel alone,
• 01:00:54so thank you.
• 01:00:56Thank you, Julie.
• 01:00:59And thank you everyone I know.
• 01:01:01Just gonna say I don't think
• 01:01:02there's any better way
• 01:01:03to conclude grand Rounds.
• 01:01:04Thank you very much, Andreas.
• 01:01:05That was wonderful.
• 01:01:06Thank you, everyone.