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

March 22, 2023

Information

YCSC Grand Rounds March 21, 2023

Andrés Martin, MD, PhD, Riva Ariella Ritvo Professor, Yale Child Study Center; Director, Simulated Participant Program, Teaching and Learning Center

ID9719

To CiteDCA Citation Guide

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.