Welcome to the Clinical Center Grand Rounds,
a weekly series of educational lectures for physicians and
health care professionals broadcast from the Clinical
Center at the National Institutes of Health in
Bethesda, MD.
The NIH Clinical Center is the world's largest hospital totally
dedicated to investigational research and leads the global
effort in training today's investigators and discovering
tomorrow's cures.
Learn more by visiting us online at http://clinicalcenter.nih.gov
I'M DR. JOYCE CHONG, EXECUTIVE
DIRECTOR OF GRADUATE MEDICAL
EDUCATION AT THE NIH CLINICAL
CENTER.
TODAY'S GRAND ROUNDS LECTURE IS
THE FIRST OF FOUR WHICH ARE
PLANNED FOR OUR JULY GRAND
ROUNDS SERIES, WHICH FOCUS ON
TOP, RELEVANT TO PHYSICIANS IN
TRAINING AND FACULTY WHO TEACH
THEM.
THIS TRADITION WAS STARTED BY
OUR PREVIOUS DIRECTOR DR. ROBERT
LEMBOW, WE KICK OFF WHEN WE
WELCOME THE ARRIVAL OF OUR NEW
NIH CLINICAL FELLOWS.
TODAY'S HOPKINS CME ACTIVITY
CODE IS ON THE SLIDE, 36729,
PLEASE TEXT THIS CODE TO THE
JOHNS HOPKINS CME PHONE NUMBER
ON THE SLIDE TO RECEIVE CREDIT
FOR THIS LECTURE.
YOU CAN DOWNLOAD AN EVALUATION
FORM ON THE CLINICAL CENTER
GRAND ROUNDS WEBSITE.
QUESTIONS FOR THE SPEAKER CAN BE
SUBMITTED AT ANYTIME DURING THE
LECTURE BY SCROLLING DOWN AND
CLICKING LIVE FEEDBACK BUTTON ON
THE VIDEOCAST WEBSITE, QUESTIONS
ANSWERED AT THE COMPLETION OF
THE PRESENTATION, TIME
PERMITTING.
I'M DELIGHTED TO INTRODUCE
TODAY'S SPEAKER DR. DAVID ROSS,
PROFESSOR AND CHAIR OF
PSYCHIATRY AT THE UNIVERSITY OF
ALBERTA, FACULTY OF MEDICINE AND
DENTISTRY IN EDMONTON, CANADA,
RECEIVED A BACHELOR, MEDICAL AND
Ph.D. DEGREES FROM YALE,
RESIDENCY IN PSYCHIATRY ALSO AT
YALE BEFORE TRANSITIONING TO
THEIR FACULTY.
AS A FACULTY MEMBER HE APPLIED
HIS RICH BACKGROUND IN
NEUROSCIENCE, CLINICAL
PSYCHIATRY AND PEDAGOGY,
ASSOCIATE PROGRAM DIRECTOR FOR
PSYCHIATRY AND RESIDENCY
PROGRAM, STAFF PSYCHIATRIST AT
THE WEST HAVEN V.A., SPECIALIZED
IN TREATMENT OF POSTTRAUMATIC
STRESS DISORDER.
RECENTLY AFTER OVER20 YEARS AT
YALE DR. ROSS MOVED TO BECOME
THE CHAIR OF THE DEPARTMENT OF
PSYCHIATRY AT THE UNIVERSITY OF
ALBERTA.
DR. ROSS IS RECOGNIZED FOR
ACADEMIC PROWESS WHEN SELECTED
IN 2007 TO RECEIVE THE NIMH
OUTSTANDING RESIDENCE AWARD
WHILE A PSYCHIATRY RESIDENT,
FOLLOWED BY INVITATION TO ATTEND
THE INAUGURAL NIMH BRAIN CAMP IN
2009, INSPIRED BY THESE
EXPERIENCES HE COMMITTED TO
TRANSLATING FINDINGS FROM THE
GROWING NEUROSCIENCE REVOLUTION
TO THE EDUCATION OF
PSYCHIATRISTS.
THIS WOULD BE A TREMENDOUS GAP
TO FILL SINCE MOST PSYCHIATRISTS
LACK KNOWLEDGE, SKILLS AND
ATTITUDES THAT ALLOW THEM TO
INTEGRATE BRAIN SCIENCE IN CARE
OF PATIENTS.
SO, IN 2014, DR. ROSCO FOUNDED
THE NATIONAL NEUROSCIENCE
CURRICULUM INITIATIVE, NNCI,
WHOSE GOAL IS TO CREATE OPEN
SOURCE RESOURCE THAT EDUCATE
PSYCHIATRISTS AND OTHERS ABOUT
CUTTING EDGE SCIENCE UNDERLYING
MENTAL ILLNESS.
SINCE STARTING THE NNCI DR. ROSS
AND COLLEAGUES CREATED 250
TEACHING AND LEARNING SESSIONS,
IMPLEMENTED AROUND THE WORLD.
HIS DRIVE AND PASSION TO
CONTINUOUSLY CREATE, INNOVATE,
PERSUADE THE FIELD OF PSYCHIATRY
TO JOIN THE NEUROSCIENCE
REVOLUTION IS NOTHING SHORT OF
MIRACULOUS.
DR. ROSS HAS ESTABLISHED HIMSELF
AS INTERNATIONAL EXPERT IN
MEDICAL EDUCATION, RECEIVED
NUMEROUS TEACHING AWARDS, FROM
ORGANIZATIONS THAT REPRESENT
PSYCHIATRY TRAINING DIRECTORS,
AMERICAN PSYCHIATRIC
ASSOCIATION, SOCIETY FOR
BIOLOGICAL PSYCHIATRY AND
AMERICAN ASSOCIATION OF MEDICAL
COLLEGES, TO NAME A FEW.
HE HAS RECEIVED FUNDING FROM
NIMH FOR DEVELOPMENT AND
CONTINUATION OF NNCI AND MOST
RECENTLY RECEIVED A GRANT FROM
THE BLAIR RESEARCH INITIATIVE
FOR DISORDERS OF THE BRAIN, PART
OF THE FOUNDATION FOR THE NIH.
IT IS NOTABLE ONE OF THE FIRST
ACTIVITIES LISTED ON DR. ROSS'S
CV IS HIS JOB AT TEACHER AND
THEN DIRECTOR OF TEACHER
TRAINING AT KAPLAN EDUCATIONAL
SERVICES.
WELL KNOWN FOR TEST PREP
INSTRUCTION.
THIS EARLY EXPOSURE AND
EXPERIENCE IN PEDAGOGY INFORMED
HOW HE APPROACHED HOW LEARNERS
LEARN, HOW TO TEACH WELL.
AS HE WOULD SAY
"THIS STUFF IS COOL."
THE TITLE IS APPLIED PRINCIPLES
OF ADULT LEARNING TO DESIGN,
LESSONS FROM THE CURRICULUM
INITIATIVE.
JOIN ME IN WELCOMING DR. DAVID
ROSS.
>> THANK YOU.
YOU CAN HEAR ME OKAY?
COOL.
SCREEN SHARE.
I LIVE AND WORK IN EDMONTON
ALBERTA, THE PROCESS OF
COLONIZATION HAS CAUSED AND
CONTINUES TO CAUSE DEEP HARM TO
INDIGENOUS PEOPLE, I ACKNOWLEDGE
THIS HISTORY AS A PART OF A
BROADER COMMITMENT TO TRUTH AND
RECONCILIATION.
PRIOR TO 1600, APPROXIMATELY
HALF OF ALL SAILORS IN THE
BRIDGE NAVY ON LONG DISTANCE
VOYAGES WOULD DIE FROM SCURVY.
YOU MAY REMEMBER IT'S A NASTY
DISEASE, BRUISING, BLEEDING
GUMS, POOR WOUND HEALING, A
DESCRIPTION FROM THE TIME
DESCRIBED IT AS PUTRID GUMS AND
DREADFUL TERRORIST.
MORE SAILORS IN THE BRITISH NAVY
DIED FROM SCURVY THAN FROM ENEMY
COMBATANTS OR ANY OTHER CAUSE.
IN 1601, CAPTAIN JAMES LANCASTER
CONDUCTED AN EXPERIMENT IN WHICH
SAILORS ON ONE OF HIS FOUR SHIPS
RECEIVED THREE TEASPOONS OF
LEMON JUICE DAILY, THE OTHERS
DIDN'T.
THE SAILORS WHO GOT JUST WERE
SECURED AND HAD TO CARE FOR
THOSE ON THE OTHER SHIPS WHO
REMAINED ILL.
IN 1747, 150 YEARS LATER, HALF
SAILORS IN THE BRITISH NAVY
STILL DIED FROM SCURVY.
A SECOND EXPERIMENT, ONE GROUP
GOT TWO ORANGES AND LEMON, THE
OTHERS GOT ASSORTED ELIXIRS AND
CONCOCTIONS, SEA WATER, VINEGAR,
CIDER, HORSERADISH, 75 DROPS OF
ELIXIR, DILUTED SULFURIC ACID.
ONCE AGAIN, HE SHOWED THAT
CITRUS CURES SCURVY, AND
PUBLISHED A DETAILED DESCRIPTION
OF HIS WORK.
IN 1795, HALF OF ALL SAILORS IN
THE BRITISH NAVY STILL DIED FROM
SCURVY.
IT WASN'T UNTIL A THIRD
SCIENTIST REPLICATED THE
ORIGINAL RESEARCH THAT THE NAVY
ULTIMATELY IMPLEMENTED A
FLEET-WIDE POLICY, ALMOST
IMMEDIATELY ERADICATED THE
DISEASE.
SO HAVING A GOOD IDEA OR MAKING
A CRUCIAL DISCOVERY ISN'T
ENOUGH.
THE QUESTION IS WHAT DOES IT
TAKE TO ACHIEVE BROADER IMPACT.
AND ACROSS ALL OF MEDICINE WE'VE
COME A LONG WAY FROM JAMES LIN'S
VITRIOLE ELIXIR, IN THE
NEUROSCIENCE REVOLUTION WE
UNDERSTAND THE BIOLOGICAL BASIS
WITH UNPRECEDENTED POWER,
SOPHISTICATED IMAGING TECHNIQUES
FROM CELLULAR LEVEL UP TO
FUNCTIONAL CONNECTIVITY AND
COMPLEX CIRCUITS.
WE CAN DIRECTLY OBSERVE THE
FIRING OF CELLS, REAL TIME,
USING CALCIUM CHANNEL IMAGING,
CONTROL FIRING PATTERNS OF
SPECIFIC NEURONS WITH TOOLS LIKE
OPTO.
WE'RE SEEING A PROGRESSION FROM
BASIC SCIENCE INTO ANIMAL
MODELS, IN SOME CASES
TRANSLATING INTO DRAMATIC HUMAN
INTERVENTIONS.
SO, SOME OF YOU MAY RECALL THIS
EXAMPLE, ALL THE WAY BACK FROM
THE 2014 WORLD CUP.
A MAN WHO HAD BEEN PARALYZED FOR
TEN YEARS FROM THE WAIST DOWN,
WITH THE HELP OF A BRAIN-MACHINE
INTERFACE KICKED OUT THE FIRST
BALL.
OR JUST A COUPLE MONTHS AGO,
THIS STORY OF A MAN WITH SPASTIC
QUADRIPLEGIA FOLLOWING BRAINSTEM
STROKE, AN IMPLANT ENABLED BASIC
SPEECH, UNBELIEVABLE STUFF.
AROUND THE TIME OF THE WORLD CUP
IN BRAZIL IN THE MIDST OF THIS
WAVE OF EXCITEMENT THEN DIRECTOR
OF THE NIH TOM INSEL WROTE A
PIECE, AND MANY OTHERS SINCE
THEN CAPTURED THIS MOMENT IN
HISTORY.
HERE'S THE AMAZING THING.
AROUND THE SAME TIME THERE WAS A
SURVEY OF PROGRAM DIRECTORS IN
WHICH THEY FOUND 95% OF PROGRAM
DIRECTORS THOUGHT IT WAS
IMPORTANT TO BE TEACHING
NEUROSCIENCE AND INCORPORATING
IT INTO THEIR CURRICULUM, AND
YET VIRTUALLY NONE OF THEM WERE
DOING IT IN THE SUBSTANTIVE
MANNER.
NOW, IF YOU WORRY, RIGHTFULLY,
THESE DATA ARE OLD, THEY ARE.
BUT IT HASN'T GOTTEN ANY BETTER.
A PAPER THAT JUST CAME OUT IN
ACADEMIC PSYCHIATRY ASKED
PROGRAM DIRECTORS HOW CONFIDENT
THEY WERE ABOUT DIFFERENT
ASPECTS OF THEIR CURRICULUM AND
WHEN PRESENTED WITH THE
STATEMENT, I THINK MY PROGRAM
TEACHES NEUROSCIENCE VERY WELL,
FEWER THAN HALF AGREED.
THIS WAS THE LOWEST OF ANY
DOMAIN THEY SURVEYED, AND THEIR
LACK OF CONFIDENCE WAS WELL
WARRANTED BECAUSE DATA FROM
RESIDENTS IN TRAINING EXAM
SHOWED SCORES LOW IN
NEUROSCIENCE, DID NOT IMPROVE
SIGNIFICANTLY OVER FOUR YEARS OF
TRAINING.
THESE DATA ARE DEVASTATING.
AT THEIR HEART, THEY SUGGEST
THAT WE'RE REENACTING A CASE OF
EDUCATIONAL SCURVY.
THAT THE WORLD HAS RADICALLY
CHANGED AND WE'RE STUCK 50 YEARS
IN THE PAST.
NOW, I REALIZE MANY OF YOU ARE
NOT IN PSYCHIATRY.
I'LL ASK THAT YOU INDULGE ME.
I'LL USE NEUROSCIENCE AS AN
EXAMPLE BUT OBVIOUSLY IT'S NOT
JUST ABOUT PSYCHIATRY.
THE EXACT SAME CHALLENGE IS TRUE
ACROSS ALL OF MEDICINE,
INTEGRATING CUTTING EDGE SCIENCE
IN TYPING AND CLINICAL PRACTICE.
MEETING WITH A FAMILY PRACTICE
YESTERDAY DESCRIBING THE EXACT
SAME STORY, FOR NEW SCIENCE
RELATING TO OBESITY.
SO AS WE GO ALONG I'LL ASK YOU
EACH TO PLEASE TRANSLATE IN YOUR
MIND WHAT THE ANALOGOUS SPACE
WOULD BE IN YOUR OWN DISCIPLINE,
AND ULTIMATELY THIS IS A TALK
ABOUT PROCESS, HOW DO WE BUILD
EFFECTIVE CURRICULA AND SO
REGARDLESS OF CONTENT WE CAN
THINK SIMILARLY ABOUT POSSIBLE
SOLUTIONS.
SO, IF WE CIRCLE BACK TO TOM'S
EDITORIAL AND THE FUTURE OF
PSYCHIATRY AS CLINICAL
NEUROSCIENCE, TO ME IT'S JUST A
TEASER TO THE REAL CONVERSATION.
THE QUESTION THAT WE NEED TO BE
ASKING IS WHY NOT NOW?
WHY AREN'T WE TEACHING IT THIS
WAY TODAY?
PROBABLY THE BIGGEST REASON IS
HOW NEW EVERYTHING IS.
I ALLUDED TO RECENT THINGS.
ONE OTHER SIMPLE EXAMPLE, GO
BACK IN TIME 25 YEARS, WITHIN
THE LIFE OF OUR TRAINEES, WHEN
WE TALKED ABOUT GENTICS 25 YEARS
AGO THE FOCUS WAS ON SPECIFIC
GENES.
WORK WAS SLOW, EXPENSIVE,
LIMITED TO SMALL SAMPLES.
SO THIS IS THE MAIN FIGURE FROM
THE SEMINAL PAPER ON DISK 1,
WHICH LOOKED AT 87 MEMBERS OF
ONE FAMILY.
THE PAPER WAS PUBLISHED IN
AMERICAN JOURNAL OF HUMAN
GENETICS IN 2001.
THAT'S THE SAME YEAR THE HUMAN
GENOME PROJECT WAS COMPLETED AT
A COST OF ALMOST $3 BILLION.
IN THE PAST 20 YEARS WE'VE SEEN
THE COST PLUMMET, WE CAN NOW
EXPECT PATIENTS TO SHOW UP
HAVING COMPLETED THEIR OWN
GENETIC TESTING.
MORE IMPORTANTLY, NEXT
GENERATION SEQUENCING OFFERS
EXPONENTIALLY MORE POWERFUL
TOOLS, SO WHOLE GENOME
SEQUENCING INCLUDING NON-CODING
REGIONS, EPIGENETIC FACTORS,
LOOKING DIRECTLY AT THE
TRANSCRIPTOME, SO WE CAN BETTER
UNDERSTAND COMPLEX INTERPLAY
BETWEEN ENVIRONMENT AND BIOLOGY.
AND CRITICALLY, AS COMPUTATIONAL
TOOLS HAVE BECOME --
[ NO AUDIO ]
(TECHNICAL DIFFICULTIES, PLEASE
STAND BY)
>> LET'S SEE IF WE CAN MAKE THIS
COME RIGHT BACK IN.
ALL RIGHT.
HOPEFULLY WE'RE SOMEWHERE AROUND
HERE.
>> LOOKING GOOD.
>> DOES THIS LOOK RIGHT?
THE MOST OBVIOUS BARRIERS IN
PSYCHIATRY BEYOND TECHNOLOGY
ITSELF IS SYSTEM OF
CLASSIFICATION TO DEFINE
PSYCHIATRIC ILLNESS.
THIRTY YEARS AGO WE WERE WORKING
WITH THE DSM-III.
WE'VE EVOLVED TO DSM-VTR, THIS
IS PROGRESS, BUT WE CAN ALSO
AGREE THE CURRENT VERSION DOES
NOT REFLECT UNDERLYING BIOLOGY
OF THE DISEASES THAT WE TREAT.
SO IT'S NOT AN ACCIDENT THAT THE
BOOK EXISTS THE WAY IT DOES, IT
WAS CREATED AT A TIME WHEN WE
DID NOT HAVE THE TOOLS TO
UNDERSTAND THE ILLNESSES, IT WAS
A DELIBERATE CHOICE TO FOCUS ON
THAT WHICH WAS EXTERNALLY
OBSERVABLE RATHER THAN THE
BIOLOGY.
THE WORLD IS CHANGING, WHETHER
THREE EFFORT TO REDEFINE
CATEGORIES OR THROUGH NARROWER
RESEARCH EFFORTS WE MAY FINALLY
BE GAINING TRACTION IN THIS
SPACE.
THE OTHER MAJOR STRUCTURAL ISSUE
IS THE WAY WHICH WE ORGANIZE OUR
TRAINING SYSTEMS.
IN THE U.S. THIS IS ALL ABOUT
THE ACGME, FOR EACH SPECIALTY
THERE ARE SPECIFIC PROGRAM
REQUIREMENTS FOR EVERYTHING THAT
HAS TO BE DONE, IF YOU READ THIS
DOCUMENT IT'S 38 PAGES AND MORE
THAN 10,000 WORDS, COVERING
EVERYTHING THAT HAS TO HAPPEN.
EVERY FORM OF THERAPY, DIFFERENT
TYPES OF CLINICAL EXPOSURES DOWN
TO MANDATED NAP TIMES FOR
RESIDENTS ON CALL.
ANYBODY WANT TO GUESS WHAT WORD
DOES NOT APPEAR IN THE PROGRAM
REQUIREMENTS?
RIGHT, IF YOU'RE KEEPING SCORE
AT HOME, NAPS, ONE, NEUROSCIENCE
ZERO.
IF YOU WANT TO STEP BACK THERE'S
NO MENTION OF THE RECOVERY
MOVEMENT, OR HEALTH EQUITY, OR
HEALTH DISPARITIES.
THIS IS IMPROVING AT LEAST A
LITTLE BIT THROUGH THE
PSYCHIATRY MILESTONES PROGRESS,
BUT CLEARLY NOWHERE CLOSE TO
WHERE WE OUGHT TO BE.
SO, WHAT'S THE IMPACT OF THIS ON
PROGRAMS?
WELL, PROGRAMS HAVE TO FOLLOW
THE REQUIREMENTS AND
REQUIREMENTS LARGELY TRACK WITH
HISTORY OF OUR FIELD.
AS NEW IDEAS AND TOPICS
DEVELOPED, THEY HAVE BEEN ADDED
IN.
SO IF YOU LOOK AT TRADITIONAL
CURRICULUM, IT'S NOT SURPRISING
IT HAS A VESTIGIAL SITUATION.
IF YOU'RE LUCKY, MAYBE SOME
PSYCHOSOCIAL REHABILITATION, IF
YOU'RE REALLY LUCKY, MAYBE SOME
NEUROSCIENCE.
I HAVE TO ADMIT IT WOULD BE
CONVENIENT IF THE WORLD WORKED
THIS WAY AND WE COULD PARSE
THINGS INTO NEAT CATEGORIES.
IT WOULD APPEAL TO OCPD IN ALL
OF US, AT LEAST IN ME.
BUT THE REALITY IT DOESN'T.
THE BEAUTY IS HOW THE PIECES FIT
TOGETHER.
IF WE WANT TO THINK ABOUT PTSD
TODAY, FUNDAMENTALLY ANY
CONVERSATION HAS TO BEGIN WITH
WHAT HAPPENS IN THE BRAIN
FOLLOWING A TRAUMATIC EVENT.
YOU GET FEAR CONDITIONING,
DISRUPTION OF THE CONNECTIVITY
BETWEEN PRE-FRONT CORTEX AND
LIMBIC SYSTEM, INCLUDING A
COMPONENT OF EXPOSURE THERAPY.
NOW WE CAN DIG INTO ALL THE COOL
SCIENCE THAT'S GOING ON.
WHAT IF WE HAD A WAY TO INCREASE
INTRINSIC PLASTICITY OF THE
BRAIN THROUGH INTERVENTION,
MEDS, TO GET THROUGH THE
EXPOSURE THERAPY IN FIVE OR SIX
SESSIONS INSTEAD OF TEN TO
TWELVE.
THERE'S THIS WHOLE SEPARATE LINE
OF RESEARCH NOW SHOWING ANYTIME
A MEMORY IS ACTIVATED IT BECOMES
MOMENTARILY LABILE AND HAS TO BE
RECONSOLIDATED.
SO WHAT IF WE HAD THE ABILITY TO
DISRUPT THAT RECONSOLIDATION
PROCESS SO YOU MIGHT BE ABLE TO
SPLIT OFF THE NEGATIVE AFFECT
FROM THE EPISODIC TRAITS WHICH
IS SOMETHING THAT'S NOW SHOWN IN
BOTH ANIMALS AND HUMANS,
BEHAVIORALLY, INTERVENTIONALLY,
PHARMACOLOGICALLY.
IF WE STEP BACK FOR ANY
PARTICULAR TYPE OF TRAUMA, IT
MAY BE ONLY TEN, TWENTY, THIRTY
PERCENT OF PEOPLE WHO DEVELOP
PTSD.
HOW DO WE THINK ABOUT THAT?
IT MAY NOT BE THE EVENT EVENT
PER SE AS HOW IT IS
CONTEXTUALIZED, WE MAY WANT TO
THINK ABOUT COGNITIVE
APPROACHES.
WE LOVE TALKING ABOUT MEDS AND
THERAPY, AS PSYCHIATRISTS.
BUT HOW DO WE THINK ABOUT ALL OF
THE DATA FROM PSYCHOSOCIAL
REHABILITATION APPROACHES?
SUPPORTIVE EMPLOYMENT,
SUPPORTIVE HOUSING, FAMILY
PSYCHOEDUCATION, AULD OF
W HICH -- ALL OF WHICH ARE
LARGER EFFECT SIZES THAN
MEDICATIONS WE PRESCRIBE.
AND AT THE END OF THE DAY, HOW
DO WE MAKE SURE THIS IS ABOUT
THE PERSON WHO IS SITTING IN
FRONT OF US?
SO, WHAT'S IT LIKE TO GO TO IRAQ
AND SPEND 14 MONTHS CONVINCED
EVERY DAY YOU'RE GOING TO DIE,
TRY COMING HOME AND DRIVING ON A
FREEWAY THAT REMINDS YOU OF IED
EXPLOSION OR CROWD AT A SMALL IS
TOO STIMULATING, HOW DO WE BRING
THESE FACTORS TO BEAR FOR THE
PERSON IN FRONT OF US?
LET'S IMAGINE YOU HAVE A
PROGRAM, OKAY, WE WANT TO DO
THIS, PUT IN PLACE A NEW
CURRICULUM.
IT'S STILL REALLY HARD.
SO FIRST, WHAT SHOULD WE
ACTUALLY BE TEACHING?
THE FIELD IS VAST AND MOVING WAY
TOO FAST FOR ANYBODY TO KEEP UP
WITH IT.
THEN, WHERE DO YOU FIT IT INTO
THE CURRICULUM THAT'S
OVERFLOWING WITH ALL OF THOSE
OTHER REQUIREMENTS?
WHO IS GOING TO TEACH IT?
SO, MAJOR ACADEMIC CENTERS MAY
HAVE NEUROSCIENCE FACULTY BUT
MANY PROGRAMS AROUND THE COUNTRY
HAVE VERY FEW PEOPLE, IF ANY,
WHO HAVE BACKGROUND EXPERTISE IN
NEUROSCIENCE.
AND MOST IMPORTANTLY, HOW DO WE
TEACH IT WELL?
SO, FOR MOST PROGRAM WHO IS ARE
TEACHING, THE DEFAULT APPROACH
IS THEY HAVE AN EXPERT COME IN
AND LECTURE ON THEIR OTHER THAN
SPECIFIC AREA OF EXPERTISE.
AND WE LIVE WITH THIS FANTASY,
THAT WE COULD JUST LINE UP OUR
RESIDENTS AND STAGE A DRAMATIC
READING OF YOUR FAVORITE TEXT
BOOK AND RESIDENTS WILL
MAGICALLY RETAIN EVERYTHING WE
SAY.
THE DATA ARE CLEAR.
IT DOESN'T WORK.
SO LESS THAN 5% OF CONTENT
PRESENTED IN A LECTURE WILL BE
RETAINED.
THERE'S AN ENTIRE FIELD OF
SCHOLARSHIP ON HOW ADULTS LEARN,
AND THERE IS A TRAGIC IRONY IF
AS THE PSYCHIATRISTS AND
NEUROSCIENTISTS STUDYING HOW
ADULTS LEARN, WE FAIL TO TAKE IT
INTO ACCOUNT IN THE WAY WE
TEACH.
SO, IF WE STEP BACK AND THINK
ABOUT TRADITIONAL GME MODEL,
HISTORICALLY IT'S ENTAILED
CENTRAL REGULATIONS THAT HAVE TO
BE IMELEMENTED AT THE INDIVIDUAL
PROGRAM LEVEL, AND FOR CUTTING
EDGE CONTENT LIKE MODERN
NEUROSCIENCE IT CAN'T WORK.
A REGULATORY SYSTEM IS TOO
COMPLEX TO ADAPT QUICKLY AND
DESIGNING CUTTING EDGE CURRICULA
IS TOO RESOURCE INTENSIVE FOR
ONE PROGRAM.
THE FUTURE OF GME IS ABOUT HOW
DO WE ALL WORK TOGETHER TO
ACHIEVE COMMON GOAL?
MY CENTRAL TENET, REQUIRING TEAM
WORK AND COLLABORATION, SO DOES
CUTTING EDGE EDUCATION.
NINE YEARS AGO A GROUP OF US
FORMED THE NNCI, AND THE GOAL
WAS TO CREATE A SET OF OPEN
ACCESS RESOURCES TO HELP IMPROVE
THE TEACHING OF NEUROSCIENCE AND
PSYCHIATRY.
AND OF COURSE, IT'S NOT JUST
ABOUT TEACHING BUT HOW DO WE
INTEGRATE THIS ACROSS ALL OF
PSYCHIATRY INCLUDING CLINICAL
PRACTICE, AND, AGAIN, FOR THOSE
NOT IN PSYCHIATRY, I WOULD
IMAGINE ENCOURAGE YOU TO IMAGINE
MORE WIDELY HOW DOES THIS HOLD
TRUE FOR CUTTING EDGE SCIENCE
ACROSS YOUR FIELD AS WELL?
THIS IS WORK I'M INCREDIBLY
GRATEFUL TO DO WITH CO-FOUNDERS
OF THE NNCI AND WITH THE FUND.
WHEN WE STARTED, WE DEFINED A
SET OF GUIDING PRINCIPLES AND
STARTED TO IMAGINE WHAT WOULD
THIS NEED TO LOOK LIKE IN A
CLASSROOM SETTING.
AND FOREMOST, IT HAS TO BE AN
INTEGRATIVE PATIENT CENTERED
APPROACH.
HOW DO WE ENSURE IT'S GOING TO
BE EXPERIENTIAL AND ROOTED IN
PRINCIPLES OF ADULT LEARNING?
WE WANT TO BE SURE IT WOULD BE
EASY TO IMPLEMENT SO ANYONE,
ANYWHERE, WOULD FEEL COMFORTABLE
PICKING UP THE MATERIALS AND
RUNNING THEM IN THEIR OWN
PROGRAM REGARDLESS OF THEIR
CONTENT EXPERTISE, AND LASTLY,
DARE I SAY IT, HOW DO WE MAKE
SURE IT'S FUN?
SO, MELISSA ARBUCKEL GAVE AN
INTERVIEW RECENTLY, REMEMBER IN
KINDERGARTEN, LEARNING WAS FUN?
WHEN DID IT STOP BEING FUN?
AND WHY CAN'T IT BE FUN NOW?
YEAH!
SO WE TAKE FUN RATHER SERIOUSLY.
AND SO, WHEN WE WERE STARTING
OUT ONE OF THE FIRST THING WE
APPROACHED WAS BASIC
NEUROSCIENCE, NEUROANATOMY.
IT'S SUPER IMPORTANT AND ONE OF
THESE TOPICS THAT IS OFTEN
TAUGHT IN A DRY AND RELATIVELY
INACCESSIBLE MANNER.
WE APPROACH DIFFERENTLY.
WE STARTED BY HANDING OUT
PLAY-DOH AND ASKING PEOPLE TO
BUILD A BRAIN.
WE GIVE THEM A VIDEO TO FOLLOW
ALONG.
>> HELLO, MY NAME IS JOSH
GORDON, I'LL SHOW YOU HOW TO
BUILD YOUR BRAIN OUT OF
PLAY-DOH.
♪
>> THIS IS IN FAST FORWARD.
♪
SO THE ACTUAL VIDEO IS ABOUT
SEVEN MINUTES LONG, AS HE'S
GOING HE'S TALKING ABOUT EACH
REACH, WHAT IT DOES, FUNCTIONAL
SIGNIFICANCE, DIFFERENT
ILLNESSES, SOME MAY RECOGNIZE
DR. GORDON FROM A DIFFERENT
CONTEXT.
I UNDERSTAND HE HAS A NEW ROLE.
HE WILL ALWAYS BE THE PLAY-DOH
PERSON IN MY HEART.
OF ALL --
[ NO AUDIO ]
(TECHNICAL DIFFICULTIES - PLEASE
STAND BY.)
>> WE MAY HE LOST HIM
WE'LL GIVE A FEW MORE SECONDS.
>> AUDIENCE, WE ASK FOR YOUR
PATIENCE AGAIN AS DR. ROSS MAY
HAVE TO SIGN BACK IN.
>> OH MY GOSH!
OKAY, I'M BACK.
YOU CAN HEAR ME?
>> WE CAN.
>> I SWEAR, I DID EVERYTHING TO
MAKE MY INTERNET WORK THIS
MORNING.
IT JUST DOESN'T LIKE ME.
LET ME GET MY SLIDES BACK UP.
>> THERE YOU GO.
>> YOU GOT 'EM?
>> PERFECT.
>> SO, CORE LEARNING OBJECTIVE
OUR AMBASSADORS -- THAT OUR
TRAINEES WILL BE AMBASSADORS OF
PSYCHIATRY AND NEUROSCIENCE WHO
CAN THOUGHTFULLY COMMUNICATE
WITH A BROAD AUDIENCE.
WE SAID, OKAY, LET'S DO THAT IN
THE CLASSROOM.
LOTS OF PROGRAMS HAVE JOURNAL
CLUBS.
THIS IS OUR MAGAZINE CLUB, IF
YOU WILL.
SO, EACH SESSION WE START BY
REVIEWING POPULAR MEDIA CONTENT
TOGETHER, FROM THE "NEW YORK
TIMES" OR HUFFINGTON POST, YOUR
FAVORITE PODCAST, WHATEVER IT
IS, WE EXPERIENCE THE MEDIA
TOGETHER AND CRITIQUE THE MEDIA
ITSELF, SO WHAT ARE MAIN CLAIMS
THEY ARE TRYING TO MAKE, WHAT
ARE BIASES IN EVIDENCE IN THIS?
SPOILER, TYPICALLY STIGMA
TOWARDS INDIVIDUALS WITH
PSYCHIATRIC ILLNESS.
WHAT DO WE THINK THE FACE
VALIDITY IS OF CLAIMS THEIR
MAKING, WHAT DO WE IMAGINE A
PATIENT OR FAMILY MEMBER WOULD
ASK IF THEY SAW THIS?
WHAT QUESTIONS DO WE HAVE?
LET'S FIND THE SCIENCE THAT'S
GOING TO LET US ANSWER THOSE
QUESTIONS.
AND THEN EACH PARTICIPANT HAS
THE CHANCE TO ROLE PLAY, HOW
WOULD YOU COMMUNICATE WITH A
GENERAL AUDIENCE ABOUT THIS
PARTICULAR TOPIC?
THIS IS BEAUTIFUL WAY TO BRING
CUTTING EDGE SCIENCE TO LIFE IN
AN EXPERIENTIAL APPROACH.
MY FAVORITE EXAMPLE WAS A RADIO
LAB PIECE FROM PRETTY FAR BACK,
A BRITISH JOURNALIST WHO THEY
FLY OUT TO A SECRET ARMY BASE
OUTSIDE SAN DIEGO AND ZAP A
BRAIN WITH ELECTRICITY AND TRAIN
HER TO BECOME A SNIPER.
AWESOME.
SO IT SOUNDS RIDICULOUS ON THE
SURFACE, BUT THE SCIENCE UNDER
THE HOOD ACTUALLY PACKS A GOOD
PUNCH.
IT'S ABOUT TRANSCRANIALAL DIRECT
STIMULATION, AT THE TIME A NEW
APPROACH, NOW THOUSANDS OF
ARTICLES USE IT tDCS.
ONE OF THE MOST PRESSING ISSUES
FACING MEDICINE NOW IS PHYSICIAN
BURNOUT AND DEPRESSION.
THIS IS BEAUTIFULLY HIGHLIGHTED
IN THE GUARDIAN FROM RIGHT
BEFORE THE PANDEMIC STARTED.
AND WE WANTED TO FIND A WAY TO
TEACH CORE DATA AND TO
FACILITATE DIALOGUE AROUND THIS
CRUCIAL TOPIC.
SO WHAT WE DID IS CREATED INTERN
YEAR, EDUCATIONAL BOARD GAME.
THIS IS PART OF THIS NEW GENRE
OF COOPERATIVE BOARD GAMES, NOT
PLAYING AGAINST EACH OTHER,
YOU'RE ALL PLAYING TOGETHER
AGAINST THE GAME ITSELF.
SO THE GAME BEGINS, EACH PERSON
ASSUMES THE ROLE OF CHARACTER.
EACH HAS UNIQUE STRENGTHS AND
VULNERABILITIES, BASED ON
PHYSICAL AND EMOTIONAL HEALTH
AND CLINICAL PERFORMANCE.
EACH PERSON GETS A ROTATION
SCHEDULE, THEY WORK IN THE
HOSPITAL, DIFFERENT EVENTS
HAPPEN, MAYBE A BAD CODE,
CONFLICT WITH STAFF, A PATIENT
DEATH.
AS THEY EXPERIENCE THESE EVENTS
THEIR CHARACTERS CHANGE.
THERE ARE REAL CONSEQUENCES.
SOME MAY BECOME CLINICALLY
DEPRESSED.
WE BUILT IN A MECHANISM FOR
SUICIDE, WHICH IS DARK FOR A
GAME, BUT IT'S A REAL THING
HAPPENING IN THE REAL WORLD, ALL
TOO FREQUENTLY.
AND WE WANTED TO CREATE SPACE
FOR DIALOGUE AROUND THE THINGS
THAT ARE IMPORTANT.
AND SO AS THE GAME PROGRESSES AT
THE END OF EACH ROTATION THERE'S
A GROUP ACTIVITY IN WHICH PEOPLE
REFLECT AROUND THE CORE THEME,
THINKING ABOUT STRESS,
RESILIENCE, LEARNED HELPLESSNESS
AS A MODEL, COPING STRATEGIES,
AND THINKING ABOUT THE
STRUCTURAL FACTORS THAT IMPACT
PHYSICIAN WELLNESS BECAUSE WE
KNOW THAT MOST OF THE PROBLEM
RESIDES AT THE SYSTEM LEVEL.
AND THIS IS JUST AN INCREDIBLY
POWERFUL SPACE FOR DIALOGUE.
OKAY.
SO THESE ARE A COUPLE OF
EXAMPLES TO GIVE YOU A SENSE OF
WHAT MODULES ARE LIKE, WITH LOTS
OF OTHER STUFF.
I WANT TO PAUSE AND ACKNOWLEDGE
NOW A GLARING IRONY THAT I
STARTED BY SAYING WE DON'T
BELIEVE IN LECTURING, AND I'VE
BEEN GOING FOR 23 MINUTES, AS
FAR AS I CAN TELL.
SO, I REALIZE STRUCTURALLY WE'RE
IN A TOUGH SPACE WITH NO ABILITY
FOR DIRECT BACK AND FORTH, NO
ABILITY FOR GROUP BREAKOUTS OR
ANY OF OUR FAVORITE TRICKS TO
USE IN ONLINE SPACE.
NEVERTHELESS, I WANT TO DO WHAT
WE CAN.
ILLUSTRATE ONE QUICK EXERCISE TO
GIVE YOU A FLAVOR FOR HOW THIS
STUFF WORKS.
BOTH AS EXPERIENTIAL LEARNING
AND ALSO AS TYPE OF EDUCATIONAL
RESOURCE THAT CAN BE EASILY
IMPLEMENTED AND DISSEMINATED
WITHOUT REQUIRING CONTENT
EXPERTISE ON THE PART OF THE
INSTRUCTOR.
THIS IS PART OF A SERIES, FIND
IT, DRAW IT, KNOW IT, TO TYPE
BASIC NEUROSCIENCE, CORE
CIRCUITS, IN AN EXPERIENTIAL
WAY.
WE'RE GOING TO START BY WATCHING
A MOVIE.
THE MOVIE IS ABOUT THREE MINUTES
LONG.
JUST TRY TO BE PRESENT, BE ONE
WITH THE EXPERIENCE, WE'LL COME
BACK ON THE FLIP SIDE.
[ NO AUDIBLE DIALOGUE ]
>> SO CREEPY!
OKAY.
YOU GRAB A SCRAP OF PAPER, OPEN
A SEPARATE WINDOW IN THE
BROWSER, WHATEVER YOU NEED TO
GET SOMETHING.
WHAT YOU TRY TO DO IS DRAW THE
CIRCUIT INVOLVED IN GENERATING
THE PROTAGONISTS, YOUR FEAR
RESPONSE IN THIS SITUATION.
A COUPLE CAVEATS.
WE KNOW THIS IS REALLY, REALLY,
REALLY HARD.
GIVEN OUR FORMAT I'M NOT GOING
TO GIVE NEARLY ENOUGH TIME, BUT
JUST TO GET A SENSE OF THE
FLAVOR.
WE'RE NOT DIRECTING ANY DATA OR
ASKING YOU TO SHARE.
THIS IS YOUR CHANCE TO HAVE A
PERSONAL LEARNING EXPERIENCE.
I'LL HELP MAKE IT A LITTLE BIT
EASIER.
AS YOU'RE STARTING TO THINK IN
YOUR MIND HOW TO DIAGRAM THIS,
YOU MIGHT WANT TO INCLUDE
PATHWAYS FOR HOW THE SIGNAL GETS
IN, HOW THE BRAIN IS PROCESSING
CONTEXT FOR THE SIGNAL, HOW THE
BRAIN GENERATES A FEAR OUTPUT.
IF WE WERE SITTING TOGETHER IN A
ROOM WE WOULD GIVE A HANDOUT
THAT HAS THIS TEMPLATE OR E-MAIL
IT, BUT, AGAIN, GIVEN THE SPACE
TAKE 60 SECONDS AND TRY TO JOT
DOWN AS BEST YOU CAN WHAT YOU
THINK IS GOING ON.
>> HOPEFULLY FOLKS WITH FEELING
CLOSE.
IN A DIFFERENT SPACE WE WOULD
LEAVE TIME AND PARROT ARE A
VIDEO, ASKING YOU ACTUALLY DRAW
ALONG WITH THIS VIDEO AT THE
SAME TIME AS SHE'S DOING IT.
WHAT I'VE DONE, I HAVE A FAST
FORWARD VERSION, I'LL PLAY THAT
AND YOU'LL GET A SENSE, THE REAL
VIDEO IS SEVEN MINUTES.
>> WE'RE GOING TO WORK TOGETHER
FOR THE BRAIN CIRCUITS.
DRAW ALONG WITH US.
♪
>> EVEN IN FAST FORWARD VISUAL
CUES COMING IN, AUDITORY
PATHWAYS, HOW DO WE INTERPRET
THE CONTEXT USING HIPPOCAMPAL
AND PREFRONTAL CORTEX.
♪
SPECIFIC REGIONS INVOLVED IN
GENERATING FEAR OUTPUT RESPONSE.
>> OKAY, FIND IT, DRAW IT, KNOW
IT.
>> OOPS.
SO, THIS IS A COOL EXERCISE.
LET'S SEE IF WE CAN PAUSE.
YOU CAN WATCH THE WHOLE THING
THERE, A CHANCE FOR INDIVIDUAL
PERMANENT COMMITMENT, CHANCE TO
PRACTICE, YOU CAN DO IT AS MANY
TIMES AS YOU WANT, THE RESOURCE
IS ALWAYS THERE FOR YOU TO BE
ABLE TO FIND.
AGAIN, YOU DON'T NEED A FACULTY
MEMBER WITH ANY EXPERTISE IN
NEUROSCIENCE, IT'S REALLY JUST
PLUG AND PLAY FOR THE EXERCISE.
I WANT TO TAKE A TIMEOUT AND
STEP BACK AND FOCUS ON PROCESS.
GIVEN THE CONTEXT FOR THIS TALK
IT BEARS SAYING EXPLICITLY, I'M
ABOUT TO GET REALLY HIGH TECH
WITH MY GRAPHICS HERE, FORGIVE
ME, SO THE TRADITIONAL MODEL FOR
MEDICAL EDUCATION IS YOU PUT A
SMART PERSON IN THE FRONT OF THE
ROOM, AND THEN THEY LECTURE TO A
ROOM FULL OF STUDENTS, AND THEY
CAN JUST POUR KNOWLEDGE INTO
THEIR BRAINS.
AND THE STUDENTS ARE GOING TO
MAGICALLY REMEMBER EVERYTHING
THAT THEY SAY AND UNICORNS AND
RAINBOWS AND SUNSHINE.
AND WE KNOW THIS IS
FUNDAMENTALLY UNTRUE.
SO, THE PERSON WHO SAID THIS
BEST WAS THE NOBEL LAUREATE,
HERBERT SIMON, WHO SAID LEARNING
RESULTS FROM WHAT THE STUDENT
DOES AND THINKS AND ONLY FROM
WHAT THE STUDENT DOES AND
THINKS.
THE TEACHER CAN ADVANCE LEARNING
ONLY BY INFLUENCING WHAT THE
STUDENT DOES TO LEARN.
WHICH IS TO SAY WHEN WE'RE
THINKING ABOUT TEACHING AND
LEARNING IN MEDICINE, WE TEND TO
FOCUS HERE ON THE PERSON
STANDING AT THE FRONT OF THE
ROOM.
BUT IT'S NOT ABOUT US.
IT'S ABOUT THEM.
THE MOST CENTRAL PRINCIPLE IS
THAT WE LEARN THROUGH
EXPERIENCE.
BY TRYING THINGS OUT, MAKING
MISTAKES, GETTING FEEDBACK.
THE ROLE OF A FACULTY MEMBER
ISN'T TO POUR KNOWLEDGE; IT'S
ABOUT CATALYZING AN EXPERIENCE.
EVERYTHING WE DO NEEDS TO START
HERE.
SO FROM RIGOROUS LEARNING
OBJECTIVES THAT ARE DEFINED
BASED ON STUDENT OUTCOMES, SO AS
A DIRECT RESULT, THE STUDENTS
WILL BE DIFFERENT IN THE
FOLLOWING WAY.
THIS MIGHT RELATE TO KNOWLEDGE,
SKILLS, ATTITUDE, BUT EVERYTHING
HAS TO START HERE.
OKAY.
SO, STEPPING BACK IN, WE SPENT
TWO YEARS THINKING ABOUT THIS,
WORKING ON CLASSROOM TEACHING,
AT THE END WE'RE SHOWING GOOD,
YEAH, WE GOT THIS.
AND THEN WE STEPPED BACK AND
THOUGHT MORE.
IF WE DESIGNED THE PERFECT SET
OF CLASSROOM TEACHING RESOURCES,
MAYBE IT INCLUDES 100 HOURS OF
CONTENT.
AND EVEN IF YOU'VE DONE THIS,
THIS IS STILL ONLY THE TINIEST
FRACTION OF TRAINING.
DURING FOUR YEARS THE RESIDENTS
ARE LIKELY TO HAVE 9,000+ HOURS
OF CLINICAL TRAINING, WHERE WE
KNOW THEY ARE WORKING WITH
FACULTY PROBABLY NOT
NEUROSCIENCE EXPERTS.
IN WHICH CASE IT'S PROBABLY NOT
BEING REINFORCED.
AND SO YOU RISK CREATING A
HIDDEN CURRICULUM THAT
NEUROSCIENCE IS THIS THING WE
TALK IN THE CLASSROOM BUT
DOESN'T APPLY IN THE REAL WORLD.
WE STARTED SHIFTING OUR FOCUS TO
THINKING ABOUT THIS.
HOW DO WE INTEGRATE NEUROSCIENCE
STRAIGHT INTO THE CLINIC.
ONE WAY IS THROUGH TALKING
PATHWAYS TO PATIENTS MODULE
WHERE WE RECOGNIZE A LOT OF
THINGS WE SAY TO PATIENTS ARE
RELICS OF AN OLDER PAST.
WE TALK ABOUT CHEMICAL
IMBALANCE, DIAGNOSTIC LABELS
THAT REFLECTS BROAD SYNDROMES,
RATHER THAN THE UNDERLYING
DISEASE PROCESS.
WE OWE IT TO OUR PATIENTS TO BE
ABLE TO EXPLAIN AS BEST WE CAN
WHAT IS ACTUALLY GOING ON.
SO THIS IS A MODULE WE GIVE
PARTICIPANTS THE CHANCE TO LEARN
AND THEN PRACTICE THIS SPECIFIC
SKILL.
ANOTHER ONE OF THESE, MY
FAVORITE, CLINICAL SCIENCE
CONVERSATIONS, THE CENTRAL GOAL
TO EXPLODE THE DEFAULT
HIERARCHICAL MODEL OF MEDICAL
EDUCATION THAT THE TEACHER NEEDS
TO KNOW EVERYTHING ABOUT EVERY
TOPIC AND IMPART WISDOM ON HIGH.
THIS IS ABOUT TEACHING WHEN THE
FACULTY ARE NOT CONTENT EXPERTS.
WITH THE INTERNET HOW CAN WE
LEVEL THE FIELD AND LEARN
TOGETHER?
EACH SESSION STARTS WITH CASE
FORMULATION, READ THE CASE, TALK
ABOUT THE CASE, HOW WOULD YOU
THINK ABOUT IT TODAY, WE GIVE
THEM A BRIEF NARRATIVE VIDEO
THAT ILLUSTRATES ONE CORE
CONCEPT RELEVANT TO THAT CASE.
NOW YOU HAVE THE CHANCE TO GO
BACK AND TALK WITH YOUR PEER
AGAIN, HOW DOES THIS CHANGE THE
WAY YOU WOULD THINK ABOUT THIS
PARTICULAR CASE?
SO, MY FAVORITE EXAMPLE IS
FUNCTIONAL NEUROLOGICAL
DISORDERS, THESE ARE REALLY
DIFFICULT INDICATIONS THAT
CHALLENGE FUNDAMENTAL
CONCEPTUALIZATIONS OF ILLNESS,
WITH THE QUESTION ESPECIALLY ARE
THEY FAKING IT?
I DIDN'T KNOW HOW TO ILLUSTRATE
THIS WAS.
THIS WAS THE CLOSEST I COULD
GET.
THESE VIDEOS ARE DESIGNED SO
THAT YOU WILL NEVER THINK ABOUT
THESE CASES THE SAME WAY AGAIN.
SO, AGAIN, WE SPENT A COUPLE
YEARS, FEELING PRETTY GOOD.
WE STEP BACK, OKAY, EVEN IF WE
COMPLETELY TRANSFORMED OUR
CLASSROOM, IT TURNS OUT THERE'S
A WIDE WORLD BEYOND THE WORLD OF
IVORY TOWERS AND MAJOR ACADEMIC
CENTERS, NOT JUST GEOGRAPHIC BUT
OUR SYSTEMS OF CARE ARE
EVOLVING, THEY OF A LONE
PSYCHIATRIST PRACTICING ON THEIR
OWN IS DYING.
WHEN WE STARTED WE WERE FOCUSED
ON PSYCHIATRY RESIDENTS.
THIS IS MY ARTIST RENDITION, YOU
CAN TELL BECAUSE THEY ARE
SMILING AND THE LABEL SAYS IT.
AS SOON AS WE BEGIN WE REALIZED
THERE WAS A BROADER AUDIENCE,
MEDICAL STUDENTS, ATTENDINGS,
M.D.s, PSYCHOLOGISTS, PATIENTS
AND FAMILIES DIRECTLY.
THE KEY QUESTION, HOW DO WE
ENGAGE WITH THIS WIDER AUDIENCE?
HOW DO WE BRING NEUROSCIENCE TO
EVERYONE?
AND THIS IS REALLY COMING BACK
TO THAT FIRST QUESTION OF WHAT
DOES IT TAKE TO ACHIEVE BROADER
IMPACT?
WE STARTED WITH CONVENTIONAL
APPROACHES OF SOCIAL MEDIA AND
STUFF.
WE REALIZED FACULTY DEVELOPMENT
WAS CRUCIAL, ASKING THEM TO
TEACH MATERIAL NOT FAMILIAR TO
THEM, IN A WAY THEY MIGHT NOT BE
USED TO.
WE WANT TO OFFER DIRECT SUPPORT.
WE'VE DONE THIS THROUGH THE
ANNUAL BRAIN MEETING, ONE
APPROACH WITH 200 STUDENTS,
EXPERIENCING THE CONTENT AS A
STUDENT AND REFLECTING ON WHAT
IT WOULD BE LIKE TO TEACH IT.
WE'VE WORKED WITH MAJOR
PROFESSIONAL ORGANIZATIONS IN
THE FIELD AND AT THE END OF THE
DAY YOU HAVE TO HAVE RESOURCES
THAT ARE AVAILABLE.
SO WE BUILT A WEBSITE,
EVERYTHING ON THE WEBSITE IS
FREE AND OPEN ACCESS.
YOU HAVE TO CREATE USERNAME AND
LOG-IN TO TRACK USAGE TO REPORT
BACK TO FOUNDERS.
EVERYTHING WE'VE BEEN TALKING
ABOUT TODAY IS HERE.
I WANT TO HIGHLIGHT TWO OF THE
MOST VALUABLE SELF-STUDY
RESOURCES.
ONE IS A SERIES OF CLINICAL
COMMENTARIES WRITING IN THE
JOURNAL, BIOLOGICAL PSYCHIATRY.
EACH IS DESIGNED TO TAKE ONE
CORE CONCEPT IN NEUROSCIENCE AND
MAKE IT CLEAR, RELEVANT,
ACCESSIBLE FOR A BROAD AUDIENCE
USING A NARRATIVE APPROACH.
THESE ARE ARTICLES THAT DON'T
BELONG, BASED ON STYLE.
THEY ARE ABOUT TRANSLATING FROM
NEUROSCIENCE INTO THE KIND OF
LANGUAGE THAT WILL BE ACCESSIBLE
FOR EVERYONE.
WE'RE NOW AT 70 COMMENTARIES
THAT WE PUBLISHED IN THE
JOURNAL.
THE OTHER ONE WE'VE DONE, WE
INITIALLY CONCEPTUALIZED A
SERIES OF BRIEF TALKS THAT WOULD
BE SOMETHING OF HYBRID, TRUE
STORIES TOLD LIVE WITH AUDIENCE
WITHOUT NOTES, A TED TALK
20 SECONDS, 20 SLIDES, SIX
MINUTES AND 40 SECRETARIES.
EACH IS DESIGNED TO CAPTURE A
PERFECT SINGLE NEUROSCIENCE
BITE.
ONE MOMENT THAT'S GOING TO MAKE
THE AUDIENCE SAY, WOW, THIS
STUFF IS REALLY COOL!
WE CALL THEM "THIS STUFF IS
REALLY COOL" TALKS, WE HAVE 35
OR 40, AMONG THE MOST POPULAR
RESOURCES ON THE WEBSITE.
SO, THIS IS WHAT WE WERE
THINKING ABOUT AND DOING BEFORE
2020.
AND WHEN THE PANDEMIC FIRST
STARTED WE HAD THIS CRAZY
THOUGHT.
WITH THIS NEW COVID THING, WHAT
ARE WE GOING TO DO IF RESIDENTS
ARE STUCK IN QUARANTINE FOR TWO
WEEKS?
CAN YOU IMAGINE BEING STUCK AT
HOME FOR A WHOLE TWO WEEKS?
WHAT IF WE COULD CREATE AN
ONLINE COURSE TO ENGAGE
RESIDENTS WHERE THEY ARE AT?
IN THIS CASE LITERALLY.
WE CALLED IT THE QUARANTINE
CURRICULUM, BRINGING TOGETHER A
TEAM OF AMAZING EDUCATORS TO
CREATE THIS 14-DAY EXPERIENCE.
AND WE RAN THE FIRST VERSION IN
APRIL OF 2020, AND IMMEDIATELY
DISCOVERED THERE WERE SO MANY
MORE PEOPLE WHO WERE INTERESTED.
SO WE DESIGNED AND IMPLEMENTED A
FORMAL MEDICAL STUDENT ELECTIVE
AND CREATED THE BRAIN ONLINE
COURSE, THERE ARE REST PROGRAMS
USING THIS FOR FORMAL PROGRAM,
WITH RESIDENTS, FACULTY,
PSYCHOLOGISTS, APRN, SOCIAL
WORKERS FROM ALL OVER THE WORLD
PARTICIPATING AND HAVE THE
OPTION TO RECEIVE CME FOR THEIR
PARTICIPATION.
AND WE'RE EXCITED THAT IT HAS
BOTH CORE CONTENT RELEVANT TO
PSYCHIATRIC NEUROSCIENCE AND
EVEN MORE THAT IT LETS US
CAPITALIZE ON PRINCIPLES OF
ADULT LEARNING AS THEY APPLY IN
THE ONLINE SPACE.
SO, THE COURSE IS DIVIDED IN 16
SESSIONS, EACH AROUND THE
PARTICULAR CONTENT DOMAIN, FOR
EACH SESSION WE START FROM A
SERIES OF ASSESSMENT QUESTIONS.
IF AT THE END OF THE SESSION OUR
PARTICIPANTS CAN ANSWER THESE
QUESTIONS, WE ARE GENUINELY
HAPPY.
OKAY.
NOW LET'S WORK BACKWARDS.
WHAT'S IT GOING TO TAKE TO HELP
THEM GET TO THAT POINT?
WE'RE GOING TO GIVE A SET OF
SELF-STUDY MATERIALS, VIDEOS,
PODCASTS, RESOURCES, WE ASK EACH
PERSON TO LOG INTO AN ONLINE
FORUM, SHARE ONE REACTION, SHARE
A QUESTION, A THOUGHT, WHAT WAS
INTERESTING OR COOL, RESPOND TO
ONE OF YOUR COLLEAGUE'S POSTS.
WE HAVE GROUP ACTIVITIES, EACH
AN EXPERIENTIAL THING TO DO
TOGETHER WITH A SMALL GROUP
RECOGNIZING THE SOCIAL DYNAMICS
A CRUCIAL FOR LEARNING
ESPECIALLY ONLINE.
SO, WE'VE RUN THIS A COUPLE
TIMES NOW.
WHAT'S REALLY COOL ABOUT THIS
FORMAT, IT LETS US TRY OUT A
RANGE OF NOVEL INTERVENTIONS, I
WANT TO GIVE A TASTE OF JUST
ONE.
SO, WE LOVE THE FORMATIVE
ASSESSMENT QUESTIONS BUILT FOR
THIS COURSE.
THEY ARE NOT JUST FACTS.
THEY ARE ABOUT KNOWLEDGE
TRANSFER.
CAN YOU APPLY NEW CONTENT INTO A
CLINICAL SCENARIO?
WHEN YOU START THINKING ABOUT
THIS TYPE OF ASSESSMENT THERE'S
AN IMMEDIATE TENSION.
YOU COULD USE MCQs, EASY TO
GRAZE AND GIVE FEEDBACK, BUT
DON'T ALIGN WITH THIS TYPE OF
LEARNING.
OR YOU CAN USE OPEN ENDED
QUESTIONS THAT ARE REALLY
POWERFUL FOR ASSESSING LEARNING,
BUT IT'S ALMOST IMPOSSIBLE TO
GIVE FEEDBACK TO STUDENTS.
ESPECIALLY IN A LARGE ONLINE
SPACE.
WE'VE BEEN WORKING WITH A TEAM
TO CREATE A NEW TYPE OF
ASSESSMENT.
I WANT YOU TO PLAY WITH IT
BRIEFLY.
IF YOU CAN POP OPEN A SEPARATE
BROWSER WINDOW AND GO HERE.
YOU'LL GET A VERY BRIEF
VIGNETTE.
MAKE UP ANY NAME FOR USERNAME,
IT'S JUST A PLACEHOLDER.
IT WILL ASK, HOW WOULD YOU THINK
ABOUT THIS VIGNETTE, TYPE IN
YOUR OWN ANSWER.
YOU'LL ADVANCE TO THE NEXT
SLIDE.
WE'LL SHOW YOU SOMEBODY ELSE'S
ANSWER FROM A PREVIOUS VERSION
OF THE COURSE.
WE'RE GOING TO ASK YOU TO GRADE
THAT USING A STANDARD RUBRIC.
WE'LL SHOW HOW WE GRADED THAT
PARTICULAR ANSWER.
AND THEN WE'LL HAVE YOU GO BACK
AND GRADE YOUR OWN ANSWER.
YOU CAN REVISE AT THE END BASED
ON WHAT YOU LEARNED FROM THE
EXPERIENCE.
I'M GOING TO AGAIN -- I'M GOING
TO PAUSE AND TURN OFF MY CAMERA
AND GIVE FIVE MINUTES TO PLAY IN
THIS SPACE FOR A SECOND AND SEE
WHAT IT FEELS LIKE.
YOU PROBABLY WANT MORE TIME.
IT'S GOING.
THE GOAL IS TO GET A LITTLE BIT
OF A FLAVOR.
[ NO AUDIBLE DIALOGUE ]
>> SO MAYBE ONE MORE MINUTE.
HOPEFULLY PEOPLE ARE IN THERE
AND PLAYING.
>> ALL RIGHT.
SO I IMAGINE PEOPLE MAY STILL BE
WORKING.
IF I'M LEAVING YOU HUNGRY AND
FEELING UNSATISFIED, GOOD.
THAT'S A GOOD SIGN FOR A
LEARNING EXPERIENCE.
GO BACK AND FINISH THE EXERCISE
AND PLAY LATER.
I HOPE IT GIVES A FLAVOR OF JUST
THE POWER FOR WHEN WE THINK
CREATIVELY ABOUT THESE TYPES
APPROACHES, THE KINDS OF THINGS
WE CAN DO TO STEP OUTSIDE OF
TRADITIONAL BOUNDS.
ALL RIGHT.
A WORD OR TWO ABOUT OUTCOMES.
OUR FIRST QUESTION WAS COULD
THIS MODEL WORK, TO BE ABLE TO
GENERATE CONTENT IN A
COLLABORATIVE MANNER?
IN THIS REGARD IT'S BEEN REALLY
COOL.
WE HAVE MORE THAN 150 AUTHORS
WHO CONTRIBUTED PIECES TO THE
NNCI, A TON OF CONTENT, IT'S
BEEN FANTASTIC.
BUT OF COURSE OUR PRIMARY GOAL
HAS ALWAYS BEEN ARE PEOPLE GOING
TO USE THE RESOURCES?
HERE AGAIN THE DATA HAVE BEEN
JUST AMAZING.
IT'S NOW MORE THAN 115,000
UNIQUE USERS FROM 156 DIFFERENT
COUNTRIES.
AND IT'S MORE THAN 200 TRAINING
PROGRAMS IN THE U.S. AND ABROAD
THAT HAVE FORMALLY ADOPTED NNCI
MATERIALS.
SO, THERE'S A BUNCH OF OTHER
STUFF, CREATING MORE CONTENT,
THINKING BACK TO SCURVY HOW DO
WE EFFECT WIDESPREAD CHANGE?
IT'S THE FLEET IN MENTAL HEALTH
IS LARGE, HOW DO WE GET CONTENT
TO THE MOST PEOPLE?
ONE WAY IS WITH NEW PODCASTS,
IT'S REALLY FUN, CHECK IT OUT,
NEWEST EPISODE DROPPED LAST
MONTH.
ANOTHER WAY WITH PLAYING WITH A
SMARTPHONE APP TO REACH A LARGE
UP IN OF PEOPLE ACROSS
DISCIPLINES, NOW THEY CAN LISTEN
TO THE PODCAST AND GET CME
CREDIT FOR PARTICIPATION.
SO, LET ME STOP THERE IN CASE
THERE'S QUESTIONS AND I'LL STOP
RIGHT THERE.
SO DR. CHUNG, I ASSUME YOU'RE
OUT THERE SOMEWHERE IN THE
INTERNET SPACE.
>> I AM.
THANK YOU.
>> ALL RIGHT, COOL.
>> SO, I HAVE A QUESTION TO
START.
THIS HAS BEEN PSYCHIATRY
FOCUSED, WE HAVE A LOT OF PEOPLE
ON THE LECTURE WHO REPRESENT A
LOT OF DIFFERENT OTHER AREAS OF
MEDICINE.
I'M WONDERING IF YOU'RE AWARE OF
OTHER INITIATIVES SIMILAR TO
THIS IN OTHER FIELDS OF MEDICINE
THAT MIGHT BE HELPFUL FOR THOSE
FOLKS TO GO TO.
DO YOU KNOW OF ANY OF THOSE?
>> YEAH, IT'S A GREAT QUESTION.
SO, I THINK THERE'S A LOT OF --
RIGHT.
SO AT ITS CORE, THE MODEL IS
STRONG.
WE HAVE TO BE COLLABORATING.
IT'S RIDICULOUS THAT EACH
PROGRAM IS EXPECTED TO CREATE
THEIR OWN CURRICULUM FROM
SCRATCH, MAKES NO SENSE.
THE HISTORICAL ISSUE HAS BEEN
ACCESSIBLE CREATION.
ON THE INTERNET YOU HAVE TO BE
ABLE TO PICK IT UP AND IT WORKS.
A COUPLE ARE CLOSE.
A GROUP IN -- A COUPLE GROUPS IN
PSYCHIATRY, A GROUP IN WOMEN'S
HEALTH, A GERIATRIC GROUP.
THE BEST IS NATIONAL ANTI-RACISM
IN MEDICINE CURRICULUM COALITION
LED BY CORY WILLIAMS AT
GEORGETOWN, I'VE BEEN CONSULTING
WITH HIM, IT'S GREAT.
THE IDEA IS THE SAME TO CREATE
SHARED RESOURCES OTHER PEOPLE
CAN USE, ESPECIALLY GIVEN THAT'S
VERY DIFFICULT TOPIC CONTENT TO
BE ABLE TO IMPLEMENT ON YOUR
OWN.
>> IS THAT -- CAN YOU SHARE THAT
LINK WITH US AT SOME POINT TOO?
>> YES.
GOOGLE NAMCC IT SHOULD GET YOU
THERE, AGAIN, IT'S CORY WILLIAMS
AND ASHLEY WALKER CO-CHAIR OF
NNCI IS CO-CHAIR OF THE NAMCC.
>> HOW DO WE GET PROGRAM
DIRECTORS TO AGREE TO TEACH AND
CHANGE THE TRAINING
REQUIREMENTS?
YOU KNOW, IN THAT SAME VEIN,
WHAT ARE BARRIERS YOU HAD TO
OVERCOME TO GET ACCEPTANCE FROM
INSTITUTIONS, FACULTY, TRAINEES
THEMSELVES?
>> YEAH, SIX QUESTIONS EMBEDDED
IN THAT.
FIRST INSTINCT IS NOT TO ANSWER
THE QUESTION.
WE HAD A COLLABORATION WITH U.K.
COLLEGE OF ROYAL PSYCHIATRISTS,
WE NEED TO BE DOING THIS.
BECAUSE OF THE WAY MEDICAL
EDUCATION IS SCRUBBING --
STRUCTURED, THEY WERE ABLE TO
SAY WE'RE MANDATING THIS IS PART
OF THE CURRICULUM AND ASSESSMENT
IF YOU WANT TO BE A PSYCHIATRIST
IN THE U.K.
THEY BUILT IT INTO THE
ASSESSMENT, CREDENTIALING
PROCESS, THAT WAS IT.
IT SHOWS HOW THINGS CAN WORK IF
THE STRUCTURES ARE BETTER
ORGANIZED.
HERE, WE'RE TALKING ABOUT THE
ACGME, WE'RE TALKING ABOUT THE
ACP WHO WRITES IN TRAINING EXAM,
ADPN, THERE'S SO MANY
ORGANIZATIONS THAT ARE INVOLVED
IT MAKES IT MUCH MORE
COMPLICATED.
SO, I THINK THAT PART OF THE
ANSWER, IF YOU WORK FROM THE TOP
DOWN, THAT IS ULTIMATELY THE
BEST WAY, BUT OUR STRUCTURES ARE
PRETTY CALCIFIED AND DIFFICULT.
IRONICALLY, IT'S BEEN EASIEST TO
WORK FROM THE BOTTOM UP THAT
WHEN STUDENTS SEE THE CONTENT
THEY SAY OH MY GOD, WELL, YEAH,
THIS IS WHY WE WENT INTO
PSYCHIATRY.
THE PERCENTAGE HAS SHOT UP OVER
THE PAST FIVE TO TEN YEARS
BECAUSE OF THE EXCITEMENT AROUND
NEUROPSYCHIATRY.
TRAINEES ARE LOOKING FOR IT AND
EXCITED ABOUT DIFFERENT
APPROACHES TO TEACHING AND
LEARNING.
THE STUDENTS HAVE BEEN
RELATIVELY EASY TO ENGAGE.
THE PROGRAM DIRECTORS ALSO TRY
IT, THIS IS REALLY COOL, IT'S
EASIER FOR THEM TO SAY, OKAY,
WE'RE GOING TO RUN THIS INSTEAD
OF CREATING SOMETHING FROM
SCRATCH.
>> SO ANOTHER QUESTION.
SOMEONE ASKED IF YOU DONE
COMPARATIVE EFFECTIVENESS
STUDIES, ONLINE MODULES VERSUS
TRADITIONAL TEXT BOOK OR ARTICLE
READING?
>> YES, GREAT QUESTION.
A WHOLE LONG THING.
SHORT ANSWER, WE DON'T HAVE
GREAT DATA TO SHARE AT THIS
POINT.
WE'VE-- THE TRADITIONAL WAYS
PEOPLE ASSESSED TENDED TO BE
FACT BASED.
THERE AREN'T GREAT RESOURCES
THAT CAME BEFORE.
WE'RE REALLY FOCUSED ON THE
CONCEPTUAL FRAMEWORK LEVEL.
I'M REALLY CURIOUS WHAT DATA ARE
GOING TO SHOW FOR ONLINE
LEARNING.
WE JUST DID THE OPIOID USE
SESSION, THAT QUESTION IS
FASCINATING, NICE DATA.
AT THE START OF THE ONLINE
COURSE, DISTURBINGLY ONLY --
THERE'S A SLIGHTLY LONGER
VERSION OF THAT PROMPT BUT IT'S
BASICALLY THE SAME.
ONLY A THIRD OF PARTICIPANTS
RECOGNIZED WE MASKED A LITTLE
BIT AS SOMEBODY WHO IS INPATIENT
FOR ENDOCARDITIS FROM I.V.
HEROIN USE, A THIRD RECOGNIZED
O.U. D AND SAID WE SHOULD
PRESCRIBE.
BUPRENORPHINE AND METHADONE,
YOU'RE SEVEN TIMES MORE LIKELY
TO DIE IF YOU'RE ON ONE OF THOSE
AND HAVE OUD.
A THIRD OF LEARNERS KNEW THAT.
WHICH IS IS ASTOUNDING.
AT THE END IT WAS 95%.
SO, I FEEL QUITE CONFIDENT WE'RE
GETTING WHERE WE NEED TO GO,
ABLE TO SHOW LEARNING OUTCOMES.
I'M CURIOUS TO SEE TODAY'S DATA.
I DON'T KNOW HOW MANY PEOPLE
HAVE DONE THE EXERCISE.
IT'S GOING TO TAKE SOME TIME TO
GET THAT KIND OF DATA.
>> ALL RIGHT.
A QUESTION ABOUT WHETHER ANY
MODULES CONTAIN CONTENT ABOUT
THE DEVELOPMENT OF THE BRAIN AND
HOW THEY MIGHT BE APPLICABLE TO
CHILD AND ADOLESCENT PSYCHIATRY?
>> YES, THERE'S A BUNCH OF CHILD
PSYCHIATRY CONTENT, IT SHOULD BE
TAGGED, THERE'S NOT ENOUGH.
WE'RE WORKING ON MORE.
>> THAT'S THE END OF THE
QUESTIONS THAT I HAVE.
AND I WANT TO SAY HOW MUCH THIS
HAS REALLY INSPIRED ME AND MANY
OTHERS TO, YOU KNOW, SIGN ON,
USE THE MATERIALS, GET
ENTHUSIASTIC.
I WOULD ENCOURAGE PEOPLE IN
OTHER FIELDS TO TAKE THIS
EXAMPLE TO KIND OF BE A CRUSADER
AS WELL.
THANK YOU SO MUCH, DR. ROSS.
CME ACTIVITY CODE, 36729.
WE'RE SO GRATEFUL YOU CAME ALL
THE WAY FROM CANADA.
THANK YOU.
THANK YOU, I REALLY
APPRECIATE IT.