 Dr. Rudy Navarri. Dr. Navarri is the clinical director of the Harper Cancer Research Institute at the Indiana University School of Medicine and is an adjunct professor of biochemistry. He is board certified in internal medicine and medical oncology and in 2012 he was named the associate dean and director of the Indiana School of Medicine. So welcome Dean Navarri. I want to tell you a little bit about a pilot project that we've done about trying to enhance the communication skills of our medical students and according to Paul Helf, some of the medical oncologists, I need some of this as well. So we, I'm sure all of you have this kind of experience in your medical school. The first year of medical students, we teach them about history taking and physical examination. Second year we put them into patient contacts and you expect them to do well. But we don't tell them that not all the patients are the same about the ones that we described in year one. And then in the third year we put them in clinical clerkships and we're surprised that they sort of have problems communicating with patients. And then of course in the fourth year we do clinical electives and take their 15 patient tests in a regional center and don't do well as well. So the question is why are students not doing well? Well part of the problems is that they have to deal with real patients in terms of depressed patients, anxious patients, angry patients, patients who don't talk to them or patients who talk too much. And they don't really know how to do this. So we started a pilot project funded by the Robert Wood Johnson Foundation to talk a little bit about how they can actually approach real patients. And we did some training with patient actors. We have some clinical intensive care nurses that we've trained as actors. We've also were fortunate to use some actors from the film, the television theater program at South Bennett University in Notre Dame to help us to present some of these scenarios. And we started out with talking with the patient. Now I know there are surgeons in the room and I don't want to offend anybody but one of the scenarios we did with patient actors and actually some of our clinicians on staff is orthopedic surgeon in the doorway who looks at the MRI and says you need a new knee. We'll schedule you. And we did this scenario and expressed to patients this is not, that's the students, this is not what you're supposed to do. I'm sure some of you have seen some of these activities. Now we also did a scenario with the laptop, the cell phone, and the iPad in the exam room. Now I'm not going to ask for hands of people who take their laptop in the exam room and the laptops between the physician and the patient and the physician treats the laptop or the iPad. Okay and we did a scenario to tell the patients this is not what you're supposed to be doing. Okay and again I don't know what you do but I don't take my laptop or my iPad in the exam room. I basically review the patient's history before I go in and I don't bring any of my devices in the room. That may be more time-consuming but I would, I would strongly suggest this is not good medicine not does not enhance patient communication so maybe you should leave your device in your office before you come to see the patient. And then we did a scenario where we do an informative patient office visit about coming in providing an adequate salutation, sitting down, asking the patient about how they're doing and how their life is going and then talk to them about the medical problem. And after we did this we went and did patient scenarios with a depressed patient with with our actors and we actually did the depressed patient, the anxious patient, the angry patient, an introvert, an extroverted patient. We actually had had scenarios in which they actually saw this and we also used film clips that were available on the internet for these patients and they could actually see how these kinds of patients would present and then we had them do this with our patient actors and actually film that. An example of one of the things we did is breaking bad news. As an oncologist I do this often. Okay so it's one of my particular interests and some effective film clips and you may be familiar with these. Lorenzo is a film clip of a child who had essentially a very bad prognosis due to a genetic illness and the physician sat down with the patients with the parents, child was somewhere else and basically explained to them the bad prognosis. It was very effective, very well done and I think it's displayed to the students how these kinds of things should be done. You may may not have seen terms of endearment in which a woman was being examined by her physician. She brought to the physician's attention that she had a lump under her arm. The physician discounted it as nothing. Call her to go ahead and go on vacation and we'll take care of when you come back. The next scene was I must admit the oncologist hovering over the bed with a patient in the bed telling her that she had a poor prognosis and she needed to get her life in order. Again an example of a bad way to break back news. And finally we actually did a scenario with the shootist. Some of you may remember this. This was with John Wayne and Jimmy Stewart. John Wayne was the gunfighter. Jimmy Stewart was the physician and John Wayne comes in saying, Doc, you freed me a number of years ago and I got well. Now I have bad, bad pain in my abdomen and I want you to examine me and tell me what I have. And then the next scene was Jimmy Stewart the physician sitting down with John Wayne the patient and did a really outstanding job of breaking bad news and really a good example of how this was done. I think the film clips, the patient actors, nurses we had really I think taught and showed students what they really should be doing. This was superimposed on their history and physical examination which is normal part of their training. We also did some counseling skills for the students. This is a very good website. You can look at active listening, asking questions, paraphrasing and summarizing, saying achievable goals and proposing action items. Now you may think this is overload for these students but you know and I worried about this but it really wasn't overload. I think it showed them things that they would really see and encounter with real patients. And so this actually worked very well. We actually did some education on palliative care settings with strong withholding interventions. I'm sure you recognize this four-pronged approach which was outlined in Mark's book Medical Indications, Patient Preferences, Quality of Life and External Factors as the things that they should consider in palliative care settings. So we did all this in year one and I think that the students actually were very interested and actually in after some practice sessions did very well. In year two we actually did all these scenarios with the students, with patient actors, patient in denial, emotional distraught patient, angry patient, overwhelmed patient, depressed palliative care options and caregiver issues. So this was the end of year two in which all the students had to go through these scenarios to deal with these experiences. And then in year three in their clerkships, in their clinical clerkships, we had them go through these scenarios with real patients. And these were observed by their clinician faculty mentors. In some cases they were filmed but in most cases they weren't because they were in the regular clinical clerkships seeing regular patients. And in pediatrics, a new infection to the patient and parents, internal medicine, new diagnosis of chronic illness, diabetes, hypertension, heart disease, a surgical intervention, prenatal care for OBGYN, a neurology, a new diagnosis of a new neurological diagnosis. And then when the students rotated in the emergency department we tried to have them take part in a interaction with a patient or mainly family post trauma. And some patients, some students did well, some students learned a lot and some students didn't do very well. So in summary, what we tried to do in this pilot project is to take these students through this. This is the second year we're doing this now and we're comparing it with another regional campus of the Indiana University Medical School system who did not get this intervention and we're going to look at the scores that they get in their fourth year, 15 patient evaluation. We hope that if we can show an improvement then we hope to be able to go back to the Robert Wood Johnson Foundation for additional funding. So we want to increase the awareness of the students, the communication skills, make them understand the need of communication skills, look at what skills are needed for specific patient interventions and have them practice these skills. Dr. Health had a third and a third and a third division. I have a third and a third and a third also. I think if you look at our medical students, and this is my personal opinion, a third of them communicate extremely well and you probably don't have to teach them very much. It's just they got that and I think you know who those physicians are. A third of our medical students need really some teaching and they can really improve their communication skills. And I must say a third of the medical students may not do well. Maybe those are the oncologists that we know about. I don't know. I hope not. So this is a power project. We seem to be on the right track. We hope that it will be effective as time goes on. Thank you.