Latest / Becker’s Healthcare Podcast / Teaching Empathy and Compassion in Dental Education with Dr. Leonardo Marchini & Dr. Brendan Young

Transcript

Teaching Empathy and Compassion in Dental Education with Dr. Leonardo Marchini & Dr. Brendan Young · Becker’s Healthcare Podcast

• 0:00
  - Hello. This is Cameron Cortejano with the Becker's
• 0:02
  - Dental and DSO review podcast.
• 0:05
  - I'm thrilled to be joined today by doctor
• 0:07
  - Leonardo Marchini, professor and DEO of the Department
• 0:10
  - of Preventive Community Dentistry
• 0:12
  - at the University of Iowa College of Dentistry,
• 0:15
  - as well as doctor Brendan Young, director of
• 0:18
  - behavioral science of preventive and community dentistry at
• 0:22
  - the University
• 0:23
  - of Iowa College of Dentistry. Doctor Marchini and
• 0:25
  - doctor Young, thank you so much for being
• 0:27
  - here today. Thank you.
• 0:28
  - Thank you for having us.
• 0:30
  - Absolutely. So just to to start us off,
• 0:32
  - do you both just wanna share a little
• 0:34
  - bit about your background, roles, all that good
• 0:36
  - stuff?
• 0:37
  - Absolutely. I'm Brendan Young. I am the director
• 0:40
  - of behavioral science at the College of Dentistry.
• 0:42
  - I'm also an associate professor in preventive and
• 0:44
  - community dentistry,
• 0:45
  - and I am not a dentist. My background
• 0:48
  - is in, health communication.
• 0:50
  - Hold my PhD in communication studies,
• 0:53
  - and I've been at the College of Dentistry
• 0:55
  - full time for about five years in my
• 0:58
  - current role, which was a a role that
• 1:00
  - was created at the College of Dentistry for
• 1:01
  - Behavioral Science.
• 1:03
  - And increasingly, we're seeing these at other colleges
• 1:05
  - of dentistry across the country. And, those of
• 1:08
  - us that fill these roles are in have
• 1:10
  - different,
• 1:11
  - backgrounds, psychology, social work, communication, sociology,
• 1:15
  - and dentistry. So I'm happy to be here.
• 1:18
  - I think doctor Young is being a little
• 1:21
  - modest.
• 1:22
  - I think his program has modeled many of
• 1:26
  - other programs
• 1:27
  - across the country, and he has produced,
• 1:30
  - amazing scholarship showing
• 1:32
  - how, behavioral science program
• 1:35
  - can improve
• 1:37
  - the qualities
• 1:38
  - we look for on
• 1:40
  - a dental graduate.
• 1:42
  - As for myself, I am Leo Martini. I
• 1:44
  - am a dentist. I am the,
• 1:48
  - a professor and chair of the department of
• 1:50
  - preventive and community dentistry here at the University
• 1:53
  - of Iowa College of Dentistry.
• 1:55
  - And my whole my role here is just
• 1:57
  - to,
• 1:59
  - support the amazing work that doctor Young does
• 2:02
  - by helping
• 2:04
  - in some capacity to implement the more clinical
• 2:08
  - parts of it
• 2:09
  - as it is needed,
• 2:11
  - because
• 2:12
  - we can't emphasize the importance of the topic
• 2:15
  - anymore.
• 2:16
  - You know? That's what the patients
• 2:19
  - the characteristic
• 2:20
  - that patients look
• 2:22
  - most,
• 2:23
  - in a dentist.
• 2:25
  - So
• 2:26
  - Awesome. Thanks so much
• 2:28
  - for those introductions.
• 2:30
  - I just wanna jump right into it and
• 2:31
  - and kinda get into your with your recent
• 2:34
  - research.
• 2:36
  - What prompted
• 2:37
  - you to focus on empathy and critical thinking
• 2:41
  - as highlighting those as as two skills that
• 2:44
  - are really important
• 2:46
  - for dental education to go alongside with the
• 2:49
  - traditional,
• 2:50
  - hand skills that that all dental students learn?
• 2:53
  - Well well, I'll go first.
• 2:55
  - Having not gone to dental school, one thing
• 2:57
  - that I observed on arriving is that, you
• 2:59
  - know, professional training in dentistry is necessarily clinician
• 3:02
  - centered. You know, students are here for their
• 3:05
  - own professional development
• 3:06
  - to become great dentists.
• 3:08
  - And often when that's the case, what gets
• 3:10
  - left out is the person centered approach that,
• 3:13
  - you know, the the broader health care system
• 3:15
  - is trying to to integrate into our our
• 3:18
  - health care system.
• 3:19
  - So that's sort of my job is to
• 3:21
  - bring in the patient centered point of view,
• 3:24
  - and I've had the good fortune to be
• 3:26
  - assigned courses. They're only one credit hour courses,
• 3:29
  - but I teach them throughout,
• 3:31
  - the sequence that students are here, the four
• 3:33
  - years that they're here. So I get to
• 3:35
  - pop up repeatedly,
• 3:37
  - in in students' days and just remind them,
• 3:40
  - their their patients and what their patients are
• 3:42
  - needing from them and their patients' perspectives and
• 3:44
  - how they differ from the clinicians' perspectives.
• 3:47
  - We try to integrate some patient centeredness into
• 3:49
  - all the courses, so it's not just me
• 3:51
  - reminding them of this.
• 3:53
  - I have the good fortune as well of
• 3:55
  - being in a culture
• 3:57
  - that I arrived in that that was very,
• 3:59
  - very,
• 4:00
  - focused on compassionate care and clinician, patient centeredness.
• 4:04
  - And I'll let doctor Marchetti talk about that
• 4:06
  - since he was here before I arrived, and
• 4:08
  - I think is largely responsible for that emphasis.
• 4:11
  - You know, this has been
• 4:14
  - a very important topic in dentistry
• 4:18
  - for a long period of time. It is,
• 4:21
  - the it's the fact that as our training
• 4:25
  - is very technical and procedure oriented,
• 4:29
  - it might
• 4:31
  - reduce
• 4:32
  - actually the empathy of the students as they
• 4:35
  - progress
• 4:36
  - throughout the dental school.
• 4:38
  - Some studies done,
• 4:40
  - a few decades ago have even shown
• 4:43
  - that there is a change in empathy,
• 4:47
  - reducing
• 4:48
  - empathy from the first years of dental school
• 4:51
  - throughout
• 4:52
  - dental school and then having a final uptick
• 4:55
  - but not going back to the initial levels.
• 4:58
  - And there is a lot of,
• 5:00
  - you know, anecdotal
• 5:01
  - evidence
• 5:02
  - of that too. I remember when I was
• 5:04
  - in dental school, a therapist who was then
• 5:08
  - giving us the psychology
• 5:10
  - course.
• 5:11
  - She,
• 5:12
  - used to say that, you know, when she
• 5:14
  - worked with d ones, the first year dentistry
• 5:17
  - students,
• 5:18
  - they were very empathetic and caring and all
• 5:20
  - that, and she did not see the same
• 5:22
  - empathy
• 5:23
  - and caring
• 5:24
  - and caring
• 5:25
  - on the d four, the last year dentistry
• 5:27
  - students.
• 5:28
  - That is thirty years ago, and it shows
• 5:31
  - that
• 5:32
  - inadvertently,
• 5:33
  - the the schools can have that effect. So
• 5:36
  - we need to be
• 5:37
  - intentional
• 5:38
  - infusing
• 5:40
  - that empathy and compassion throughout dental school to
• 5:43
  - keep it alive. There are students come in
• 5:45
  - empathetic,
• 5:46
  - and we want to keep that alive and
• 5:49
  - bring it to the forefront of their minds.
• 5:52
  - And that's what we try to do
• 5:54
  - with the program. And we are fortunate to
• 5:57
  - be in Iowa where, you know, empathy seems
• 6:00
  - to be, you know, part of the personality
• 6:04
  - of our students already when they come in,
• 6:06
  - and that helps a lot as well as
• 6:08
  - the community that surrounds us that's caring and
• 6:12
  - compassionate
• 6:13
  - overall.
• 6:14
  - Yeah. I think it's really interesting just
• 6:17
  - your your anecdote there where
• 6:19
  - you yourself have seen people coming in
• 6:23
  - super empathetic, and then they go through four
• 6:25
  - four years of all this technical training, and
• 6:27
  - then they kinda lose it throughout their way.
• 6:30
  - But get it back a little bit at
• 6:32
  - the end. Your work introduces
• 6:35
  - the the emulation
• 6:37
  - empathy reflection
• 6:38
  - model. How did this framework evolve, and and
• 6:41
  - why do you believe that it offers a
• 6:43
  - practical way to teach this compassionate care in
• 6:47
  - a a dental curriculum that that is obviously
• 6:49
  - jam packed, like you said, with a lot
• 6:51
  - of technical things.
• 6:53
  - I would give the word to doctor Young
• 6:55
  - because he is the mastermind behind it and
• 6:59
  - the experts that can explain it much better.
• 7:03
  - Well, thank you, doctor Martini.
• 7:04
  - You know, I think that the compassionate care
• 7:07
  - model on one level is just a good
• 7:09
  - idea. You want to treat your patients as
• 7:11
  - they would, want to be treated.
• 7:13
  - But I you know, that's not sufficient for
• 7:16
  - pursuing a model like the one we've developed
• 7:18
  - and the one that we pursue.
• 7:20
  - We try to ground everything in evidence. So
• 7:22
  - I've done a deep dive into the evidence,
• 7:24
  - much of it from the medical literature, but
• 7:27
  - increasingly,
• 7:28
  - also coming from the dental literature that there
• 7:30
  - are benefits to a compassionate care model and
• 7:33
  - an empathy,
• 7:34
  - based communication
• 7:35
  - practice. So for patients, we know that they
• 7:37
  - have, in compassionate care model, reduced anxiety, reduced
• 7:41
  - depression,
• 7:42
  - reduced reduced emotional distress.
• 7:44
  - There's some evidence of improving cardiovascular
• 7:47
  - health, immune function, glycemic control,
• 7:49
  - wound healing, overall quality of life, and even
• 7:52
  - survival rates.
• 7:54
  - But, you know, as we're empathizing with our
• 7:56
  - patients, I, as an instructor, also wanna empathize
• 8:00
  - with my students. And so as Doctor. Marchetti
• 8:02
  - was talking about the evidence that there is
• 8:03
  - a decline in in, empathy among students, I
• 8:06
  - try and understand why that is. And,
• 8:08
  - I think he sort of hit the nail
• 8:10
  - on the head that there's so many,
• 8:11
  - burdens placed on them and demands and stresses
• 8:14
  - placed on them during their time here that
• 8:16
  - empathy often gets crowded out. We know though
• 8:18
  - from a compassionate care model that there are
• 8:20
  - benefits for clinicians as well. There's evidence of
• 8:23
  - improved personal well-being,
• 8:25
  - reduced burnout, and enhanced perceptions of competency.
• 8:29
  - And all of those are particularly important right
• 8:31
  - now, especially in the wake of the pandemic
• 8:33
  - when burnout, you know, sort of hit record
• 8:35
  - levels and people were leaving the profession.
• 8:38
  - So I see something of a feedback loop.
• 8:40
  - You know, I talk in our article about
• 8:42
  - a a recursive
• 8:43
  - approach.
• 8:44
  - So what I see here is that enhanced
• 8:46
  - communication fosters treatment adherence, which improves patient health,
• 8:50
  - which makes both patients and providers,
• 8:53
  - more satisfied, and that creates relationships that foster
• 8:56
  - enhanced communication. So it always comes back to
• 8:59
  - having
• 9:00
  - positive communication and positive relationship encounters,
• 9:03
  - which which lead to all of these,
• 9:06
  - tangential,
• 9:07
  - but important health improvements?
• 9:10
  - I I would say that, you know, when
• 9:12
  - we look at com at providing more compassionate
• 9:16
  - care overall and one way to do that
• 9:18
  - is training our, students to be more compassionate,
• 9:23
  - The the benefits of compassion are across the
• 9:25
  - board. I mean, they they benefit the patients
• 9:28
  - directly as doctor Young has presented,
• 9:32
  - perfectly,
• 9:33
  - but they also improve their well-being of the,
• 9:37
  - providers. They improve the efficiency
• 9:40
  - of the health care system overall
• 9:42
  - because it improves, say, patient adoption of therapeutic
• 9:46
  - measures,
• 9:48
  - patient adoption patient abiding to their prescriptions,
• 9:52
  - patients
• 9:53
  - abiding to therapeutic
• 9:55
  - regimens,
• 9:56
  - and reducing cost
• 9:58
  - to the overall health system
• 10:00
  - and and improving patient satisfaction,
• 10:03
  - right, which is,
• 10:05
  - for many people considered
• 10:07
  - one of the most important,
• 10:10
  - outcomes of a health care system. Right? It's
• 10:12
  - having the public
• 10:14
  - satisfied
• 10:15
  - with the care they receive.
• 10:17
  - So
• 10:18
  - I think by applying the system that we
• 10:21
  - have been doing, we
• 10:23
  - can see
• 10:24
  - that,
• 10:25
  - being reflected
• 10:26
  - on the quality of care our patients receive
• 10:29
  - in the college, on the
• 10:31
  - satisfaction
• 10:31
  - of the students with their coursework,
• 10:35
  - and also the efficiency in the clinics going
• 10:39
  - up. So, you know, it's,
• 10:41
  - all around,
• 10:42
  - net benefit from compassionate care.
• 10:46
  - Yeah. Definitely. It sounds like kinda how doctor
• 10:49
  - Young was talking about that loop where it's
• 10:51
  - just
• 10:52
  - basically all positive benefits and and really no
• 10:56
  - drawbacks,
• 10:56
  - and one positive
• 10:58
  - leads into another, leads into another.
• 11:01
  - If I could just add to that, briefly.
• 11:03
  - You know,
• 11:04
  - one thing that I do is teach students
• 11:06
  - how to teach their patients about oral health
• 11:09
  - care.
• 11:10
  - And as I do that, I realize, well,
• 11:11
  - I need to incorporate a lot of what
• 11:13
  - I'm teaching my students to do in my
• 11:15
  - own curriculum.
• 11:16
  - So I increasingly follow the pattern that I'm
• 11:18
  - teaching the students, which is to observe behavior.
• 11:21
  - They are observing their patients. I'm observing my
• 11:23
  - students. Consider why it might be occurring, decide
• 11:26
  - how to respond, and then reflect on what
• 11:28
  - happened, and and then let that feed into,
• 11:32
  - you know, the next step of observing behavior.
• 11:34
  - So I've learned an awful lot from this
• 11:36
  - process of teaching students how to engage with
• 11:38
  - their patients about teaching.
• 11:41
  - And research has shown the importance of having
• 11:44
  - faculty who cares about
• 11:47
  - the students
• 11:48
  - on feelings
• 11:50
  - and,
• 11:50
  - and emotions and, how empathetic
• 11:54
  - faculty
• 11:55
  - are towards the students. It seems to be
• 11:58
  - one of the
• 11:59
  - most important predictors of, students'
• 12:02
  - empathy
• 12:03
  - towards their patients. So in other words, when
• 12:06
  - they have role models who treat them with
• 12:09
  - empathy, they tend to treat their patients with
• 12:13
  - with empathy as well. Does that make sense?
• 12:16
  - Yep. Absolutely.
• 12:18
  - One of the more
• 12:20
  - intriguing aspects
• 12:21
  - of this curriculum is the use of simulations,
• 12:25
  - peer patient experiences,
• 12:27
  - and structured self reflection.
• 12:29
  - Which of these interventions,
• 12:32
  - do you feel has had the greatest impact
• 12:35
  - on students?
• 12:36
  - And were there any unexpected
• 12:38
  - lessons that you learned?
• 12:41
  - I I hesitate to sort of rank my
• 12:43
  - assignments because if one did something better than
• 12:45
  - all the rest of them, I would use
• 12:46
  - that one all the time. I think that,
• 12:48
  - you know, the different, assignments and scenarios teach
• 12:51
  - different things. So students writing case analysis
• 12:54
  - learn to be more thoughtful in their responses,
• 12:56
  - while students when they work on standardized patients
• 12:58
  - learn to think quickly and accept in patient,
• 13:01
  - in person feedback.
• 13:02
  - So I think that they they function differently
• 13:05
  - in,
• 13:06
  - students' learning.
• 13:08
  - However, having said that, a feature of the
• 13:10
  - process seems more impactful from my point of
• 13:12
  - view, and that is recording students and requiring
• 13:15
  - them them to watch themselves and to think
• 13:17
  - deeply about how they interact.
• 13:19
  - That I think is is maybe one of
• 13:21
  - the more effective ways that we teach.
• 13:24
  - During the first three years of training, they
• 13:26
  - have to have patient encounters which are recorded,
• 13:29
  - and they end up having to afterward
• 13:32
  - watch themselves
• 13:33
  - on video
• 13:35
  - and fill out a very detailed template,
• 13:37
  - which includes the same rubric that they are
• 13:40
  - evaluated on by me and by standardized patients
• 13:42
  - and peer patients.
• 13:44
  - So they are from that perspective, having to
• 13:46
  - take the patient's perspective
• 13:48
  - of sort of evaluating themselves
• 13:50
  - from a patient point of view. And even
• 13:52
  - just watching yourself from more more objective,
• 13:56
  - third person perspective,
• 13:57
  - can be somewhat jarring as all of us
• 13:59
  - that have done that know. So it's so
• 14:02
  - detailed that they have to record the time
• 14:03
  - stamp when each visit stage begins and when
• 14:06
  - it ends. They identify what they did well
• 14:08
  - and what they need to improve on. Toward
• 14:11
  - the end, they're required to score themselves from
• 14:13
  - one to 10 on both their cognitive empathy,
• 14:16
  - meaning their ability to see the point of
• 14:18
  - view of the patient, and their emotional empathy,
• 14:20
  - their ability to emotionally
• 14:23
  - align with their patient. And they must explain
• 14:25
  - why they chose the number, and they have
• 14:27
  - to provide me with an example from their
• 14:29
  - visit of when they expressed cognitive empathy and
• 14:32
  - when they expressed emotional empathy.
• 14:35
  - So they, ultimately must reflect on the way
• 14:37
  - the patient provided feedback and what they learned
• 14:40
  - about giving feedback. So in addition to the
• 14:42
  - content they get back from the patient about
• 14:44
  - what they could do better or maybe what
• 14:46
  - they are doing well at, they also have
• 14:48
  - to to think about, well, how was the
• 14:50
  - way that they delivered that? Was that telling
• 14:53
  - me something that I could learn from when
• 14:55
  - I'm giving feedback to my patients or ultimately
• 14:57
  - when I'm in my own practice and giving
• 14:59
  - feedback to my employees?
• 15:01
  - So I think, ultimately, that recording is super,
• 15:04
  - super valuable, and it's hard to replicate in
• 15:06
  - any other sort of assignment.
• 15:08
  - Now to the point of your question about,
• 15:11
  - you know,
• 15:12
  - to technical aspects of,
• 15:15
  - of the curriculum of the those experiences,
• 15:18
  - I need to say that
• 15:20
  - it is
• 15:21
  - it is, time consuming.
• 15:24
  - It requires a lot of expertise.
• 15:27
  - I really think having an expert
• 15:30
  - in behavioral
• 15:32
  - sciences like doctor Young is,
• 15:35
  - crucial
• 15:36
  - for the success
• 15:38
  - of the program
• 15:39
  - because it requires
• 15:42
  - a really in-depth
• 15:43
  - knowledge of all the language,
• 15:47
  - behavioral,
• 15:48
  - and pedagogy
• 15:49
  - involved in on that that goes beyond the
• 15:52
  - training of a dentist. Right? So I think
• 15:55
  - it's really, really important
• 15:57
  - to have
• 15:58
  - resources,
• 16:00
  - time, but, fundamentally, the,
• 16:03
  - workforce
• 16:05
  - that is,
• 16:07
  - not only
• 16:08
  - engaged
• 16:09
  - with
• 16:10
  - the importance
• 16:11
  - of the topic, but also
• 16:14
  - have the necessary
• 16:16
  - expertise
• 16:17
  - to,
• 16:19
  - do it in an effective way.
• 16:22
  - Yeah. Absolutely. That makes a lot of sense.
• 16:24
  - And then looking ahead,
• 16:26
  - how would you define
• 16:28
  - success for this model?
• 16:30
  - And what type of evidence would convince you
• 16:33
  - that graduates are becoming not only technically proficient
• 16:38
  - dentists, which is obviously really important,
• 16:41
  - but also more thoughtful, empathetic,
• 16:43
  - in person centered clinicians,
• 16:45
  - which is also equally as important.
• 16:48
  - That's a great question because we do, as
• 16:50
  - I indicated earlier, always want to be evidence
• 16:53
  - based.
• 16:54
  - One of the challenges of this is that
• 16:56
  - you ultimately want your patients to give you
• 16:58
  - feedback
• 16:58
  - on how well you're doing. And, you know,
• 17:01
  - as dental patients, we often don't want to
• 17:03
  - give negative feedback to our dentist because they
• 17:05
  - hold so much,
• 17:07
  - power to, you know, help or harm us.
• 17:09
  - And so there's there's a
• 17:11
  - a a hesitation there for people to be
• 17:13
  - honest about their experiences.
• 17:15
  - We do, however, get patient evaluations. And when
• 17:17
  - we get those from our students here at
• 17:19
  - the College of Dentistry and our dental clinics,
• 17:22
  - they're always shared with faculty and with the
• 17:24
  - students,
• 17:25
  - who are the ones that,
• 17:26
  - were were reported by the the patients. And
• 17:29
  - and by and large, they are really, really
• 17:31
  - positive and often about the the communication that
• 17:34
  - the patient or that the student engages in.
• 17:36
  - We also have standardized patient evaluations.
• 17:39
  - My coauthor, Dean Johnson, David Johnson, and I
• 17:42
  - coauthored a study in 2023.
• 17:44
  - We found that eighty one point seven percent
• 17:46
  - of our d three student evaluation evaluations were
• 17:49
  - classified as excellent.
• 17:51
  - We discovered treatment planning was a particular strong
• 17:53
  - point.
• 17:54
  - We also discovered that we needed to work
• 17:56
  - on our health history recording,
• 17:59
  - so we have focused on that in the
• 18:01
  - interim.
• 18:02
  - Dean Johnson and I focused on the, we
• 18:05
  - developed a typology of empathic communication strategies based
• 18:08
  - on examples provided by our standardized patients.
• 18:11
  - We have published, doctor McQuiston and I here
• 18:14
  - at the College of Dentistry have published a
• 18:16
  - study on our poverty simulation,
• 18:18
  - and we found that attitudes about poverty and
• 18:20
  - patients in poverty improved by an average of
• 18:23
  - 9.4
• 18:24
  - points following our poverty simulation.
• 18:27
  - We also have faculty evaluations in the clinic.
• 18:30
  - The students in our,
• 18:32
  - clinics beginning in their first year are practicing
• 18:35
  - in the clinics and overseen by faculty, and
• 18:37
  - so they get daily or weekly evaluations in
• 18:39
  - the different clinics.
• 18:41
  - More recently, I've developed an AI chatbot
• 18:44
  - so students can practice their their verbal communication
• 18:47
  - skills and that artificial intelligence, large language model
• 18:51
  - gives feedback on their performance.
• 18:53
  - And,
• 18:54
  - finally, the student reflections,
• 18:56
  - as I mentioned,
• 18:58
  - that's a big part of of our curriculum.
• 19:01
  - I have not published anything on that yet,
• 19:03
  - but I have graded all of these, over
• 19:05
  - the years. And I can tell you that
• 19:07
  - students are very,
• 19:09
  - surprisingly honest. And so,
• 19:11
  - you know, they rarely give themselves perfect scores.
• 19:14
  - They always leave room for improvement, which is
• 19:15
  - something we emphasize here. So I'm continuing to
• 19:19
  - publish on this and hope to have more,
• 19:21
  - coming out in coming years.
• 19:23
  - This is the type of amazing scholarship and
• 19:26
  - assessment
• 19:27
  - tools that
• 19:28
  - we need for this field of
• 19:31
  - dental education.
• 19:33
  - And I am always amazed by the,
• 19:36
  - multiple points of assessment that doctor Young
• 19:39
  - is able
• 19:41
  - to,
• 19:41
  - compile for our students throughout their time in
• 19:44
  - dental school.
• 19:46
  - One thing that has also been observed
• 19:49
  - is that in the geriatric and special needs
• 19:51
  - clinic, which is in our department,
• 19:54
  - our
• 19:55
  - last year dental students are d fours,
• 19:58
  - see patients
• 19:59
  - who require
• 20:01
  - a lot of,
• 20:03
  - accommodations
• 20:04
  - of all types
• 20:05
  - so they can be seen in an ambulatory
• 20:08
  - setting. So in other words, those are patients
• 20:10
  - with
• 20:12
  - important
• 20:13
  - special health care needs, important,
• 20:15
  - disabilities
• 20:17
  - that,
• 20:18
  - include mental health issues, include dementia,
• 20:22
  - include,
• 20:23
  - intellectual
• 20:24
  - disability,
• 20:25
  - and
• 20:26
  - they are challenging. They have challenging behaviors.
• 20:29
  - They have,
• 20:31
  - challenging
• 20:32
  - attitudes.
• 20:33
  - They can be verbally
• 20:35
  - offensive at times, and we
• 20:38
  - and our students, our last year dental students
• 20:42
  - handle them
• 20:44
  - with a lot of compassion,
• 20:45
  - empathy, and care in the most extreme
• 20:49
  - circumstances
• 20:50
  - you would see in a dental office. And
• 20:53
  - I would say that
• 20:54
  - for me as a
• 20:56
  - clinician
• 20:57
  - teaching the next generation of the dental workforce,
• 21:01
  - that's pretty much
• 21:02
  - the proof in the pudding, right, that everything
• 21:06
  - that doctor Young
• 21:07
  - has been doing throughout these years
• 21:10
  - are having
• 21:11
  - the that final benefits that we wanna see
• 21:15
  - even when they are tested in the more
• 21:18
  - extreme
• 21:19
  - on their empathy and compassion. Does that make
• 21:21
  - sense?
• 21:22
  - Yeah. Absolutely.
• 21:24
  - I think you hit the nail on the
• 21:25
  - head with the finding the proof in the
• 21:27
  - pudding with all this. Well,
• 21:30
  - I wanna thank you both for joining us
• 21:32
  - today, doctor Marchini and doctor Young, and and
• 21:35
  - sharing
• 21:35
  - your valuable expertise insights,
• 21:38
  - into this topic. It's been a pleasure speaking
• 21:41
  - with you both, and I look forward to
• 21:43
  - connecting with you both again in the future.
• 21:45
  - Thank you so much for having us. It's
• 21:47
  - been a joy.
• 21:48
  - Thank you very much to you for having
• 21:50
  - us and to your audience to have the
• 21:52
  - patience to listen to us.
• 21:54
  - Thank you.