IIE IDEAL Podcast: Episode 6
IIE IDEAL Podcast: Episode 6
Universal Design for Standardized Patient Programs
Guest Speakers: Kelsey Sherman, EdD. & Marlee Gaby-Dater, BS.
Recording Date: August 20th, 2024
[Announcer]
We acknowledge with respect the Seneca Nation known as the Great Hill People and keepers of the western door of the Haudenosaunee Confederacy. We take this opportunity to thank the people on whose ancestral lands The University of Rochester currently resides in Rochester, New York. To learn more about ancestral lands upon which we live and work. Please check out native-land.ca
[Kirstie McCormick]
Hello, and thank you for joining us for another episode of the IDEAL Podcast. My name is Kirstie McCormick, and I am a member of the IDEAL Committee. Our committee focuses on inclusion, diversity, equity, accessibility, and lifelong learning. Today we are discussing Universal Design with Dr. Kelsey Sherman and Marlee Gaby-Dater from the University of Rochester Center for Experiential Learning's simulation team. Kelsey and Marlee, would you mind telling us a bit about yourselves and what brings you here today?
[Kelsey Sherman]
Sure. So hi, this is Kelsey. I recently obtained my doctorate from the Warner School of Education and during my first course that I took there, I was partnered with somebody who, their focus was going to be about Universal Design. And so, she was telling me a little bit about it and then actually a lot of the work throughout my program was kind of focused around this idea of universal design and universal design for learning. That's how I ended up here and I'll pass it over to Marlee.
[Marlee Gaby-Dater]
Hi, everybody. So as Kelsey said, my name is Marlee, and I am one of the standardized patient education managers here. However, I did get my start as a standardized patient back in 2006 at the University of Rochester and was an SP here for many years before then moving to New York City and working at the medical schools there as an SP and trainer. And then I came back to Rochester and now I’m very grateful to be in this leadership position.
[Kirstie McCormick]
Well, thank you for being here today. We appreciate your time and thanks for going over some of your background and why you're here today. Let's begin with a basic explanation of what universal design is and why it is an important part of your standardized patient program.
[Kelsey Sherman]
Yeah, so universal design is the design composition of an environment so that it can be accessed, understood, and used by the greatest extent possible of all people regardless of their age, size, ability, or disability. And the founding father of this was an architect by the name of Ronald Mace. He was a student at North Carolina State University, and he faced inaccessible facilities while he was a student there. So, he got together a cohort of folks, and they developed seven principles to guide the design of environments, products, and communications. And then kind of as an off section of universal design is the universal design for learning, which is more focused on developing pedagogy and curriculum that is accessible for all learners. That is a little bit about the background of universal design and universal design for learning.
[Marlee Gaby-Dater]
Yeah, thank you, Kelsey, and I would say in terms of it being applicable and important to standardized patient programs, along with, you know, students where which it's intended original design, for lack of a better word, is because we have such a robust team of SPs. We have about 150 here at the university and that's quite comparable to a lot of other medical schools and their SP programs. And it's important that they feel included and not only with the emphasis on gender and ethnicity in the past few years, which of course is wonderful. But also, things like size and weight bias and ability. I feel like those are kind of the final pieces of equity and inclusion that we still have to work on, and especially in the medical field. And especially with SPs who are being used to practice physical exam skills with students and are those exams even accessible to them? For example, so that is why it is particularly important in this scenario as well. And also, education, and all of the medical students going to schools and this is also beyond just medical schools but just any healthcare training. This is where the learning starts. This is where it can be very successfully implemented before all of those folks head out into the real world. It's a really important time to be doing this work as well.
[Kirstie McCormick]
So, this is a great foundation for those individuals who are going to go out and need to make inclusive environments for their patients. It seems like this is a really good start for them. When you have a diverse pool of standardized patients. And then also what struck me there was the number of standardized patients that you have, which is essentially larger than some of the small businesses in Rochester have employees. So, it's a pretty large group. Which is great. And I know you work on expanding who you have in that pool every day. So, that's really important. So, what are some ways you and your team have implemented universal design into your program? And can you tell us a bit about the conference you recently attended where you discussed universal design implementations.
[Marlee Gaby-Dater]
And I can take the lead on this one, Kelsey. And then after if you'd like to talk more about ASPE. But we've actually taken a lot of steps, which is why we were able to present at the conference, which Kelsey will share about shortly. Because we've really developed this in all areas. As I mentioned earlier, body and weight bias as well as disability. So, I will also say, if anybody's listening who attended our presentation in Vancouver, we gave a lot of examples of things that happened within our SP program and also in my own experience as an SP that prompted many of these. So, there might be questions for some of those listening as to, well, how did that come about needing that? But just a few things I'll mention, but there are definitely bigger stories behind this all. But in terms of body size bias, we actually only had one size of blood pressure cuff available for our SPs in each of the PBLs, or problem-based learning rooms that are here on site at the CEL. And that one size is not one size fits all. So, what we have done is we have purchase small and large blood pressure cuffs for each of those PBLs. We also have various gown sizes as well for SPs because that is also something that is not, though they are, can be quite uh large, it's still not one size fits all. And also, yeah, some people might drown in them as well so, it's important to have various options for our SPs and as well as patients as well. So, this isn't only stemming, again, in our program, but also out in the world. I know folks that go to the doctor's office and even there, they might not have a blood pressure cuff that fits them properly. So again, such an important reason why we're doing this work at this level. And then in terms of a weight bias, we would often get requests from faculty, especially when doing physical exams or ultrasounds for thin, smaller framed SPs because it's easier to find and listen to the various organs and such, right? To which we have now said, we will give you the SPs that we will give you because it is important, especially based on the demographics of this country to be able to find organs and listen to different organs in any body or shape, and especially in the learning environment, what a great opportunity to do so. So now we recruit all different sizes for that. We've also had some cases that were a bit outdated and stereotypical, especially in terms of like diabetes and nutritional counseling. So, we've also been working with faculty in editing those cases and making them less stereotypical. And including less weight bias. And we're also very excitingly working with the Office of Equity and Inclusion on collaborating on a weight bias workshop to be able to offer this education, not only to students and learners, but also practicing clinicians all throughout the county, really. So that's something that is really exciting and we're hoping to implement SPs into that as well. So more to come about that. And then as I mentioned, we also talked about disability. And so that includes things like invisible physical disabilities. So, we had some SPs who do have those, and we have different accommodations. Like having a stool for the exam tables and the PBLs that are electric and they don't have a stool that kind of lets the like one of the pullout stools at the bottom of an exam table. So they had difficulty getting onto the exam table in those PBLs. We have little stools on those certain PBLs. We also try to assign the SPs who have difficulty with mobility, rooms near the elevators, or if they have to go into multiple rooms, having them close by each other. So those are some of the things that we've done there. And also, if we have SPs with mobility difficulty that are working in other places like the School of Nursing, which we provide SPs for, we also give them a heads up and say, hey, these are the accommodations that that these folks will be needing. And then we've also done a lot of work in terms of visual impairment. We did hire our first blind SP this year, which is very exciting. And we found that there was a lot of really wonderful resources in disability compliance on site. So, we were able to, if need be, provide a special laptop for this individual, with a special software. We also had an SP who had their own laptop though that had a keyboard that it pops up Braille, which is really cool. And we had them come in and practice doing checklists with us and they also came in with their mobility specialist to get used to the location and really exciting. They work with the Commission for the Blind and so we actually had them come on site. And Kirstie, you were there as well and do vision sensitive sensitivity training on site, which was very insightful for lack of a better word. And the last thing I want to do there too is start integrating this into the curriculum for the medical students so they could get to work with a blind individual. So that's something we've been in talks with faculty about. And then the last piece that we've been working on is folks who are hard of hearing. And we have three SPs who are deaf and so we've worked with deaf professional interpreter services to see what's available in terms of making sure that there's interpreters there. And there is a program called Deaf Strong Hospital that's already part of the medical education for the first years. But they don't even work with SPs or deaf individuals for that. They work with each other and learn basics, the alphabet of sign language. And so, this is also something that we're really hoping to integrate into the curriculum and also use these SPs with lived experience. I know that was a lot, but we've been doing a lot, so I wanted to give a shout out to each of those things.
[Kirstie McCormick]
No, that's great to hear all of the progress you've made to help students understand different disabilities and making it accessible for everyone making sure that those PBLs are inclusive and that your SPs cans be in their role and do it successfully. I think that it's really important given my own history and experience in the medical field. And knowing how I've been treated by medical professionals, knowing that you are creating a better foundation for students to understand that not everyone is just prime health. Yes, they're coming in sometimes for an illness, but they're not always coming in with the typical the typical body type or the typical mobility or also learning through your changes in the program. How to adapt to their exam rooms in the future too, I'm sure.
[Marlee Gaby-Dater]
Yeah, and before Kelsey steps in to talk about the conference we went to I think everything you just said is very important, especially because we have had some pushback with some folks that we work with externally that you know are a little bit apprehensive to work with SPs that might need accommodations because it might be more difficult for the student. To which our SPs would say, well, this is real life practice. This is what my doctor does when I see them. They put out a chair for me because the exam table is uncomfortable. So, I think it's important to kind of develop that awareness for all of us. Because yes, we are set in our ways because a lot of times these waves are very successful. But I think it's important to expand our outlook to say, oh, right. They're still a real patient and this is the real thing that would happen. So, you know, and I also think you know not protecting the students from seeing a slight, you know, quote unquote more challenging individual because they have an accommodation. I think the students, especially what they share with us is that they're itching for more. They want to be challenged. And also, the new generation of learners is all about inclusivity and equitability so I think this is something that we should not shy away from anymore. I think it's something that can be integrated even sooner and also like what a wonderful opportunity I'm sure any learner would be like, oh, I'd love to be in the room with that SP who's got that lived experience of a disability, et cetera.
[Kirstie McCormick]
I can imagine that having an SP that's just like perfect scenario is not very helpful for a medical student in the end, right? Yeah.
[Kelsey Sherman]
Right. Mm-hmm.
[Kirstie McCormick]
So that's great. This is great work. Thank you for sharing. That is not too much. I hope that there's more and it just keeps growing. But Kelsey, do you want to share a little bit about the conference that you attended and how you got to that conference just because you had to apply to be a part of that, correct?
[Kelsey Sherman]
Yeah, so we were presenters at the Association for Standardized Patient Educators annual conference. This is an international conference. With, oh gosh, I don't know how many off the top of my head, but many, many schools were there from all across the globe and it was just a really neat opportunity to network with other folks in this field and see where other programs are excelling in how we can learn from them and then maybe help other programs to grow by sharing knowledge that we have. And so, it's a really, really neat community and I remember when I attended this conference for the first time a few years ago. This line of work I was not familiar with, initially. And so, I was like, oh my gosh, there's other people here that know what I do and understand me and understand what I'm talking about when I say like SPs and they understand my woes. And so, just being with those folks has been super helpful and like Marlee was saying before, we've noticed that at these conferences in the past, there's been a lot of recognition and a lot of presentations, a lot of workshops around race and gender and incorporating that and how to enhance that within your programs. But we took it from a different lens to try and integrate that and into the conversation as well. And our presentation was highly attended, which was awesome. And we hope that we're able to present in the future to the same group of folks and show, look, these are the changes that we made and this is what we've learned along the way keep our community up to date with what we're doing and how we can help other institutions in the same realm. Like I mentioned at the beginning of this podcast, this is an area that I have been interested in for a very long time and so…and I wrote many papers on this during my doctoral program and so I had this idea Last year about maybe submitting something like this and then in talking with Marlee and Keri. It just kind of like built on from there, we submitted an abstract and it was accepted. That's how we were able to attend that conference.
[Marlee Gaby-Dater]
Yeah, and I'd actually love to piggyback on that as well, and share that everybody you know, as Kelsey said, it was very well attended and folks were coming up to us in throngs afterwards just like, “This is so needed. Oh my gosh.” So, this is definitely something that people and programs are craving and we hope to continue to do So if anybody wants to help support us in doing that, we would be very grateful. But I did want to share a little bit as well about how exactly we became on this topic because It's so interesting because Kelsey had, you know, presented to us like to Keri and I, my fellow SP education manager about presenting for ASPE and something to think about. But we didn't really have an idea yet of a topic or anything, but we did have an experience where we had hired a bunch of new SPs last year and they came on site to do physical exams for the first time and it happened to be a day where the first year medical students were learning vital signs, which includes taking blood pressure. And one of our SPs came up to us after and I asked them, you know, how it went. And they said, “Well, it was great, except the blood pressure cuff wouldn't fit me.” And… For me, I had that moment kind of a flashback of my own experiences as an SP and having that happen and being really embarrassed and feeling ashamed and always you know being worried about if one of those days of the blood pressure cuff would happen again and not feeling able to speak up about it because I was embarrassed about my size and that the blood pressure cuff didn't fit. So, what was so meaningful for me is one that we've established an environment that's full of safety and open communication so that this SP felt comfortable sharing that with us in the first place. And then also it was empowering because we were in a place to do something about it. So, I asked Sarah Bond, she's now, she was formerly called the Lab Technician. Now it's the Simulation Assistant, I believe, Kelsey. We all got new titles, as everybody knows. Yeah, CPM. But she orders things and like supplies from Medline for us. And so, we inquired about, okay, can you let us know what the large blood pressure cuff price would be and if they're available? And they were double the price, I think even more than double the price of a regular blood pressure, quote unquote regular blood pressure cuff. So that was pretty shocking and jarring to us. And that kind of really prompted this whole topic. So, we're very grateful to that SP for reaching out to us. And as we mentioned, we now have all different sizes in each of those rooms. But this really spun off a whole a whole new gamut of topics to look into and eventually submit to be presented at ASPE. And yes, that was a selective process. So not everybody who submits gets to present so It was quite an honor and also we got an hour time slot Some folks get a shorter time slot, so they definitely saw the merit in what we had to present so Yeah, go us.
[Kirstie McCormick]
That's really great. I have so many things I could go off of from that conversation. In terms of even just getting supplies that are useful for your SPs and having that cost difference. And then you said, you know, you have some pushback from certain people, I'm assuming it was faculty in terms of implementing these measures. So, you probably come up against a lot of barriers as you're going through this and how do you navigate those and maybe give an example of what you have done to make sure that this runs smoothly and that you can continue to do that work.
[Marlee Gaby-Dater]
Yeah, I'm happy to share about that because as I mentioned, we work in an institution of education. So there's curriculum and things are created the way they're created and it's very thought out and well thought out And so I think, you know, for Keri, Kelsey and I, we were so excited to start initiating some of these SPs who are visually impaired or hard of hearing like straight away like day one with the first year medical students. But because we're not in the education background particularly in terms of the medical education side of things. And how, you know, it's all we provide SPs you know maybe a course or two, but there's all these other courses and things that are being considered. And so, we have had actual faculty who are very receptive, but also reminded us that this might not be for a first year medical student. It doesn't mean that it can't be for a medical student at all because they do see the importance of students getting experience with these folks. But it would probably fit better with like a second or third year student. So, where we had like, you know, we were so energized after conference to start getting those people in. And so that was a little bit of a, oh, because right, we were excited. We wanted to get him in right away. However, it definitely makes sense. And so, this is all about you know unifying resources and those faculty members are, you know, keeping this awareness about this and ways to integrate this. So that makes us feel very hopeful in that regard. So, we could look at it as kind of a barrier or a slowdown, but I think the energy has been put out there, the awareness has been sprinkled. So hopefully we'll be able to find a better fit for these opportunities. But that's just an example of one course. We obviously have many different courses, many different departments, and other educational schools that we work with. There's lots of opportunities and we have started to integrate these folks But a little bit slower than we would have hoped for.
[Kirstie McCormick]
And then have you found, at least when you were at the conference, that the other universities are not doing this type of work? Are they not making these changes at all? Maybe they come up against even more barriers.
[Marlee Gaby-Dater]
Correct. A lot of folks came up to us afterwards and said, you know, we've been wanting to do this and change this, but it's so hard. Because there is that kind of separation right between the curriculum and the simulation team. And so, we're not there necessarily, when cases are being written and course guidelines and outcomes are being discussed. So that can be difficult because there are so many people involved. But we do have a really wonderful relationship with the curriculum team here and they're so supportive of us and love the standardized patient program and see the value of that. So, we're definitely hopeful, but we definitely heard a lot of stories from folks in other universities about this very thing and how it's been very challenging to integrate these folks. It's definitely a need for sure.
[Kirstie McCormick]
Can you share a personal story where Universal Design made a positive impact?
[Kelsey Sherman]
Yeah, so I this is maybe like a roundabout way to answering this question, but I think the positive impact that it's had is just like opening my eyes to seeing all of the inequities there are in our society when it comes to ability. So, for example, there's a building on the River Campus that was recently built within the last 10-15 years. And it's a beautiful big building It has this big grand staircase that leads up to the front of this beautiful building. However, the accessible entrance is down around the back of the building. So, what kind of messaging is that sending to learners with disabilities that you can't enter the building at this beautiful front entrance, the front entryway, you have to go around the back. And it brings you down at the ground level. Or the basement level, whereas if you're walking up the stairs and entering through the main doors, you're on the first level. So again, just like some of these inherent like things that I didn't think about before, wasn't privy to before. It's just really opened up my eyes and it has I guess like energized me more to like continue this conversation and bring it to folks and like let them know like yeah when you're out at a restaurant like where is the accessible entrance? Is it down the random hallway near the bathrooms like that's where people that have disabilities or mobility impairments have to enter to eat dinner like what? And so I think that's been my experience. And again, I know it was like a bit of a roundabout, but yeah, just hoping to continue the conversation.
[Kirstie McCormick]
No, I don't think it's a roundabout at all because there's so many different people involved in these conversations and you never know who and which career, you're going to stumble upon that you need to discuss these options with, right? And how to make something more accessible. My sister is an interior designer and I talk to her all the time about accessibility because she's actually making those built spaces and that's a huge consideration for them. I mean, yes, there's standards, but then like you mentioned, there's more to consider than just the standards. How are we making this look for people who need that accessibility and having it in the back is that really like, I feel like that almost makes it like that shameful. Right? For those individuals. So why is the back entrance used and not a primary spot? Or why wasn't it just all built to be accessible to begin with, right? Which is essentially where we are heading and where we want to be. Are there any other examples you wanted to share? I don't know if Marlee has one to share as well.
[Marlee Gaby-Dater]
Yeah, well, I obviously we've been on the other side of making a positive impact for our SPs. But I also had an experience of universal design but inadvertently, I don't think They realized it at the time what it was. But back when I was an SP, in New York City at New York City. So, this is probably, let's see, it could have been anywhere between 2011 and 2020. But at one time I started doing some work with them as a nurse. And so, I needed scrubs. I had also worked at other medical schools in New York City and had to play nurses and basically all the scrubs they had were like one size and way too tight for me and I just kind of suffered through that. However, NYU was the first school that had multiple sizes and it happened to be that my size was purple, which is my favorite color. And the SP manager there had kind of, I think, realized kind of the situation and said, you know, usually we return things that we wear like gowns or something afterwards, but she said, I know you work at a lot of different places, so if you'd like to keep those to use, you can. And so, I use those at all the different schools and it was so nice to feel comfortable and not restricted while I did my job. You knw? So that was really a positive impact for me, when I was SPing and something that I actually saw this colleague at ASPE and they attended our workshop in Vancouver and I told them the story and they didn't even remember or realize like, you know, what an impact that was. So that was pretty special to kind of have that full circle moment.
[Kirstie McCormick]
Yeah, what a great moment to have with someone to show them that what happened may have been some of the inspiration behind what you do, right? I'm sure it inspires you every day when you think of that moment. I think those moments are what drive us. A lot of the time. So for listeners who have never heard of Universal Design, how might you suggest they implement this into their programs? Maybe when we think of the people we work with in our department, is there a way that they can make sure that they're focusing on making environments universally acceptable for all people?
[Kelsey Sherman]
I would first recommend anybody reach out to Dr. Lisa Brown and her team of instructional designers. They are incredible and Lisa is just a wealth of knowledge when it comes to universal design for learning. So, I would highly recommend any of our colleagues that are interested in this topic or interested in how they can make their websites or their content, their course content, any of that more applicable or usable by everybody, reach out to that team. Just wanted to give her a little shout out because truly they're a great team.
[Marlee Gaby-Dater]
Yeah, I was also going to say on-site resources. There's actually so much that I didn't even know was available. That even if you're not a faculty member and creating course content, that it's still available for you as a UR employee. So, there's really so much even just looking in the website as well. And also using, you know, disability accommodations and compliance and OEI and all of the things there's actually a lot of resources and work being done in this area, which is very exciting.
[Kirstie McCormick]
Also, it sounds like we have both of you to reach out to as great resources as well as you develop programs. We may just have a question that resonates with what has been discussed here and we could present that to you, right? Maybe get a little a little input.
[Kelsey Sherman]
For sure. Definitely.
[Kirstie McCormick]
Great. So, we like to ask all of our guests if they have any recommended resources or anything that our listeners could either watch or read through that would give them some additional information.
[Kelsey Sherman]
Yeah, so I would recommend folks check out the CAST website. So, it's C as in cat, A as in apple, S as in snake, T as in tiger dot org. And that is all of the information about universal design for learning and um and universal design and just gives you like so many resources. There's videos, there's pictures that show how each of the stages are broken down. The seven principles that I mentioned at the beginning are explained here. So that is the website that I would turn to. There's also, through the US Department of Labor, they also have a specific web page dedicated to universal design resources. So, I would Also recommend that website to folks.
[Marlee Gaby-Dater]
And for me, I think because of my own lived experience, weight bias is really important to me and there's not a lot out there, especially in terms of medical education. And so, while we were preparing for a presentation, we were looking at different journals and articles and We found one in the Clinical Obesity Journal from 2022 that was titled, Interventions for Reducing Weight Bias in Healthcare Providers. And they did all of these studies and researched all the different methods of having weight bias education and how successful different ways of doing it are, and also the data that shows that this does make a difference, especially in the educational setting when folks are still learning in school and things like that. So that was very inspiring and helpful. And that's an article you can even just log on to the URMC library site and access their online journal. So, I would definitely say to check that out.
[Kirstie McCormick]
So, is there anything else you'd like to share today before we end the podcast?
[Marlee Gaby-Dater]
Yeah, we actually included a testimonial from one of our SPs who is disabled in our presentation. And we thought it would be a nice way to end this podcast and really share that population’s experience. And she was talking about an incident that happened and this is what she had to say, “It as exhausting as a disabled person for the responsibility to always be on me to see that my needs are met. This is the main flaw of disability models worldwide. Accommodations should be the rule, not the exception. It is incredibly frustrating to encounter attitudes like this in a medical education environment where better behavior should be practiced and modeled for the students. I think the need for accommodations should be baked into the system. I know that the need for standardization means that SP disabilities can interfere with student assessment, but that is not always the case. My disability and the dynamic nature of it should not be a barrier to my working with students. People like me have a vested interest in the education of these students as I will continue to utilize the medical system more than the average person. For their sake in mind, we must do better. As we say in the disabled community. “Anyone can become disabled. It's a matter of when, not if.”
[Kirstie McCormick]
Thank you so much for sharing that. That gives me chills. I do agree that there's a lot of improvement needed. And I, like I've said throughout the podcast, I think that giving students this foundation of working with individuals who are diverse and who have disabilities and have differences is key to making everything more accessible for patients. And ultimately, you want them to be able to be the best doctors they can be. And this is how you start that. Thank you both for all the hard work to do that.
[Marlee Gaby-Dater]
Our pleasure.
[Kirstie McCormick]
Thank you again for tuning in to the Ideal Podcast. Next month, we will have a session on Indigenous culture, and we hope you will join us again. Please refer to our email that will be sent out with additional resources on Universal Design for Learning. Have a great day.