A collaborative pilot project at the University of New Mexico School of Medicine uses actors and simulation to help medical students learn how to care for people who are experiencing homelessness, mental illness, and/or substance use. Students practice Motivational Interviewing techniques and de-escalation and safety skills in a controlled environment with actors and experienced medical professionals. Consulting psychiatrist Nils Rosenbaum shares his perspectives on using Motivational Interviewing as a medical professional working on an outreach team.
Nils Rosenbaum is a psychiatrist on an Assertive Community Treatment Team (ACT) with the University of New Mexico School of Medicine. He consults with a pilot project that uses actors and simulation to teach medical students how to interact with and treat people experiencing homelessness, mental illness, and/or substance use.
The project uses actors who play the roles of people in distress. The acting is based on case studies of individuals who sought care at the Albuquerque Opportunity Center, which provides shelter and services for men. Medical students who have been trained in Motivational Interviewing, de-escalation skills, and safety skills interact with the actors to test the effectiveness of their skills. The project was developed by Dr. Cynthia Arndell of the University of New Mexico Schools of Medicine and Pharmacy, in collaboration with the Metropolitan Homelessness Project and the Albuquerque Opportunity Center.
Nils sees the simulations as unique opportunities for medical students to experience what it might be like to interact with a patient experiencing mental illness, homelessness, and/or substance use. “In the simulation, they are interacting with someone who is going through methamphetamine withdrawal and psychiatric symptoms. They have to remember the skills they learned and must integrate them in a very stressful situation. The next best option is to see real patients and discuss the patient cases with an attending physician.” He believes the simulation is an effective way of testing students’ skills when paired with formal teaching of skills, didactic sessions, memorization, and an understanding of how these skills fit into the medical model.
He once believed that empathy could not be taught, but his experiences have shown him differently. “Motivational Interviewing is one way of teaching empathy,” says Nils. He notes that people can learn empathy in different ways.
Nils shares that he came to his own work through a need for greater connection. “Many years ago, in my fourth year of medical residency, I realized that I wanted to do something different. I was churning through people and I did not feel connected. I decided to hitch my wagon to community psychiatry at Health Care for the Homeless with the medical outreach team.” Nils found he was able to offer an empathetic perspective and loved the work so much that he wondered if it would be something he could do professionally.He notes that there can be a gap between the medical and social work models of care. During his medical residency, many of his colleagues would say that they were in medical school to “do medicine, not social work.”
While in medical school, Nils took courses in Motivational Interviewing. At the time, Motivational Interviewing was an evidence-based practice that few of his peers were familiar with. “The most inspiring thing for me is to see changes in people who are working on their recovery. Soon after I graduated I worked with a woman who had recently become homeless and was suffering from mental illness.” She was found in a ditch, homeless and experiencing psychiatric symptoms. As the outreach team became involved, they located transitional housing for her and helped her move toward an opportunity for recovery.
“She was the nicest, sweetest person, with unusual insights into her illness. I conducted a physical exam and started her on medications. While she is not cured, she is better. She is an artist and has sold her work. She made a painting for me of a woman consoling another woman. While it is abstract, you can see the emotion painted in the grief and relief that reflects her ongoing struggles and success.”
Nils sees little distinction between someone experiencing mental illness on the streets and someone who is suffering from cancer. “Society would never leave a child with cancer to live on the street,” explains Nils. He believes it is critical to see people in the context of who they are as whole people, beyond pathology and diagnosis.