Loud and Clear

For many young girls in conflict with their parents, complaining to a friend about it is a rite of passage. A similar exchange with a girlfriend in middle school has been the catalyst for second-year medical student Natalie Perlov’s career and lifelong passion, a journey that has transformed not only her own life, but also the lives of countless others.

Perlov’s friend was a “CODA” (child of Deaf adults) who could hear and was fluent in American Sign Language (ASL). Perlov recalls, “We were complaining about our mothers, and she said, ‘I hate it when my mom yells at me in sign language.’ It blew my mind that you could yell at somebody using your hands—and it planted this idea in my head—to study how our brains process language, and the difference between sign versus spoken languages. I wanted to do something where I could learn ASL, apply it, engage with the Deaf community, and understand the issues they face.”

The critical importance of language and communication shaped Perlov and her studies. As a biopsychology major with a minor in linguistics at Tufts University, she wanted to learn how language is processed and the cognitive implications. A child of immigrant parents, she recalls asking her father, whose first language is Russian, how he would feel if someone tried to speak with him in Russian, even if it wasn’t perfect. “He said, ‘I would see they’re making an effort, and it would mean a lot to see somebody trying to step into my shoes,’” she says. 

Perlov believes that future healthcare providers need to have a solid understanding of where their patients are coming from. At Jefferson, she found a medical school that emphasizes this kind of empathy, with an emphasis on the medical humanities and the ways students can deepen their understanding of themselves and medicine.

In 2022, for her Humanities Scholarly Inquiry project through the JeffMD Curriculum, Perlov conceived the Deaf Education and Awareness for Medical Students program (DEAFMed). Her goal was to engender an understanding of the Deaf community and an increased willingness to work with populations who don’t speak English, especially populations that identify as Deaf. Designed as a supplementary curriculum, the pioneering program aims to bridge communication gaps to improve the quality of care. To kick things off, Perlov connected with the Deaf and Hearing Communication Centre, a local advocacy organization for Deaf and hard-of-hearing individuals, engaging a group of Deaf professionals and advocates to speak on topics around Deaf culture.

Running from August through November 2022, the pilot comprised five 90-minute lectures presented by Deaf professionals. The depth and breadth of the offerings included an introduction to Deaf culture and Deaf sensitivity training, milestones in American Deaf history, a history of the Americans with Disabilities Act, medical terminology in ASL, a “crash course” outlining the linguistic differences between ASL and English, and communications tips and strategies. 

The course had 20-25 participants at each session, for a total of 98 participants throughout the series. “We had a great interdisciplinary turnout, including a mix of healthcare providers, students, and research coordinators across nursing, medicine, occupational therapy, and audiology,” says Perlov. All student participants were encouraged to fill out pre- and post-test surveys capturing demographics, attitudes, and beliefs; and assessing the course’s efficacy in changing participant perceptions and beliefs.

Perlov notes that it is critical to understand an individual’s cultural background and to recognize its nuances while communicating with patients. “In many cases, medical information is disseminated in either written or spoken English,” she says. “Yet for Deaf individuals, English may not be their first language. Deaf patients may not have the same health literacy as patients who utilize spoken language that can be translated into written language, producing barriers to care and leading to poor health outcomes.” 

It is an issue, Perlov believes, all healthcare professionals should be aware of and care about. She says, “Hearing loss is pervasive across all age demographics, and Philadelphia has one of the largest and most thriving Deaf communities in the country. Jefferson medical students will not have to look far before coming into contact with a Deaf patient.”

A new session of DEAFMed will kick off in July. The course will introduce a panel on bioethics and discussions of gene editing and eugenics. There will also be a panel of Deaf physicians, nurses, and educators, as well as a practice session on dealing with acute mental health emergencies with patients who communicate differently than providers.

“What I love about Jefferson’s humanities track is that it allows you to express your artistic creativity and explore other cultures in a way that applies to medicine,” Perlov shares. “That’s how I saw DEAFMed. I’ve been really fortunate. I’ve worked very hard on this project, and it’s been very rewarding.”

The implications—and applications—of DEAFMed are far-reaching. “One of the most exciting data points that we found in our research is that students strongly agreed after participating that they would feel more comfortable communicating with patients who don’t use English as a primary mode of communication,” says Perlov. “That applies not only to Deaf patients, but also to a lot of our immigrant populations.” 

Perlov hopes that DEAFMed will outlast her time at Jefferson, and ultimately become a longitudinal medical ASL course. “Part of the power of this program is empowering healthcare professionals to expand their communication skills,” she says. “I would love for students to immerse themselves in ASL and transition it into a medical focus; and for future healthcare providers to have a solid understanding of where their patients are coming from. For example, if they come into the emergency department and there is a Deaf patient, what skills and tools do they have to give this patient the best standard of care?”

Her fellow students inspire Perlov every day. “What’s made my Jefferson experience so special is my classmates, and the incredible people they are,” she shares. “It’s a really beautiful thing to see how far we’ve come. I look at them and think, ‘Oh, there’s a budding orthopedic surgeon.’ Or, ‘Oh, there’s a budding neurologist.’ I hope they feel the same way about me.”

Perlov’s future is alive with excitement and possibility. Later this year, she plans to marry her college sweetheart. And she is open to where her studies take her. “I like the idea of working in pediatric ENT with families and their children,” she says. “I think having more providers who are aware of what Deaf culture is, how ASL differs from English, and how crucial it is to give children access to language is imperative, and I would like to be part of that.”