12-1: YES!: Setting Goals

December 01, 2023

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00:02To be part of the medical education series.
00:04And yes, as you just heard,
00:06we are recording this session.
00:09It's been helpful for others who
00:11are not able to make it at this time
00:13to be able to visit the recording.
00:15So just to inform you that that's happening.
00:19So the series is directed by
00:21doctors Dana Dunn and Andreas
00:22Martin who are both on today.
00:25They're both faculty
00:26associates of the center,
00:27and we have a special treat today because
00:30they're both involved in this session.
00:32So Doctor Martin will actually
00:34be moderating the discussion,
00:35largely by just making sure that
00:38he's keeping track of anything that
00:40you might place in the chat box.
00:42So any questions or comments,
00:44you're welcome to put those in chat and
00:46he'll make sure that they get attention.
00:49Doctor Dunn is our presenter today,
00:51so we're very lucky she's going
00:53to be presenting on the topic of
00:55setting goals in medical education.
00:57So just a little bit of background to
00:59what Dana has done within the medical school.
01:02She's worn many hats.
01:04She's associate Professor of Medicine
01:06in the section of Infectious Diseases,
01:09and as such she works clinically
01:11at the Nathan Smith Clinic,
01:13which provides HIV AIDS treatment and
01:16care and HIV prevention for adults in
01:20her department of Internal Medicine.
01:21She's Associate chair of Education
01:23and Academic Affairs,
01:25offering teaching faculty support
01:28and resources.
01:29In fact,
01:29it was through that role that she
01:32initially presented a Med Ed Faculty
01:34Development series for those who
01:36teach in her department That's
01:38evolved into this Yes series that
01:40she and Doctor Martin Co direct for
01:44undergraduate Medical Education.
01:45Doctor Dunn is director of the
01:47brand new Longitudinal Coaching
01:49program that matches small groups
01:51of medical students with coaches
01:53who stay with them for the duration
01:56of their medical education careers.
01:59The program uses a Master
02:01Adaptive Learning model that,
02:02if you're interested in
02:04learning more about that,
02:05Dana can certainly tell you about
02:07that in in at some future time.
02:10But if I can also use this
02:12opportunity as a plug,
02:13save the date on February 22nd.
02:16One of the key proponents of
02:18the Master Adaptive Model is
02:19going to be with us by Zoom.
02:21So mark that on your calendars.
02:23February 22nd for Graduate Medical
02:27Education Doctor Dunn's Associate
02:30Designated Institutional Officer,
02:32working closely with Doctor Steve Hewitt to
02:35oversee all of Yale's medical GME programs.
02:38So as I said,
02:40many hats and major hats.
02:42There are many more
02:43contributions that I could list,
02:45but that would take us the whole hour.
02:47So I don't want to do that,
02:49but I do want to take the opportunity
02:52to say that Doctor Dunn has recently,
02:55very recently received an award
02:57from the Connecticut chapter of
03:00the American College of Physicians.
03:02She's received the George Thornton
03:04Teaching Award for a career for,
03:06quote,
03:07a career distinguished by involvement
03:10and excellence in medical education.
03:12So as you now hear,
03:14you're in very good hands for
03:17the next 50 minutes
03:18or so. Doctor Dana Dunn.
03:20Oh, thanks so much.
03:21That's nice of you.
03:23Welcome, everybody.
03:23Dana Dunn, you know who I am.
03:26I'd love to know who you are
03:28outside of your name tiles.
03:30So if you could just like in the
03:32chat put if you're teaching in GME
03:36or or UME and if you're teaching an
03:38undergraduate medical education.
03:39If you're pre clerkship preclinic,
03:41no pre clerkship education like
03:43in the 1st 18 months or if you're
03:45in the clinical And if you're
03:47GME do you do like residents or
03:49fellows just so I can get an idea
03:51So just put that in the chat if
03:53you wouldn't mind like where.
03:54Because in the context of setting
03:56goals I would love to know a
03:58little bit more about everybody
04:01what what they're thinking about
04:05when they're setting goals.
04:07So any that we have Chris
04:11Anki who does everything.
04:16UMEGME residents and fellows
04:20a lot of
04:24GMEGMEPA online. Awesome.
04:25OK, keep those coming in
04:27because I want to have this,
04:29make sure that I make this feel
04:31relevant to everybody because it really
04:33ideally will be feeling relevant to
04:36everybody as we'll discover and find
04:39out together that you know goals.
04:42Setting goals and thinking about
04:44goals is a really major part of
04:46the mastery learning cycle that
04:48starts like with why are they here?
04:50And then, you know,
04:51we observe them and then we give
04:53them feedback and set individual
04:54action plans for them to improve.
04:56So hopefully it's going to be
04:58feeling relevant to everybody.
04:59But I was going to try to make
05:01some specific call outs and Andres
05:04will monitor the chat if people
05:06are kind of wanting more examples
05:08in your particular area.
05:10So this is the CME code.
05:13Linda put it in there, 38933,
05:16she'll probably put that in again.
05:20So it would be remiss of me to have a
05:22session on communication of goals if
05:24I don't tell you the goals of the session.
05:27So by the end of this session,
05:29I'm hoping you're going to be able to
05:32differentiate some like terminology that
05:34this comes from the Stanford Faculty
05:36Development Center conceptualization
05:38about how to be thinking about goals.
05:40So they use some terminology
05:42of ends and means goals.
05:43You'll probably recognize some synonyms,
05:45but I want you to recognize the
05:47difference in between the two of those.
05:49And also,
05:49we're gonna spend the majority of
05:51the time thinking about how we can be
05:53more effective in expressing goals,
05:54including using verbs explicitly
05:57and relevant statements,
05:59and we'll have a little practice with that.
06:01But I'm not putting you in
06:02breakout rooms to do that.
06:04Never fear if you're chewing
06:06or otherwise just kind of being
06:09able to listen in the background.
06:10I don't want you to feel like you
06:12can't stay on and participate.
06:15So how we're going to do that?
06:17You know what will be the means to the end.
06:19I'm going to give you some little
06:21mini lecture that defines some of
06:23these terms and gives you some examples.
06:25Then depending on how much,
06:27how many questions you might have about that,
06:29we might be able to watch a 3 minute
06:31video which is a clinical example of
06:33if you were watching a learner in a
06:35clinical situation might you what
06:37kind of things you might think about
06:38for goals and how you might express them.
06:41And then we have a,
06:43a worksheet and Linda's just putting
06:46in the chat now a handout that you
06:48can follow along that has some of
06:50these things so you don't feel like
06:51you have to take a lot of notes.
06:52And then part of it'll you'll also
06:55use towards the end to think about
06:57almost having a deliverable for
06:59yourself of like starting to think
07:01about goals that you often or
07:03objectives that you often have in
07:05your pre clerkship or clerkship
07:07or GME setting and how to maybe
07:10use some of the tools today
07:12to refine those and make those
07:14more effective for yourself.
07:16So does everybody did you put the
07:19handout in there Linda. Awesome.
07:22So at the top the you'll see that
07:25there's a definition of communicating
07:26goals and I'm I've put it here the
07:29establishment and explicit expression
07:31for the teachers and or learners
07:34expectations for the learners.
07:36So we're really talking about
07:37goals we have for our learners,
07:39not despite our learners,
07:41but really for our learners.
07:43So in the lay definition of this
07:45might be why are our learners here?
07:47And this should be why this should be
07:50very motivating 'cause this is really
07:52about like what we're all doing.
07:53We're here and hoping that we
07:55have a goal that the knowledge,
07:57goals, skill, goal, attitude goals.
08:00Why are learners here?
08:02They're really here to learn this
08:04content and there's a lot of
08:06interactions when you're thinking
08:07about content between teacher,
08:09what you might goals you might have for them.
08:11Learners have their own goals.
08:13We're going to talk about that.
08:15But then you see these kind of layers
08:17around this triadic graphic here,
08:21that the goals might you might
08:24have your goals,
08:25but the goals also might be overlaid
08:27upon you by the office of curriculum or
08:30the course director for the course or
08:32the clerkship director or the OR the,
08:35you know,
08:35a CGME and the residency
08:38program requirements.
08:38So some of these goals for teaching
08:41knowledge killer attitudes might
08:43be coming from you or they might be
08:46coming from societies or schools.
08:48So there are a lot of layers that can
08:50affect the context about how we have
08:52to think about goals and how much
08:55variability we have over them or or control.
08:59But there's really the content is looming
09:02large here about why our learners are here.
09:05And I'll say at least in
09:07the Department of Medicine,
09:08our teaching evaluations are organized,
09:12that students,
09:13residents,
09:13and fellows evaluate us by our learning
09:16climate and our ability to teach
09:18and our ability to get feedback,
09:20etcetera.
09:20But we have a a question about
09:23communicating goals,
09:23and this is the one we do the worst AT.
09:25And I think that maybe some people
09:27have felt like they just don't
09:29realize that the learners value
09:32goals that they really do want.
09:35It really decreases anxiety for the
09:38learners to know explicitly what you
09:40want because you really do have goals,
09:42even if you don't say them,
09:43you do know that you want things you
09:46expect for them to know and to do and
09:48to behave professionally, etcetera.
09:50So This is why I'm hoping this is
09:52a fairly motivational activity to
09:55be thinking about getting better
09:57at because goals.
09:59And you know,
10:00we're using the term goal a little
10:02bit vaguely in here as kind of
10:05synonymous with some other terms
10:07like learning objectives or
10:09educational objectives or you know,
10:10outcomes etcetera.
10:11They're for purposes of our discussion today,
10:15we're going to use them
10:16a bit interchangeably,
10:17but they really help your learners
10:19know what to master.
10:20You know, if you have a goal
10:21for a session and pre, you know,
10:22in your anatomy course or you have a
10:24goal at the beginning of the clerkship,
10:25you have a goal at the
10:27beginning of your residency.
10:28You know, if you don't have a goal,
10:30part of part of the mastery learning cycle
10:31is having learners where they're going,
10:33where are they going, what,
10:35what am I supposed to know
10:37by the end of this time?
10:38So then it helps you by them
10:40knowing what the goal is, you know,
10:41starting with the end in mind.
10:42It helps you know what content
10:44and other things that you need
10:46to provide the learner for,
10:48for them to be able to reach their goal.
10:50And then there's a shared mental
10:52model that seems very fair to them,
10:54that there's a shared idea of
10:56how you're going to assess them.
10:58So if you were to just start giving them,
11:00you know,
11:01a course on microbiology and not tell
11:03them what the goals are or what you
11:05expected the learner to know at the end,
11:06and then you gave them a test
11:08at the end that might feel very
11:11uncomfortable or challenging and
11:12potentially not fair for them.
11:14Similarly,
11:14in the clinical arena,
11:16at the end of the rotation,
11:17you give them feedback that they didn't,
11:19you know,
11:19present with this kind of efficiency or
11:21they didn't write their notes by this
11:23time or they didn't do some sort of thing.
11:26Then you don't have the shared mental
11:28model that's very explicit about what
11:31you want them to do and that they
11:32understand and can contribute to that.
11:34So this is hopefully feeling motivating
11:37that and the relevant statement for why.
11:40By the end of this hour,
11:42I'm hoping that we will meet our
11:44learning objectives of you feeling more
11:46effective in in communicating goals.
11:48All right.
11:49So we're going to talk about three things.
11:52We'll talk.
11:53We're going to start talking
11:54about types of goals and this is
11:55where we're going to talk about
11:56ends goals and means goals.
11:57And I'll define those brief word on timing.
12:00And then we're going to get into
12:02kind of the key components of how we
12:04can get better in expressing goal.
12:06And and please interrupt at any time.
12:09I am not seeing the chat actively,
12:11but I'm trusting that Andres can
12:14decide if he wants to interrupt me.
12:17All right.
12:18So the first thing is just this or
12:21for your consideration A terminology.
12:23So you can consider two types of goals.
12:26Ends goals and means goals.
12:27So an end goal would be AC if
12:29you have a learner here at the
12:31beginning T1 like time one.
12:32This could be at the beginning of
12:34grand rounds talk or at the beginning
12:37of the clerkship block or the
12:39beginning of some you know internship.
12:41Could really depend.
12:42Some of you are here thinking
12:44about goals for a whole course,
12:45some of you are here thinking
12:47about goals for a
12:48teaching sessions.
12:48So whatever you're picturing right now,
12:51the, the, the, if you have a learner
12:53that's at time one, your end goal,
12:55is it really at the end of that time,
12:58time 2, we'll call, you know,
12:59what do you want for your learner?
13:01You know what?
13:02What is your goal for the end of that time?
13:04You know it could be just a knowledge goal.
13:05It could be an outcome goal.
13:08What What is your thought at the end?
13:10And we're gonna be talking about
13:12how to get better and verbalizing
13:13that but it's what you're hoping
13:15for them by the end of the session.
13:17However you define that means goals
13:19are the what are the educational
13:23activities that you're gonna recommend
13:25or that they can come up with that are
13:27gonna help them meet that goal right.
13:29So ends is where do they gonna be
13:31at the at the end and and the means
13:33goals are how what are the activities
13:35So they should be action verbs what
13:37are the activities that they're gonna
13:39do to be able to meet that end goal.
13:41Now if some of you just are doing a
13:44end goal for thinking about learning
13:47objectives for a talk like by the end
13:50of this session I want you to be able
13:52to articulate goals or I want you to
13:54define ends goals and means goals.
13:56The educational activity might
13:57be pay attention,
13:59listen to me and that's the activity.
14:02Or it may be that I'm going to have
14:04you watch a video and it may be that
14:06I'm going to have you do a worksheet.
14:08But some just content heavy things
14:10might be just and so I'm going to help
14:12you get there because I'm going to I'm
14:14going to teach you with my words So
14:16I'm gonna just give you some examples.
14:18So here's for example you know we
14:21can but we can bunch domains of of
14:24of goals into knowledge skill and
14:27attitudes and so you can imagine
14:29any of you on here you could have
14:32your own knowledge goal I'm sure
14:33like Andres Martin might have some
14:35child psychiatry knowledge goal.
14:38John and Candela might have something
14:40about a skill of running a focus group.
14:42So just as an example,
14:45let's Chris,
14:46say we have a cardiologist on here
14:48or maybe Chris think he wants his
14:51student to understand heart failure.
14:53So I want you to be able to
14:55understand heart failure.
14:55We're going to come back about maybe
14:57why that verb is not the greatest,
14:59but
15:01what would be some mean what
15:03what could that learner do to
15:05be able to get to that goal?
15:06So you know, Chris might recommend you know,
15:10read this chapter, you know,
15:11go to up to date, read this thing,
15:14do that rotation, you know,
15:16go to the SIM center and do that
15:18simulation and get feedback on it.
15:19So you can see that you've
15:21got these action verbs, read,
15:22rotate, do a simulation.
15:24And we really like to have ideally a
15:27couple of different means goals because
15:29learners sometimes learn differently and
15:30maybe they want to have it be hands on.
15:32Maybe sometimes people would
15:34rather watch a video.
15:35Maybe they need options because they
15:37can't do the CC rotation because it's
15:40booked up or not available to them.
15:42Maybe they need something other
15:44than simulation because they don't
15:46have a SIM center where they are,
15:48so just being able to have or or maybe
15:50the first means goal that you got
15:52them didn't help them meet their ends.
15:54It really wasn't enough.
15:56So coming up with brainstorming a variety
15:58of activities to help them a skill goal.
16:02Similarly,
16:02like a skill could be a communication
16:05skill or it could be a psychomotor skill,
16:07it could be a procedural skill.
16:09So place a central line.
16:10I want you to be able to place a
16:12central line and so how can you do that?
16:14Here's some examples again here
16:17and then attitudes.
16:18I see Andre's got your your hand raised.
16:21I'll just say this last thing,
16:24an end goal might be be patient centered.
16:27I want you to be patient centered.
16:28I want you to be whatever you know
16:32learner centered or be respectful and
16:35here's some some potential activities
16:38here that you might be thinking about
16:40interviewing a patient getting feedback,
16:43reading the mirrors criteria.
16:44Andres did you want to ask something
16:52not me but Chris Sankey has a very good
16:54comment that I think we could expand on.
16:56So Chris, do you want to share
16:57with the group and with Dana.
17:02Oh sure, I I I'm just merely under score.
17:06The I I think the essentiality so
17:10to speak of of actually making the
17:13difference between sort of ends
17:15goals and means goals. Because in my
17:18experience with both you and me
17:19and GME learners, if you sit
17:21down and ask the learner to identify
17:24their for whatever experience
17:26you're about to start,
17:30I I, I have invariably gotten knowledge
17:33based ends goals like I want to
17:35be better at EKGS, I want to be.
17:38I want to understand antibiotics
17:40and like they they tend to sort
17:43of make sense at face value.
17:45But in my experience,
17:46it's a recipe for total lack of success
17:50in in really achieving and meaningful.
17:53Because at the end of the experience,
17:56you sit back down, you say,
17:57I don't know anything more about EKGS.
17:58Do you feel antibiotics and you get sort
18:01of some form of a shoulder shrug. So
18:04if you're explicit about the difference
18:05between ends goals and means goals,
18:07you can really have some meaningful
18:09discussions about different
18:10domains like behaviors, skills,
18:14attitudes and specific behaviors that can
18:18more effectively tracked and achieved.
18:20Yeah, yes. And I'm setting myself
18:23up here to be using some poor ends
18:25goals verbs here of understanding
18:28'cause that's not very behavioral,
18:30it's not very observable.
18:32So we'll talk about how we can help
18:34either when we're expressing or when
18:36we're learners are coming to us with
18:38goals that they're expressing to help
18:39them use some some some behaviors that
18:42I'll I'll talk about after we talk
18:45about timing to help it be less vague.
18:48But I just wanted to make the hopefully
18:50you're getting just the the idea here,
18:51but the definition between
18:52ends goals and a mean goal.
18:54Because some people to
18:56Chris's point are very endsy.
18:58And you know you're you're an advisor
19:00to somebody or you might be a coach
19:01to somebody or you might be a program
19:03director and people your learner will
19:05come in and say I want to be able to get
19:08better and teaching clinical reasoning.
19:09And a lot of us would just be like,
19:12OK, good luck with that.
19:13That sounds like a great goal,
19:14but we're not so mindful about like how,
19:18how are you going to do that?
19:19I've got this great book,
19:20Teaching in the Hospital, Chapter 3,
19:22How to Teach Clinical Reasoning.
19:24Here's like an app on your phone that
19:26you can use for clinical reasoning.
19:27Medicine tool kit.
19:28I mean,
19:29sometimes they figure it out,
19:30but a lot of times they don't and they
19:33need us to be thinking about the means.
19:35Conversely,
19:35a lot of times we can be very meansy.
19:39We're like draw that blood tote that
19:41bail you know call that family and
19:43the students might be thinking or
19:45go to that workshop and be prepared
19:47for the to interact with your peers.
19:49They might be thinking that you know
19:51what does that have to do with anything.
19:52And if you could say because because
19:54that ties back to like what it is
19:57to be patient centered or how to
19:58take care of the whole team or how
20:00to demonstrate communication skills
20:02that you're gonna be able to you know
20:04need to draw on as you continue to
20:06have professional identity formation.
20:08So making sure that we're we're
20:11not how they relate to each other
20:14similarly like you could might
20:16think that the anatomists.
20:18Think that they're only in the knowledge.
20:19They only have knowledge as a a goal
20:22and and you know they might recognize
20:24that they could have attitude goals
20:27in the dissection lab around being
20:31respectful or being team members.
20:34So I think it's it's useful to always
20:36do a a survey of ourselves to be broad
20:40and think about ends and means goals.
20:43I'm going to,
20:43we're going to come back to
20:45refining this a little bit,
20:46but I just wanted to make sure
20:48we did those definitions.
20:50OK, a brief word on timing,
20:52thinking about goals,
20:53so you can be thinking about goals before,
20:56during and after.
20:57I would think a lot of us who are
21:01doing a talk or we're doing a
21:04course or you know even those of
21:06us who might teach frequently and
21:08you're kind of going into repeated
21:10clinical sessioning probably
21:11often have a repertoire of of
21:13goals in our heads ahead of time.
21:15And certainly before you plan any
21:17curriculum or you plan any talk,
21:19you do need to think about goals
21:21ahead because that as our three
21:23main motivating goal reasons
21:25for goals helps us know what to
21:27how to plan our teaching.
21:29You're really starting with the end in
21:31mind what do we really want to know.
21:33So we do a lot of goal thinking before,
21:36but sometimes it comes to us during.
21:39And I think this is not limited to clinical,
21:42but a lot of us who are doing clinical
21:44teaching can recognize that while
21:46we're watching someone present or
21:48while we're watching the resident
21:50lead the team or while we're watching
21:53a student attempt a physical exam.
21:56A goal comes to us based on our
21:59direct observation that, you know,
22:01there could be a goal around, you know,
22:03a knowledge, skill or an attitude.
22:05Or maybe even after, you know,
22:07you recognize that you had a kind
22:10of goals set up because you thought
22:12your learner was at LL1, you know,
22:14kind of level.
22:15And so you had some goals and
22:17some teaching plan.
22:18And then you you went into it and you
22:20realized that your learners all knew
22:22a lot more and that they were at L4
22:24and that you need to do a doctor.
22:26You were at L -, 2.
22:28Oh,
22:28OK,
22:29you're going to see her because
22:32they really weren't able to.
22:35They they were behind or maybe they didn't
22:37have some fundamental foundational content.
22:39So you might have to just based
22:42on where your learners are,
22:43what you're noticing etcetera.
22:46So just to remind you that goals can
22:51come at you at different times based on
22:55direct observation in your experience.
22:58So what we're going to get into now,
22:59and this is we're going to drop
23:01one more hand out into the chat,
23:03is we've talked about kind of
23:05ends goals and means goals that,
23:07you know,
23:08we're motivated to get better at this
23:10because it's really so fundamental
23:12for why our learners are here.
23:14Thought about kind of the timing,
23:15but how can we get better
23:17at expressing our goals?
23:18So we're gonna go over you using
23:21verbs to to help us express goals
23:24that would be specific and observable.
23:27And a lot of you are probably familiar
23:29with SMART goals and you're gonna be
23:31hearing probably some synonyms in there.
23:32So we're gonna talk about
23:35using verbs more deliberately,
23:37and then we're going to talk about
23:40using relevant statements and
23:42expected levels of competence.
23:44So I'm not going to probably.
23:46Does everybody have the
23:48handout that has the verbs?
23:50Were you able to put that in there,
23:51Linda? Awesome. All right,
23:55so if you can open that.
23:58Oh, I forgot that I made a slide on it.
23:59It should look like this.
24:01So this is something you're
24:02going to want to keep close by.
24:04If you're somebody who has
24:05to give a lot of talks,
24:06or you run courses and you're
24:08like or people are always asking
24:09you for your learning objectives,
24:11it's always good to have some verbs.
24:13You can probably find this
24:14online in a number of places,
24:15but on the top you've got some
24:18knowledge verbs and from left to right
24:20in the screen that you're seeing,
24:23you can see that they get
24:24cognitively more complex.
24:25Recall all the way up to application.
24:28So using verbs wisely means
24:30for your ends goals.
24:32You want to make sure that you're
24:34matching really kind of the level that
24:36you're expecting to your learner.
24:38So you can see that if you've
24:40got an early learner,
24:41maybe you're not having to
24:43manage heart failure yet,
24:44but maybe they need they would
24:46be able to define heart failure,
24:48or maybe they would be able to
24:49list the causes of heart failure.
24:51So understanding heart failure is
24:54not an observable behavior and we
24:57can be more effective in expressing
24:59our goals if we use verbs that match
25:02what we really can observe and what
25:05we expect that they would be able to do.
25:08So like to Chris's example of an EKG,
25:11if the resident,
25:12if the goal comes from the resident
25:14saying I want to get better at EKG,
25:16you can help them.
25:17Like what?
25:18Do you want to be able to really like,
25:20compare and contrast just
25:22an atrial tachycardia?
25:24You know this atrial arrhythmia
25:26to the other atrial arrhythma?
25:28Or do you want to really be able to
25:31interpret a complex EKG, Et cetera?
25:35So using the knowledge,
25:37and I have a couple of examples for
25:39these are good for your knowledge verbs.
25:41The skill verbs are a little more
25:44sparse and you could probably
25:46still come up with your own,
25:47but for psychomotor skills or
25:50for communication skills,
25:51you can see some examples here
25:53that you could use to express
25:56yourself more precisely.
25:57And I really like the attitude
25:59ones here 'cause sometimes this is
26:01really can help you and I'll I'll
26:03give you an example in in our table
26:06that I had previously filled out.
26:08But if you have somebody who's showing
26:10up late for teaching rounds all the time,
26:12or they're for them to be able
26:15to attach value to educational
26:19time or adhere to professional,
26:21you know, responsibilities,
26:22etcetera,
26:23that can be useful for you to
26:26have these these verbs.
26:28But verbs can help you feel like
26:31you're using specific asking,
26:33specific behaviors that you can
26:35observe that match their level.
26:37So I'm just starting to kind
26:39of fill in here to refine my
26:41end school that if I have a
26:44P GY1 maybe if they want to know
26:45about heart failure we would have a
26:47a verb that matches that compared
26:49to maybe a first year Med student.
26:51Same with the central line or a
26:53skill that they would be able to
26:55place one as opposed to a sub intern
26:57might just be able to assemble the
27:00you know or or list the parts.
27:02And if I'm talking about an an
27:06attitude goal of filling out your
27:08teaching evaluations on time,
27:10maybe through a conversation
27:11really that that you know,
27:13maybe people aren't filling out
27:15their teaching evaluation because
27:16it's a time management skill.
27:18So sometimes there is a differential
27:19diagnosis for what you might be seeing.
27:22You have to make sure is it
27:23a skill or an attitude.
27:24But if you feel it's an attitude,
27:25being able to, say,
27:26placing value on teaching evaluations
27:28brings up a whole different means
27:30goal list than a time management
27:33skill of finding a time to fill out
27:35your teaching evaluations would so
27:38place value on teaching evaluation.
27:40So hopefully you're you're
27:41recognizing that the ends goals can
27:44be more refined and you can be more
27:47effective in expressing yourself by
27:49thinking about verbs that match.
27:51Another way that you can be more effective
27:55in expressing it is explaining why.
27:58Why do I want you to be able to do that?
28:00Why should you be able to do that?
28:03And I started this conversation with saying,
28:05like,
28:05why should you know,
28:06my ends goal for you on about this session
28:08is the finance and means goals of blah,
28:11blah, blah.
28:12And then I said because because
28:15there's these three things,
28:17these three things that
28:18should really motivate you.
28:20It, it does this,
28:21it serves that, it does that.
28:23So maybe that resonated with you.
28:25So if I said, you know,
28:27let's see who's on the call,
28:29Michael Green or Rob Homer,
28:31I'm like, I want you to listen
28:33to my travel clinic talk.
28:35And and Michael Green might be like,
28:36I I get so bored with travel.
28:38And I'm like,
28:39because you know,
28:41so maybe it's going to be on the
28:42boards because you're going to
28:43go to Costa Rica and you're going
28:45to be really mad that you didn't
28:46pay attention to know whether you
28:48should take malaria prophylaxis
28:49or your aunt's going to call you
28:51and they're going to want to know.
28:52So why? Why do I?
28:55Why should you want to pay attention?
28:57That can be also really motivating
29:00to tell a first year intern who's
29:03a dermatology resident that they
29:05need to learn how to read the EKG.
29:08They might say why,
29:09and maybe you have to have a
29:11little thing in your pocket,
29:13and if you can't come up with one,
29:14maybe it's not a relevant goal.
29:17So that that's all I'm going to say
29:19about that, relevant statements.
29:22Have a little elevator pitch
29:24in your pocket about why.
29:25Another thing that can be
29:27really super useful,
29:28and this is along the lines of the verbs that
29:30help people feel like it's more concrete,
29:32is really being explicit about
29:34the level of competence.
29:36So you know how I want you to be
29:38able to do this? Super, you know,
29:41this triple lumen catheter or a
29:45central line, aided or unaided.
29:47You know, I want you to be able to
29:49read these Ekgs perfectly, or 50%.
29:51I want you to be able to present, you know,
29:54as opposed to I want you to present better.
29:57You're like I want you to be able to
30:00present a new H&amp;P using this framework
30:05in 5 minutes with minimal notes by
30:08the end of week and then by week
30:10two you're going to have no notes.
30:13You know, that doesn't leave a lot
30:15of room for the student not really
30:17being clear about what you want.
30:19So you can also improve your effectiveness
30:23in expressing goals by using verbs.
30:26Any Any questions here?
30:29Goals and objectives?
30:30Yeah,
30:32Scott, I would use them synonymously here.
30:36We're just using that goals
30:37as a kind of a general term,
30:40so you can use them synonymously for the
30:42purposes of ends and means, etcetera.
30:43The last thing I would say that a
30:46lot of us are not so great at is
30:48like we might feel all empowered to
30:50talk about goals at the beginning.
30:51This is maybe more for people who've
30:54got longitudinal relationship or
30:56you're clinically with somebody
30:57as opposed to a lecture.
30:59You don't necessarily have
31:00to repeat goals periodically.
31:02But if you've had a goal discussion and
31:05to be able to come back and say how
31:07are you doing and meeting that goal if.
31:10Because if they're not do you
31:11need a different means goal?
31:13Do you need to be kind of brainstorming
31:16about or did they that they accomplish
31:18that goal and you can now come up with
31:21another one and you can really make
31:23progress in these in these periods
31:25of time that you're with people.
31:27So lastly before we watch a quick video,
31:32you know we've been kind of talking
31:34about being very teacher centered
31:36at this point but we do also want
31:39to be learner centered.
31:40So what can be,
31:41what can the learner centered
31:43part be and like how where is the
31:45Co creation of goals happening?
31:46So I would say in two areas,
31:48because you do have goals.
31:50I mean,
31:51even if you have goals that can
31:53stand by themselves because you know
31:54that there's we're going to evaluate
31:56them or there's going to be a,
31:58there's going to be a test.
32:00There's there's graduation requirements.
32:02There's definitely things that
32:04are going to be outside of the OP
32:06thing for the student to opt out
32:08of or the resident to opt out of.
32:10But for the resident to and student
32:13to to buy in and understand you
32:15the goals that you have for them.
32:17Maybe there's some negotiation.
32:18Maybe you're going to need to
32:19have another relevant statement.
32:21If they don't get,
32:21if they don't buy into your goal
32:25and then you can ask for their goals also,
32:27right? So you can.
32:28It's an important part.
32:30You have your goals.
32:31Their goals don't get to trump yours,
32:33but for you to find out about theirs
32:35so that you they can intermix,
32:37you can prioritize them,
32:38you can help them be more specific
32:41and develop their own SMART goals.
32:43You can help them brainstorm their
32:45own means goals and you can follow
32:47them so that in that way you
32:49are kind of Co creating Andres.
32:53Yes,
32:56Scott Casper, who is frequent attendee,
33:00good to see you, Scott.
33:01He asked a question that
33:03that I had in my mind.
33:04So maybe you can expand,
33:05but can you explain any difference
33:08between goals and objectives?
33:09I know that you and I talked about it.
33:13I mean I think just for the
33:15purposes of today, I mean you
33:17can have educational objectives,
33:19you get objectives for yourself as
33:21a teacher, you can have educate
33:23objectives for your learner.
33:25So I think just for today, I would,
33:28I would just love for people just
33:30to feel like we're using goals
33:33and objectives synonymously.
33:37I mean, in other context, goals
33:40tend to be more
33:42all-encompassing and can be broken
33:44down into smaller objectives.
33:47But I agree for this purpose
33:51they could be interchangeable.
33:57Awesome. All right.
34:00Are there any questions to this point?
34:02So you're motivated,
34:03you're motivated to think of that
34:05goals are serving an important purpose.
34:08So why are our learners here
34:12that there's certainly a lot of
34:14stakeholders that are involved,
34:15but you're you're picturing your your
34:18main educational role as a course
34:20director or as a as a clinical supervisor.
34:23And that in that context you can be
34:25thinking about goals for your learners
34:27and that you want to be able to.
34:29You can think about them in a variety of
34:31domains, knowledge, skills and attitudes.
34:33And there's going to be ends and means.
34:35There's timing differences.
34:36We talked about being able
34:38to effectively express them.
34:39So any questions?
34:40I'm just going to have us watch
34:43a 3 minute video as an example
34:45to be thinking about how goals
34:48can arrive during a teaching.
34:50And so as you're watching this video,
34:53I want you to be thinking about if you
34:55were the teacher in that video and you
34:57were watching this medical student present,
35:00what goals would you start
35:01to have for that person?
35:03And think about an end goal,
35:05think about some means goals,
35:07think it.
35:07Would it be an,
35:08would it be a knowledge skill or an attitude?
35:09There's not going to be a right
35:11or wrong question here 'cause
35:12there's a number of goals that
35:14you'll all recognize as as being
35:15potential goals for this learner.
35:17But I just want you to kind
35:18of start to practice how you
35:20would put these things into,
35:23into something that you would then
35:26be needing to think about expressing.
35:28Alright, Can everybody see this video still
35:34looks like a video still.
35:36Yeah, we see it. OK,
35:38So you're going to be pretending
35:39you're this middle attending
35:41physician here and you're watching
35:42this medical student over here.
35:44And I would just take a piece of
35:45paper and I would just jot down
35:47for yourself, like end goal.
35:49You know, 1-2 means goal.
35:51And then maybe like a relevant
35:53statement and kind of thinking
35:55about the verb just so you would
35:57be practicing this in real time,
35:59just two minutes and 26 seconds.
36:04It'll start in a second.
36:08So the patient is a 68 year old
36:11male with a history of coronary
36:13artery disease status post cabbage,
36:16coronary artery bypass graft in 2002,
36:19history of pulmonary embolus and deep
36:21vein thrombosis in 2002 and 2009.
36:24Now presents with nausea,
36:27vomiting for the past few days along
36:29with a Disney on exertion and a oh and a
36:33pulmonary embolus in the right lower lobe.
36:35His most recent story and his
36:38story changes fairly frequently.
36:40He also has multiple Ed visits at our
36:42hospital and also at A at Fairmont.
36:45At Fairmont Hospital for nausea,
36:46vomiting and was also discharged on
36:48the same day at all of those places.
36:51So he was admitted to the holding
36:53unit basically for for IV hydration
36:54and he was also given Ativan there
36:57for for alcohol withdrawal.
36:58He was setting 90% on room air.
37:01His hematocrit was 40 EKG,
37:03didn't show any changes from prior
37:06visits and tropes were negative.
37:08Creatinine was 1.5, Ethanol tox was negative.
37:12However, he became increasingly tacky
37:15overnight and per Doctor Stevens's note,
37:17his CT came back showing the right
37:20lower low PE.
37:21Currently,
37:22the patient was was not on any Coumadin.
37:25This is a little vague.
37:27When I reviewed the history,
37:29it appeared that his pulmonary embolism
37:31occurred during vascular surgery.
37:33Yeah,
37:33it may have occurred following the surgery,
37:36but it just isn't clear right now.
37:38The recent piece we're documented
37:39at the outside hospital records.
37:41We just don't have those records yet.
37:43Moving on to relevant past medical history,
37:48so he has a history of coronary artery
37:52disease and eye surgery and I'm not
37:54really sure which eye or what kind
37:56of surgery it was a hernia repair,
37:59an appendectomy,
38:01which surgery do you think is
38:03the most pertinent?
38:04I think, well, maybe his,
38:06his coronary artery disease is the most,
38:08is the most pertinent here
38:10because that's kind of OK.
38:13But it sounds like he had an aneurysm
38:15repaired and that contributed
38:16to his chest pain. Oh, OK.
38:17And it was at that time that he had his PVCS.
38:20Not sure whether he had a PE
38:23at that time or what. Yeah.
38:26It's.
38:26Yeah,
38:27it's not really clear about that right now.
38:34All right. So just curious that
38:36you can put this in the chat or if
38:39anybody wants to just volunteer a
38:41couple of thoughts that they had,
38:42I would love to have some thoughts
38:45about you're watching that conversation
38:47and a goal comes to you in your head.
38:50So just as it's coming to you,
38:52it helps for you to categorize it.
38:54Is this a knowledge skill or
38:55an attitude goal?
38:55Maybe there's a few that are coming to you.
38:57So you could put down in the chat
38:59some goals that were coming to you for
39:01that learner that was an end goal.
39:04And like if it's a knowledge
39:05or an attitude goal,
39:06you could just kind of start putting
39:08that in there so I can see the range,
39:10the, the video was very triggering.
39:14Yes, you know, and so sometimes,
39:16you know you're in the middle of something,
39:18somebody's presenting to you and you're
39:20like thinking this is a hot mess.
39:21It's like, where do I start?
39:23Like you have to dissect it a little
39:27bit back memories from from medical,
39:31is it?
39:32What back memories from medical school?
39:36So I didn't know anybody want to throw
39:38out a because there's no wrong answer.
39:40There's just like fodder for us to
39:42start with any kind of ends goal that
39:44you would have had for that person
39:48organization good. So that's knowledge,
39:52skill or attitude, would you say?
40:04And then Janie says, you know,
40:06fluidity of presentation.
40:07So sometimes this is really good
40:09for you to be really clear in your
40:12own mind because it could be that
40:14it was organized but not fluid.
40:17So you have to kind of like
40:18what what is it exactly?
40:19Or maybe it's both.
40:21And then you're having to also
40:22prioritize cause see the if you just
40:26say I want you to be better at that,
40:28you can imagine that that doesn't
40:30help the the student have a shared
40:33understanding of when you're
40:34going to assess them on that
40:36what you're really expecting.
40:38I want that to be better. That was bad.
40:41That's so focus on the relevant information.
40:43So. So Ellie, is it.
40:46Ellie, am I saying that right?
40:48Yeah, Yes.
40:49So that could be an an,
40:55an ends goal or a means goal I suppose,
40:58depending on where your your learner is.
41:02So focusing on the relevant information.
41:06So it you know, it could be a a,
41:11a knowledge thing that they don't
41:12know what's relevant or a skill thing
41:14because they left it out because
41:16they weren't systematic in the
41:17way that they're taking a history.
41:19So you know, having a conversation
41:23with them knowledge
41:27list the key risk factors for PE,
41:29rank them in order.
41:31Read the Bates chapter.
41:32So Kofi is starting to list some
41:37you know maybe a knowledge ends goal.
41:40I want you to be able to
41:41list the risk factors for PE.
41:43So he's using list as a verb.
41:47So he doesn't.
41:48He's just saying like not saying
41:49I want you to know PEI want you to
41:51be able to list the causes of PE.
41:53So for a for a these goals you know list,
41:58you know write them all out the
42:00the ones that you know about and
42:01rank them in order of likelihood
42:03and maybe get feedback on that.
42:05Read the debates chapter on soap
42:08note write and that and that
42:10might be kind of separate soap
42:11note writing might be kind of
42:13more of an organizational thing.
42:18Let's see. You have a goal for
42:21the intern as well. Atta. Yeah.
42:24So there's a lot of things that the
42:25attendant could have been watching there.
42:26What you knew you can put down an
42:28ends goal for the intern. Atta.
42:33So the the key thing I'm wanting you to
42:36take away from this is you're watching some,
42:39you might have a goal that came to you
42:41before, maybe that you were going to
42:43teach them about something, et cetera.
42:46But sometimes goals come to you during and
42:48while you were watching that presentation,
42:53you were noticing some things.
42:54So you're trying to be like thinking,
42:55what am I noticing?
42:56Is it was it knowledge,
42:58skill or attitudes? If it's an if,
42:59it's a depending on what it is,
43:02let me try to pick off a few that seem
43:04to be high priority because, you know,
43:06maybe some of those were above like
43:07what shoes he was wearing right there.
43:09You're going to have someones that
43:11maybe have to do with patient safety
43:13and etcetera that are going to be
43:15higher up on your priority list,
43:18thinking about using your verbs
43:20to to refine the knowledge goals
43:22or the skill goals.
43:23So it'd be, it'd be observable and then
43:25to start to brainstorm some things.
43:27Now let's just try one more thing.
43:30Actually,
43:30I'm not going to try one more thing.
43:32This is going to be the second activity
43:33that we do because the second activity,
43:35if you have the first hand
43:37outlet that Linda gave you,
43:39no breakout rooms.
43:40So please, please hang in there.
43:44But because you know,
43:46we only have our 45 minutes together,
43:49if we don't do a little bit of
43:51this skills practice,
43:53then it's really hard for you to
43:55walk away feeling like you're you're
43:57you've got some tangible things
43:59that you remember from the session.
44:01So a means goal for you to get better
44:05and effectively expressing goals is for
44:08you to practice on your worksheet I gave you.
44:11All right.
44:12So this is a means goal.
44:14Why?
44:14This is a relevant statement because
44:17you're going to otherwise walk
44:18away and you're not going to really
44:20feel like you learned anything
44:21unless we have you do an activity.
44:22This is how you cement things.
44:24So if you would take the bottom
44:26part of that worksheet,
44:27which was handed number one
44:29that Linda gave you,
44:30I want we're going to just take
44:32like 3 minutes of silence.
44:34I'll sing in the meantime in the background,
44:36gently,
44:37quietly and you'll see that
44:40it says knowledge,
44:40skill and attitudes on your worksheet.
44:43And even if you've if you're like driving,
44:45you don't have a worksheet or
44:47you or you can't print it out.
44:50Just if you're driving,
44:51not driving and you can just write on
44:53a piece of paper make a make a three
44:55by three table that says knowledge,
44:57skill and attitudes.
44:58Then it has ends.
44:59Goals means goals, relevant statement.
45:02So picture where you usually teach.
45:05Picture like Mike Green is going to
45:07go precept an HIV clinic tomorrow.
45:10Pam
45:12is going to go be associate clerkship
45:14director for the Students in Psychiatry,
45:16and she's going to have to
45:17Orient the clerkship students.
45:18Rob Homer is going to be doing attacks
45:20and defenses wherever it might be.
45:22Like, think, what are my knowledge goal?
45:24What's a skill goal?
45:25Let me practice using a verb.
45:27Let me practice making some means
45:29goals and a relevant statement.
45:31So you're just going to take 5
45:33minutes to fill in your worksheet
45:35a little bit with something that
45:37you really feel is useful for you.
45:40And then we're going to call it at
45:45maybe in in 3 minutes from now
45:50and just have people put some of
45:52the things that they put in there,
45:54'cause we wanna give,
45:55make sure that people are
45:56understanding the concepts correctly.
45:58So just take 3 minutes by yourself,
46:02fill in the worksheet.
46:06Amazing. I'm, I'm kidding.
46:08I'm not really gonna sing.
46:11It'll drive you to distraction
46:14and please ask me some questions
46:17in the chat in the meantime.
46:19You can even write them in the chat
46:21if you want to get feedback on them,
46:23but I want everybody to have
46:24something on their worksheets
46:25when they're done. Here
47:44You want us to put it in the chat
47:47if you would like.
47:55Especially if like you're.
47:56I think a lot of times people can
47:59struggle with attitude and means goals.
48:01You might be observing,
48:05you know, an intern speaking
48:12disrespectfully to a nurse on the
48:15phone and so you have a goal for them.
48:17You think you watch that and you're like,
48:20I would like you to be
48:22respectful and you're like,
48:25good luck with that. Or you know,
48:27I've gotten that feedback before.
48:29You know I don't.
48:30I don't know what you're talking about.
48:32What are some means goals for attitudes.
48:35So if anybody has an attitude,
48:36end goal and you,
48:38we want the group to brainstorm.
48:41Sometimes for attitude means goals,
48:43we need to brainstorm ideas.
48:47What have you found that works?
48:48When you have somebody
48:49who's not patient centered,
48:50what have you found works?
48:52If somebody has a blind spot,
48:55if somebody's disrespectful.
49:02Oh, and did you just do that?
49:07Oh, somebody. Somebody else.
49:09Oh, you're you're back. Yeah.
49:12That looked like it was an
49:13interesting thing to do.
49:20All right. Hopefully you're working on
49:22that and you're feeling like you can use
49:24it as a template to get more explicit.
49:29A lot of us who attend in the hospital,
49:33you do as regularly.
49:35You know, you meet your team.
49:37You know, you kind of have these
49:39things that come up repeatedly.
49:40You might even decide you're
49:41going to print some of these out,
49:43like team expectations.
49:48You know going around and asking
49:50each person for their goals
49:52and as you express your goals,
49:54anybody wanna to to talk about a
49:56a goal that they were struggling
49:58with a means goal or an ends goal.
50:00Before we do our final couple of slides,
50:04I just have an implementation slide and
50:06we have a little final thought slide that
50:11any challenges that you're
50:12struggling with with this,
50:14you want to say something at the
50:17end about following up on goals.
50:20Yeah, I had only the only
50:21thing I had said so far,
50:22but I do have a implementation idea
50:24about that is that it's good to kind
50:27of revisit them because you might
50:29need another relevant statement.
50:30Maybe you've accomplished that goal
50:32and it's time to go to the next one.
50:34But anybody have any goals that they
50:36were finding a hard time coming up
50:38with a means or a relevant statement,
50:40anything that's challenging,
50:44I put one in the chat.
50:45It wasn't particularly challenging,
50:47but I have the and goals
50:50and mean goals. But
50:52where where is that? Oh
50:54I didn't click it.
50:56Now it should be there
50:58conduct shared decision making
51:01encounter regarding statins and HIV.
51:03So is it you think it's a
51:06knowledge or a skill goal? I
51:08think it's a skill goal and or
51:10decision making and then there
51:12were I put some means goals
51:13in there after it.
51:17Yeah. Any feedback for him?
51:23Maybe get had somebody
51:25watch you and get feedback
51:30is the HIV residents are doing a team
51:32Qi project on this
51:38and then if there's you know you have
51:40a means like the relevant statement
51:42is because you know because it
51:44decreases you know CV risk by X amount.
51:48Well I hope you're all not being shy
51:51or anything and that you're feeling
51:53like you this is making sense 'cause
51:56I I really want to Jane. I've got one.
51:58You know if you don't mind.
52:00Yeah I I'm just just motivated for you to
52:02feel like you can implement this Janie.
52:04So OK so mine was a skill goal
52:07and I just put in here. We do this
52:10when the students are on campus, but
52:12successfully obtain blood from venipuncture
52:14is one of our skills.
52:17And so the means goal would be to practice
52:21that, I guess practice
52:22veniplexure. But I'm trying
52:23to come up with a relevant statement. I mean,
52:27so you don't mess up a
52:29patient's arm. I don't know,
52:32because you might be oh,
52:33anybody else? I'm sorry.
52:35I mean, anybody else have a
52:37relevant statement for Janie?
52:38Why they should know how
52:40to do phlebotomy? It's
52:42a an essential skill for medical
52:46students to obtain in order to
52:50become competent physicians.
52:51Gotcha. I like that. Thank you.
52:56All right, I'll just finish this up here.
52:59But I was going to just mention
53:03the idea for implementation.
53:04You know, you, if you're a classroom teacher,
53:06you're obviously thinking
53:07about these ahead of time.
53:08I just implore you.
53:10I just suggest,
53:11you know using your verbs wisely and
53:14explicitly and including relevant
53:15statements to really have them
53:17feel like they're buying in and
53:19engaging because they they're going
53:21to realize why it's important.
53:22And I I have a little example here.
53:25I don't know if you you can't really
53:27see if you see my screen but I have
53:29this little card that I keep and
53:31I've got this little table here is
53:34basically reduplicated down below
53:36or at the beginning I'll try to
53:38really I'll I'll talk about my
53:40goals that are that I I try to do
53:42my best practices as much as I can.
53:44But when I'm asking them for
53:46their goals to kind of track them.
53:48You know,
53:48what did they really want to be able to do?
53:50Why help them use goals the verbs
53:52a little bit and have them be more
53:54smart goals and think about means
53:56goals and if we've completed them.
53:58So I can kind of circle back like
54:00how are you doing on that goal of
54:02being able to identify splunomegaly.
54:04But we haven't had any patients
54:06with big squeines on our patient.
54:08Like let's go over to the hematology floor,
54:10you know,
54:11So revisiting them to see if they
54:13need different means goals, et cetera.
54:18And before we do the take home
54:24points because oh, it's starting.
54:26Oh, the time, the timer's already starting.
54:29But we've been implementing,
54:30getting feedback from you about the
54:32sessions before we give you our takeaways.
54:34So if you can just scan that QR code and
54:39I don't know if there's a link in the
54:41chat that Linda's also going to put,
54:45but we've found we get more
54:48feedback on these sessions.
54:50If you do this now one minute
54:55we have our countdown timer.
55:12The other thing that Linda just put in
55:15the chat is I have a handout for you
55:19that has some a bunch of different ends,
55:21goal kind of domains and
55:23some suggested means, goals,
55:24activities just for you to feel like
55:26you have a menu that you can draw
55:29from when you're running out of ideas
55:31for activities for your learners.
55:36I guess that's time if you're
55:39not done with it.
55:40Don't stop though,
55:41because the only thing I'm just
55:43going to end by saying that I'm
55:47feeling that by the end of this
55:49session you have been convinced
55:51in the relevance of being more
55:54effective in expressing a goal.
55:56And you kind of had the idea between
55:58the difference between ends and goals.
55:59And we could try to stop being all
56:01endsy and all meansy and they really
56:03do well together and that we can
56:05use verbs and relevant statements
56:07and conditions to be more effective
56:10in being able to express goals.
56:12But we don't want to leave
56:13our learners behind.
56:14So they're definitely part
56:15of the the conversation,
56:17but their their goals don't
56:18get to trump your goals.
56:21They can coexist and you can help each other
56:26on making them more effective.
56:29I think that is all I have except just
56:33to highlight the upcoming sessions
56:37here ChatGPT by some Med students which
56:41is so great and APHD collaborator.
56:45And then Andres is going to do a
56:47session for really professional
56:49development on writing abstracts
56:52and the information about all of
56:55our sessions at that that QR code.
57:00Any questions
57:04or comments?
57:11I think the dates for the two
57:13upcoming lectures were mixed up. I
57:15was looking, I was looking
57:17at the same thing. Thank you.
57:20Because I'm presenting on a Friday
57:22and Linda, can you take a look?
57:25It should probably, it's probably
57:26right on the website, right?
57:27Linda, if you think we'll have
57:30to check our website. Ellie,
57:31thank you for being a perspicacious.
57:33They shouldn't be
57:34correct on the website, they should be.
57:36Let me just check if your goal is
57:39to learn about those two topics.
57:40Your meaning is that
57:41you need to show up. So
57:47any questions? Thank you.
57:51Everybody, please reach out
57:52for any questions and I can.
57:54I'll be happy to grade your worksheets.
57:57Thank you. Thanks. Thank you very much.
58:01Thank you. Bye, bye.
58:04Thank you.