Virtual Open House - September 7, 2023

October 06, 2023

ID10830

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00:00All right. Well,
00:01I'm going to introduce other people.
00:02Maybe you can briefly tell me raisins
00:05versus olives for a warm up short
00:08and then maybe tell me one thing
00:12that is most exciting about this
00:15residency that you really appreciate.
00:17So I'm going to go to Jeff
00:20Dewey who is a graduate of a
00:22residency and fellowship programs,
00:23associate clerkship associate
00:25program director,
00:26Wellness director for the program for the
00:30department and clerkship director many,
00:32many titles and educator extraordinary.
00:34So Jeff any thoughts versus
00:36olives what you like.
00:38But yeah so I'm pro Raisin anti Olive
00:42that's me in a nutshell.
00:45Thank you for the kind introduction. I'm
00:46excited to be here. Excited
00:48to see all of you here. My,
00:52let's see, one of the things I mean,
00:53the thing I
00:54love about the residency is,
00:55of course, the residence.
00:56It's what keeps me young.
00:58And it's one of the reasons I
00:59get out of bed in the morning
01:00is to support our residents
01:01and everything that they do.
01:02So I'll take that one before anyone
01:06else takes it.
01:09All right. JP McHale, you can go next.
01:15So I'm JP. I'm a P GY4.
01:17I'm one of the recruitment
01:18chiefs this year with is Hawk.
01:19See, you guys will be seeing
01:21us a lot if you apply.
01:23I like both raisins and olives,
01:24but if I had to pick,
01:25I'd probably say raisins.
01:27But I agree that it's not as
01:29good in dishes because sometimes,
01:30I don't know, I feel like sweet
01:32is a little weird in most dishes.
01:34And then my favorite thing
01:37about the residency,
01:39I everyone says the people
01:40and I love the people.
01:41But I will say something else.
01:43Also I I I think we get
01:46really good training here.
01:48You know I think when I was looking
01:50for a place where I feel like I
01:51was going to see a high volume of
01:53patients and and be introduced to a
01:54lot of diversity in many different
01:55ways and and I do feel like I've
01:57gotten that experience thus far.
01:58So I really appreciated
01:59that part of my training
02:01outstanding. Issac, where do you go next? So
02:06everyone on Issac, as JP just
02:09mentioned, also recruitment Chief.
02:15I'm from Atlanta, GA Also,
02:18I love raisins and olives.
02:20I don't know if I would pick
02:23one more than the other.
02:24I feel like I grew up on raisins and
02:26painted dolls as a child and then
02:29developed my appreciation later on.
02:30So, but I definitely still
02:33eat my kids raisins. You know,
02:35sneak one or two from them occasionally.
02:38And I have to disagree.
02:39I think raisins are definitely
02:42excellent and dishes particularly.
02:45I'm surprised.
02:45JP also could like Mediterranean
02:47dishes and like,
02:48I don't know if you guys
02:50would have some Afghani rice
02:52and some water reasons. All
02:53right, all right, I'll move on.
02:55But my favorite thing or a
02:59good thing about the program,
03:00I probably would say because people have
03:03already taken the low hanging fruit.
03:05But really about like how supportive
03:08I think the bunch that we've had,
03:10there've been a lot of good times
03:12and a lot of tough times through our
03:15residency and the people that have,
03:17which you grow and develop relationships.
03:20But then there's residency.
03:21Like, I really we stick together
03:23and help each other through
03:25definitely those tough times.
03:27So it's a good bunch. I love everyone here.
03:31So that's me.
03:34So I've got Diad of PGY ones who are there.
03:40So I we have Yang and Laura,
03:42we have 3 PGY ones.
03:43You'll need another one in a second.
03:46So you've just gotten to know the program,
03:47but you were excited enough
03:49to match with us last year.
03:50So you can give us your raisins,
03:52olives thoughts and then some thoughts
03:53about early on about the program.
03:57Well, on raisins versus olives,
03:59I have to say both are great.
04:02I happen to prefer olives.
04:03I think combining them would be a pretty
04:06versatile and interesting experiment.
04:07So I'll have to try that when I go home,
04:11but in in terms of what
04:13I love about the program,
04:15I would echo you know what we've already
04:18heard about the people being just phenomenal.
04:20I've actually been on this is my 4th
04:23week of neuro electives right now.
04:25I'm in my first year and I've just loved
04:27working with every single resident and
04:29attending who I've been on service with
04:31and it's been phenomenal to make those
04:33connections early on in the residency.
04:35And I think the flexibility is really
04:37a great thing that if you want to
04:39pursue those electives earlier on,
04:41you know during your first year,
04:42you're absolutely able to.
04:43There's actually 62 week elective
04:45slots that we have during our
04:47PG by one year here at Yale.
04:49And so if you wanted to do 6 neuro ones,
04:51I think that's that's actually
04:53possible and that's in addition to
04:54the four weeks of stroke in the the
04:56two weeks of neuro ICU that we get.
04:58So we get a lot of great integration
05:00early on with our program.
05:06Hi, I'm young. I'm another P
05:09GY1 and raisins versus olives.
05:12I would actually also say, you know, olives.
05:17I think olives over raisins because my,
05:20my mom actually traveled to an
05:23area in China called Xinjiang.
05:26It's a province that produces
05:28a lot of grapes.
05:29So whenever she comes back
05:31from her business trip,
05:32she would raise my bags and bags of braces,
05:36which is why, yeah,
05:38I just have too much in my childhood.
05:40But yeah, you know,
05:43olives is actually not part of a
05:46regular diet that I grew up with.
05:48But you know I've acquired a tight such,
05:52you know, it's it's it's nice.
05:56So apparently I also only had,
06:01you know a little bit of
06:06especially to the program so far,
06:08but I would echo that the electives is
06:12one of my favorite experiences so far.
06:14I'm currently on a education focused
06:19elective, the epilepsy and EG elective.
06:22It's I'm totally loving it.
06:26You don't carry any patients doing
06:28this elective and you just focus
06:30on learning and yeah, you get to
06:33work with the EMU and go to clinic.
06:36I went to clinic this after this.
06:38So yeah, I'm looking forward to obviously
06:42discovering new things as my years.
06:47You know, a handful of years ago we
06:49expanded our program and then expanded
06:51the prelim program commensurately.
06:53And one of the goals and doing so
06:56and Jeff you probably remember this,
06:58we were really deliberate about it.
07:00It's nice to see it pay off,
07:02was integrating our PGY ones much more into
07:06the the the residency family and being
07:09thoughtful how about how we did that,
07:11which was bringing them in for a stroke
07:14and neurosite ICU and expanding electives,
07:17but doing so without having to make our
07:19prelims work night or nights or weekends.
07:21So all of these electives are with
07:24nights and weekends free and I
07:26think that was very thoughtful.
07:28We we really got a lot of clear sort
07:30of planning and feedback about how
07:32to do that negotiated that and it's
07:34I think worked spectacularly well
07:36and it's just really nice.
07:37It's really gratifying to me to hear
07:39you say that we didn't plan this,
07:41but it's gratifying to because these
07:44things take years to bear fruit
07:47sometimes Speaking of raisins and olives.
07:50So, Izzy, you're next.
07:56Hi everyone. I'm I'm Izzy.
07:57I'm a teacher.
07:58Wife are reading the program.
07:59I am a Raisin nay Sayer and olive yay Sayer.
08:05But I agree that the raisins are
08:08great in like, certain rice dishes.
08:13And the one thing that I've really
08:16appreciated about the program is just
08:19how approachable everybody is from
08:22the other residents to of course
08:24faculty and that it's been really
08:27nice to have kind of both formal
08:29mentorship relationships but also
08:31informal mentorship relationships.
08:33And and you know, we work with them very,
08:37very closely.
08:38It really doesn't feel like too much of
08:42A hierarchy as you know you might have
08:44seen in Med school or anything like that.
08:46And they really do value you know
08:51our input in terms of patient care
08:55and sort of you know planning for
08:58the next steps for a diagnostic
09:00or treatment considerations.
09:02And it it's nice to be treated
09:05like a colleague and really having
09:08our opinions matter and that's
09:10really been great for independence
09:12and sort of learning as I grow,
09:15especially this year becoming a senior
09:18and taking the next steps in managing
09:20patients and learning neurology.
09:25Sam think last but not least
09:27another one of our PGY ones.
09:30Hi.
09:31I was late to join on, but it
09:34sounds like there is a debate about
09:36raisins versus olives and I took the
09:39liberty of going into my country
09:41just to kind of show
09:43you all the stuff
09:44that we have here.
09:46With that said, I also like dollars.
09:49It's like I just don't keep them around.
09:52But yeah, it's nice to be here.
09:54I was just here.
09:56It feels like, I don't know,
09:58a couple of months ago,
09:59but it's been a whole year.
10:01So it's very nice to to be able to do this.
10:05Neurology at Yale.
10:06I have had my stroke elective
10:10so far and I loved it.
10:13It was too short, busy,
10:16but I learned a lot and I I thought
10:21our seniors were fantastic.
10:23They were they gave us grace and you
10:26know let us out when the work was done.
10:29They one of my, you know,
10:33one of the the seniors that was on my,
10:36I guess, in the area that that
10:38we were working in one time,
10:39who was not my direct senior,
10:41actually overheard me having a
10:43conversation about how I just witnessed,
10:46you know,
10:47a sad situation with the patient and,
10:50you know, checked in with me like
10:51hours later towards the end of the day.
10:53And I really appreciated the humanity
10:56of just like the mindfulness.
10:58So it's a great program.
11:00Please come.
11:03That's awesome. Sam and Nick,
11:05now you can feel less alone.
11:07Clearly you have somebody who's similarly
11:11enthusiastic about raisins. The
11:16I'll go last. So I'm going to
11:19be a typical middle child and
11:20Canadian and say I like them all,
11:21they're great and and be completely
11:23noncommittal and conflict diverse
11:25and and all that sort of thing.
11:26But you know, I really do like
11:30raisins better and baked goods.
11:32I actually am a big fan and it's a
11:34delight to bite into some banana bread
11:36or something and get a soft Raisin.
11:39I really enjoy that.
11:40But for example, so I'm going to,
11:45I'm going to say something different
11:46about what I like about the program
11:48and what I like about the job.
11:50And I was thinking about this a lot.
11:52So my children are in grade school
11:57and they do something called
12:00social and emotional learning.
12:02I think this was something I don't
12:03remember having in grade school.
12:04It sounds fantastic.
12:05And they learn about how to
12:08manage their emotions and how
12:10to manage developing a growth
12:11mindset and all that sort of thing.
12:12In my 8 year old who just started 3rd
12:15grade told me about something they
12:18learned recently which was the 2nd valley.
12:20You know and they said when you're
12:22sort of climbing a mountain,
12:24you know you sort of make that ascent.
12:26And then often there's a little
12:28dip and you go into this valley,
12:30this sort of second valley from
12:32the from the first valley and all
12:34you can see is yourself going down.
12:37And you can either think of that as
12:40sort of an ongoing descent or you can
12:42think of that as a dip that's going
12:44to set you up for the 2nd ascent.
12:46You know, and it really depends
12:47on what you do about that,
12:49you know, so they're,
12:50this is what they're teaching
12:518 year olds in Connecticut,
12:52or at least my 8 year olds in Connecticut.
12:54And Jeff,
12:55who has taught me a lot about
12:57Wellness over the years,
12:59has shown me similar diagrams.
13:00And it's really nice to think.
13:02And you know,
13:03I really like that second valley.
13:06I really like what makes it interesting
13:08for me at this stage 10 years later
13:11is that challenge that's going to
13:14be for the next period of growth.
13:17And you know,
13:17for example,
13:18we had a challenge of PGY twos coming
13:21and not feeling really part of the team,
13:23you know,
13:23and not as integrating as well after
13:25their PGY one year and feeling
13:26separated and not doing much neurology,
13:28you know,
13:29that's just one of many examples
13:30And it looked like a task that
13:32would be difficult to overcome.
13:34But we did and it took a long
13:36time and it took longer than it
13:38would have wanted or expected to,
13:39but it happened.
13:40And you know,
13:41the longer you do something like that,
13:43the more you get used to and more
13:45comfortable with those second
13:46valleys and you'll have many of
13:47them in your residency.
13:48Asak talked about,
13:49you know,
13:50depending on the support of his
13:52peers during those times.
13:54And we, you know, if you're interested,
13:56Jeff wrote a really nice paper
13:59about thriving in residency.
14:00And one of the things that he found
14:04in his interviews and in our analysis
14:06of interviewing residents was just
14:10how that growth happens through
14:12challenge with the appropriate support.
14:14And it can always be perceived at the time.
14:16And all of you will have second or third
14:19valleys as you go through the airas process,
14:21as you go through your interviews,
14:23everything will seem extremely high
14:25stakes and but you'll get through them.
14:27That's just what they are.
14:28They'll be an ongoing nether ascent
14:30after that and there always is.
14:33So that's that's that's my
14:35moment of philosophy.
14:37No, I'm no, I'm going to go from
14:40that to PowerPoint as we do.
14:42So let me just pull it up.
14:43I'm not going to belabor this presentation
14:45because I did it at our first day and
14:47I'm sure many people had it there.
14:48And it's also on Zoom or on.
14:50We're going to put these up videos up,
14:53but here's our residency.
14:55We're very proud of it.
14:56This is my backyard.
14:57Here's our chair,
14:58Doctor Haffler,
14:59who has never missed one of our opening
15:01picnic and the rest of our team.
15:03And we work in a highly supportive
15:06environment that's very focused on education.
15:09We're all over the web in every way,
15:12Twitter and Instagram and our websites,
15:14which we carefully update and look at.
15:17Or we have a couple of podcasts and
15:19you can always e-mail us and most of us
15:21are emails are ourfirst.last.yale.edu.
15:26We are an advanced program.
15:27Currently we will have 10 positions starting
15:30at P GY2 with 10 guaranteed prelim spots.
15:35Stay tuned as to whether that changed.
15:36No one, no big announcement right now.
15:39We are a highly academic program.
15:42You heard from our PGY ones.
15:44They get six weeks of neurology and
15:46six weeks of electives that they
15:47can spend any way they like and many
15:49choose neurology or other things.
15:51In that way 95% of our residents
15:54pursue fellowships.
15:55Really good mix of inpatient
15:57and outpatient specialties,
15:58really good mix,
15:59something I'm also very proud of.
16:00Lots of people do movement disorders
16:03and neuro immunology and neuromuscular
16:05medicine and headache and R2 for example.
16:09R2 recruitment chiefs are both
16:11pursuing outpatient specialties,
16:13out focus specialties and many do.
16:16So a lot of residents have anxiety
16:19about getting that experience.
16:21And then on a side note,
16:23one of our,
16:25one of our former residents is very
16:27interested in doing a study on
16:30developing some standardized curricula.
16:32I just met with him this afternoon
16:34for outpatient neurology.
16:34So we care about that and
16:36we're thinking about
16:40that. You will all need a minimum of three
16:41reference letters, a maximum of four.
16:43At least one should focus on clinical
16:46neurology for international graduates,
16:48ideally something from the United States.
16:50But we realize that there are
16:53challenges with that and we can
16:54understand that that's difficult to get.
16:56You know, electives and observerships and
16:57all those sorts of things are much harder.
16:59Since the onset of the pandemic,
17:01we will interview about 100
17:03and 32140 applicants,
17:05which is a relatively small
17:07fraction of the applications we get.
17:09So it's very competitive and it'll
17:12be 12 applicants per interview day.
17:14And we do pretty brisk interviews.
17:16So we do half day sessions,
17:18either 9:00 to 1:00 or 12:00 to 4:00 and
17:21there's an overlap in the middle for a
17:23case discussion and and clinical stuff.
17:26We reviewed all applications.
17:27We've been doing holistic review forever.
17:29I'm reading about this all the
17:30time now and I'm like, yeah,
17:31we've kind of always been doing
17:33this by at least two reviewers.
17:36All of our reviewers will be
17:37educated on sources of bias.
17:38Most are very experienced reviewers will.
17:40If we have new reviewers,
17:41we always them with with
17:43some education about that.
17:44We don't have cut off scores or
17:46filters or anything like that.
17:47We do interview and match
17:50international medical graduates.
17:52I always get a lot of questions about
17:53that during these sessions and I was
17:55just want to be very transparent about that,
17:57right?
17:59We do interview and match
18:02international graduates.
18:03US experience is preferred.
18:04We realize that we review everything
18:06holistically and in context,
18:08but it is preferred.
18:10It is highly,
18:12highly preferred that graduation
18:14from medical school would have
18:15been the in the past five years.
18:17There are rare exceptions to this that
18:20relate to additional training and
18:21personal circumstances or things like that.
18:24But I always want to be very,
18:25very open about that and and this
18:27is as you heard from our residents,
18:30an extremely clinically busy
18:32and intense program.
18:33It's very hard to reintegrate
18:35into residency after a long gap.
18:37And so I I always want to just be very
18:40clear about that and that the reasons for it.
18:43And we do offer both J1 and H1B visas
18:45depending on the circumstances.
18:47Those typically are discussions
18:49that I have with applicants at the
18:51time they interview or afterwards.
18:56This is how we review.
18:57So for the application,
18:58we look at your grades and MSPE,
19:00your research and scholarly work,
19:01your leadership engagement.
19:02And we like to look at resilience,
19:05evidence of resilience,
19:06which we could see throughout the
19:08application during the interview.
19:09We look at a lot of the same things
19:11and these are really carefully
19:13aligned with the objectives of
19:14our program because our residents
19:16are what make our program work.
19:18And so we want to recruit our residents
19:20on the basis of what our mission is.
19:22And and we've been enormously successful
19:24when we've stuck to this process.
19:28We've had lots of innovations
19:30that I think have helped.
19:32We have an X + Y clinic format.
19:34We were one of the first.
19:35We've caught a lot of
19:36other people how to do it.
19:38We we don't have any 28 hour in house call.
19:41We have overnight call at the VA,
19:43but that's phone call and like I said before,
19:46very early exposure to outpatient
19:48subspecialties which has not been an
19:50issue with our fellowship matching.
19:52We have lots of leadership opportunities.
19:55We can talk about that more.
19:56One of our residents will be going to Kapala,
19:58Uganda next week,
20:00I think this weekend as part
20:02of our Global Health program.
20:04We've had a very successful
20:06clinician educator track.
20:07One of our former residents,
20:09recent graduates was just invited
20:10to be a member of the editorial
20:13board of the neurology education
20:14journal Harry Sutherland.
20:16So just really excited for him about that.
20:19He just learned that Monday or Tuesday
20:22we've had a great success with our 25
20:25program with healthcare management,
20:27lots of people on editorial
20:29boards in different places.
20:31We had a resident who was on the
20:34board of the match and remains
20:36involved with that organization
20:38since starting on the board.
20:40Jeff as a resident was the
20:42resident member of the residency
20:44Review Committee of the A/C GME.
20:46And so we really look to train leaders
20:48and scholars and I and I feel very,
20:50very proud of our track record of of
20:54offering and being successful with
20:57leadership opportunities for residents.
20:59We have a strong commitment to diversity,
21:01equity, inclusion.
21:02We have Vanessa Cooper's actually
21:04doing another open house tonight,
21:06but she's our Associate Director
21:08of Diversity Education,
21:09so she sends her regrets.
21:11Reshmaud Arula is our departmental
21:12Director of Diversity, Equity Inclusion.
21:14We really,
21:15I think got on board with
21:17best practices very early on.
21:19We do do critical grand rounds with
21:22the health disparities focus and
21:24we're very interested in developing
21:26novel educational tools and taking
21:28our usual approach to education to
21:32to DEI topics what's our vision.
21:35So increased diversity in the
21:37faculty neuro hospitalist service.
21:39We have ongoing discussions and
21:41planning for this and ensuring that
21:42the residents size is commensurate
21:44with the educational opportunities.
21:46We will be expanding to a new
21:48tower opening in 2027 which is
21:50an enormous opportunity.
21:52It's been very exciting.
21:53I've been part of some of the processes
21:57of recruiting faculty leaders,
21:59you know, as part of this expansion,
22:00which has been really fun.
22:01So I think this is really going to be
22:03some growth and we want to continue
22:05to do what I've talked about before,
22:07right?
22:07We want to continue to nourish,
22:10nurture, grow leaders and scholars.
22:12And I think what you've heard from
22:14residents to empower our residents
22:16to make meaningful changes within
22:18the system and to innovate.
22:19I think we have an amazing track
22:21record of innovating educationally.
22:23I think it's one of our strengths
22:25and the expertise.
22:26The depth of our bench in
22:28terms of educational experts
22:30I think is second to none in the nation.
22:33I'm, I'm really proud to say
22:34that we've really built out in
22:36terms of educational expertise.
22:37So we're really proud of that.
22:41I was interviewing A faculty applicant
22:44who was talking about sort of the
22:46future of education and neurology
22:49education and sort of being scholarly
22:51and sort of asked my view on this.
22:53And I said it's most important to
22:56me that my home is in order first,
22:59you know, before I go out into the world
23:00and talk about innovations elsewhere.
23:02So for us, for all of us,
23:05education starts with our residency
23:07and with our educational programs here
23:09at Yale and doing a good job of that.
23:11And we can innovate and share
23:13and grow and build.
23:14But our focus is on these residents,
23:17is on this program and is on the
23:19experiences that we can get here.
23:21So we're really proud of it,
23:23really proud of our residents.
23:26We're going to leave it open to questions.
23:28You can raise your hand and ask
23:30a question in person or you can
23:33take something into the chat.
23:35JP and Isak have been expert.
23:38We had a very, very active chat.
23:40I'm going to pause for a moment,
23:42but if there's a longer pause,
23:44I'll just start asking questions.
23:46But as as I might have anticipated,
23:49there hasn't been a longer pause.
23:50So,
23:50Mohammed Mansour,
23:51you can go ahead and ask a question.
23:56Yeah. Hello, everyone.
23:57Thank you so much for hosting this.
24:00I'm Mohammed Mansour and Egyptian IMG,
24:03and I'm currently an Epilepsy research
24:05fellow at George Washington University.
24:08Well, actually I think you have like the
24:12perfect program as as far as it can be.
24:15But I just want to to get more
24:18information about the about your epilepsy
24:20center like for instance the number
24:23of beds and the volume of epilepsy
24:26surgical cases that you that you do.
24:29Oh man, you're getting into the weeds,
24:31Mohammed. So well one of the many
24:33hats I'm wearing right now is the
24:35interim clinical chief for epilepsy.
24:36So I have looked at my fingertips.
24:40We're actively recruiting the clinical
24:42chief which is very exciting.
24:45So, so we have an 8 bed Atlas minor unit.
24:49We will be expanding to 10
24:51once we go to the new tower.
24:52Our surgical volume fluctuates but we
24:54have an extensive surgical program.
24:56We do a combination of stereo,
24:58EEG, grids and strips resections,
25:02Ecog, we have a very active
25:05neuro stimulation program.
25:07Izzy is is very active actually in
25:09doing some work on one of our clinical
25:12trials in in status epilepticus.
25:14We have one of the most active
25:18ICU EEG programs in the country.
25:21We are expanding broadly across the
25:24system in terms of from New York to
25:27Rhode Island in terms of the outpatient
25:29epilepsy care that we provide.
25:32It's a very,
25:33very exciting time to be interested
25:35in epilepsy in the world and I think
25:37it's extremely exciting time at Yale.
25:39I think there would be amazing opportunities.
25:41Thank you. Brenda, you're next.
25:48Hello. Thank you so much
25:50for this wonderful session.
25:51Clearly, Yale is a dream program.
25:54And one of the most interesting
25:56thing I want to ask no more
25:58about is the leadership program
26:00that you are talking about.
26:01I'm personally very much interested in the
26:03academics and the teaching opportunities.
26:05So what are the teaching
26:06opportunities that are that the
26:08residents can participate in?
26:10Maybe I'll hand that off to the
26:12residents, maybe they can talk about
26:13some of the teaching they've done.
26:16Okay. Thank you.
26:18Yeah, I can start. I mean I think
26:21I would say one of the many strong
26:23points for Yale is there is a very
26:25strong educator clinical track.
26:27I think you'll see here most of a
26:30decent number of our faculty actually
26:32have advanced degrees in education,
26:34which I would not say is ubiquitous
26:36amongst a lot of programs and it shows.
26:39I think that you know, people are
26:41interested in everything from education,
26:42Wellness, sorry, resident,
26:44Wellness and well-being to actual like
26:48education and pedagogical methods.
26:51And so all of that from the flat faculty I
26:53think bleeds into what we get as residents.
26:57So there is pretty ample
26:59opportunities to teach.
27:00You can do morning reports.
27:01As a resident,
27:02I had the opportunity to give a lecture
27:05to like the Neuro Psych program about
27:08neuroanatomy of attention last year.
27:10You could do a lot of work
27:12with the medical students,
27:13clinical handson teaching
27:14as well as lectures.
27:16And then there's a lot of research
27:19that people do as well in terms of
27:21education and education pedagogy.
27:22Harry Sutherland,
27:24who Doctor Mueller was just mentioning,
27:26has you know,
27:27like a whole EE G game that he
27:30set up regarding education and
27:32how we learn about Eegs.
27:35And people do things like that
27:37pretty routinely, I would say.
27:38So I think that's very just a strong
27:39point of the program, certainly.
27:42Thank you so much.
27:43Another another big component that
27:46some people have gotten involved in
27:49as residents is one of the podcasts
27:51that we do with the neurology
27:53board that Dr. Mueller and Dr.
27:55Dooley are very much involved in.
27:57But if there are some residents that are
27:59particularly interested in being involved
28:01in hosting some of those episodes as well.
28:03So that's another opportunity that
28:06many people have taken advantage of.
28:07And you can teach a lot of people on
28:09a broad scale through those podcasts.
28:13I'm Invisible. I'm Chris.
28:17Vacation chief. Yeah, this
28:20is who This is who we needed.
28:22So I'm below the street side
28:24to the top of your head. Yes, hi,
28:27there we go. Everybody
28:29has already mentioned
28:30a lot of of teaching opportunities
28:32that they're. So like,
28:34if you can imagine it,
28:35there's probably a way to do it.
28:37Doctor Dewey and I have been
28:38working on an enrichment program
28:40for students who are interested in
28:42applying into neurology as well and have
28:44been doing some individualized teaching
28:47in that around sort of to augment
28:50clerkship experiences and the things
28:52that we've have in a more set structures.
28:54There are lots of opportunities if
28:56that's something you're interested in.
28:57And I certainly feel like I've
28:59personally grown throughout residency
29:01and I'm continuing to grow as a would
29:05be want to be somebody educators.
29:07So if you're interested in that we
29:11have lots of opportunities and I
29:12think there's both like
29:14informal and formal ways.
29:15I think the more informal ways would
29:18be you know you will get assigned
29:20medical students on your teams to
29:23to kind of nurture but then also
29:28more formal teaching opportunities.
29:30I know that how Blumenfeld runs
29:33a clinical neuroanatomy and case
29:34based teaching series that he does
29:37with the medical students and
29:39he invites the residents to come
29:41present and faculty as well to help
29:43with the case based discussions.
29:44And then I I think there's also a
29:47lot of community outreach education
29:49that I'm aware of.
29:51There is the like local high school
29:54programs that I believe Doctor Foreman
29:56and then on the stroke service.
29:59And then Dr.
30:00Schaefer is also involved in for
30:02sort of community education outreach
30:04programs from like the K to 12 piece
30:07of it and then sort of like maybe
30:10teaching for stroke care as well.
30:12So that it's not just like within
30:13the hospital system itself,
30:14it's also within a broader
30:17sense of community.
30:23Thank you. Thank you. So
30:24one thing to add,
30:25I just got an e-mail about this today.
30:28You know, there's lots of hospital
30:30wide opportunities for leadership
30:31and and career development as well.
30:34For example, there's a quality care,
30:37quality improvement and quality care,
30:40I can't remember the name of it,
30:42track with specific training on
30:44quality improvement through the
30:47hospital and one of our residents
30:48is going to be enrolling in that.
30:49So that's formal training
30:51and high quality care,
30:53quality improvement program evaluation.
30:55It's something that we I think
30:57can continue to grow with.
30:58It's an exciting field.
31:00I think that neurologists are getting
31:01better about and we have resources
31:03to provide formal training in that,
31:05which is really exciting.
31:06So one of our PGY threes is
31:07going to join that track.
31:11All right. Thank you, Bittor.
31:13I think you're next.
31:16Hi, everyone. Thank you all for this.
31:19I would like to know a little bit
31:22more about the research track and
31:25specifically is it feasible for
31:28residents without the PhD to join the
31:31clinical neurosciences research program.
31:35It's possible it's been
31:37done it's much harder.
31:38The reason is that the focus of the
31:41R 25 grant that's that funds that
31:44tends to be on mechanisms of disease.
31:48So so that is clinical and sorry
31:53translational and basic research.
31:55It's so much harder to learn and develop
31:58those techniques during residency.
32:00It's possible so that this has to be
32:02discussed on a case by case basis.
32:04That said, the vast majority of our
32:07residents do scholarly work and that can
32:10range anywhere from case reports or series,
32:13chart reviews, clinical trials,
32:16other clinical studies.
32:19I really think there's tremendous value
32:20in doing a chart review for anyone
32:22whether or not you're going to do,
32:24you know,
32:25do a ton of clinical research in your career.
32:28We have, we had our third annual
32:31resident research blast,
32:32which is during Grand Grand onslaught
32:34where our residents just give
32:36a very short 5 minute overview
32:37of their research projects.
32:39And that's always been enormously successful.
32:41And actually I'm always embarrassed
32:43to learn that there's stuff that
32:44residents are doing that I wasn't
32:46totally aware of when I see that,
32:48which is really nice.
32:49So there's just so much support for
32:51research and there's elective time to do it.
32:53Whether or not you choose to do the research,
32:55check
32:58Abaji. Abaji, I think you're next.
33:02Hi. Thank you so much for organizing this.
33:07I'm a graduate student at Mayo
33:09Clinic studying neuro immune
33:10mechanisms and epilepsy.
33:12For the prayer program,
33:13I was wondering how do residents receive
33:15feedback on their clinical performance,
33:17especially if they make a mistake or say,
33:19take a suboptimal decision?
33:22How, how are they given a feedback
33:26on those situations? Yeah,
33:28it's a great question.
33:31Anybody want to speak to that?
33:33Any of our residents do a little
33:34bit through it. So there are
33:37a wide breadth of opportunities for
33:39feedback that we take advantage of and
33:41it kind of falls in line in regards
33:43to the strong emphasis of education
33:45that we have within that program.
33:48So just from the general standpoint,
33:52we have the standard Met Hub
33:54evaluations that we often do which
33:56we do take a lot of emphasis on and
33:59many people do follow those and then
34:01we do emphasize in person feedback.
34:04So we have feedback Fridays where
34:07it is stressed that the particularly
34:09the attendings make sure it's pull
34:12everyone aside and give a little
34:14bit of feedback in person.
34:15But that's not just the attendings
34:17but also us as residents giving
34:19feedback to like as you said earlier
34:21we have medical school students,
34:23PA students as well as like off
34:27service rotators through internal
34:29medicine or even different campuses
34:32or different hospital systems
34:34that come in and rotate with us.
34:36So we try to do that as well
34:38and we provide evaluations.
34:40We even have inter kind of resident
34:44evaluations to some extent where
34:46maybe someone's doing a night
34:48rotation is starting off early on.
34:50We may give feedback to the the
34:53junior resident on kind of how
34:54they did throughout the night,
34:56their night shifts etcetera.
34:59In particular about like a situation
35:02of where there may be a decision
35:04that may have happened or something
35:06that may have gone wrong.
35:08There's always a stress that
35:10you know we work as a team.
35:12I've never been in a situation
35:15where in people do make mistakes.
35:17There are mistakes that are made.
35:19There are systems in place where if
35:22you may make a mistake that you should
35:26always have some sort of mechanism
35:28where that's there's someone else
35:30that may catch that sometimes things
35:32may not go as fully as planned.
35:35I've never been in myself in a situation
35:38where I truly felt like I've been
35:40reprimanded for any sort of mistake.
35:43I felt like it's always been
35:44a supportive environment.
35:45I personally really do like and
35:47I've done this myself as a senior
35:49where I just kind of we just kind
35:52of they fell right after the event
35:54or even when everybody's together
35:56the following morning before round
35:58just take a moment and just have
36:01a discussion just stop.
36:03Have everyone express how they feel
36:06about something that how things
36:08went down and kind of just have a
36:12conversation and really dedicate
36:14time to that before just brushing
36:16it under the rug and moving on.
36:18And I feel like I've been in that
36:20situation several times where we
36:22just had that conversation as a team
36:24and I've never in my own moments
36:26of making mistakes you're seeing
36:27someone else making mistake.
36:29I've never seen something where
36:30we've been particularly felt like
36:32they're negatives only positives and
36:34constructive criticism of feedback.
36:37You know, it's it's such a
36:40great question, Abhijit.
36:41And we feel very strongly that you can't
36:43have a functioning training environment
36:45where people can't feel like it's not
36:48possible to make a mistake, right.
36:50You know, it's going to happen and
36:52our approach has to be we take
36:54it seriously but not personally.
36:55What have we learned?
36:56The other thing actually is Jeff
36:58as a Director of Wellness develop
37:00used some best practices,
37:01develop a critical instant
37:04debriefing process.
37:05So Jeff, did you want to speak to that?
37:07I think that's actually been very effective.
37:09We could use it more,
37:10but it's been effective.
37:11Yeah.
37:11It's, it's basically
37:12a formalized version of what
37:14Isak was talking about with,
37:15which is an opportunity to get together
37:18with anyone involved in a significant event.
37:20And that could be a bad patient outcome,
37:24a tough family interaction,
37:25you know, medical error,
37:28anything that really pushes you
37:30beyond your coping mechanisms.
37:31And so it's an opportunity to get together
37:34and formally debrief the experience,
37:37unpack some of the emotions around it
37:39and normalize what everybody's feeling
37:41and make sure people have connections
37:43to the support that they need to move
37:46on and learn from these experiences.
37:49So I agree it's something we
37:50can always do more of,
37:51but in the instances that I have done it,
37:53I found
37:53it really effective.
37:57And I will also say that
37:59Doctor Dooley also helps us out was
38:02particularly this is not necessarily
38:04fully related to that scenario.
38:06But in general with Wellness kind
38:08of we've had these brainstorming,
38:11brainstorming sessions where this is a
38:14confidential safe space where it's just
38:17you and your class and Doctor Dillon,
38:20it's just a chance to for having events
38:24get together as a class
38:26and discuss any problems,
38:27any good things etcetera.
38:28Just have that conversation in that
38:31safe space which we've have had
38:33many kind of beneficial sessions,
38:34I feel like and many people have
38:37reported some positive outcomes from that.
38:40And then there's always within
38:42the hospital itself kind of
38:44anonymous kind of mechanism for
38:46reporting if there's any sort of
38:51any sort of issue that arises,
38:53whether that's with any sort
38:55of member within the hospital,
38:57different teams etcetera,
38:58where you wanted to report something
39:01that can be done and it will go
39:03to the respective programs and
39:06their faculty to hopefully produce
39:09outcomes following that or at
39:11least be reported and recognized.
39:12So there are many mechanisms
39:15that are in place and I think we
39:17kind of do a good job and trying
39:19to maintain positive attitudes
39:21around and all those. All
39:24right, Betty, I hope I'm
39:27pronouncing your name right.
39:27I'm just going to address a
39:29question in the chat and then
39:30and then I'll let you go.
39:31So Omar asked about the reserved
39:37for a physician position at Eras.
39:40Feel free to apply for that if you
39:41already have preliminary training.
39:43So either a transitional year
39:45or a prelim year.
39:48Currently, we don't have positions open,
39:50but that may change.
39:51So we are opening that for people
39:53who are interested in applying.
39:55You can reach out to me directly with
39:58questions, but that that would be for
40:02somebody starting in P GY2 in 2024.
40:05So most people applying for the
40:07regular match would be P GY2 in 2025,
40:09right And then the prelim
40:11year the year before.
40:12But if you already have prelim year training,
40:15feel free to apply to that.
40:16I can't give you more details right now,
40:18but we wanted to have that open in Airas.
40:20So if you have applied
40:21and if you want question.
40:22If you have questions,
40:23you can reach out an e-mail.
40:25So, Etty, go ahead.
40:29Yeah,
40:30you're spelling that right.
40:34So thank you so much for this meeting.
40:37I met M and IMG from Albania,
40:39currently an Associate Research Scientist
40:41here at Columbia University in New York.
40:44At the stroke department,
40:45as someone interested in
40:47vascular, I just wanted to
40:48ask, how much exposure do
40:51the residents have to DSA or
40:53the INR suite during their
40:55general Neurology residency here?
40:58Oh yeah, barely any.
41:00No, I'm just kidding.
41:01I'm just kidding.
41:01It's quite the opposite.
41:03So any thoughts about our exposure
41:06to especially in the acute setting
41:09to treating patients with advanced
41:13treatments for acute stroke,
41:14any any questions about that residence
41:18as the stroke, as the stroke senior right
41:20now I would have to say that we get a lot
41:23of exposure to stroke patients both as
41:27the stroke code responder to the patients
41:30who present with a possible stroke.
41:32You know, as you're on consults,
41:34you see a lot of that across the board.
41:37I think our volume here at Yale sort of
41:40is more in comparison than some other
41:43centers in the state of Connecticut.
41:45And then in terms of shared decision making
41:49between us and endovascular neurology,
41:52there's a lot of crosstalk back
41:54and forth about sort of is this a
41:56patient going to be a candidate for
41:59thrombectomy or not And then you wheel
42:02the patients up to the endovascular
42:06suite and if you're not busy,
42:09you're welcome to stay And you know take a
42:11look at the procedure and all those things.
42:14I believe there may be opportunities for
42:17elective time specifically dedicated
42:19for that as well specifically more
42:23like the DSA side of things if you
42:27wanted to sort of go and sort of down,
42:30up and do those things.
42:31And then generally you know we do
42:35spend a good amount of time in the
42:37neuro ICU working closely with our
42:40neurosurgery colleagues on treating
42:42patients who need require Dsa's for
42:44other indications like aneurysms
42:46and repairs and all those things.
42:49And so you will also be taking care
42:52of those patients as it's a closed
42:55ICU unit for neurology run ICU
42:58that you will also make codecisions
43:01regarding certain patient populations.
43:04So there will be ample opportunity
43:06for exposure.
43:12Our residents respond to approximately
43:16220 stroke alerts a month,
43:19something like that,
43:20that number and of those I think
43:24the average that keeps moving,
43:27I don't want to be misquoted,
43:29but well over a dozen Tier 2
43:33activations a month well over.
43:36So this is one of the busiest acute
43:39stroke centers that you're going to find.
43:41Yeah, I was just going
43:42to say I think Yale does.
43:43It's upwards of 200 throwing
43:45back to me a year and I would
43:47say like the average like for
43:49the for hospital like 20 a year.
43:50So it's a very high volume
43:51from back to me center.
43:57It's more often than not there'll
43:58be a thrown back to me case when
43:59you're on call basically, right.
44:02So and and and balance with
44:04that is a lot of support, right.
44:05We have stroke nurse navigators
44:07who do a lot of the work for that.
44:10We're now doing TNK which can be
44:13pushed by nurses doesn't require any
44:15premixing is given in a single bolus
44:18rather than the infusion afterwards.
44:21We have a telestroke programs
44:23for outlying hospitals.
44:24Our residents are not involved in
44:25that but could be on an elected basis.
44:27Our fellows are our stroke fellows
44:29and we have very advanced and
44:33thoughtful processes for basically
44:34every aspect of vascular neurology.
44:36It's a real strength both
44:39academically and clinically.
44:41And they honestly the challenges is
44:42trying to make the most of those
44:45educational opportunities right.
44:46About 60% of stroke alerts
44:50aren't strokes right in the D,
44:5295% aren't strokes in the inpatient setting.
44:54That's across the nation and
44:56it's true at Yale.
44:57So we have to make sure that we're
44:59creative about how to deal with that
45:01volume and still make it educational.
45:03We lots of thoughts about that.
45:04I could talk about EDLIN,
45:08any other questions?
45:10Let's see what is the value?
45:12Yeah, what is the value of
45:14signaling and eras for the Yale
45:17Neurology Residency program.
45:18So this is so for those who don't know,
45:21I guess all the applicants do,
45:23but and I see Yang and Laura and
45:27Sam smiling there because they went
45:30through singling signaling last year.
45:32I'll actually tell you,
45:34it honestly wasn't on our end.
45:38I think we picked the people for
45:41interviews that we would have
45:43picked just to be entirely honest.
45:45I mean it's nice to know,
45:46you know around the margins if
45:49somebody's from a different geographical
45:51error area or if it's unclear if
45:54somebody's really serious about
45:55the program or things like that,
45:57that was helpful.
45:58You know,
45:59it was that was information we
46:02sometimes received other ways and
46:03personal statements or or that sort of thing.
46:06It's it's not like that we do holistic
46:09review, it's not the big thing.
46:10So we look at that signaling.
46:13There was an option,
46:14I don't know if it'll be for this
46:15year for people to actually elaborate
46:17on their geographical preferences,
46:19you know, with a little sentence
46:20or two or something like that.
46:21Sometimes that was useful,
46:23you know to understand.
46:24And the goal is we want obviously
46:26the best residents we can recruit,
46:29which we are very successful with,
46:31which I'm very happy about and
46:33we want people to be happy here.
46:35And so if the signaling indicates
46:38that somebody's very enthusiastic,
46:40then I suppose it helps,
46:41but it's not central.
46:43But we're we're still,
46:45we're still learning that process and
46:47I don't think it's changed this year.
46:49The applicants will have to tell
46:50me is it 3 signals, is that right?
46:52Is it still three?
46:54And then you can call it graphical
46:56areas and things like that.
46:59Yeah, that's right. Yeah.
47:01So, you know, don't sweat it.
47:03Lots of people who didn't signal
47:05got interviewed.
47:05You know,
47:06like it's lots of,
47:08I don't know what the numbers were
47:09in terms of people who signaled
47:11or not who matched with us.
47:12I actually didn't even bother
47:13to look at that and go back.
47:15I suppose I should.
47:20So that's my wishy washy answer.
47:22We're still, it's the world of signal.
47:24This is a new thing.
47:24I still don't totally understand.
47:28All right, Victor, you're up next.
47:31Hi. Hi. I want to hear from
47:34the residents about their
47:35experiences with the clinic
47:37blocks and what kinds of super
47:39specialty clinics are available.
47:43Good, good one.
47:48I like the X + Y model.
47:51You'll see across the board there's like the
47:54continuity clinic you can get at each week.
47:56But for me it works well because
47:58you're just on clinic that week.
48:00And I think for about 95% of those
48:04weeks you also get the weekend off.
48:07And so it's nice to just be in the clinic
48:10setting for that week and then you get one,
48:14three to four half days to get some
48:19specialty clinic during that time along
48:22with three afternoons of continuity
48:25clinic as well and then another I think
48:28morning half day of continuity clinic.
48:30So there's a wide range of options.
48:33We kind of signal our preferences for which
48:37subspecialty clinics we do each clinic block.
48:41So you'll you'll do you know two to three
48:44different subspecialty clinics each quarter,
48:47so like six months, I'm sorry half year,
48:50six months and then you will be able to
48:55attend those clinics and have some choices
48:58in terms of different attendings as well.
49:00So for example, right now I'm on neuro opto,
49:04neuro immunology and the neuro
49:08oncology for my clinic preferences.
49:11And so you know we have,
49:14I think we have most if not
49:18all subspecialty neurology.
49:20We have neurotology, neuro ophthalmology,
49:23neuro, onc, neuromuscular epilepsy,
49:26headache, lumbar puncture clinics,
49:28injection clinics,
49:30movement and Botox clinics
49:32and then stroke obviously.
49:34And
49:36I don't know if I'm missing some,
49:38but you know, lots of different
49:40things to choose from.
49:41Lots of ways to rotate in them,
49:43even outside of your scheduled
49:45clinic blocks and the elective time.
49:48Also, you can spend it entirely
49:50inpatient if you are wanting to do that,
49:52or entirely outpatient as well.
49:56Thank you so much.
49:58They all do. All right.
50:01Well, I'm very sensitive of time.
50:05I saw the top of Muhammad's had.
50:06Everybody should give
50:07Muhammad a round of applause.
50:09It was his first alone day in the
50:12emergency department is a P GY2.
50:14So it's a big day in a in a young
50:17resident's life and everybody's very happy.
50:20He he nailed it.
50:21He called me to review one of my agents.
50:24So it's
50:28good. Graduated responsibility
50:29is what that's called.
50:34Thank you for that lovely day
50:37with my best buddy here, Chris.
50:40Plus you gave your first
50:42T&amp;K the yesterday too.
50:45Oh wow, good for him. action-packed.
50:51So couple more questions in the chat.
50:54I can do one brief. So one of them is.
50:58The first one is, is there an option
50:59to do part of one's fellowship
51:01and folded with the residency?
51:02For example, by utilizing elective
51:04time of the 3rd and 4th year?
51:07I mean there's no,
51:08I mean and you can correct me if I'm wrong,
51:09doctor. Well there's no it's it's not
51:11wouldn't be a formal unfolding of any
51:13sort of fellowship into the residency.
51:14You can certainly get the training needed.
51:18You know what would be recommended
51:19by most of those societies.
51:21So for instance you're really focused on it.
51:24You could probably try to read 500 E G's,
51:25which I think is the recommendation,
51:27but you would not have
51:28like a formal fellowship.
51:28Similarly for EMG and nerve conduction
51:31studies, I think it's about 200.
51:33If you were really diligent
51:34about it and went to clinics,
51:35you could probably do 200 EM G's hands on,
51:38but again it would not be
51:40like a formal fellowship.
51:41So I think that's what
51:41I would say about that.
51:42But I know we have EEG and epilepsy
51:44and neuromuscular attendance here.
51:46So
51:47there is there is fairly generous
51:49elective time especially when you
51:52consider the the clinic block you
51:54know and then sort of half of that.
51:56So clinic block is 2 months of every year,
51:59elective time is sort of 10
52:02to 12 weeks of every year.
52:03So that's almost a little less
52:05than half the year that sort of
52:07outpatient or or sort of focused
52:08on what you're interested in,
52:10in P GY3 and four.
52:13And so there's a lot of opportunities
52:15to do that.
52:15In terms of unfolding fellowships,
52:17I know the neurosurgeons do this
52:19really hard to do because of most of
52:21our fellowships are accredited, right.
52:22They said GME or UCNS accredited.
52:24And so there's a certain amount of
52:25time that has to be spent after
52:27residency doing those things.
52:28So you know,
52:29I suppose in neuromunology or
52:31something like that but but you
52:32know most of the other fellowships
52:34have a specific accreditation
52:36standards which are time based.
52:38If I'm nerding out on competency
52:40versus time based medical education,
52:42there is,
52:42there is a difference
52:46and I think we're out of time.
52:48I really want to be
52:50sensitive to people's time.
52:52But I think JP answered the question
52:54about working with residents and fellows.
52:56I'll just mention the fact which is
52:58usually approximately half of our stroke
53:01fellows are our former residents,
53:03which I think helps a lot.
53:04So they totally get it.
53:06It's something like that typically
53:07it is this this year for example.
53:09So I think that dynamic tends
53:11to work out really well.
53:13I do just want to touch base a little
53:15bit more specifics for that question.
53:17I would say ultimately the
53:19relationship between residents
53:20and fellows with decision making,
53:21I think overall it's pretty
53:22large and shared decision
53:24making in the sense of you know,
53:25discussing the patient's case.
53:28As JP mentions,
53:30you know you're often the first person
53:32see or you're here there overnight,
53:34you're waking the fellow up,
53:35you're providing,
53:36you know the overall assessment and
53:38kind of the resident will look over
53:41the case and make a final decision
53:43on with the discussion for attending,
53:45especially interventions required.
53:48It depends also on the service or
53:50stroke like inpatient services,
53:52you're working directly with the resident,
53:54the fellow on the attending.
53:56Ultimately the decision kind
53:57of lands in their hands.
53:59But I have had plenty of conversations
54:01where I've thought one thing that may
54:03have opposed what the fellow has thought,
54:05we have a conversation and we make
54:08a decision ultimately based on kind
54:09of thoughts between the attendees.
54:12Also do strongly push to have the
54:14fellows often kind of take a lead in
54:17kind of as a leadership role of the
54:19team and often times they may give
54:21them a decision over their own attendees.
54:25The decision oftentimes can occur even
54:29if they kind of have a disagreement on
54:32kind of the the specifics or the details.
54:35But I think overall you have a lot
54:38of independence that are that's given
54:40over time and your opinions are valued
54:45amongst the fellows in the attendings,
54:47especially given that you're often
54:49in the first line or the front
54:52front line for your assessments and
54:54they depend heavily on your your,
54:57your thoughts.
55:00Well,
55:02Mohammed, I think we're going to
55:04have to leave it for maybe you
55:06could send an e-mail offline or
55:07there'll be other opportunities.
55:09I'm sure, sorry that we're.
55:10I think we're out of time
55:12and we're respectful.
55:12People have other good houses
55:16and things like that. But
55:19I just wanted to say something
55:21very important, which is
55:22that I really love olives.
55:24Oh, gosh. Oh, well, yes.
55:26I shouldn't have cut you off
55:28for that. So yeah, I don't
55:29think we'll need an e-mail.
55:32Very good. Thank you for clarifying that.
55:34That's excellent. So well,
55:36it turns out that's Chris put
55:38one more in olives column there.
55:41So it's, it's still winning.
55:45This was wonderful.
55:46Thanks to everyone for attending.
55:49As it is for our second group,
55:50it's sometimes a smaller group,
55:52but I think it was very active.
55:54And thanks to all our
55:56residents for taking time,
55:57especially those in the resident
55:59room who are busy and those at home
56:01are taking their time afterwards.
56:03And it was really wonderful.
56:05I'm really proud of this group.
56:07So thanks to all of you and good
56:09luck to everybody in the next step.