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ISCE 101 CBD station

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Summary

Join our comprehensive session covering everything you need to know about the CBD (Case Based Discussion) Station, which is an integral part of medical examinations. We'll discuss what the CBD station entails, go through the Mark schemes for you to know what should be included in a case, and walk you through some social and ethical aspects of medical cases. We'll also share an example CBD for clearer understanding. We'll round-up the session by discussing how to present your case correctly, maintain professionalism throughout, and how to tailor your response during the session for maximum points. This teaching session will also cover a range of potential ethical topics like refused treatment, children consenting to treatment, communication difficulties and others. Whether you’re a seasoned medical professional or just starting out, this informative session will provide you with crucial insights, guidelines, and strategies to succeed at the CBD station.

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Description

In this teaching session, participants will learn how to structure their presentations for patient case discussions with senior clinicians, a key component of their final exam assessment. The session will cover how to organize a clear presentation, including the patient's history, clinical findings, management plan, and relevant investigations. Guidance will be provided on selecting a suitable case that highlights clinical reasoning and understanding. Strategies for addressing questions related to management, investigations, and ethical/social considerations will also be discussed.

Learning objectives

  1. By the end of this session, participants should be able to define and explain the purpose of a case based discussion (CBD) in a medical examination setting.
  2. Participants will be able to identify the elements that should be included in a CBD, including the essential components of history, examination, investigations, management, as well as a social or ethical discussion point.
  3. Participants will learn to access and interpret the CBD mark scheme and understand how this may be used to guide their presentation.
  4. By discussing examples, participants will identify key ethical or social aspects that could be incorporated into a CBD, such as refusal of treatment, mental health legislation, or communication difficulties.
  5. Participants will understand key confidentiality aspects and guidelines related to case presentations, ensuring that patient information remains anonymous and is handled appropriately.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Ok. I think we're live. Hi, thank you for joining tonight. Um, our presentation today is on the CBD station. So I'm just gonna quickly share my slides. Um, we've got Riser Jocelyn and Kath in the chat answering any Q and A. So feel free to type in your questions throughout the session. Can I just check and see the sides? Yeah. Yeah, we can indeed. Great. Ok, so, um, this talk is gonna cover what the CBD station is. Um, we're gonna go over the Mark scheme. So, you know exactly what the case should be and what it should include. Um, I've also included my own CBD as an example and then we're gonna go over some of the social and ethical aspects. Um, just so you have something that you can use as a revision resource as well. So what is the CB station? Um, it's a case based discussion. You have seven minutes to present your case and then the remainder of the time will be, um, the examiner asking you questions about your case. Um, with the case, you want to discuss the history, examination, investigations and management. It should have a social or ethical component to it. And you'll be given your a four piece of paper as a prompt during the exam. So this is a criteria from the handbook. Um So your paper one side and you've got caliber size 12 font, um your full name and student number should be in the right hand corner, make sure that the case is anonymous. So you don't want any patient identifiable information. Um What we'd recommend is you have a structure with your case. I'm gonna show you an example, but it will make it easier for you to kind of look back on the case if you've forgotten a little bit during the during the station. Um and it also looks better to the examiner widely, abbreviations are accepted, but I personally write it out in full and then carry on with the abbreviation. Um And then when you submit to make sure it's a PDF version, a new case. So for the mock, um your mock and BREO is they must, it must be different. You can't use the same case again and you can't use a case that you've submitted for your patient pathway your oncology project or your se. So it has to be a new case that you've not submitted through Tanin before. So once you've presented your case within the seven minutes, they're going to ask you some questions. Um These are the questions taken from the 2023 CBD template. Um So you're likely to get these questions, but sometimes the examiner can go a bit rogue and not ask you any of these questions. So for my is I was hasn't asked any of the questions from the template or completely different, but ethically, they should use the questions from the template. So one question will be about um the investigation specific investigation that occurred. Um Another one would be about patient management. So kind of looking at the risks and benefits and you want to talk about any guidelines, so nice guidelines or specific to whatever the case is. Um the management plan for that, then there will be a question about your ethical social aspect. So that's why it's really important to have an ethical or social point to your case because a third of the questions is based on that. Um And most people pass the CBD station, it's really nice. Um You've practiced it, you've rehearsed it, you know what's going to come up. Um The only reason people would fail the station is because they don't have the ethical social component. So they don't, they're not able to speak about it and because you don't have anything to speak about, you lose the marks. So that's kind of why we're stressing that you have an ethical or social component to it. So looking at the ma scheme quickly, um you want to succinctly present the case, so make sure that you've rehearsed it, it sounds slick. Um You don't want to waffle and then anything that you include should be relevant to the case. Um in terms of the management, you should look at the risks and benefits and use evidence based guidelines. Um It should be a case that you've been involved in personally. Um And you've seen and spoken to the patient examined the patient and again, it should have the ethical and social aspect which I will be banking on about, sorry. Ok. Um This is looking at the Mark scheme just in a bit more detail. Um So if you haven't seen the Mark scheme for the icus, I'd really recommend it cos it breaks it down. Um And you can see exactly what you're marked on. Um So the first section is about communication skills. So like I said, you want it to be adhesive, try not to read off your a four sheet, make sure you've rehearsed it. So it sounds slick. Um I would basically make your a four sheet quite brief. So you're not tempted to just read off of it, use it more as a prompt sheet instead and try to make eye contact with the examiner. Um It just kind of builds rapport and it shows that you're kind of interacting with them then communication skills content. So again, Ecosoc component um and just make sure that you have a good case with some sort of meat to it. So you have something to discuss. Um MP3 is diagnostic and clinical reasoning. So this will ask you about your investigations, your differentials and kind of what management occurred. Um And then that kind of links to clinical care and patient safety. So the risk versus benefits and guidelines and then the last one is professionalism. So you, you want to be empathetic about the case. Um And again, just kind of making sure that you've got a good rapport. I think that kind of feeds into your professionalism too. Yeah. Um Yeah, Stevens are saying that um they got the presentation is not moving. Um It is moving for me. Yeah, it's moving for me as well. Oh It might be my wi fi what lines can you guys see? Um Should I stop sharing and maybe reha again? Yeah. So. Right. Let's see. Sorry. Um II was seeing the move and so were you? That's strange. I'll just reha it and hopefully that works. OK. Can you see the slides now? Um Yes. And then if I move on, can you see that? I've moved the slide. Yeah. Is it working for everyone? Can you move them again first? Yasmin. So this is the original slide and now I've moved it to the next slide. Yeah, it is moving for me. It is moving for me. Yeah. OK. If it persists, maybe it's not new for me. OK. Are we, are we all on the professionalism slide right now? Mm. That's where I am anyway. Yeah. That's right then cool. If it carries on I'll maybe I'll try and present um instead of showing my screen, I'll just share the, the powerpoint or something. Just let you know because I can't see the chart at all. So yeah, guys just um let us know if you have any problems. Ok, thank you. Um ok, so this was my um, CBD, it's not the end all be all. Um I passed the station but I just, you example of how you can lay it out because I was a bit confused um because you just get a four paper and you don't know where or what bits to write. Um So I kind of just break it down and you're very welcome to use this as a as something that you can um kind of copy the layout if you want. So um with my history, I made it really clear mainly for me. So I could, sorry. Um Someone's asked if you can click on the hide button but yeah, and Laura um what slide can you see? Cos I'm on the example session section. Oh, ok. Um Right. Um They can see the professionalism slide. Not the That's so strange. I really don't know why it's not moving. Um Other option would be I can try and share it. Um If I do it like this, I know it's not in full screen which is a bit annoying but can people see this instead? Yeah. Yeah. Ok. Well, sorry, I know it's not annoying. Maybe if I bring everything I know it's not full screen but um hopefully it will be ok. Ok. Um So going into the example with the history, I just used really clear um kind of abbreviations. So I knew exactly which bit of the history I was talking about. So I had presenting of complaint history of presenting complaint systems, review past medical history, medication, family history, social history under ice at the end. Um You don't have to lay it out like this to find it useful because if I forgot during the E GI just could quickly glance at the section that I was on and kind of find where I was. Um it also meant it was easy examiner to read. Um So just quickly, my case was about a 16 year old male who presented um with a with a first seizure at the first seizure clinic. Um The main aspect of the case was that he was refused antiepileptics. So that's kind of my social slash ethical point. Um So that's just an example of a case that you could case that you could do. Um And then if we move on the examination again, so this wasn't just everything that I spoke about. So um like it was just point, but actually, when I was explaining into more detail, um and I'd recommend because you'd have to read off your sheep and then nations differentials management. And I also had a box for the discussion because Taylor, you can kind of make the examiner ask you the questions you want if you put the prompts on your sheet. So um for example, like I wanted them to ask about and reject or refuse treatment. Hence, I put it in my, in my sheet. So I kind of tailored my prompt sheet. So the examiner would ask me specific questions, but he ended up not asking me anything on the template. So you never know, but um you can try to do it that way. So going over some social ethical topics you could talk about. So refusing treatment, Children consenting to treatment. So that's kind of like Fraser and G competencies, um the Mental Health Act Mental Capacity Act dolls. Um and I'm gonna speak about all of these as well, communication difficulties. So for example, having to use like a translator or language line um or maybe a patient with learning difficulties, how, how are they actually communicating their wishes? And then DNA CPR S. Um so they're all quite good um topics to kind of talk about. I also think cases seem to the year three cases just because they're a bit more in depth and a bit more specialists. So there's more to talk about. Um So like pediatric cases are really good and g because when you think about it, you've got two patients instead of one psych is really good for finding a case as well and even on chronic disease, um there's, you can talk about mental capacity at dos um and things like that. So I think the cases or things that you're seeing on placement now are probably the best cases. Um So what is capacity? I might ask people? Um So if we think about capacity, what are the four things we kind of think of or what are the four criteria that you need to reach for someone to have capacity if you don't know that? So, ok, I can't see the, I can't see the charts so much. Yeah, no one's written anything. That's OK. The slide did have fancy graphics, but we've had to, I don't think slides have changed. Um No, what slide are you on? I really don't know why the slides aren't changing. I'm sorry. So we're not actually we're not on a slide about capacity yet. Are we, we just want to slide the social ethical topics? Yeah, that's correct. And we've got some answers as well by the way. So age being able to remember information and weigh up pros and cons. Yeah, that's great. Not suicidal. Thank you for helping. Yeah. OK. So sorry, someone oops, sorry to cut across. What do you mean by not suicidal? What, what what they are they saying? That's part of the capacity assessment. What do they mean by that? So basically, Yasmin, someone's commented in the comments saying uh not suicidal. I didn't know if they were saying that in reference to what is capacity. Ok. Just wondering what, sorry you carry on and maybe someone else can write in the chat, what what they want to expand on that, what they mean? Ok, maybe it's along the mental health mental health act instead. Not sure, but we'll see. Um so capacity is ability to make a decision for yourself. Um the decision and time specific. So you may have capacity for one decision but not the other. Um So it could be something something simple as you could have capacity to pick kind of what you want for lunch, but you might not have the capacity to kind of consent to an operation, for example. And these are the four things you need. So you need to understand the information, retain the information like the person said in the chat, we up the risk and benefit and also communicate that decision um in a way that we can understand. So capacity is quite a good one to use as your so social um dilemma. Um because it's kind of got lay out, they need to have these four things. Um And then if they don't have capacity, um use mental mental capacity Act is for physical health. Um So maybe this is why the chat wrote about um not being suicidal. Um I'll talk about that a little bit more when we get onto the Mental Health Act Um So the mean was a legislation put in to make sure that if someone doesn't have capacity, we kind of um do things in their best interest and try and pick the the least risk of intervention for them. So we assume that everybody has to and then we want to support people to try and make vision if they can, which means that even if they make an unwise decision to us, um they have the right to make that decision if they have capacity. So for example, someone might want to discharge themselves from hospital even we, you know, we think that that's not the best idea. Um But if they have capacity, they have to do that. And then if for some reason, your dad, so they're not able to kind of retain the information, then you want to formally do a capacity assessment and then if they don't have capacity, then there'll be discussions within the team to try and make sure that we work in their best interest. And like I said, the least restrictive intervention. Um So like for example, if you, if you're doing your C BDA good case would be someone who's kind of refusing treatment or they're wanting to leave the hospital, but they may have capacity. So that's ok. Um Baty, but are trying to kind of leave the hospital or um you know, doing things that you're gonna harm them, then something like a deprivation of liberty starts might be put in place. Um So they strict someone's freedom to treat them safe and the person must lack capacity to consent for their care or treatment. It must be in the person's best interest and the least restricted option. Um And it must be legally authorized. So you have to fill in a dos assessment specifically. Um So I don't know if you, you've done your chronic disease blocks, but you might see the dulls. Um So they lack capacity, kind of trying to escape. They might have dementia and trying to leave the board where actually they've got a horrible cap which needs to be treated has to be treated for the cap and adults will need to be put into place because they're trying to leave a board. I hope that makes sense. Sometimes it, I find these quite confusing. So I've tried to make them quite simplified. Um But if you have any questions, please pop them in the chart. Um So a little bit about advanced directives. So this is the advanced decision to refuse treatment. Um It's kind of a running free theme. It has to be specific, so specific treatment in a specific circumstance. Um And an important thing you might see this on past me, it comes up quite a lot, but they can't demand treatment. So this is only for refusing treatment. So it's like for CPR, you can't demand to have CPR um advanced directives, they must be written down and signed and they're legal. Um whereas DNA CPR is not legally binding, so they're slightly different. Um I've given kind of an example of an advanced directive. Um So this patient, they have CO PD and they created an advanced directive and this is what they've documented. So I do not wish to receive invasive mechanical ventilation or any form of resuscitation if I'm unable to breathe independently and my prognosis is poor. So as you can see, it's a specific treatment. So they don't want mechanical ventilation or any form of resuscitation and it's specific. So it's for end stage COPD and it's when they're unable to communicate their wishes, it has to be very specific. Um and it has to be signed and done by the patient, uh not the patient, but it needs to be signed, signed by the patient under um because it's a legal document. Ok. So DNA CPR again, this is quite a good one to bring up and when you're on the wards time, make sure you look at the right. Um cos they have a lot of information on there. Um So this is a medical decision. So a patient or patient's really can't request to have CPR um and the conversation should be had with the patient and the family and it should be documented with on, on the red form that this discussion has happened. If the patient or the family disagrees with, then it, it's kind of best practice to offer a second opinion. Um DNA CPR is not legally binding and the medical team's decision, but it doesn't apply if there's a reversible cause. So if you see someone, well, they've had anaphylaxis, um then they should still receive the treatment and potentially have CPR until you reverse that course. Um Does anyone have any questions? Questions about DNA CPR? Cause I know sometimes it can be a bit confusing. I'm gonna take that as a it. Ok. Sorry, I feel like I'm speeding through this but um it means we have time at the end for some questions. So the Mental Health Act um this is specifically for mental health conditions. Um It's when the patients are at risk to themselves are diffusing urgent treatment for, for their mental health. Um And this kind of is back to the comment earlier. Yeah, about um they can't, so this can override the Mental Capacity Act. And what that means is that they may have capacity with their mental health, but you, you still need to use the Mental Health Act because they're a risk to themselves others or they're refusing urgent treatment. So they may have capacity, you might still have to use the Mental Health Act. I hope that makes sense. Um And this is what people call sectioning. So I've just written um the different types of sections who can actually administer the section and what it actually does. Um I won't read through it. Um But this is quite useful just to know for um progress tests as well. Sometimes this comes up. So it's summarized in the table there. Um and then Gilli and Fraser guidelines. So this is another thing that you might want to discuss with your CBD. Um And I always used to get confused between Fraser guidelines and gil competency. So we'll go through them individually. Um So Fraser guidelines is mainly rela related to contraception and sexual health. Um And it's for Children under 16 years without parental involvement. So the child has to understand the advice that's given as a healthcare professional, you haven't been able to persuade them to kind of inform their pa parents and they're like they're likely to engage in sexual activity regardless of what the outcome of the consultation is. So it's in their best interest to provide um the contraceptive advice and treatment. Um and then competency. Um this is what kind of types of treatment instead of just contraception. Um Again, it's for under sixteens and it's if they have the kind of understanding a maturity to understand um um what's going to happen and the implications, it's kind of um it's kind of like you do a mini capacity assessment. Um like we spoke about earlier, can they kind of weigh up the risk and benefits? Do they understand the consequence of the decision? And are they able to communicate that with you? Um And again, Children refusing treatment is a bit more tricky. Um, but, um, which I'll talk about in the next slide, but this is if they want something, for example, they might want a specific treatment, but their parents are saying no, then if they get it competent, then you can go with what the child is thing. So just try to simplify it down a little bit 16, uh, less than 16. If they're competently consent to treatment, then you can give the treatment regardless of what their parents have said. If they're competent and refuse treatment, then this could be overridden by the court or by parents. Um Depending on what the situation is. Um For example, you have a 15 year old who comes in with appendicitis, so they need appendectomy, but they're like, I want to go and I want to leave, I want to discharge myself. Um I want to go out with my friends, something like that. Um But their parents are saying no, no, you need to have the appendectomy or there'll be a best interest meeting or, or something like that to my own, have the appendectomy. Um And then if the child is incompetent, they have meetings instead um with the social and ethical aspects, I would just make sure that you kind of read up on the guidelines because sometimes you can get yourself in a um So just make yourself aware of the li works. Um Hopefully these slides kind of give you a revision resource or something to look back on. Um That's quite simplified just in case you do get a bit confused with like Mental Health Act and Mental past the Act and things. Um And then with the management question, these are just some guidelines that I'd recommend. So nice guidelines, micro guide. Um There's an app called A OAS which you can use for specific health board guidelines. Um Any of the Royal Colleges and research papers. So I spoke about a research paper when I was asked about my management. So just having some just make sure that you've done some wider reading and you're able to kind of portray that the actual station because it comes across um that you've actually kind of looked into your case and you just come across a patient. Um That's kind of been a whistle stop tour. It's only been half an hour, but um thank you for listening and please let me know if you have any questions or you want me to go back to any of the slides that you didn't see. Um But the recording will be available. So you'll be able to read the example case um that I did. So if you want to just use that as a baseline, that might be help. OK, let me go back. What is the app called the app? Yola, let me just write that in the chart. You need to ask for permission from the health board to access it. Um ok, I can see them. So what do you mean by a second opinion? Um For DNA CPR. Um what do you mean that DNA CPR doesn't apply to a because so, um it's best practice that if a patient disagrees um with them needing DNA CPR. So for example, the seniors had a discussion with the patient and they're like, I don't agree with you. I feel like CPR would benefit me. Then it's best practice to offer them opinion. So a second senior will go and discuss the case. Um Read up on the case and see if they need DNA CPR if that makes sense. Um Does that happen in practice all the time? No. Um That is just what best practice says, but it doesn't happen all the time. And like I said, ultimately, it is a, it is a medical decision. So even if a patient disagrees, but that's what your team feels like. Um is best for the patient, then that's what stands. And then um what do you mean that DNA CPR doesn't apply to reversible causes? Um So if, if they, so it's not all reversible causes, but it's like if they are choking or if they have anaphylaxis, um then there's a quick, easy treatment. So if anaphylaxis has caused them to go into an arrest, then you should still give them i adrenaline to try and reverse that cause might need like a round of CPR while it kind of takes effect. So that could still be possible and still be allowed even if they have DNA CPR or if they're choking, you want to dislodge whatever it was that they were choking with. Um, but like, say they had a cap and that's what caused the arrest then, then that, that, that we call like a quick reversible course. So, um, yeah, it's very, if you kind of want to look into more detail, um You can just kind of look at the DNA CPR um guidelines online and it will tell you like very specific things, but choking and anaphylaxis are the ones that I can think of straight away. I'm just gonna see if there's any more questions. Um I'm really sorry about the slides as well. I'm not sure why that happened. Um Were there any other questions? Riso Nope. Yeah, the CBD station is quite a nice station. Um Try and find your case early and don't use your good case for the mock, use it for the actual. So don't worry about the mock if you don't have a good case, that's OK. Um What I would my my little tip would be pick a case that you actually know. So not something that your red saw, your F one saw and then they mentioned it even if it is like that, make sure you actually go speak to the patient and you are involved in the case so go speak to the patient. You can ask your f one or who you're with to help you go through the blood. You need all those results and you need a full, what happened every time they were in the hospital, sort of big shot. Um, and when, oh, sorry was, as Yasmin said, uh, big something that, something that fits along, uh, social, ethical problems and the asthma has gone through quite a, quite a bit. So you have a little bit of an idea of what you can use if you're completely lost. Um, they are usually and going like pediatrics, uh, geriatrics, all of them tend to have quite a bit going on. I was just gonna say as well. Um, make sure you, you know, the investigations that they, they had, if you note it down, be prepared to be asked about it. So, um, for example, just to give you guys an idea, my case was of a, of a gent with, um, with Parkinson's disease and he had a barium swallow, which is quite, well, it's, it's quite, it's quite niche and that it doesn't happen every day. Um, and I was expecting them to ask me a lot about it. And unlike Yasmin, who, unfortunately, you know, sounds like her examiner went rogue. I completely off peace, but my examiner actually asked me the set questions. So I was expected to know, well, II already knew before I went in that she was she or he was going to ask me about that, which they did. And um it, it's like, like Yasmin said, it's a good one. All this. Um uh sorry s and GP they're all really good. Jerry's particularly good as well. Um And if you guys are concerned by anything, just email us and we can, you know, we can uh give advice or um see what we think about your cases. But yeah, so make sure that everything that's written down, be confident in knowing enough about it. If they ask you a question, that's what my advice would be. The other little tip would be uh practice as much as we can. So if you find any doctors around, um, kindly ask if they have any time so you can go through the CBD with them, just go into the ward, explain to them that you have your final oy. And if they would be kind enough to listen to you and ask you questions, so the more people who go through it with you, the more ideas you will get regarding what kind of questions can come up and it will help you polish it. Absolutely. And the other thing to say is as Riza did say that you, you kind of do need to know about uh the blood test investigations and um, unless things have changed since I was a student, we didn't have access to W CP, which is the, um, which is at the, the platform that we use to see patients, blood tests and scans and everything. So if you find a nice doctor, ask if they wouldn't mind just signing in and they obviously they can stay with you if they don't want to, you know, leave you loose for their account just so you can see the, the blood test results and the scans. So you can have an idea because it is important that you include those in the CBD as well. And I would also say practice more with doctors who have, who are qualified um cause that will give you a different perspective rather than just practicing with your colleagues. Obviously practice with your colleagues that will help you with the timing and everything that you need to anyway, practice the practicing with actual doctors who are working in the hospital will give you different perspectives. Oh I would also add as well not to use a, a case that's too confusing. So if there's a really complex case with loads of different medical problems, um It, it's not really about that. It, it, it's, it's not your opportunity to flex all the, you know, snazzy niche things, you know about antiepileptic meds. It's not, it's more, you know, you've got your other stations for showing off that, but this is more about showing that you're human and seeing that you see the um uh the fact that people can socially find difficulties in health or like, like Yasmin was saying about getting competence phrase of guidelines, all those things. So, yeah, even if the case is a simple, you could have a really simple diagnosis like appendicitis. But maybe there's a, there's a social aspect to that which makes it more interesting. So, don't worry if it's a quote unquote boring um, diagnosis because it's, it's not about that. It's not your chance to, to kind of talk all the medical jargon. Yeah, I definitely think the simpler the better because then you can kinda tailor it. So, you know what? I just as well. Hopefully they follow the template. Um, but yeah, both just to reassure you pretty much. Oh, sorry, sorry, sorry. I didn't mean to but it, I was just saying that, um, another thing is you never know, you might have like a consultant neurologist who specializes in, I don't know, absent seizures as your examiner. I mean, I doubt this but, and then you end up saying that they were on this drug and this consultant might end up asking you about this drug or whatever. So, keep it vague and remember more than likely you are going to have a, a GP on your, um, CB or, or someone like a generalist on your, um, examination for that station. So just, just keep it, keep it simple and just to reassure you, most people do pass this station, in fact, nearly everybody does. So, as, as long as you make sure that you kind of are aligned to the Mark scheme and you practiced and rehearsed your case, you know that it's kind of a station in the bag. Um And it kind of settles your nerves as well because it's something familiar if you guys are really struggling, feel free to email us. Um We will try and help if we can. Sorry, as man, you were needed. Thank you for coming. Please fill um fill in the feedback if you can and if you have any questions we'll stick around or you can email us anyone has any questions. Ok? Um We're gonna wrap it up unless anyone has any questions or anything you want us to go through. Um If you're stressing about CBD, anything, we'll go through it, we'll go through it now. If not, I'll end the session in like a minute. No worries. Hope it was useful. Ok, bye.