Computer generated transcript

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

just let months. There we go. It's just like that. So high on welcome, everyone. Um before introducing our wonderful speaker today on highlighting what will be discussing today, I want to welcome you. Everyone for a tan in today for war is a virtual character of journal carb. Sorry, that is accessible to it all. And the real goal of this, um or excites me about this is that it gives this opportunity to share expert knowledge knowledge cross whole healthcare professionals driving interest in science from with ultimate am all the Linus to work that bit closer on improve the health care service that we provide your passions. So how can you enjoy tonight? Well, while she won't be able to join in with your video audio, what you can do is pop in the little Q and a section and you just see a lot of box of the message there. And you can pop in any questions that you have. And I'll be able to take those on the dressers to careful and who's kindly agree to text, um QNASL for us, which is fantastic. Thank you on on. Really not so it's they're not steel cap fulls, Funder. I'm going to give you a little brief introduction to so he is a senior lecture off physiology at the interest of ulcer. He has a restroom. Clinical car. Cardiac scientists are on these under attack in a significant body of research In that what we're talking about today, and that is in the E C g. Training. Um, so thank you very much for joining us That I cancel. Perfect. Thank you. I just started present. Yeah, I'm gonna just turn off my camera. Okay. Thank you. Okay. So hi. Good afternoon. It's great to be here today and thank you to Gavin for the invite. I'm providing just some background on who I am on what I'm doing. Just to Kenneth Flash a little bit more of what Gavin had said there. So I'm coming to you all the way from Northern Ireland today. On where I was in a lecture of physiology, scooted medicine goes to university. I'm also the cardiac and basket of team leader for the physiological society. So I'd like to introduce myself in that context on to ask you to reach it under that context for potential collaborations or assistance enough. Enough, David. And also can I just I like my twitter handle alcohol brain here for further connections. I'm following this presentation today. So this presentation and research included is best represented by the following cold attributed to Confucius which really described elements attributed to successfully learning. So I hear and I forget. I see. And I remember really, What I hope to establish today is I do on I understand what you're seeing here or minus stones attributed to easy GI practice or provided on screen here in the timeline on specifically those milestones that are highlighted in boulder them and represent the impacts to STD recording practice on these include them. The designer three live three lead, easy GI. The then, um precordial eats integrated to the EKG recording system on. Then again, the augmented EKG leads also attributed to the reporting HCG system with the standards at the standardization from the edge A of 12, you get a C G is as we know what happening around in 1954. So I told him the seminal images that you're seeing here should be familiar to us on the call up today On the represent a Hoffman's three. Leave the C G on the trees in following Wilson on Goldberg's contributions until one second contribution to the GI recording involved the Revolution of the String. Galvin. Over. With this slide, you can illustrate here higher. This significant C G signal acquisition has changed from that original capillary electric recording, diabetic to the street and Calvin Order. So interpretation off the 12 lead EKG involves analyzing these reforms. Highlighted is a peak your S T complex. On these permit the detection of abnormalities that affect normal electrical conduction. Competency. Interpreted on the C G is an important core area off on the graduate. Um, Post graduate. A critical training. So within the medical profession, for example, ah, qualified doctor is enabled to report a full detail tracing of the electrical activity of the heart, using a machine work order in the C G on Interpret the recording for science of heart disease. And that's a Stephen provided by the GMC. Other statements provided, for example, by the National School of Healthcare Science. D. It's the other Non medical professions are able to demonstrate the recognition on interpretation of the C G reforms. So the recording off a 12 80 CG that is one of the most useful and common. A performed medical procedures. STD's air used in diagnosis and risk stratification management decision making on assessment to the response of therapies. What you could see in the street here then, or examples off where on the C G recording drives. Typical care. I'm decision making and of having those areas within the care pathways and using the red box. So this is the nice guideline mg 1 96 for each for gradation diagnosis of management and then you see here this is the care nice guideline and G 25 for the end stemi or unstable angina. Early management with again where the EKG is integrated with this care pathway really wanted to start her entry to the care pathway so it can drive and clinical care decisions. So a CT interpretation then has moved on Since those original timelines that I shared with you on what really assisted this was the use of computerized easy GI interpretation on this was a very natural progression following on from the digitalization off the e z e g recording. So the effectiveness of computer dies. HCG interpretation has seen evaluated with the literature where we have, um, offer such a shot on ribbon in 2007, comparing a computer Biest analysis to that off the cardiologists. And so what? They were able to determine Waas that the computerized SCG interpretation was lower than that of the cardiologists. And in fact, the computer scored an average of 69.7% Upper city. Where is the cardiologists? 76.3% accuracy And that was a statistic, a significant difference and findings there. But what we find, most notably when lucky, not computerized SCG interpretation is through the work of Bogan and 2000 for where there was a medication oven over reliance on computerized easy GI interpretation on its impact on patient care. So what? This offer determined balls of the initiation of inappropriate treatment, um, referral to potentially additional unnecessary testing was reported in my bar 10 between 10 to 24% of patients whose PCG was interpreted by a computer program rather than ordering physician. So the computer EKG and I'll sorry. So the computerized EKG interpretation, then is quite then significantly elaborated to us through the work off demon on guard in 2013. On this was where a 97,000 easy tracings were provided for analysis to computerize ACG. 16.7 of these illustrated the presence of what's called a prolonged QT interval. Okay, but these were not included on the summary of the GI interpretation findings provided by the computer. So this lead to a significant underlying, um, recommendation, Easy GI interpretation is that computerizing CG interpretation should always be over. Read by a human on somebody who has modifications and experience with which to do that. A provider for your one screen two examples of we're buying computerized easy interpretation is incorrect and you can see from the top we're seeing an interpretation of marked Sinus products. Hardly. Oh, on if you go with the GI, hopefully you can see how I love. It's different on the bottom. The CGM we can see on interpretive interpretation from the computer of normal Sinus rhythm. And although identified as an abnormally CJ, no real criteria have been provided here to identify what is potentially a very narrow or shortened pee or interval. So this reliance that computerized eastern interpretation did not solve a problem in confidence. See and so the focus minty and was in the teaching on learning practices of Easy. The interpretation to confine TCG practice further weaken. See on screen here that there are many variations of which we can record in a. C. G. And here you see some examples off. 35. Lead the standard 12 lead on the medicine like a 12 lead electoral positions. So incorrect Positioning of easy electrodes can significantly impact the easy recording by falsely indicating on emergent abnormality or the requirement to administer therapeutic interventions. Variation off on the CT electric basement by settlers. Two centimeters can produce diagnostically important differences in the easy GI recording on that considered if ically impact therapeutic decisions. So it's actually been reported that in clinical trials of up to 4% off all 12 lead Easy G's acquired in various clinical settings have being recorded in correctly. Electrodes are typically positions too high or too low to the correct dose. For Michael Bony. Lot more so typically patients that you are a base or female and are identified as the most common reasons for this EKG electoral ms please. So even before we attempt Foreman interpretation, STD diagnosis that must be status are only valid. If the electrodes are placed in the correct on topical location, the lady wires are touched to the appropriate electro. There's no Ms much on that. The recording is appeared to technical quality, and that's quite significant before we part of me. That's quite a significant amount off task to complete even before we start to interpret the easy job. So there remains know established standard methods for teaching ACG interpretation on within the evidence or in the evidence based. This is from the report in defense of 2015. So a search of the Lister ravines They're only ready to review articles on just several experiments and involved novel HCG teaching, too. On these at some anecdotal comment, Trees by experts recognized experts. So within the Lipitor, then the teaching of the C G interpretation mostly occurred through lecture four months on. Um, this was supplemented by small group practical teaching with the CT interpretation Herschel representing the me and learning activity. And if we look across the literature, we can see here. If I refer you to the bottom section of this screen that co cats for task for three. Steven what we can see here than is, um, sorry for ambulatory e, c. G and exercise. Treating. This suggests that's interpreting approximately 3000 to 3500 e c gs within 36 months, and that's really equipment. About 1000 MG interpretations per year should provide ample experience to acquire competency in this chemical skill. If we compare that to the age a chemical confidence statement off the C g by the American College of Cardiology and a this states of the minimum of 500 s E g is a required within a 12 month period to attend Easy GI interpretation of confidence e. I'm not sure on that. Should be supported with a minimum of 100 s e gs a yearly to team this still And then again if we looked at the bottom right hand side of the screen, what you're looking at here? The paper presented published by Hamel and 2000 and eight he describes a spoke HCG interpretation training four months for card it Technician Reader confidence, see, And this is based upon the number of easy geez interpreted overtraining. Time frame on the findings remount people suggest that is part of a 16 week training program. 11,000 Easy Geez, which were equivalent to 680 it easy geez per week or 34,400 MGs per year were recommended for compliments. Seeing this clearly excessively conflicts with the other recommendations I'm using. This is an illustration to show great variation. There is on hard that should be a choir. You see the term ubiquitous you also hear. This is also fine to be, ah factor with the practice of these GI interpretation being ubiquitous. So it's everywhere. It's familiar. Everybody can do it. But apparently there is no evidence be his method, which teaches one of the other reasons why easy gene transportation is lacking or genes. Just because off the curriculum I've seen populated with more modern technology will abounds, is in medical imaging, and this has led them to a reduction in time that's available to dedicate to ECD interpretation practices what you can see here that is, of course, water medical imaging techniques that are used now, inpatient care pathway on the learning timeframe, for this is interrupting that for a CG interpretation. Traditional practices off the CD interpretation already best hide out into the work off Hearst in 2000 were, um, the The association between the Electrical Mechanical Association of the Heartbeat can really be focused using vector on back to diagrams and you can see here what I'm trying to show you is the overall electoral easy GI activity on Tom McNeeley and physiologically how that looks like in a factor diagram. When then, of course, that can be applied in practice by using something like access deviation detection. It's really the opinion off first, that this lack off detail in the current issue. The interpretation learning practice is really then limiting the deep learning of this. Still on their four, impacting the accuracy of practice, there's a preference night and memorizing me see GI signals on morphology ease on the's memorizing of the signals in such as the shape of the complex have seen and I'm associating the disease process is is very limited on. The reason for this is that there's a really a little correlation between this goal of electoral chemical, a substitution so therefore, teaching of STD interpretation remains a really challenge for educators. There's a possibility off quantity of the research on expert ECD performance. We just can't access sufficient data and therefore much insight off. Higher experts extract information from the medical from the C G is through the work off on medical image interpretation, typically, as we would see in video radiology So medical image interpretation and involves a two stage process that incorporates the perceptual skills on the decision skills off the reader. And so the repeated implementation of a skill which can be applied over on over again until fluency is achieved is conducive to effective learning. Four months and such approach like this is postulated to enhance the C G interpretation practices, particularly off the novice. And so that's what my engagement in research has bean loss for. And this is what I'd like to talk to you about some of the following slides. So the remains, the lack of this practice in easy interpretation process. And so the most current one exhaustive reviewed states that there is no current evidence based that improves or men teens easy GI interpretation skills that further research is needed or a new method is required. And so I'm gonna see if I can offer you some insight into this new methods that I've been engaging with a publishing with so I can have your opinion on your context of this. So if we go back to medical image interpretation, then I have the EKG count be reviewed. Camby's similar to a medical or printed image. The illustration of the way of forms can inform anatomy and physiology of the heart on the easy chicken. You know, for us an inside and did if whether or not there are pathological findings there. But unlike a printed image, the E C G signal we have forms represent temporal processes of the F, the electrical activity of the heart. So medical image interpretation research helps in forms here off success with interpretation through the the interpreter on so research. Establishing virtual expertise in detecting on diagnosing with Allah geez demonstrates a medical and image interpretations to process. The first initial fees is the instant recognition of pattern. So when you look at something, you instantly recognize it. It comes from it on the interpreter. Then we'll make a global impression. Are free, is called ogestral off the image daisy in front of them on this, require them to image recall using really anatomy and physiology provide the perceptual system with the information needed to complete the detection task. Okay, deliberate I movement following the dissection paths or the Jessel Evils Theater prettier. Discount the image systematically for patterns seemed a discovery, perturbations or abnormalities that we're not focused upon these ones of these either, and confirm or deny the initial impression by looking for key factors and metrics that would back over support and not initial impression. This. It's in what's on screen at the moment here, which is called the Working Memory. And this is an active memory system responsible for storage on simultaneous processing off information necessary to carry a complex commented tasks activities. The working memory is a short term memory buffer that allies for manipulation of stored um, of stored information on this functionally gave it by a central exactly that you'll see on screen here on attentional controlled system of is responsible for the activation of processes on representations that air held in the long term memory, which is a radiated to L T A M. So the central exactly access is long term memory by controlling unregulated to sleep subsystems, and these are on screen as the fall Actually, this is in charge of temporary storage of verbal on acoustic of information on Then you also have visual spatial sketchpad on this temporarily holes. Verbal Sorry, visual on special information on this work, of course, is jumping through at the delay here, and his references are on screen. So the point of this slide is then Teo propose that active learning strategies on the repeated implementation off task support deeper learning on cognition. Of the task on this is what's really crucial in memory formation. So we repeated interpretation of easy tracings. Although being a common method utilized in his teaching office important 10 tissue this night could be manipulated to offer a deeper earning, um, awareness of that. It's this contacted, like, know to talk about in regard to some of the projects that I have published and I worked into to really, I was looking for a CT interpretation, earning accidents. So the first people like to talk me through here is presented on screen, and what we're seeing here is an easy GI interpreter. Nothing on a CG through and I tracking sell for system, and this is tracking where the key is their ideas is going to If you just continue to watch the movie here, we're going to see that the doctor on screen move all around the easy GI image, and that tells us where the interpreter is focusing on looking. And then what we can see is there's changes to these red circles that we see they get bigger on the course. That is the time frame of which the GI is is located to that specific region within this image here. So you'll see lots of Redox Point across the screen here, the movie, the image. And then what you'll see then is some of those red dots increasing in size to really highlight focus. And so we were able to do some a quantitative analytics through the sole for a package I'm using the eye off. The idea is for the eye tracker on this. What you see here in the image guided is a identifies hot spots in red, which is really where the me and focus off this EKG interpreter. But he and so if we look at ACG and we could be critical of this and see that the the rhythm strip lead to the bottom wasn't fully visualized, only half of it was looked at. And also, if we really want the critical lead A of your very light in regards to image doctor there before also very light. So in this context dot all leads we're not that and they're not instantly could lead to be it off. Is that the reason why interpretation maybe was accurate or whether issues with that in the image provided here being what we're seeing is then actually the initial where the I G is first went to then where it went to you next next? I want not on this also supports where that red blob enlarged to show that there was a more intense keys or are continued season not certain area off the e z e g again if we just left it where these green dots of bean I located, there's quite there's quite some areas of the GI that I'm not even be looked at our guest upon. And that became very interesting because the results of this really this studies showed us that there was no consistency across experts of STD interpretation. This is because there was a quite a very reimage of expertise in terms of medical profession, but also that there was not one way which to do this. And that was so enlightening to me. Because isn't that what we're trying to do? Trying to teach people hard to interpret these huge, even do it in the best context and that findings from this paper intimated that they're actually wasn't one way of which to do something, So that was very useful and insightful to build on a on to work across other research projects that would over us more insight into this practice. And so the next people like to talk to you by involves on the online open source online training system that offers and easy interpretation practice. So this was an association with the university Oxford. Together, we built this lightly of system which was accessible to students. Healthcare science students off guard and physiology on was available to them in their own time, in peace, of burning to engage with practicing the city interpretation and so they would be there would be instructed to do two things, one on a table in the sug with the various issues components were on then to and complete the report card. The bottom here illustrated this be to provide an interpretation off the GI, and this really provided an insight to the question that we pose before, which was about the only certainty but the number off the CDs that one should interpret to a team competency. The findings at this paper. Then, of course, I never. Even though students could interpret quite high numbers of easy G, it did not, anyway, impact they're accuracy or then becoming more superior, are confident at the C G interpretation. What this fine waas What this also offer this war's credence in consistency with the mic, lecture and language associated with Eastern interpretation. I'm not lead then two other research projects that would focus on that. Then the purpose of this lightly it was to offer feedback also on the students and interpretation that so what you're seeing at the top off the screen is an example of the back they were receiving, as you can hopefully appreciate it. It's quite and it's quite elaborate. It's not just right or wrong on that respect. And so then, coming from this experience, I was able to lead on the design of a smart phone up, which is called Analyze SCG Reporting. So what you see here, then is this became a clinical decision support to to assist with the interpretation of the 12. The CGM was very specific to novices. So this is a smart phone up on. You can access this on the IOS are Google Online platforms. But if I just walk you through some sites shows here, we can see that this actually broke dying various elements of the study interpretation that were necessary to afford correct interpretation down in front of us. So we go patient information, okay? And we're going to swipe to progress through the next aspects. And here you're receiving it sounds to interpret the PR interval, so they have to measure it. And based on the measurement, they have to then applying it to either normal or abnormal, um, kind of interpretation. So backing off their initial impressions, initial illustrations from the C G and then with um in line, they would ask to then qualify. So something measures some way. If it's abnormal, can have qualified that abnormality, and so they will be given aspects with which to do that. The yeast on whatever dot is that they began is to look at. So the significance of this up then you could see is hiding in blue dark brews. Where is most significant across the world has been a really great optic over $50,000 nodes of this on this has been a two later incorporated into very scoot medical school, um, across the world here and that is highlighting that on the real goal of this research showed us that if we can make tasks intended broken down and lift into deliberate practice, we can then afford more efficient learning curve for novices, particularly in easy GI interpretation. What we're looking at here and so on example of how to do that is provided for you here on screen, which is called a method of called tace deconstruction. And so if we look a higher, we would task the construct easy to interpretation. We can see that if we provide on analytical free and work which has steps on processes in it, we can really accelerate the ability off anonymous to interpret the sug to the level of confidence See on each one of these components labeled one through nine are aspects or tasks off the EKG amylase, but then enables their nerves Are novices of the city interpretation to really engage with this. Okay, so that really took me then to the next Kenneth aspect of research, which I'm focusing on, which combines these three strategic on salmon oil can, uh, viewpoint. So what you're seeing here in your top left is the progression from novice to expert, as highlighted by Dreyfus and Dreyfus on has been represented in physical manual labor in processes. What you see is that what I've already talked to you about the deeply working memory model on how we can access the normal term memory through the subsidy of units of visual spatial sketchpad on the particular tree for lunch. And then we're seeing here is the context off breakfast and drafthouse as per Patricia ban it into nursing on what her model. What was different about her model was that brought deliberate practice. So a deliberate focus on task and then, of course, reflective practices. So more of an in anymore to the unleaded process, where when, when owners were completing tasks that they were reflected those tasks that reflection cemented, they're learning, provided a deeper learning in here in regards to the Taxol, which they were involved in. And so they combining this together has laid to those recent research project that I wish to industry with you today. I'm actually give you permission. The accidents have to go with. And so we're looking at combining what we've learned already. The problem with the CT interpretation is that electromechanical association, how we collaborated that the A defunct in focusing on factor cardiogram on has has been one of the reasons why this skill has diminished you that encompassed he's strategic learning frameworks that enabled task and component of pants on reflection on task with which then do you make the learning process much more efficient? And that's demonstrated through the up. And then through this process, which represents breakfast and drifters foot I've seen through deliberate practice, which again is, uh, what a seminal these work provided by hours. And so the impact of this work are are showing on screen here in terms of the activities that I'm involved in or have been involved in on. I put that I've been able to contribute to represent us all in this deposit e you can see also that we're going with this, then, is about the use of augmented reality in a research project called Implemented Physiology. And so now what we're going to do is address the issue off SED interpretation still requiring accurate SCG electric placement to enable that to occur. So even with all of the research I've looked at and tired of teach on vitamin D, CT interpretation turning four months unless the EKG is I acquired correctly, that still was again on issue in regards to being successful in this every search agenda. And so my most recent and and every night is on a or up through a non drying device. And this is an association with the Wonder Labs in the Netherlands. So what you're seeing on the image here is if you open this up on your phone, you'll get access to this avatar on. What you're gonna be asked to do then, is to complete these tasks these air hcg electro placement ass off the chest electrodes. Now, what you're seeing here is just somebody's effort, okay? Look different for everybody who does it. But what would be able to offer is a piece of learning on environment for a nurse to really practice this I'm perfected before they actually have hands on experience on another individual person within the health service. So I would really like you to appeal of this on to have a goal for me to Tennessee. What can you use your ability and opinion? You would have professionals in this feet. So in order to do that, you need to open this where Pitch on your iPhone on, then you need to scan this. You're cold. And Gavin and I will talk you through a bit of that. And just as we finish up in this section today. So it was a real pleasure to just talk to you today about this contact. And it's really big debate with you all in to have This is the inaugural conversation I have with you. You can see on screen there a few areas which I'm doctor researching on the very bad. I'm going to write those in the future as well. What? When the purposes of time for today that completes the conversation I'm having with you today and I'll just stop shopping spree? Well, thank you very much. That that was cost. It's really good to get an insight into that research beyond just reading articles and get your insights into its Well, that's great on that link that careful, Let it Teo just popped into the chapped. I'm Phipps can see a great if you could let me know on also, if you can pop any questions that you might have for careful or I can address to him. Um, great appetite is we can see the link. Good. Um, I don't know if you want to. Careful. If you want to bring up that slice and people can scan that code on, then they can have a lot of go with it and try the intravenous. And if your hot beet and perhaps we might be able to share it on that on the post, like on the metal website, if you're happy to get up, your slides predicted possibly on that code, and they will work. So if anybody tries it, if you could give me a little thumbs up that it's working, think what couple hunters at work. You need to be trying on your phone Or can you try? This is this is on drive home so it won't work with a knife own. Okay, so that should open this link on your phone. You been a little ask you just to scan the QR code on give you access them to them. This video? You what? The video showing you what? You'll see that. Okay, you'll be able to do this. And once you convict those process cool. All right. On that since good, um, juices. So let people trial on that. They're on. In the meantime, if it's are you careful would be great to ask you a couple of questions a little bit by what you presented today. Um, I guess one of the underlying questions I was thinking about, um is it was great. One of those things is we've got that continue push of a I mean, we're seeing it more in image in particular. Are you allergic to write the star of your presentation high that automated reporting we get for the CT traipsing this quite often. Inaccurate. Um, and it would be very much Miss Lady if you were to trust it alone. Do you see a push in a I transferring tcg tracing your 12 Your son or 12 the B c D. Tracing wearing, we'll put it in front off bolts of some description of some way in. And it'll interpretive for us, assuming, like we've alluded to the person in question has placed electricity correct positions. Yeah, So it's very It's very fair to say that that that's already happening is happening successfully, and we can see examples off autumn A. I have interpretations through the life core. You can see that through associations that cardio logs they do really well in regards to etiology in. But my comment waas Jews of those research findings the practice off, not overrating or, you know, checking the computerized Easy G is still not at this point. Now we're seeing technology like the Apple watch is, well, very successfully interpreting east rhythms. Yeah, I suppose it's the issue off. What what are we ask in the eye to do? Is a rhythm interpretation, or is it more complex? Issue the interpretation And I think the examples that I provided really focused on 12 million easy gene interpretation. Limitations on that issue I proposed still exists is because the human hasn't perfected and there are analysis. Four month yet on their four. Therefore, the technology is waiting for that. But certainly in regards to rhythm analysis. Okay, I definitely is in that space and does well, you know, the focus of that was the focus of my point. Today was to just really highlight that the practice is not changed yet because of the accuracy issue. So although EKG drug, the cities are being computerized red, the practice should always still be that it's over read by a confidence individual. Cool. You know, I agree. Um, it certainly can handle like we've seen that. That what? Just don't forget your stuff. Like, I guess, Um, But when it comes to more subtle things, perhaps even just simple TV have inversions with little occasional that that might be a bit more of a challenge to push for it. One thing I know is, uh, um, with that on in line of thinking in terms of that GI interpretation skills and really skill in our our capacity to interpret e c gs, and it's amazing that you've got this out that's got over $55. That's incredible. Me kind of said that like it was just a little small achievement. It'll be quite said it light enough, but that's that is crazy on what have you ever considered moving it like moving into one future project I've seen done give it in terms of context is over half came from the athletic athlete's heart perspective on a great thing I've seen. Pushed out by the University of Washington on the Australian Asian College of Sport, Exercise Positions is a free online model we're in. Anyone can access it and they can go through. And there's a series of lectures available there. There's a series of different steps cycle through in terms of scaly. Not that something you've ever considered it moving into in the future. It's interesting you bring that up because, as academics, the one thing we find about a four month like a mood think you're going to call on your massive, open online class is that those typically are very pretty. It here to there. If you ask people, have you ever completed one? They say, You know what? You signed up to it, but we've never completed it. And so there's something about that for months. Sure, people's back to what I talked about in that didactic teaching. You know, there is a bit of a hypocrisy here because I'm sitting talking to you today and you're listening, you know, versus doing didactic lecturing is is definitely very much in transition on. We see strategies on four months, like the hip to cash room and, you know, tasks based learning. Antibodies call me as a preferred for months, and we do that in terms of efficiency, of burning, but also in really edgy teen mint. Also, you know people. It's difficult to go into a two or a lecture on listen, make notes and then reflect and conceptual azo all after that. Whereas if you get on to do tasks and have a focus, well, then actually the reflection is occurring as the task is undergoing. You were fine. Your behaviors, you get better at it. And there's a really kind of win win 22 issue from the educator on the corner in regards to the efficiency and came in effectiveness of that burning four months. So, um, albeit open access learning. It's definitely a good thing, and definitely something that has been around for a while. Unless I'm teaching four months divvy, it's learning activities that been working through the working memory, the working memory model. It will be ineffective. I think that's the key. Is with something that large. I'm not kidding, right? Optically for mother Did that without medicine. You know, I get you, Um, I think you're on element. All that mean? If it was online to happen, um, of your lad, component it on and help. I know in different fields and economics, that's something that's definitely getting a big cushion. Um, of a friend of mine who's in that field on. But it's interesting to see what they're doing and of course, taking learnings from other areas and see if you can apply it to our world's to see if I can work. It's always something that's interesting. Where that would work. Really Well, it is. It's called the PS of learning. So you know, you and I will learn differently. Work different in that respect. Yeah, Everybody is but to have a standardized point in time for assessment. So we all have to be a 12 weeks before we could be assessed. I think that form up you describe works best talking. Not this you where maybe students can be or efficiently be assessed and get through things in a foster piece because they just are versus others. You require a sore PS or a different type of peace on a four month off. That and all of that organization is up for a refinement. Nine. We've learned a lot in cold, but also with the dependency to the online solution. There's a really opportunity to do something with that which is more effective, offers ambitions, but definitely in the piece of earnings. Cool. That's great with, um, I guess one final question from May. If you were to point folks into a really good resource to guide the interpretation of VCG, um, where would you point them in the direction to it? Really, it really depends on the nerve and stay on many of us during in certain ways and in education. There's up with a four, but I think it's a five. I haven't kind of your system, and I were. The bark system would really be used to clarify your learning style and number four months where you have visual for audio. Are you a reader, or do you do kinesthetic on type learning four months now in in our institution, we would test on every year it first year so that we have somebody be a concept of foods in the room because you know you need to be and appealing to your audience. You know, unfortunately, in a lecture is know who the audience is, so you can appeal to them. But that also goes to the learning style as well. So I suppose, is backtracking a little bit. We just don't teach in one for March. We would, right? Yeah, yeah, We try to keep a breakdown things deliver them in various four months so that they would have paid into the learning for mine off that individual for me, the resource is available on nine hour days and, you know, some of the there's some of the video images they're used to came of. Highlight. You know, physiological components are really accent on something I really would have wished. I had a learner. So that's why I find them very effective me because it's more beauty, my visual learning for Martin style, but definitely activities that require me to do things. So, you know, trial check task. There's a lot of, um, online resources that you could go to for that that offer you tests and insights into, say, for example, least the interpretation. The one thing that limits them is it's the feedback. So being told right or wrong is a very limited feedback component. You need to know the way on any herbal is the deeper turning to current. There was a limited in in, um, availability. Yeah, that's a good point. In terms of their actually is supposed AOL a This this is probably where you degree. And this is also where we perhaps could an improve Things are You might have missed this. And this is we should look for the future for sure. Um, definitely is a big impact. All right. Um, that is, I guess, everything for today if we don't have any more questions. Thank you very much for your time today. Um what if you can? It'll be lovely. If you agree that we could possibly part the slides afterwards, we'll put up a recording off the lecture. That means anybody can catch up again. A time that works best Brand more, perhaps within sign. If they weren't sure. And something on so thank you very much for joining. Today. We will have another episode coming up in a month's time, and that's all they're going to be. A Rhine See pet of specific interest in congenital heart disease patients from our present or in exer is a great PhD student. And he's on some really good, systematic reviews that so it should be gripped. All right. Thank you very much, folks. Here.