Multi-disciplinary education has expanded in the last decade or so as a way to ensure that healthcare teams cooperate, coordinate care and communicate to make care more patient-centered, continuous and reliable.
On this episode of Write Medicine I talk with Lorna Lucas, MSM, a healthcare education professional and advocate for equitable healthcare. We discuss the role of multidisciplinary education in improving patient outcomes, the challenges in delivering and evaluating multidisciplinary education, and interventions that emerged during the early months of the COVID 19 pandemic to provide psychosocial support for both professionals and patients.
Lorna shares the need to focus on designing and delivering educational content in a holistic, equitable, and patient-centric way that fosters interdisciplinary collaborative practice.
She says, “We must look holistically at the team dynamic. It’s great to have everyone performing at the top of their medical discipline. However, coordinated care requires attention between the cracks.”
In this episode we talk about the importance of the following:
✔️ Local/onsite champions to support multidisciplinary education
✔️ Deep listening to perspectives in each discipline
✔️ Ensuring that everyone involved feels heard
✔️ Emphasizing a comprehensive team approach to address challenges, many of which are operational
✔️ Designing and delivering programs that work with everyone’s role in mind
We also touched on the ways in which the COVID-19 pandemic highlighted existing disparities and inequities in education. She described how educators can play a role in providing psychosocial support for health professionals and how this support can improve patient outcomes.
Connect with Lorna
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Multi-disciplinary education has expanded in the last decade or so as a way to ensure that healthcare teams cooperate, coordinate care and communicate to make care more patient-centered, continuous and reliable. On this episode of Write Medicine I talk with Lorna Lucas, a healthcare education professional and advocate for equitable healthcare about the role of multidisciplinary education in improving patient outcomes. We talk about the challenges in delivering and evaluating multi-disciplinary education and interventions that emerged during the early months of the COVID 19 pandemic to support both professionals and patients. Join I want to jump in here quickly before we get started on this episode. In response to the many questions I get about writing needs assessments. I'm offering a four week hands-on workshop on writing needs assessments. That's designed to support deliberate practice with expert feedback. Where and when is this happening on Mondays at 12 noon Pacific time from October the 31st to November the 21st. Let me know if you have questions and when you're ready to register you can do so via a link in the show notes where you'll also find more information about what to expect for each week of this workshopAlex Howson:
hello and welcome to Write Medicine. I'm your host Alex Howson, and I'm here today with Lorna Lucas. Welcome Lorna.Lorna Lucas:
Hi. Thanks so much, Alex. It's great to be here. goodAlex Howson:
to see you. So you know, I like to start by asking people to tell us a little bit about who you are and your background in education for health professionals.Lorna Lucas:
Absolutely. Well, I am so excited to speak with you today and like so many talented professionals in this space and arena, it's kind of been such a whirlwind and such a journey to, to be here and to become a professional healthcare educator. So, you know, it's, it's funny, I always had wanted to be involved in healthcare. I thought I wanted to be a physical therapist. You know, in high school I worked at a physical therapy office, but then I started to realize that if I wanted to be a physician I would have to maybe, I don't know, deal with cadavers and things that I was not probably gonna be able to handle very well. And so coming from a family was a long history of being in the healthcare space. I knew that there were other ways that I could probably contribute to healthcare and education. So it kind of found me, I think, through the years and really focusing on, you know, how do you organize, how do you build around ideas and concepts to really help The cancer care team in this case. And so, you know, through the years I was involved in various medical organizations and it was always kind of going back to how do you create and develop education that is meeting the learners where they are and you know, developing education that's real world for them. So that's kind of where I've landed. And through the past, oh goodness, almost 12 years now, I've been involved in some capacity of working together. The amazing healthcare professionals most recently in the oncology space. But really working together, hand in hand to identify where there's gaps in education and to really develop those methods and, and models for education that truly does tap into what they need at the moment. And look at the patient journey as really the guide for how to develop that type of education to support the healthcare professionals. So at the end of the day, it's always keeping the patient centered. And I am just so honored and thrilled that I've had the opportunity to work with so many healthcare professionals along the way.Alex Howson:
And you have worked with a range of a healthcare professionals, and it's interesting when you were talking about. You know, really kind of zeroing in on developing education for health professionals where they need it and, and what they need I was thinking I trained as a nurse decades ago and education was not like that. It was very much a kind of rigid curriculum. And I can remember many of us thinking at the time, this doesn't really reflect what we're doing in the clinical space. And so, you know, it's interesting just to kind of be mindful of, you know, how much has changed over the last few decades. Absolutely. Now you've worked with different kinds of healthcare professionals including gastroenterologists and oncologists. Can you talk a little bit about developing education that has a kind of multidisciplinary spirit and, how that fits into the overall approach to improving patient outcomes.Lorna Lucas:
Absolutely. So, yes. Several moons ago used to work with the. American Gastroenterological Association and there was a wonderful little conference, I say little sarcastically called Digestive Disease Week, which is still thriving and, and it's a wonderful conference and it actually convenes the membership of four societies that all focus on different disciplines involved in GI care and. What is so magical about that type of education and, and building that content was realizing that it, it really is a team approach. We can't just focus on just one discipline and what they're going through or what their needs are as far as education, but really looking holistically at the, the team dynamic. And again, at the team for the patient care and what their experience is going to be like. And truly aiming for that coordination is so important because it's great to have everyone performing at top of their license and their medical discipline. However, there's so much kind of in between the cracks that's needed for that coordinated care. So that was really my first foray into realizing that we need to look beyond just one discipline at a time but truly build that comprehensive education that really brings into consideration all of the different disciplines and where along that patient care journey they're involved or touching a patient. So that was really eyeopening for me. I, I truly, again, just really loved working with the different professionals and disciplines that are involved in patient care. And I just wanted to note, cuz you had mentioned obviously your path, Alex, as a nurse, there are so many clinicians and non-clinicians that go into these care teams. And have such critical roles. Right. And so that's definitely where I kind of got first sampling of what multidisciplinary education can really look like. Mm-hmm. and have been able to really kind of focus and on, in, on that through the years. IAlex Howson:
wanted to touch on, you know, you, we we're talking about multidisciplinary Education. What do you see as the differences between multidisciplinary education and interdisciplinary education? Because I, I certainly hear, you know, people use those terms interchangeably. Yeah. But then there are a lot of people who argue there are some very distinct differences between these Two terms because you can educate a lot of different health professionals about the same topic, but not necessarily in a way that allows 'em to work as a multidisciplinary or interdisciplinary team. So could you speak to that a little bit? Yeah,Lorna Lucas:
absolutely. And I think this is such a great topic that I know there's been a lot of great research on too, through the years. You know, typically we, I've been using the term multidisciplinary because we want to be able to develop education that really, you know, hits the nail on the head for specific disciplines and, and what resonates with them. But I truly think what we're always aiming for and striving for is interdisciplinary education. So instead of having high quality education specific for their disciplinary roles, I think what we really wanna do is look more at the interdisciplinary of how it's integrated, so how the roles truly compliment each other and are integrated. So really instead of. Breaking down into kind of barriers or siloed roles and education. I, I really do hope, and I do think that we're getting there that there is a lot more education being built around that coordinated effort. And from my most recent experience working with the Association of Community Cancer Centers, we did focus a lot on more of that kind of integrated experience in education. Specifically in a lot of the structural pieces that are so important to be able mm-hmm. to provide high quality care. So a lot of quality improvement initiatives, process improvement initiatives. They can be educational and have interventions that are multidisciplinary in nature, but at the end of the day, the outcome were really looking for is to have that interdisciplinary approach to the education. So it's a work in progress, I feel, But I. At the end of the day, that's what we're really looking for is the interdisciplinary, and someAlex Howson:
of that's the in between the cracks stuff that you Exactly. That you kind of flagged up earlier. Do you have any examples of education that you've you've contributed to, that you've helped to, you know, design and implement that really? Manages that in, be in between the cracks. Stuff that can be so frustrating for, you know, members of the healthcare team.Lorna Lucas:
Absolutely. I think those kind of in between the cracks kind of barriers and challenges are so pervasive but are off, are often the, the most challenging to really get at. So I think it all really starts with, first off, having the space. That and the champion behind supporting, even looking at something that might be a little bit more, not like non-clinical in nature. So having the support to look at even a topic or any issues that they might be having. Again, i, I bring up operational because. We had found that that was a lot of the challenges that were preventing providers and healthcare professionals from being able to give the patient the best time attention and best outcomes. So, you know, a lot of the times it can be things that are just a process or a workflow or. Physicality issue within a building or within the cancer program or the clinic, but it all, I'll back up again. It all starts with really having a champion. Sometimes in the administrative space too, which is again, why it's so important to bring in the voices and perspectives from the entire care team. And I think it's important to note that often time is the administrative professionals as well. But to really be able to have that space carved out to look at what are those challenges? What is even a problem you're having? Sometimes clinicians we know are so busy, they don't even have the time to pause and reflect and say, Well, you know, I've been having this issue with this flagging thing in the ehr. How do I get around? How do, how do we fix this? How do we streamline this? You know, I'm trying to order a molecular test for a patient, but I keep getting this error or this flag in the system, you know, So those are things that might be minor. But we need to address them because we need everyone to be able to, again, deliver the best quality of care in such a timely manner since there's so many competing priorities. So a lot of the education, I think that's in between the cracks. Really revolves around some of those administrative challenges. Things that just need some time and attention and really need a, a strong game plan to formulate what are some solutions, how do we do this as a team? And so much of that goes back to then understanding the roles on a multidisciplinary team. Respecting the roles on the multi of your team and coming up with those collective solutions together to make sure it's feasible and it works for everyone's role in mind. Some of the examples we've seen over the years have been some kind of process improvement exercises that we've done to really look at what is the whole flow for something like ordering a molecular test for a patient whose outcomes will probably be improved if they have access to precision medicine. But it all starts with the testing. So where do. Create those synergies and create that nice flow that really respects everyone's role on the team. And at the end of the day then results in better outcomes and care for patients. So yes, I'm a strong believer in paying attention to the, the things that are in the cracks. And in my experience, a lot of that has been very administrative or project management even. Mm-hmm. kind. You know, principles and things that need to be addressed to make sure that everyone's functioning the best they can. And a lot of that too is education and different interventions that we can develop along the way to.Alex Howson:
So all of that sounds like a very proactive role for education organizations to take in, in really doing the background research to figure out what a particular healthcare setting or organization looks like, what the roles and responsibilities are. And I know that some education providers might shy away from. Because that's a lot of, that's a lot of organizational and change management work. Can you talk a little bit about how education providers, such as ACCC approach, The kind of question of identifying what are the things that we need to look at and be aware of, you know, operationally or strategically, or in terms of roles and responsibilities mm-hmm. Within a given healthcare. Context, You know, how do you start that process? How do you identify a challenge that education is a suitable intervention to be part of the solution?Lorna Lucas:
Well, I think as a, as a healthcare educator, I wanna say, well, the answer and the solution's always more education, right? I think in this case, it's just so important to always start off with really convening again, all of the voices, all of the perspectives, anyone that has a role and really elevating to make sure that they, they feel heard. So. Pretty much everything that we embark on or have embarked on when it comes to building out potential educational interventions always starts with some level of kind of a needs assessment, right? I think we're all very familiar with kind of the building blocks to building any type of education. However, in this era of the implications and challenges that Covid 19 has just exasperated, right? It's just opened up such a can of worms. I. More than ever. It's so important to start off by, by truly listening to the multidisciplinary voices. So again, you're not just getting perspective from one discipline and you're not just focusing on just one angle of education, but again, looking at that sweet spot of how do we bring in something that can really suit and fit the needs of everyone. So we've had a lot of success in the past of, of doing different styled focus groups. Different interviews different kind of supportive, what we called coffee chats when we were supporting our president's theme work. So really hearing directly from the membership. And I, I will say, I think there's so much power in it being informal too, right? We don't want to create a stigma that we're looking to have a very necessarily clinical edge or just it has. You know that we're not looking at guidelines per se, but we wanna make sure that we're looking again, at that comprehensive kind of wraparound education. And so that really is important to kind of probe and then sit back and listen to all of the perspectives and really everyone that's involved. And at the end of the day, Not giving weight to one voice or one discipline over another, but truly looking at how do we create an equitable process for our education as well?Alex Howson:
And it's often in those listening moments where you hear a little bit more about what's happening at the margins and what's happening kind of in between the, the cracks as people get more and more comfortable talking and sharing their perspectives and their experiences. With you then they're probably more likely to tell you some of the things that they feel are important to them that they don't necessarily see as an organizational or workflow or team issue. But in that listening moment, it turns out, Aha. Yeah, actually I have that problem too. Absolutely. And so you, you kind of build up your data from the, the, the ground up. You talked a little bit about. The pandemic and the way that the pandemic has changed a lot of lives and the way that healthcare's delivered, especially in oncology. Mm-hmm. what kind of inter, and you mentioned the president's theme as well. Can you talk a little bit about some of the interventions that you have been involved in to support both health professionals and patients in the last couple of years? Because, It seems to me those, those have grown very much from deep listening.Lorna Lucas:
Absolutely. Yes. And you know, the pandemic has really shifted the landscape of, of healthcare in general. And then specifically really looking at oncology. You know, I'm sure there's gonna be longitudinal research for a very long time to really look at the effects of, of the pandemic. And of course trying to stay optimistic and look on the bright side. I think there's been a lot of really great advancements that have been accelerated in patient care, which, you know, telehealth different kind of opening up, you know, and getting rid of some red tape and things like clinical trial access and things of that nature that we really hope can, you know, hopefully sustain. And that can be tweaked. Through the years. So I think on the upside, there's a lot of positives that hopefully will come from how we kinda reconfigured how we deliver care and how we deliver education and how we address a lot of those issues that will be feeling for years to come because of the pandemic and the effect on of course patients. But we cannot ignore the effect on healthcare providers. So yes, very big topic that I'm sure will be explored for years to. But yeah, some of the kind of ways that we addressed some of the issues and gaps that were presenting due to the pandemic we, we really wanted to focus on the membership of ACCC, which again is the multidisciplinary oncology care team and. First and foremost, we have to look at the wellbeing of the providers. I mean, what was being asked and still being asked in many cases is just so strenuous. There's a lot of stressors, a lot of challenges that they're facing. You know, there were already burdens on the healthcare system well before, and now of course that has completely opened up so much more for healthcare providers as well as patients. So specifically in cancer, we really wanted to understand what does the landscape look like? What are gonna be those immediate needs, and then what are probably gonna be some long term needs that will need to be addressed through education incrementally for years to come. And so the first one was really the wellbeing of the healthcare providers. So we definitely, you know, as soon as the pandemic was ramping up, We got to work, We did a lot of kind of urgent, immediate education kind of interventions. A lot of peer to peer, right? Especially in the beginning of the pandemic. We had members from Seattle who kind of went through it first, the first wave. They were beginning on different kind of. Peer to peer calls, webinars, town halls to say, how do we immediately address these issues? So that call to action in the first days of the pandemic I think was really inspiring because it really just mobilized, I think healthcare providers, regardless of what, where they provided care or which discipline they represented it, it truly mobilized and I think in oncology even strengthened the team approach even. because there were oftentimes that perhaps. Maybe a nurse who typically delivered chemo infusions might have been called out to triage the ER right in the early days, or even provide monoclonal antibody treatments because it's a similar similar infusion to chemo. So knowing that in mind, we needed. As healthcare educators, we needed to understand what the membership and the learners were going through because we couldn't address their educational needs in that moment unless we were aware of everything that they were going through. So staying in touch and being in touch with everything the healthcare providers were going through was really paramount for us to then really craft and develop kind of an education program. We were very fortunate through the Pandemic to be led by Kristen Nelson at a c. She is a amazing person. And secondly, she's an oncology social worker who just, oh my gosh, if you're ever gonna go through a pandemic. Krista really did an amazing job navigating those challenges and just being such a rock for the membership. In that. So again, that's where the psychosocial element of support for healthcare providers is so important and should be a theme and a thread carried forward indefinitely. And we see that as a growing field as well, and and place for education. And I, I would say, you know, secondly, just really looking at health equity and access. Again, I think the pandemic really showed everyone maybe where the existing disparities and inequalities were already, but then with the pandemic, so many other things became very visible. And I think with that has renewed a sense of. We need to address this as healthcare providers and as really as a country. And the pandemic has just, I think, accelerated that. So that's also another element really, really important and critical to developing healthcare education for providers is truly understanding the communities they serve, understanding all of the challenges, barriers, disparities, inequities that exist. Looking for trainings and education to help mitigate, to help improve those outcomes in the long run. And that's definitely not probably gonna be solved overnight, but it's the fact that the awareness needs to be there and acknowledging that there are so many gaps and challenges and really taking the charge to incorporate into our education moving forward. That there should always be elements of looking at how we incorporate EDI into everything we do as healthcare educators. Really understanding where the healthcare professionals are. With their own psychosocial status and how we can support there. And then that trickles down into how they can also provide more advanced psychosocial care to patients as well, patients and caregivers. Mm-hmm. So it's really very interconnected. And it truly is such an ecosystem that really is all based on that interdisciplinary education. By then being able to address and hopefully, you know, move the needle in kind of all these challenges we know are facing. Facing really societyAlex Howson:
and being able to take that approach is it, you know, is definitely, or it sounds as though it's very much part of the value of a member association where you can kind of build up pretty solid data over time about who your members are and what they need. Can we talk a little bit about the kinds of education that you have found especially effective in addressing the needs of the multidisciplinary care team, particularly in in oncology, but in any of the other areas that you've worked in as well.Lorna Lucas:
Absolutely, and I think these are some lessons that can be a. Applied across the board. But I think especially through the education and work that ACCC embarked on, it was really focused at how do you create access to education that can be applied regardless of the care setting, the structure of the cancer center the community that they might be in. Is it a rural, urban setting? Just so many different factors can obviously impact how care is delivered and also how education can be absorbed in those situations. So I think what is so important is, is not building one size fits all education, but it's creating. Basically a model that could then be tweaked or tailored around what works best based on the available resources or the time or even the roles that are present. There is no, also, there's no standard multidisciplinary oncology team, right? So when we're building education, you know, we need to build and keep that in mind that it needs to ebb and flow. It needs to be flexible. So really just having kind of the, the building blocks in place, but also the ability for that kind of model or educational intervention to be able to be applied regardless of how they are structured or how they are set up. So there is a lot of thought and process that goes into developing an educational program or. Or tool or intervention that could be applied at many different types of settings. and again, with the pandemic we definitely had to scale back a lot of the live in person education. Mm-hmm. So, you know, that was always kind of a, a bright spot to be able to even go directly to the membership where they were, whether it was a conference, a regional meeting a workshop. And so a lot of that had to be completely reconfigured, which everyone has done. And if we hear the word pivot, I think one more time, we might, we might just, you know, give up. But yeah, I think not only did we have to really look at the formats of how we were delivering and making sure it was realistic and feasible for multiple settings, we then found. Again, by listening to the membership that there are other ways that we can do it. So we definitely saw an increase in some of our education, such as like an Echo series which is a wonderful model and format. We definitely learned that kind of some hybrid approaches to education was really well received, creating some learning kind of platforms and spaces that. Used different kind of mixed methodologies, whether it be some kind of online kind of cohort, you know, interaction with each other with a faculty member, but then some self-paced independent work. And then of course we still went forward with a lot of our quality improvement initiatives. They were just pivoted over to the virtual format. And we actually found that there were a lot of benefits to really transitioning pretty much all the models of education we did to virtual settings. Because it really opened up the ability for. More members of the multidisciplinary team to participate and be active in the education. So for example, if we did a virtual workshop on. Learning about the latest and greatest treatments for non-small cell lung cancer stage ratio four patients. Typically, we would probably have a handful of clinicians be able to participate live right between their schedules, seeing patients and clinic. Realistically, it would probably be a very small group and they'd probably be coming and going. What we found by creating a very deliberate virtual schedule and agenda is we were able to tap into even other departments. We were able to involve the pathology department. They were located offsite at a different facility together, and by doing things virtually, we were actually able to convene and bring together. More active participants and learners than if we had been live in person at a cancer center. So I find that very powerful and I think. You know, of course there's downsides to everything being virtual. But we really needed to embrace that we can reach more people and we can truly create more of that even extended multidisciplinary team by having more of these kind of virtual collaborative opportunities. DoAlex Howson:
you think that hybrid model is going to kind of be sustained, you know, looking forward?Lorna Lucas:
I really hope so. I think, you know, again, we were all kind of forced into it in a way, but I think absolutely just the, the value and the impact that we're seeing from being able to include more people and again, meet people where they are, what's convenient for them. There's already. All those burdens we've talked about and variables and factors that are pressing on healthcare providers, and especially in oncology, there is a lot Oftentimes because they might be generalists they might be seeing patients that have many different types of cancer. And so when you're helping support a provider who is seeing patients across the whole oncology spectrum, We need it to be flexible and, and definitely adaptable in the education we're providing because they provide such flexible, adaptable care. And so that was really, really important and I think it will continue to be enhanced to be improved upon. But I think it's there and I think the appetite and the interest, and everyone at least I think sees the value that this hybrid kind of educational components can really bring.Alex Howson:
And looking forward, just to kind of wrap up, you know, you mentioned psychosocial education is an important part of overall education for mm-hmm. The oncology team in particular, but other healthcare professionals as well. Where do you see education really needing to kind of focus its attention to, in order to better upskill health professionals in oncology and in other disciplinesLorna Lucas:
or specialties. Yeah. I think there's so many areas I, I think that's like a tricky one to really pinpoint, but I think in. Acknowledging and bringing forward that psychosocial has a place and that there is really truly a place for comprehensive care. And this doesn't even just apply to oncology, but really all of the healthcare professions. It's so important to look at the patient as a whole, right? We know that improved outcomes are going to be present if a patient is looked at more than just a patient or a case. And so, There really is so much education that can still be done, not only to improve things in coordinated care, such as psychosocial support and other supportive services, but for the, for the caregivers themselves. They need that support to be able to provide for the patient. They need that education just as much they're part of the care team. And then of course the providers themselves. I mean, this is just such a big area. That I think just there isn't time, there isn't necessarily reimbursement available to be able to support that type of service or that type of education. So I think definitely looking for ways that the healthcare system can shed light on the importance of these more kind of comprehensive approaches to full care for the patient as well as the healthcare provider will hopefully, you know, be more of a priority in the future. And just understanding that everything is so interconnected. To have a health literate patient all starts with the healthcare team and how they're communicating. How are they trained to be able to make sure that a patient is hearing and understanding and absorbing the information that they're providing. So, you know, that starts with something that might not have been taught in med. And I think that really takes organizations and, and, and professional educators to always be aware of those gaps and things that were maybe not taught in med school, but my goodness, they're very, very important elements to be able to provide. Really high quality patient care. And then that hopefully will tie into more shared decision making that will tie into more equitable healthcare more shared decision making when it comes to you know, making those decisions based upon the information that's provided. So that hopefully will go a long way in, in dispelling. Disparities along the way too. So knowing that it's a journey, we, we all know that this is going to be solved overnight, but really having, I think, dedicated healthcare educators focused on, again, a lot of these connectors in between the, the typical, you know, education, healthcare, education. So not really ever losing sight of those really important pieces that. In a nutshell, provide that coordinated care that the patient hopefully will receive.Alex Howson:
And that comes back again to in between the cracks and how important it is to have a powerful light to shine into those spaces. Because that's often where the gold is. Yeah, exactly. Lorna Lucas Healthcare Education Professional and advocate for Equitable Healthcare. Thanks so much for sharing your insight and wisdom with listeners on Write Medicine.Lorna Lucas:
Thank you so much, Alex. It's been a joy speaking with you.
We might think of multidisciplinary practice as disciplines with different goals working in parallel. And interdisciplinary practice as collaboration between medical and other health specialties. Whichever term we're using. Lorna reminds us that listening to a range of perspectives and voices from multiple disciplines is key in designing education interventions that shine, a light into the cracks that often threatened to derail care coordination. And become an unbreachable chasm. Virtual education formats often enable a wider range of team members to participate in education. Reach the extended multidisciplinary team. And offer a flexible adaptive approach that fosters flexible adaptive care. Listening widely can also help education providers to identify strategies that drive more equitable outcomes for both health professionals and patients. This listening during early years of the pandemic. Mobilize or rapid psychosocial response to support oncology provider wellbeing in ways that also strengthened ties among oncology team members. Lorna reminds us that these ties between different disciplines and team members are so important and form a fabric that holds health professionals together. And connects them with the communities they serve. Thanks for listening to this episode. As always I'd love to hear what you think about this episode and the podcast in general. Which topics would you like to hear more about? And who would you like to hear from. You can email me, write a podcast review on apple podcasts or whichever platform you listen on. And you can also use SpeakPipe direct from the podcast page on my website. And if you haven't yet joined the right medicine community, there's a link to join in the show notes. And as a thank you, you will receive downloadable bonus content from podcast episodes. Until next I'm Alex. And this is Write Medicine.