One of the consequences of the COVID-19 pandemic has been the massive shift from live meetings and education to virtual formats and the longer term implications of this shift is an ongoing conversation in the continuing healthcare education world. The 2020 ACCME Annual Report noted that online activities engaged most learners compared with live courses and regularly scheduled series, the dominant activity types in preceding years.
The shift to online education is itself not new in the US although its expansion has been patchy and there are several factors that pose barriers to the development and implementation of online learning, such as time constraints, poor technical skills, inadequate infrastructure, absence of institutional strategies and support and negative attitudes.
As a result of these barriers, as well as the impact of the evolving science of learning, the demand for instructional designers in continuing healthcare education is increasing. One study predicts that by 2025, there will be a 28% in ID jobs in education.
But what do instructional designers do and what is their role in continuing healthcare education? My guest today Jessica Martello answers those questions. As VP of of content and editorial at EVERFI, a digital education company, Jessica brings deep expertise to the potential of instruction design in adult learning.
Join us to hear more about:
On Being with Krista Tippett: Ariel Berger—Be a Blessing
Instructional Design Resources from ACCME
Accreditation Council for Continuing Medical Education (ACCME). ACCME Data Report. Rising to the Challenge in Accredited Continuing Education—2020.
Love LM, Anderson MC, Haggar FL. Strategically integrating instructional designers in medical education. Academic Medicine. 2019;94:146.
Snell L, Son D, Onishi H. Instructional Design. Applying Theory to Practice. In Swanwick T, Forrest K, O’Brien BC (eds) Understanding Medical Education: Evidence, Theory, and Practice. Third Edition. 2018. London: Wiley.
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Alexandra Howson 06:49
Hello, and welcome to Write Medicine. I'm Alex Howson your host and I'm here today with Jessie Martello VP of content and editorial at EVERFI, welcome Jesse. Oh, it's so good to see you. I've known Jesse for a few years, we've worked together in projects in the past and so it's really great to make this connection again and have the opportunity to have a conversation about what you're doing now. So, let's start by talking a little bit about your background in learning and education.
Good to talk with you. Sure. Yeah. So, I graduated from college and was kind of not sure what my next steps would be. I majored in marketing and wasn't having a lot of success in finding a full-time job. So I got connected to a woman who was developing e-learning content for high school learners and digitizing in person classes. And in working with her, I really learned that there was an industry around e-learning and instructional design. And through the time that I worked with her, we also you know, had opportunities to practice using different tools to build e-learning, started thinking about different approaches and principles. And at that point in time, you know, I was such a newbie, I didn't even realize instructional design was a field. So, she really encouraged me to pursue it, you know, more formally and look towards you know, a program with a certificate or some other type of certification to just build some credentials beyond, you know, a few months of job experience. So, I did, you know, start looking for that certificate experience. So I started to get this more theoretical background around adult learning. So even though our work was focused on k-12, at the time, the program focused on adult learners. And after taking the program, I just continued, I really enjoyed it and found it super applicable to any type of business and all industries, which was really cool, you could take it in a lot of directions, and I liked that. So I continued to pursue Master's in that field, as well as just pursuing other job opportunities. So, you know, after working with her, I moved into adult training at a program for adults who were pursuing credentials in it or project management. And then, from that point, just continued to try out some different career paths around doing adult education in an HR setting. So training internally for our workforce, and then started doing some government contracting, where we created education for really specialized industries, and paths. And just through all of those experiences, I started to learn kind of what I liked and didn't like to do around e-learning development, adult education adult learning theory. And it was pretty cool to be learning in my classroom, and then also living it on the job at the same time during those years. So, more recently I've learned I really enjoy the product space and started pursuing that. And that's where our paths started to intertwine when I moved more into a product space and was introduced to the world of CME, so bringing my instructional design skills into that world was really interesting, because it's such a specific need that's ever changing, ever growing. And then where I am now, I'm focused on creating adult learning experiences and K-12 learning experiences. So I get to kind of have the best of both worlds. But yeah, that was kind of the pathway to get here.
Alexandra Howson 11:33
Thanks for sharing all of that so it's a multi path. If we can see that. And I have a lot of questions, actually, when you talk about product, what are you talking about?
Yeah. Sure. Sure, so I'm thinking of product in the sense of software as a service or something that you know, an organization or a company is putting out to the masses, versus, you know, some sort of educational experience that's used internally for the company that I work for. Something that is of quality design, and, you know, maintenance and upkeep that we go out and sell to customers, and that they subscribe to year over a year.
Alexandra Howson 12:22
Okay, no thanks for that, that that clarification. So, like a digital learning platform would come under that heading of product. Okay. So one of the things that struck me about when you were talking about the experience of being immersed in instructional design as part of your own learning, and then kind of going into the work world to deliver instructional design work, you know what are some of the things that you see that are different or similar between instructional design for people who are learning in a classroom, a physical classroom environment? Maybe we'll get back to that, at some point here, a physical classroom environment or a workplace environment versus e-learning. You talked about that right at the beginning at the very beginning of your story. So, you know what do you see as the main differences and similarities there in terms of you know, that the design components? How can you talk a little bit about some of the things that might support that that kind of experience in an e-learning environment?
That's a great question. I think what you're able to do in designing some sort of educational experience that's in the classroom is leave a lot more open and flexibility to riff on, you know, the people who are in the room with you to have more, you know, conversations that might take different directions. And so, you can think about that in the design of the educational experience and build off of that, and leave some space for that and say, you know, open this up to a facilitated conversation, and people can kind of play off of one another. And I think that applies, you know, in a workplace training or some other forum, let's say at a conference, you're able to have that kind of back and forth between a facilitator. When designing for a digital experience, especially if it is something self-paced, where someone is just coming into that educational experience, you don't have that kind of room to riff. So, you really have to think everything out, end to end, what this experience is going to look like. And, you know, try and bring some of the elements that are really great from the instructor led live experiences, like hearing other perspectives and, and bring that into the experience in some way where you're still giving that benefit to the learner, even if they're not experiencing it in the exact same way that they might in person.
Alexandra Howson 16:22
And are those kinds of tactics? Are they possible within an asynchronous learning experience? So, if you're doing a kind, of course that self-basis in your own time, you're not having to kind of do it at the same time that everybody else can you still have that kind of interactive element where you see what other people are thinking and kind of responding to questions.
Certainly, I think, something as simple as an e-learning self-paced course giving learners reminders or stopping points to stop and reflect can be really effective and reflection upon what you've just read or an experience you just did is a way to bring what you might do in the classroom into that e-learning experience. Something else that we have experimented with and I think could be used across you know, other digital experiences or polls and interactions within the course where you're able to answer questions and then see anonymously how people are answering and kind of compare yourself to your peers and see, you know, am I in the majority or the minority? When I answer a question in this way, you know, whether it's right or wrong kind of question, or just around attitudes and beliefs, I think it's really useful to give learners that reflection moment to say, you know, well, what are the perceived attitudes and beliefs? I think about others, I think that others might have versus, you know, giving them that data to see and really take into account and use as part of their reflection.
Alexandra Howson 17:32
And I'm guessing that there are platforms or products kind of across that spectrum of possibility in terms of live data versus banked data that that gives you that kind of data snack. I like that.
Yeah, absolutely, I think, you know, depending on the tech stack you have available to you and how much you can invest into it in our product, you can build in those types of measurements where you're getting live data fed in and can reflect on it. And I think if that's not available, something like a quick data snack, like in 2025, respondents in this survey said X, Y, and Z can also be, you know, a lower lift and less tech intensive way to bring that compared to comparison for a learner to say, you know, how do my peers think and what do I think and how is that different? And maybe why, and lead them down that moment of reflection?
I borrowed that term from someone else. There are definitely tools out there that you can utilize. And then you know, you can kind of make it a hi-fi experience collecting live data, or use the data snacks for little bit lo-fi but still getting that impactful learning moment.
Alexandra Howson 18:08
So, you've mentioned reflection, you've mentioned comparison, kind of key components of adult learning, right? What other things do you feel strongly about that have to be components of the adult learning experience, particularly, if we're talking about an e-learning environment? Because we're all headed in that direction? I mean, that's been a trend for a long time, right. I know 10 or 15 years at least. But what sort of thing, what kind of components need to be in a really effective e-learning environment?
Yeah. Yeah, I think, you know, you're right, we were headed in the direction of lots of e-learning, and lots of growth there. And then, you know, the COVID-19 outbreak really poured some fuel on the fire, where, you know, now all of us have done a zoom meeting, who might not have done them before. But for an e-learning experience, and for adults, I really think backing it up to the very beginning, getting to know your learners before you begin any work towards a program is so, so critical to being successful. And that is part of, you know, a training needs analysis, understanding what kind of gaps in knowledge are perceived and who's perceiving them. So, you might have a situation where a business is saying our workforce is making these mistakes, we need to upskill them here, or we went to provide this behavioral education to prepare people to interview or in the CME world, you know, something from bedside manner to actually putting hands on educational information out about best practices for doctors and nurses and other medical professionals. But I think understanding your audience is just so key to creating a good e-learning experience, and then can lead into how you structure that experience. So, thinking about what they need to know and doing some research, you know, I encourage our team and love when we have the opportunities to actually speak with potential end users who are our learners to learn a little bit more about them, who they are in their experience, you know, professionally, personally, and then also learning a little bit about, you know, what their learning environment is even as they're engaging with an e-learning course. You know, are they sitting at a quiet desk in an office are they in a noisy cafe or depending where they are, that can weigh into how we think about structuring a digital program. And then also just taking into account adult learners come into educational experiences with a lot of context and knowledge and just meeting people where they are, it's going to really engage them in learning. So those are some really critical points, I think, to creating successful experiences.
Alexandra Howson 20:18
No, that's, that's terrific. I do want to dig into those three things. identifying who your learners are finding more about their learning environment and meeting people where they are. That first piece getting to know who your learners are, what do you find are the kind of best methodologies for really drilling down to the gaps in practice and learning needs. We know whether we're talking about an organization you know, a workplace environment, or whether we're talking about healthcare, which is, you know, exponentially more complex then, you know, perhaps one kind of self-contained organization.
Yeah, I think, you know, in an ideal approach, you're talking to your potential learners either live, or you could send them some sort of survey, but I think asking them questions about their level of comfort with certain topics. That can be interesting, because you can start to dig into, you know, do they think they know, but don't realize they don't know a certain area? Or do they perceive this as a need? And are they interested and feeling like this? Is it a training experience I really want? Or is it more of a check the box, I have to do this? And that can inform just a lot of the ways you're approaching your content development?
Alexandra Howson 23:10
Yeah, no, so we're talking about, you know, what kind of needs assessments methodologies do you kind of recommend to really drill down to get to know who your learners are and what their learning needs are or what their practice gaps are.
So, in drilling into the learning needs, and the gaps, asking learners to give some sort of self-assessment of where they are in in their knowledge, if they feel that they have a strong grasp, and then using some other data points, whether it's talking with a program manager, the person enlisting your assistance in creating this program, like why that's a perceived need, kind of comparing the two. There's lots of great data points you can find in studies and research around different topics that can help inform some of the questions. So, whether that's mirroring some of those questions with your subset of learners that can be useful as well. But I think really digging into why there needs to be an education solution and confirming that to be the case can be another useful piece of the exercise. So in talking with your potential learners and talking with the program managers, you can start to better understand why there's a perceived need for an educational intervention. And I think also talking with your learners about where they are in their journey in terms of physically, where are they in their journey? Would they be accessing education through their phone, or are they going to be in another environment? Those can help give you some shaping ideas towards how you're developing the solution.
Alexandra Howson 24:58
And what sort of tweaks, might you or modifications might you make? Or what kind of design things would you be taking into consideration to address some of those issues around? Actually, I'll back up there because, you know, you mentioned, find out why there needs to be an education solution. Are there red flags that tell you, okay, this, this is not really an area where there needs to be an educational solution, there needs to be some kind of something else. What would that something else be? And what are those red flags?
Yeah, I think if there's an expectation to follow some sort procedure and the procedures and being followed in terms of, you know, a standard operation operating procedure that employees or individuals aren't following. As you're talking with individuals and saying, so why don't you follow the steps, if they're saying to you well, I don't know what the steps are, versus, I don't know where to find that information, you know, there might just be a simple cause and effect of lack of access, and just not knowing where to find information. Once you have the information to follow a procedure, it's really simple and straightforward, they just don't know where to go. That can be a flag is it just, you know, people are super capable, but they just don't have what they need in front of them to do something that can be a flag. I think, also when there's kind of initiatives around certain areas that are influenced by outside forces, like saying, oh, it's, you know, Financial Awareness Month, I think we really should put a program out about, you know, best practices for your 401 K or something like that. It is a reason to step back and say, well, is this truly a problem? Or is this more like you want to have a splashy, engaging, you know, more marketing, heavy activity? That's not really an educational intervention? You know, what's the goal and outcome you want learners to take away? And is it something they really need? So those are the kinds of questions you can dig into to make sure that education is the correct solution for the problem.
Alexandra Howson 27:02
Right. Right, yeah, sometimes those boundaries between marketing and education get a little bit blurred, don't they? And they can be friends. Not in continuing medical education. One of the other things that you talked about struck me about learning about the learning environments, and obviously, you talked about, you know, that particular environment that informs how people are going to access the education. How do you structure your approach to find out? What's going on in the learning environment? And I mean, beyond whether people are going to access education on their phone, or on a laptop or whatever, but the actual well, I was gonna say, the physical environment, of course, for many people, now, the workplace environment is virtual as well. So, I guess that a subsidiary question there is, is that going to change the way that you approach your initial discovery methodologies? So, there's two questions there.
Yeah, they can be friends, they can live together, but yes, not the same. Right? The physical environment? Yeah, I got, I think, to learn more about where learners are, especially pre-pandemic, times, when we were all, you know, out of our homes and working in different workplaces and environments. That's something we learn in my workplace through, you know, talking with contacts that we have at different businesses, you know, are your employees working at a desk? Are they all sharing one computer because they work at a cash register, and then they have to each take turns using the shared computer to access the course for themselves, like one at a time? For a student learner? For younger learners? Are they in a classroom that doesn't have great Wi-Fi? And that can apply for adult learners to, you know, are they working in a remote setting where Wi-Fi or high-speed internet isn't available? So, digging into questions there, and that can be accessed, you know, through a program manager through talking to a learner and you know, you can find people through connections, you can send out surveys, you can enlist the help of other groups who can put you in touch with some of the key people you would like to speak to. But I think just starting to have those conversations about describing your day to day can unlock more information that can be really useful about what environment they're in, are they interrupted a lot? Do they really have an hour block during the day, you know, more and more questions you can add on and lead on as you kind of build that picture in your mind of where they are, and what kind of constraints they're working within?
Alexandra Howson 29:27
Right. How do you use all that information to structure e-learning content and delivery? You build in that reinforcement as well. That's really helpful. What about assessing outcomes, assessing educational outcomes and outcomes, specifically that impact behavior as you know, because you've worked in continuing medical education, a huge issue in this in this field. What do you see as some of the best practices for assessing outcomes through an e-learning context?
Yeah, I think for something, as you know, clear as we don't have great Wi-Fi or high-speed internet that's giving the ability to download supporting materials that contain a lot of information, but aren't the full digital experience and being really thoughtful and judicious with using video or other types of multimedia that eat up the internet, Wi-Fi, and if you're thinking about learners in a physical environment who aren't tied to a desk and have a personal laptop, thinking, well, if you know 40 people have to share one computer, we should make this really brief, really focused on keeping it short, really focused on making sure the platform is easy for learners to come in and out of and swap their accounts. If we know they're interrupted, often being thoughtful about how the learning experience kind of marks your progress, and can save your progress. And putting a lot of thought into the content itself to call back to something that you learned previously and another module or even a few pages ago, and just giving easy access to calling back some of that information if a learner isn't able to sit and give a dedicated, you know, 30-60 minute block of time. So those are just some of the little threads that we start to pull on and think like this can really inform the design and still gives a great useful experience at the end that will better fit their needs.
Alexandra Howson 35:34
No, that's a great, that's a great response and I think probably reflects, when you look across the suite of educational interventions within continuing medical education, we certainly see a lot of the things that you've talked about, but you're right behavioral changes. It's the golden goose it's the thing that you know, everybody's kind of aiming for what can you share any examples where you've really seen behavioral change through e-learning, in particular, but, you know, any other kind of educational intervention? Right.
Yeah, we use a tool that's called an intervention map in terms of, you know, changing behavior as an ultimate goal. And so when doing your training needs analysis, as you're starting to form this e-learning course experience, you always want to start with the end in mind, what are the outcomes you want learners to take away, if that's some sort of behavioral change as your ultimate takeaway, you start by writing that down and mapping backwards with, you know, objective type language, how you're going to get your learner there and kind of build a scaffolded approach have to get to a behavior change, I might need to learn something new, I need to apply some different use of attitude and behavior, I need to learn more about my peers to norm some of my behaviors and understand, you know, everyone is washing their hands for 90 seconds, I should wash my hands for 90 seconds to or something like that, thinking of COVID. And then building up to that I think just putting together a plan of the objectives, you need to get to some sort of behavior. So, you do all of that upfront, you're developing content, you're building activities in an e-learning context around supporting each of those steps to make sure your learners can get to those objectives. So, by the end, you've given them some sort of interaction or information or experience where they've addressed each of those needs. But in terms of assessing, you know, you've given them everything they need in terms of information. We like to use pre and post surveys, and not just assessments for knowledge gain, but surveys around attitudes and beliefs. And any no planned behavior like I will do this differently next time I agree or disagree. And we'd like to use that before and after the course experience and something that I think can be useful as well as to do interstitial surveys and sending out some sort of surveying mechanism to again, ask the learner to answer those same questions. But 30 days after they've taken the training or 90 days after that, to keep it front of mind for them and to really get good data around have they truly changed that and using that data to inform and iterate your approach. I think behavioral changes the loftiest but you know most can be most important or one of the most important outcomes that you seek to change. And I think it just helps to break down how you plan to teach that into smaller pieces and then assess against the pieces that you use to get there and then doing some follow up Yeah, I'm trying to think of some good examples. I think the best feedback that we get from learners that I, I will say, you know, in my eyes, I take that as, you know, changing behavior of one person, we do a lot of education around diversity, equity and inclusion. And you know, that is all about building, not just knowledge, but skills and behaviors and attitudes that support you know, a healthy workplace or a healthy, healthy campus environment or a healthy classroom. I mean, that applies everywhere to just give people respect, and be thoughtful about, you know, differences, and in an approach that tactfully.
Alexandra Howson 38:28
That's a great example. I really love what you're saying about, you know, having a safe place to test those things I was listening to. One of the podcasts I listened to is On being with Krista Tippett, and she was interviewing Ariel Burger, who is Jewish scholar and artist, and they were talking about learning and talking about change and behavioral change. And he was saying that the key moments of change for him have always been when he's challenged, but challenged in a way that that provides the opportunity to explore what it is that you're resisting, in your response to what you're being challenged about. And so, in order to get to that change, you really do need that safe space. To think things through and to develop that awareness and acknowledgement that oh, yeah, I'm not doing this the right way. I'm not approaching this the right way. I really only have some work to do here. And I think so much of our education is not really providing certainly and continuing education not necessarily providing those moments of challenge that that we all need.
Some of the feedback we've received on various courses that we've put out is, you know, people having an aha moment of self-awareness, realizing they might say, phrases, or make jokes, or just, you know, make comments not fully grasping, that they were saying, or doing something that could have been perceived as, you know, inappropriate or just, you know, offensive or questionable, you know, kind of on the spectrum of where that falls. But I think what helps them to have that moment and recognize it, care and make a change, or say next time, I'm not going to phrase a question that way, or whatever that changes for them, personally, is to give a lot of examples, scenarios and situations in the content where we try and get as close to real life and believable dialogue and behaviors. So that a learner can see themselves in the content, whether they're on kind of the correct or incorrect side of the behavior. It's a safe place to really see, oh, my gosh, I've said this, like, that's, I didn't realize that could be taken that way. But here I can. I can recognize that I've made a mistake, and I care now enough to make a change and be more cognizant about how I carry myself or the language I use. And I think you know, another reason that e-learning can be a great medium for education is to feel those challenges and make mistakes in a place where only you know that and that's okay, and you can really take the time you need to think about that.
Alexandra Howson 40:15
Yeah, yeah, that's great. Just to kind of wrap up because you've shared a lot of really helpful detail. What two questions I guess, you know, what would you recommend as kind of best practices in designing e-learning education that is effective for, you know, adults working in complex areas like health care?
So Yeah, for designing those types of courses for complex subject area, again, just starting with the end in mind is going to be key to making sure you're solving your learner's needs. Doing your research about who your learners are doing testing for, along with your learner's and a great and very reassuring principle is just the rule of five, you only need to or you can test with five people and get enough feedback that it will provide you with some insights to adjust and iterate, I think it is important to give yourself the space and in your time to do some testing and iteration with your learners, whether it's putting language in front of them an interaction or an activity, and just hearing what they think if it falls flat if they didn't understand how to use it. And using that to inform the design of your course. I think with really complex topic areas, being mindful of giving learners just little bite sized pieces of information and practice, kind of give a little knowledge, let them apply it. And then doing some knowledge checks along the way less frequently than maybe knowledge and application. But making sure they can track their own progress through that experience, are just some of the ways you can start to build up to a more complex experience. And really carrying the chunking forward giving, you know, an hour session or less on something. And then combining that with a library or a suite of you know, maybe five total hours. But being mindful about breaking things into pieces so that people can, at their own pace, kind of master step one before step two, without feeling the pressure to move through the entire thing. You know, too quickly.
Alexandra Howson 42:53
Yeah. I haven't heard about the rule of five before is that something that is particular to the approach of instructional design?
It's a rule, the rule of five is something I've learned from my colleagues who work in UX or user experience. And so as you think about instructional design, through the lens of learner experience, just like a UX designers can, creating the environment that the e-learning is living in or platform experience. We borrow a lot of principles from UX. And rule of five is just one of them that, you know, works just as well for us too.
Alexandra Howson 43:12
I was just gonna say, yeah, sounds like user experience. Yeah.
Yeah, yeah. Yes. Nice. You know, plenty, just like every industry, there's so many, I think, e-learning. It's really interesting to me that, you know, a lot of times we are really happy with ourselves if we've pretty much digitized a textbook but haven't taken it that step further of using the benefit of having a digital experience and all the flexibility that can land in terms of collecting and sharing data points, more interactive elements on your screen than just scrolling through text or manipulating text in different ways. But essentially just reading a textbook in a digital medium. I think that's a tough balance to strike and an investment of time, but it can be well worth it. I think also when developing content for e-learning experiences brevity can be really key and really essential. And like I've said a couple times just focusing on creating chunking learning experiences and small bite sized pieces of information. And then as you're going through reviews or you know having other stakeholders look at content tends to expand and become more verbose. But I think, really aiming to keep the content you're showing on screen at one time really, really tight and small and chest knowing you have endless pages you could fill potentially, is another kind of balancing act that I run into in all of our projects where we really have to trim back or rethink our presenting content. So, it's not just a lot in your face, which, you know, is just two of the challenges, I think, in in many projects, but are universal.
Alexandra Howson 43:43
That's interesting, because I you know, I think UX is a pretty borrowed discipline, you know, in the sense that the UX is borrowed from, you know, pretty much everyone. So, there's a lot of crossover between UX and learner design. I imagine. Somebody is going to complain about that. I'm sure that I'm mischaracterizing UX and we have a UX researcher in our house. So, apologies to UX researchers are there. Final question, challenges that you see consistently kind of popping up in the design and delivery of e-learning, pretty key challenges how do we move beyond the text? Because that that you know we're locked into text I mean I think text is important, I'm a writer, I'm a reader, how do we move beyond text in that e-learning environment?
Yeah. We do. Yeah, I think going back to what's interesting to learners, giving them what they need to know, and striking a fair balance. So, thinking about how adults find the answer to a question they need today, they might Google it, and they're willing to read, you know, a few lines, or if they need a little more detail, they're willing to invest more time in reading more and digging in more. So, I think just being conscious about how invested is your learner going to be in this piece of information? And how critical is it for the learning experience can help you find that fine line between like, I'm going to give you a lot of information and I think that'll go over? Well, because you really will be interested in want to know all the details, versus something you could skim over and just being happy leaving it at that, because that's going to give the learners exactly what they need. And then also thinking about where there's words, you know, could we use some sort of multimedia, whether it's video podcast, I think is incredible, because you can use it on the go, finding other ways to take your text and put some, some entertainment behind it really is effective. Because like you said, you read for pleasure, we all can enjoy reading. So what's to say we can't make our e-learning experiences, you know, kind of mimic that as much as possible. And then you know, you're getting some education in there as well.
Alexandra Howson 48:14
That's a great place to start I do have more questions but we are we're almost at the top of the hour and it's interesting to me how many people on the podcast so far have talked about learning should be fun work, should be fun pleasure find the pleasure in the in the learning is kind of a key. A key learning for today. Jesse Martello thank you so much for your time and everything that you shared with the Write Medicine podcast audience. I appreciate it very much.