WEBVTT 00:00:05.690 --> 00:00:06.831 Hi, I'm Nick Rainey. 00:00:07.110 --> 00:00:08.451 I am part of AOMT's Pelvic 00:00:08.492 --> 00:00:10.413 Health SIG and the SIG's 00:00:10.634 --> 00:00:11.534 former vice president. 00:00:12.054 --> 00:00:12.974 I'm also on the research 00:00:12.994 --> 00:00:14.516 committee with AOMT and an 00:00:14.635 --> 00:00:15.717 interviewer on the AOMT 00:00:15.776 --> 00:00:17.538 podcast through that committee. 00:00:18.359 --> 00:00:20.199 Today, we have Natalie Turrentine, 00:00:20.760 --> 00:00:21.701 a board-certified 00:00:21.861 --> 00:00:23.042 orthopedic therapist at 00:00:23.141 --> 00:00:24.062 Rosalind Franklin 00:00:24.102 --> 00:00:25.943 University in North Chicago. 00:00:26.623 --> 00:00:28.385 Welcome, Natalie. 00:00:28.644 --> 00:00:29.004 Hi, Nick. 00:00:29.045 --> 00:00:30.006 Thank you for having me today. 00:00:30.085 --> 00:00:30.867 I'm really looking forward 00:00:30.887 --> 00:00:31.466 to talking more. 00:00:34.482 --> 00:00:36.463 Well, we're excited to have you on here. 00:00:37.743 --> 00:00:39.445 As I was thinking about what 00:00:39.744 --> 00:00:42.265 to do for this podcast, 00:00:42.286 --> 00:00:43.345 I was doing some research 00:00:43.786 --> 00:00:46.927 and I came across your poster at CSM, 00:00:46.968 --> 00:00:47.908 twenty twenty four. 00:00:49.088 --> 00:00:50.069 You and some students 00:00:50.109 --> 00:00:51.329 presented a poster titled 00:00:51.429 --> 00:00:52.469 Prevalence and Faculty 00:00:52.509 --> 00:00:55.511 Perception of Obstetrics 00:00:55.710 --> 00:00:57.250 Education at the Entry 00:00:57.290 --> 00:00:58.271 Level Doctor of Physical 00:00:58.292 --> 00:00:59.171 Therapy Curriculum. 00:01:00.134 --> 00:01:01.113 When I came across this, 00:01:01.634 --> 00:01:03.134 I thought it pertinent for our listeners, 00:01:03.555 --> 00:01:04.855 as we've all been in 00:01:04.896 --> 00:01:05.876 entry-level programs. 00:01:06.596 --> 00:01:08.798 All of us care about the 00:01:09.998 --> 00:01:11.358 direction our profession takes, 00:01:11.759 --> 00:01:12.980 and some of us are involved 00:01:13.140 --> 00:01:14.521 in entry-level programs currently. 00:01:15.441 --> 00:01:16.602 As this is an orthopedic and 00:01:16.641 --> 00:01:18.121 manual therapy organization, 00:01:18.462 --> 00:01:21.424 normally the emphasis is in these areas. 00:01:23.055 --> 00:01:24.075 personally love the immense 00:01:24.115 --> 00:01:25.296 crossover between pelvic 00:01:25.335 --> 00:01:27.236 health and orthopedics. 00:01:27.798 --> 00:01:28.677 Since I want more people to 00:01:28.697 --> 00:01:29.418 appreciate this, 00:01:29.459 --> 00:01:30.638 I thought this would be a 00:01:31.340 --> 00:01:32.260 pertinent poster and 00:01:32.340 --> 00:01:35.382 pertinent discussion for everybody. 00:01:35.462 --> 00:01:35.861 Thank you. 00:01:35.882 --> 00:01:37.382 Yeah, I'm definitely in agreement. 00:01:39.864 --> 00:01:40.704 So I wanted to start off 00:01:40.745 --> 00:01:42.885 with a bit of a broader question. 00:01:43.325 --> 00:01:44.367 In your research, 00:01:45.087 --> 00:01:47.108 you use the term obstetric 00:01:47.507 --> 00:01:49.088 rather than the common 00:01:49.129 --> 00:01:50.030 physical pelvic health. 00:01:50.831 --> 00:01:51.831 Can you elaborate on the 00:01:51.850 --> 00:01:53.311 distinction you see between 00:01:53.352 --> 00:01:54.792 these terms and why you 00:01:54.831 --> 00:01:56.852 choose to use obstetric in 00:01:56.873 --> 00:01:58.933 this particular study? 00:01:58.953 --> 00:01:59.513 Sure, of course. 00:02:00.254 --> 00:02:01.433 So as you already mentioned, 00:02:01.534 --> 00:02:03.234 I come from a lens of I'm a 00:02:03.355 --> 00:02:04.894 board certified orthopedic 00:02:04.935 --> 00:02:05.956 physical therapist, 00:02:06.415 --> 00:02:07.835 and I'm also an academic. 00:02:07.936 --> 00:02:09.757 So when I started working on 00:02:09.817 --> 00:02:10.977 my line of research, 00:02:11.076 --> 00:02:12.557 I really found that I 00:02:12.578 --> 00:02:14.979 wanted to find a category 00:02:15.538 --> 00:02:17.538 of interest based off of 00:02:17.598 --> 00:02:19.240 what I had already seen clinically. 00:02:20.223 --> 00:02:20.362 Um, 00:02:20.543 --> 00:02:22.145 so the settings that I had worked in 00:02:22.185 --> 00:02:23.545 clinically were primarily 00:02:24.066 --> 00:02:25.587 outpatient orthopedic. 00:02:26.008 --> 00:02:27.028 And I started to notice a 00:02:27.068 --> 00:02:28.509 trend that if someone were 00:02:28.550 --> 00:02:30.471 to call with any type of 00:02:30.510 --> 00:02:33.954 pathology or any type of diagnosis, 00:02:34.014 --> 00:02:36.436 and also happened to be pregnant, 00:02:36.877 --> 00:02:37.437 that they would 00:02:37.556 --> 00:02:38.957 automatically be referred 00:02:38.997 --> 00:02:40.459 to a pelvic health specialist, 00:02:40.560 --> 00:02:42.260 which in many cases that 00:02:42.381 --> 00:02:44.723 may be best case scenario. 00:02:45.338 --> 00:02:47.340 But in other cases where 00:02:47.439 --> 00:02:49.900 perhaps accessibility is limited, 00:02:51.121 --> 00:02:52.200 there may be a little bit 00:02:52.241 --> 00:02:53.942 of a disconnect between 00:02:54.162 --> 00:02:54.822 what I was seeing 00:02:54.861 --> 00:02:56.462 clinically and what I 00:02:56.502 --> 00:02:58.062 thought maybe could be happening. 00:02:58.782 --> 00:02:59.963 So this is really the 00:03:00.003 --> 00:03:01.824 premise of why I wanted to 00:03:01.883 --> 00:03:03.485 start learning more and 00:03:03.544 --> 00:03:05.064 looking a little bit into 00:03:05.625 --> 00:03:06.945 the term obstetrics as 00:03:06.985 --> 00:03:08.725 mentioned and our current 00:03:08.765 --> 00:03:10.167 practice of obstetrics. 00:03:11.538 --> 00:03:13.520 So what this led to is one 00:03:13.580 --> 00:03:15.102 of my first research 00:03:15.141 --> 00:03:16.663 studies with a student 00:03:16.704 --> 00:03:19.086 group was looking at the 00:03:19.105 --> 00:03:20.606 opinions of outpatient 00:03:20.627 --> 00:03:21.647 physical therapists. 00:03:21.867 --> 00:03:24.890 So we surveyed about a 00:03:24.911 --> 00:03:26.092 little over six hundred 00:03:26.391 --> 00:03:27.233 outpatient physical 00:03:27.252 --> 00:03:28.774 therapists to get their 00:03:28.813 --> 00:03:29.995 perspective on what was 00:03:30.034 --> 00:03:32.837 currently happening in the field. 00:03:33.430 --> 00:03:34.909 So we had a pretty good mix 00:03:34.990 --> 00:03:36.890 of pelvic health specialists, 00:03:37.070 --> 00:03:38.311 orthopedic specialists, 00:03:38.711 --> 00:03:39.610 and individuals who 00:03:39.631 --> 00:03:41.092 identified of not having 00:03:41.132 --> 00:03:42.151 any specialty at all. 00:03:42.931 --> 00:03:44.431 And we asked questions about 00:03:44.512 --> 00:03:46.312 if someone were to have a diagnosis of, 00:03:46.353 --> 00:03:46.712 let's say, 00:03:46.853 --> 00:03:50.293 shoulder pain or back pain or knee pain, 00:03:51.373 --> 00:03:52.313 what would you think? 00:03:52.413 --> 00:03:53.593 What do you think would be 00:03:53.633 --> 00:03:55.153 the best person to see this 00:03:55.914 --> 00:03:56.854 particular individual? 00:03:57.314 --> 00:03:58.435 And overwhelmingly, 00:03:58.555 --> 00:04:01.475 with the exception of wrist, hand, 00:04:01.695 --> 00:04:03.276 and then diagnoses that pertain to the 00:04:05.212 --> 00:04:06.794 These physical therapists 00:04:06.834 --> 00:04:09.056 said that a pelvic health 00:04:09.075 --> 00:04:11.396 specialist would be most appropriate, 00:04:11.557 --> 00:04:13.399 which again, that may be the case, 00:04:13.479 --> 00:04:14.400 but we do know that 00:04:14.439 --> 00:04:16.560 accessibility can be limited. 00:04:17.581 --> 00:04:21.944 So we wanted to see what can 00:04:21.985 --> 00:04:24.086 we do to fill in a gap where needed. 00:04:25.406 --> 00:04:27.069 I feel like as a profession, 00:04:27.088 --> 00:04:30.170 the more generalized knowledge we have, 00:04:30.430 --> 00:04:31.512 the better off we can be. 00:04:32.011 --> 00:04:33.512 in our ability to not only 00:04:33.552 --> 00:04:35.432 diagnose and treat, but also refer. 00:04:36.413 --> 00:04:37.773 And I do feel like sometimes 00:04:37.793 --> 00:04:39.093 there's a stigma or an 00:04:39.194 --> 00:04:42.714 apprehension or maybe a 00:04:42.795 --> 00:04:43.915 fear of treating 00:04:43.935 --> 00:04:44.815 individuals who are 00:04:44.855 --> 00:04:45.956 pregnant and postpartum. 00:04:46.156 --> 00:04:47.596 And so my goal and my line 00:04:47.637 --> 00:04:49.017 of research and teaching 00:04:49.098 --> 00:04:51.319 and advocacy is to make 00:04:51.338 --> 00:04:52.298 sure that's not the case. 00:04:52.619 --> 00:04:52.819 You know, 00:04:52.839 --> 00:04:54.259 if someone comes in and they are 00:04:54.379 --> 00:04:55.961 pregnant or they wanted to 00:04:56.021 --> 00:04:57.521 return to something postpartum, 00:04:57.862 --> 00:04:59.822 that as a generalized physical therapist, 00:04:59.862 --> 00:05:01.103 we either know what to do 00:05:01.673 --> 00:05:03.413 or we know when to refer. 00:05:03.494 --> 00:05:04.814 And so that's why I use the 00:05:04.855 --> 00:05:05.615 term obstetrics. 00:05:05.634 --> 00:05:09.377 That's great insight. 00:05:09.418 --> 00:05:11.079 I know when I first looked at the study, 00:05:12.079 --> 00:05:12.358 you know, 00:05:12.399 --> 00:05:13.399 I didn't think about it just 00:05:13.439 --> 00:05:16.201 from a pregnancy lens. 00:05:16.302 --> 00:05:16.682 You know, 00:05:17.021 --> 00:05:18.622 when I first looked at the title there, 00:05:19.524 --> 00:05:19.843 you know, 00:05:20.564 --> 00:05:21.625 what you're saying is that when 00:05:21.665 --> 00:05:22.485 people would come in and 00:05:22.505 --> 00:05:23.225 they were pregnant, 00:05:23.846 --> 00:05:24.766 automatically classed to 00:05:24.786 --> 00:05:25.867 the pelvic health therapist, 00:05:25.927 --> 00:05:26.767 no matter if it's, 00:05:28.048 --> 00:05:28.608 even if it's not 00:05:28.668 --> 00:05:30.250 lumbopelvic or specifically 00:05:30.290 --> 00:05:31.190 pregnancy related. 00:05:31.834 --> 00:05:32.074 Correct. 00:05:32.093 --> 00:05:32.213 Yeah. 00:05:32.233 --> 00:05:34.435 And that was my observation. 00:05:34.495 --> 00:05:36.637 And I think it could be at 00:05:36.677 --> 00:05:37.338 least a little bit 00:05:37.377 --> 00:05:39.238 generalized to more of 00:05:39.259 --> 00:05:42.000 what's going on in our field, 00:05:42.141 --> 00:05:43.040 just based on the research 00:05:43.081 --> 00:05:45.603 that I've done thus far. 00:05:46.083 --> 00:05:46.343 You know, 00:05:46.362 --> 00:05:47.663 that also makes me think of like 00:05:47.684 --> 00:05:49.024 a pediatric specialist. 00:05:49.605 --> 00:05:50.005 You know, 00:05:50.165 --> 00:05:50.985 a lot of times we talk about 00:05:51.005 --> 00:05:52.567 pediatrics and not little adults, 00:05:53.088 --> 00:05:53.447 you know, 00:05:53.487 --> 00:05:54.629 but we're kind of treating the 00:05:54.649 --> 00:05:56.930 obstetric patient like that, you know, 00:05:56.949 --> 00:05:57.831 the pregnant patient that 00:05:57.850 --> 00:05:58.531 we're going to be saying to 00:05:58.550 --> 00:05:59.572 the pelvic health therapist 00:05:59.612 --> 00:06:01.333 that it must be different, even if it's a 00:06:02.144 --> 00:06:03.925 even if it's a shoulder issue or whatnot. 00:06:03.966 --> 00:06:04.985 Whereas with pregnancy, 00:06:05.065 --> 00:06:06.685 I can feel like there's 00:06:06.766 --> 00:06:07.607 some specific 00:06:07.646 --> 00:06:09.487 considerations for lumbopelvic hip, 00:06:10.086 --> 00:06:13.228 but maybe not for shoulder, knee, 00:06:13.908 --> 00:06:14.848 you know, and obviously they didn't, 00:06:15.088 --> 00:06:17.870 you know, with the respondents for hand, 00:06:17.910 --> 00:06:19.529 wrist, ankle, foot, it sounds like. 00:06:19.550 --> 00:06:20.550 Yeah, absolutely. 00:06:20.891 --> 00:06:23.071 And not to downplay by any means, 00:06:23.752 --> 00:06:24.692 there's definitely a time 00:06:24.732 --> 00:06:25.752 and a place where a pelvic 00:06:25.771 --> 00:06:28.093 health specialist, they are most equipped, 00:06:28.333 --> 00:06:28.632 right? 00:06:29.072 --> 00:06:31.413 But I do feel like if we 00:06:32.423 --> 00:06:35.324 we reduce some of the stigma and the fear, 00:06:35.404 --> 00:06:35.946 as we said, 00:06:36.406 --> 00:06:38.767 that we could reach out to a 00:06:38.827 --> 00:06:40.588 bigger population. 00:06:40.649 --> 00:06:41.709 Our research continues to 00:06:41.750 --> 00:06:43.130 change and to advocate for 00:06:43.531 --> 00:06:45.033 more activity and more 00:06:45.153 --> 00:06:47.714 exercise and the ability to 00:06:47.754 --> 00:06:50.117 return or keep up with certain athletics. 00:06:50.456 --> 00:06:51.197 And I feel like that's 00:06:51.237 --> 00:06:53.620 something at entry level, 00:06:53.639 --> 00:06:54.519 we could at least have some 00:06:54.560 --> 00:06:56.281 exposure to so that we 00:06:56.302 --> 00:06:58.002 could have education for our patients. 00:07:00.387 --> 00:07:01.086 That's great thoughts. 00:07:01.687 --> 00:07:02.987 So I guess a little more 00:07:03.067 --> 00:07:04.307 follow on the entry level. 00:07:05.348 --> 00:07:06.389 For those of our listeners 00:07:06.408 --> 00:07:07.769 who may not be as familiar, 00:07:08.369 --> 00:07:09.269 could you briefly explain 00:07:09.288 --> 00:07:10.529 the CAPT requirements 00:07:10.569 --> 00:07:12.110 regarding pelvic health 00:07:12.170 --> 00:07:13.129 education in general, 00:07:13.149 --> 00:07:14.170 maybe obstetrics more 00:07:14.250 --> 00:07:16.571 specifically in physical 00:07:16.591 --> 00:07:17.331 therapy programs? 00:07:17.370 --> 00:07:17.471 Sure. 00:07:20.187 --> 00:07:21.567 For CAPTI requirements, 00:07:21.648 --> 00:07:23.088 they are broken up into 00:07:23.149 --> 00:07:24.728 these things called elements. 00:07:24.889 --> 00:07:27.069 So there are a list of 00:07:27.129 --> 00:07:29.471 different elements that universities, 00:07:29.591 --> 00:07:31.411 institutions need to show 00:07:31.511 --> 00:07:32.732 evidence that they're doing. 00:07:33.271 --> 00:07:34.331 So for example, 00:07:34.451 --> 00:07:35.572 one of the elements that we 00:07:35.612 --> 00:07:38.112 have in academics is an 00:07:38.213 --> 00:07:39.334 element that makes sure 00:07:39.353 --> 00:07:42.774 that we address the anatomy, physiology, 00:07:42.995 --> 00:07:45.675 pathology throughout the lifespan, 00:07:45.915 --> 00:07:47.675 including different categories. 00:07:48.055 --> 00:07:50.499 So including genital, reproductive, 00:07:50.538 --> 00:07:52.863 gastrointestinal, and the list goes on. 00:07:53.925 --> 00:07:54.466 Once we, 00:07:55.088 --> 00:07:57.050 evaluate that element, 00:07:57.290 --> 00:07:59.091 then we have to show what 00:07:59.172 --> 00:08:01.033 objectives in teaching and 00:08:01.072 --> 00:08:02.874 how we really teach this information. 00:08:03.494 --> 00:08:05.274 So I use that as an example 00:08:05.355 --> 00:08:07.036 because usually these elements, 00:08:07.516 --> 00:08:09.358 they give you some leeway 00:08:09.557 --> 00:08:11.199 in how you're doing them in 00:08:11.238 --> 00:08:14.261 that each institution can be addressing, 00:08:14.341 --> 00:08:14.920 for example, 00:08:14.961 --> 00:08:16.341 this one particular element 00:08:16.382 --> 00:08:19.184 cited a lot of different ways, right? 00:08:19.244 --> 00:08:21.264 So not only do we have these 00:08:21.305 --> 00:08:22.886 CAPD standards that we have 00:08:22.925 --> 00:08:24.026 to show evidence of, 00:08:24.396 --> 00:08:25.757 but we also have these other 00:08:25.898 --> 00:08:28.180 influencing factors within academics. 00:08:28.680 --> 00:08:30.560 So we use the research 00:08:30.600 --> 00:08:32.101 coming out of the APTA, 00:08:32.201 --> 00:08:33.682 we use the guide to 00:08:33.722 --> 00:08:35.264 physical therapy practice, 00:08:35.985 --> 00:08:37.946 we use ACAPT information, 00:08:38.066 --> 00:08:39.746 and then also the MPTE. 00:08:41.528 --> 00:08:42.788 The role that I'm in here at 00:08:42.808 --> 00:08:43.970 the university is 00:08:44.476 --> 00:08:45.457 is helping in student 00:08:45.498 --> 00:08:47.479 support for the board exams. 00:08:47.919 --> 00:08:50.120 So we also have to have an 00:08:50.160 --> 00:08:51.942 awareness of what is and is 00:08:52.001 --> 00:08:53.082 not being tested. 00:08:53.583 --> 00:08:56.725 So there is a category under the MPT, 00:08:56.806 --> 00:08:57.787 the FSPPT, 00:08:58.447 --> 00:09:01.068 that does talk about pelvic health. 00:09:01.568 --> 00:09:03.591 So we do have these certain 00:09:03.931 --> 00:09:05.591 standards that we have to meet, 00:09:05.951 --> 00:09:07.312 but outside of that, 00:09:07.352 --> 00:09:09.375 there is some ambiguity as to 00:09:09.995 --> 00:09:12.076 how much and in what detail 00:09:12.576 --> 00:09:13.918 this information has to be 00:09:13.957 --> 00:09:15.538 included in our curriculum. 00:09:16.720 --> 00:09:20.182 The APTA has a guideline for curriculum. 00:09:20.623 --> 00:09:22.524 That guideline is a recommendation. 00:09:22.764 --> 00:09:24.725 It is not something that is 00:09:26.046 --> 00:09:27.807 published by CAPTI. 00:09:28.268 --> 00:09:29.408 So it is a really good 00:09:29.469 --> 00:09:30.590 resource for anyone in 00:09:30.830 --> 00:09:32.610 academics who are looking 00:09:32.691 --> 00:09:34.091 for a guideline. 00:09:34.628 --> 00:09:37.269 But the CAPTI recommendation 00:09:37.328 --> 00:09:38.929 in itself is a little bit broad. 00:09:39.450 --> 00:09:40.149 And I think that that's 00:09:40.169 --> 00:09:41.370 important to bring up in 00:09:41.811 --> 00:09:43.371 some of the next questions too. 00:09:43.392 --> 00:09:48.734 Well, that was a very detailed answer. 00:09:48.754 --> 00:09:49.494 You were the right person to 00:09:49.514 --> 00:09:50.254 ask that question too. 00:09:50.274 --> 00:09:51.434 Thank you. 00:09:51.774 --> 00:09:52.075 You know, 00:09:52.115 --> 00:09:53.875 we just went through our reaccreditation, 00:09:54.216 --> 00:09:55.437 so I have learned more 00:09:55.517 --> 00:09:57.076 about that than I ever 00:09:57.096 --> 00:09:58.298 would have known otherwise. 00:09:58.317 --> 00:10:00.438 Very good. 00:10:00.499 --> 00:10:01.339 Good timing then. 00:10:03.378 --> 00:10:05.399 As you said, it could be vague, 00:10:05.698 --> 00:10:07.080 a little bit broad, 00:10:07.519 --> 00:10:08.679 what the requirements are. 00:10:10.020 --> 00:10:10.941 With your detailed knowledge 00:10:10.961 --> 00:10:12.501 of that and your interest there, 00:10:12.662 --> 00:10:14.442 I'm assuming that you've 00:10:14.462 --> 00:10:15.102 worked to do this at 00:10:15.143 --> 00:10:16.682 Rosalind Franklin University. 00:10:17.504 --> 00:10:18.583 Could you share some 00:10:18.703 --> 00:10:20.085 specific ways that you've 00:10:20.105 --> 00:10:21.205 successfully integrated 00:10:21.705 --> 00:10:24.326 pelvic health and obstetric 00:10:24.546 --> 00:10:26.006 education into your curriculum there? 00:10:26.792 --> 00:10:27.552 Yeah, of course. 00:10:27.592 --> 00:10:27.793 You know, 00:10:27.854 --> 00:10:28.815 I'm really proud of the work 00:10:28.835 --> 00:10:29.897 that's been done here, 00:10:29.937 --> 00:10:31.799 and it's something that we 00:10:31.820 --> 00:10:32.761 put some thought into. 00:10:33.241 --> 00:10:35.566 So what we try to do is to 00:10:35.625 --> 00:10:36.648 thread our content 00:10:36.707 --> 00:10:37.710 throughout the curriculum. 00:10:37.809 --> 00:10:39.913 So what we mean by that is 00:10:39.932 --> 00:10:40.955 within the first quarter, 00:10:41.481 --> 00:10:43.863 We introduce the students to 00:10:44.082 --> 00:10:45.244 our diverse faculty. 00:10:46.043 --> 00:10:47.083 We have individuals who are 00:10:47.124 --> 00:10:48.404 specialized in orthopedics, 00:10:48.485 --> 00:10:50.645 but also pelvic health and 00:10:50.686 --> 00:10:51.625 everything in between. 00:10:52.105 --> 00:10:53.787 So we give an introduction 00:10:53.927 --> 00:10:54.886 as to what exists, 00:10:55.648 --> 00:10:57.028 how we got there and what 00:10:57.107 --> 00:10:58.729 resources there are for the students, 00:10:58.908 --> 00:11:01.669 even in starting in their 00:11:01.830 --> 00:11:02.630 academic career. 00:11:03.471 --> 00:11:05.692 So really to kind of give a 00:11:05.731 --> 00:11:07.753 gauge as to these are all 00:11:07.773 --> 00:11:08.493 of the things that you'll 00:11:08.513 --> 00:11:10.573 be able to do after your entry level. 00:11:11.357 --> 00:11:12.198 um, academics. 00:11:13.139 --> 00:11:14.580 Then later in the curriculum, 00:11:14.620 --> 00:11:16.041 we get a little bit more specific. 00:11:16.480 --> 00:11:18.381 So we incorporate some of 00:11:18.402 --> 00:11:20.763 the obstetric considerations. 00:11:21.144 --> 00:11:23.325 Um, you know, I, I do, 00:11:23.524 --> 00:11:24.706 I have a class session 00:11:24.765 --> 00:11:26.226 where we talk about just 00:11:26.667 --> 00:11:28.248 broad understanding of all 00:11:28.288 --> 00:11:29.849 the physiological changes 00:11:29.869 --> 00:11:31.590 that occur and how we have 00:11:31.610 --> 00:11:33.650 to adapt our examination. 00:11:33.791 --> 00:11:34.711 If for example, 00:11:34.811 --> 00:11:36.532 we were seeing someone for 00:11:36.552 --> 00:11:38.312 their ankle and they were 00:11:38.352 --> 00:11:39.394 in their third trimester. 00:11:40.000 --> 00:11:41.821 So starting to problem solve, 00:11:42.360 --> 00:11:43.461 how will the person feel 00:11:43.500 --> 00:11:44.701 most comfortable and safe 00:11:45.402 --> 00:11:48.403 in our evaluation technique? 00:11:48.482 --> 00:11:50.322 Another thing that I'm proud 00:11:50.403 --> 00:11:52.423 of is that we've had the 00:11:52.464 --> 00:11:54.244 ability to bring some of 00:11:54.264 --> 00:11:57.125 the continuing ed courses to our campus. 00:11:57.664 --> 00:11:58.566 And I really think that this 00:11:58.605 --> 00:11:59.446 has helped with 00:11:59.505 --> 00:12:00.605 accessibility for our 00:12:00.645 --> 00:12:02.767 students and community with 00:12:02.787 --> 00:12:03.927 some of the pelvic health 00:12:04.126 --> 00:12:06.567 and obstetric coursework that exists. 00:12:06.727 --> 00:12:09.249 So I think it's going. 00:12:12.090 --> 00:12:12.291 Yeah. 00:12:12.311 --> 00:12:12.390 Yeah. 00:12:12.410 --> 00:12:13.672 I think that, I mean, 00:12:13.731 --> 00:12:14.712 if an orthopedic therapist 00:12:14.732 --> 00:12:15.352 is seeing somebody for 00:12:15.373 --> 00:12:18.054 their ankle to not have any idea how to, 00:12:18.875 --> 00:12:19.176 you know, 00:12:19.216 --> 00:12:20.998 the considerations for a pregnant patient, 00:12:21.477 --> 00:12:23.019 I think it's very important there. 00:12:23.038 --> 00:12:23.720 So I think that's great. 00:12:23.759 --> 00:12:24.821 You're able to incorporate 00:12:24.860 --> 00:12:27.883 that and that's maybe unique, you know, 00:12:27.923 --> 00:12:28.744 somewhat to your program. 00:12:28.764 --> 00:12:29.625 I can't imagine that's 00:12:30.225 --> 00:12:32.307 ubiquitous across programs there. 00:12:32.386 --> 00:12:33.087 So that's excellent. 00:12:33.107 --> 00:12:33.207 Yeah. 00:12:33.227 --> 00:12:33.567 Thank you. 00:12:33.628 --> 00:12:35.068 I appreciate it. 00:12:35.129 --> 00:12:35.809 We're trying. 00:12:36.897 --> 00:12:39.658 And with the continuing education courses, 00:12:39.798 --> 00:12:40.359 are those, 00:12:40.399 --> 00:12:41.500 do clinicians from around the 00:12:41.519 --> 00:12:42.561 community come to those? 00:12:42.640 --> 00:12:44.241 Is it just focused on your 00:12:44.282 --> 00:12:45.623 students or how do those work? 00:12:46.363 --> 00:12:46.663 No. 00:12:47.102 --> 00:12:49.745 So we've hosted the APTA 00:12:49.784 --> 00:12:50.605 sanctioned courses. 00:12:50.885 --> 00:12:52.006 So pelvic health one, 00:12:52.466 --> 00:12:53.607 and there's an obstetric 00:12:53.687 --> 00:12:56.909 certificate where there's a lab portion. 00:12:56.990 --> 00:12:58.630 So we've hosted the labs on 00:12:58.671 --> 00:13:00.251 campus and they're open to anyone. 00:13:01.272 --> 00:13:02.192 And, you know, 00:13:02.232 --> 00:13:04.553 the hope is that in bringing 00:13:04.573 --> 00:13:05.355 them locally, 00:13:05.759 --> 00:13:07.279 that we could also have some 00:13:07.320 --> 00:13:09.821 of our students enroll, which they have, 00:13:09.860 --> 00:13:10.660 which is wonderful. 00:13:10.760 --> 00:13:12.481 Some of our new grads have enrolled, 00:13:12.782 --> 00:13:15.942 but then also anyone, I'm in the Midwest, 00:13:16.322 --> 00:13:17.423 so we've had a lot of 00:13:17.443 --> 00:13:18.663 people come from the Midwest, 00:13:18.703 --> 00:13:20.164 but really from anywhere, 00:13:20.524 --> 00:13:21.245 it's open to anyone. 00:13:23.508 --> 00:13:24.509 I think that's fabulous. 00:13:25.830 --> 00:13:26.549 As a clinician, 00:13:26.610 --> 00:13:27.750 one of our recent grads 00:13:27.770 --> 00:13:28.572 that we brought on, 00:13:29.471 --> 00:13:30.192 she'd already had some 00:13:30.253 --> 00:13:31.173 specific pelvic health 00:13:31.192 --> 00:13:31.913 training she'd done in an 00:13:32.153 --> 00:13:34.095 extra coursework before, you know, 00:13:34.115 --> 00:13:35.035 before graduating. 00:13:35.056 --> 00:13:36.817 And that really sets her off for the, 00:13:36.917 --> 00:13:37.758 you know, the ground running. 00:13:37.778 --> 00:13:38.837 Oh, absolutely. 00:13:38.977 --> 00:13:40.119 When she started practice. 00:13:40.139 --> 00:13:41.419 So that's outstanding. 00:13:41.440 --> 00:13:43.181 Absolutely. 00:13:43.201 --> 00:13:43.802 Thank you. 00:13:43.822 --> 00:13:46.163 I also really liked how you 00:13:46.182 --> 00:13:47.124 talked about the faculty 00:13:47.163 --> 00:13:48.264 talk about how they got to 00:13:48.304 --> 00:13:48.884 where they're at. 00:13:50.485 --> 00:13:51.186 I think that's really 00:13:51.206 --> 00:13:52.586 important for students to have a vision. 00:13:52.706 --> 00:13:55.746 We all know that models are 00:13:55.807 --> 00:13:57.148 extremely important in life. 00:13:57.388 --> 00:13:58.488 And so they could see where 00:13:58.528 --> 00:14:00.368 other faculty have been and 00:14:00.388 --> 00:14:01.288 you get that early on, 00:14:01.327 --> 00:14:02.489 it sounds like in your program. 00:14:02.908 --> 00:14:04.288 I think that's very excellent. 00:14:04.308 --> 00:14:05.948 So kudos to you on that as well. 00:14:06.469 --> 00:14:07.450 Yeah, thank you very much. 00:14:08.029 --> 00:14:09.409 We've all gotten through 00:14:09.429 --> 00:14:10.429 different ways and 00:14:10.470 --> 00:14:11.831 different pathways to get 00:14:11.850 --> 00:14:12.750 to where we are now. 00:14:12.850 --> 00:14:14.410 So I think everyone on our 00:14:14.451 --> 00:14:15.551 faculty just likes sharing 00:14:15.591 --> 00:14:16.412 that and showing that 00:14:16.432 --> 00:14:17.812 there's not always a direct path, 00:14:18.111 --> 00:14:18.491 but there's 00:14:19.010 --> 00:14:20.030 different options depending 00:14:20.071 --> 00:14:21.150 on what piques your interest. 00:14:21.390 --> 00:14:24.072 So we want to make sure that we expose, 00:14:24.091 --> 00:14:25.211 expose our students to that. 00:14:27.273 --> 00:14:29.873 So as it going on with 00:14:30.013 --> 00:14:31.312 entry-level education then, 00:14:33.033 --> 00:14:33.874 so you've been able to 00:14:34.053 --> 00:14:35.114 really focus on that at 00:14:35.153 --> 00:14:37.095 Rosalind Franklin University. 00:14:37.134 --> 00:14:37.695 What do you see as the 00:14:37.735 --> 00:14:38.794 primary challenges that 00:14:39.394 --> 00:14:40.595 other programs may face in 00:14:40.735 --> 00:14:42.596 implementing robust public 00:14:42.615 --> 00:14:43.535 health education? 00:14:44.275 --> 00:14:45.995 And maybe any ideas on how 00:14:46.056 --> 00:14:48.317 these challenges can be addressed? 00:14:48.437 --> 00:14:48.636 Sure. 00:14:49.371 --> 00:14:52.014 Um, undoubtedly I would say time. 00:14:52.913 --> 00:14:53.495 Um, you know, 00:14:53.514 --> 00:14:54.794 this is a question that we 00:14:54.835 --> 00:14:56.076 specifically asked in our 00:14:56.135 --> 00:14:57.576 survey and overwhelmingly 00:14:57.636 --> 00:14:59.057 that's what the feedback was, was, 00:14:59.197 --> 00:15:00.479 was time in the curriculum. 00:15:01.359 --> 00:15:04.000 Um, I could say firsthand, you know, 00:15:04.020 --> 00:15:05.682 I'm a part of the curriculum committee. 00:15:05.861 --> 00:15:06.623 As I mentioned, 00:15:07.003 --> 00:15:07.982 we had just gone through 00:15:08.062 --> 00:15:09.985 reaccreditation and we have 00:15:10.004 --> 00:15:11.225 a lot of good stuff, you know, 00:15:11.365 --> 00:15:12.206 within our field, 00:15:12.245 --> 00:15:14.407 we are a pretty generalized 00:15:14.447 --> 00:15:15.607 profession in that when 00:15:15.648 --> 00:15:17.269 those students take the board exams, 00:15:17.587 --> 00:15:18.628 They have a lot of 00:15:18.687 --> 00:15:19.969 information about a lot of 00:15:20.028 --> 00:15:20.849 interesting things. 00:15:21.229 --> 00:15:22.089 So because of that, 00:15:22.168 --> 00:15:24.190 time is always of an 00:15:24.250 --> 00:15:26.330 essence and you need time 00:15:26.370 --> 00:15:28.191 in order to either add 00:15:28.230 --> 00:15:29.750 content or make sure that 00:15:29.770 --> 00:15:31.490 you're doing things to the 00:15:31.530 --> 00:15:33.511 standard in education that 00:15:33.812 --> 00:15:34.912 you want to achieve. 00:15:37.373 --> 00:15:38.273 So that being said, 00:15:39.493 --> 00:15:40.714 I've put some thought into 00:15:41.033 --> 00:15:44.153 how we can do this all, right? 00:15:44.214 --> 00:15:45.394 How we can still have 00:15:45.455 --> 00:15:46.575 generalized information 00:15:47.028 --> 00:15:48.707 without adding onto time. 00:15:49.187 --> 00:15:50.729 And I guess my thought is, 00:15:50.808 --> 00:15:53.028 and this just may be my perspective, 00:15:53.089 --> 00:15:55.208 but I feel like we already 00:15:55.489 --> 00:15:57.710 do a lot of things in which 00:15:57.730 --> 00:15:59.610 this content could be incorporated. 00:16:00.190 --> 00:16:01.750 So, you know, a couple of examples. 00:16:01.890 --> 00:16:03.150 So we start off, 00:16:03.191 --> 00:16:04.171 at least in our curriculum, 00:16:04.211 --> 00:16:05.831 we have some generalized sciences, 00:16:05.870 --> 00:16:07.991 we have anatomy and physiology. 00:16:08.011 --> 00:16:09.871 And from my perspective, 00:16:10.392 --> 00:16:12.091 I feel like if we had a 00:16:12.131 --> 00:16:14.033 conversation about, for example, 00:16:14.092 --> 00:16:15.653 the physiologic changes that occur, 00:16:16.537 --> 00:16:17.658 pregnancy you know we don't 00:16:17.677 --> 00:16:18.837 have to go into too much 00:16:18.878 --> 00:16:20.019 depth but at least have a 00:16:20.058 --> 00:16:21.399 touch point early in the 00:16:21.418 --> 00:16:23.019 curriculum then we could 00:16:23.100 --> 00:16:24.421 build on that later in our 00:16:24.441 --> 00:16:26.041 clinical sciences we could 00:16:26.501 --> 00:16:28.042 maybe supplement some of 00:16:28.081 --> 00:16:29.663 the cases that we discuss 00:16:30.283 --> 00:16:32.104 and use a case in which 00:16:32.163 --> 00:16:33.105 someone's in their second 00:16:33.125 --> 00:16:35.245 trimester they're a one 00:16:35.285 --> 00:16:37.826 month um after they're 00:16:37.846 --> 00:16:39.447 having a baby and they want 00:16:39.486 --> 00:16:40.687 to get back into running 00:16:41.269 --> 00:16:42.590 or one month and they have a 00:16:42.629 --> 00:16:43.509 certain occupation. 00:16:43.809 --> 00:16:44.009 You know, 00:16:44.029 --> 00:16:45.091 we could use this case 00:16:45.130 --> 00:16:46.291 information in things that 00:16:46.311 --> 00:16:48.932 we already do in order for 00:16:48.991 --> 00:16:50.972 us to have repetition and 00:16:51.613 --> 00:16:53.033 improve the comfort level 00:16:53.073 --> 00:16:54.193 of our students in working 00:16:54.214 --> 00:16:55.095 with these individuals. 00:16:58.336 --> 00:16:59.897 You know, as I think about, 00:16:59.956 --> 00:17:01.356 I'm a clinical instructor 00:17:02.357 --> 00:17:04.439 and for most months out of the year, 00:17:04.479 --> 00:17:05.538 we have students here at 00:17:05.558 --> 00:17:09.300 this clinic and I'm continually 00:17:10.134 --> 00:17:11.295 I don't know about surprised, 00:17:11.694 --> 00:17:12.796 but how much that, you know, 00:17:12.836 --> 00:17:13.695 things they do remember 00:17:13.715 --> 00:17:15.037 from their entry level education, 00:17:15.477 --> 00:17:16.097 you know, I'm just like, 00:17:16.117 --> 00:17:17.417 there was this one slide, you know, 00:17:17.458 --> 00:17:19.240 two or three semesters ago, you know, 00:17:19.259 --> 00:17:19.880 there's one little 00:17:19.920 --> 00:17:21.780 discussion that they log away. 00:17:21.800 --> 00:17:22.961 And then when it becomes pertinent, 00:17:22.981 --> 00:17:23.902 they can bring it out. 00:17:24.262 --> 00:17:24.762 And so, you know, 00:17:24.883 --> 00:17:25.643 I think that approach is 00:17:25.663 --> 00:17:26.403 you're discussing, 00:17:27.875 --> 00:17:29.175 Even just being here in our clinic, 00:17:29.256 --> 00:17:32.297 if our students have some of those, 00:17:32.376 --> 00:17:34.377 a slide here, a conversation there, 00:17:34.778 --> 00:17:35.618 it would benefit them at 00:17:35.638 --> 00:17:38.000 those moments when it's needed. 00:17:38.359 --> 00:17:39.319 It may not be every day for 00:17:39.339 --> 00:17:40.941 a lot of clinicians, but when it's needed, 00:17:40.961 --> 00:17:42.342 that's how a lot of our education is, 00:17:42.362 --> 00:17:43.061 that we don't use it. 00:17:44.078 --> 00:17:45.840 Until the one day that it's needed. 00:17:45.861 --> 00:17:46.080 Right. 00:17:46.121 --> 00:17:47.902 The one day where it's really important. 00:17:48.002 --> 00:17:48.303 Right. 00:17:48.363 --> 00:17:49.443 And at least you could look 00:17:49.463 --> 00:17:51.586 back at a discussion that you had. 00:17:51.945 --> 00:17:52.145 Right. 00:17:52.185 --> 00:17:53.426 That otherwise maybe you wouldn't. 00:17:53.847 --> 00:17:54.728 And so stuff like that, 00:17:55.009 --> 00:17:56.130 it does take some time, 00:17:56.170 --> 00:17:57.530 but we're already doing a 00:17:57.570 --> 00:17:58.612 lot of things where this 00:17:58.652 --> 00:18:00.012 information could be incorporated. 00:18:00.413 --> 00:18:01.153 And I think it would be for 00:18:01.173 --> 00:18:02.095 the better good for those 00:18:02.615 --> 00:18:03.875 couple of people that that 00:18:03.915 --> 00:18:04.396 really need it. 00:18:07.272 --> 00:18:09.693 Do you have any examples to 00:18:09.733 --> 00:18:11.434 illustrate the importance of this topic? 00:18:12.195 --> 00:18:13.957 Maybe where there was a lack 00:18:13.997 --> 00:18:15.178 of obstetric or pelvic 00:18:15.198 --> 00:18:16.657 health education and it 00:18:17.019 --> 00:18:19.799 negatively impacted patient care? 00:18:19.839 --> 00:18:20.480 Sure. 00:18:22.461 --> 00:18:23.501 So I'm sure there are some 00:18:23.582 --> 00:18:24.782 specific examples, 00:18:25.222 --> 00:18:26.864 but I think something that 00:18:26.903 --> 00:18:28.644 really sticks out to me is 00:18:29.066 --> 00:18:30.586 some of the responses that 00:18:30.626 --> 00:18:31.727 we got in our research. 00:18:32.327 --> 00:18:32.587 So 00:18:33.496 --> 00:18:33.736 You know, 00:18:33.796 --> 00:18:36.356 an example in one of the studies 00:18:36.396 --> 00:18:37.517 that I had talked about, 00:18:37.957 --> 00:18:39.778 we had over six hundred 00:18:39.837 --> 00:18:40.917 physical therapists respond. 00:18:40.938 --> 00:18:42.259 So it's a pretty good amount. 00:18:42.878 --> 00:18:44.538 And in that research study, 00:18:44.618 --> 00:18:46.359 about eighty seven percent of them. 00:18:46.460 --> 00:18:48.441 So that's five hundred thirty ish. 00:18:48.480 --> 00:18:50.260 Physical therapists reported that patients, 00:18:50.621 --> 00:18:51.882 they did not receive enough 00:18:51.981 --> 00:18:52.862 information about their 00:18:52.902 --> 00:18:54.301 physical well-being during 00:18:54.321 --> 00:18:55.063 their pregnancy. 00:18:55.603 --> 00:18:58.124 And that number went up when 00:18:58.163 --> 00:18:59.344 we asked about patient 00:18:59.423 --> 00:19:01.105 education after their pregnancy. 00:19:01.144 --> 00:19:02.644 It was about ninety six percent of 00:19:03.248 --> 00:19:04.188 our physical therapists, 00:19:04.208 --> 00:19:04.888 so people within our 00:19:04.929 --> 00:19:06.169 profession said that 00:19:06.229 --> 00:19:07.608 individuals did not receive 00:19:07.848 --> 00:19:08.930 enough education. 00:19:09.549 --> 00:19:11.410 And so those numbers, 00:19:11.509 --> 00:19:12.911 those stand out to me in 00:19:12.971 --> 00:19:16.531 that there's something that we could do, 00:19:16.951 --> 00:19:17.211 right? 00:19:17.551 --> 00:19:19.532 If a big chunk of the PTs 00:19:19.553 --> 00:19:21.573 that were at least answered 00:19:21.813 --> 00:19:23.814 the survey are saying that 00:19:23.993 --> 00:19:24.753 they don't think that 00:19:24.773 --> 00:19:26.035 patients are getting the 00:19:26.095 --> 00:19:26.994 education that they need. 00:19:28.315 --> 00:19:30.635 We know that information is, 00:19:31.178 --> 00:19:33.239 really crucial for wellness 00:19:33.499 --> 00:19:35.440 and well-being and even 00:19:35.619 --> 00:19:37.741 seeking out medical attention. 00:19:38.201 --> 00:19:41.963 So I feel like having the 00:19:42.064 --> 00:19:43.785 knowledge that there is 00:19:43.845 --> 00:19:45.586 something missing is enough 00:19:45.605 --> 00:19:48.586 for me to say we should do better. 00:19:49.107 --> 00:19:50.367 Right. 00:19:50.428 --> 00:19:51.628 And I think that that that 00:19:52.980 --> 00:19:56.442 was a primary base for why I 00:19:56.481 --> 00:19:57.602 wanted to start looking at 00:19:57.662 --> 00:19:59.222 what is happening even 00:19:59.262 --> 00:20:01.103 nationally at the entry 00:20:01.143 --> 00:20:02.982 level and why I wanted to 00:20:03.063 --> 00:20:04.544 start having this 00:20:04.584 --> 00:20:07.003 conversation here and just 00:20:07.304 --> 00:20:08.664 trying to advocate for 00:20:09.105 --> 00:20:11.325 change or trying to 00:20:11.444 --> 00:20:13.826 advocate for the ability to 00:20:14.205 --> 00:20:14.945 incorporate this 00:20:14.986 --> 00:20:16.606 information so that we can 00:20:16.666 --> 00:20:17.767 better serve our patients. 00:20:17.787 --> 00:20:22.008 Well, I think that was a 00:20:22.517 --> 00:20:23.777 That was a great answer as well. 00:20:24.116 --> 00:20:25.178 So, you know, outside, 00:20:25.238 --> 00:20:26.238 it's difficult to have 00:20:26.278 --> 00:20:28.798 maybe a specific example where, you know, 00:20:28.818 --> 00:20:29.398 because we're getting about 00:20:29.419 --> 00:20:31.019 to provide some level of care, 00:20:31.499 --> 00:20:32.839 but if the patient and the 00:20:32.880 --> 00:20:34.180 provider side both feel 00:20:34.220 --> 00:20:36.500 that there's information lacking, 00:20:37.121 --> 00:20:37.401 you know, 00:20:37.421 --> 00:20:38.800 that means the patient is wanting it. 00:20:38.820 --> 00:20:39.361 The provider, 00:20:39.401 --> 00:20:40.402 the physical therapist knows 00:20:40.442 --> 00:20:41.842 that they would like to be 00:20:41.862 --> 00:20:42.761 able to provide more, 00:20:43.662 --> 00:20:45.442 but they don't have it themselves. 00:20:45.462 --> 00:20:46.143 So that's a great 00:20:47.009 --> 00:20:48.170 a great answer on how, 00:20:48.529 --> 00:20:50.230 if we can have a little bit 00:20:50.250 --> 00:20:51.070 more to give them, 00:20:51.530 --> 00:20:52.932 then both people are gonna be, 00:20:53.372 --> 00:20:54.192 both sides are gonna be 00:20:54.212 --> 00:20:54.932 appreciative there. 00:20:54.952 --> 00:20:57.153 Yeah, that's the hope. 00:21:00.296 --> 00:21:02.036 Any other thoughts that you have, 00:21:02.076 --> 00:21:02.936 anything you'd like to 00:21:02.957 --> 00:21:04.137 share with our audience 00:21:04.897 --> 00:21:06.558 before we finish today? 00:21:07.419 --> 00:21:08.720 That's a loaded question. 00:21:11.280 --> 00:21:12.961 No, I think- The floor is yours. 00:21:14.786 --> 00:21:15.388 No, you know, 00:21:15.790 --> 00:21:18.001 I'm proud of what we've achieved so far. 00:21:18.580 --> 00:21:20.362 I'm proud of the changes 00:21:20.402 --> 00:21:22.923 that we've made at our institution. 00:21:23.462 --> 00:21:25.722 And I just hope that, you know, 00:21:25.762 --> 00:21:27.243 we continue to see progress. 00:21:27.364 --> 00:21:27.963 I think that we will. 00:21:28.124 --> 00:21:28.884 I'm optimistic. 00:21:29.204 --> 00:21:29.464 You know, 00:21:29.484 --> 00:21:30.924 we have certificates where they 00:21:30.944 --> 00:21:32.105 never existed before. 00:21:32.486 --> 00:21:33.705 I'm continuously reading of 00:21:33.806 --> 00:21:35.346 new research and protocols 00:21:35.366 --> 00:21:37.086 where they never were there before. 00:21:37.528 --> 00:21:38.647 But I think that as long as 00:21:38.667 --> 00:21:39.748 we continue conversations 00:21:39.788 --> 00:21:41.088 like this one we're having today, 00:21:41.429 --> 00:21:42.689 that we're on a good trajectory. 00:21:43.630 --> 00:21:44.670 There's just more work to do. 00:21:47.232 --> 00:21:47.473 Cool. 00:21:47.574 --> 00:21:48.917 Well, thank you very much, Natalie. 00:21:48.978 --> 00:21:50.864 I appreciate you coming on today. 00:21:50.884 --> 00:21:51.526 Yeah, thank you. 00:21:51.566 --> 00:21:52.528 It's been nice talking with you. 00:21:52.548 --> 00:21:53.230 I appreciate it.