Episode 28: Beyond the Clinic: How Medical Podcasts Are Educating Today’s Doctors 
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[00:00:03] Michael Donovan: Welcome to the Evidence to Impact podcast, the podcast that brings together academics and their research partners to talk about insights and real world policy solutions in Pennsylvania and beyond. I'm Michael Donovan, the Associate Director of the Evidence to Impact Collaborative here at Penn State. In this episode, we'll be discussing how podcasts are changing clinical learning. My guests today are William Calo, associate Professor of Public Health Sciences and Associate Director of the Penn State Cancer Institute, Ben Fogel, professor of Pediatrics at Penn State College of Medicine, and Paul Williams, professor of Internal Medicine at the Penn State College of Medicine, and also the co-host of the podcast, CurbSiders. Thank you all for being here today, and I'd love to invite you to introduce yourselves a bit further beyond what your titles describe. Maybe we could start with Ben. 

[00:00:59] Ben Fogel: Sure. Thanks Michael. I'm a pediatrician primary care pediatrician here at Penn State, and I've been here for about 12 years, caring for children in this region. When I'm not seeing patients and taking care of patients, I have a bunch of other hats that I wear including the vice chair of quality improvement for our department. So I do a lot of work trying to figure out how to  faithfully deliver the highest level of evidence-based care to our primary care population. And that's sort of how I got into this work through working on immunizations and then working with  Dr. Calo. You'll hear from him a minute on strategies for improving vaccination rates. So that's how I got here. 

[00:01:40] Michael Donovan: Excellent. Thank you. Welcome to the show. With that, maybe we'll go to Dr. Calo, William. 

[00:01:45] William Calo: Hi. Thank you, Michael, for having me today. I have been at Penn State for almost nine years. My research focus on vaccine communication and cancer prevention, specifically around HPV vaccination. I'm not a clinician, but I work closely with many clinicians, including band for a couple of years now, and more recently with Paul. My work focus primarily on identify way to better train providers, to communicate about vaccination during clinic encounters, and also to help families who understand the benefits of getting vaccinations, including HPV vaccine. 

[00:02:24] Michael Donovan: Wonderful. Thank you. Welcome to the show. And lastly, Paul? 

[00:02:30] Paul Williams: Thank you so much for having me. I'm Paul Williams, I'm a general internist. I do primary care and addiction medicine here at Penn State. I've been here for about three years. Probably one of the reasons you're talking to me is also because I co-host the Curbside podcast, which is a medical education podcast that has been around for over 10 years now, which just sounds wild to say. So it started out very small. My co-host actually interviewed me for one of the first episodes and which was listened to all of like 47 people and it sort of grown steadily from that time to a sort of a larger audience. So, yeah, excited about the topic today. 

[00:03:02] Michael Donovan: Wonderful. Thank you. Welcome to the show and I will be referring to everyone by your first names and that'll be  our standard today. But you all went to school for a long time for your titles as well. So that, that kind of segues us quite well. Paul, I would love to talk about how podcasts as a medium can be really wonderful aids in translating complex clinical research into practical knowledge for providers that can be utilized in patient's everyday care. Really, many podcasts are targeted to different niche audiences this is a really interesting space where clinicians themselves are the audience that you're speaking to your peers, and your partners in different ways. So, I don't know if you wanted to talk about what that landscape looks like, and this is open to anyone please.

[00:03:50] Paul Williams: I will say for the curbside specifically  I think one of the most important things in terms of developing it and our entire process, how we choose topics, what the format looks like is this we, ourselves were our audience. We were our target audience, so it was always something that we were making for people. In the clinical space who experienced certain pain points with primary care topics, and what did we wish we knew more about? What do we wish we could do better? And if other people benefited from that's great and it turns out lots of people seem to have the same pain points that we were having, kind of, not surprisingly people, the struggle is really consistent, no matter where you practice. So even though lots of different people listen to it with different careers and of different backgrounds. The audience that we built was based on the audience that was us, so we were trying to create something that would've been mostly selfishly helpful to us, and if other people benefited, all the better.

[00:04:39] Ben Fogel: Yeah, I think that resonates as a listener of medical podcasts that are aimed at providers. I think when William and Paul and you and I were talking about this project, this vaccine and answered project, we know how to teach doctors about vaccine communication, so it wasn't so much about that. It's how to get to them because they're busy. So I think one of the nice things about this format for really busy professionals, and this extends way past physicians is just finding something that you can record and listen to asynchronously and a bit here in the car and a bit there later on the way home. And it just, this just lends itself well to that. So that, I think that it's good for this audience. 

[00:05:23] William Calo: Michael, I wanna add something to Ben and, and Paul. I'm not a podcaster but I have been spending many years developing training to providers to better communicate with families in primary care. And Ben and I have been working for almost five years now, and some of the training that we develop is too much for basic clinicians. We're asking them, you know, every other week at this specific time of the day, you have to join for one hour or two hours. Most of the time it does not make sense for clinical workflows, so I was inspired by a podcast to offer a more flexible and portable way to disseminate best practice communication training in a format that providers can really enjoy it at the time that they want and how they wanna consume it. So that is a way that I first listened to the curb siders and I said, well, let me see. Let me see. One podcast that I know people are enjoying, that is well received. That inspired me to develop this Vaxxed and Answered it has a more specific focus and it's more research oriented, but I think this is a very useful way to disseminate knowledge in a way that providers feel a profit it.

[00:06:39] Michael Donovan: Yeah. And William, could you kinda give us a little more contour on Vaxxed and Answered, as you both mentioned it? 

[00:06:45] William Calo: Yeah. Vax and Answered is a study funded by Merck and we got funding to study the feasibility of using podcasts to deliver HPV Vaccine Communication training to providers. It's a study enrolling 40 primary care providers in Pennsylvania, six 30 minute episodes and Ben and Paul are the people behind that. They help me a lot, not only developing the content, but also running the show. I'm not a podcaster, you will not listen to my boss in any of those six episodes, it's just all of them. We have been recruiting over 45 people. We recruited the last one two weeks ago, and we have been looking at the data and it's just amazing. People are our participants are just showing that they feel more confident. About talking about vaccines and addressing families' concerns about vaccines, comparing post participation versus baseline. So we're seeing how podcasting, the data that we're getting right now, at least for Vaxxed and Answered, is just showing providers to increase their confidence about vaccine communication. And I would imagine that there are many other studies out there showing similar results. Ours is the first one just showing that for HPV vaccination. 

[00:08:08] Michael Donovan: That's excellent, and recognizing that the study is trying to capture the experiences pre and post for the clinicians themselves that are enrolled. We have to imagine that there's ostensibly some cascade effect here for patient outcomes or potentially recognizing that's not measured here. Have you experienced that either through qualitatively with conversations with clinicians and how there's been a difference in patient outcomes or experience.

[00:08:37] William Calo: Not for this particular Vaxxed and Answered study because it's a small sample, it's just a feasibility study. The future goal for me and including Ben and Paul, is to submit a larger trial with the appropriate sample size, estimation, and power analysis to understand what you're saying how by disseminating this knowledge to providers through podcasts have an impact on their vaccination rates. And maybe Ben can talk more about that. 

[00:09:08] Ben Fogel: Sure. Yeah. William, you know you're being careful because you're the researcher and I'll just not be careful because that's my job. I will say two things. One, the fact that you always wonder in a research project if there's something else going on in the background that's changing your results. And the thing going on in the background right now is increasing vaccine hesitancy and increasing misinformation and more difficult conversations with patients. So the fact that the people that are a part of this feasibility project are saying that they're more confident, despite the fact that the world is making everybody less confident, I think speaks volumes, So that's kind of cool. That's not a scientific result, but I think it's pretty, it's pretty interesting and encouraging to hear that. In my quality improvement role, I look at vaccination rates among the different providers that I oversee, specifically for HPV vaccine is one of the things that we look at. And one of the, one of the strategies that I've used that is helpful in getting people to raise their immunization rates among their patients is saying, uh, pairing up people with low immunization rates, with those with higher immunization rates and saying, why don't you guys talk to each other and see what's going on? And just recently I reached out to somebody in our practice who has very high immunization rates for HPV and I said, what are you doing? What are you doing that's different? And she wrote back and said, well, it's really not that complicated. And then listed our talking points basically. And she has been a part of vaccine hesitancy training that we have delivered. So that's again, not a scientific outcome, but to your point, Michael, yes, this information goes to clinicians. That's not the ultimate point. The ultimate point is to help them be able to take care of their patients  and they tell us that anecdotally.

[00:10:49] Michael Donovan: You, you really touched on such an important topic here around misinformation and hesitancy around vaccines. I wonder Paul, in your time with Curbsiders over the last 10 years, how have you seen this discussion come up? Have you been working on and this with your the clinicians that you reach in your audience at all?

[00:11:12] Paul Williams: Misinformation as such is not, believe it or not, a topic that comes all too much in sort of fundamental clinical practice, which is the stuff that we talk about. I will say we, when we talk to the experts one, something we almost always ask. So because the format of this show is we interview specialists about their areas of expertise to help us learn about specific topics. And sometimes these people even write the guidelines and do the research and they will translate that research into something that is actionable for us. One of the things that we almost ask everyone is, how do you talk to patients about this? Or if this patient expresses this particular concern, what is your script to address that concern specifically? So, it's not a direct combating misinformation, you know, misinformation and the acceptance of it ultimately stems from patient concerns and sort of anxiety about things. And so how do we best address that? So we ask people, we, we ask the experts who deal with this on a day-to-day basis, what their script is, how they reassure patients that we are treating them with their best interests at heart and what their illness script are and, and often that I think, will at least indirectly combat misinformation to some extent.

[00:12:09] Michael Donovan: I wonder as you think about the clinician focused podcast medium as one that is intended ,as Ben pointed out, to reach an especially busy and spread thin community I wonder what further growth you could see in this space, as an area of development. As you mentioned around different disease states or types of vaccine or type of developmental trajectory, or age, along the lines, how anything on the trajectory of what this thing could be?

[00:12:44] Paul Williams: It's a good question. Uh, I, I will say, so I don't, embarrassingly, I don't listen to any medical podcasts, just because it just, it feels too close to what I do with most of my free time anyway. But I will say I don't, in the space that I work, I don't see too many that actually incorporate patient perspectives or even patients in general. So I, I think as you note, they do tend to be fairly siloed, like it's clinicians talking to other clinicians. And I, I don't see a lot of I a chance to talk about the clinical space, but actually in involve the patient experience and the patient perspective. So I, I think a format that does, that might be a sort of neat inflection point, but that would. That's more something I'd like to see than something I'm actually predicting, so I'm not sure if that's helpful at all or not. I'd love to hear the perspectives of others.

[00:13:27] Ben Fogel: I guess I would say that what we have done with this sort of narrowed and answered project is really delivering education directly about a very specific topic. And yes, I think that is, you could expand that to lots of other things. So anything you wanted to teach clinicians about? I think that this is a reasonable format and that's kind of what Paul does , with Curbsiders, right? I mean, it is it there that is not specific at all. It is. Every different episode has a different focus with the same audience and the same general idea of what you're trying to improve I think it's for sure you could teach people about other topics. Paul's idea is an interesting one, right? We sort of, we talk about what our experiences are with the patients without talking to the patients. 

[00:14:17] William Calo: I would like to add two things there. One that motivated me to move into the use of podcasts for delivering best practice communication to providers was a fact about. Including CMEs or MOOCs for providers. Usually in medical education, you see those for very rigorous trainings. I learned that podcasts can serve also as a platform that can offer CMEs and MOOCs because these are rigorous ways to deliver medical education. I think for me, that's one thing. Maybe one thing that we should be doing better is just to promote podcasts as a more serious way to earn continuous medical education and as a platform for learners. Okay. Which I think it's, I think that's what Paul has been doing for the last 10 years. You know, it's just showing that it can be rigorous and serious and at the same time it's something that enter 10 people. Right? So that's one thing. And I think the second thing is I focus more on vaccine communication. That's the reason I developed Vaxxed and Answered, but I think what I, I'm thinking about what other diseases or topics or public health problems. And they serve the attention of podcasts as a way to be more flexible and portable, not only for practitioners or providers, but also to patients and the young public. So I think that's where I see as a public health practitioner the way growing in the future. 

[00:15:50] Ben Fogel: I think that there is a real, you know, in talking to patients about where they get their information they get their information from all sorts of different places now. But there is a real willingness among many patients to not just trust their own doctor, but trust a doctor who they found online who seems to speak to them. So I hear that all the time, now, you know, I read all this stuff, but then I also, there's this doctor who posts things on TikTok little videos about vaccines, and that what they said really resonates me. And now because of that, I am interested in getting this vaccine, or whatever the thing is. So, I actually think that there could be a real role for having this same format where it may be, it may even be doctors talking to doctors but for the purpose of disseminating to the public. I think that those are conversations that people want to hear. 

[00:16:47] Paul Williams: Yeah, I, agree with all that. I think it's an exciting space. I do wanna go back to something that, that William had mentioned. So this idea of providing continuing medical education and maintenance of certification credits and those kind of things, ways to kind of prove that you're doing ongoing education to licensing boards, that kind of things, but then also just to increase your own knowledge. One of the things that I am most excited about with the Vaxxed and Answered Project is the fact that whenever you're assessing any medical education intervention, it's really hard to assess patient outcomes that result from that educational intervention. You can assess whether someone likes it or not. And that's usually the stuff that's done. They'll do a survey, you listen to this thing, did you like it? Okay, great. Then I guess we prove something. And then the next step is did you learn something? And then you, maybe you'll do it before and after quiz and that can be helpful too. But in, in order to actually evaluate, did the thing that we talked to you about actually impact your practice is really notoriously hard to measure from an outcome standpoint. So the fact that part of built into this project is a way to kind of look at vaccines sort of before and after is, exciting. And to Ben's point, yeah, I think that's exactly right. In the same way that a lot of times in medical education, what our learners are learning from and what we teach them are not necessarily the same source. I think that's doubly triply, quadruple true of patients. Like, they're getting so much information from media that we are not utilizing as clinicians and medical professionals. And I think there's a chance to take advantage of that space, and do broader public health education. And there's some missed opportunities and that space is sometimes being filled by people whom quite frankly I wish would not be influencing our patients and their health behaviors. 

[00:18:18] Michael Donovan: Yeah, I'm hearing this interesting discussion of something existing on the boundaries of education and entertainment, right? How do we really blend what is captivating and engaging and also available at the ease and pace of someone's life with the rigor that's required for something to be measured at a continuing medical education credit, for example. That's a really big challenge. The other piece here is the rise of the medical influencer, both for the patient community, which I'm sure as you mentioned, you're hearing a lot in the exam room and also how that affects clinicians as well, so not just the patient community. And the questionable quality of that of that advice. The challenge there around, making sure there's rigor behind it. To that end, of course, we will be including in our podcast show, our show notes plenty of references to further things to, to check out for our audience here. But that does pose a challenge to make something really interesting and dynamic, but rigorous at the same time. And also to do it at a pace that keeps audiences engaged, speaking of the opportunity to blend what is done, in a relatively informal podcast conversational setting and how that could have opportunities to affect treatment options or guidelines in future. I wonder, Paul, in your experience with Curbsiders, have you had moments where there's been this interesting play between what is a conversation and that leads to changes in guidelines or  treatment options for patients? 

[00:20:03] Paul Williams: It's an interesting question. We have been mindful of our influence  which sounds really self-important. There's this guy named Tony Brew, who's an incredible medical educator who's actually written what about what he called the Curbsider Effect, where we talked about this idea of iron supplementation being just as effective, taken every other day. Like this was something that we talked about in an episode and then there, there did seem to be sort of a, a larger practice change and I don't, I don't know that we can take credit for it, but it's just something that he happened to know. But I, I do think we have to be sort of mindful that the things that we talk about are listened to by people. So, to that end, you know we do vet the people that we talk to fairly thoroughly. We actually have a fairly  rigorous  quality improvement process just to make sure that what goes out is as accurate as we can do. And then we're constantly updating topics that do evolve over time. But there have been hints and kind of whispers that perhaps some of the things that we say may have impacted practice, but as I said it's really hard to quantify that in a meaningful way.

[00:20:58] Michael Donovan: Understood. And going back to the topic of the boundary living in the space between education and entertainment, and this is for William, I wonder if you could go into some detail on, what can we learn from the lay social media, for example that is valuable for making things really interesting for audiences, even in a medical audience. I'm thinking about personal narratives and discussions of  anecdotal experiences, are there learnings we can have from other settings? 

[00:21:36] William Calo: Yeah. In addition to this project that I have been doing using podcasts with Ben and Paul, I'm also exploring installing the use of storytelling or narrative from cancer survivors in a way to educate actual families about the benefits of HPV vaccination. So, I'm conducting a randomized controlled trial with 200 patents in three primary care clinics at Penn State. Where we randomize half of those patterns to watch a video intervention, a short video intervention of someone who was diagnosed with an HPV related cancer is a cancer patient or survivor. And that person tells a story and at the very end recommend HPV vaccination. Over half of the patents in those study, in that study are randomized to a placebo video about healthy eating tips for families. The main purpose here is to understand how storytelling, using video communication or small media communication, influence their knowledge and behavior towards getting the HPV vaccine at their next appointment. So this is not necessarily related to podcast communication, but one thing that I have been doing in the last two or three years with podcasts and this video storytelling intervention, is maximizing small media communication. There is strong evidence showing that consumption of video, including through YouTube small ME media claims through social media. Information through podcasts is increasing among the general public. So part of my role is studying how these small media channels are helping both clinicians through podcasts and families through due to videos to be more active in the way that they accept vaccination. 

[00:23:48] Michael Donovan: And you mentioned earlier that this was the Vaxxed and Answered effort was funded from pharmaceutical company. Are there opportunities for growth in the funding landscape? Is this something that the federal funding mechanisms recognize as valuable?

[00:24:06] William Calo: For research, yes. This study was funded through Merck and there are many other industry partners, I would not mention specific names here, but there's some that I have been putting my eyes on because they have requests for applications where they mention podcasts as a way that they would like to get grant applications, testing podcasts as vehicles for provider and patient education. The other story that I mentioned about storytelling is funded through the National Cancer Institute. I can tell you that from my own experience and experience of researchers, yes, there is appetite among industry partners to explore ways to increase or improve the delivery of training and programs to clinical teams. And podcasts is one of them that is very fundable and maybe I will just ask Paul if outside research how podcasts are funded. 

[00:25:10] Paul Williams: I mean by, by and large podcasts, regardless of the medium, like regardless of the actual subject matter, are funded by ads for a particular sponsor. So it's, if you listen to a podcast, I won't, I, maybe I'll avoid naming it, but yeah, this is brought to you by this particular mattress company and maybe some of the sketchier ones are brought to you by, you know, mail enhancement products, but it is  the funding comes from external ads. And so it's relatively  chaotic as to how these things sort of come about or don't. So, there are ways to get these things funded. The providence can be of varying quality, I guess I'll say.

[00:25:41] Michael Donovan: Any other thoughts on the concepts of storytelling or personal narratives as a valuable tool in this area?

[00:25:48] Paul Williams: Yeah, I can share some anecdotal stuff, and something that I've been thinking about is a lot of the feedback that we get , with the Curbsiders specifically, is almost regarding the parasocial elements of things. Like people appreciate that we are open about knowledge gaps or that we are open about something that is particularly scary to us, or that we are open about being just excited and learning about medicine. So I think there's something above and beyond just the transmission of knowledge that people are sort of locking into as well. So, I just in terms of engaging with patients at large, you know, from a public health standpoint, if a listener is listening, I would hope, I think it would be actually helpful for them to hear us saying, I did not know that or, here's something I don't know, or here's this thing I'm having trouble navigating. I think that would actually go a long way towards sort of regaining public trust. And I and among clinicians that listen  they really appreciate the fact that we remain excited about medicine, the fact that we voice anxiety about things and concerns about things and do acknowledge our own ignorance in certain spaces as well. And I think there's opportunity there above and beyond just sharing knowledge. And I think that kind of is, goes along with the storytelling. I think people like a narrative. They like feeling like they are a part of something rather than just being talked at. And I think that's a way to engage patients and public health more broadly. Like I think there's opportunity there. 

[00:26:58] Michael Donovan: Sure. It's almost a feature of the podcasting modality that there's a self-effacing authenticity that comes through especially when someone rambles like myself sometimes. Ben, did you wanna jump in on any of this? 

[00:27:17] Ben Fogel: No, I think  again, just this idea that that it's sort of entertaining as well as knowledge delivery is what makes these interesting to people. It's what makes it fun. So that's what, I could read about this, but it is more fun to listen to somebody talk about it, who sounds like they're having fun.

[00:27:38] Michael Donovan: I wonder if there's an opportunity going back to the funding piece as well, that, going to the traditional providers of CMEs and thinking about how they would potentially expand their opportunities for for CME into this modality. If there was a way to make that rigorous enough and ensure there's enough assessment perhaps required of clinicians to be able to reach the threshold that a CME would be, continuing medical education credit. That could be an opportunity to work within the system instead of revolution a little reform.

[00:28:15] Ben Fogel: I don't know a lot about that space other than as somebody who needs continuing education credits as CMEs. And it's definitely a motivator for physicians to participate in these things. Now, it depends a little on the audience. If you're at an academic center, like Paul and I are, often we're swimming in CME credits from going to grand rounds and going to conferences, like I actually don't need them. But I have, but I know that it's a big motivator for people who are, who are not doing those activities all the time. Figuring out ways to get them does drive people to things like this.

[00:28:52] Michael Donovan: We talked about hesitancy a bit, but we can go back into that. William, if you wanted to touch on anything further on that front.

[00:28:59] William Calo: Yeah, I'll like to say that with the issue of vaccine hesitancy or misinformation another thing that I'm seeing a lot, especially with patients and families is information overload. And Ben and Paul alluded to there's many things out there in social media or channels, or many influencers, you know, it's very difficult for many parents, families, and individuals to really understand what is true and what is not true. So, I think the way that we can develop podcasts with this idea of being very flexible, portable easy to understand, easy to absorb that information is to serve to a kind of a filter. All the noise out there, you don't only need to maybe listen to a 30, 40 minute podcast. Maybe we can be more proactive developing small social media clips that are just 45 seconds, one minute long, and then put them in social media with specific content with that podcast that motivates people, you know, just to increase the demand for this other evidence-based sources of information. So, I think there's something that we can do. I know at least for vaccine communication that misinformation is increasing and is just everywhere. I think there are ways that podcasts can be more active in a way to filter that information and help not only the providers with the training, but also the families to understand what's going on. Especially these days that we have competing guidelines from the federal government and the American Academy of Pediatrics. I'm not gonna be going into that debate. Maybe Ben would like to go into that debate, but I think how podcasts can help families to understand which one to follow, right? I think that's a way that podcasts can serve not only for pro provider training, but also as a direct service to families.

[00:31:10] Michael Donovan: Absolutely, to form some sort of North Star in terms of what is valuable information to take in, versus what is not. It increasingly is challenging to do so. Are there other topics that we want to cover? Is there anything that we haven't covered that we wanna expand upon?

[00:31:29] Paul Williams: I will say, I think something else that might be helpful is if there was a way to communicate with the public how we come to the decisions that we actually come to in, in a sort of way that's open. I feel like oftentimes discussions around things like even vaccines are offered as binary, like, you should get this or you should not get this. Rather than sort of, here's why I think this might be helpful for you. I think, you know, even vaccines are good is probably not sufficient information for patients these days. So, what, when you say good, does this mean it reduces your chance of getting something? Does it mean it keeps you outta the hospital? Does it mean you might not get dementia later down the line? I think people have very specific and fair questions and I, it's, medicine has a long history of paternalism and I think we're often very opaque when we're patient facing with how we come to the decisions we make and the recommendations that we make. So, if there's a way to share process and how we come to these determinations and how we think about these things as opposed to, you should get this, which is not, I think as understandably as accepted these days. I think that's, that is the way to sort of frame these conversations moving forward.

[00:32:24] Ben Fogel: Yeah. Paul, I think that makes a lot of sense, and I do think it relates to what we're talking about in terms of, the format of the podcast where a doctor is talking to another doctor. For the purpose of training doctors, I think we get that, but the format of a doctor talking to another doctor for the purpose of getting information to the public, I think there's still a lot of value in, and because of exactly what you just said, we are not robots. It shows how it shows our vulnerabilities and what we know and what we don't know, how we think things through. The answer is almost never clear. And we are weighing all sorts of different sources of information and coming up with our best decision. And that's the way that we think. And I don't know that patients always know that. And especially around vaccines, I'm actually now very careful about the way that I talk about different vaccines for the reasons that you just said because otherwise people will tell me that it didn't work. So if I got the flu vaccine and I still got the flu, so I'm actually fairly careful now about saying, you know, the flu vaccine, this is not the measles vaccine. The measles vaccine, you get the measles vaccine, you don't get the measles. That's how that works really well. The flu vaccine doesn't really work that way. It works. You still might get the flu. In fact, you still are likely gonna get the flu and you're just less likely to die and you're less likely to end up in the hospital, and that's worth it to me. So I think, yeah, those kind of vulnerabilities are probably really good for people to see.

[00:33:49] Paul Williams: Yeah, that it's, I think, I don't wanna call it a Mandela effect, but I feel like there's this post COVID, perception among some patients, at least anecdotally of a sense of surety from the medical community. Like it's  we know what we're doing here. And then I hear it repeated back. I was told if I got the vaccine, I, we can get COVID. And I did so like it that translates to this a mistrust and that what we're talking without knowing what we're talking about or we're being dishonest. And I think reintroducing that nuance and the uncertainty and being really transparent about that, I think would go one way. So thank you, Ben. That was really well said. 

[00:34:17] Michael Donovan: Yeah  it's almost what we were saying before where, there's the modality of the podcast allows you to have kind of a humanization of the profession that is lost a bit because of  the training, the rigor to be the voice of of credibility and being able to see behind the curtain a little bit. To see the work being done and the challenges to get into that answer, that recommendation is really valuable. I think it's a humanizing effect. 

[00:34:48] William Calo: I wanna just make a comment or a statement from my other role as Associate director at the Penn State Cancer Institute. I'm seeing a trend in academic settings, including cancer centers across the country where they're now using podcasts. As a way to communicate with the people who live in their catchment area and with their own scientists. So many cancer centers right now, they have their very own podcast and the major cancer organizations across the US also have their own podcast. So, I think there's something about what Ben and Paul is saying, how we make this information more democratic to everybody. It's not only with the people in white coats or the PhDs like me, it's how we make this information more accessible. So I'm seeing a movement from the cancer centers to try to do that. Beyond vaccination, there are other topics where there's a heavy investment institutionally , to make that happen. We don't have that kind of podcast here at Penn State Cancer Institute. Hopefully we can have that in the future. Maybe have to advocate more for doing that, but that's a trend that I'm seeing nationally. I don't know if there are other type of medical association or groups, but I know that they have their own I don't know Ben if you follow them, but has their own and many over half. So I, this is something that is getting a lot of  attention and traction. It's just how we be more strategic to maximize our impact providers. Beyond clinicians also to impact, the way I would like to learn, as a scientist, how I can better communicate my science with others, and I think maybe podcast is a good way for me to practice that. That's something that we should be probably doing a better job with our clinicians here, how they can use podcasts more strategically to move that knowledge from papers and publications and conference posters to something that really get into the ears and the hands of our community members.

[00:36:52] Michael Donovan: That's a great summary of the thrust of this conversation today. And as we mentioned earlier the current overwhelm of information also means the overwhelm of podcasts. So we will try to make this podcast a little shorter by concluding here. Thank you all for joining me today. Really rich discussion. I really am so grateful for your time. Again, we were joined today by  William Calo, the associate professor of Public Health Sciences and associate director of the Penn State Cancer Institute, Ben Fogel, the Professor of Pediatrics at Penn State College of Medicine and Paul Williams, professor of Internal Medicine at Penn State College of Medicine, and the co-host of Podcast CurbSiders. Thank you all for joining me today.