Small Group Teaching
November 23, 2020
Speakers
- Richard Brown, DMin, ACPE, BCC, Director of Chaplaincy Services, Carilion Clinic and Assistant Professor, Interprofessionalism, VTCSOM
Objectives
Upon completion of this session, participants will be able to:
- Describe the theories that support group practice.
- Identify the types of small-group learning: function and outcomes.
- Discuss the role of a small group facilitator: opportunities and challenges.
Good afternoon everyone and welcome i'm excited for today's presentation mainly because as teachers in health professions education it really doesn't matter what we're teaching or to whom we're teaching um we all teach in a small group setting at one point or another and really the skills for doing so effectively are just different in some ways and today dr richard brown who is carilion's director of tripletsy services and clinical pastoral education and also assistant professor of virginia tech school of medicine is going to show you how it's different and hopefully equip us with some skills to to teach in the small group more effectively every day the floor is yours dr brown so the first question is this well why small group learning anyway why don't we just do everything in a large group well groups have the power to move people in in new and creative ways in my experience working with groups of uh students one of the several of the things that i've learned have began to sort of come to come to the forefront for me and that when we do small group education small group learning it gives our students a chance to to develop skills that they may not acquire in a large group atmosphere things like leadership working with small groups of students allows the individual students to sort of step forward and claim some leadership gifts and abilities for a lot of students moving to small group learning helps them to find their voice and we all know it's easy for students if they choose to get lost in a large group context so when we move to the small group group learning it lets students actually give them the opportunity to find and practice using their voice one of the other things i've learned is that small group learning really emulates professional practice and this is one of the keys with the chaplaincy residency when we are together with a group of four to six six peers throughout the course of a year not only does it give content and education but it teaches the individuals how to function in a group setting in essence the chaplaincy education is almost like doing a family meeting because you get to engage not only content but group process and group dynamics as well and third i think small group learning really is relational learning and when we move our education into the small group context not only do we get to learn with others and learn about how others think but we also really get to learn about ourselves as well one of my favorite educational theorists is parker palmer and in one of his texts he writes about the the question of why we learn and how we learn and he says that for most of us the the why we learn is because we like to find congruence between who we are as individuals with the people that we work with and with the knowledge that we gain and share as well so let's look at group work what does it mean to have to do group work to be involved in group work and the first thing i would like to say is this a small group size or a small number of students doesn't automatically mean that we're doing small group education or small group learning transitioning from the classroom to a small group environment is really about making an educational shift in philosophy well it's actually not making a shift it's really adding the component of group dynamics into the learning environment and when we make that shift it changes what happens within the context now this work may differ based on a lot of different factors such as what is the length of time that you're with the student what is the context of the time and with your student if you're with a small group of students for one afternoon or for one hour that's very different than if you're mentoring students over six weeks or a half a year or a semester or a whole year so when you begin thinking about your contacts for the what are the ways and where the places where you find yourself with a smaller number of students what does the context tell you about what's going to happen with within that parameter it also opens the door to help you look at well what is possible what can we do in this context whether you have an hour together or six weeks together or a whole year together so when we begin moving from the large classroom environment into the small group context really one of the key words that i start to think about is this is relational learning so we are delivering content but we are also developing relationships that are different with our students than we can provide in the large context or a large format setting so when we move into this relational model or relational understanding of learning there are several things that we really need to be aware of and the first is this many of our students have a history of being psychologically wounded in relationships so when students transfer from the large group environment to the smaller contacts this work can be really hard now for most of us we may not recognize the difficulty that students have moving to a small group context many students like being in the lecture hall because they can come their voice does not have to be heard they do not have to be engaged they can glean the content that they need and they can continue on but when we move into this small group when we move into the relational learning students may find that this can be very hard but it can also be very healing for example we may have students that that we are mentoring or shadowing a variety of different environments and we may be totally unaware of the history that they bring to group work or relationships we may have no idea about the transference issues or the counter transference issues that they that may emerge in that process you know one of the prime examples is maybe a student that grows up in a household without a without a father or with an abusive mother or a variety of other family systems dynamics and when they come into the small group context some of those may sort of emulate their history and all of a sudden they may be challenged with well what's it like to have a male leader in my group or a female that's absent or you know just a variety of different things that can emerge from moving into that small group context because as we make that that move uh we i think we need to remember it's a transition that not only we need to sort of be comfortable with and we need to be able to make but we need to help our students make that transition as well the other piece i think it's important for us to remember is that doing small group work is not therapy um oftentimes when i'm working with my chaplaincy residents they they sort of uh find themselves in a situation where they where they just uh get some invaluable insight into who they are as a person into who they are as a professional to how they see life and i always remind my students because i i tell them this on the first week of orientation that the the experience of small group education is not therapy but you may find some things along the way that become very therapeutic for you and while my role is not that of a therapist it's of an educator i'm going to support you as you navigate these life-changing images and understandings that you have about yourself as you go through the process so i think it's very important that we that we keep in mind that this transition from large group to small group requires the transition of both us the facilitator the educator but it also is important that we understand that that is true for the student as well so let's talk a little bit about within you know as we think about creating these small group experiences what are the things that we need to keep in mind is first order of doing the pre-work or the pre-planning for creating these small group experiences and that may differ whether you're in the clinical site doing rounds with residents if you're doing a small group education in the classroom and of course the list of that can just go on and on when we think about the types of groups in the context of the groups in which we find ourselves uh of course uh we always need to think about content what is it that we are delivering what are our outcomes what are our objectives what do we want to see that's happening in the lives of our students what do they need to develop what do they need to understand so as we begin thinking about creating that small group experience what's the content now that may be driven by our syllabus it may be driven by our program outcomes it may be driven by a textbook that we are reading or it may be driven by your understanding of what you think the group needs so when you think about content don't forget as we look at the outcomes and objectives also do an assessment of your small group and just ask yourself what is this group of students need to learn where are they in developing themselves as individuals and as a group the second thing we need to think about is group process and the question that i always ask myself is what is happening in the group right now there are all sorts of things and we could spend several hours together talking about group process but as you think about your group especially in the context in which most of us find ourselves engaging students who are in the medical process i keep reframing this by saying how how does this work how is our time together helping them to develop as a professional what skills what awarenesses what insights are we providing them so when you think about group development i think about things like trust can the can the group trust each other what does that trust look like is it a verbal thing is it a behavioral acknowledgement of that but think about where your group is and the level of trust with each other i think about things like disclosure how how well does this group disclose to each other their learning process and what they're learning how do they deal with conflict what's it like when the group finds themselves in disagreement with each other or with the instructor and how do they navigate through the resistance part of the small roof environment it's a great place to let students start experimenting with feedback and i know in this series throughout the years we have talked about giving feedback and providing feedback along the way so when you move from the large classroom into the small group environment this is a great place to help people to help students find their voice about giving feedback you know it's one thing to think about is on a cognitive level it's a little bit different when you step up to the mic and start actually providing feedback to each other and to the peers and then what do you do with silence and we're going to talk a little bit more about silence later on in the process because silence and and what silence does to the small group environment can be a very powerful experience to help the student and the facilitator sort of move through some difficult parts of the group development process you also need to think about stages and we're not going to spend a lot of time i think most of you know that there are several pretty popular models about group development and the stages that groups go through from beginning to ending so we're not going to spend a lot of time on stages but i think we do need to be aware that as groups develop and as they stay stay connected over over time that that the group itself becomes its own living organism and it goes through stages of development just as any other process would and then finally i mentioned this already when i start thinking about the content and the group process especially in the in the context of medical education i'm i'm constantly uh asking myself how how is this process helping these students develop as a professional how is it gaining their how is it developing their identity of who they are and what kind of practicing professionals they would like to be one of the one of the really short-term small group experiences that i'm involved in right now as i meet with uh with our our m3s at the end of some of their clinical first shift rotations mainly pediatric and uh psychiatry and in in that experience it's a one-time one-hour experience so when we sit down to talk about their process and it really is a process group to talk about what this clinical rotation has been like i always have this question in the back of my mind of this guy that's like how is this group process helping these students become a more competent professional in that time together i encourage them to each name a strength because i think that's one of the things that is it's a challenge for people to step up and say this is something i'm discovering about myself that i'm really good at and they have to voice that in the in the midst of of their small group and as they talk about the strengths that they're developing through the small group experience i think that all ties directly back to their professional development as practitioners so i know some of you are really the theory motivated individuals or educators so let me just talk about a couple of models real quick uh when you talk about small group in general there's not a lot of small group theory that's out there there are techniques there are models of of intervention but really when you're talking about small group theory you're not abandoning the theoretical models that have got you to be an educator you're just taking those to a different context and a different model so uh corey corey and corey wrote a book called groups process of practice and for me uh this has really sort of been been my guide for developing a lot of what i do with small group learning and i want to introduce just two of his models or two of their models for you today because i think these two in combination can give us a lot of insight into the work that we do in our environment the first model that corey presents is what he calls a task bottle and this is a very comfortable model for a lot of folks especially if they're in the clinical world especially if they're in the process of teaching a skill or a task because in the task model we have very clear outcomes we have very clear objectives we have a check-off list for our assessment so so when we step into that into the task model with a small group of individuals both the leaders and the students we we know what we're here for we're going to get down to business and we're going to get this house done and we're going to check off our competency sheet as we leave the day so but the the task model alone really can create problems if we as the leader or facilitator are thinking about small groups in sort of a different light because as educators we need to start or ask the question how do we connect the task to the process of learning and we have the potential to run into the risks that that about helping students create deeper meaning in the process of learning a skill or a task if we if our main goal is to help them to give their competency left checklist completed then what happens to the opportunities for students to learn about groups to demonstrate their skills to one another to have one student teach another student how they navigate a certain skill that they've been asked to do and what's it like to have a student say you know i'm just not getting this can someone help me can someone reframe these instruction instructions to help me be successful in this task model so if you find yourself with a group of students in in your your primary goal is to complete a task or complete a checklist don't forget to ask about what's it like for this it was really interesting i was doing some observing some rounds with some students at one point and they were they were in the simulation lab and they were working on a skill that they were doing and one of the students was really struggling with with the skill set and and as i watched the group you could see the other three or four peers sort of and physically sort of take us take a step back from the table in which which they were working and in my mind i was thinking i wonder what would happen if we asked the students who stepped back to say what's it like to watch your peers struggling with a skill and sort of ask them what sort of feelings this so does this sort of unearth if you knowing that you may be next at the table and just use that to tie use that to talk about a group process which can be combined with the task model so don't forget when you're doing tasks that there's also the potential for group process as well so the other model and this is really the model where i camp out and a lot of the work that i do with students and corey calls these the psycho-educational groups and these are groups that are formed either short-term or long-term they may have a variety of outcomes and objectives a lot of the education that needs to go on but he also equally starts talking about well what are the psycho group dynamics that are happening with this and how do we combine the cognitive the effective and the behavioral so that all that comes together in the small group environment to create one solid education but help students start developing that internal and self-awareness of who they are is professionals about group dynamics and all the other things that we have been talking about that goes along with group process so so most of the work that i do whether it's with the med school with the tag groups with apprenticeship groups i'm continually thinking about this psycho educational model and how do we blend content and process together with that now i'll be real honest when you start moving to this sort of model and understanding of small group dynamics it it has the potential to really limit the amount of content or skills that you can cover in a certain amount of time because when you start creating that environment for students to talk about process that naturally starts taking time out of our process so one of the challenges for me is that how do i find the appropriate balance between the skill the education and the process and again that that's different for every context and it may be different for every group that you have as well so just keep in mind that as you move from one idea or ideology to another you may need to rethink how much content and how much curricula can i facilitate through in a 50 minute hour with that richard i was just thinking of that um that's an excellent point and that you may be able to cover less quantitatively but when you're in a small group the quality of what you're teaching really can be so dramatically increased so it's just a matter of being even more flexible in your teaching i think yes it really does it actually uh sometimes it creates attention for me because i know that there may have to be a trade-off you know i may have to trade off three or four points that i would would like to talk about in order for the students to process what it's like what is it like to be in a group what's it like that mean i just can't get this or you know all those other things and you it sort of creates attention for us how do we find the right balance uh with with what we need to do in the needs of the students outside of the cognitive piece with that thank you for that so uh i have a few more slides and i would not be a a great uh presenter for this topic if i filled our whole hour with content and didn't allow us time for process so uh we're going to move through a few other things that i've been thinking about and then we're going to sort of jump into more of that conversation but feel free to stop me as we go along as well so so how do we become more effective as in small group learning as a small group educator about about two things for you one it starts with your understanding of group work and about emphasize this is your understanding how do you understand what it is that you do and where are you comfortable as you move into group work and here's a couple questions to ask yourself that may help you sort of cypher through that and this first question was a question that my educator at uva asked me and it has stuck with me for the last 13 years so dick asked me he said when you're sitting with a group of students do you see yourself in being with a group of individuals or individuals in a group and when he said that for one of the few times in my life i was pretty much speechless because i never really thought about how i saw the groups that i sat with because if you see your group as a group of individuals you're going to be really prone to look at a lot of group dynamics and in the propensity to see everybody is the same or if you see yourself as or if you see your your class as individuals in a group then you start doing one-on-one education with a group of people that are looking on so for me it was really enlightening it took me a long time to sort of work through this question is it group a group of individuals or is it individuals in a group and where i finally came out it's not one or the other it's both and because when you find yourself studying with students there are times when you see the work that you do as as individuals in a group and there are also times where you see the group in its totality as just a group of individuals and then she began to be more and more uh connected with the group process with the psycho-educational model you will probably find yourself floating back and forth between those those two images based on the needs of the group and the needs of your curricula that you sort of go through the other question i tend to ask myself is what is my goal for this hour what is my goal for this time is that the delivery of content is a group process does one outweigh the the other in that process and i began to ask myself you know in the next 50 minutes at the end of it where do i want to be with my students and where do i want my students to be so you really have to start within yourself and ask yourself the questions about how you understand group work the the second thing i would like to encourage you and this may be even more important how do you understand your role and how do you understand your function in the group and again this may vary from group to group and context to contacts but some of the questions that you may want to ask yourself is are you yourself a member of the group or are you sort of outside the group and if so what is the relationship between your role and the group of students that you sit with how do you create trust how do you step up and create an environment that will allow students to be successful to be vulnerable to succeed how do you create that environment of trust within your classroom now that can be kind of easy if you're going to be with students for six weeks it may be more challenging if you have one hour with them so you need to think about how based on the content context do i create that trust and how do you create challenge how do you give feedback how do you how do you step into those places based on the context of your group to help your students succeed are you comfortable sharing your own vulnerabilities and is that part of your image what's it like to share your own struggles in your own challenges with your students does that become part of your role does that become part of your you're helping the group process through their own difficulties and struggles and then finally what's it like engaging in raw emotions you know because the potential for moving to when you move into small group learning while some students may be really struggling to find their voice some students may have been just waiting for a smaller safer environment where they can start talking about the group process that they're experiencing within within the course of academia so you need to identify you need to start understanding what is your role and i would encourage you to find a metaphor find a metaphor that you use that you can apply to yourself that helps you give grounding that helps you give understanding to to the work that you do with small groups it may be facilitator mentor coach shepherd co-journeyer bear the light you know and the list can just go on and on but as you think about your role with groups and how you engage with your groups i find it very helpful to find a metaphor for your understanding of yourselves because that's a piece where you can always go back to and ground yourself when things are getting kind of wild and maybe the group is sort of going in a different direction if you see yourself as a mentor then you can always go back to that image when the group process stuff gets challenging because most of us are a lot better with content than we are with group process so finding that metaphor that grounds you when the group gets uh sort of goes a different direction can be really really helpful this is a great concept about catherine poisson just reminds us that learning is not truth being conveyed from us to the student but it's the the discovery process of all of us engaged in learning so as you as you think about your role is one of those images as a student as well and start asking yourselves what are these students teaching me what am i learning about who i am as an individual because i spoke earlier about how the work that we that we do can be really influential as far as professional development well sitting in that chair with students can do the same thing for us as well we can learn things about ourselves and our identity and how we relate and how we respond to students just as much as they can and sitting in a small group with us as well so let's talk a little bit about techniques so again i mentioned earlier that techniques are probably more important or more supportive than theories so i would i would encourage you if you're going to spend some time trying to develop your role as a small group facility facilitator educator mentor or whatever image you have start working on developing techniques in a word of caution i wouldn't just get a wild hair in the middle of a session say hey i want to try something without actually thinking it through and trying it out either putting yourself in that chair or observing someone else do that and on the next slide i want to talk about some of the some of the techniques that i have found that i typically like to use in working with students but just i would say if you're going to try something new do a mock committee do a test run you know talk it through with a colleague or observe it with a colleague before before you jump into that so so these group techniques i call them interventions uh need to be leading somewhere we don't do a technique or an intervention just because we think it was fun we need to have an understanding of where it's going to move us how does it help the group address conflict or resistance or silence or feedback our techniques need to have an object of why we're doing those and these are the three that i use pretty consistently the first is what i call framing you know if you're if you're with a group of students and you ask a question and the room goes silent well it often helps the student if you frame the silence and you follow that up by saying i just asked a question about x y and z and the room went silent what is the silence telling me and oftentimes if you can frame the group process it will encourage people to start talk of talking about that or you could frame well i see when student a was at the table and struggling with a skill students b c and d took a step back what is that behavior telling me about what you're thinking and what you're feeling so if you can if you can begin to frame what you're seeing behaviorally with the students it will help them step into that place and start talking about it the other technique that i use a lot is role play yeah i use this a lot with students and their interviewing skills with people uh and sometimes we'll sort of rewind and i have my students like write a lot of verbatims and i'll say okay let's sort of role play this we're going to do three these three interchanges as written and then let's just sort of role play and i'll step into a role and the student will step into a role and we'll let them sort of try a different way to engage in conversation or a different way to explain something so role play can be a very useful technique in a very safe environment and then they can get immediate feedback and direction on how to engage in conversations better and again any sort of problem solving activity if you challenge a group it sort of helps them come together they trust each other they start discovering what sort of individual skills and strengths that they bring to the process so anytime you can give them a problem-solving challenge or task that's a technique that students really love and remember said this earlier not only are we involved in the work of making that transition to small group learning we have to sort of help our students make that transition as well because students need to learn the the context about small small group environment as well one one trick that i've learned if you're going to be with students over several weeks or at least several days for several weeks ask the groups to think about what are your group norms you know as we you know we're going to spend the next six weeks together working on this issue as we think about what are some things that are important for group cohesion for process let the students actually come up with the rules of engagement for the group because from the get-go you help them to sort of invest and jump into that and then finally the last thought i'd like to share what's the biggest lesson i've learned and i'll be real honest i learned this the hard way i discovered that sometimes i find myself over working in my role in the group and when i find myself if i if i become aware that i'm working harder in my small group than my students are then maybe i need to ask myself the question huh why am i doing that it may be because i'm carrying the group's anxiety i may be carrying their fear i may be carrying their confusion i may be carrying the dynamics of the group but the bottom line is it may be the fact that i'm just uncomfortable with our silence and i have not yet developed a way to frame that silence in a way that can be helpful and healthy for the group so if you find yourself in the midst of your group if you feel like you're overworking or if you're working too hard that's a good indicator that you sort of need to sort of take a step back and let the group sort of step into that process and learn how to facilitate the group moving into that with you in the process and then finally here's just a short bibliography of some of the works that i read as i was going through my group process development that were pretty significant for me so these will be posted i think in a couple days on the on the chief website so you'll have access but these are some of these are old tried and true uh historical stuff some of them a little bit more modern context but these were some of the some of the texts that were very info influential to me as i sort of uh began developing my group understanding of small group learning so thank you for your time to letting me sort of uh talk about really my journey and my experience with with group work so i just want to open it up so what what questions or what about the parts of this have really resonated with you in your understanding of small group learning thank you richard this has been great um i think we can apply these techniques that you've discussed um whether we're at crewing clinic teaching to nurses residence fellows or other healthcare providers or virginia tech kerillian school of medicine if we're teaching to our students or at radford university krillin for their myriad of variety of healthcare professionals some of the some of the conversation that we've had going on a little bit behind the scenes um was just the acknowledgement that um small group learning just like feedback is so incredibly relational and it's important to have that comfort level with one another and it is so different than the large group experience and so much more customizable and easier to customize the learning experience way more than let's say if you have 55 participants in your session just really establishing what the learners know on an individual level and complementarily as a group um and really just the importance of being flexible if you're using the task model in full recognition that you may not be able to accomplish all of your tasks because again that quality over the quantity i think is is going to be such an important element of the small group teaching experience are there any other questions that please feel free to unmute yourself or and or um show your video if you'd like to ask a question or just share a comment uh somebody else did comment um very similar to how i feel a lot of the times you mentioned role-playing um and role-playing is so uncomfortable i think for a lot of people that to me i i tend to only use role-playing if i know a group really well and we're really grooving and um and or another approach to role-playing might be to um have established role players ahead of time so maybe people are more observing the role playing experience rather than participating because you can be it's such a vulnerable situation but if you do it well it can be done uh very effectively yeah and i would definitely say role play is the one you wanna you wanna uh practice beforehand you just you don't wanna be in the middle of a session and say hey let's try a role play and you really don't know where you're going or whether whether that's going to lead you so role play is one of those that i would definitely encourage you to sort of play out and think through and and prior to actually getting in the middle of it excellent what do other folks have to say or any questions richard just a comment uh richard thank you um you you ignited my uh the fact that i really hope cove dissipates over the next in the next academic year because uh we so much miss that interpersonal relationship and it's difficult to do by zoom for us right now or whatever but i'm doing an elective for with the students and it's it would be so much better to be in person truthfully yeah and it allows you to become a group together a oneness if you will and vacillate back and forth as you discussed between the is it a group of individuals or individuals in a group and uh that was a very good point i like that point very much thank you yes it's really difficult to see a per a person swarming in their seat you know when something is feeling uncomfortable for them or something is presented that's a totally different concept for them you know if you're physically with them typically there's a bodily behavioral manifestation of that that's really hard to pick up on zoom with that so uh i've gotten better with that over the last eight months but it's still not like sitting right there in the room with that yeah you missed the gas you missed the oh you know you miss all those other things that that that are that behavioral part of that is really challenged on zoom yeah you're right and there's also a different feel of cohesiveness um when you have that proximal feeling of just the same people in the same room you know talking about the same stuff yeah so one of the other things i was gonna say is you can take this small group philosophy and you can actually do it with larger groups uh it's a little bit different but uh but like for example i do i do a session with the m1s at the med school it's called remembering your first patient and we do this after that second week in anatomy lab and it's a time for them to talk about the experience what they're learning what they carried into that now you can actually get larger groups actually this year as 49 you can actually use some of these same dynamics to help them sort of process that in a larger group but again it's going to be a slower process than if you did that with four or five so so there's really no cut off for numbers it really is more about philosophy and understanding your role in helping the students move into that role as well other questions comments richard i would um first of all thank you for so many things this morning but um your emphasis on the benefits of small group teaching and learning especially when you talked about the the opportunity to emulate professional practice um and two thoughts came to mind for me um it is striking to me how punctuality is a non-issue in undergraduate education showing up for lectures um nobody's nobody's watching you and as you know in in medical school um students have found other ways to learn besides going to lectures so with without a small group um to remind students that when you meet at eight mountain icu at 6 30 in the morning it means 6 30 in the morning because patients are related to this thing and a team is waiting for you and i don't think it at our medical school we have many opportunities to drive that point home other than small group learning so i thought that was a great great lesson for us all and the other the other um emulation of professional behavior has to do with the moment when two students have a different answer to the same question and when uh when a doctor and a patient disagree you know the first thing that the doctor needs to do is listen to the other side and we can watch that play out in a small group very very often and and what a lesson uh when there's disagreement to be the listener instead of the speaker so great points thank you yeah yeah and you need to move it to a family meeting now if you're sitting down with a group of family members it's really the same context we have family members have a different right answer and how do you sure listen to all those different opinions and sort of bring some consensus to the to the equation with that absolutely and in the same way that students can't um you made the point earlier that small groups are different students can't hide in the in a sea of faces right um in in the same way the teacher can't hide behind their powerpoint or hide behind the podium or even in cases of you know bedside teaching can't hide behind the patient experience this is a real live conversation that you're having um a dialogue that you're having uh amongst a group of individuals with um some shared and some really varied experiences and you just have to explore that as a part of it so that's where it comes to the quality over quantity too i think yeah and part of that sherry i think i think sometimes we have those encounters where we get touched as well and when conversation with a student and something touches part of our history and part of our persona as well and all of a sudden we get this burst of emotions and feelings inside of us as well and i think learning how to navigate those learning how to filter those as we go throughout the work that we do is also a very valuable skill that we need to learn and being aware of those as a small group facilitator uh gives us the chance to understand what we do when all of a sudden the grief of my dad just sort of wells up within me and i'm in the middle of a conversation you know having those small groups experience gives us gives us a place to start trying to figure those things out uh so we don't leave a patient's bedside shopping you know so absolutely it's part of our own lifelong learning process and it does model uh you know what things will be like in your long-term career for these learners um you're not immune to those emotions you're not immune to those things once you um get in to a grow into a faculty role it's still the same but you will handle them hopefully a little bit more expertly yeah right yeah all right anything else as a reminder sandy has posted in the chat um links to both uh acquiring cme and or faculty development related to teaching so just follow those links and answer a few quick questions and you too could have credit for this session so otherwise please enjoy your day and enjoy hopefully you all will find some sort of relaxation in amongst the craziness during this holiday week and please be safe thank you you.