So, that's when I really, really began to let myself feel that self-attack, actually embrace it and welcome up this deep anger. And initially, I felt anger at being sick. That was the first level I could get to.  After all these years, after all that I've done, I still feel sick. I still feel a lack of well-being. And then dropping below that to, is there anything else I'm feeling angry about?  All of these I felt through, felt through, kept dropping down below that, anger at God, and then finally deep, deep anger at the self that I thought I was. And so, just perfectly in a line with what you were saying. And in that, I felt a discharging of this tension that had been in my system for so long that I just learned to live with. You know, just like this tension in the shoulders and the tension in your stomach and just an overall kind of shaky feeling. The more anger I released, the more calm it became. Because I always thought being calm and peaceful was a matter of calm down. You know, just simmer down, calm down, as opposed to welcoming up that which seems to be the epitome of lack of calm. Welcoming, chaotic, very, very stressful and peaceful feelings to the surface. And through doing that and embracing that and accepting that, those underlying thoughts and beliefs became very, very apparent. And at that point, I started to get dramatic, dramatic symptomally.  I used to be so physical and so vital and I could hike up mountains and stand at the top like Rocky and just feel on top of the world. And for years and years, I didn't have the energy to do any physical exercise of any kind and basically just get in my car, go to my office, come back, make some food, relate with a few people, go to bed really early. And if any of you have experienced chronic fatigue, you really start to have a very narrow life because there just seems to be so little energy available. So the energy started to come back and I had to own, why did I want chronic fatigue? What torqued purpose was it serving for my ego? Because at that point I really got, we are always without accepting, experiencing what we want on some level. So looking at how I wanted to withdraw, I wanted to not be available. It was my way of saying no to all the obligatory giving that I was doing in my life, all the people pleasing. And so I had this handy excuse, I can't do it, I'm just too tired. I mean you certainly understand, how could I possibly say yes, I'm exhausted. And people were very convinced by that and I got really convinced by it. But as I saw that it was all a means of punishing myself, punishing others. And just on the deepest level, like we were talking about in our expression session this morning, just the outpicturing of the guilt. That's when my heart started to open and I began to feel that, wow, there really is no external cause whatsoever. It has nothing at all to do with anything in the physical. It has only to do with my relationship with myself and my relationship with my feelings. So chronic fatigue was this beautiful gift to me to confront lifelong patterns of self-denial and self-abuse. And self-hatred and identifying with that which I am not. And I'm telling this story quickly, but just so you get the realistic sense of it, it took about six years to go through this whole internal journey until the energy began to flow back again. And even then, I was still focused on symptom relief. I thought that was the miracle. Oh my God, I got my energy back. Wow, I wanted to shout it to the rooftops. I wanted to write a book about it. I wanted to start to do seminars. You can heal anything. And the spirit showed me another layer that I think we're all really falling into now. That the healing is not the symptom relief at all. That that was a byproduct. And what was really healing was the mind misidentifying and adhering to beliefs and harboring repressed feelings that weren't the truth. That was the healing. That the body seemed to follow suit. But it really wasn't about that. So you can see that we could reframe it from just kind of symptoms to starting to take it underneath a little bit like, hmm, I'm trying to avoid something with the sickness, like she was saying, really trying to avoid the people pleasing. And I think most people can relate to that a bit like when we're in school and school starts to get so routine, so methodical, so boring, so intolerable that all of a sudden, you know, oh, I'm sick today.  Andy acted it out with that. That's the happy look of sickness. Right, right, like having a joint. Or no, thermometer. Thermometer, oh. It has almost generations in it. Thermometer or a joint. But instead of avoiding the sorrow, for me, I really did not like to go to church. So I would just kind of wake up in the morning with this ghastly feeling of having to be forced to go to church. And so I would just stay in the bed and I would just go round and round around in my mind about how I did not want to go, because I focused my full attention on not wanting to go to church. And then slowly I would work my way into a fever, a pretty good fever. And then once it really, I got worked up pretty good. And I'd write Mom in and say, come in. I don't feel really well under the covers. And she'd say, oh, well, I don't know. We have church today. And then she'd kind of say, you know my forehead.  Yes.  It wasn't like offered as a choice.  Do you want to go to church this week? No, it wasn't offered.   So the self-concept is so firmly held in place and it's such a feeling of being suffocated or trapped that sickness seems like a pretty good option. Like, well, there's one option I can do to get out of going to church and that's to make myself sick. And of course, people do that in various professions, you know, where they just start to get a real burnout of the job or the career and then how convenient sick leave or sickness and it can even be more of a plan of like, okay, I can't really tell my boss that I'm going to quit or I can't really voluntarily do it, so I'll just make myself sick, get all the pity of everyone involved, all the poor baby, and then if I make myself real sick, that might get me out of the whole thing completely.  You see, this whole thing is all invented and really what we're seeing is sickness is often used as an avoidance to face some kind of issue deeper down in the mind, which really would be good to put your full attention on, what is that that I'm not facing? What is that that I'm hiding? And it's this causation thing that Noel's mentioning that the basic underlying assumption underneath it is I've got problems and there are problems in the world and I'm going to have to do lots and lots of very complicated things to try to extract myself from a very, very, very tangled mess the way that it seems on the surface and when you start to say, wait a minute, no, no, no, this can't be that way, it can just be an invitation for me to go much, much deeper inside and if I'm really willing to do that authentically to go much, much deeper inside the Spirit will give me the means of support the people, the symbols, everything I need if it's such a glorious purpose and the little chart that she laid out she was delighted to say, oh, this was like your little chart, your rings it was very, very similar it's like what that is in her sense the heart speaking, giving her intuitively a map of the mind or a map of consciousness and saying, okay, you've got to get your causation straight what you seem to have or do or perceive is really the bottom of the line it's really the end point, it's not the causation at all and you see how different that is from the typical human belief that, oh, I would be much happier if I didn't have this dead if I didn't have these symptoms, if I didn't have that's what much of your life was thinking, if I just see the right specialist and I can just be lifted from this specific problem that will make my life so much more easy and yet, it just, the ego's like, okay it's fine, a temporary solution there it just shifts over here, try this one or try this one or try this one it's like a dam breaking loose and you're running along with pebbles and stones and clay to plug the dam and the water is coming through everywhere it just gets to be unmanageable you think, my life is a total mess, it's a wreck and you can always turn on the TV and do the comparison thing and say, well there are people that have their lives together but my life is a total mess the dam is breaking on all fronts and that little piecemeal approach of running up and down the dam and frantically plugging rocks and clay and to try to stop the many holes that are just popping and you plug a few and ten more pop open that's where the depression can come in that's where people get suicidal when they have holes just popping and popping and popping and they still have an ideal that there are these healthy people well adjusted people that are living happy lives like they all look at the commercials for vacations, there they are going out laying on the beach towel and vacationing and the cool breeze blowing by and all these problems, how can it be and you can see where it can get projected onto God it can get projected onto yourself the body self and it just won't go anywhere so that's part of what we've been talking about all along I can give the metaphysics but then at some point it just has to be this this switch to I am not going to play this game anymore of looking for causes in the world and believing in causes in the world and trying to handle an internal problem with all of these externals I mean, all of us sometimes it's the school of hard knocks before we start to be ready I guess to hear that we have to look inside and we really do, it's not just kind of like well that's one option in life to look inside it's like so important it's actually crucial that we do that and that's what we're here for we're here to facilitate that


All right, this is super exciting. So, you know, by a show of, no, let's not do that. Let's just clap because it's a good day. Let's give each other a hand, a round of applause. It also wakes us up a little bit. Sometimes I make people stand up and do that and then I take social and like, look, I got a standing ovation. No, I would never do that. But really excited to be here to close out. We have just a few minutes left together and I thought it would be a great opportunity to hear the story that often we don't get to tell, which is, you know, how we got started. What was that moment that we were like, let's do this, or maybe even a moment that encouraged us to stay? Our hero's journey, if you will. So, if you wouldn't mind, we actually have a recording that we're gonna be doing that other people can see, so hi to everyone on Zoom. But also later on where we're collecting lots of different people talking about their career in tech and how they got started. So, we wanted to take a moment and contribute to that as well. So, Charlotte, maybe we'll start with you. Give us a little bit about yourself. Okay. My name is Charlotte and I grew up in an inner city school. It was a place where I had a high poverty rate. My dad died of cancer when I was 15 and my mom entered a mental facility shortly after. So, my high school years were not filled with basketball games and theater. Those were in fact the things I gave up to take care of my mom. And I did manage to get a scholarship for college at the school that I wanted to go to in Florida. I was in Michigan at the time. And I couldn't take it because the amount of money I would have still had to pay was more than my family made in a year. So, I took a scholarship to the local community college instead and I did pretty well. I liked my classes but I was working multiple jobs in order to support my family and I missed one too many English classes. The teacher had a policy that you weren't allowed to miss a certain number and so I lost my scholarship. I wanna share that story at the start because where you are now, if your family's circumstance is not ideal and even if you experience a major setback like flunking out of college, even community college, it doesn't mean you can't go back. And in fact, I went back five times. And the fifth time, I went to Harvard. So, you can still go to Harvard and flunk out of community college. That is my story. Go ahead, Ms. Renee. How far back? Four score and... Oh, no, just maybe turn it on. Okay. Okay, I'm sorry. So, I think I shared some of my journey with you. My life has been very non-traditional and I have done many things. I think growing up, I was always very curious and sometimes a very curious student could also be a very disruptive student. So, I would say my high school journey was me on a quest as my teachers would say for entertainment. And I think I also spoke so much in class, sometimes being so disruptive. My principal said to me, she prays that I'll be able to make a living speaking. Actually, I've done that quite successfully. I say that to tell you that one of the... If it's one thing that I want you to remember is that question and I spoke about it about imagination and I continuously over my... And I continue to imagine now, always imagined myself doing something. If it was working in fashion, if it was working in music, if it was broadcasting, if it was meeting certain people, I think in my own journey, I got the opportunity to meet women who really inspired me. Among them would have been Dr. Maya Angelou, who I was able to spend an extraordinary amount of time with, able to interview as well, and really informed much of the ways in which I have tried to live my life. I always come from a place of justice because I have so many friends and people who I care about who have had interactions with the criminal justice system that have been far from favorable. And really it's always about just finding ways in which we can make society more equitable. As I said to you in my presentation, I am very committed to legacies and I always think in the work that I do, how could I enhance an individual's opportunity to build an extraordinary legacy because we inherit a legacy and then we are able to create our own legacy that our generations are going to inherit. And one of the things that I have seen in particular with technology is how technology has a way of undermining in real time your ability to acquire a really sustainable and resilient legacy and just wanting everyone to be able to imagine the things they want to do and the things they want to be and have the kind of opportunities and access to create that. So I think for me it is always about justice, equity and inclusion and ensuring that we have the kind of diversity because diversity and imagination is what this world was built on. Wonderful, thank you. That was awesome. So my journey into tech, I think I restart my journey into tech every few years. Like I recommit to going back in to the technical world but my first introduction actually came more from understanding what I was good at. So I've taken, I take lots of tests on like personality tests. I took recently an enneagram test. Anyone know what that is? Anyway, it's another kind of test. I've taken the Myers-Briggs and the, it's like called Colby A, anyway, all these tests. And in attempt to figure out like my purpose, like what am I here to do? What am I inherently good at? What I figured out that what's the best way for me to contribute myself to the world? So I take all these tests and it's very interesting because a theme that I saw very early on, and I was trying to figure out earlier like why I ever did this. But in my young, I was like 16 years old. I was given a chance to share, in front of a bunch of people, my experiences. And at that time, it wasn't, it was Hurricane Andrew. I don't know if you all, you wouldn't remember it but it was a tough time. Basically this huge category five hurricane came and blew away my entire town. I don't have any pictures of myself as a baby unless my grandmother gave them to me before she died, which like four. But I have no pictures of myself as a baby, as a young person because all everything got destroyed in that hurricane. And it's weird what happens when everything gets destroyed and you lose that like looking at pictures. As a result, my poor children, I take pictures of them all the time and I make them look at them all the time. Like, look, I don't have this. You should look at it. But I got interested, that made me realize like in telling that story, so many people were like changed. People came up to me afterwards and they're like, oh my gosh, I thought I was the only one who felt this kind of weird emptiness when that happened. And all these people were impacted, not in like a dramatic, oh, you did a such an amazing speech, but in this like teary-eyed, I'm not alone kind of place. And I was like, how do I use that? And so when I first got into tech, someone told me that I would make a great teacher. And I was like, oh no, I'm a terrible student. And they're like, oh, it doesn't matter. Being a student and a teacher, not the same. But what happens is that you make tech relatable. So my first job was teaching a programming language I did not know, Java. I was teaching Java and learning Java at the exact same time. And I learned something. Actually, there's a movie called, I can't remember, but it's about a con man with Leonardo DiCaprio. Catch me if you can. And he said, he ended up becoming a professor at a university for like a couple years and no one ever questioned him. And at the end, the FBI guy was like, so how did you do that? How did you end up staying like credible? How did people still come to your class? And he was like, oh, I just stayed one chapter ahead of my students. And I literally did, I mean, I'm not a con person, but that's what I was, maybe I was at that time. I was a 22 year old Hispanic, Latina teaching Java to cobalt programmers, none of whom looked like me. They all called me kiddo, like legit kiddo. Kiddo, can you get me some coffee? I had a guy cut his nails in my class. I had another one, pull up the newspaper. We still have those, I think. But at the time, pulled up the newspaper and read it while I was teaching. I only later found out that the male instructors never had this happen to them.  Like, I was terrible. But the reason I mentioned this is like, that was my first job. I was going in and I immediately, there's a little short I want to encourage you to go take a look at, it's called Pearl. It's by Pixar, the Toy Story people. And it's about a little ball of yarn who goes to work and goes to work in like Silicon Valley, Bro country. And what happens to that ball of yarn? And it ultimately happens to a lot of us. And NPR has a podcast on this, as well as a movie was just created, it's called Code Switching. Have you heard this term? All of us do it. The funny thing is it knows no gender, it knows no ethnicity, everyone switches. And the damage that's done when you decrease who you are to be accepted by the people who you are not, it changes the way you perform. I didn't realize this at first. I noticed it over time. But I then became a huge advocate for authentic communication. And guess what? In a technical world, it's an anomaly. I am one of very few people who talk about this. So I began to, there is now an entire profession called technical evangelism, developer advocacy. And you can have a job paying you six figures where you teach people other tech that you just learned. Literally, that's the job. You learn it, then you teach it. You learn it, you write a blog post. You learn it, you do a Twitch. You learn it. If you're into tech and changing all the time and you like I'm one of those people, I need new tech all the time. Advocacy worked for me. My job was to help people who were one chapter behind. I didn't know that that was a job. Otherwise I would have purposely gone after it. But I'm telling you, like there's so many jobs available that, and actually I've had companies say to me, well, what do you wanna do? Those are good companies. What are you good at? What do you care about? And then they make a role that fits you. That doesn't happen everywhere. But here's the sad thing. What if you don't know the answers to those questions? What if you've never thought, what am I good at? What would I wanna do if somebody asked me? What job would I get if I could pick the job? Because you might run into a leader who asks you those questions and is serious and will give you the role that makes your internal, personal, it basically is that blend I told one of our breakouts of getting everything you want, doing something you love, getting paid to do it, and then ultimately sharing it with a community. I mean, it doesn't get much better than that. But yeah, my journey, that's how my journey started. So what one thing I did wanna do is, I don't necessarily want it to be a sad story, but I know all three of us have gone through some pretty significant challenges in our career. And I do know, I want you to know that they are overcomable. Is that a word? I'm sorry, English people. They're not easily overcome, but we do overcome them. I always say we've all overcome 100% of our bad days or we wouldn't be sitting here listening to us talk. So I'd love to talk about maybe one of your bad days and how you overcame it. I guess I'm going first again. Again, yeah. So 2008, perhaps you have heard of the dot-com bust. At this time I had been creating things. I may not have had a college degree at this time, but I guess it was 2006. Little bit, well, let's see. We gotta back up even further. 2003, 2003 was the time of this dot-com bust. I did not yet have a college degree, but I had made a bunch of tech stuff and I was working in tech. I had had some college courses enough to get a job and the most important thing there is to actually make things and be a creator and have things to show a portfolio that identifies your work and that is how you get your first job. It will not be the most awesome job and you do it anyway to get the experience and skills. So I had been working in the dot-com space and 2003 was the time when things were shifting technology-wise and my husband and I both lost our jobs on the same day and we had a six-month-old at home. So we very quickly had to find new jobs and pivot and that was maybe not the best day and it ended up being a long process, 2004, 2005, 2006. Every year you're needing to get a new job because the companies are closing or the workplace is shifting or you need a new skill set and the way that we solved that problem was to move. We actually came here in 2008 to the Raleigh-Durham area because the job market was better here. So when you're solving a problem like facing unemployment, you may have to make a shift in either the work, the type of work that you're doing or the place that you do it and for us that meant moving away from family. So I just wanna say one way that you overcome is to work the problem and sometimes the solution might not be what you expect. By the way, I'm glad I came here. I would say for me a very long time ago I stopped looking at days as good and bad and just introduced the word challenging in my vocabulary. So some days we're definitely more challenging than others but I think I come from a place of a very strong faith and whatever day that is and whatever I'm dealing with on that day, I always believe it's something that's going to make me grow and something that is going to make me stronger and something that is going to strengthen my resolve and that's the ways in which that I have dealt with challenges. There is no life that is unchallenged. There is no experience that goes wasted. Many times I would ask myself over the years, why was I doing this or why am I doing this? And I had many careers and many times people will say to me, why don't you settle on one thing? Why is it that you always have to do so much? Why is it that you just can't focus on one career? Why do you need to do three and four things at the same time? And I think now that I speak a lot about the interdisciplinary imagination and now that I bring such interdisciplinary skills into technology, I realize why I was doing all of this. It all eventually comes together. So for the days that people would say are bad, whatever it was and I have had moments, trust me, I have had many moments and moments that make you cry some days, moments that make you question yourself some days, moments that just make you feel as though whatever you're putting into this thing is somehow not working for you. But those are the times I think for me that I really said to myself, there is a lesson to be learned from this experience. And not every time I have been open to those lessons, but most times I've been able to really gain the experience and the knowledge from that moment. So what I would say is as you navigate life, you too would realize that there are some days that make you question yourself and some days that make you feel challenged and some days that make you feel overwhelmed. But it's just one day. It is just one day sometimes, it's a few days and it could feel like a lifetime. But eventually you're able to negotiate and to move past those obstacles. So it's really just about believing that in you you already hold all the potential and all that you need to do the great things that you are destined to do and let no one day or no one month or no one year ever make you feel that you are not going to reach that potential. That was amazing. I'm like, I can't go after that. That was amazing. What was the question? Challenging, oh yes, okay. So I was going to tell you all about a very specific time where I did, and I actually do, I go in these, throughout my career, I've worked at some of the best companies, but I've also had some of the worst experiences. So I'm like, sometimes I think to myself, I don't wanna do this anymore. I've often asked myself, do I want my daughter going into tech? Do I even wanna approach it as a thing knowing the challenges that she might face? But the hard part, one of the hard parts I realized was not about the technology. It's almost never about the technology. It's about the humanity. And I was actually in my last year, I didn't know this at the time at Amazon Alexa, and I went out on maternity leave. And I took it, which not everyone does. Most people take the minimal amount and go back to work as soon as they possibly can. It was just the Amazon way at the time. I didn't, it was my fourth child, I presumed probably the last one, like I was having, I had a lot. And I was like, I'm gonna take this, I'm gonna enjoy my time. I even did 100 days of Jocelyn on Instagram, like took pictures every day. Anyway, thoroughly enjoyed it. I got back though, and my manager changed, had changed over that nine months. I was gone nine months, which is a long time, but nine months that I was gone. And no longer, like she was my champion when I left, like as I was a hard worker and I done a lot of stuff. But when I came back, I was like irritating her, I could tell. So much so that I stopped getting asked to come to certain meetings, and then eventually I stopped getting asked to participate in projects that I started. And I was like, what is going on? So I, you know when something's bad, right? When something's not going well. So I sensed it and I was like, let me just find another opportunity, which I had done before. I'll just find another place, go to a new team. Cause obviously something happened with me leaving. I don't know what happened, but anyway, it's not working out. So I go to another team, speech recognition actually. I get, go through the interviews. They love me, everything's good.  They're super excited. They give me a verbal offer. I'm like, awesome. Let me know when I, you know, when we can start. They have to do the formalized paperwork. Well, two days later, I remember it was Christmas Eve.  I get a call from that person who had given me the verbal offer, the team lead. And he, his voice was really weird, like cracking and nervous. And I was like, what's up? I'm super excited. He's like, yeah, so I'm gonna have to rescind the offer that we gave you. And I was like, wait, what, why? I talked to everyone on the team. I've talked to your leadership. Everyone's excited. And he was like, I can't tell you why, but I'd encourage you to talk to your manager, who was this person who had basically started cutting me. I'm like, why would you even talk to her? Like, what does she have to do with this in my future? And he was like, I can't tell you. You're just gonna have to talk to her. And I immediately started crying and was like, how is this possible? How can someone have so much power that they can completely disintegrate my career? Like that in a second, how is this possible? And of course, to your point, my entire life was built into this one moment where I was like, this is everything. This is me. This is my work. This is my worth. Of course I got through that and I always say work hard and silence and let success be your noise. I never go back and rub my success in my manager's faces, maybe a little bit, but not really. But what I did realize though, is later, years later, the person who ended up telling me that they couldn't hire me, even though they wanted to, was at Twitter and he reached out to me and was like, hey, I wanna hire you as a TPM at Twitter. And I was like, yeah, I'm not going to Twitter. Not for any political reasons, just I didn't wanna work there. My brother works there. No, not gonna go work there. And he was like, look, I wanna make right what was wrong that day. And I was like, tell me more. And in that moment, after years, I was vindicated. Like, okay, it wasn't about me, but I will tell you in that moment, I thought, I questioned everything. When you have a bad day or a challenging moment, you question yourself, your goals, you're like, are you on the right track or are you the right person? And it often has nothing to do with you as this had nothing really to do with me. But you have a choice in that moment to act on that and take the direction of, oh, it's me, I should do less. Or to take the other path, which is, I know who I am, I know what I want, and I want to do more. And that's when people around us start saying, no, well, my goodness, you don't have to do all the things. You don't have to be in all the things. You don't have to have a startup and be an entrepreneur at a company. You don't have to be talking to high school kids and Fortune 500 CEOs. Like you could just sit down, you could rest, you can enjoy your family. And I do all those things, but I choose at the end of the day. And so my hardest day was that day where I now look back on it and I'm sad that I questioned myself. Like I literally was like, am I not supposed to do this? And how many women, since I've shared this story, have come up to me saying they have these moments all the time where they're like, is it me? Am I not supposed to be here? And sometimes it feels like you're not supposed to be in the room when you're the only voice saying what you're saying. And so I encourage you all to just keep, be one, self-aware of what you want to do and what you want to be in this world, but then also be willing to stand up for yourself in these moments when you're starting to question. The last thing, and we'll start with Renee, so you don't have to go first. The last thing we want to do is kind of do a bit of advice, right? If we could tell our younger selves or just tell you what we would do, either as a first step or a next step to move into technology, what advice would you give to all of you as we push you out of the nest into the world of AI? What advice would you give them? To my younger self, I would say be kind to yourself. That is the first thing. Don't be too hard on yourself. Celebrate yourself because every day, every week, every month, every year, it's a milestone. Be kind to yourself, celebrate yourself, and understand always you already have in you that unique ability and extraordinary potential to be what you want to be and do the great things that you want to do. If you've imagined it, you've done it. Now just go out there and do it. So that is what I would say. Thank you, Charlotte. Well, first I want to say what you described was a crime and you should have had people there supporting you and I'm sorry it happened, but she's a survivor. I think what I would say as advice is that you have the ability to do the things that you want to do, but you have to scrounge up the motivation. And if you are not motivated in school, it doesn't mean you can't do the things that you want to do, but that you have to do the things that you want to do and not just hope for them. It's not really about the grade, it's about the doing.  And for the most part, you can do it. I'll give you an example. I am a girl who loved baseball. And shocker, girls can't play baseball. I mean, literally they wouldn't let me try out for the team in high school, but I loved baseball. And so I got a job at our minor league team the first year they opened, I ran a scoreboard, I worked in the press box, I ran a camera for the Detroit Tigers, I've worked in the audio booth for the Detroit Red Wings. And so I got to do the thing that I wanted to do, which was watch baseball every day and get money. And so it might not have been on the field, but I did get to drag the field with the tool out there and the fifth inning or whatever. And so find a way to do the thing that you want to do and it's probably some terrible job to start, but start and don't let your current circumstances determine your future. You make your future. Awesome. Okay, my advice, I would have to say, I forgot my phone, you know I gotta take a selfie with these ladies up here. My advice would be around network. It's why I take pictures and because I'm traumatized from Hurricane Andrew. So I take pictures of everything. But, and you know, terrible, funny story. I guess I attract these experiences about five years ago. I was moving, I loved what you said about just move and sometimes that's weird. I have moved for tech. Well, my entire career, I go where the tech is and it's offered me incredible opportunity that if I wasn't willing to move, I would never have worked in Amazon if I wasn't willing to move to Seattle. I would never have gotten where I did at Alexa if I wasn't willing to move back to Cambridge. And in that move back from Seattle to Cambridge with my family, I was pregnant with my fourth child. A trailer that all my stuff was in caught on fire. So everything we owned burned. And I then got to see what my parents I guess saw in the trauma that my kids endured losing everything that they thought was important. Here's a cool thing though. I am not very materialistic anymore as a result but now my kids really aren't either. They don't, they just don't think about things the same way when you realize how fragile and just non pertinent and permanent things are. So, but weird, right? Like Hurricane Andrew, then I never put that two together. But I've learned to let go. And I think that's part of what keeps me in technology is that I let go of things. I learned cloud. It was, I was awesome at it. It was my favorite thing. And then AI came and I became a voice person. And I voice became my favorite thing. And then I learned about computer vision. And then computer vision became my favorite thing. And then I learned that people were getting hurt by technology and now AI and ethics is my favorite thing. And none of that was connected. Like it just, I keep myself open. But the number one way I got to do everything I did was because I created a network of people everywhere I went. Every stage I got on or every stage or audience I sat in, I took pictures, I tagged people, I connected with them on LinkedIn. And that is everything I do now comes from someone I know Renee is here because we met, you know, we didn't meet in person at first. We met on a social media network, talking about the same stuff. We found our tribe remotely, but you never know. Like you could end up being on stage with someone you're meeting here five years from now. I always tell people I spoke at Girls Who Code five years ago. And this girl was in this session. A few years later, she sent me a message and she was like, I'm so glad I heard you speak back then. And I remember when I read this, I cried because she sent me a message on Instagram. And she's like, I just want you to know that I decided to go into tech, to stay in tech. And I just got my first job at Microsoft. And I was like, that's my baby. I barely knew her. I don't even think I knew her, knew her. I know her now, because we're friends now, but she ended up doing the thing because she saw someone who looked like her. Someone who was one chapter ahead. Okay, I was a little bit further by then, but just she could see it. Here's the key. If each of you share even a little bit about your journey as you move into some of the technology we talked about today, someone looking over your shoulder is gonna be like, okay, well, if they can do it, I can do it. And you never think what you do is important until that person comes up to you and go, and tells you, I took that job because I saw you do it. And it is life-changing, and you don't have to do anything. All you have to do is be willing to share your story. So sharing your story, be willing to create real connections through social media, create a network of people you actually will talk to. I think that is probably my biggest advice. Care more about the people than the tech. The tech will change, but the people over here to stay. Oh yeah, thank you. Let's give a hand for all of us. Thank you very much. All right, I'm looking for someone who knows what I'm doing. Okay, are we good? Are you gonna come up and do your thing? What's that?  I was gonna wrap this up, but let's get one more round of applause for the panel. Oh, and really quick, if you all wouldn't share just the best wafer that I selfishly told you about my Instagram, but if you have a way for them to connect with you, do you wanna share that really quick? Sure, any social media platform, as well as the University of Virginia's website and Columbia University's website. My numbers are there and my email address is there. Renee Cummings, everyone, thank you. Yeah, I do AI, so I'm afraid of social media. Charlotte at aiedu.org, or I am on LinkedIn, so if you are looking for a connection, friend me. Thank you. Thank you for the privilege of your time. Always.


There are a few, there are some changes that I wanted to make in the, in the, in the course you promote for residents, but this topic still applies, so they can, they can present, they can talk at the end of this. Do you want the lights on or lights off? For us it's good for you. As long as nobody falls asleep on me quite yet, I am good. It is okay to me, for me. I am Luca, I can't remember if I met any of you last time, I was here about a year ago. I am a value engineer that reports through hospital and clinics, so I had, but also I work with the School of Medicine and various other colleges, both with the graduate medical education program as well as the undergraduate, undergraduate education. So I've had the pleasure and the opportunity to work with learners of various experience, primarily in teaching aspects of quality improvement, value as well as cultural transformation, etc. My background is that I have been assisting, learning with other people for the last 10 years in healthcare. I spent five years at Intermountain Healthcare where we developed what they now call the continuous improvement framework. And then I came here to work with the academic and research enterprise. I actually, and I didn't mention, but I also work with the CCTS and the tri-innovation network in assisting researchers and removing barriers to participate in research as well. I was thinking about it, usually my approach is for this one-hour sessions, which I don't mind, but like I said, there's a lot of information and I end up talking a lot because I feel like I have to convey this information, but ultimately because then I have this naive belief that if people have questions, they can always reach me later and I can answer them, etc. Sometimes people don't have time either, though. Still, there is some information that is going to be conveyed to you, some of it is going to be familiar, some others is going to be new to you. I would like to challenge you to at least have one big idea. And what I mean for big idea is there's a lot, at least capture one thing, one concept, one principle, one tool, one idea of how you can use, you can take all this all in and help you in your practice. And I could even make it broader, I could say, I don't want to be like, how can this information help you in your life because as you're going to see, you're already doing these things, this is nothing new. It's how I'm packaging it that is going to be sounding like, hopefully it's going to be like, that's pretty cool. But one big idea, one concept that you're going to take out, take away with you, that can help you with your current job. Quality improvement. You can read this slide, but I'm going to ask you anyways. You've heard it, what does quality improvement means to you? I like it. Yeah, doing something, something better. Anything else? Sometimes to get better outcomes. Are we going to simply get better outcomes? Right. Is the focus of quality improvement always... It's not a trick question, I swear. Is the focus of quality improvement always to improve an outcome? Because ultimately it is. But sometimes you can't quite get to the outcome right away. You have to focus on other things. I briefly mentioned them here. There are outcome metrics and there are process metrics. The focus of your quality improvement project, let's use that term for once, it may actually be to just focus on those process metrics. Because the outcome is just too big. You can't focus on that quite right away. Quality improvement. This slide also mentions something else, the word systematic. Can you do quality improvement without actually thinking things through? It won't be very good. It will work. I don't want to say you can get lucky. But it does happen. You can just implement a change without a system, without a method, and you just may get lucky. And that's probably solved. There is this... Another challenge that I have is that the term quality improvement to me is somewhat diminishing. I use the term process improvement for a broader reason. Because quality is one aspect of what we're trying to achieve. Improving quality is one aspect of what we're trying to achieve. I want to show you the value of the question in a moment. But ultimately what creates quality, what creates cost, what creates service is driven by processes. What you do every day, coming to work, scrubbing in, operating on the patient, checking on the patient, running on the patient, those are all processes. And improving them is really what we're talking about in here. And I like that. But what quality improvement should be? Well, quality improvement should be your use to making the system safer, more timely, provide effective and efficient outcomes. And then equitable should be cost-effective. And then patient-centered. This is my... I used to have 10 slides over what quality improvement was and what lean was... Well, what is lean? What is Six Sigma was? It is what I'm going to give you now. Because I find that this is... It's pretty comprehensive for the purpose of what you're trying to do. And what you're trying to do is make sense of this. Have you seen this before? What do we mean by value equal quality plus service under cost? What it... Is this pretty unique to the University of Utah? It's not. There are different variations of this equation captured from different organizations. We add... Actually, the main... The only difference is that we add the service component other organizations leave it out. To us, it's important because we made a big deal out of it. And it is a big deal. And we're very good at it. So we feel that including the service as part of what our value outcome is makes sense. So we define value being equal quality plus service under cost. How do you define value? Yes, I'm going to try to make you talk for the next hour. Because this is helpful. It's about conversation. Is value different for you than this framework, this equation? Right. What's your name? Brad. Brad. Now, this is applying healthcare too. Yeah, I think so. Your patients come in they should be able to see you and be treated by all your staff and with high quality care and with good manners, bad side manners treat nicely, and then pay as little as possible. What does quality mean though? What's a good quality outcome? And who defines what that is? Do you, the patient, the nurses? Sometimes it depends. Sometimes we have projects that are, that also deal more, I guess, satisfaction of the residents for their learning experience. And then one thing that I would add to cost is that value should also be timely. But time is money, so I guess it's like time is cash. But I feel like a lot of the processes that we try to address in quality improvement is timeliness. If something's not efficient or the workflow has a problem, then we try to increase the efficiency or effectiveness in a timely fashion. I like what you said and you actually used another word. You talk to us about timeliness and importance of the processes from the point of view of the residents. Value according to who? There is another piece of this equation that I've not mentioned yet, which but use this. Who defines what the value is? Which defines what is it we're working on? Is it a resident? Is it a provider? Is it a patient? Is it Luca? I wish you could decide what we work on, but I think they're never mine. I think sometimes I would lead the right way. Sometimes they're probably somewhat selfish, which is actually very important too. This is what we're talking about, sponsors and people that help you with your project. Remember, people are people and they have their own priorities. For the purpose of these conversations, we always talk about the patient defining what value is. They are the ones that ultimately we're trying to cater with their definition of value. And value is an activity that transforms or add to the product or service being created. The didactic's a luxury statement, but ultimately I stand by it. You are doing something, you're operating on your patient, you are talking with him or her, or you're walking to the patient, or you're changing to treat the patient. The changing, the walking is not value added. A patient doesn't care about that. A patient just want to be treated. They want to be told what is wrong with them and so on. But also many of the processes don't directly tie to the patient. So like residence, log, charting and logging, or tracking of information, that is not really direct tying to the patient. Those are processes too. The customer just different changes. All throughout the patient care journey from a registration all the way to inpatient, all the way to billing and so on, there is view. There is a downstream, there is an upstream. There are value added activities and non-value added activities that take place. Ultimately for the purpose of simplicity, an activity in healthcare is value added when it builds on patient's information or it is part of direct care provision. So when we are talking about patient treatment, patient care, that the previous statement I gave is still valid, but for patient treatment, we say that an activity is value added when it builds on patient information or it helps with care provision. That is you. This slide is important to me because hopefully it gives you visual that there are people helping, working in the process before you and after you. We call them stakeholders in this process. And when we say we cannot improve the processes, improve quality by ourselves, we mean that there are other people involved in the process. And sometimes there are problems. Not everything goes well. Patient doesn't show up on time or any instrument is missing in the surgical tray or there was an incorrect error in the chart. There was an incorrect statement in the chart, et cetera. The patient bill was never sent. There are errors in the problem. There are errors in the system. There are problems. For the purpose of Lucas presentations, a problem is a gap in performance. Problems are not bad. Problems are expected. Most of the time, the reasons why we're doing quality improvement projects is because we're addressing an identified and known problem. We just don't know what's causing it. Question for you, which also this builds on your potential quality improvement projects. What are examples of non-value added activities? The value added activity is something that builds to direct care provision or adds to the patient's information. And for the non-patient related processes, a value added activity is something that builds and adds towards the completion of an outcome. What are examples of non-value added activities? Quality improvement project that involves just resident education alone. Fun one. Is this this resident education value added? It could be. Technically. Technically. Let's take an example. When you're moving the patient from the waiting room to the OR or from the surgery, I'm not familiar with how many steps there are in ophthalmologist surgery. I'm a little bit more familiar with different surgery. But from the little room to the OR table is that process of moving the patient's value added. It's not, it's not, it's not. You have transportations, you have motion of the patient. All this going between rooms is not value added. It's waste. It's wasteful. It is making and having to fix the chart or having to fix the building or having to fix the scheduling because an error was making and doing it. Is that value added? No. Errors are not value added. They delay the process of care. What else? Overdoing more exams. This is one is easy. It's always in the news. Doing more exams like whether there are X-rays or CTs than the patient requires. Is it value added? It's not. We call them over-processing or over-producing. Any other examples? Think about this. Because most of the quality improvement projects something like implementing a protocol for patients checking or implementing a hand-offs process or something like that. They are aiming to eliminate some sort of waste. Non-value other activities that are also called waste. Usually it's something like addressing communications, waiting for something to take place. Waiting is a big one. That's right. I forgot about it. How can I forget about waiting? The OR, that patient is not there yet. Usually I have the patient waiting. Let's make him a surgeon waiting. I had an orthopedic surgeon. He was waiting for 10 minutes. Eventually he looked at me. We had a good relationship. He was like, where's my patient? I'm here waiting. And the patient is in the area. This stuff happens. You know this more than me. The patient had to go to the bathroom at the last moment. The provider was waiting. It's waiting value added. Now, waiting is not quite added to the current process and then the one coming later as well. So, there are documents that are hand-outs I've prepared and I'm going to make available to you which actually goes through examples of seven types of these non-value other activities or waste. Take a look at them. This may help you to get ideas of what to work on. This is not a trick question. What is problem solving? Perfect. Thank you. Identifying a problem using some sort of method to fix and make a change. How often do we do problem solving? How complex is problem solving? It depends on the problem. Bingo. This does not tend to over complicate things. There is a time and a place for complex problem solving and there is time and a place for just doing something simple. The easiest way I came up to help you see the difference is if you're driving on the freeway or you're driving anywhere and your fuel gauge which by the way is called visual management is a visual indicator of something which is how much fuel I have in my car is going with the little light, orange light that lights up. What do you do when you see the little orange light lights up in your fuel gauge indicator? You could ignore it. That helps. You can put a bandaid on it. What do you do? You think about getting gas but you could hopefully get put gas in it. Do you take the car to the mechanic? Oh my gosh. There is an orange light in there. It's light up. Next. Now this is one of the examples where it's simple problem solving. You can't wait until forever. You can be like Cramer in Seinfeld and see how far you can go with an empty tank of gas or you can go to the nearest gas station and put gas in it. Now you're driving on the freeway or any other road and your car starts rattling and your engine shuts off. What do you do? You pull over. Now you go to the mechanic. Now it's complex problem solving. Now you need some help from other from other people. It's different. There are examples. This is important to me because then I get into argument and debates for hours with people explaining trying to get me to say Luca, just do it. Those ideas that don't require a team that just help you fix a simple process that you know what's causing the problem and you just want to make a quick change. Is that quality improvement? Yes it is. It's a complex problem solving where you use a framework of some sort like we were saying earlier where you collect data you analyze it then you finally make a change. Is that quality improvement? Yes. It's research where really you're trying to test an idea, you're trying to get new information. Is that quality improvement? Yes it is. So why are you telling me that I really should be doing complex problem solving? Because I'm trying to create this process where you're actually learning to use certain tools and then just making a change. But Luca, what about I have a gut feeling about this problem and I really don't my QI project is going to be surveying people to collect data. Is that quality improvement process? I don't like it but yes it is because if you're trying to make a change and you have no data and you know that there is a problem the act of collecting the data is part of your future quality improvement project. I call them phase 0 or the beginning of a project but then you go there and you present in front of the audience I thought we had this problem we surveyed people this is our result and that's the end of it. Okay, that is great. So these are all type of complex problems of quality improvement processes but it just depends what varies in complexity is your resources it's a much time you're going to take a project and so on. Notice I have tried not to use a word project yet because if someone comes to me and say do I need a project to do a just do it kind of implementation do I need a project to see to get permission to get more cables to fit the right computers because one is always running away so I have a great idea let's just have a backup cord now you don't need to assemble a team you just do it that's what I call them just do it this is where you have a project this is where you have a project this is where you have your teams working with you also right for the next 30 minutes or so my goal my focus is to help you get some understanding of tools in complex problem solving by the way how many of you are familiar with the IHI modules in quality improvement have you gone through the videos right through them ok they're valid they're good there's a lot of information out there we're making our own I think I like it and I think we're doing a good job the IHI modules promotes what is the PDSA cycle plan do study act to me plan do study act is here and that's what I finally settled in when you're doing a small those are the plan do study act works well with a small test of change otherwise you've got to when you have right back and forth and I apologize for that in here most of the time you know what the cause of the problem is or if you don't it's usually very simple to figure it out complex problem solving you don't know what the problem is what's causing the problem and that's what you need to figure out the difference between the two approaches is really root cause analysis which is what now we're going to talk about it there are many variations of methods and system in ways of approaching quality improvement sorry I didn't even remember I got your name Rachel when you were talking to us about problem solving you kind of mentioned framework for solving problems how are you familiar with stuff have you taken these kind of classes before no I think it's just a bit more it's like this where we talk about so if I said things like Six Sigma or Demake or PDSA that's good one out of four so far or A3 or 20 I'm making stuff up now I have counted about 15 different frameworks for doing complex problem solving at the University of Utah it's entertaining to me because in the end call them what you want I don't care ultimately when you're doing complex problem solving and this happens in daily life as well this is not about healthcare quality improvement you're trying to figure out if you have a problem you're trying to figure out why is it a problem what is causing it and how are you going to solve it and how do you know if it worked is how we call our steps which is somewhat borrowed by the Six Sigma framework what is that don't worry about it for now to me it's just important that when you have a project when you have something to work on you can when you have a problem that you want to address you know that and you come to me look I would like some help you owe me a problem statement and then I'm going to help you do a baseline analysis which is collecting the data then we're going to figure out what's causing the problem before you are actually solving anything usually people come to me with look I want to create a protocol is creating a protocol a problem let me rephrase that question is not having a protocol a problem not necessarily it could be we don't know yet so why do we why do we jump start this process by saying we need to implement a protocol we need to create a standard we need to buy a machine those poor wonderful robots we need to have them in the OR they just buy a bunch of them because they make us happy and it cost millions of dollars there is a problem we have millions of dollars to spend let's spend them let's quickly go through this this is where we're going to be spending time if we meet together specifically on a project by the way I guess I should have been clarified what is a quality improvement project at this point for you question I swear to identify the problem you're going to address it and you will dedicate a specific amount of time and personal resources that's your project right let's all agree to that I'm making arbitrary decision that's what a quality improvement project is it really is so when we have a quality improvement a problem statement is where things start people this is important because if you don't have a well formulated problem statement you're going to get lost in the problem it becomes there is such a worded scope you do problem statements all the time when you meet with patients you ask questions you ask them do you hurt where does it hurt where can you see what is going on what about this, what about that you are trying to clarify what the problem is before you actually address it I have found and I'm happy to actually have seen that if I give you these questions you actually come up with a pretty good problem statement from those people that used to come to me and say look my problem is that I need to implement a standard work document a protocol in my department because people are late so I need to improve the charting if they start thinking okay what is the problem why is it a problem how does the problem impact the customer when and where does it happen that's just when is the frequency like in the morning in the afternoon when the patient arrives etc and where is the unit I'm just trying to be specific if you answer these questions that's how an example of a problem statement that was written I don't know if you can read from over there women presenting for screening mammography at enhancement cancer institute have to wait an average of 6 days to receive final normal results for 97%, 98% of women who can be given normal results after routine exam this is a necessary delay and a major source of anxiety time to result service is a surrogate target for reducing arms now what's the problem why is it a problem because of anxiety where does it happen husband how often that is 98% of the patients it's a simple enough formula when you get to your how many of you have you guys identified a problem already you're going to be working on have you built your problem statement in some sort of fashion what problem are you working on what's the problem there so many is that we have an inter-manual that's five years out of date there are so many processes that you mess up for the patient or waste an undue anxiety for the intern and the patient I have to ask these questions because people are like, just give me a break I just make a change no, you can't if you can't think through why an old manual isn't bad then you're just through it guys, the fact is that time, money, resources are limited if we had unlimited resources there is a concept around lean lean is built around the principles and management system of the Toyota production system the guys that build cars there is a principle in there unlike in Six Sigma from a different methodology from Motorola in lean we say that we're going to work on all the problems eventually we're going to get there so you work on the smallest thing possible but you still have to understand what you're working on so the first part is what is the problem, you build a problem statement the second part, why is it a problem is the baseline analysis baseline analysis is collecting the data how did you know that the manuals were five years old the handwriting of residents how did I go back five years so how did you know that did you go look what about the lack of the not having training formalized training or what you were saying earlier there just isn't a curriculum the fact that it's not a curriculum how did you know that again, you want to look for it so this is not, again I'm over simplifying things but ultimately what you did is called going and seeing the only Japanese word you may or may not choose to remember is gamba if you like to use it, do it if you don't like me, say go and see it's doing observations basically you're going to before you can make a change before you understand what the problem is you gotta talk to people you gotta open a binary to actually check the dates you go and see but this is important because when you're going and saying when you're doing observations you're asking questions you're there to learn you're not there to give advice refrain from making judgments refrain from giving advice or trying to solve problems on the spot that's not what you're doing there some other times you may need to do a process map usually when you're looking at something like timing components or delays or waiting or trying to figure out where the issues are in the process it is not very well known you do a process map these are just examples of them and if you would like some help with your specific projects let me know and I will help you more details of creating a process map for your project process mapping which is visualizing the process usually it takes place in a room like this you are on a white board you're drawing steps and you're talking and everybody thinks they know what is going on nobody by themselves really does because unless you own the process and you're the only person doing it but still going to the Gamba observing it's important to fill in the gaps often what actually takes place in the workplace and then of course collect some data the easiest again we can talk about more detail when we meet separately but the point we're making that some quite often just talking about averages it doesn't provide a complete picture so leveraging histograms bar charts or run charts gives you a better vision of what actually this is a problem this is where complex problem solving is different from just do it kind of implementation because in just do it you identify your problem you look at your base and analysis I want to know how to fix it you just fix it in complex problem solving you're like what the heck is like I'm doing a project for to simplify the clinical placement of students of learners Residents also but primarily undergrad students or people from different colleges are placed in clinics this process of getting view you've gone through this trying to find try to match your schedule to the provider schedule the clinic schedule so you can observe the process in there and learn it's a mess how to fix it is not simple that's what we used and by the way this funny to me because it's usually somebody's fault but it's not there is a process there is sorry there is the causes of the problem are usually deeper and what you think they are trying to decide what to address it's it revolves around specific tools like these fishbone diagrams 5 y's then ANOVA, Pareto analysis, FMEA risk analysis what are those things I don't even talk about them most of the time the type of problem solving we do here in healthcare at this level 5 fishbone diagram and 5 y's are more than sufficient I had some handouts on that to get you started finally we have collected all this data we have decided what cause we are going to address if I say what cause we are going to address what do I mean do I have to explain it differently what's the cause of the problem what's the cause of the problem system system can be part of it too but when I talk about cause of the problem the problem is the problem is still there you are just picking something that you are going to be addressing on don't jump to solution when do you know when it's time to fix it well because the group has decided to hopefully your project is going to include other people besides yourself there are specific tools to improve a process but unless your change eliminate waste eliminate errors improve performance please don't make a change is it going to be pointless if you are actually not improving anything it's pointless if if the curriculum you are building that you are making it clear because it's going to decrease variation in knowledge it's going to improve performance it doesn't actually get to there maybe you need to reconsider your intervention this is important because everybody does this one of my favorite learning experience was when me and this improvement group made a change we were so proud of it we found a way to streamline the intake process by having the patient charts being reviewed earlier and we saved 10 minutes of the intake process and then the surgery director told me that the top surgeon came to her and is like where is the patient chart or the nurse has it but I need to view it first but we did an improvement project and so this saves us 10 minutes but I can't see the chart so where is the chart don't worry I'll make it work I don't want the surgeon to tell me I don't want anyone to tell me how it works we missed the opportunity to include them in a discussion around improving the process in reality we didn't really make any difference I'm almost done how do you know it worked is a conversation around outcome measure, process measure, balance measures when you're trying to improve patient experience when you're trying to reduce mortality rates when you're trying to improve those are effectual rates vaccinations screenings those are outcomes it's different type of metrics that you set for those otherwise because sometimes if somebody comes to me and say look we're going to increase improve our discharge time okay how are you gonna do that because discharge times has a lot of factors into it there are many processes that go into making it happen and so decreasing discharge time it's a complex problem solving sure but it's also an outcome so how are you gonna do that well we're going to focus on residence order reviews okay, residence order reviews that's your process metric discharge time that's your outcome and you don't want to make anybody mad patient satisfaction or customer satisfaction is your balance measure without this you don't know if your project worked or not that's why many QI projects that go like we surveyed people by the way everybody does it so if your project is that I have no problem I'm just being clear if your QI project is collecting data and surveying people and in the end you've not made a change you don't know if something happened in reality that is not the full cycle QI project yours specific thank you for providing me some examples education you can work with something like that in reviewing last in reviewing the past five years of projects either you do a lot of rotations on the VA for the VA and I thought of a portfolio it is which I'm glad because they're visible you can see them every time I ask people you know what I'm not picking on them actually I'm very glad that residents or people that work at the VA they can find problems just like that because when I ask people here what problem can you solve I don't know but you don't know so VA for making easier to find problems whether you have more of them or not I don't know flow when you're trying to improve a response code or improving patient access that's a flow type of project quality or cost you can partner up with two peers to reduce costs as well this is a lot of information all at once this is why there are other resources when I send you some links for it you can review them this is our versions of IHI modules and then don't forget you're not alone there are many other people that you can leverage and you can ask questions and you can learn from I do this all the time


Hi Vogue's Basil Trap and sitting here for Tom O'Brien and we're looking at a dow that he's up 218 points at 34,379 that sounds big but these days with 1,000 point moves up and down that's just kind of par for the course in fact there's a little mini uh look at this this doji candle right here sorry this the roman chev only roman candle right here with a tiny wick a long body the wick at the bottom the shadow at the bottom and now we're trading nicely to the top side there's a whole bunch of implications we'll get to that but you know I'm listening to that commercial just a moment ago I I really think that that sums it up for many of us and even for the hosts I don't think there's any one of the hosts that doesn't when they have a chance try to listen to one of the shows and just kind of think wow that's really interesting that you know built a bit of both the technique on something that I never thought of I must listen to it closely uh how it pertains to the market uh and that's really what we try here at TFN is to be an educational resource I remember when I spoke to Tom O'Brien back in 2002 I believe it was I met him up in his New Hampshire studio uh we had been in touch I'd sent him some charts and over the period of a couple months they evidently were quite correct so he went to to meet with me and we met and I don't go through the whole thing other than to say that when he at the within 15 minutes of us meeting together I'm me showing him different charts and doing something's live when he said would you like to join TFN I said to the first thing I said to him was I'd love to but for me it's really about education independently if you're monitoring all that stuff but this is education and I kind of I think that that's what we've done here TFN and we've built a huge resource for the whole educational aspect and um now let's get straight to the market what we're looking at is the Dow is up a little more it's up 247 there are a couple of things going on no let me just do all the numbers and then I'll tell you what I think is going on S&P is up uh 53 at 43.79 so the Dow is up 0.72 percent the S&P is up 1.22 because we've got a couple of Dow stocks like Caterpillar that are down quite sharp but then you've got Visa up huge and American Express the other day had really good earnings that was up huge so it's a very mixed market in many ways the QQQ and the X100 trading vehicle we're looking at uh at 347.18 up 6 of 1.7 percent it sounds like a good number but look at this chart I'll talk about it in a moment we just finished all the notable notations here in the chat where they've deed to downside and IWM the Russell 2000 small caps they've just been failing they're just not done very well when you think about them at 244.46 on the 8th of November trading uh down to 188.09 this morning now at 191.79 Look at this. This is a propeller shaft in the weekly chart spoken for months, almost all year, about this rectangle formation, how we can go above it. In the channel wave methodology I have a whole bunch of webinars based on that. Besides my newsletter at the opening call where I discuss these things, but a narrow trading range means that there's a chance at the upper end of the range says that there's a good chance that you're going to break to the upside. And if you do it with a Pd in the channel wave notation, that's the fourth highest peak from that moment on. You've got to be careful because of the vulnerability. Well, lo and behold, it went back and tested the 207 support. It had a nice bounce to the 221 area. And then, boom, it breaks like a propeller shaft. Look, on the upside you've got the blade. This is the big fulcrum in the middle. Now you've gone to the downside. Unfortunately, we've gone a little deeper to the downside than we should have. This is the weekly chart and the MACD is very weak. The stochastic is down at 14%. Ombowners volume is getting oversold, but really bad. And the 9-3 moving average for a couple of weeks now is crossed negative. So that says that you've got a cell mode in the data chart. You've got a cell mode. That's just a description. Remember, it just says, oh my God, cell mode. Everything's going, no, just says, at this point, it's in a cell mode because it achieves certain levels of support and then broken And on the weekly chart, look at this. If we close anywhere near here, that means there's a really good chance I have to at least consider that the monthly chart is very close to a cell signal. And then it gets upgraded to a cell mode if it goes lower. But that becomes quite serious. But look, the 9-period in the week, monthly chart is still way above the 14. So that says, don't get too carried away. The technicals, the key technicals that I follow in the monthly chart are still positive. Let's get to gold. I want to do as many of these as we can. Gold is trading down about six points in 1789. Talk about the rectangle formation. I'd identify this quite a while back and I said, look, this is the core of the major trading in gold between 1840s and 1760s. That's really the fulcrum, the middle point. We've gone above, we've gone below. Now we're heading towards the low part. And that just says that the whole area of 1760, we're at 1789 right now, should become very important support unless you see this here is like a head and shoulders pattern. I don't like those patterns. I mean, I know they're around. I don't like them because when you finally recognize that it is head and shoulders, that's when it's already broken and it's ready to bounce. But what I am looking at is, if you look at the way the MACD is turned down in the weekly chart, if you look at the way this on balance volume has just made a V-shaped reversal, inverted V-shaped reversal. And the stochastic is very poor at 48%. It's just saying there's a little bit of vulnerability in gold that says it's still stuck in a trading range, but you've got to be careful that it doesn't start to make in the weekly chart lower highs and lower lows. And the only reason why I say that is because, let me just quickly finish silver, and I'll tell you why I'm saying that. Silver is almost the same thing. It's a little bit weaker chart formation. It's getting closer to the lows. It's broken key support in a trend line. Look at this three times here. Almost exact time frame. Not patterned, but time frame of the arch formation. It's gone under it. Just be real careful because if silver trades under 19.75, it's vulnerable to go down to, what did I say? Closes under 21.94. I don't know what I said before. 21.94, then it could retest that low that was made back on, I think it was December 13th or something. December 15th at 21.41. All right. The reason why I'm saying this is because the dollar is in Leg C, the chapter where we're always looking for at least four higher peaks, should go to a Leg D. And then you've got to be careful where the weekly chart is in Leg D. The monthly chart is made in Leg C. But the daily chart is only in Leg C. In Basel's dollar, why do I say that? Because in 2018, in April, we went along the dollar. So we'd go from 19 to 103, 102.89. Pull back to 89.21. And now I have a really good rebound. It just remained long. We have to take them one little bit off at 96. I'll be back. Basel Chap is sitting in for Tom and Brian. We'll be having a look at the E-minis in a moment with you.