What's up everybody once again it's Brandon man Sean and this is Inside the Network where we show you exclusive clips and artist sessions from InsideBrandManNetwork.com. This particular clip was with Russ B where we were talking about a subject that a lot of artists don't get into enough. It's more than just how do I build a fan base on Instagram. It's more about how do you choose where you blow up. You can get so much deeper nuance so I'm going to go ahead and let Russ V talk and then I'm going to give you all some gems at the end.  There's like a lot of different things that you know as an artist that you can that you can do that you might you might not necessarily know if they're like the right things to do or it's just a lot of different things that you can do like performing, trying to get on somebody's tour or you know going in that workout with you know music executives or like really honing and focusing all your attention on social media like just a lot of different things that you can do. So my question to you is with I guess some of the stories and come on story that you've heard recently what are some of the most important avenues I guess I call them to like focus on when you're trying to you know when you want to come up trying to do it and then for yourself. Yeah well obviously the elephant in the room is social media you know that's the most obvious I don't think social media is everything some people preach that it's damn it everything I don't believe it's everything but I believe you know it's it is what it is and you do have to play to it after that I would say really just really just like creating I feel like a lot of artists are waiting on like a label or like to be big to like actually monetize the dip themselves and actually like create their brand identity I think that's some artists should be doing on the ground level I think you should in 2019 I don't care if you have seven fans if you have seven fans you need to sell seven t-shirts you know I'm saying you need to you need to like brand yourself now because that's actually the whole game you know you look at like Travis Scott's and everything and they'll sell 500,000 he didn't actually sell 500,000 he was selling clothes Nikki was right you know I'm saying but that's actually the way these artists coming in the game now especially like going into like this next decade like yeah artists should you know artists with a thousand fans without a deal should be selling like 200 something 200 pieces of experience to 200 people you know and I think once artists really have that mindset of just like complete independence and just like figuring it out like like like a real business that's really like that's really the route to go you know what I'm saying so as far as like what's most important I really can't say anything is more important I'll tell you one thing as an independent artist don't focus on radio don't focus on television those things are they don't matter but as far as the clubs you know without the clubs but depending on where you live I wouldn't suggest it you know you said you're like Idaho I'm in Iowa right now yeah so Iowa you can skip out on the clubs yeah I mean like that's not gonna that's a couple a couple of bars yeah those those areas you could probably skip out on the club but you know it it also really depends on the artist man and I can't stress that enough some artists are YouTube's dream some artists are Spotify's dream some artists are the shit on Twitter look at Lil Nas X some artists you know it really depend on the artists you know some artists are are you know it really just depends on the artist man because depending on what you're talking about who you're talking to all of these different things that'll tell you where you belong you know if you're if you love dancing and you're 16 years old and you rap I'm not gonna tell you go to Twitter I'm gonna tell you go to TikTok you know I'm saying I'm gonna tell you go to Triller I'm not gonna tell you go to Twitter you know I'm saying so it really depends on who you are and you know the type of music you're making and all of that all right all right I got to start here Bress V said something that was it was pretty big I don't know if you caught it but he said branding yourself is the whole game today he said go ahead and get that merch started you have seven fans you should be able to sell seven shirts and get that whole business in line because branding yourself is the whole game is that true I wonder I know a lot of people are wondering that yes it is true in so many ways when we look at the fact that so many of the artists are looking at how do I flip the brand that I built into actual income when we look at the top of the Billboard charts and that's where artists even the big artists who have a whole lot of streams right who have all these record sales quote-unquote whatever they're still looking to monetize outside of music you need to be building your infrastructure to do that as soon as possible it doesn't mean that you can't focus on building your music and getting your streams first a lot of people still need to start there but at the same time brah you got to monetize right and to monetize and especially if you want to consider yourself independent means you have to have business systems in place you have to know what your merch plan is going to look like you don't have to sell merch immediately but know what the plan is going to look like start getting into those designs get an idea of what your system would look like other things that you can sell in other ways that you can monetize outside of just a regular tour show right can I do private sessions with my fans somehow online how can I connect with them and what kind of calls can I do maybe there's there's so many different things that you can touch on maybe I do shoutouts for my fans birthday shoutouts for my friend fans they charge for maybe I don't charge for there's so many ways to flip this or maybe you can write little custom songs for your fans there's so many ways to flip it but you have to get those business business systems in place and see the opportunities because especially as an indie right you want to be able to figure out how you're going to bring in more income and you are a business and your brand is the core of how you flip that brand because we're not working on needs this isn't needs markets where we're selling soap or I mean you know some people are you that you don't need so but we're selling I don't know some medicine or something like that the people need to live they don't need your music so you need to have a brand that makes them want to make some kind of exchange with you that's first and foremost we got to start there of course there's some people who just have music and most of their old business is built on selling music through placements and and you know just scoring and and so many other ways of monetizing music where you don't have to be a front-facing artist but if you want people to see your face as an artist and you're building that type of brand the typical celebrity artist brand whether it's a huge celebrity or a minor celebrity you're trying to build a brand and that is the core that's what it's all about now something else I know a lot of people are really weird on this pick your platform everybody's like yo why are we even talking about this because we already know what the platforms are we already know that you need to be on ig and youtube or we need to be on I don't know maybe tiktok today I know that that's what some people are thinking but the reality is no you need to be able to reverse engineering we'll talk about that in a second your particular brand and how you decide where your particular brand and fan base will lead you to a particular platform why is that it well here's a perfect example there's an artist I just spoke to we were sitting down yesterday and he was telling me that most of his fans right are on facebook double his fan bases and this is in like some old guy he's a pretty young guy um and he has and as a matter of fact and it's not even like he only has a little views on youtube he has videos with a million views but he's like literally if my video has one million organic views on youtube then I have two million on facebook and really I think one particular video it probably added up to like 13 million on facebook went with all the people who shared it to other channels and other bigger channels on facebook that started to you know post it and get views themselves so when you think about this you got to remember at the end of the day where are you the best fit and I always try to tell people even if you're winning a game if it's not your game you're probably losing right chances are you're losing so what does that mean in this practical situation that might look like you doing your thing on instagram 100,000 followers maybe 500,000 followers and getting good engagement and all that stuff but maybe if you were doing the exact same thing almost on tiktok you might have two million followers and who knows what your engagement or maybe you should be on youtube right so even if you're winning don't get stuck in the fact that you're winning to keep you from experimenting and finding if there's someplace better and don't just listen to the general places that people are talking about because all of these things at the end of the day are opportunities that we talk about but they don't mean that you need to be there and that's the beauty of reverse engineering where you belong there's a few questions that you can ask that can help with this so here they are number one what are your strengths are you really really good with the visuals are your visuals funny are they really short and you're good at doing that really short content do you need long form do you do good at telling stories what are your strengths are you really great with lyrics there's there's so many types of strengths figure out what those strengths are number two where is your audience this is a huge one right your potential audience not the people that you want to follow you the people who are likely to follow you where do they spend a lot of attention but that's not the last thing because we know there's you know big platforms that have some of everybody's audience so that's not the only thing number three what type of content do you want to create remember we already talked about what are your strengths what is that lean towards this should help you and inform you on the type of content that you want to create because you should want to create something in the lane of your strength because it's going to make it easier not only you to do one video but to create content at scale and we know that social media you know quantity is a very real thing those simple questions your what are your strengths what type of content do you want to create and where is your audience that's a great place to start because then you start to look at the platforms and say what are the platforms with all of this criteria and consideration actually speak to these things and where I need to go listen from there and figure it out from there and that's pretty much it is that simple because after that it's all experimentation so once again this is another episode of inside the network what is inside the network where we show you inclusive clips and artist sessions from inside brahmannetwork.com to show you how we go deeper into the artist process and we can go back and forth as opposed to just answering these one-off questions get the nuances of whatever your situation is so we can give you a custom answer for you but not just a custom Q&A session we're building your marketing strategy with you we're building your advertising strategy with you and even greater what so many people need is just developing your brand which is the foundation that you do the rest of that mess on top of in the first place so keep that in mind especially if you're an artist on a budget and you can afford a full-time marketer we help develop you into the systems that can market for you we become your ongoing marketing and business managers and mentors so we can help you build those branding and marketing systems where you don't have to actually need a full-time marketing manager you can do these things yourself but it takes true progress and guidance versus just taking random information and trying to piece mill it together and then starting back at square one after a year hard time of work we're seeing artists make far more progress in four months than they made in one or two years of just watching or in consuming random information from other places on the internet that's another episode of inside the network since you've been on a couple calls what's been your impression of the network or your experience so far yeah i like it man i like how there's the cause i mean only joined like less than a week ago and i've already this is my third call already so like i feel like it's very um you're very approachable like if i had an urgent question i've run out of questions already pretty that way


As the world prepares for the 26th United Nations Convention on Climate Change Conference of Parties in Glasgow, Scotland, experts have warned of an impending catastrophe should not be done to prevent its consequences. This came up on the occasion of the launch of Reset Works on Red and Great Green War Initiative and Natural Capacity or Capital Accounting at the National Assembly Complex. Environmental advocate Sam Onigu charged the 9th Assembly to fast track the process of passing many bills related to climate change before it, as this will guarantee in-house funding for the initiative. Onigu says Nigeria, like many other countries which have done the same, would have brought the day 2030 set to end carbon emission globally closer. He commanded the Nigeria Senate for passing and giving concurrence to the Climate Change Bill. Nigeria has of course taken the very important step of applying nature-based solutions in our quest to mitigate and adapt to the impacts of climate change through its revision emissions from forest degradation and deforestation. We are talking about red now, red plus, and the Great Green War Initiative programs. For a speaker who was represented by the Minority Leader, Honourable Undidi Elumelu commanded the initiative, assuring that the House will support the initiative, beginning with a fast track passage of climate change bills before it. The law-making body, they have a very huge role to play in naturalizing this dream. So I want to assure you that the House of Representatives will be up and doing in ensuring that we support it and all the bills, both the forestry bill, the climate change bill, all the outstanding bills, as soon as we are through with the money bill, which is the budget of 2022. I can assure you that we will fast track those bills. Stakeholders are the launch code for appropriation of funds for the initiative, since climate change is a global issue. As we stand on the cusp of one of the most important UN summits in history, COP26, it's brilliant to see that Nigeria is not just talking about climate action, but walking the walk and finding practical solutions to the climate change phenomenon. Stakeholders at the forum also agreed that the world is facing an existential threat that demands that all hands must be on deck to save it.


Workplaces play a huge role in unlocking the true potential of employees. But is that enough for millennials? Hi guys, this is Astha Singhal. And here are four ways employers can decode the ideal workplace for their new generation employees. Collaborative workplaces are tastefully designed to cater to the needs of the employees that range from millennials to Gen B. They have a strong aversion to being confined to a desk or cubicle therefore more open-planned layouts are important. In terms of perception and functionality, co-working is largely synonymous to collaboration. People share opinions and formulate opinions based on their continuous interactions with other colleagues, encouraging a highly open environment. With the complexity of work increasing, the work hours are no more rigid. Hence, it is vital to have an environment that prevents burnout. Socializing, various activities across the floor, music and quirky ambience provide an environment that is otherwise missed out on when buried in work. Millennials today are looking for high-quality, high-speed connectivity, reliable and convertible products at work and are already shaping office spaces today. Laptops and smartphones in the near future will transform into voice-activated assistant ensuring the seamless connection of work surfaces and individuals. Are you having a productive day?


Hepatitis C is a virus that is transmitted by blood-to-blood contact so it's very common in people who've had poor quality medical practice or people who use drugs and inject drugs into their veins. Once you have the virus the virus will go to the liver and once the virus is in the liver over 20, 30, 40 years it will slowly cause the liver to scar and eventually the liver will reach a stage cirrhosis. Once you have liver cirrhosis from Hepatitis C you have a very high chance of getting a liver cancer or the liver failing so it's really important that we find people with Hepatitis C before they have cirrhosis before their liver is permanently damaged. What is the most effective form of treatment for Hepatitis C? We now have a large number of different treatments they're all tablet-based treatments they're all very effective they all have very few side effects and I think we can now safely say to our patients with Hepatitis C if you take the tablets you'll get cured. How was your experience with interferon when you were treated with interferon how was it? It was terrible it was like a chemotherapy I had like so many side effects with high fever muscular pains my hair fell out my skin became very dry I coped with depressions one after another I felt suicidal sometimes I felt very weak I've done it for one year it didn't work but it was very hard. How is the new treatment compared to that? So there's no nothing to compare it's very easy to take I didn't feel no side effects. How does it feel now after Hepatitis C? I feel lighter and I feel like I don't have like any more nothing in my body that one day would kill me like it did to some friends of mine and families. If you inject drugs you will very often share needles you will share syringes the paraphernalia the so-called works and that puts you at very high risk of infection but these are the people who are likely to pass the virus on and in my view these are the people we need to target treatment so we can stop the virus in its tracks. These are exactly the people who are excluded in several countries from treatment why is it so? This is pure stigma pure bias the WHO makes very clear that everyone should be treated the easel and the American liver associations all recommend that everyone should get treatment so there is no excuse for not treating people who inject drugs because they're the groups who need it most. In the UK so major barriers for people who inject drugs are stigma they don't want to disclose this is a particularly issue for women who have children they may not want to be identified as a drug user so even asking for a hepatitis C test may inadvertently out them. Doctors also create barriers by refusing to treat people who inject drugs creating requirements that people cease injecting or people cease using particular drugs when that's actually not supported by national and international guidelines. We feel like we don't deserve to ask for treatments because we were told like you destroy your health so much how come you are like demanding for better health and that is a label that is art to take. When we speak about drug users who are more than 90 percent of new infections we have also to speak about criminalization because that is a huge barrier to go to any treatment to any health treatment and that is something what need to be addressed. Why do you think the testing level of migrant populations is so low? Lack of awareness first of all lack of awareness you know systems are challenging but if there is good information appropriate cultural appropriate in languages people can understand it's much easier for people to be you know insensitized. Many people say that the drug is very expensive so it's not you know governments kind of afford it what would you be your message to government? The message to governments is very simple you either pay now or you pay much more later because if you don't treat hepatitis C early when it's easy to treat it will cause cirrhosis it will cause liver cancer and that's even more expensive to treat so the most effective way the most cost effective way of treating hepatitis C is treat it early treat it in people using drugs so they don't transmit it you'll spend a lot less money than waiting till people are dying of the disease. One of the major barrier and that's largely recognized is the price of the new treatment when there is a patent when there is the monopoly there is only one company allowed to sell the product so basically the company can ask for whatever the price they want. USA we have like Sovaldi was priced around $80,000 it was called the 1000 pill generic medicine is today available for $200 the cure so it's much more cheaper it's just the same drug but it is manufactured by someone else than the patent holder at Metsan du Monde we are advocating for countries to better negotiate prices and use the legislation that allow country to suspend patent and intellectual property rights to allow for generic production or import. Many pharmaceutical companies claim that they keeping the prices high because they need a lot of money for research and innovation. Sophos Bivier is a molecule that has been developed by a small American firm called Pharmacet that spent let's say millions of dollars to develop the drug the patent has simply been bought by Gilead science for 11 billion of dollars so the price paid by Gilead has actually nothing to do with the cost of the development of this drug. For many countries hepatitis treatment for a huge population is not achievable but at the same time we see that pricing prices are going down that in some countries also in Europe the prices are quite affordable for example in Spain in other countries it's more than 10 times expensive so that is a very curious situation and we saw examples of civil society and advocacy for example in Georgia and other countries that they can they achieve great successes in bringing prices down. What do you call an excellent example of national hepatitis C response like can you maybe tell us some concrete examples? Well we had exciting examples from my perspective for again from Scotland if you want to do something it is so easy you can deliver the drugs via pharmacies community pharmacies which are reachable in a range of 20 minutes from from every patient you can go to the pharmacy you have you make your test and you get your pills there is no medical specialist needed anymore and we also have excellent examples in in in Europe for example the Swedish drug user union who who established user academies where they teach each other on an hcv prevention and so on so that is really amazing to see and that is the most effective way to do it. What what do governments need to do to eliminate hepatitis C? It needs to be well planned and developed into a national hepatitis strategy and also a national action plan that's an important starting point and to bring everybody together and very importantly among the stakeholders there needs to be the community and civil society really nothing can move forward without good community engagement and activity. One of the important things in terms of the Australian story is is the role of the community and and how much involvement they had in terms of discussing with the government and working with the government to really advocate for access for all so no restrictions based on disease stage no restrictions based on drug and alcohol use and then to allow for broadened prescribing by general practitioners so it's not restricted by specialists and what's amazing is that you know we've you know had these therapies since since March of last year and you know there's 230,000 people with hepatitis C in Australia and and we have treated 30,000 people in nine months of these new therapies being available we've cured more people last year than we have in in two decades of of interferon based therapies. Why harm reduction is important in people getting access to treatment of hep C? Harm reduction as a program based on outreach approach when when the peers when the people from community trying to reach those who are usually hard to reach this is really works. We have a great hepatologist in Belgium and he's make the difference for me when I was in hospital for other diseases I had long problems and he came to my bed and he said you know there is something we can do about your hep C and now this hepatologist is my colleague and we have our C body project with him and it shows that drug users a good hepatologist and a low threshold center this I call this the triangle that this works very well. What can we learn from from the literature about reinfections? Is it a real risk that if we treat people they will reinfect with the same behavior? I think we've got to be very aware of that risk in some populations and to study it and monitor it. I think we've been reassured by some studies and very importantly among the injection drug users they're extremely good response to treatment even if they're actively using drugs. So I think the important message is that we need to monitor this carefully. It should never be a reason for not treating but we need to make sure that treatment is always linked to prevention and good harm reduction educational messages. What would you recommend to other drug users who are still live with the virus? I recommend that they demand the human right to health even if they choose to keep on doing drugs we have the right to health we have the right to meds and if there is a cure let's go and get it because there's no use dying of a disease when there is a cure and very easy to do.


The vast majority of breast cancer start out hormone dependent, meaning the primary human estrogen called estradiol, plays a crucial role in breast cancer development and progression. That's one of the reasons why soy food consumption appears so protective against breast cancer, because soy phytoestrogens like Genestine act as estrogen blockers. They block the binding of estrogens like estradiol to breast cancer cells. But wait a second. The majority of breast cancers occur after menopause when the ovaries have stopped producing estrogen. What's the point of eating estrogen blockers if there's no estrogen to block? It turns out the breast cancer tumors themselves produce their own estrogen from scratch to fuel their own growth. Estrogens may be formed in breast tumors by multiple pathways. The breast cancer takes cholesterol and using the romatase enzyme, or two hydroxy steroid dehydrogenase enzymes, produces its own estrogen.  One is to use anti-estrogens, estrogen blockers like the soy phytoestrogens or the anti-estrogen drug Tamoxifen. However, another way to block estradiol is by using anti-enzymes to prevent the breast cancer from making all the estrogen in the first place. And indeed, there are a variety of anti-eromatase drugs in current use. In fact, inhibiting the estrogen production has been shown to be more effective than just trying to block the effects of the estrogen, suggesting that the inhibition of estrogen synthesis is clinically very important for the treatment of estrogen-dependent breast cancer. Turns out soy phytoestrogens can do both. Using ovary cells taken from women undergoing in vitro fertilization, soy phytoestrogens were found to reduce the expression of the aromatase enzyme. What about in breast cancer cells, though? Breast cancer cells, too. Not only suppressing aromatase activity, but the other estrogen producing enzyme, too. But this is in a Petri dish, soy suppress estrogen production in people, too. Well, circulating estrogen levels appear significantly lower in Japanese women than in American white women, and Japan does have the highest per capita soy food consumption, but you don't know it's the soy until you put it to the test. Japanese women were randomized to add soy milk to their diet, or not, for a few months. Estrogen levels did seem to drop about a quarter in the soy milk supplemented group. Interestingly, when they tried the same experiment in men, they got similar results, a significant drop in female hormone levels, with no change in testosterone levels. These results, though, are in Japanese men and women that were already consuming soy in their baseline diet, so it's really just looking at higher versus lower soy intake. What happens if you give soy milk to women in Texas? Circulating estrogen levels cut in half. Since increased estrogen levels are a marker for high risk for breast cancer, the effectiveness of soy to reduce estrogen levels may help explain why Chinese and Japanese women have such low rates of breast cancer. And what was truly remarkable is that estrogen levels stayed down a month or two even after they stopped drinking it. This suggests you don't have to consume soy every day to have the cancer protective benefit.


T. F. N. N. Headline news update. Good afternoon, folks. This is your 2 p.m. Live update. Steve Rhodes coming to you live from Delray Beach, Florida. Currently, we've got mixed indices. Everything is in the green, with the exception of the NDX100. It's up $3.60, so basically flat. But the Dow is up 97. S&P about six. Russell's up six. Summars are flat. New York Stock Exchange and Willstrup 35 and 63 points. Trannies are up 72 points. NASDAQ composite up five. Spotball of Tilnex is down 45 cents. Trade out is $12.68. Gold is flat. Trade in $14.63. Silver off seven pennies. Trade out is $16.99 out there. Let's go take a look at the S&P 500 and see what it is that we've got going on right now. First, with regard to the daily chart for the S&P 500, we've got the active topping pattern and signal out here. That's called your TD setup nine count pattern. That pattern confirmed just a few days ago, and that suggests that a top may be in. That confirmed on November the 19th. Yeah, price is up. Price may rally even further inside the S&P 500. 3119 would be its target that is referred to as Stevie's green line out there. But you do have a valid active top inside the S&P 500. You've got one inside the Dow Jones as well. So a nice little rally. But at this stage here, we've got to call it a countertrend rally in a move that's got a nice top. A TD setup nine count to sell the D point of the A to B equal CD rally could move up to 27 913 from here. But still this suggests more likely than not. We're going to see price head down towards a 27 407 area. Don't get caught up into the rally that we're seeing going on out here. It could be just simply a setup to go ahead and sell into the market. If you take a look at the NDX 100, you've got the same TD setup nine count out here. No confirmed A to B equal CD to the downside just yet, but you do have a active pattern. And you've got the same inside the Russell 2000, Russell 2000 generated this topping signal a couple of weeks ago and has been trading sideways to slightly lower downside target. And it is about 15 44 out there. What? Now, if the market is going to move to those levels, what you're going to see and we don't see it right now is the spot volatility X trade above its 50 day exponential moving average. That's priced at 14 13. We're trading at 12 72. So that says a lot of sideways action, but it's very toppy out there. What's the straw that's going to break the camel's back? They have a terrific, fantastic Friday. Tune in next Monday, nine o'clock during Larry Pestimento show to hear me do my Traders Ed show. Take care.


As this consciousness expands, you start to observe this world around you differently. It starts to reveal the mystery that is going on, the magic that is going on. As the consciousness expands beyond the conceptual into that transformative state, which is the occult state, suddenly you start to make all these associations. You start to see things you never saw before. You start to understand why this happened and that happened, why the other happened. And you start to see that it is an unfolding magic, a transformative unfolding magic, a matrix of perfection unfolding.


For example, when Nipsey Hussle was slain, and a condolences to his family, and they have a church right up the street from us. But I remember that night clearly where I was standing up over a rooftop, and you could see it was real dark gray right up the street from where the incident happened. Like a lot of people don't know the aura when Nipsey got killed. That's another one. Or slim 400. Usually what happens is, particularly with the internet, and how quickly things could get out that might not be true rumors and stuff like that, which could lead to somebody getting killed. Particularly if they say another warring faction did it, when in fact they didn't. But just like for example, when Nipsey Hussle was slain, and a condolences to his family, and they have a church right up the street from us. But I remember that night clearly where I was standing up over a rooftop, and you could see it was real dark gray right up the street from where the incident happened.  But I got a show called Voices from the Street, Sounds of the Streets, and you couldn't hear nothing. The cars had got off the street, and everybody went in the house, because at that time they didn't know who had killed Nipsey. And they knew if certain organizations were even mentioning about doing it, it could explode. So that whole night it was dark gray, overcast, real spooky, and wasn't nobody on the streets. Nobody, but even more importantly after they had LA Gangs unite. And all of them came over to on the Nipsey Hussle. We did Love and Hip Hop Hollywood where I worked with Yo-Yo and Apple Watts. I did the security for them when we filmed that. It was sad that the elected officials, all of those local elected and state officials, did not come to intervene to keep the dialogue going. And that's what's one of the problems that happens out here when we go back to, we have to look at our local elected officials, as far as making a change, and maybe have to start getting them out of office. If they've been there 15 years within the same district and it's nothing changed, we have to start looking toward changing people in office and making sure the funding go to those that are actually doing the work that can make an impact and make a difference in the community. Here we go.


Welcome everybody. In this lecture, we're going to walk through the types of implications we can derive from basic economic insights. Specifically, we're going to see the types of things we can learn about reality just from thinking through the implications of the fact that people act, meaning they behave purposefully, that they have conscious goals they're trying to achieve. As we'll see, there's a lot of things we can learn about that situation just by thinking through it. Let me start though by giving a review of what we covered in the last lecture. There we talked about the fact that there's a difference between the natural sciences and the social sciences and that the methods that are appropriate in each can be different. And so it's true, we want to be able to say that economics is a science. It's an objective field that gives us results that we can be confident about. And the results in economics, what you can call economic principles or economic laws, those things are valid whether or not the person hearing them likes them. So just as the laws of physics are what they are and if the people in government don't like it and say, no, no, we want to be able to send a ship into space that goes faster than the speed of light and how much money do we need to throw at that. Just tell us what we need to do and that's what we're going to do and get it done. Because we have the political will, gosh darn it. And the physicists can say, no, I don't care how much money you throw at it. I don't care how much political willpower you put into it. The laws of physics say you can't accelerate a rocket ship faster than the speed of light. By the same token, the sorts of things we're going to learn as we go through my book, Lessons for the Young Economist, which is the textbook for this course, those things are objective economic laws or principles. And it's not based on my personal political whims or preferences. Those are objective principles. And if people in government or supporters of certain government measures don't like those results, well, too bad. They can't overturn objective reality. However, having said that, even though we're acknowledging economics is a science and that you can come up with conclusions in economics that aren't based just on your prior political prejudices or feelings about the way you think things ought to go, even so, that doesn't mean that the way we develop economic principles or laws is the same technique that we use in physics to come up with laws of physics. So in the natural sciences, again loosely speaking here, I'm just going to boil it down very simply, what they do is they come up with guesses at the underlying laws governing the behavior of the matter and energy that they're observing. And ultimately, the way physicists think they've hit upon a good description of nature is if they can explain observations in that way. And in particular, if they can predict beforehand what an experiment is going to reveal or what an observation is going to be, like if it's an astronomy or something, and they're going to say, you know what, we think that tomorrow at such and such time, at any point of telescope, at this part in the sky, we're going to see the comet. And then, if lo and behold, that happens, comes to pass as they predicted, they're going to say, see, we have a good understanding of the laws governing the behavior of objects in the solar system. So a lot of people mistakenly think that that approach is what we ought to be doing in economics and that the way we develop laws or principles in economics is to come up with guesses or hypotheses, if you want to use a fancier term, that yield certain testable implications, that the hypothesis says you're going to see results that look like such and such, and then we go and test it and see, okay, the conditions that this thing said need to be true are going to be true next Thursday, and then this hypothesis said under those circumstances you should see these results, you should see prices behaving a certain way, you should see certain things happen in the grocery store, you should see something happen with the reported profits of these certain firms, whatever it is, and then you go and look and see, was the hypothesis confirmed or rejected? And there's a whole discussion we can have about that type of enterprise, but the point is that's what people think is going on, or that's what a lot of people think we should be doing in economics in order to make it truly scientific and objective, because again, that's clearly the kind of thing that happens in the natural sciences or what's often called the hard sciences, and so people think that's what we ought to be doing in economics. And what we went over last lecture is to say that, no, that's actually not what we should be doing in economics, at least if we're talking about basic economic principles or economic laws. And I gave an example that if you open up any introductory microeconomics textbook, if you're taking a standard course in college, the introductory economics class, or even if you go into Barnes & Noble and grab some of the sort of pop econ books off the shelf that are written by professional economists for the layperson to try to get the person to be interested in economics and say, hey, economics is fun. Let's learn about the way an economist looks at the world. And I said one of the things you will often see in books like that that are trying to explain economics to the complete novice is they'll open up with things along the lines of, hey, this is how you think like an economist. These are some principles that the economist uses when he or she is looking at the world. These are sort of the tools that an economist has to help understand reality. So just like the physicist approaches the world armed with knowledge of the laws of physics, by the same token the economist approaches the world and analyzes things from the perspective of these principles or laws of economics. And it's often described as the economic way of thinking or thinking like an economist. So last lecture we talked about one of those principles is something like people respond to incentives that they'll phrase it in that way or something along those lines. And they'll say that's the kind of thing that the economist knows is true and the economist uses to help make sense of things whereas somebody else might not think along those lines. And so the economist has an insight into a situation because the economist knows people respond to incentives and armed with that knowledge about reality and how people are I the economist have something useful to contribute to this discussion that the mathematician might not or that the physicist might overlook. The physicist and the chemist and the mathematician they all have certain things they might want to say and contribute to some issue based on their knowledge and expertise from their own fields but the economist comes to this scene and has a certain perspective and one of the things the economist has that other people might not is this knowledge that people respond to incentives. I know that because I'm an economist. So my question is how does the economist know that that's true? What reason does the economist have for thinking that people respond to incentives? And I argued that really it's not an empirical question. It's not that the economist grabbed thousands of people and ran an experiment to see do they respond to incentives or not and let me remind you of the example I used.  And the person says no thanks I'm not going to do that. Did I just show that this is one instance where a person did not respond to incentives? Well I offered him $100 to chop his left arm off and he didn't do it. So would I say well that's one strike against my hypothesis that people respond to incentives but let me go get a broader sample and let me see if I can find 70% of the people I asked to chop their left arm off well then I can say as a general rule most people respond to incentives but you know there's 30% of them. No you see what I'm saying that's not at all how the economist would handle that situation. The economist would not blink an eye at that. He would say correctly and reasonably that oh no no no this guy responds to incentives it's just the $100 was not incentive enough to get him to chop his arm off. Okay does everyone see how that works? And so my point is there that's how the economist would deal with that and so clearly when the economist walks around the world looking at situations thinking okay the way I'm gonna make sense of what I see here is to always keep in mind that people respond to incentives because that's the way economists think about things that that's actually that principle that the economist is carrying around in his or her toolbox is not something that has been empirically tested and that's why it's in the toolbox because hey we've vetted this thing and lo and behold it stood the test of time. That in various experiments and observations and so on we feel pretty confident in our statement that people respond to and say that's not the kind of knowledge that it is. It's just a decision that you make as the social scientists and particulars and economists to say the economic way of thinking looks at reality like this. One of the things we do is we try to make sense of everything by believing that people respond to incentives and you couldn't falsify that principle. The way that a physicist might be very sure that no sorry Mr. President I don't care how much money you give the NASA budget we can't make a spaceship that goes faster than light. Well it could happen they could see a comet or something that gets faster and faster and it seems to be going faster than the speed of light and then they would say huh maybe we were wrong that's that's interesting. So ultimately what we think of as the laws of physics could be overturned tomorrow in light of new observations whereas what we're going to be learning in this course is the principles or laws of economics are not like that. Okay so now that I've sort of gotten you to see the type of thing that we're going to be studying in this course and that's fleshed out through the entire book Lessons for the Economist let me just deal with one obvious objection to that. A lot of people when they hear someone like me explaining this is what we're going to be doing when we go over basic economic principles they're going to recoil in horror and say what are you talking about that's very unscientific that seems very dogmatic it sounds like you're saying you already know the way everything's got to turn out the answers are already in your head and you don't care what the evidence says and isn't that that's almost medieval or something that seems like you're doing theology it doesn't seem like you're doing science. And we talked about last class that the reason people think that is that their model for what science is is something like physics or chemistry where yes in physics or chemistry if you had the kind of procedure we just talked about that we use in economics you would be horrified and you would say no that's just not a good way to do physics or chemistry but I pointed out think of a different analogy where the type of procedure I'm outlining here makes perfect sense and that's geometry so in geometry what do you do? You start out with definitions or they could call them axioms and then you go through you start with these primitive things because okay that's fine I'm okay with those definitions and axioms and then you just step by step work through what's called a proof and you end up with a theorem at the end of that thing and you know that that conclusion is true it has to be true so long as you didn't make a mistake starting from the axioms and going step by step down and reaching the conclusion it's a logical deductive process so it's deduction not induction if you're familiar with those terms so the specific example I gave was the Pythagorean theorem because that's probably the most famous theorem that many of you if you ever took geometry you would at least know what that was where you have a right triangle with the sides labeled A, B and C where C is the hypotenuse and if it is a right triangle and it satisfies the other assumptions or conditions of what's called Euclidean geometry well then you can prove it has to be the case that A squared plus B squared equals C squared and then I walked you through a way you might go about proving that it's certainly not that you go out and measure a bunch of triangles in the real world and then see how often does the Pythagorean theorem turn out correct or is it close enough to seeming correct that we just say that it's because our ruler was a little bit off or we didn't quite measure it right but yeah it looks like it's true it's close enough our observations that's not at all the way you try to establish the Pythagorean theorem you prove it by doing something like drawing lines to make squares connected to each of the legs of the triangle and then you can kind of move the squares around and show look at for any right triangle that you draw for me I can always construct these three squares such that the area of the square connected to the A side and the area of the square connected to the B side you add those together and that equals the area of the square connected to the C side hence A squared plus B squared equals C squared and since I just proved that for an arbitrary triangle where we didn't plug in specific numbers I just proved it for any right triangle because we can always take a right triangle and write A, B and C and I just showed you it has to be the case that I can always build these squares and move them around blah blah blah I just did it in general so for any triangle you give me as long as it really is a right triangle according to what's called Euclidean geometry the answer has to be true and I can go to sleep tonight and I'm not going to worry that tomorrow I'm going to wake up and someone's going to on a piece of paper draw and demonstrate to me that oh no see you made a mistake I just came up with a right triangle for which this is not true I don't have to worry about it the way technically physicists could be proven wrong tomorrow that what they thought were the laws of physics might turn out not to be the laws of physics so that's the way we do things in math and that's a general principle that's not just in geometry in general in math when you prove something in math that's what you're doing you're walking through a deductive process such that as long as you didn't make a mistake in any of the steps and the mistakes should be or sorry the steps should be things that you can just verify in terms of it being self-evident that yeah can I go from step four to step five and the person reading the proof can say yeah that's obvious that you have to be able to do that otherwise reality doesn't make any sense to me that's the way my mind works that you can make that jump so as long as you've done that correctly then the answer you end up with has to be true so long as the initial conditions were true the initial assumptions or axioms and if somebody said some critic said oh my gosh you mathematicians that's just so unscientific all you're doing is coming to the table with your preconceived notions about what a squared and b squared and c squared have to be and then you're just picking your definitions to get that at the end because that's what you wanted to be like in the beginning and so you're just arguing in a big circle and just spitting out results that you already knew in the beginning because you assumed them right that's the kind of thing that someone might say to the economist who heard me explain the kind of economics we're going to go over in this class right so I'm hoping you see how silly that would be to say it to somebody teaching geometry to say oh no no you're not making it scientific I want you to teach your geometry by having your students go out and empirically observe the world and that's the way you teach geometry don't just do it with these so-called proofs where all you're doing is plugging in your initial assumptions and then transforming them and ending up with just a rearrangement of what you already assumed see that would be a crazy objection to the enterprise of geometry and a mathematician would rightly say okay what you're talking about your objection is relevant for the hard natural sciences like physics and chemistry and astronomy but uh-uh that's not the way we do things in geometry because math is a different type of knowledge from what the natural scientists are exploring and the methods that are appropriate in advancing knowledge in mathematics are different from the methods that are appropriate to advancing knowledge in physics or chemistry or astronomy and so don't wag your finger at me what we're doing here in math makes sense because of the nature of what math is so by the same token I'm saying the type of thing that we're trying to teach you in this course the type of economic principles or laws by their nature they're a kind of knowledge it's something that mathematicians don't know historians don't know biologists don't know, chemists don't know the stuff we're gonna learn in this course is a new type of knowledge it's a distinct branch of human inquiry it's called economics but I'm saying the way we discover these principles is by thinking through the implications of the idea or the axiom the starting point that hey I think there are thinking beings out there who are trying to achieve goals and they have reason and they're trying to change the course of reality by their choices just our decision to see that in the world then kicks in a bunch of implications just like our decision to say I'm gonna define this thing and call it a triangle I'm gonna define what a right angle is so on and so forth once you decide to do that then the Pythagorean theorem sort of spits out of that that it's a necessary implication of your decision to choose those initial definitions and so on so that's what we're doing in this course and I just wanna make sure you understand that because it's important to know that economics is a science but the kind of principles or foundational laws we're going over here you discover by just thinking through the implications of your initial decision to interpret reality as there are conscious beings out there who are trying to achieve purposes or goals so that's what we're gonna go over in today's lecture I'm just gonna give you some examples of what you can learn just by following this technique


The study compares the electronic and optical properties of graphene nanoribbons with coronene and ovaline molecules, and their silicon atoms substituted counterparts using density functional theory, DFT, and time-dependent DFT, finding a general reduction in the fundamental gap and a redshift of the optical onset after chemical modification. This article was authored by P. Mocchi, Akkadia, and G. Cappellini.


Good morning. This is Ariana Longley from the Patient Safety Movement Foundation. It is 9 o'clock Pacific time on the dot, so we're going to get started with our quarterly Patient Safety Movement Foundation webinar. So again, thank you all for joining. Just as a tiny bit of housekeeping, we have muted everyone upon entry. So please keep yourself muted throughout the presentation. We will have time for questions at the end. So today we present to you our Patient Safety Curriculum for all health professionals webinar. Again, I'm Ariana Longley, the Chief Operating Officer here at the Patient Safety Movement Foundation, and we are very excited to have two expert presenters with us this morning, Dr. Steven Scheinman and Dr. Margaret or Peggy Shoemaker. So I'm going to go through our agenda real briefly just so you have an idea of what our goals are for today. The first 10 minutes I'll spend introducing you to the Patient Safety Movement Foundation and our actionable patient safety solutions. We call those apps. We'll then have the majority of the time 40 minutes to hear from Dr. Scheinman and Dr. Shoemaker, and then we'll have 10 minutes at the end for Q&A. Please utilize the chat feature that you'll see on Webex. You can post your questions as they come throughout the presentation. We're happy to we'll be kind of scrubbing those at the end and we'll have again 10 minutes to answer those questions via chat. We haven't been successful on the line just because there's feedback. So again, please note that you should be using the chat feature so we can answer your questions at the end. So the Patient Safety Movement Foundation, we have this bold and audacious bowl of zero preventable deaths by 2020. And how we do that is we're fostering new efforts and building on to existing patient safety programs through commitments to zero. I just wanted to briefly for those of you who are new to our network, give you an example of all can take action within our network. So the first group that we work with are hospital and healthcare organizations and we encourage them to make commitments which are free online commitments that we encourage through our website that encourage shared learning through our The second group that we work with are committed and these are organizations that, you know, nonprofits, professional societies, associations, advocacy groups, anyone else, the way I explain it is anyone who would want to wave a patient safety flag if it existed. We work with those partners and they sign visualized commitment to action letters and all of those are transparently shared through our website so you can see organizations are doing what? The third group that we work with are healthcare technology companies. So all of those technology companies that sit at the bedside that help connect data and information. We encourage them to sign the open data pledge, which is a pledge that we designed in 2013 to freely share information without simply blocking or charging for that data connection. The fourth group that we work with are students and family advocates. We encourage them to share their story or their family member's story so to inspire change and we also encourage them to utilize resources and also share resources that they've found that have been helpful so that we can share that through our network. So our actionable patient safety solutions. These are essentially our product. They're freely available online. We currently focus on 18 overarching challenges that we feel are challenging hospitals today. And if they implemented processes around these issues, they could get close to and hover around zero preventable deaths. So you'll see on this slide the list of 18. Some of these topics also have we call them sub apps or some sub topics. And those would include, for instance, healthcare associated infections or medication safety or even embolic events where we focus in on and hone in on specific solutions to these challenges. In total, there are 34 total solutions that we recommend that hospitals review and essentially take a self assessment to ensure that their hospital is truly doing everything available to get to zero. So today, we're going to be focusing on the bottom left corner patient safety curriculum. Our newest actionable patient safety solution published in January of this year that Dr. Scheinman and Dr. Shoemaker were instrumental in in helping to develop. I also just wanted to share briefly some of the impact that we've had to date by in engaging these partners in our work. So we started again in 2012, our first data point in 2013. We had 63 hospitals in our network. And in 2019, earlier this year in January, we announced that 4,710 hospitals are working with a patient safety movement foundation. And that spread across 43 countries. Those hospitals, by making commitments around those topics that I showed you on the previous slide, have shared with us that they've saved 90,146 lives in 2018 alone by implementing those processes or other known processes. So that's why we're here is to save lives, to encourage implementation of processes and to share those successes with the larger network. So with that, I'd like to introduce our two esteemed speakers for the day. I'll first start with Dr. Stephen Scheinman. He's president and dean of Geisinger Commonwealth School of Medicine. He's also the EVP and chief academic officer at the Geisinger Health System. And Dr. Scheinman is an internist and nephrologist who has earned international prominence for his research into the genetics of inherited kidney diseases and kidney stones. He's published more than 90 peer reviewed articles, reviews and book chapters on topics related to kidney disease and genetics. He's also served on review boards for the NIH, American Heart Association, American Society of Nephrology, American Federation for Clinical and Medical Research, and National Kidney Foundation, amongst others. He's a fellow of the American College of Physicians and of the American Society of Nephrology and is an elected member of the American Society for Clinical Investigation. Dr. Scheinman is an advocate on healthcare workforce issues and matters affecting medical schools. Our next speaker is Margaret Shoemaker. She is assistant chair of internal medicine at Geisinger Commonwealth School of Medicine and chair of the Geisinger Patient Safety Workgroup. Dr. Scheinman is a graduate of the University of Pittsburgh School of Medicine and completed her residency in internal medicine and fellowship in endocrinology and metabolism there. She's board certified in both and in addition to maintaining a clinical endocrinology practice in Williamsport she's been instrumental in the clinical education of physician assistant students, medical students and family medicine residents. Dr. Shoemaker joined clinical faculty at the Commonwealth Medical College which is Geisinger Commonwealth School of Medicine and as a regional assistant dean in 2010 and has served as assistant chair for internal medicine since 2012. She has special interest in quality and safety and that led her to oversee development and implementation of a quality and safety curriculum for medical students at Geisinger Commonwealth School of Medicine since 2016. She joined the Patient Safety Movement Foundation curriculum group in 2017 and helps head the patient safety curriculum development project with Dr. Scheinman. So with that I'm going to pass it first off to Dr. Scheinman to continue the webinar. Thank you very much Ariana and good morning or good afternoon to everyone on this webinar. It's a great pleasure to describe this curriculum which represents the work of a group, a core group that was over a dozen people but had significant contributions from a larger number including I imagine some people on this ball working over the past year and a half and although we announced this curriculum at the summit in January the curriculum remains a living document. The group continues to meet regularly and we plan to keep this curriculum updated and to build onto the website the ability for users of the curriculum to suggest updates or improvements so we welcome those. The charge that Joe Chiani gave us was not to reproduce the excellent curricular content that's already out there from the World Health Organization of the Institute for Healthcare Improvement and the number of specialties but rather to create a curriculum that would be implemented and used more widely than those have been adopted because it's user-friendly and so the goal is to create a curriculum that is adaptable to clinical learners across the spectrum of professional development from novice introductory learners to advanced experts practitioners. The curriculum is applicable across all healthcare professions and not specific to any individual profession that emphasizes the benefits of team-based care and very importantly and consistent with the values and culture of the the patient safety movement foundation itself highlights the patient's voice and the family's voice in the healthcare experience. These are these all represent the significant foundation of the curriculum I'll be describing so on the next slide the what we've called these the virtues that we believe will make this curriculum adaptable and usable across a wide range of settings so once again it's modular and the because it's modular we believe it will be quite adaptable to a range of learners novice to expert across the professions and effective for use in part or in its entirety so people can choose to emphasize for example communication which is critically important in patient safety and focus on that more than on other areas if that's felt to be the need in that particular clinical setting suitable for a variety of teaching strategies whether they are classroom or a range of other settings conducive to delivery by non-expert facilitators which is important since not everybody has got a faculty of patient safety educators on site so that a range of facilitators can will find this curriculum easy to use and to adapt to various settings the time requirements are practical and again modular so that these can be can be expanded to be to fit multiple sessions for example or it can be abbreviated to fit brief sessions over multiple on multiple occasions there are multiple opportunities to make the examples experiential and to link the curriculum to specific experiential settings in the clinical environment and we offer within the curriculum a wide range of resource support which I'll describe in a few slides so moving on we began by defining eight fundamental domains and these are this is the organizing structure for the curriculum and I think everyone as you see these domains will agree that they are fundamental to patient safety so error science and system science the human factors that are that contribute unfortunately so significantly to errors technology which is clearly very important teamwork and communication which the the team writing this curriculum spent a lot of time thinking about in which the evidence clearly indicates is a significant contributor to patient error leadership training and leading change as we will all need to promote organizational change wherever we are to bring us to the next level of patient safety to create a culture of safety and ultimately achieve patient oriented safe care so in each of these domains we've identified specific areas within those domains subdomains to focus on and I will illustrate the structure of how we've taken this approach around these eight domains on the next slide so for each domain of what we have within the curriculum is a definition of the domain and a but we illustrate using a sticky note and I'll show you what that looks like it looks like a sticky note which has on it a reference to a national initiative on patient safety that is relevant to that domain and within each domain we have identified two or more subdomains and within each subdomain there are specific learning objectives and for each learning objective there are examples of competencies that should be demonstrated for us to be able to or for you to be able to determine that somebody has achieved the goal for that learning objective and I'll be more specific and give examples of as we go forward the and for each domain we have a specific set of resources and some of the resources for example case examples illustrate principles for more than one domain but we'll get into that in a minute so on the next slide we have an example of how this modular design works for one of the domains one that we think is particularly important teamwork and communication so our definition of this domain is that it addresses the concept of teams and health care delivery and emphasizes the knowledge attitudes skills and behaviors required of effective teams to deliver safe care error prone gaps in care are highlighted with content operating offering validated communications framework to ensure patients safe transitions across the health care experience and the sticky note illustrates that the joint commission and some of you may need to move your chat window away you have the ability to do that or close it to see the sticky note the joint this sticky note illustrates the joint commission's national patient safety goals including communicating medication information teamwork training order read back standardized abbreviations and the national quality forums safe practice so so the sticky notes simply illustrate and emphasize elements of this and then if we look at the subdomains within teamwork and communication there are three teams and health care handoffs and gaps and team steps and if we look at the at a learning objective under the first subdomain teams that learning objective would have a developmental verb which is which changes which is different for each of the five developmental stages that we've defined so and I'll give an example I'll show that on a subsequent slide that we're not ready to advance to yet so either to understand or to a model or to master the benefits of effective interprofessional teams and their role in patient safety I'll go more into that in a minute and the resources supporting these learning objectives our resources include role play materials which we think is a really valuable technique for illustrating these examples these principles so they are role playing not literal scripts but they are role playing role playing cues that assign roles to people who can in your team exercise each play out various scenarios we have videos links to videos specific case examples people are free to use local experiences for group discussion and we offer some experiences online links to online resources materials for didactics and supplemental readings and for each of the learning objectives we give examples of how you can show the competency is achieved so if we move on to the next slide I'll be more specific about this so if we look at that subdomain first subdomain under the domain of teams the learning objectives the developmental verb varies depending on whether you're a novice an advanced beginner competent practitioner proficient practitioner or an expert so a novice just beginning their education in that profession would be expected to demonstrate competency would need to show that they can recognize the benefits of effective interprofessional teams an advanced beginner would be expected to be able to articulate those benefits and moving along somebody who's an expert would be expected not just to model it but to actually teach the role of effective interprofessional teams in their role in patient safety and we can show on the next slide how each of these learners might demonstrate their competency through these examples and so there are several and I won't go through all of them but the first one shows that after discussion of case studies the student if this is a novice these are all these bullets are for the novice learner who needs to demonstrate that they can recognize the benefits of effective interprofessional teams so one would be that they can demonstrate that they can identify the benefits of professional teams or can list the effect of characteristics of highly profession highly functioning interprofessional teams showing mutual respect and shared values and psychological safety etc and I won't go through the other bullets but you'll have the slides and you could read them so if we move on to the next slide the resources as I've said include links to videos and patient stories and as is the foundation illustrates so well there's nothing more powerful in educating people and motivating them to master a competency or to solve a problem than to appreciate the specific patient stories in which patients can teach us about the importance of that particular competency real life experiences and if we keep moving along links to online resources materials for didactics materials for role play which we think as I said is very important and supplemental readings so these vary by domain but and some of them as I've said overlap and facilitators can choose which one is the most valuable for the setting and for the goal for that particular session so I think with this slide I'm now about to hand the the presentation over to Peggy Shoemaker Yes and and I'm here good to go thank you Arianna and thank you Steve and thanks everyone for joining us today so now that you've had an overview of the content and the design of our curriculum what I'd like to talk about is implementation so one approach might be programmatic implementation which would involve a crosswalk of your curriculum from the entry level through the graduate graduating level the identification of gaps that are not currently being delivered across the again first through the final years and then decisions on where and when to to implement them and also a lot of commitment from leadership not only a variety of course directors but curriculum committees and so on then beyond that all the faculty have to undergo faculty development so everybody's on board and etc etc etc so I would say that even for the most ardent supporters of patient safety that may be a bit daunting so alternatively I'd like us to think about small steps that can still lead to significant change because frankly we don't have the luxury of sitting back and taking time when patients are dying or suffering from medical error otherwise unnecessarily next slide please so let's talk about what we can do let's talk about achievable implementation so what I'd like us to do is to consider a four step process and this process facilitator pre-work curriculum preparation engagement of learners and outcomes assessment is also included uh step by step in your introduction that is getting started the getting started section of our curriculum next slide step one the facilitator so you as an educator have authority over a specific area of content on which you interact with your learners so I would suggest that you look at our executive summary it's all of three pages it includes the eight domains their definitions and their subdomains only and after that review of the executive summary identify the area of content of our curriculum that best overlaps with the area content that you cover with your learners once you've identified that then you can look at areas of gap that you might be able to practically integrate into what you're already doing to do more to train your learners in patient safety principles next slide so for example if you are a facilitator who works with pre-clinical students in any health care discipline it's very likely that you're training them on some sort of patient-centered communication but in doing that are you also emphasizing to the students that this is um it is foundational to patient safety that we include the patient and family and their voice as part of the health care team you may be offering team building skills for your students and some inter-professional education experiences but are you emphasizing that this too is foundational to patient safety and the part of why we do this is to develop respect shared values and psychological safety among team members as they provide care in the clinical setting your coursework may include case-based learning it would be very simple I suggest that you might compare and contrast in a given case what the difference between a younger individual who presents with that problem let's say nephrolithiasis for example a 40-year-old otherwise healthy presenting with nephrolithiasis versus an elderly patient with multiple comorbidities and how those patient characteristics increase the risk for medical error in a variety of ways so these are opportunities to emphasize patient safety and what you're already doing now if you are a facilitator who oh thank you if you're a facilitator who works with students in the clinical setting opportunities to include increase patient safety teaching abound for example students in the clinical setting might simply reflect on the benefit of including the patient and family as team members in the decision to choose what medication they're going to select for treatment of nuance that hypertension or if you're in part of running a simulation based clinical skills training for your students it would be very simple for example to require that the student opens the encounter by verifying the full name and date of birth of the patient and develop that so that they develop that habit for the future and that would also be beneficial to reducing medical error and then there is the just in time teaching that can happen throughout the day in the clinical setting where facilitators like yourselves who are advocates of patient safety are modeling behaviors that will reduce medical error in a variety of ways by communicating with patients communicating with peers modeling just culture in team settings perhaps reporting a near miss in your medical error system etc etc next slide please let's go on to step two then and remember you as the facilitator are now going to be doing this curricular preparation for your own specific area of content within our curriculum that is most relevant to what you teach you would at that point identify the domain or domains of interest and take a deeper dive into the module that Steve described the module that includes its definition it's a sub domain it's learning objectives and all its resources having an understanding of that module you can then identify the area that will best fill the gap that you've noted in what you're currently delivering and the other thing you need to do is to identify what target level of competency you would like your learners to achieve in other words Steve mentioned that we have learning objectives for novice through expert so that's something you will need to identify is it important that I bring my students to the advanced beginner level or or should they have a higher level of competency depending on their level of clinical training next you have I think the fun part is to identify an educational method and the materials to deliver that teaching so for example are you going to do this as a small group discussion or are you going to do this as an individual reflection or you know is this going to be a larger classroom event is this going to even be perhaps a required logging element and again our modules are robust with their various teaching materials so we have videos we have case prompts we have the role play material that Steve mentioned all kinds of all kinds of things that will engage the students and then after choosing teaching method and materials to promote that teaching you can review examples of how that learning objective could have its competency demonstrated but I would encourage you to only see them as examples and that you might take the opportunity to personalize demonstration of competency specifically to the context of your learners next slide here is our suggestion for educational targets or levels of competency for different types of learners across the header I've listed a variety of domains that is foundational linking and aspirational when Steve mentioned the slide with the eight domain he called them the fundamental domain so I don't want to cause confusion we have labeled some of our domains as foundational the foundational domains are those that explain the science of medical error and the nuts and bolts as to why errors happen despite the best efforts of well-intentioned clinicians and those four are error science system science technology and human factors the linking domains are those that have an impact across the entire field of patient safety and they are teamwork and communication and leadership and leading change and our aspirational domains then would be to achieve a culture of safety and patient oriented safe care and I make I bring that detail to your attention because as you look at a pre-clinical learner if you're dealing with the the very early learner perhaps for the foundational domains you want them to have a reasonable understanding of these nuts and bolts of patient safety science but certainly when it comes to leadership and leading change or a culture of safety they're going to be at a lower level of competency so consider that it is not necessarily appropriate for pre-clinical learners to achieve the to achieve the same level of competency across all eight domains now having said that by the time one gets to early practice we would hope whether it's the medical resident or the graduate nurse or the newly trained pharmacist in their first professional unsupervised role we would hope that those individuals would have as a minimum level that they would be would be considered competent across all eight of our domains next slide please okay so competent I'm going to stick with the example of teens in healthcare that Steve brought to your attention so I want to show you just how practical this can be and how you're already doing this and how we can just gain so much by offering additional emphasis so if you have a learner whom you feel should be able to be competent in the understanding of the the teams and all the types of teams that we have in healthcare some of the ways that they might demonstrate this but first of all they should show that they value the benefit of an inter of effective interprofessional team and they can demonstrate this by simply actively participating as a member of an interprofessional team or going out of their way to incorporate patients and families into the team and decision making or by actively demonstrating that they respect the contribution of all the team members and what they bring to the discussion so you see these are nothing that people are going to be tested on per se these are behaviors that are demonstrated in very practical settings so it really means that this kind of thing should be brought to the attention of your clinical supervisory staff and the staff should be encouraged to acknowledge the successes on the part of the learner and to offer affirmative feedback or otherwise formative feedback so that they might improve. Next slide. Step three in our simple store four step recipe for success is engaging our learners so first of all I would say I would set the expectation for the learner let them know what the curriculum is all about and why you're doing it and what level of competency you hope they will be able to achieve in any given domain or the domain that is of course specific to your area of instruction. Next I would say engage the learners by keeping it lively give them a variety of content give them a video have them do something in the clinical setting get them in a small group discussion where they will discuss frozen cons of different experiences that they have observed and by all means keep it patient based because that will be of the greatest interest to them they are very ready to move away from the textbook online learning the flashcard learning they're very eager to move on to the patient based learning. Similarly when it comes to learner assessment I would avoid quote unquote test I would avoid thank you I would avoid test because it may be that testing is just going to promote some transient or artificial knowledge or behavior or something like that and really our clinical professional learners are tested quite excessively already so I would suggest that more effective learner assessment comes in these active ways having them debrief discuss submit reflections or observing them in clinical settings and again offering feedback. Next slide. So the fourth step in the process is to assess the outcomes of the small piece that you have done so one of those is going to look at perhaps the knowledge of your learners if they're very early preclinical learners learning those nuts and bolts of patient safety it may be skills in a simulation based center or in the clinical setting or it could be attitudes and behaviors that are assessed on the clinical wards in the pharmacy or in the outpatient office. Your next question for yourself will be have my curricular outcomes been appropriately have I been successful in my curricular outcomes have my learners needs been met have my program goals been met did these methods of educational instruction and these resources seem to achieve the outcomes that I intended and you know the larger question would be are the health systems needs being met am I doing my share to prepare these students and emphasizing the points in patient safety that I need for them to carry on as young professionals into their clinical practice and finally you know this is the pie in the sky the patient's safety outcomes would there be any measurable impact of you as a single instructor facilitator course director focusing on you know a particular area of content within the large field of patient safety well you know I would argue that you have the ability to make a difference even even with these small interventions and you're with your students in patient safety outcomes for example if you're working with clinical learners who are interacting with patients a survey of patient satisfaction may show improved satisfaction as being after being included after family and patients have been included in care discussions and decision-making or I would also say imagine the impact of an entire class of your students the class of 2020 for example being on the clinical wards and asking their facilitators how one goes about reporting a medical error or a near miss in this particular health system and what types of errors or near misses should be reported I wonder if 100 students are asking facilitators that question if it might cause the facilitators themselves to reconsider that and ask themselves if they're doing their fair share to to adequately report errors in near misses so we can go to the next slide so I in conclusion I hope that this practical small step approach to implementation makes the use of our curriculum a little bit more manageable for you and on behalf of Steve, myself and our curriculum work group both at Geisinger and at the Patient Safety Movement Foundation I pose the challenge to all of you to implement actionable patient safety solution number 17 in the patient safety curriculum in your learner's experience so thank you very much Thank you Dr. Shoemaker and Dr. Scheinman we still appreciate your expertise and your time today I think that focusing on the implementation and breaking it up into four steps is really helpful I just got back from a patient safety meeting and it's we were just talking about how it's not always the what that people are having trouble with but it's the how so this gives us a real quick overview of how you all in the field in the academic setting and in hospitals can take these four steps and improve the implementation of the curriculum so I really appreciate your time today so thank you so we have gotten a few questions for our Q&A session so I will go back to the chat real quick so just as a reminder if you have any questions at all we do have actually about 17 minutes we'll give it 10 if we have more we can keep it going but we got a question from Edwin Hansen he said his first question was that do you have examples of competencies which we did show in slide 24 but he carries on to say he would like a deeper evaluation like when you report to your department so Peggy, Steve, I don't know who might want to take that but that's our first question I guess I guess I will address that so the question is when do you report to your department I believe that if if you as the course director have the authority to make changes within your course then you would do that and then we have to generate annual course reports and present them to our curriculum committee for review and comment so I would say your end I think is what I would do and because this is such an important issue I think that anything relating to patient safety that is newly integrated into the into the course should be very much emphasized because our hope would be as one individual starts initiating some emphasis on patient safety in coursework or in the clinical setting that others will say well of course we we want our care to be safe and I think that it will just have a ripple effect and eventually we hope to reach a tipping point so I would say definitely emphasize it in your year-end course report so sorry I started to answer realized I was on mute so thank you for picking up the ball Peggy I think what Peggy just gave an excellent example of how you might handle this in a in a school setting within a structured course which is certainly one of the settings that we would expect this curriculum to be used but I think my answer in general to this question would would be it depends on your own setting because some courses are year-long some courses are semester-based some courses use even different schedules and much of the use of this curriculum will not be within the formal setting of degree granting certainly the first two levels of development yes but for competent practitioners or expert practitioners they will already be they'll be doing this curriculum in the in the setting of continuing professional development or potentially required hospital credentialing and so I think the question is do how you report the competency will be will vary depending on the setting and the expectation of the entity to whom you're reporting it great thank you both we have another question from Rita Rita asks regarding the assessment part which I guess she means step four do you believe numbers are an important way to assess like giving a grade or a percentage I'll take a shot at that as well I think in in some settings that can be very that can be motivating and so it might be useful but it's it's certainly many most medical schools are past fail these days and so it's I wouldn't say it's universal and I think it might be another question that could be answered in a setting by setting basis so it's not inherent to the curriculum I think the curriculum lends itself to being used either way so I think the curriculum itself is agnostic on that question but you're what you're asking for is advice and I think that would that would depend on your read on the setting in which you're delivering it great Peggy any any additional thoughts or should we move on I think you can move on okay great thank you the next question is from Christy Berg and she asks can you share how you calculated or determined the 90146 lives saved in 2018 that's directed to me so I'll take that so Christy what we do is when we ask hospitals to make their online commitments if it aligns with a one of the actionable patient safety solutions where there are metrics available we we give them a formula for calculating those lives saved so it's based on the NHSN CDC the HIN program through CMS all standard kind of ways of measuring now there are topics like for instance handoff communications where we certainly have no proof that by implementing a handoff communications process that and going through checklist for example that that's going to save lives so in those areas we cannot have the hospitals reporting save lives however if a hospital has a novel way of measuring that and it differs from the recommendations that we post in our actionable patient safety solutions we have a section that they can include the methodology that they use to measure their lives saved or lives spared harm and here within the team we're very cautious and very conservative in the numbers that we approve these are all self-reported numbers so we do not go out and do visits or audits they purely are self-reported so I hope that's helpful I have another question coming in from Ria and it says in the domains you mentioned technology as a way to improve patient safety can you give any example well okay I'll take that one well technology Rita we we see as a double-edged sword because certainly technology has improved our ability to deliver care but our sub domain address the impact of technology on patient safety both pro and con for example we have alerts filled into electronic medical records and of course there is a well-known they're well known this well-known data looking at people ignoring alerts because of alert fatigue there's also the human tech interface and and how that impacts our ability to stay focused and it's the ability of us to interact with our patients as human beings and then we also looked at the limitations of of technology specifically for folks who are trained where tech resources are very robust and then they either they go to a remote clinical setting where they don't have all those resources or on that God awful day when the system is down and is no longer available and its impact on patient safety based on the absence of technology so I think if you look at the technology domain um you will find all kinds of interesting ways that technology us as as the clinicians and the use of technology and the the pros and cons of how it impacts our ability to care for patients is very interesting thanks Peggy go ahead yeah it's simply to expand on Peggy's last point I think technology domain is a particularly interesting one I would encourage people who are interested to to look within the curriculum the published curriculum and the link is on the foundation's website to read the competencies and to look at the resources that are offered because this is I think a particularly important domain so that would be I think you'll find that reading interesting great thanks Steve we have two more questions coming in so we have one that asks from Raquel are virtual patients a way of improving patient safety education for learners absolutely I think simulation is a wonderful technique um uh and uh frankly I think that we could expand as we continue to modify the curriculum on opportunities for um for using simulation to demonstrate this but it's already represented there in the in the role playing exercises great next question is from Vonda Vaiden Bates she asks thanks to the work group who have put this curriculum together I hope you will report back after it's been utilized and eager to hear how instructions excuse me instructors and students are experiencing it so I'm sorry that wasn't a question I hadn't had a chance to read it yet so she gave some kudos to you all and then we do have another question from Douglas Stoughton that says I strongly recommend that the language we use is significant rather than ask people to report we should ask them to document issues not every safety issue is an error or an incident also reporting has negative connotation to it if we document and share we encourage communication and knowledge building reports are usually a summary of analysis of the documented documented information so again a statement but maybe um if you have any reflections on that that is the last question that has come in so I appreciate both of those comments because I think I think they're valuable and the the last one regarding documenting I think fits within establishing a culture of safety and the part of doing that is is encouraging mechanisms that will promote the fullest discussion of events and even the word event may not be the right one but communication about these issues so I think I think your suggestion is a helpful one and Vonda I want to thank you for your comment as well because I I think you're making a very important point which is that as we continue to rethink and reshape this curriculum which we will be doing continually we we should get feedback on on the use from the users of the curriculum and how effective various elements of it are gather data publish those data because I think they would be helpful to to everybody going forward as we want to encourage more and more use of this curriculum exactly and this is Arianna I'll just chime in for a second um so uh based on the kind of getting feedback and being able to share learning remember that any of you who work in the academic setting or in the hospital where you might have a residency program um you can make a commitment around actionable patient safety solution over 17 patient safety curriculum we will be adding some specialized questions here in the next um hopefully few weeks or so but in the meantime you can um kind of commit to implementing this and give details of how you plan on rolling it out we do have time I think for one more question it's from Rita Rita says as you mentioned simulation I would like to ask you if you believe that learners lose something by training with virtual patients um I'm not sure I understand unless you mean virtual patients not being as effective a way to teach as real patients and if that's the case I certainly think there's no substitute for the real life setting and for training in the real clinical setting but that um simulation is a way to illustrate specific points and to demonstrate things that may you may not be able and hopefully won't see but you may not be able to anticipate reliably seeing in the clinical setting but maybe I'm missing the point of the question I don't know Peggy if you Rita said yes so as you were speaking when you were asking she said yes so I think they both have value yeah I see it as a developmental step um you know going through that simulation based uh practice so that if you do it incorrectly you're not going to harm anybody um it's observed and somebody's giving you feedback so you know it's a very effective way to learn but again once you have those skills um at a level of development then you need to you need to solidify them in the clinical setting because our learners you know they they have so much that they're trying to to learn in the short period of time and so much of it is just memorization and then we we put the skills piece on as well if we don't have them practicing these things repeatedly in the clinical setting it's just what we taught them the year prior in simulation isn't going to stick so it's it's a step but it's only the first step and it has to be solidified by repetitive practice in a real world setting great well that was the last posted question um we do have two minutes left I have one more quick slide um for house keeping I just wanted to let everyone know that we will be posting um both the audio and visuals online those should be up within 24 hours we will send you an email when they're up and also let you fill out a survey so that we can improve our quarterly webinars going forward but just to wrap up I wanted to remind you all of some save the dates that we have for the foundation so our mid-year planning meeting is scheduled for Tuesday September 17th on purpose we've scheduled this on world patient safety day it's technically not world patient safety day yet it's going to the world health assembly later this month but we've heard very positive feedback that it should be accepted as I think the 10th world health organization day it is co-convened with UC Irvine health and it will be here in Southern California you can go online and request your invitation today and then our next quarterly webinar will be June 12th it will be on a lengthy topic called reducing emergency department boarding time hospital length of stay and inpatient mortality for hospitalized patients after implementation of an electronic throughput dashboard our expert presenter will be Brandon Lau he is assistant professor of radiology and radiological science and health science informatics at Johns Hopkins School of Medicine he's also associate faculty of the Armstrong Institute for patient safety and quality so please join us and save the date on June 12th you can register just as you did for the webinar today and with that it's 10 o'clock on the dot so I will be respectful of all of your time again thank you Steve Peggy for your expertise in this area and your knowledge sharing thank you to everyone who joined and we hope to speak to you and see you all on future webinars and in person again soon so thank you so much