We've got a fantastic panel now, and I would like to invite, well, first I'd like to introduce our moderator, Elena Allen. She is currently the CEO for Water for People, which is based in the United States. She's a world-leading water expert who's dedicated her career to really providing access to safe drinking water and sanitation to particularly the poor. She has worked in many positions. She's worked both in Peace Corps, and she's also worked for companies such as CH2 and Hill, Jacobs and Arcadis. And at Arcadis, she held a very senior position. As I said, she now works as the CEO for Water for People, and she's been a business executive, and she's had extensive experience in water and sanitation throughout the world. She's worked in many, many countries. So without further ado, I'd like to invite Elena Allen to chair the panel. Thank you, Kala. So I think, oh yes, I'm mic'd. So I'm going to introduce this incredible panel, one by one, if you can join me when I introduce you. So first we have, let me get my glasses here. We have Russian Raj Sriksa from the Gates Foundation, and Russian is from Nepal originally, but he's living in Seattle now. He's a senior program officer and lead of the Urban Tentation Markets. And previously he was a technical advisor at UN Habitat, and he worked in the Water for Asian Cities program with Water, Scarcity and Sewage across the Asian continent. He's a PhD in Applied Sciences from the University of Natural Resources and Applied Life Sciences Boku in Austria. And he favors the holistic approach to sanitation and foresees that non-sewered sanitation, septic management will speed up sanitation in Asia and Pacific region and Africa as well as we've been talking about earlier today. So Rafaela. Rafaela Matos is from Portugal, and she is a principal researcher in hydraulics in environmental department at the National Laboratory for Civil Engineering. Her work has covered the development of performance indicators for wastewater management, adaptive urban water management for climate change, and the sustainable management of urban water among others. She's a member of the Portuguese Water Partnership, a prolific author and researcher, and a leader of H2O 20 Bingo, which is bringing innovation to ongoing water management, and on the advisory board of Klima 2050, the Norwegian Center of Excellence, a climate change and built environment. And then we have Marcus Rink. Marcus is the Chief Inspector for the Drinking Water Inspectorate, a nearly 30 years experience working health environment in the water industry in the UK. He's been in the Drinking Water Inspectorate since 2002, and from 2008 he's been responsible for the operational regulation to England and Wales as the Deputy Chief Inspector. Mr. Rink is a UK member from the European Microbiology Expert Group and Chair of the Strategic Board of the Standing Committee of Analysts. And last, we have Rosie Ween. Rosie's passionate about human rights, gender equality and leadership. She's worked in development for two decades, including six years living and working in the eastern islands of Indonesia. She's worked at Water Aid Australia since its inception in 2004, and I learned she was the first employee. She was the Director of International Programs prior to becoming the Chief Executive in 2016. Rosie's leadership manifesto focuses on being an authentic servant leader and a commitment to pushing beyond her comfort zone in all aspects of her life. This is where she believes she learns most and performs her best. She's on the board of the Three Foundation and is a founder and committee member of the newly formed Not In My Workplace, a group of executive leaders working to address workplace harassment and abuse across all industries in Victoria. And she's recently discovered adventure and obstacle racing. I'd like to hear about that. And electric bikes, which keep her stated healthy and she's a proud mom of two boys. So this amazing panel, we are going to have a conversation and reflect on Silver's talk. And I'd like to think about all these different experiences you all have. What do we still face in strengthening and expanding our institutions in the water sector to reach and maintain sustainable development goal number six? So I'd like to hear from each of you about your thoughts in the area of regulation, people and institution building and have a few specific questions that I'm going to ask and we can have a conversation. And I'm going to start with Marcus as our regulatory expert. So when you reflected on Silver's talk, how do you see the role of regulation changing and low and middle income economies in light of SDG 6? Yes, I mean, I'd like to start off by saying that... Oh, we need a microphone for you. Yeah, can you... Yeah. Okay. So I'd like to start off by saying that I'm a water quality regulator and one of my objectives or my primary objectives is the production of safe, clean water. And so a strategic development goal six really is complementary to the objective of me and my organisation and the support that we give throughout the world together with the World Health Organisation. And it's probably another thing that's worth thinking about is as a regulator we might be seen as a police force which is intended to hit organisations to meet these goals. But you need to put this in context. What we try to do is look at a strategic long-term outcome. We look at the countries that perhaps we're helping and we want to work with them to provide the right stepping stones to the objective of producing safe, clean drinking water. So that often is the provision of advice, guidance, discussing with politicians, creating the bridge between politicians and policy makers and putting in place enforcement, putting in place guidance and putting in place the opportunity for companies to meet those requirements over a long period of time. So regulation and water quality regulation is a relatively new thing. We have been ourselves as the drinking water inspector at less than 30 years in the United Kingdom and many countries don't have a water quality regulator. They rely on the Department of Health or water companies as a whole. And we feel that by working together with policy makers and water companies we can put in learning from different countries into those companies to allow and project safe drinking water quality. Thank you, Marcus. I think we know in some countries where we work and there might be regulations actually written but not necessarily enforced and this is also an area of growing but still very challenging. And so Rosie, what about in your experience at WaterAid and generally working in the countries where you work and developing services and water and sanitation. Have you seen shifts recently or changes in institutional strengthening and regulation in the countries where you work? Yeah, thanks, Eleanor. And thanks again, Silva, for that really inspiring speech and presentation. And I think Eleanor, regulation is a really key part of sector strengthening but to date I think it's been neglected so we are seeing some shifts towards more of an emphasis on regulation and its importance. And I've been lucky enough to visit Campala and see some of the work by Silva's team and visit some of the pro-poor meters where people are able to get access to safe drinking water and really able to transform their lives because they're not playing the previously incredibly inflated prices and I was particularly struck by something that one of Silva's staff said and we saw how engaged and focused they are on the mission and they said serving the poor is not about putting in infrastructure but about the mechanisms you use to keep those systems working and I think that really emphasises the role that regulation plays to keep those systems working. Another great example that I've seen is also from Africa, from West Africa and Burkina Faso where the government there has enshrined the right to water and sanitation in their constitution and also the regulatory framework and this is a really important shift that we're seeing where the right to water and sanitation is informing regulatory frameworks in Burkina Faso I think it's particularly pleasing because there's the emphasis not just on water but also on sanitation and also I would like to flag there's a great opportunity to hear more about the human rights of water and sanitation through the IWA launch of the manual in French so that'll be a key chance to discuss that further then. Great, thanks Rosie. So I loved hearing about people and Silva you also mentioned the performance indicators which is super interesting and I'm familiar with some of the work at National Water about the incentives so I was thinking as we think about our sector and water and sanitation and all of us here knowing we need to approximately double by 2030 to meet SDG number six just to be able to do the work that's being planned with all this new infrastructure being built bringing people to the sector has been hard already but it's just going to continue to be a challenge so especially sanitation I'm thinking about you and your work it's not necessarily the career that some people aspire to get into although some of us that are in the field of course think it's the best in the world so what about the demand as the sanitation services are increasing globally what about the demand for the work and what examples have you seen through your work at the Gates Foundation about attracting people either young professionals or small businesses into the sector in the country's way of work. Thank you. Yeah, of course, sanitation is still... It's on. Yeah, you're good. Sanitation is still an issue that we need to address but I can see in a couple of years back since like five, six years if you see that time and we used to talk about the toilet we used to talk about the pipe sewer system and so on and there is no attraction when we talk seat so who really cares? Nobody likes to talk about the seat nobody likes to listen to the seat the seat is not like the attraction in the past in the past it was just six, seven years ago five, six years back so now at least the mindset of the people or professionals at least slowly changing their mindset seat is a business so seat is a business then there is some attraction what the business there is so that converted slowly of course still takes some time after SDG even that really bring another issue like the we need to talk about the service it's not like coverage so sanitation service so we are talking about we need to achieve sanitation services better sanitation services to do all reach poor everybody so that means when we talk about service then I agree with you that my colleague from when she was talking about like the building infrastructure is not a solution for the poor it's more service if you provide services then definitely they will have better service better sanitation facility so in that sense you know the things are changing but of course we need professionals we have limited professionals now if you see the old schools colleague who really working since last 20-30 years in the sector they don't know all those business model service model whatever you are talking about sanitation but now slowly since is emerging and then the young professionals are coming in just I want to give example I have a colleague who also got award so they come up with the new course on sanitation new scientist and master course and when they close the admission then more than 1800 students they apply and from 90 countries that means there is interest similarly there are a lot of online courses now running and thousands of those young professionals are admitted there so because they have seen that there is business that's why what I am saying here is now we have to really change the way how we talk about sanitation then definitely we can increase science and profile and we really need to show a lot of business opportunity on sanitation we are talking about re-inventing toilets so totally different toilet system similarly we are talking about the sludge management from their agriculture fertilizer all those things produce production everything coming up so I think I am very much hopeful and in next generation definitely we will not have the problem that what we are saying now Thank you Roshan shit business is growing that's good news so what about the clean water side Rafela you are working in hydraulics in Portugal and at the national lab and you have worked a lot on developing performance indicators for utilities what have you learned about performance indicators with respect to the management particularly in low and middle income countries and what about growing talent in the sector in these countries Thank you Hello everyone when I look back really for the work that we have done for IWA PI system 20 years are already passed and I think the main added value of this IWA work started by Elena Alec then followed by myself with a great team was really to have a mainframe for performance assessment that shift from just technological and infrastructure point of view for a more global approach dealing with people with staff with institutional aspects and this global framework did not exist before so this was really the starting point and the idea, the objective was to set this global framework complemented by a set of PI's a huge number of PI's that were able to see like a menu to show up like a menu to be customized by others in several points of the world and the objective of this approach was on one side to have a framework to improve the behavior within an utility or an institution regulatory body to compare, allow for comparison among several institutions and also to from people starting from the scratch to have a kind of a roadmap so this is how I see the starting point since 20 years after the manuals were published a lot of initiatives to help develop all over the world and I think with a lot of success stories I probably don't know every success story but if I may refer some that I know I would point it out the India case where we had this couple MIR and Danish meta with the past performance assessment system and in that for sure impacted a lot of people and this was dealing with water supply and sanitation the full value chain we have also initiatives in Malaysia in China, China is no more a middle income country, I think it's upper middle but in China in Beijing water we had also interesting initiatives on PI for water supply and wastewater we have also some interesting experience with regulators for instance in Albania and Kosovo in Europe in Mozambique, my home country also from the side of the regulator and in South America and the EWI PIs were also the basis, the foundation for the World Bank IBNET that of course impacted all over the world so there were a lot of initiatives around in this last years the manuals were translated in several languages for instance the water supply in French, in Spanish, in Japanese in Iranian and more recently in Chinese so this was really something that EWI did very well to spread around that information and the wastewater manual was also at the recent Chinese version so these reports translated in several languages all these initiatives pop up with their reports were for sure a great inspiration for a lot of people and also a lot of students and young professionals just to a final note if I may say the PI approach is still very alive and it is increasing we see applications in water treatment and wastewater treatment plants, we see application in strategic asset management we see application in decentralized sanitation we see also that ISO standards are now dealing with this matter that is also a very good point to spread up the information and I see also that in this IWA congress we have a lot of sessions dealing with benchmarking of utilities with PIs comparing utilities and cities and benchmarking so I think it's well alive and we'll have a good years ahead excellent thank you Arfila so Silver I have a question for you on people that were on the people topic you touched on people in your presentation but I'm curious in Uganda bringing young professionals into the utility sector do you have programs or partnerships with universities or what's your attraction method for getting them to want to work for national water okay we have young water professionals I saw the young man he's here taking photos there he's actually the president of the young water professionals and these guys are very serious they are planting trees they are teaching people sanitation issues they have introduced the school water and sanitation clubs in schools and with the whole objective of teaching young people to understand matters of environmental protection matters of how to use water and also matters of hygiene promotion so we have them inside the cooperation in the universities and also in other institutions so for us that's a very very good mechanism of succession planning that you have a young generation that is appreciating all these issues so when some of us grow old they can easily take over they're getting ready to take over yes so leading from our people to the institutions and silver you touched on this about building these institutions and looking for ways to not be inefficient and not have role duplication as we look to get countries to full coverage and keeping the services sustainable so everyone keeps high quality of life we know that we need to build resilient institutions and systems that are reliable so this is about regulation and long term planning so Rosie I'm thinking about you and WaterAid and watching communities over the long term change in a level of service from having none or not reliable to having good services what have you experienced and how can you attribute that into institutional strengthening to keep the services going I think that's a really great link as you were just saying to people and as you said in your presentation the institutions, our organizations are our people and I think the power that we have is the global water industry and the people of the water industry is to get better at selling the careers that you have that we have because what we do changes people's lives as silver described a head isn't for carrying water it's for thinking and the work of providing clean water and basic sanitation changes lives so people aren't wasting time particularly women and girls collecting water so that girls can stay in school when there is water and toilets because they have somewhere safe and dignified to manage their periods so the work that we do can really attract great people into our organizations and the institution building work that I see is central to connecting people with people so a great example is in Ethiopia one of the nearly 40 countries where water aid works so in Ethiopia we've had a partnership with Yorkshire Water and Water Aid and we've been working in 20 cities in Ethiopia and very much as you described they're facing huge challenges around really being stretched in their capacity and so how can they build the capacity of their people and so in these 20 towns since 2014 there's been a program looking somewhat similar to the governor of Tokyo described my Japanese isn't great but the head mind and spirit sorry the mind, body and skill the shingi tai really focusing on governance skills on technical skills and the human resource capacity building and what we're seeing is tremendous results in these 20 cities one of these cities has in itself hosted another 160 towns that have come to visit and see the work that they're doing as a result of the capacity building of the institution of the people and with the investment that we've made in that has been relatively small 1 million pounds compared to the investment by others by other banks and the government of Ethiopia they've invested 45 million pounds as a result of the strengthening of the capacity building and I think this signals the way to end that song that you are singing of donors, donors the song of the day is to really strengthen the capacity and it is only with that that we will achieve the sustainable development goals and I think this really shows the power of partnerships and also the power of the people as I said at the outset of the water industry and how we can connect up globally to achieve the sustainable development goals. We've only got 4,488 days left so we really do need to have a sense of urgency. Thank you for that pressure for the time the clock keeps ticking so one thing we haven't touched on yet but I'd like to hear from panelists about institution building with related to extreme weather and climate change there's things happening at home in the US right now that are unprecedented so I know Rafael you're one of your areas of expertise is climate change adaptation and what about utilities in this area and global management and taking this into account within water resources management and part of their institutional strengthening what have you seen in your experience? Thank you again Helian or as you referred I'm working now more in Europe on cities and climate adaptation against resilience against hydroclimate risks but what I can say what I see around the world is that first there is a huge awareness growing on the topic and this is very positive and everybody's also feeling that there's a huge need for action so the sense of urgency is also now much more clear there is also a very positive growing of exchange of experiences so this is good because this can be a shortcut to the point on the other hand there are also huge funds and investments for climate change adaptation where the water and the sanitation can benefit from namely to achieve STG-6 but also STG-13 climate change so these are all good news just to give an example again in my home the country where I was born in Mozambique the master drainage plan the metropolitan master drainage plan for Maputo and the climate adaptation plan of World Bank so there are a lot of possibilities by now two main messages in my understanding that are really important for low and middle income countries first the reality of the very urban cities the slums they are growing and growing more than the cities themselves they have 80-90% of the population of the city and when there are extreme events like floods these people cannot escape so they are really squeezed in place and more than this when there is flooding the flooding leachivates the sludge from the latrines so there are huge problems of health of quality in the place so you can spread cholera so I do believe that a big priority is to take care of the peri-urban areas that is a reality that we don't have so much in other countries also in these areas the role of capacity building institutional strengthening that we have referred so much here governance overall it's even more needed than others because in upper middle countries you have a vertical structure from government to the citizen but in these places the government cannot reach to the people so more and more the local arena is needed so the playing role of education and capacity building is extremely important when you invest in infrastructure if you do not invest at the same time on capacity building and education there will be no return of this investment so this is in my point of view a key message just a piece of information if I am made to conclude and now we are now creating in Lisbon where I live the Liswater Liswater is an international center of excellence that got already some funds from the European Commission and the center is for public policies and regulation on water and water resources related water resources and the aim of Liswater is exactly to tackle this huge challenge how do you internalize how do you transfer knowledge, innovation and research to capacity building to strategic advising to entrepreneurship and to society engagement the logo of Liswater is a butterfly or is a flower you see what you want and the the significant cut is really this from the core from the petals from inside to the flies of these aspects where you have to transfer I do hope that you heard in the near future about Liswater and we will have our own page and I do hope this will contribute to fill this gap that is so important to achieve the strategic goals and the future of the system and in the near future of the system I will go ahead and I will start with you Rafaela you mentioned something I would like Marcus to build on a bit the urban slums lots of people moving in and we are not quite there with water quality so I'm curious about how we training for institutions that can help provide that high level of water quality? Yes, from a water quality point of view, I'm a great believer in big data and understanding where the challenges are. I see this as a multi-faceted, multi-strategical objective in putting water safety plans in place to make sure that appropriate assessment and care of the sources of water are of the best quality possible, but also then carrying out surveillance of that with testing that is accessible. For developed nations, that's a relatively easy thing because you have laboratories, you have trained staff, you have transport and the majority of costs associated with that are transport people and infrastructure laboratories and that may not exist. One of the things that I was reading about was that regulation is sometimes thought to block innovation in water quality testing and I think that's fallacy. I think regulations about working with the circumstances that you find yourself in building on that and then being able to develop that. If you have portable tests, whether they're chemistry or microbiological tests, which you can gain data from, that gives you an idea of your prioritization. So there's clear chemical testing that's easy, colorometric, photometric, chemical test strips and so on where you can test for nitrate and fluoride and chlorine and so on, microbiological testing is a little bit more difficult and yet it's the most important part of it because in the more remote areas, that is really where you need to focus on. That's where you really need to understand. You really need to understand what kind of water supply you have and in the cases where there is flooding or rainfall or disaster, testing that sufficiently rapid. So it's important to have a low cost, easily accessible, easy usable without specialist knowledge that can be done in the field without laboratories or incubators and we're starting to see an increase in that. It's almost looking at technology that was used 20 years ago, but advancing on that and making it innovative. So we've seen for instance, multiple tube techniques, plates and filter membranes, which have been adapted into into mobile kits and now you can carry out filtration in the field. You can carry out a simple test where you put it into a bag and it has a chromogenic medium in there without the need for UV technologies. You might not have electricity. You might not have anything to incubate it in. So it's nice to see some innovation in a test in a bag that you can pop it in, see the changes of colour and that gives you a clear understanding that you have code forms or E. coli where you can take photographs of that through your mobile phone technology and that's then gives you a clear picture where your priorities are and where, for instance, there may be a disaster looming. So in some of the tests, particularly some of the gel chromogenic techniques where you're pushing through in a filter and looking at the change in colour of the filter, you can sensibly get an understanding of gross contamination within an hour or two hours and you can communicate that back. Now that gives you a real opportunity to stop disasters happening and be also proactive. So once you gather that data, you can then send out your resource to provide the guidance, the training, the help, redigging wells, protecting wells, not just improving the wells but making the wells such that it will produce safe quality water because after all that is what our objective is. It's producing safe water. Thank you Marcus. Okay, we're out of time here. Just one last question for Roshan to close up our panel here. I'm curious from your perspective on institutional strengthening as a foundation, you play a unique role, you can convene others, you can bring together civil society and government and private partners. So where do you see that going with regards to getting institutions stronger? Yeah, our role is to play the facilitation role. For example, main thing is there are a lot of best practices are available and people like Dr. Silva and many other colleagues who are nearly champion, we need to really bring it up there and we are actually helping to working with a couple of the institutions who are really mobilizing the lot of institutions like the SOHSA from Africa. Similarly, several countries in South Asia, for example, likely working with the government and bringing the issues there and then the main thing is how to really learn each other and how to establish a lot of training programs so that the best practices can be transferred to other cities. For example, Kampala can be one of the basic examples that Dr. Silva is saying so that practices need to be transferred to others and then the institutional setup and regulation cannot really happen easily. We need to really show the people how this is going and for that purpose we are working with the development partner, development bank and government, city authorities to work together and we are playing kind of facilitated role to bring these issues on the ground. Excellent, thank you. I'd like to thank all my panelists and keynote speaker and please join me in giving a round of applause to this excellent panel.


Welcome to the week's sports minute. I'm James and Flavik. We're back playing Kentucky Dirty Horse or ad agency volume four. That's right, if we were the Avengers, this would be our end game. This year our contestants are playing for a ticket to a virtual social media week event, which is a worldwide event that brings together global leaders, social media practitioners and digital marketers for a multi-day event that serves as a central meeting point for the entire social media marketing industry. All right, let's play. All right, first one, been there, done that. That's gotta be a horse. No, that is an ad agency. Instigator. Horse. No, that's an ad agency. Palm and circumstance. All right, that's gotta be a horse. No, that's also an ad agency. Like the king. Derby horse. That's correct. Brothers and sisters. Ad agency. That's correct. Cato river. Derby horse. That's correct, something else. Horse. Incorrect, known agenda. Ad agency. Incorrect, rock your world. Ad agency. Incorrect, the adventures of. Agency. Correct, dynamic one. Agency. Incorrect, social studies. Horse. That's incorrect. I'm sorry to say you only got four rights so you did not win the ad week sports minute, but thank you for playing, Ken. Thank you for having me. Social studies. Ad agency. That's correct. You got eight right. You are a winner of the ad week sports minute. You are going to social media week in May. Yay, that's amazing. Thank you. Congratulations. All right, are you ready? Yeah. Okay, here we go. Super stock. Derby horse. That's correct. Highly motivated. Derby horse. That's correct. Cognito. Not incognito, just cognito. Agency. That's correct. Prodigious. Derby horse. That's incorrect. Crowded trade. Derby horse. That's correct. Craving beast. No, I think that's a derby horse. No, that's an agency. Red brick road. Horse. That's an actual agency. Alpha century. Derby horse. That's also an agency. Tank top. I'm going derby horse again. That's also an agency. Helium. Agency. That's actually a derby horse. Electric glue. Derby horse. Oh, that's incorrect. We beastie. Agency. That's correct. Unfortunately, you only got six right, so you did not win the Iowa Exports Minute. We beastie. Agency. That's correct. You got seven right. That was your winner. You are going to social media week, my friend. Nice. Here we go. Forge Apollo. Ad agency. Correct. Essential quality. Ad agency. That's incorrect. Our man in Havana. I'm going to go with horse. That's incorrect. That's an actual agency. Gee whiz. Horse. That's incorrect. Hot rod, Charlie. Also going to go with horse. That one's correct. Super bolt. Ad agency. That's correct. No fixed address. Ad agency. Correct. Amanda Lewin. Ad agency. That's incorrect. Dream shake. I'm going to go with horse. That's correct. Antidote. Agency. That's correct. Lover fear. Ad agency. That's correct. St. Hood. Ad agency. That's incorrect. But you still got seven right.  And you are going to social media week. Thank you for playing the alley sports minute. I'm excited. Thank you. St. Hood. Oh, that's gotta be a horse. That's correct. You got eight right.  You are going to social media week. I've won the lottery. You really have here. This is truly a great prize. So congratulations. That's it for this year's version of Kentucky Derby Horse or Ad agency. For the alley sports minute, I'm James Swenner.


Hey everybody welcome back to my channel thank you so much for watching don't forget to like and subscribe. Wow so I'm reading this on the USMLE website. USMLE United States Medical Licensing Examination Board is saying that the USMLE program will change score reporting for step one from a three-digit score to reporting only a pass-fail outcome. A numeric score will continue to be reported for step two clinical knowledge CK and step three. Step two clinical skills CS will continue to be reported as pass-fail which has always been the case. This policy will take effect no earlier than January 1st 2022 with further details to follow later this year. Okay wow Pacific consideration was placed on supporting the educational engagement and overall experience of medical students and on increasing the dialogue about how multiple assessments of competency could best be utilized by the stakeholders in medical regulation and in medical education. So I heard about this decision coming to light you know in the last week or so and actually saw some other response videos to this on YouTube and I decided to make my own because I have just recently sent email to one of my mentees about you know what she should be doing as far as getting ready for applying to residency next year. So you know we talked about the step one score which was the issue it wasn't you know in her opinion a really good score so she was worried. So now you know this situation is going to be totally upended in 2022 when it becomes a pass-fail system. It's a crazy concept to think about because the step one usmally step one score has been the number that most residencies looked at to determine you know whether or not a candidate was even to be interviewed and then even going forward from there should that candidate be ranked. I'm very closely involved in this process in my particular anesthesiology residency program and so we look at these things and it's a part of our decision-making process. So now that it's going from a numeric score to a pass-fail system that is going to really change things for the stakeholders which would be you as a medical student everyone who is involved in the residency application process everyone is affected by this. So now that this is going to be the thing like what else are we going to be looking for to make sure that we are selecting candidates that will be successful. So a lot of people out there have been saying oh this is horrible this is not a good thing like you know step one you know it's really important to have this number but I actually I'm a proponent of the other end of things. I feel that the clinical skills and clinical knowledge part of the assessment from the USMLE I think those are actually very much more effective predictors of how well someone is going to do in a residency. Now you may wonder why you know why you're supposed to know a lot of knowledge as a doctor this is true you're supposed to have a very strong basis in the basic sciences this is true but does it always translate to you being a great clinician or even a competent clinician and how you interact with patients does that always translate you know the knowledge that you have does that always translate to someone being a good clinician or someone who is able to connect with patients figure out diagnoses and treat them maybe not I think you know those who haven't actually taken this step to clinical skills portion of the three step exams that test really is great because you're physically going in you're presented with clinical scenarios and then you're going in to see patients you know they have people who are sitting there as actors they're prepared for you know presenting and describing their symptoms and you go in and you see these patients after reading a clinical scenario and you have to formulate your decision making process as far as what are you going to do in your history questioning so how are you going to ask them about their symptoms and based on those questions how are you going to perform or what types of exams are you going to perform for physical assessment so are you going to listen to the lungs are you going to listen to the heart probably always but what else will you examine what other signs are you looking for and it really tests your conglomeration of knowledge the way that you put together I should say your clinical knowledge with your physical exam skills and clinical assessment skills so those are all the things that a resident physician needs to be doing every day and that's why I think it is a better test to look at again there's a past fail component but then the other numeric score for the clinical knowledge is the one that we're going to be looking at in another vein this is going to propose a lot of challenge for I would say people who are more medical students who are doing the USM lead to you know enter a US residency which we all know the spaces are limited to begin with you know there's such a high demand and low supply but knowing all that that being said this clinical skills test is really a test of your communication skills and most of the time in residency that is like the key that you need to have mastered so that you can actually present information examine your patients well and figure out what's going on so the communication aspect and you know especially if someone has the barrier of having English as a second language that may also you know make it a more challenging test and an assessment point for them so that's something that again it's a tough thing I think you know when there's so much emphasis on this portion of the test so that might make it even harder it's going to be very interesting to see you know just there are the pros and the cons it's very it's going to be very interesting to see how all of this affects the residency so all of this came to be as a result of a vote that involved the AMA or American Medical Association there were residents medical students and physicians that voted so once again voting matters some final thoughts right there are a lot of questions how is this all going to affect everything most specifically like the timing of these tests how is it going to be restructured is it going to be restructured to allow for people to have time to take step two and get those scores back before they're applying for residency because currently you didn't really have to have that all submitted to submit your application for residency the competitiveness of residencies what other criteria they're going to be putting at the forefront addition to step two what this means for the spots that we have available as far as you know different programs that are considered more competitive are they going to be more spot are they going to be any changes to the number of you know spaces that are allowed for training with the ACGME we don't know there are a lot of questions a lot of possibilities that will come up only time will tell if this is going to be a change for the better i know that there's a lot of stress and a lot of emphasis on the step one with medical students and this is actually probably the most distressing part of their training and that was mentioned by the statement that was put out by the AMA that you know it's going to relieve this really really tough burden off of medical students that actually improve their education yeah potentially that could be so and if that is the case and if that is so i think that that's excellent and great and will hopefully make for you know a better generation of doctors to come but you know it really does affect many many people who are pursuing medicine it affects you definitely you know those that are on their road to medical school and those that are currently just starting medical school are in there that will end up needing to apply after 2023 we'll see how it goes if not done right things could go either way so like i i keep thinking like my whole process and getting into residency when i was in medical school like my focus going in through the door was okay got to do well on your step one that's it you got to make sure that from the day that you start your basic sciences that you're thinking about studying for step one as a matter of fact the moment i started you know started taking exams in medical school i bought a book to review for step one and as i went through each topic i went to that topic in the review book to make sure that i was able to see the links to the standardized tests what they were going to ask me and the like so you know going in with that focus i knew like i wanted to get into anesthesia and it was very competitive so my goal was like you need to score in the 99 percentile you have to do it and so that was my goal i went in and that's basically what i had to do and because of that i was able to get into my first choice residency program and so i think that that one test the step one really like set my destiny so what is going to happen now i mean like all of the really competitive specialties look at step one you know you're wanting to go into radiology ophthalmology all of these specialties of surgery ortho like you need to have a really high step one and that's how it's been so what are we going to be looking at now we don't know you know they may switch up the timing where step one and step two are very like closely timed so you're gonna have a step one and then you're gonna have a step two maybe less than six months later you they may reverse it who knows they may call it something totally different so it's not step one it's just part of the test so it's usm only test you know we don't know what they're gonna call it maybe they may take away the numbers who knows step two may become step one whatever they may change it all together what i really want to emphasize is that all of these tests they're there for a reason we want to make sure that everyone has a standardized base of medical knowledge and also everyone is trained to take care of patients that's the most important part so i feel that if whatever way the test needs to be structured to make sure that the physicians that are coming through that are going into residency and that are in the community treating patients are the excellent and best they can be that i feel would be the most ideal outcome so however we can accomplish that let's do it guys leave your questions in the comments below people you know have varied opinions on this topic i want to hear what yours are yeah and don't forget to like and subscribe and i'll see you guys in the next video take care


ing next week and give a short bit of evidence to explain the situation on this. I am also going to ask Sir Clarks to write on behalf of the committee, the regulatory authorities, to ask if there is any evidence that they would like to submit. That evidence might be difficult to gather in the timescale, but I will give them the deadline of Monday morning next week so that we have time to consider it before the meeting on Tuesday. I think that that is a logical way to deal with this so that we can fully understand it. If everyone has agreed with that, that is what I am going to progress to do. Okay, so we have agreed on that. Thank you very much. Now, we have one more item, do we not, Clarks, which is the consideration of gender isolation 4, which is a negative instrument. The water and sewage service is to dwellings collection of unmetered charges by local authorities Scotland order 2023. This instrument is laid under the negative procedure, which means that its provisions will come into force unless the Parliament agrees to annul them. No motions to annul have been made. Do any members have any comments on this? I have one question that I assume this is done each year. It would be useful to know if all the money that is levied is actually collected, and if there is a difference between the levy amount and what is actually passed to Scottish Water, I assume. We could write, if the committee were happy, just write for an information point to the minister to ask him for that information so that we can understand what that is. However, if there are no other comments, would the committee be happy to agree that it does not want to make any specific recommendations in relation to this instrument? If we are agreed on that, that means that this part of the meeting is concluded and we are now going to go into private session.