Welcome back to theCUBE's coverage of VMworld 2021, the virtual edition. Tom Gillis is back on theCUBE. He's an SVP at VMware in the GM of Network and Advanced Security at the company. Tom, always a pleasure to see you. Thanks for coming on. Hey, thanks for having me. It's always a pleasure to be back here on theCUBE. I really enjoy it. We've known each other for, I don't want to count how many years, but more than a few. And it's always an interesting conversation. Yeah, we've had a lot of face-to-face interactions a couple of years in a row now, where virtual, we'll be back together at some point. I'm confident. Yeah, I'm actually on the road with customers. So it's starting to happen. Yeah, us too. We did public sector summit in DC this week. I'm heading out to Vegas next week for a show. So it is starting to happen. So just a matter of time. Hey, wanna start with your scope of responsibilities, network and advanced security. You're kind of putting those two areas together. Very important. It makes sense synergistically, but how are you guys thinking about that? Maybe you could add some color. Yeah, sure thing. So network and advanced security means all things security at VMware. So it's carbon black with our endpoint product. It's NSX in the data center. It's our tons of service mesh for cloud native applications. It's all the security stuff that goes into our anywhere workspace. And I think you probably get the message here, Dave, that at VMware, there's three big waves that we're trying to ride. Multi-cloud computing platform, which is our hallmark is what we're known for, running that across every cloud. It's the cloud native applications, building tools for new modern apps. And then really kind of the future of both networking and compute is being defined by this anywhere workspace. And our mission is to put security and connectivity into all of that, that makes it work and makes it work well at scale. And so it made sense to put all that under one roof on the guy and that's what we're doing. Yeah, you talk about that anywhere workspace, which was always kind of a great vision. And then it was somewhat aspirational, but then it became not only a reality, but a mandate over the past 15, 18 months. And that has that ripples through to implications on networking, even getting flatter and the security implications. So all those things are coming together. There really are. I think we can't underestimate the profound impact that COVID and the kind of work from home has had on our lives, on society. Like we're still churning through what those implications are. But in networking, it's cause for a fundamental rethink. And for 20 years, I've been doing networking. And for 20 years, we had this notion of a demarcation point and networks defined as something that there was a DMZ, right? And on one side of that DMZ was a dirty, untrusted internet. Ooh, it's scary. The other side is the clean, blissful corporate network where only butterflies and unicorns exist. And wherever you were in the world, your traffic would be backhauled through that DMZ so that it could be scrubbed. And if you ever used tools like we're using now, Zoom, you realize that that experience of backhauling traffic through a traditional VPN is pretty suboptimal. And so across the industry, enterprises are saying, you know what, this got to be a different way, right? Instead of moving my traffic to the security services, what if I turn that upside down? That's what we're doing at VMware, which we're taking those security services that live in the DMZ, we're doing what VMware does well, which is define them as software and then running them in hundreds of points of presence around the world, hundreds. And so we effectively move the security close to the users, wherever the users are, instead of the other way around. And that's the way we think we'll be building networks in a post-pandemic world. Yeah, and that talks to the trend of this hyper-decentralized system that's basically everywhere. Now, you know, even out to the edge. And so you now have this, you know, zero trust used to be a buzzword. And again, it's become this mandate. You guys actually did some, I think it was you who did some really interesting research post the SolarWinds hack on, and kind of talking about things like island hopping and explaining how malware was getting in, self-forming and some of the insidious ways in which the adversaries, and that is a function of a lot of things. The adversaries are obviously highly capable. They're motivated because it's lucrative and they keep upping the game on the good guys, if you will. Yeah, it's nuts. And so think about the impact that ransomware has had, you know? And also to your point about the NAO workspace, I'm right now in Boston, I could, you know, tomorrow I'm going to be in Texas and the day after that I'll be in San Francisco. So I'm popping all over the place, you know, we're back meeting customers, going wherever they want us to be. But wherever I am, I'm able to connect and my traffic needs to be protected. Now in Boston, it was a ransomware attack against a ferry.  And it disrupted that ferry for days. So at VMware, we're measuring all the inner workings of what's happening in the data center. And we collect more than eight trillion with a T, eight trillion events per week. And that allows us to be able to identify these anomalies, like ransomware. And so just in the last 90 days, we've stopped more than a million ransomware attacks, 1.1 million ransomware attacks that we stopped within six seconds. And more than a million ransomware attacks in the last 90 days, to give you a sense of the magnitude of this problem. It's everywhere.  Zero trust is a concept. It's a philosophy. It's not a product, you know, buy zero trust. You implement a zero trust model, which says in a de-perimeterized world, in a world where people like Tom are hopscotch on all over the place, and Dave's in Boston, and, you know, I could be at San Francisco, we have to make the assumption that somehow, some way, you know, our machine or a user has been compromised.  And that's how we stop running somewhere. That's how we can keep your infrastructure safe. And this is something that VMware does very uniquely because of the intrinsic attributes of our platform, our virtualization platform, and our multi-cloud platform. Yeah, you talk about the ferry. Anybody who's ever taken the ferry to Nantucket knows it's a pretty low-tech operation. And when that ferry goes down, if it's one thing it's weather, you can kind of understand that, but people's lives get ruined, their vacations get ruined, they can't get off the island. Commerce comes to a grinding halt. It's extremely, extremely expensive, really. For days. For days. It wasn't like it wasn't a 20-minute outage. You know, it was like, oh, ferry's not running for a couple of days. Like that is a huge, huge, very high-impact bang. And the fact that it was so pedestrian, like they don't have billions of dollars in the bank and, you know, sort of, you know, super secret defense technologies. It's a ferry, you know. Right, right. Come on, ransomware is everywhere. So talk about your software approach to networking and security a little bit more. How that changes the experience for organizations, generally, and developers, specifically. Yeah, so in a multi-cloud world, you can't always count on having physical infrastructure that you can touch. And in fact, do you really want to touch that stuff? And so our idea is that if you think about infrastructure, its job is to support the needs of the application. And so, for example, in Kubernetes, we have the ability for developers to say, look, here's my cool new application. And this piece talks to this piece talks to this piece and nothing else. And so we can implement those types of controls using what we call a service mesh, which allows us to make those connections smooth and seamless across clouds. Some of it could run on Amazon. Some of it could be running in a private cloud infrastructure. Some of it could be running in a traditional VM. And in fact, you know, many complicated applications do just that. So we can facilitate that communication back and forth. And we have the ability to look for stuff that you just never happen. Because when you understand how an application is supposed to work, it allows you to spot, hey, wait a minute, that's not right. That looks like someone trying to manipulate the ferry system rather than somebody trying to board the ferry and get on. And I think, you know, there's a really interesting observation here, which is when you, if you could see the inner workings of an application, like Dave looks for example, let's think about a mortgage payment application. If I had a mortgage payment application and an attacker has stolen a credential and they're going to get in, it's really hard to figure out, friend from file. But once they get into a mortgage payment application, they're not going to pay my mortgage, right? They do crazy anomalous things, like wildly anomalous things. If you can see them, you can stop them. And we have the unique ability to see them because we put the telemetry, the observation into our virtualization platform that runs on every cloud, that runs wherever the user is, right? And pulling all that together into a centralized view. That's something I think VMware can do uniquely. And this is why we're having such success in security. I wonder if you could talk a little bit more about securing containers. You just sort of referenced that, but containers are a moving target. Just a few short years ago, containers were ephemeral.  You're getting state. But so that's a moving target. How are you thinking about handling, you know, those kind of changes? And what about the architecture allows you to be kind of future proof, if you will. Sorry to use that word. Yeah. No, no, no, it's a good question. So you've articulated it right. So if you think about a traditional application, we used to always talk about three tiered web app. There's the web server, there's the app server, and then the database. That's a little more complicated than that, but you could usually go in and you could touch those three tiers. This box is the web tier, this box is the app tier, this big box is the database. And so security controls were built around this idea that you could wrap that relatively easily. We talk about a container-based application and all these microservices. It's not three tiers anymore. It's 300 tiers or maybe 3000 tiers. It's these bitty little things, these little services that turn up and turn down, and they all have APIs. And so our view is that the API is the new endpoint. The API is where the action happens. And not just the API that faces the internet, but all the inner workings, all the internal APIs. And so because we put that application together, because we help the developers create those APIs, we have a unique understanding of how those APIs are used. And we're just introducing the ability to provide visibility around how are these APIs being used? And then we can do anomaly detection. And we are seeing a whole new set of attacks that are using legitimate APIs. They're not APIs that are broken or malformed, but their attackers are finding ways to extract data from an API that maybe they shouldn't have. Do you remember some of the Facebook stuff where they had these attackers were profiling users? And there was no limit to how they could profile users and they were just expecting huge amounts of data. That's an API breach. And these are the kind of problems that we can solve for our customers with these built-in Tanzu service mesh and API security controls. You think about all these trends we're talking about, and I want to ask you about how it's affected go-to-market because kind of in the old days, you had box sellers, they would integrate VMware or whatever. You might have a specialist that was really good at say, for instance, SAP, and they were good partners, so they're kind of value add. Developers have become a new channel for you. And I wonder how you think about that, how they're now influencing the go-to-market. Yeah, that's a clear trend in the industry you're absolutely right on. And we call it moving left, right? So it's getting earlier and earlier in the development process. And so one of the things that we're announcing at the show here is that the Tanzu Community Edition that makes it super easy for developers without putting down a credit card or making a big expensive commitment, they can start using these tools and get productive right away. And so on top of that, we've built security controls that understand the total life cycle. So as a developer is writing code, we're checking that code to make sure, is this compliant? Does this have any known vulnerabilities? Is this gonna break something if you put it out there? And then when you go to hit commit and say, all right, I'm ready to go, we've already done the homework to make sure the code is clean. We'll put it in the right place. So placing it into production in a way that it's wrapped with the security that it needs, that the guardrails are in place. And now we have this X-ray vision, this ability to look at the inner workings and understand the APIs, what's happening inside the application and identify anomalies. And lastly, once this thing is up and running, we actually have the ability to measure, we call it posture, and make sure that it doesn't drift from its intended configuration. All of this is done across every cloud. So this is how we think we have a kind of new and very holistic approach to securing cloud native applications. Tom, I want to ask you about telco transformation. I mean, NFV kind of just barely scratched the surface in my view. Now we're seeing with the Edge and 5G and the cloud, there's some O-RAN, some really interesting opportunities going on in telco. Say what you want about telcos. Yeah, the connectivity and okay, fine. But one thing you say about the telco networks is they work, you know, and they actually did a great job during the pandemic. They had to pivot to landlines. And so when it comes to reliability and rock solidness, those guys kind of get it, but they've got to be more flexible. So you see those two worlds colliding. What's going on in telco and where does VMware play? Yeah, sure thing. A huge amount of emphasis on telco. We've won some very large telco deals. 5G is not just a faster version of 4G. 5G is a new take on what an Edge network can do. It has the ability to run extremely high performance network connections and the ability to control the performance. So this is an idea of what we call network slicing. So you can guarantee a certain amount of latency or a certain amount of bandwidth. So combine that with this explosion of IoT devices. We're going to have, you know, sort of infinite number of devices. Every device you can imagine has a computer in it.  We keep coming up with new and interesting ways to analyze that data, to do things like, you know, control a self-driving car, to do things like create a customized retail experience, to do things like help guide research for an oil company on the oil platform. Okay, these are all examples of Edge computing. Now, the infrastructure that you need to protect those workloads is what we're defining in software and putting it everywhere. Not just in the traditional data center, where you might be in 10, 20 locations. We're talking about hundreds going into thousands of locations. And this is what the industry is calling SASE, or Secure Access Services Edge. So where's your firewall, your web proxy, the controls that you need to protect those apps, where do they live? They're going to live in the telco infrastructure. And that stuff all runs on x86 servers. So if you're putting the data center services into this distributed architecture, and you've got tons and tons of data that's being produced locally, why wouldn't you want to move the compute there? And we think you can and will. And this is why VMware with our telco partners is uniquely suited to build the groundwork for this edge computing infrastructure. And I think edge computing is going to be the next big wave. So we went from private clouds to public clouds. And a public cloud was built on, the scale out fault tolerant model. As we move to edge computing, edge computing is going to be around applications that need huge amounts of data with very low latency and they're highly distributed. So they're going to run not in 10 or 20 locations, but in a thousand or more. And we can do all of this with our tons of Kubernetes, with our virtual networking infrastructure and our anywhere workspace and the secure access services edge, the pops that we're building. And I think VMware is probably one of the few, if any companies that have all of these pieces that we can put together to make the edge actually work. Yeah, exciting times and all that data, AI inferencing at the edge, new processor models, and you guys are thinking about all of that stuff. Tom, we got to leave it there. Thanks so much for coming back in theCUBE. Great conversation. Always a pleasure. Thanks very much, Dave. Take care. All right, you too. And keep it right there, everybody. This is Dave Vellante for theCUBE's coverage of VMworld 2021, the virtual edition. We'll be right back.


Thank you very much. I'm incredibly grateful to Walter who's just explained the tumor to you in detail saving me a great deal of work Thank you, Walter I'm even more grateful to the Brain Foundation. It's a it's a real honor to be here and The weather is certainly better than in Melbourne. So that's a plus, too I Want to tell you a bit about what it means for me to receive a gift of this sort From this organization and what that means in terms of progressing my research Now I'm training to be a neurosurgeon and in the course of my work in hospitals around Australia. I Have become increasingly just just made and distressed By the following scenario. So I want you to imagine It's two in the morning in the emergency department and I've been called to see a patient who's come in with a headache And they've had a seizure or a funny turn and the whole family is there and everyone's really distressed And in their hands, they're clutching this packet And it's a scan that the GP has organized and I open up that packet and I have a look at it And there's a lump in the brain And when I see that lump my heart sinks because I know that there is nothing good that looks like that on a scan And I know that if this is an aggressive tumor if it is a glioblastoma Then this is the lump that will limit my patient's life So then I go through the process of explaining to them What it is that we can do for them in the next days weeks and months and you've had some of that described to you already But I know that what we're able to offer them is not enough And I've watched my colleagues in other tumor streams people working in breast cancer or Melanoma have wonderful breakthroughs with amazing new biological treatments for these cancers And I've seen them shift the dial for their patients and more than anything else. I want that for my patients So I've embarked on a journey of learning to be a scientist not just a surgeon because as you've already heard This isn't the surgical disease the answers are in the lab So my work focuses on a protein called the epidermal growth factor receptor This protein lives on the surface of cells and in normal cells it helps them to grow and develop in brain tumor cells it can be Over-expressed there can be too much of it. It can be improperly folded can have mutations and in those cases It can be driving the cancer And so what we are focusing on in my lab and it is a lab that has a lot of expertise with this receptor and has Contributed to significant breakthroughs in EGFR structure and function in the past is we're actually having another look At the structure in light of some of the novel agents that have arisen some of these small molecule agents some of the immunotherapies That have become available ways of hijacking the cells equipment to kill the cell And we're isolating this receptor on little tiny slips of Basically a little bit of lipid with a little ring around it called nanodisks So that we can have a look at those receptors in detail And then see what happens to the structure of the receptor as we add combinations of Different agents that are available At the end of the day what we'd like to be able to do is to stop these cancer cells from growing And if we can kill those cancer cells then my patients will get to live so thank you for your help with that


Say we are given a long thick wire whose radius is r and the current through it is i. Imagine this is a very long infinitely long wire if you want. Our goal is to figure out the magnetic field everywhere in space. In this video we'll focus on calculating the magnetic field outside the wire and in the next video we'll calculate the magnetic field inside the wire. So let's say we want to calculate the magnetic field at some distance r at this point. The question is how do we do this? Well we have seen two laws that help us calculate magnetic field due to current. One is called the Biot-Sawar law and the other one is Ampere's circuit law. To use Biot-Sawar we have to take this entire conductor and divide into tiny tiny pieces and calculate the magnetic field due to each piece because that's what Biot-Sawar does and that's and then you have to add all of that up and this is a very long conductor meaning we have to integrate this is going to be a nightmare so not going to use Biot-Sawar at all but instead we'll use Ampere's circuit law. What does this say? It's a quick refresher. It says choose a closed loop and walk along that loop and calculate this integral and that should always always equal mu naught times the current enclosed by the loop. I have talked more about that in our previous videos on Ampere's circuit law. If you need more refresher feel free to go back and check that out but at this point you might say hold on a second Mahesh even this has an integral so what's the point? The point is in certain situations like this one as we will see we can choose very specific closed loops very special closed loops and if you do that then this integral becomes super easy really really easy you don't even actually have to integrate and then we can use this in a few steps we can calculate with the magnitude what the value of magnetic field is that's the whole idea so the question is what closed loop should I choose over here? Well before we do that let's look at how the magnetic field looks like then I can think about what the closed loop would what loop should I choose so what would the magnetic field look like over here well we've seen before I mean in our earth stats experiment that magnetic field through due to a wire will always be in concentric circles so the magnetic field over here would be in a circular shape so maybe somewhat like this goes from behind comes from here and guava and what's the direction of that field? Well we use right hand thumb rule if the thumb points in the direction of the current the encircling fingers will give us the direction of the field and so our direction of the field would be this way let me get rid of the thumb now let me show you what's special about this situation because every single point is at the same distance from the center is a circle right the magnetic field everywhere should have the same value so the magnetic field over here for example it's tangential so it's going to be in this direction and if the value over here is hundred the magnetic field over here should also be hundred because the same distance this also a distance r this also a distance r so over here again it's going to be tangent and maybe it's into the screen but the value should stay the same hundred even here the magnetic field should say value should say the same it's hundred and we're going to take the advantage of that because the magnetic field everywhere has the same value if we choose a very specific closed loop maybe b over that loop becomes a constant and then i take the integral that b can come out and the integral that can become very very easy so can you pause the video and think about what closed loop would you choose so that the integral would become easy so pause and give it a try it's okay if if you're wrong but it's just just give it a shot try it okay let me start by choosing a rectangle just like that so what will happen if i choose a rectangle can i use ampere's law yes ampere's law works for any closed loop i can walk along that rectangle calculate that b dot d l integral and i should get mu naught times the current and cost the problem is because every point is not at the same distance from the center that means the magnetic field everywhere over on this is not the same and so now that integral becomes really really complicated even the direction of the b and the direction of d l will also be like not the same so calculating dot product will also be really complicated so don't choose a rectangle it's not a good loop ampere's law work but it's not gonna help us so to take advantage maybe you have guessed it let's choose a circular loop itself and we call this an amperean loop whatever loop you are choosing so let's choose a circular loop of the same radius r okay here we go now notice as i walk around that loop the magnetic field value everywhere is going to be the same and so we can come out but another interesting thing is remember we have to do a dot product so we need to also know the direction of d l and the direction of d l everywhere is in the same direction as b because both are circles so over here d l is in this direction same direction as b over here d l is in same direction here also d l is in same direction and so now the dot product also becomes easier to calculate because b and d l everywhere are in the same direction so why don't you pause the video now and try yourself okay i'm hopefully you're all pumped up to try yourself what the left hand side eventually simplifies to so pause and give it a shot okay let's do this let's do this together so what happens when i simplify the left hand side let's only consider left hand side b and d l are in the same direction so what happens to b dot d l remember dot dot product b dot d l would be so b dot d l would be b d l cos theta where theta is the angle between b and d l but since the angle between b and d l is zero cos zero is one so this will just be b d l so i'll just get magnitude of b times magnitude of d l so i only have to worry about magnitudes now i don't have to worry about direction anymore okay what is that equal well notice because the magnetic field is the same everywhere the magnitude is all that matters now the magnitude of the magnitude of the field is the same i can pull this b outside so this is a constant this is a constant so i can pull that b outside the integral and now i just have to do integral of d l now what is integral of d l well logically integrating d l means adding up all so adding up all these pieces tiny tiny pieces of d l adding all of them up tiny lengths what happens when you add all these tiny lengths you get the total length right and do we know what the total length of this loop is yes it's a circle we know the total length of a circle that's the circumference yay so we don't have to do an integral and that's what we meant this is the circumference this is circumference and therefore what happens let me write that down over here now um let me write over here yeah so what what happens we get b times what's the circumference of the circle it's two pi r it is two pi times r which are small r or capital r well we're taking circumference of this circle right that's why it's small r so always think about what we are doing and you will not have any confusion and that's our left-hand side like i promised no integral at all okay now let's look at the right-hand side what is the right-hand side we get mu naught times i enclosed what is i enclosed it is the current that is enclosed by the loop and you can see that the entire current i is enclosed by the loop but i'll do what ampere suggests us in general ampere tells us to attach a surface to it and then find what the current passing through that surface and the way i imagine attaching a surface is imagine i dip this entire loop in a soap solution and then there'll be a film attached let me draw that there you go and i enclosed is the current punching through that film and you can now see that the entire current i is punching through that film and so the entire current i would be our i enclosed and now we can calculate what b is let me write that over here b equals mu naught i divide by if we rearrange that we get divide by two pi r and what we see is that the magnetic field depends on the current which makes sense more current more magnetic field and we also see it's inversely proportional to the distance from the center the farther i go the magnetic field drops as one over r which also sort of makes sense what's interesting to see is that capital r is not in the picture at all which means the thickness of the conductor doesn't matter so whether this was a thick conductor or it was a thin wire as long as the current punching through was the same the magnetic field remains the same incredible isn't it uh is this obvious not at all but ampere's law helps us understand that because in ampere's law we say that it doesn't matter how thick that current wire is as long all that matters is how much current is penetrating and therefore whether it's a thick wire or a thin wire you get the same result and finally look at the number of steps in the world not much right so you don't even have to i don't even remember this equation whenever i have to think about the magnetic field to long straight wires i go back to ampere's law and derive it


So first let's start off with a new thing that's having a cross ophthalmology that may or may not be applicable or needed in our residency program That's night float. So night float is something that Became really in vogue in internal medicine and other specialties When the original work hour restrictions came into play And so in any given intern year you'll have a month that can be on night float That might be for a senior resident junior resident. So how that's looking in some programs. It would essentially be a Month where one of the residents or two of the residents would actually cover all of the evening call And that might be a just during the week where rather than be here during the day They're actually covering the overnight it could be a hybrid where you have a night float for the weekend So for the weekend, they might be on call from 10 o'clock to 8 o'clock 10 o'clock to 8 o'clock and then have a Monday off something like that as This discussion came up at the AUPO meeting It was actually quite controversial There's some really good evidence that night float is no less effective and no less helpful and no less healthy Than the current system that we have So really that one I'll just put out there for residents. We certainly would be interested if that's something that might make sense for a program Integrated intern year something that We all know about well, but integrated internship is now being mandated across the country And even though there were several well, there were three full months of opportunity for input From the program director's chairs around the country when this was rubber hitting the road at our AUPO meeting in in January It was as excited as exciting and as heated as that room has ever been several chairs stood up and say said things like do you Recognize that there are some programs that may not be able to do this And if we're shutting down programs with an ophthalmology, are we really gaining or are we harming our profession? There has not been any significant change in the number of ophthalmology residents We've been training now for almost 15 to 20 years So our the number of ophthalmologists being trained in our country is fairly static despite the fact that our population Continues to increase with the grain of our population What will ultimately happen? There will be an integrated intern year For for everyone across the country and whether that's an implantation over one year two or three years that remains to be seen And the most compelling argument for this was if we stepped back and we decided how do we want to train ophthalmologists? We would never set up a system where we give away one year of training to go train in medicine Where we have zero control over what they learn how they learn whether it's a transitional year or preliminary year We would Design it in a way where they can get experience in internal medicine They can get some experience in surgery and they can integrate with the rest of the body of medicine But we would do it in a way that was deliberate and thoughtful to prepare them to become ophthalmologists in the end So with that I'll just pause for any thoughts questions comments concerns. Dr. Jardine Do you see That's an amazing question and you you've you've well, let me just do this before I answer that question anything else regarding Integrated intern year questions That's a good question. I think for some of the chairs. I Gathered this was the first time they heard about this was at the meeting rather than previous meetings or during the comment period and so Let's just take New York. There are a number of New York programs Which are smaller which may not even have an affiliated medicine program with them That that's present outside of New York as well And so that is a pretty heavy lift for them as opposed to a program like Iowa who would have close relationships for their internal with their internal medicine or their general surgery program and and that was really it it was really just just something that That that kind of came as a surprise to some of these chicks no one Literally no one argued This is a worse way to train. Everyone said this is better It's just the implementation how we get there to make sure that we don't leave anyone out along the way Just a comment. I'm stunned how long it's taken for this to go through us as we put this program in 35 years ago. I'm just amazed that this didn't really catch on for that long It's a wonderful way to get training extra training you know before people Yeah, yeah, thank you Nick like I say even among the most I'll just say vociferous opponents of Implementing this now There wasn't a single Person even there that was trying to argue that this is a worse way to train so it has taken a long time in and it does I think the biggest reason is it just hasn't had a champion to really take this and push it through academic medicine is You know we do things the way we've always done things and it does take a lot of Energy to change the inertia of how we've always done things And Yeah, so so to two final comments on that it's really interesting Until the ACG me mandated this Programs really didn't have anything they could go to their graduate medical education offices and say Other than would you help us because we'd like to do this now that it's a mandate It actually gives programs a lot of power so that's kind of an interesting dynamic that I think was was lost on several people there The other piece is payment. The ACG me is not telling you really how to do this. We could Decide as a program to pay for all four years and Decide exactly where residents go and how and how they rotate and just own four years of ophthalmology Or we can partner with an internal medicine or general surgery and love that the residents to match into their programs and hopefully have some you know, we'll just say Sway on what the residents are able to do during their training But at the very least they have to have three months of ophthalmology in their training during during their intern year That's kind of the baseline. So More to come on that and Griffin. I'll get I'll get your other comment as well here in a moment National ophthalmology surgical wet lab curriculum so what this is There are there are a number of programs around the country where Residents don't really get a wet lab experience outside of sending them to an industry-sponsored event and the challenge for academic centers is more and more though those lines The I'll just say the restrictions and regulations from academic medicine on what is allowed in terms of industry Participation and training. It's becoming more restrictive over time and and there's many good reasons for that so Many of you in residency attendings you might have you know flown down to the Alcon course that that's on there That's on the Alcon campus in Fort Worth and gone down and participated and really dug into the Alcon machines Currently Bausch and Lomoff or something where they'll fly you to their institution also Abbott Johnson Johnson will do the same and and that's just becoming more expensive for industry and Less and less residents are able to do it. ASCRS has done a great job filling a role here As well the the question to this body from industry has been Would you like to partner with us in a way that we could give all of the residents across the country an Equivalent experience so that we would know Every PG y3 entering their PG y4 year has had this set of curriculum This type of wet lab experience and and at the very least that's the baseline that we can say For an ophthalmology resident how this would look whether it's large regional wet labs like ASCRS has done or the old core program Has done or maybe a program like ours with resources We could just deliver that curriculum and do our own wet lab how that looks it really to be determined But that's going to be a heavy lift coming in in the near future That's questions a little less controversial now, but next year's meeting I think it will will be a little more controversial. All right Griffin to your to your Question comment Currently applicants are applying to greater than 80% of all ophthalmology programs So essentially every applicant is now applying to essentially every program across the country We talk about getting over 500 applications for four residency spots And that is real and that's really now the same same way across the country all programs are inundated Judith can tell you the the Herculean effort it is to try and give the dude due diligence and credence to each one Of those applications many programs just just for simple ease will say if you don't get a 245 or above We're just not going to review your application because they just have to somehow weed down the 500 applications to something that's manageable Each application that we get right now It's about 20 pages of Data reading and some of that is very dense the personal statement the letters of recommendation and The amount of time it takes to really dig into any of these applications for for many of us who have been on the committee it is intense and So we've talked about this at house that faculty before talking about different issues potential options One of the key issues right now. We use San Francisco match San Francisco matches an early match Historically the early match was done Because it was a competitive specialty. We wanted to give the unmatched people an opportunity to match into something else Now there's a couple of things that have changes and Griffin points out the integrated intern year The integrated intern year now when an applicant is applying to ophthalmology They're going to match into their intern year at the time they match into the residency programs And so one of the the big big arguments for an early match is going away And I think potentially the bigger issue and I don't know if Tara's here. I know she's on the VA rotation probably getting Tara did almost Didn't go into ophthalmology because she and her significant other Richard Going to try and match together and essentially what we're asking 10% of applicants to all Residencies right now are doing early match or sorry are doing couples match I'll just say that again because I messed it up 10% of all applicants in medicine to any residency are doing a couples match so we're now asking 10% of the the Potential applicant pool to be willing to give up matching with their significant other that that's a big big problem For medicine, so there's a lot of things that that are happening around this The the real elephant in the room is that the Academy AUPO and San Francisco match are Incredibly closely in twine together We were told for all of the kind of ideas and things San Francisco match is not going away Going to the NRMP is not an option with the rest of medicine right now And so our opportunity is we now do something with San Francisco match that might address some of these issues Thoughts comments questions I'm gonna jump into one thing which I want to allow for some discussion because I think I think if you're any jerk reaction To this is the same as mine. We could have a pretty interesting discussion for this All right a narrative letter of recommendation a narrative letter of recommendation is a traditional letter of recommendation So if you've been around long enough either on the admissions committee or certainly in retina fellowship If you get a letter from Paul Sternberg, you know what it's going to be if you get one of Randy's letters You know what it's going to be and these two right great letters They give you the information that you want they use terminology that's clear These type of letters are the exception When we get letters for ophthalmology residency, it is just a total potpourri of information And it's really really difficult to get some of the just just baseline key information that we need to get and So is there a better way? So let's just let's just present this as an option By the way, when you get this guy's letter of recommendation, you don't know what it means yet So that that's part of the the issue here Okay, and letter of recommendation at its core is a measurement tool So if we think about a measurement tool, you need it to be reliable right measure the same each time You also need to have it actually measure What it is you're trying to measure and with this as a benchmark we can see that narrative lack of recommendations Quickly run into some problems. There's incredible variability in the type and depth of information. There's lack of uniform descriptors There was a UC Irvine paper that just came out which talked about Key words that are indicators for matching an ophthalmology and if you use things like superlative or exceptional how likely someone is to match and and particularly for a junior faculty as we're trying to figure out how to write these letters We're just you know, we go look at some letters that we've seen before and that's about the extent that we have So this is called a standardized letter of recommendation This is actually available now and we did receive some application So it's going to standardize a certain portion of the information we get and then it still allows you to have a narrative portion This is what it standardizes who you are Whether we as a letter writer feel there in the top 1% 5% 10% 20% 50% We're gonna put aside the whole challenge of what called grade inflation on letter of recommendations because that's present in narrative letters It has the risk to be present here But let's just say in a perfect world. You actually got this accurate information That would be extraordinarily valuable to really understand where someone stands in this person's experience How long have we known the applicant? What's the nature of the contact? How many days you've actually spent with the applicant? What was the grade and ophthalmology on your service and they're they're These are the only questions right with this rubric here So there are seven questions commitment to ophthalmology passion enthusiasm for the field work ethic Grasp of exam skills findings level of curiosity asking appropriate questions works well with peers and co-workers Ability to communicate carrying nature to patients. How highly would you estimate the candidate will reside on your institution's rank list? the rubric is Top 1 out of 10 top 1 3rd top middle 3rd lower 3rd cannot assess So If we could get this information that would be incredibly powerful to be able to compare applicants to other applicants now Let's just pause here for comments questions concerns Acknowledging the flaws in the other way it's done presently. This seems just totally flawed to me because Hey, how do you rank somebody within a percentile when a lot of these metrics? You might have like very few data points right what the narrative allows is if your relationship falls outside of these kind of Very rigidly defined parameters You can still express what the person has done well or what they've shown if you have to answer these Like either the the the person evaluated the person might just create inflate which makes it useless or Cannot access what do you do with that if you're the person now about in these letters or people are gonna get unfairly kind of placed in these percentile scores and like the top one Five ten that was on the first question is gonna be inherently subject to till all the biases we carry with us all the cognitive biases, right? Maybe just how much we like the person how recent they experience all those things. I Don't know. I just feel like it's it it'll become a way of Sifting through applications quickly that doesn't really then there's already so many ways to do that, right? We keep trying to like box ourselves in as people into these very kind of rigid Definitions that I would hesitate to do that more so as we try to evaluate humans So a number of challenges brought up I'm just gonna maybe pull out to and make make sure that I heard this right so one We'll talk about great inflation of bias, right? So I'm gonna set that aside and I'll address that here in a moment the other is These are seven characteristics and then you're going to again have this overall What is your experience with them and then these you know? These are just kind of straightforward. Okay. Are these the right questions to ask Does this allow you to capture everything that we should in an app? I think it's a great valid question. Should these be the questions or should there be less should there be more? The more you have the the greater the risk of people checking boxes And then the less you have the less data you're going to get Let me present a challenge inherent in every letter of recommendation that we write is a conflict We have a mentee that oftentimes has done an incredible amount of work for us They they've perhaps worked on research projects. They've devoted time and energy We are invested in their success and actually there's a really compelling argument that I Had an I talked with Paul Sternberg about that as a chair of a department One of your core obligations is to help your medical students match in top themology when they want to so we will just accept There is an incredible amount of investment in that individual and then the the other side of that is we also have an obligation to our profession If I receive a letter from someone saying this is a slam dunk top 1% of ever worked with and this individual is someone who is not a good trainee who ultimately Is not going to be in a good addition to our profession Then that letter writer, right has not been at the very least Accurate and potentially not honest and so that's that's the tension that we're dealing with here We know in letters. There is great inflation and we know in in narrative and in these standardized letter of recommendation up to 30% of these will have Inflation so the question then is If we were to be it if we could get all of our letters in this format And I'll just continue on to give you a little more. Would that be better? Overall than getting all of our letters in a narrative format We had a problem in reviewing abstracts for our vote so we wanted to Have it be educational for the applicant in a way how to write an abstract But we also wanted to reduce the burden Because we get like 200 that a person would have to review So what we did and I'm wondering maybe you've already done this But we came up with guidelines is what you need in the letter What what are the program directors and the committees and residency programs looking for what do you need? What do you absolutely want to see but you still allow people to be able to add You know what they wanted about the applicant so it's sort of a hybrid I love that and did in the back. Did you hear what she said? I just want to make sure except was that was That's really brilliant and the answer is no that hasn't been done But that really is potentially kind of a middle of ground So let me let me show you what else is is in it So you do have an ability to write a narrative portion And that narrative portion allows you really two paragraphs to capture what it is You want to say about that applicant and the irony is When when we did this just informal poll asking program directors and others to raise their hands How much of the letters of recommendation are they reading it was over half that we're willing to say They're only reading the first and last paragraphs already, which is what this allows you to do a 200-word limit So this is what a 200-word limit looks like You don't have to read it Charles Barkley and something about Doug Marks But the question would be with that first and last paragraph just Switch to what's their overall percentile and a quick gestalt of what what are their boxes look like on the next part, right? And if that's a trend towards the right or it's not one five ten I'm gonna read the paragraph. You've lost any nuance in it. Why would it not go that direction? That's fair. So if I find hearing you right if we're back here and everything's over here on bottom third middle third They're probably not going to read that portion that that's a risk That that that I think that's a valid point in concern Uncomfortable with these kinds of things where you categorize people like that and for lots of reasons, right?  You know, I think that gives us information that that's very helpful, but I think some of these are No, I think it's difficult. So personally Judge if you don't mind just could you Define the problem in other words Is it that there's so many applications we need a more efficient way to get through so many applications that's You know driving looking at a standardized way. It's quicker Or is there a flaw? With the narratives, is there a flaw? it's a The core system is too cumbersome and time-consuming or it's flawed. I think I think the primary issue is this the reliability right variability can be fly and secondary it's it's just a time issue and I'll get to some some some papers published in an emergency medicine to start this a long time ago and they There's a dramatic time savings for both the writer and the reviewer That is I'd say kind of tertiary to all of this. This is the issue. I mean This is I would say number one two three Well, we're trying to quantify something that may not be quantifiable and that's that's the main issue that we're looking at here I'm not sure if any of these will get away from what we call the like war with God effect Which is everybody's above average And so if you get if you get a letter that says yeah, this guy's in the top 50% They're gonna just get tossed on the pile. So that doesn't mean anything, but everybody can't be taught 10% That's the problem when you look at these letters after gosh 10 years of Everybody was top 10% Every single letters of this guy is talking percent of this girl's top 10% And it's the Lake Wobegon effect because again, if someone's worked with you you want them to get a residency You're never going to say they're the top, you know, they're a G35 percent That's not going to get him a residency program So I don't know how we get around that Lake Wobegon effect because again every letter says every applicant is top 10% Great point in court one of the issues and you'll notice it only goes to top 50% there is no below Right to to your point and I'll just make one comment take up other Comments and we'll wrap it up. I Had two chairs tell me They want to see every letter that comes across their desk be in this format But they would not be willing to use this because they have to advocate for their students in a way That they feel this could could undermine Which again gets back to that that that real challenge that we have here We're not as a profession giving accurate assessments, right? Just objectively accurate if we were we'd feel much more comfortable saying okay This person's in the top half of students that I rotated with so that becomes a Real question for us as a professional Are we doing a disservice to ourselves by not giving accurate information when we try to get our mentees matched? I think one of the things is when you start thinking about this like in literal terms Residents, so I can only say one of them is in the top 10% today. I know which one it is, too Anybody yeah for four residents that does become interesting right because they've already differentiated themselves to get into Ophthalmology and then get into our residency, which is more competitive. That's a great point Griffin couple more comments that we're gonna wrap it up Yeah We had a hundred applications we had one quarter of the applications To go through I understand one time on each one of them. I would be more interested in that qualitative data So I feel like this is a band-aid to a deeper problem that would be Numbers down and that's I know you've already met Jeff. It's not legal Barriers Just less come and sorry I want to make sure that at least I'm Jean I Back when I was applying years and years ago I think I applied to 11 programs and I was told oh my god You're playing you know that you're crazy to apply that many programs And now I've talked to Telling me something like 80 or 90 and that's average And they say they feel that they have to do that because everybody else is doing So I kind of wonder if you know if it could do something with I don't know anything about this match But if the match program could have say maybe 20 included for a certain price And then they have to have a much higher price for any other It is a logical idea That that benefits San Francisco match only because if I have 80 Programs that everyone else is applying to I'm gonna play the programs and I don't care if it's an extra $10,000 or $20,000 My career I love it. All right, we're gonna wrap this up So Let me just run through Paper So I guess Griffin the question then is is this adequate? to comment on the Qualitative component of who this individual is because let me just show you show you a couple things standardized letter of recommendation has been shown to improve the inter and intra evaluated reliability content consistency and Of course the nature of the relationship between the rider and the applicant Emergency medicine has been doing this for almost 20 years This is this is their information 92% say the standardized letter of recommendation not the narrative 92% of the standardized is The top factor in deciding who should be interviewed 99.3% Say that it should continue to be used You don't see that type of Numbers for something when it becomes It's it's emergency medicine and it's different I Love all these comments Mean writing times just as an FYI So we know what we get from these people. We don't always know what we get from others Is this a potential step forward? Or not, I'm just gonna leave that there and turn the time over to our other speakers But thank you for your attention We literally are in the middle of some of the fundamental changes going on up Thelmaic education With with Griffin now really playing a pretty big role there as well in terms of medical student education as well So with that, thank you for your time