Good day, everyone. My name is Haris Lizzi-Dakis. I am the chief executive officer designate of the World Organization of Family Doctors, WONCA, and I would like to welcome you all in this webinar on education and training and the COVID-19 pandemic. Before we start, I would like just to inform our attendees that you can interact on Zoom through two ways. Using the chat button that is located on the bottom of your screen, where you can exchange messages with other attendees and the panelists, and also using the Q&A button in which you can write questions and we will do our best to reply either via text or pick one or two questions that are the most relevant so that we can address them all together out loud. There is also a live streaming on Facebook and we will be taking comments from there and we will be reading your posts. And so without further ado, I would like to introduce you to Dr. Garth Manik, the chief executive officer of WONCA. Good day, everybody, and a very warm welcome to this, the third in a series of WONCA webinars. Today, the topic is education and training in the time of pandemic. The session will be led by Professor Val Woss, chair of WONCA's working party on education, ably assisted by Dr. Victor Ring of Canada. Presenters will include Dr. Kamil Gadjira of UK, Dr. Vivi Martinez Bianchi of USA and Argentina, and Dr. Robin Ramsey of the UK. We'd also like to offer a warm WONCA welcome to Dr. Gaia Gamawaga of WHO, and we're delighted, Gaia, that you could join us for this important topic. Of course, we'll also be trying to take a number of your questions, as Harris described in his opening remarks, and these will be monitored by Drs. Sonja Tsukagoshi and Kim Yu, and panellists for these will include Professor Mary Andradez of Pakistan, Dr. Nagwanashat of Egypt, and Dr. Joi Mogambi of Kenya. It's really a very international panel of experts. But before I hand over to Val and Victor and the panellists, I'd like to first hand over to our WONCA President, Dr. Donald Lee, for his opening remarks. Donald. Good day, everybody. Good morning. Good afternoon. Good evening. Welcome to the third WONCA webinar. Family doctors around the world are continuing to rise to the challenge of this awful pandemic. We are working with our public health colleagues, our specialist colleagues, and all healthcare workers. In the midst of the massively increased workload for family doctors, I'm proud of the level of support and collegiality displayed within and across our member organizations and from region to region. I'm also proud of the work that all of you are doing as family doctors. Next please. Colleagues are disseminating scientific advice, clinical updates, reflective messages, and professional support through their social media links and connections. They are keeping in touch with each other regularly, like family members, relaying information, urging courage in these extraordinary times. Tonight, next please, our working group education of education led by Chair Val Ross and Vice Chair Victor Ng together with contributions from invited colleagues and WHO colleagues will consider some challenges in training family medicine as COVID-19 affects everyone's well-being and daily lives. Before I hand over to the Chair, I would like to share two personal reflections about education and training. The first one is a quote from the Lancet Commission, health professionals for 21st century. To have a positive effect on the functioning of health systems and ultimately on health outcomes of patients and populations, educational institutions have to be designed to generate an optimum instructional process. The second one is education and training is not about teaching people to know what they don't know. It's about teaching them to behave as they do not behave. So with this, I would like to hand over to Chair Val. Thank you Donald and thank you so much for the introduction and to Wonka World for setting this up for us as a working party. We're really very grateful indeed. Thank you Donald for your quote from the Lancet report which many of us have been struggling so hard to deliver and then suddenly we have this pandemic upon us all which has really opened I feel a pandora's box of issues for others educators. Today it's going to be difficult to rather do more than skim the surface of the issues that are out there for you all. We're going to stick to our continuum of education which is Wonka working party we've been trying to do. Those of you who know me well know that I dislike the borders between undergraduate, postgraduate and cp and continuous professional development but it seemed the best framework today. So we're going to start with medical students and the issues for medical schools then I'm delighted that we can move into postgraduate and introduce you to the Wonka challenge of delivering educational globally and updating new knowledge Gaia and then we will be looking at the real challenges of redeploying trainees to be doing new things and finally we'll bring it together by looking at the broad educational issues of delivering globally to people with completely diversified educational needs. Before we kick off and I'll leave the presenters to present themselves just a thanks to our extra panellists Maria from Pakistan, Joy from Kenya and Nagua from Egypt but a big big thank you to Sonya Sukhas Goshi and to Kim Yoo who are going to be beavering away behind us behind the scenes looking at what this chat you're sending in and delivering it to Victor who is then going to be delivering the questions. We're going to have a gap between each of the presentations between undergraduate, postgraduate and cpt for your questions so that we can be having a dialogue and looking hopefully to areas where we can bring more education to yours. I'm going to hand over to my partner in crime Victor now who's going to broadly cover what we plan to do. Thank you Victor. Thank you Val and welcome to everybody. Good morning, good afternoon, good evening to you all and thank you for joining our webinar. So we'll get started like Val was saying the divisions between the divisions between undergraduate medical education, postgraduate and cpd is in some ways very very artificial and hopefully despite the fact that we've artificially tried to separate each of these sort of continuum of education hopefully we'll be able to to link them all together with you quite well. So if we think just in the first segment in the undergraduate medical education you know in the pandemic world how do we actually get from traditionally if you think back in the days of the anatomy theater how do we move from that structure all the way to perhaps a very virtual way of teaching so how do we do that and how are medical students in the world of pandemic and covid where they're not able to go to classes how are they supposed to adapt and move on. The other challenge that we'll explore and hopefully touch on during the question period is you know in in countries or in systems where technology is not as prevalent how do we actually ensure that students are able to have the technological abilities and resources to be able to engage in those classes that are mostly virtual. So those are some of the questions and challenges we'll be left with as we evolve our medical education during the covid 19 and beyond. Next slide Harris and in postgraduate medical education so teaching residents and registrars and postgraduate trainees how do we move from a didactic system of teaching so in a traditional classroom to one that is virtual. So how do we assess trainees in that setting how do we look at them as they do their assessments in their virtual clinics how do we judge whether they are using the correct judgment the selectivity of tests and also investigations and blood work and imaging and so forth how are we able to do that and then on top of that how are we able to mentor and role model a skill that we ourselves as teachers are only being exposed to for the very first time that's very new to us so how do we as teachers are able to do that enable ourselves to have those skills quickly to be able to actually role model and showcase that to our students in our training so that's going to be a challenge for us as well and how do we on top of that deliver that curriculum in a very quick way despite sort of this novel issue that's come on to us quite quickly. Next slide Harris and finally I put in brackets their adaptive cpd adaptive continuing professional development so in in the world of novel diseases and illnesses such as covid 19 how are we able to get information to frontline practitioners quickly so you'll recall on the left slide in the previous epidemic of hiv and aids information flowed very very quite slowly in the sense of practitioners in many cases were afraid to touch patients worried that they would get the disease themselves nurses positions and it took a very long time and a lot of navigation and advocacy for people to actually realize that touching and and being close to patients you would not get the disease so if you look on the right side this was a very recent study that was published just April 22nd of 2020 thinking about the resources that we need for covid and intubation and ventilators and resources such as that in critical care and ICU how do we get that information quickly to frontline practitioners so that they can incorporate that behaviors and that level of knowledge and competencies when they're practicing with patients so it's going to be a challenge for us to be able to have that deliberate adaptive cpd that goes on to the to the frontline provider in a very quick sense and something really that we've been struggling to do is that once we finish with postgraduate medical education in many cases practicing physicians do not have a strict curriculum to follow and there really is limited feedback that we as a profession or society are able to provide physicians in many cases about their professional development so that's going to be a challenge for us as these novel entities and novel diseases really occur in the world so thank you thank oh get it right thank you thank you very much victor so now shall we kick off formally and are you ready camille could you unmute and i'm delighted that camille gajira who's at the when you'll introduce yourself gajira i'm delighted that you're going to be talking to us about your challenges thank you thank you um my name's camille i'm part of the faculty at imperial college gp teaching and like many of you we have moved our curriculum online in the last six weeks so very rapidly and um there is a array of challenges that you will recognize um that we will go through um next slide please hers and the next one okay thank you um so moving the existing material online um there's a lot of help available on the academy of medical educators Amy they've run a series of excellent webinars um and it's important that um we maintain our educational standards within these it's not to direct um transfer another issue has been faculty development we're all at different stages of our online um teaching journey so there's some people who are highly experienced in flipped classroom for example and there's others who hadn't been doing any online teaching then the issue of resources and every medical school has access to different levels of resources and um this links into platform choice i wouldn't worry too much about which platform you choose it's just important to get to know the platforms really well a key issue a key challenge we've been facing is that this is all happening in the context of covid it's not just moving things online independently of that and because the effect of covid has been fast um on each one of us the pastoral support aspect is really key both for students and for faculty and one of the things we've done is try to um keep a well being aspect to our work within the faculty as well um linked into the pastoral support is the issue of equity that was touched on in the introduction and I think we'll discuss that more in the questions um but I wanted to emphasize that it's not just about whether students have access to laptops um but it's also things like what the their environment is like for learning they may be living in crowded situations with in a noisy place this links into assessment um Imperial College ran what we believe is the first online open book written finals in a noisy place and sorry there's echo and um and and this may sound alarming at first but we found that the psychometrics matched with previous years which was incredible um there were lots of safeguards put in place by the team um for example uh the questions only had about a minute time to answer each one so even if a student was to look something up it would be very difficult for them to find an answer that quickly and um the content of the questions was was not just simply knowledge based so it made it very difficult for students to cheat and it was important for Imperial to carry out the assessments for finals because we don't want to leave a gap in the workforce we don't want to have a whole cohort of medical students who can't graduate and then not serve in in the workforce at a time when we need the workforce but similarly we needed professional standards to be maintained we couldn't just ask them without checking that they'd achieve the competencies we would normally expect and and we also need to consider that the pandemic effects will last for months if not years how do we redesign for this in the longer term there's a thought we need to keep in mind next slide please and what i'm really excited about is the opportunities that we've had um as a result um we've been able to implement things very quickly and i'm sure a lot of you have found that a lot of bureaucracy has been removed um it's been an opportunity to develop community we have uh both within the team also amongst the medical students themselves um but also in terms of making links with the local community um i think this has been phenomenal um one point i wanted to mention was about our students volunteering um this has been a formalized process which we've worked with um societies um with the british medical association to make sure that it's safe but also um respecting that students role is as learners um and although we need to be careful and make sure that students don't get into dangerous situations at the same time our students have been saying things like they've learned a lot more by by actually doing something that is useful so i was wondering that this effect of service learning i wonder if it's actually going to make a big difference and make um sort of improve the quality of what our students come out with like what does it drive professionalism is it is it more authentic is it more value driven next slide please so in summary it is a challenging time you have a lot of the important skills already and we are always learning and i will leave you with some references on the next slide which i found really interesting um and uh lots of opportunities within the references to explore further thank you thank thank you very much camille and now victor are you ready to kick off with the questions yes thanks pal so we had a quite a robust question and answer and chat forum and i know our colleagues kim and saunay are feverishly typing and sending them to us so i've got a first question for nagua from egypt so um i briefly mentioned this in the preamble and i know um uh camille had also referred to this is the idea of technology so recognizing that in a virtual learning environment you need to have resources and technology both for the teacher and the preceptor but also for the students um it in different places around the world maybe using your your own as a contact network how have you uh had to navigate this and what kind of solutions do you think you can offer our suggestions that that other countries or contexts can can do to equip their students and teachers with technological resources to pursue virtual learning thanks vector for the question and it's really um an important one because we had that technology in equity here uh having that most of the students doesn't have laptops and having that knowing that the family has may have more than one child so all of them cannot use the same computer at the same time so for that thing we had to use the applications that can be uploaded on the smartphone so our smartphone if you are going to use uh the phone we have to make sure that any app that you would like our students to use or to navigate through should be found on the smartphone this is number one one of the important things also we had here in Egypt the egyptian knowledge bank which is a learning management system a strong one by the way had been evolved with in the last two years this one has many modules virtual modules for the base level for the clinic levels and we also have the virtual cases maybe we were not using that in the previous years but with the sudden shift we had to go through we had almost virtual cases and many of the disciplines where the student can go to the uh to the system and interview the virtual case from the history up to the management and also we have modules in the anatomy in the in the surgery in the going and ops for the instrument for the 3d anatomy and so on so for all of these we had we didn't use before but we are using it right now to compensate for that remote sudden teaching shift sometimes we have also students who don't have the accessibility to go for that and we totally understand that because the shift is completely emergency without any preparation we go virtual means that we do schedule a zoom meeting with our students trying to explain for them the things that you already have been tackling during the lectures and trying to do role plays with them simulating with our colleagues a scenario for something that is demanded a certain competency for them in order to demonstrate a role play where we can tackle a few things required for their competency this what had been done so far regarding the technology part here thank you hey thank you uh negua so i think we have another question and i'm gonna direct this question to robin um so uh there's been some discussion about what we i guess consider now is zoom fatigue so we're always online uh from one meeting to the next i guess sometimes you you go to the next meeting or the next lecture you don't even know what you're lecturing about uh so so i guess in the world of a virtual classroom or a virtual learning setting uh whether i guess it's synchronous or asynchronous you know how do we manage that that what we call you know zoom fatigue how do we ensure that both from the student perspective and the and the educator perspective that that we can mitigate some of that robin can you share some perspectives uh yeah thanks victor um i was gonna just share my experience of the of the tutor fatigue that um we'd experience tutoring online i mean i our tutors actually tutor online all the time so this is something that's quite familiar to me and we mitigate that through teamwork basically um we have i'm gonna talk about and when i talk later on about connection um we have regular time to connect and reflect as tutors um on a weekly basis on on issues such as fatigue so that we can support each other and try and mitigate any issues that that we have and um i think as time has gone on that's been the most powerful tool to to try and deal with that so that's maybe something that uh is worth setting up if tutors are now moving into online um teaching from being face to face it's very difficult because you're often speaking to a computer screen it's faceless there's very little interaction and um that in itself um poses challenges so the other thing we've done is we've we've allowed tutors to feed give peer to peer support and feedback on sessions that we've been running to try and help improve our our skills and our use of different techniques on online thank you robin that's helpful that that's really helpful and um we're dead on time folks so thank you very much indeed um there's been a request camille for your references um um and i certainly know the one on imperial is is very good on assessments where is that can you just tell the person asking briefly um it's in a newspaper isn't it about your online assessment yeah so um that's the guardian reference um all the references are on the slides and you'll be able to i understand look back at the webinar after so that's right harris go say more yeah so thank you camille that was a really helpful practical and it's lovely to have the young view on how we cope with all these challenges for suddenly moving into good technology thank you so much so i'm now delighted and we are very delighted to have you here gaya to give us your amazing world perspective on how you've opened it up to millions of people so thank you very much indeed and i'll hand over to you now if you unmute then we can move on thank you very much thank you val thank you everybody i'm looking at the screen and seeing i'm the odd person out but i'm very very happy to be here so right at the beginning let me introduce myself i'm gaya gamheberge i am the head of learning and capacity development for the world health organizations health emergency program and uh unfortunately there are many uh emergencies around the world africa the african continent we uh experience at least three um outbreaks every week so unfortunately we've had lots of practice in outbreak management but more and more we're looking at training and retraining personnel who can work in this the first thing i must say is i am not in medical education that is accredited what we do at the world health organization is public health education and the division tends to blur during a real emergency because we have clinicians and non-clinicians working together my opening slide is uh i'm just sharing with you the pride we have and the happiness that we just celebrated last week two million enrollments on the www open who dot org uh platform it's a free platform and i think this is because of the pandemic we are seeing a surge in numbers what i'll do in the next four minutes is to share our experience and share some of the learning and hope that this particularly feeds to postgraduate but also cross-disciplinary education that is required next slide please great so uh we didn't start during this pandemic we've had a demand for massive learning particularly in the west africa ebola outbreak where i was the international coordination for training one day i was asked to train 108 000 responders in six weeks that was when i really realized the scale of an outbreak response so quickly after that in 2017 we set up a free platform and that being free was only one of the conditions we had we had to focus on reaching the front line so in your context it will be general practitioners but in any epidemic pandemic contest it could be different people some clinical some not clinical we even trained highly trained icu teams that came from developed countries who didn't know how to work in low-income settings we had a philosophy to remove barriers and i really like the presentation before because it touched on equity we had to have low bandwidth and offline with our app it had to be free and it had to be open source and we realized with our research that having information in your own language was very important so we have translated into swahili and in the even in design language different courses and of course the relevance was very very important you'll see that you can you know the links are very easy to find and there is a official languages channel and a non-official languages channel next please so what we do is we're lucky during an emergency we have the technical experts who come up with the knowledge and the guidance what we do is focus on learning objectives we transform these using adult learning techniques and i agree with some of the challenges that was spoken before about getting attention having fatigue you know what makes people learn online is very different than face to face and we need to translate and make sure people get it disseminate widely so the numbers are good they're growing really fast next line please next slide this is just a later you can look at it this is the six nine big courses we have in all of the languages so we have very general ones from introduction to covid to management of secure um severe acute respiratory infections clinical care how to set up your facility to do reception triage treatment discharge and so on next one please and you can see amazing you know how it just took off in january we had 180 000 people and you can see you know with each global meeting that talked about this with the declaration of the public health emergency of international concern the declaration of the pandemic how the numbers just kept going up and this is from 196 countries next slide so what have we learned let me just take the last minute to do that for us for public health in emergencies i i believe who is a trusted brand and because knowledge was new it was a new virus i think that really helped with the numbers we really had to focus on what the learner needed and and this was the the thing to get right what did the front line respond the need you had to be confident about your content so i only transformed into trainings that were the already who guidance we had to regularly update the material because as the knowledge grew our courses have been updated three four times in the last three months we had to remove barriers i think it was important to remember that the most successful courses are the ones with the human face a practitioner or an expert talking not just lecturing but having an interaction with people we had to acknowledge that the learner is under stress they are fighting for themselves for their health well-being their families this is not here is a victim and we are rescuers we now are all in the same boat and the psychology of that is very challenging we had to be very explicit about our purpose we also the technical platform has to be able to grow with these numbers in a pandemic and we follow the data so we really analyze the data i think my last point is to say i don't really believe things will go back to what they were before we are all having to shift with the fourth industrial revolution the growth in biotech and digital tech it is going to be we're going to have to use digital means going forward and we ourselves are struggling you know how to do competency assessments how to keep up standards but i'm really happy to be part of this conversation and hopefully work with wonka looking at the future of lifelong learning in public health and not just in medicine i'll stop there for now thank you so much gaya i think one of the joys of doing this webinar has been meeting you and and sharing we share so much in common i believe i found a kindred spirit so thank you so much can i just check with my partner in crime victor do you want to put a question in here before we move on if you've got one lined up you do actually in fact thanks val so this question i'm going to direct to joy amy from kenya so there's been discussion of how we actually teach uh whether it's trainees or residents i guess in your context joy you know i'm curious to understand you know how are you adapting to virtual technology and how are you engaging with your residents could you give us some examples and some techniques that you've used thank you very much victor and thanks to the speakers who have come uh up ahead for us in kenya i do have time lecturing at sabarak university we've always had a blended model of teaching both classroom and virtual and as well as clerkship in the residence areas where our residents are we've not had any difficulties because these are things that started off at the very beginning of our program where we've had virtual learning going through from the blackboard app so we had just shifted from the blackboard app to a different app that we had started training our residents as well as doing their exams through the virtual platform so it's been easy it's something that's very doable in places where the internet access though yes there are challenges sometimes when internet is down electricity is down those challenges do come up but those can be mitigated by doing the on-site training as well as exams at their residence clerkship areas thank you back to you victor thank you very much joy for that i think i'll move on to val and i think val will introduce our next speaker thanks thanks so much victor thank you joy as well it's lovely to have these views from all over the world so now vivi can we move to you in the usa and you'll i'll leave you to introduce yourself in your talk but thank you so much for volunteering truly grateful thank you so much val thank you so much to everyone in the panel i'm viviana martinez bianchi i am the program director of the family medicine residency program at duke and i'm also a member of the wonka executive um so family medicine residents or trainees are considered essential personnel in primary health care settings and thus they should be considered to be essential in the fight against covid on the front lines with a proper supervision and pp as the pandemic arrived at each country however many training programs around the world removed family medicine trainees from their regular clinical sites some became quarantined due to exposure some are told to wait until programs can configure at the situation on the ground mainly rotations were canceled service considered non-essential stopped seeing patients and then the residents didn't have a elective rotation to go to some program directors pulled residents from rotations out of fear as a residency program director i understand this feeling of fear confronting a pandemic of such such dimensions and i really know that i don't want to ever have to call the parents of any of my own young trainees to let them know that their son or daughter has been admitted to the intensive care unit for example so i understand that next slide please one of the issues of the current pandemic is that when covid 19 hit there were very few senior physicians who have had experiences treating patients with this type of illness and who had expertise in managing the unique treatment and infection control protocols and procedures that were required to do this care with time information has become broadly available including the who and our own wonka website and the websites of most of our member organizations and it is important to make sure that residents fellow and faculty members providing care to patients potentially infected with the coronavirus are fully trained in treatment and infection control protocols before engaging in this care next slide please a proper PPE must be worn and measures to keep sanitation and this infection need to be maintained even when creativity when products are not available comes to the place one of the slides there shows our colleagues in argentina for making alcohol gel to be able to use it for in their clinical settings lack of PPE has caused the lives of healthcare workers all around the world and we must demand the presence next slide please physical isolation has impacted the educational component of residency training conference sessions that have largely moved online with some still doing in-person lectures but maintaining that physical distance within their settings guy attached on this before somebody had asked in the chat what are the best practices you know being brief short times engaging people zoom for example allows moving trainees into different rooms to be able to have separate discussions on topics next slide please in many cases family medicine trainees have been repurposed to work in the inpatient setting supporting internal medicine intensive care units labor and delivery floors in patient pediatrics the comprehensive training of their specialty allows family doctors to serve in any aspect of the health system they can get pulled into many places where they're useful during these coveted times next slide please presidents are developing their skills as clinicians but doing so in the current healthcare environment means adjusting daily routines to embrace new norms while surrounded by uncertainty with guidance they can apply their situational leadership skills and understand flexibility and reorganization while working as members of teams next slide in the middle of the chaos family medicine rises understanding the community more than any other specialty our trainees were not going to let themselves be defeated by fear but by fear certainly not without the fight family medicine team membership and belonging builds the resilience needed during these difficult times strengthening the role of family medicine in their medical community challenging inequities in access to testing and care creating public service announcements and community and communities to address the multiple needs people have which have been identified in conjunction with community partners next slide please family medicine trainees all around the world have the capacity of working in the front lines seeing the whole family unit connecting with the people managing chronic conditions maintaining preventing measures like timely immunizations visiting families in need while wearing PPE we must avoid the collateral damage on the unmanaged preventive and treatable conditions that we always see in primary health care we must become involved in community action next slide please reaching their patients via telehealth and learning the art of communication with the patient with a virtual platforms telehealth checklists have been created to make sure residents are adapting appropriate bedside manner to the virtual environment there's an art to do in telehealth and the patient-doctor interaction is always there in a very important way next slide in the words in the words of Monica Nivello from Chile a colleague whose faculty at the university at the Chile residents need guidance to avoid heroes who avoid becoming heroes who will risk their personal health to save lives without the proper PPE they must take care of themselves to continue carry comply with protocols of personal protection of patients of their colleagues of themselves and on the work spaces reinforce that even in the middle of a catastrophe they have to try to act according to the evidence optimizing resources that they keep in mind the principles of family medicine and the comprehensive healthcare model and primary healthcare in their actions while also taking good care of themselves next slide please family medicine must work with communities to defeat the coronavirus a disease in the community needs a family medicine and community health response our trainees and faculty are ready for the challenge in these difficult times thank you very much thank you so much Vivi fascinating and you're doing some wonderful work there as well technical question Victor do you need Maria to look at her chat Maria Val do you need Maria Mari to look at her chat uh yes I was wondering if Maria is able to see the chat but but maybe we can go on to the next question but Maria your chat okay over to you Victor for questions right okay thank you very much Val we'll we'll move on I just wanted to address a couple of the questions uh in the uh chat and the question and answer so this webinar is focused more on education and training we'll probably have other webinars uh down the road that focuses on clinical care of covid so we'll maybe part those questions for now and then we'll focus on more on the ones that are have to do with training and education so we do want to note that and that's really good participation and an acute uh uh acute argument from our from our folks that are listening so I do have a question that I want to direct at Nagua from Egypt so so Vivi had a really good presentation describing uh teaching and learning both for residents and also her as a teacher I guess you know it is very novel for us as teachers to have to teach virtually and engage with our students doing that how do we as ourselves you know Nagua in your own context in Egypt how do you up skill yourself to do that number one to be able to treat your patients yourself virtually and also to role model that to your students um thanks for the question that's actually a tricky one and the director of the medical education and human resources developments and through knowledge and taking the leads in development at F is something huge where I was able to get the that skills I am a fortunate person because I have two big families I have the one family and I have the family so both of them I was able to do the community of practice so being networking with others trying to improve ourselves by the community of practice by attending webinars by trying to find what is the best evidence for doing this shift right now with the network of both members in both families actually it has been beneficial to so doing that that um based on that which had been this one thing fascinating so all of this had worked together in order to be able to gain the basic competency to deliver uh what do we need to our faculty and to our students too because our students um were having a technology problems during that shift and how to deal with and how to to adapt to that um having this network of experience with others definitely made a value for what has had been done so far so thank you to my big family both big families back to you Victor for the next question I think you've contacted Mari have you yeah sorry about my my computer just froze there for a second maybe forgive us everyone we do have these little hiccups that's the issue with with webinars and working from home we're all at the uh okay are you going over to Mari now that's right so so Mari I guess what what I might do is get your uh feedback on the same question probably at Niagara and in your old context in Pakistan you know just thinking about how how you adapt to this virtual contact how are you engaging with your patients uh virtually and then also you know how is it that you're able to roam all that to your students right thank you Victor we have actually developed a telemedicine clinic at our university we're doing it through uh telephoning consultations but in some universities it's also through telehealth where they're using free online software which can actually uh be downloaded and multiple users can use it so there's a university in Punjab which is another province of Pakistan where it's a 24 hour consultation where different people come in physicians come in and they do the consultation over there the only challenge is how do you get to standardized care because physicians are coming from all over the country these are volunteers to answer not just covert questions but also general health questions and for that we are currently in the process of developing simple guidelines for different health issues or different complaints so that everybody sort of is standardized in giving the type of care the reason we have only telephonic consultation and our university is uh we cater to the low socioeconomic class many of them do not even have smartphone so for them it's much easier to do a telephonic consultation and for that we have to do a lot of background teaching ourselves on how to do telephonic as well as e-consultations. Very good thank you very much Maria for that perspective so I'll turn it back to Val for our next presenter. Okay thank you and well done team we're on time and we're doing well so finally Robin you can relax you're on air thank you Robin. Thank you Val and thank you to all the presenters that have come before me. So yeah hi everyone I'm Robin Ramsey I'm a family doctor working just outside of Edinburgh in Scotland but I'm speaking to you today in my capacity as program director for the master of family medicine online program at the University of Edinburgh so we've been teaching family doctors a postgraduate setting online for the past five years exclusively online so I want to share some of our experiences of dealing or adapting and during COVID and hopefully stimulate some more discussion. So all of our students are actually in low most of them are in low and middle income countries so and they come from a variety of different countries so they do have diverse educational needs so that's the other thing that we try to address in our program. The first thing we did as a team was we tried to engage our students and identify their learning needs this is something that's already been mentioned as a theme and we use Blackboard Collaborate the system that Joy mentioned so most of our students have access to this via their app and it's a system similar to Zoom. What we decided to do was we started off by by using interactive sessions you can actually use a whiteboard on Collaborate and you can do the similar thing on Zoom where students can be posed questions or open questions and they can they can actually comment on a board and you can sort of collate different responses and you can also use polling and there's lots of different ways you can sort of enhance your use of these sort of Zoom and Collaborate and so it's very interactive and this is what we the sort of process we went through of course when we first addressed the students they wanted information from us and these are the sorts of areas that they wanted to learn about and the top box there and this of course sort of represents the comprehensive response of family medicine to the pandemic but what we recognised as a discussion went on was that actually giving them information was not what they needed because there was information overload from a variety of different sources but coupled with that the staff and the students had less time so all our teachers are also clinicians so we all had less time there's lack of evidence so providing good evidence based information is difficult but also our students have varied experiences so some of them are working in private sector some of them public sector working in different countries with different sort of government protocols and things and of course the information is rapidly changing over time as well so this leads to a lot of uncertainty and anxiety amongst the students and this again is a theme that I think has come up so what we recognised was that these are family doctor students require common sort of skills in order to deal with all these things as information overload, this anxiety and those are skills that we teach actually in our master's program anyway but we kind of have enhanced that so things like critical thinking, reflection, critical evaluation of different sources of information, adaptability, self-care and I'm going to add academic writing to that as well that's something we've taught this week because we want our students to be able to actually write about their experience of the pandemic and next slide please and so the next stage was the adapting stage again another common theme discussed today so our learners had to adapt our teachers had to adapt but the most important thing to us was that our institution the university adapted and adapted very quickly and one of the things they did was that they collated a lot of the resources that they had and actually increased access to them so that was very useful to us but they also gave us the flexibility to for example alter our assessments and change our current online courses to include teaching about COVID so one of the successful things we've done for example has changed our assessment to include blog writing on experiences of COVID and teaching the specific skill of blog writing alongside that along with the adaptability we also have recognized that our students are quite anxious about this actual process but one of the things we found beneficial is that it's important for them to to be aware that they already possess these sort of soft skills that you can see in this diagram here one of them being adaptability and family doctors have all these skills within them and just by addressing that and allowing students to reflect on that we feel that it's actually helped them to realize the some of the skills that they naturally have within them and next slide please. The final part of the process for us is is connection and Camille mentioned this is sort of development of the community of practice and we've taken it a bit further to this international community of practice and I've seen the benefit of this over the years particularly working with Wonka and you know doing you know international exchanges with the young doctor movements and things like that this by developing this international community of practice you really do benefit all the members do shared experience and I think what we've learned is to try and focus on common values. I love this quote by Ian McQuinney which says when taken together the the principles of family medicine represent a world view so when we're connecting with our students and doing our webinars we often sort of bring it back to these sort of common principles of family medicine these common values that we that we have and we try and build our teaching around them and so that sort of overcomes the diversity within our group and this connection at the end of the day is about promoting personal well-being it's one of the the the main parts of what we're trying to achieve is keeping our students well during this process and I'll just end by the sort of tagline that we use at the end of our own webinars which is take it steady because we know that this isn't this isn't going to be a short-term process but I think through connection and through sort of using online and teaching and new ways of working perhaps there's some silver lining at the end of this pandemic and we can improve and increase our our community of practice so thank you I'll move back to Val and I thank you so much Robin and thank you for pulling that so nicely together reminding us of our values and reminding us that we are a community of practice and I think we're learning today we're here for our learners but we're also here to support ourselves as educators and it's privileged to be with you all but the really good news Victor is we've now got nearly 15 minutes for questions so we can bring other views in before we lead to Anna who's hiding time you're going to sum up for us but you've got I reckon a good 15 minutes almost for your questions now so I'll hand over to you and just another thank you to Sonia and Kim who've been look so calm there in the background but I'm sure you're paddling furiously underneath so thank you for keeping us going we're really really grateful over to you Victor thank you Val and and definitely Sonia and Kim are typing away and and it's difficult to keep it up with all the activity I do want to address a couple other questions in the Q&A I know there's been some questions about posting resources and then you know Val and I think we need to see how we can can pursue that after the webinar is over I think that's really good advice for us to be able to share resources that we think you know I want are useful and to share that with you just to feed in there Victor because I know it's a huge issue for the working party I'm meeting with Harris in Monday we can't we Maris I'm going to try and use him to get our resources up there so we're on the case excellent excellent we'll pass that to Harris excellent excellent delegation Val good leadership okay all right so from so what we'll do now is move on to questions I've got two questions already one for Joy and then one for Maria afterwards so the first question is for Joy so thinking about you know that the presentations that we've heard that described undergraduate medical education postgraduate medical education and PPD and the idea of the the continuum of education how how has you know in some ways has the COVID-19 pandemic actually provided an opportunity for us to to take away some of the artificial divisiveness between those three kind of sections or you know if we think about our resources and learning can we produce virtual learning that could really be applied to all three and you know I just be interested in some of your perspective Joy around that and whether we can sort of take away that that divisiveness between those three artificial barriers to education thank you very much speak yes we've had a lot of division in in those three key areas but one thing that we have done is we've integrated yes the undergraduate students the residents and the doctors to participate in most of the PPD activities instead of just doing one webinar that is speaking to doctors alone or one webinar that's speaking to residents or the undergraduate students we've been doing webinars that bring us together which are multidisciplinary not just presenting one discipline at the time so this has really brought out integration and also collaboration between different departments so that we share what we need to learn and bring out the education path that really integrates all key areas together thank you great thank you very much George because I was very insightful and I think you know in some ways that's going to be an issue that we're going to have to explore as we go forward in this sort of new era I guess of education so the next question I have for Maria thinking a little bit about how we we take away some of the barriers to undergraduate postgraduate degree I guess maybe you can seek a little bit about even interprofessional education so if you think about family medicine as a team we work with other disciplines you know whether they be specialists or even nursing and other professionals how does how does this environment create challenges for us to teach and work together in this in this sort of multidisciplinary team is there some ways that we can engage with learning with nurses or engage with learning with cardiologists you know what are some experiences and some advice that you could offer us Maria right so Victor we've been working with nurses actually we have developed a course a COVID course for general practitioners for Pakistan which went online and it's been very successful and then we realize that the people who are in the front line are actually not just doctors but the paramedical staff and the nurses and so we work with the nurses in the university to develop a course which they have actually developed for the nursing as well as the paramedical staff and you know when we were working together it really gave us a perspective of the other profession and how they what are their areas that they are expert in and how do they move forward what are their thinking processes and it really helps in us when we think of how we're going to train our GPs who have nurses as well as other pharmacist dispensers in their clinic so it builds a collaborative environment where the team is actually the most important part and I think what we learn from our process is the teamwork wonderful Maria and I think you really hit it on the head with the teamwork I think you know whether it's in a physical environment we're all we're all together or whether it's a virtual environment it's really that teamwork and communication and collaboration that really glues all of us together I've got another question for Magwa so I'll turn it over to you uh you're like I look down because you're at the bottom of my screen but you actually might be at the top of the screen for somebody else in any case um question for you is about students so we look at you know the virtual environment of learning and of course you know we we think of ourselves as the teachers and the preceptors but probably in the use of virtual technology our students may actually be more gifted in that than we are so I get from your context could you comment on maybe some of the lessons that it may be a reverse classroom where where the teachers are actually teaching the teachers as opposed to us you know thinking that we're the wise professors offering them the knowledge what are your thoughts Magwa you just hit it correctly we think we think that we are the teachers meanwhile we are teaching the technology generation who actually knows a lot about this issue so a lot of lessons have been heard this is a learning experience a huge learning experience for both of us actually we went with that concept and turned upside down after the first contact after the first week it went upside down because the students had a completely different point of view we were doing something traditional they they didn't like that they want different apps they have been directing us actually I have to say that they have been saying no this app is not suitable we cannot go by this actually we do prefer to have a live discussion posting the lecture actually we do prefer do that x and y post questions kindly use that app for doing that at the start maybe we were slightly rigid in responding but because it's finally that you'd like to put them on the right track we had to listen and listening it marvelous results by the videos that's how learning is this advice is to be flexible to be adaptable and so to listen to this I think we're losing you a bit Nagua do you hear me now that's a bit better I think I think you wake up a bit I think perhaps we leave you there till we get the right connection um like to do we just would we just like to have Gaia's perspective did she answer you there yep so we've got actually Gaia able to answer a question so you know certainly Gaia's our guest today and and we definitely want her perspective I guess hearing a lot of different perspectives on undergraduate postgraduate and CBD Gaia and you know sitting from your position from the WHO what are some further initiatives you think you know hearing some of the feedback of family doctors around the world that that you think the WHO can provide further resources and guidance you know as we as we move forward with this pandemic and and further of course beyond as we're planning for the future what are your thoughts Gaia thanks very much Victor I think the pandemic is just accelerating something inevitable we are really working in multi-discipline routines the pandemic has allowed people even old dinosaurs like me to embrace technology I mean whether we like it or not we have to do it it's it's forced this on us right and I think the demand from people from professionals from doctors from everybody for current usable knowledge and skills building is going to be immense I really believe this I think with the biotech industry moving so fast your patients as family doctors are going to have a different understanding of health their role in maintaining your health and the whole relationship will transform so I think going forward what we've had is the opportunity now I told you we're following the data of these millions of users I can tell you how many three and a half minutes people get bored and leave the page you know we're doing that kind of analytics and I think we should publish these and we should share what is optimal for adults who are busy and go beyond the digital divide the digital divide is one thing but there are many other things that stop people from learning from wh chose perspective what we are trying to do is work with institutions and associations such as yourself to shape the future of public future of learning for public health we know that 95 percent of countries around the world will not meet the target three the health target of the sustainable development goals 95 won't reach it so this is a terrible statistic so we are going to need to shape training learning education in public health not the way we want to deliver but the way people want to consume it so I think you know really I think this is amazing it's about collaboration it's about use orientation it's about getting the student to take over as moderators sometime the knot that we are trying to crack in WHO the digital learning is easy but the competency assessment is hard and I really appreciate hearing from Imperial College and others about how to assess this but this is something we can only do together this has to be a collective approach and unless we get ahead of the curve you know we are all going to lose so I'm really I'm tremendously grateful for this opportunity to interact with you great thank you very much guy I think you know I really echo what you're saying is that you know in some ways the disasters really offered us a impetus to really move forward into the future and and further collaboration and recognizing that the world is in fact smaller than we we expect and and certainly your leadership and your guidance is very much well welcomed I think we have time for one more question Val probably I would say five more questions or five more minutes I'm going to take that as five more minutes all right okay let's move along I'm going to direct the next question over to Joy Joy if you're able to listen to us there I guess you know one of the things that we've heard and understanding from even from what Gaia was saying is that you know we're moving towards the future and thinking about you know further ahead I guess if you imagine yourself as a teacher probably in 10 years time or 15 years time or 20 years time you know how do you think your your interactions will be and in some ways you know probably in that time we'll we'll think of hopefully COVID-19 as a bit of history as opposed to the present you know what opportunities do you think there are you know as a teacher in 2030 or a teacher in 2045 or down the road what do you what do you see your role and how do you see that that will evolve as teachers thank you very much Vic yes we've learned quite a lot from this experience because the students are teaching us quite a lot I thought I was very tech savvy but I have learned quite a lot during this period of of COVID because a lot of things have changed our system actually changed from the normal system that we used to teach using the blackboards to model model which is a very different system and the reason was the students felt the other system wasn't working for them we moved to this new system but I think in the coming future as we go forward we'll learn quite a lot from technology and we'll have to adapt quite a lot we have been preparing systems but systems have to change to what is happening within the world and probably in the future we'll not be talking about teaching in Kenya we'll be talking about teaching worldwide from Kenya other than what we are doing now locally thank you Vic well I thank you Joy and I look forward to that I think it'd be great to be able to have you know the world as our classroom and also vice versa and to be able to enjoy all the experiences that we're learning from around the world you know I think one of the interesting concepts that we've learned from this COVID-19 is that as there's been unfortunately a disaster that happened around the world we're actually learning very very quickly certainly in the clinical world we learned from Asia we learned in Europe and of course unfortunately in New York we're also learning from all the lessons that people have gathered from COVID-19 so in some ways I think I echo your sentiments Joy that in fact our world is going to get smaller relating to education as opposed to getting larger I'll turn it back to Val I think thank you thank you so much Victor well Harris I think we're dead on timing phew it always reminds me of Nelson's Mandela that education is the most powerful weapon to change the world and I think working together as a team under the Wonka umbrella which we're terribly grateful for Donald that this shows us the way we can move forward we will try and answer all the questions I haven't quite worked out how because I think it's been a huge chat going on there thank you team for monitoring that and Victor thank you for taking the challenge of doing the questions I'm really grateful we are in the future still looking aren't we guys of ways of getting a resource on the website and I'm sure that with Harris's young technology excuse me guys but we are a similar generation we will be able to move forward for our working party and for all of Wonka that we can really get an exciting resource going but in the meantime I'm looking with Harris's how we can get all the resource the day out so now we're looking really forward to working with you Anna when you become our president but as our president elect can we hand you the privilege of summing up and thank you very much for agreeing to do it I'll say goodbye now from all of us from the Wonka working party and hand you back to Anna and Donald to sign off so thank you very much indeed and a big thank you to Harris thank you you need to unmute I've been silent yes I've been silent for so long so I have my own voice here I am good afternoon from Oslo thank you Val and your crew your crew of educators and learners I think we all hold both roles that has been very clear to me during the last hour thank you for presentations and discussion thank you also for input from participants online while listening today a quote by a British colleague Dennis Gray Pereira came to my mind he said something like general practice is the easiest job to do badly and the hardest job to do well I think we we can submit to that statement and this pandemic has provided us with or provides us with quite challenging environments clinically and also for for education we are living a huge experiment said Nagua and this is forced upon us Gaia said and I think we we we we realize that this is true so training is needed training of clinicians and training of educators and we must train each other it's not necessarily about teaching new knowledge I learned today it's also about changing behavior and to do that to induce change of behavior we must adapt to the needs of the learners this approach complies well with the quote Harris I think you've got this slide there by the Danish philosopher Søren Kierkegaard on the art of helping if one is truly to succeed and you can read it because now I can I do not know it by heart and I cannot see the whole screen but the essence is we have to find him where he is and begin there and this is true whatever environments we are working in there is a need for innovation in medical education as well as in research and this awful pandemic provides us with the opportunities in that direction from what I've heard today I think we are on the right track we are up to the task thank you once again I'll hand over to you guys and Donald to conclude thank you very much Hannah and thanks echo vowels sentiments thank you to the to the the entire team and to everybody and I'd like to hand over to Donald now for his concluding remarks so Donald over to you right before I make my concluding remarks let me advertise our next webinar on May the 3rd same time as we all know the outburst next slide please the outburst of the COVID-19 pandemic has had a significant impact on the incidence of family violence not only have some of the risk factors greatly increased by the lockdown economic crisis and social isolation but also the availability of specialized services and ways of assessing them have changed significantly next week so the aim of the next webinar will be to give an overview of family violence highlighting special aspects related to the pandemic offer practical tools useful to family doctors in daily practice as well as in the current situation so see you next Sunday the same time so to conclude thank you next please panelists for leading a wonderful presentation all those tuned in thank you for joining us I wish to say that this is a pandemic with an unknown end game I wish each and every one of you family doctors well during this time use the best advice available work collaboratively with your teams do the best you can for your patients you should stand proud of your contribution to tackling this world crisis no one knows what we will face in the weeks and months ahead but everyone knows enough to understand that COVID-19 will test our capacities to be kind and generous and to see beyond ourselves and our own interests our task now is to bring the best of who we are and what we do to a world that is more complex and more confused than any of us would like it to be maybe all proceed with wisdom and grace thank you very much thank you Donald thank you for those inspiring words and again thank you to all the panel to everybody who's taken part today to all of those of you who are online please join us again next week for the webinar on family violence and until then everyone please stay safe thank you all good afternoon


Today, I'm going to talk about India's unemployment crisis. Everyone talks about it and it's one of the major issues that we always hear about. Does it make a difference to elections? That's a completely different story, which we will tackle in another show perhaps. But today, let's just look at the numbers. So, when I started looking at economic data, I used to think that after a certain age, everyone works, right? And those who don't get work are the unemployed. Now, that is not the case. When we talk about unemployment or unemployment rate, it's a technical term. Essentially, we have to first take the number of people who can work. So, the working age population of any country is those who are above 15 years of age. They're considered to be of working age population. They can work. But out of that, not everyone works. Not everyone looks for work because there are students, those who study after 15, obviously. There are people who are pretty old and very old, they retire and don't work anymore. There are people who, for various social reasons, don't work. There are people who are too affluent to work. There are people who are probably too weak and unwell to work. So, there's an entire range of people who don't look for work and who would not look for work in any country. This is not just India alone. Now, if we take the global average and we say that the working age population or people who are above 15 years of age are about 100, then the global average is that 61 out of them would be looking for work, would actively participate in the labour force. Now, that is called labour force participation rate, which globally is about 61%. Now, in India, I'm going to take a slightly different figure because data is such that it's difficult to actually calculate how many people are registered. It doesn't get captured a lot. Throughout this video, I'm going to be using data from the Centre for Monitoring Indian Economy, CMIE, and they're the most robust data that they collect every day and every week they publish it. And you also get the data compiled in more details every month and every quarter. So, I'm going to take what CMIE calls the greater labour force. This is not just those who say, I'm looking for work, but also those who say not looking for it right now, but would be willing to work. Because in India, there are a lot of people who have been looking for work for months and then they're too tired to look for work because they haven't got any work. So, they've given up hope temporarily, but if they get work, they will work. So, I'm going to take that entire lot and I'm going to look at that and say that this is the comparable figure for the labour force in India. In India, there are about 105 crore people who are above 15 years of age. If I take the global average of 61%, labour force participation rate as I explained, those who should be working or looking for work, then we get about 64 crore. So, 64 crore people in India going by the global average should be working or looking for work. But if I take a look at CMI's greater labour force, which is those who are willing to work, are looking for work and working, we're taking all of that together, then we get a number of just 45 crore. So, about 19 crore people in India who should be looking for work, should be working, don't even look for work, aren't even willing to work. Why is that? There could be social reasons which are different from other countries. Another major reason is that they've looked for work for years and haven't got it. They have no hope of getting any work, so they just don't look for work. That is one key big reason why the labour force participation rate is so low in India. Even what I said, CMI's greater labour force participation rate, which is those who are willing to work even if they're not actively looking for work. As I said, I'm going to be taking this number throughout. Now, as I said, 64 crore people should be looking for work. That's the global average. In China, it's much higher. In Sri Lanka, it's about 55-56%. And as I said, in India, it's much lower, about 42-odd percent. The greater labour force participation rate. Out of that, how many people have worked? 64 crore should be looking for work. Most probably need work in a poor country. How many people actually have paid work for which they get paid? Only 39 crore. So 25 crore people in this country do not have work. 25 crore people who should be looking for work, should be willing to work, do not have work. So that is the real level of unemployment in this country. So when someone tells you that unemployment is just 7%, 8%, that is not true. Because our labour force participation rate is so low, people have given up all hope of getting any work that it appears to be just 8-9%. In reality, it is much, much higher. This is just the surface of the unemployment problem. We're going to look at it in detail and make it as easy as possible to follow. Keep watching the show. So as I said, about 25 crore people who should be looking for work, do not have work in India. Out of the 64 crore people who should be looking for work. And that gives us an unemployment rate of close to 39%. That means out of every 10 people who should be looking for work, only 6 have it, 4 don't have it. And actually 3 out of those 4 have given up all hope of finding work. So they've completely gone out of the labour force altogether. It does not mean that they don't need work. It does not mean that they're affluent and therefore don't need work. It's simply that they cannot get jobs so they've given up. One of the reasons given, and I'm going to keep consulting my paper here because there are a lot of numbers to go through and I don't want to make a mistake. One of the reasons given to us is that Indians are uneducated, right? And they don't have enough education, they don't have enough skills, they're not trained. So therefore it's difficult to hire them. And that is one of the reasons why we have such low employment levels. Alright, if that is the case then it should be that those who have gone to college or more should have work, their unemployment rate should be much lower. So out of the working age population, about 10% of people, slightly lower than 10% are graduates and more. And as I said that if education is the issue, if skills is the issue, if training is the issue then they should have a higher employment rate and a lower unemployment rate. In fact, one of the things that we see that the higher the education, the more the labour force participation rate. If we take the greater labour force participation rate that I explained at the beginning of the interview, it's not just those who are actively looking forward, but also those who are not currently looking but are willing to work. Then amongst graduates in India, the labour force participation rate is about 60%, which is pretty close to the global average of 61% that we talked about. Now, what is the global unemployment rate right now? And this is in the middle of COVID. Before COVID it was about 5.5% and after COVID it has gone to 6.5%, which is pretty bad. It's not good. I mean, as I said, if 100 people are of more than 15 years old, they are working age population, 61 out of them want work. As I said, 61% is the labour force participation rate globally. 4 don't have work. 6.5% of the 61 is close to 4, so 4 don't have work. That is not a great number. I mean, you know, not having work, you might think it's a very small number, but not having work makes a huge difference to people's lives. Now, what about India when I take a look at graduates? Again, I said that the labour force participation rate, the global greater labour force participation rate amongst graduates is not bad at all. It's close to 60%. So if 100, there are 100 graduates in the population, 60 of them are looking for work or are willing to work, how many have jobs out there? 16 out of them didn't have work. 16, that's the number. 16, that's more than 26% of 4 times the global average unemployment rate. More than 26% greater unemployment rate amongst graduates in India. So graduation, education makes no difference. In fact, the more educated you are, the higher the unemployment rate amongst Indians. That's the amazing fact. So it clearly means that the educated do not get jobs and education has nothing to do with getting jobs. All right, another thing that we see and this is in some way related as well. And this has to do with the fact that younger people in India, right, have a higher unemployment rate. This is a crucial thing to understand. For instance, if I take those who are between the age of 20 to 24, which is they're starting off, they've just graduated or finished school and they're starting off new jobs, almost half of them, 46% are unemployed. The greater unemployment rate there is 46%, all right, younger people. As they get older, once we go to between 25 years to 29 years, that unemployment rate drops to 15%, pretty high even then. Then it drops further to 6% and then it keeps dropping till we reach the age of about 45 to 65, the last age of one's working life, 45 to 65, the last 20 years. The unemployment rate, the greater unemployment rate just drops to just 2%. Just 2%. What does that tell us? That tells us that the quality of jobs that India provides is poor. Younger people join the workforce. They look for work. They don't get what they want, right? What they think is a good job. They hold on for a few years. They think they'll get a better job and gradually they begin to compromise. So by the time they're 25, they have to settle down as their parents and relatives say, get married. You have to settle down. You need a job. Now take whatever you've got and the unemployment rate drops from 46% to 15%. A little further, by the time the person is 30 years old, the family is putting a lot of pressure. You have to take this job. You've got this job, just don't hold out. If you get a better job, switch. So they then take the job and the unemployment rate drops to 6%. By the end of it, by 35, they take whatever they have. So the quality of jobs, what people want, what they aspire for is not available. So even if they're working, it's not really their dream job. It's a compromise that is probably three, four steps ahead of what they wanted. Three, four steps behind what they wanted, actually. So that is one of the reasons why we see that as people get older, as the workforce gets older, unemployment rate drops because they're willing to take any job. That could also mean that the joblessness or unemployment rate has actually increased over the past two decades. Because think about it. Those who were in their mid-20s, 20 years ago, would be in their mid-40s now. And we know that the unemployment rate there is just 2%. Those who were in their mid-20s, 10 years ago, in their mid-30s now, and the unemployment rate there is about 6% to 4%. So it is possible that people were getting jobs which they've held on to 10 years ago, 20 years ago when they joined work. Now it's becoming more and more difficult. I think the truth is probably somewhere in the middle. One is that probably getting jobs has become much tougher now for younger people. Number one. And number two, younger people don't take any job at all. They want to wait for a better job. And as they get older, they compromise and take jobs. Alright, so two things gone. Education doesn't matter. The more educated you are, the more unemployed you are likely to be. The younger you are, the more unemployed you are likely to be. And now there's another thing that is said that, okay, actually when you talk about India's labour force participation rate, this is actually a wrong figure because in India women don't work. Could be true. There are social conditions under which in various societies women don't work. It's also been argued, and I've heard this argument for the last, I'd say 10 years or more, that women are falling out of the labour force. They're not participating in the labour force because families are getting more affluent. And as they're getting affluent, women no longer have to go out and work. Now, of course, it's a laughable thing to say because even male employment is so low in India that if no one's earning in the family, how can the woman stay at home in any case? We know that's not the case, but even if it were the case, right? If that were the case, then women's unemployment should be low. Because look at it, the greater labour participation rate, which means that the number of women who are willing to work, are looking for work and are working is just 12% in India. Just 12%. This is CMI's data. And globally, that rate is 47% out of 100 working age people, 47 women globally on an average work. In India, only 12 look for work or are willing to work, only 12. But if only 12 are looking for work and willing to work, then one would imagine that most of them would be employed because if the demand is so low, then that should more or less meet the supply for women workers, right? But here's the amazing figure that the greater unemployment rate, that is the number of women who don't have work but are willing to work or are looking for work, is 36%. 36% of women who are willing to work and are looking for work don't have work. And mind you, that's just out of 12% of the female working age population. So it is clear that even if women wanted to work, they wouldn't get work in India. So this entire thing of women not wanting to work is actually poppycock. It's not true at all. The truth is women do not work because they cannot get work. They have no hope of getting work. So they've moved out of the labour force. And when I say don't work, I mean paid work. Because we know surveys have shown, recent surveys have also shown us that women do an overwhelming amount of housework which takes hours to do. So they have to cook. They have to clean. They have to raise the kids. They have to run the family. They have to do the washing. And in rural areas, they have to walk for miles to fetch firewood and water. And it takes the entire day. So even if they went out to earn money, they would not be able to give the entire day, not be counted as a full working day. That is also an important thing to remember. So therefore, there are these three things we have right in front of us. Education doesn't matter. The more educated you are, the less your chances of getting proper job. The younger you are, the less chances of you getting a good job.  That's the truth about India's unemployment levels. The real unemployment level, if you go by global figures of labour participation, rate of 61% of the working-age population, our real unemployment rate is 39%. 39%, that's a huge, huge number, right? It is not the 89% that you hear. The 89% is because people just don't look for work anymore. They have no hope for looking for work. Does that matter in elections? The amazing thing is that it does not. But as I said, that is another show.