1 00:00:04,920 --> 00:00:07,600 Hello everyone and welcome to the Quorum podcast. 2 00:00:07,640 --> 00:00:11,320 This is where academic medicine meets remote, austere and 3 00:00:11,320 --> 00:00:18,160 resource limited areas. Welcome back to the podcast. 4 00:00:18,160 --> 00:00:22,640 This is Avacol Kelly. This week we are again with Zach 5 00:00:22,640 --> 00:00:27,360 Andrews, one of our Masters of austere Critical Care graduates 6 00:00:27,360 --> 00:00:31,560 who impressed us so much we hired him on the spot. 7 00:00:32,280 --> 00:00:34,400 Zach, welcome back to the podcast. 8 00:00:35,520 --> 00:00:37,720 Hey a brick, thanks for having me on again so. 9 00:00:37,720 --> 00:00:40,480 Tell us a bit about yourself and what's keeping you busy. 10 00:00:41,200 --> 00:00:44,920 Oh, you know, I mean, I'm constantly, constantly working 11 00:00:44,920 --> 00:00:49,160 on some projects, you know, bunch of educational things, 12 00:00:49,440 --> 00:00:51,640 trying to finish up some projects. 13 00:00:51,640 --> 00:00:54,640 For you guys. And working. 14 00:00:54,640 --> 00:01:00,240 With Phil also to try to do the. The student success department 15 00:01:00,240 --> 00:01:03,200 for, for the undergraduate programmes and graduate 16 00:01:03,200 --> 00:01:07,200 programmes, you know, I always stay busy doing remote 17 00:01:07,200 --> 00:01:12,440 paramedicine here in Texas and that's, it's kind of always 18 00:01:12,440 --> 00:01:15,200 keeps me busy and learning and, and catches my eyes so. 19 00:01:15,200 --> 00:01:19,000 It's that's how I. Stay stay relevant when when I 20 00:01:19,000 --> 00:01:20,880 can't be out in the field like I want to. 21 00:01:20,880 --> 00:01:24,760 So you've. Joined Phil Clark on the Student 22 00:01:24,760 --> 00:01:28,960 Success Department, which sounds like an SF mission because it's 23 00:01:28,960 --> 00:01:32,240 so vague it could be just about anything. 24 00:01:32,520 --> 00:01:35,040 So tell us what? What do you do there? 25 00:01:35,880 --> 00:01:39,080 Yeah, you know my role they're working with. 26 00:01:39,080 --> 00:01:41,040 Phil is it? It's a. 27 00:01:41,120 --> 00:01:42,040 It's a. Bit different. 28 00:01:42,040 --> 00:01:44,880 It's a bridging role, it. It's a role where. 29 00:01:45,600 --> 00:01:48,720 I'm not working for. The. 30 00:01:49,080 --> 00:01:53,880 Professors and I'm not, I'm not necessarily working for the 31 00:01:53,880 --> 00:01:55,680 students either. I'm working. 32 00:01:55,680 --> 00:01:59,280 For the. Best outcome of everyone who's 33 00:01:59,280 --> 00:02:01,160 going through there, you know, so. 34 00:02:01,920 --> 00:02:04,600 I I guess. You know. 35 00:02:05,040 --> 00:02:07,120 The best way to to to put it there. 36 00:02:07,120 --> 00:02:12,640 Is I kind of bridge from? The student body to the 37 00:02:13,120 --> 00:02:16,040 professor body. And I I helped, kind of. 38 00:02:16,040 --> 00:02:17,680 Tie that together. To make. 39 00:02:17,680 --> 00:02:21,520 Sure that both are. Meeting the needs of each other 40 00:02:21,520 --> 00:02:24,640 and understanding each other and the roles and in that. 41 00:02:24,640 --> 00:02:28,240 Super broad. Within it I I wish I could kind 42 00:02:28,240 --> 00:02:29,680 of. Say that better but. 43 00:02:30,000 --> 00:02:33,800 You know, it's, it's making sure that the, the students are being 44 00:02:33,800 --> 00:02:38,280 challenged, which they may not want, but they, they need to 45 00:02:38,280 --> 00:02:41,000 become, you know, as professional as possible, but 46 00:02:41,000 --> 00:02:44,640 also make sure that they're being enabled to, to reach that 47 00:02:44,640 --> 00:02:46,600 goal. And so it's, it's a dynamic 48 00:02:46,600 --> 00:02:49,520 position where you kind of play on both sides of the line. 49 00:02:49,520 --> 00:02:51,920 And I really like it. So you hit the ground running. 50 00:02:51,920 --> 00:02:55,560 You sent out a student satisfaction survey. 51 00:02:56,440 --> 00:02:59,280 What did you find out about our student programmes? 52 00:02:59,960 --> 00:03:02,920 You know the student programmes, what came out of. 53 00:03:02,920 --> 00:03:09,320 There is high value. And pertinent instruction, you 54 00:03:09,320 --> 00:03:12,320 know, and so the students. Really like that. 55 00:03:12,400 --> 00:03:14,720 This is a A. Programme that hits that 56 00:03:14,920 --> 00:03:17,960 medicine, you know, that's its focus and and that's what they 57 00:03:17,960 --> 00:03:20,000 want and they feel. That it has high. 58 00:03:20,000 --> 00:03:25,480 Value into the field experience and and as clinicians. 59 00:03:25,480 --> 00:03:28,000 It it it grows. Them and on the other. 60 00:03:28,000 --> 00:03:30,280 Side of that too, though, there's also difficulties. 61 00:03:30,280 --> 00:03:34,160 You know, Korom has a very unique approach to make. 62 00:03:34,520 --> 00:03:38,840 School affordable. And it's not. 63 00:03:38,840 --> 00:03:42,840 Full of full. Time staff, everybody isn't 64 00:03:42,840 --> 00:03:47,360 sitting there, you know, working in a a building and with. 65 00:03:48,720 --> 00:03:51,480 With full. Classrooms and you know. 66 00:03:51,680 --> 00:03:54,280 Teacher's aides. And secretaries and all these 67 00:03:54,280 --> 00:03:59,400 things that make university so prohibitively expensive, 68 00:03:59,400 --> 00:04:02,040 especially, you know, as we're going here in the US. 69 00:04:02,920 --> 00:04:06,040 And so because of that, you know, there's a little bit of of 70 00:04:06,040 --> 00:04:10,080 dynamic that the students have to to learn and the college has 71 00:04:10,080 --> 00:04:16,040 to meet midway on within being a bit. 72 00:04:16,040 --> 00:04:19,240 Of a self starter. With programmes and having to 73 00:04:19,240 --> 00:04:23,480 maybe not having as much contact and direct instructions for 74 00:04:23,480 --> 00:04:27,280 everything, especially within that European mindset of, hey, 75 00:04:27,280 --> 00:04:29,040 we're giving you the baseline and we want. 76 00:04:29,040 --> 00:04:31,560 You to explore past these topics. 77 00:04:31,560 --> 00:04:33,960 And we want you to professionally grow. 78 00:04:33,960 --> 00:04:36,760 As you're, as you're. Taking these courses and so 79 00:04:36,760 --> 00:04:37,600 that. That's a bit. 80 00:04:37,600 --> 00:04:41,400 Of a challenge for a lot of students to get is many 81 00:04:41,400 --> 00:04:44,800 countries, including the US. Here in the US, we tell you. 82 00:04:44,800 --> 00:04:47,480 Exactly what you we. Want you to know, in an 83 00:04:47,480 --> 00:04:50,160 undergraduate programme we we don't care if you do any 84 00:04:50,160 --> 00:04:53,040 exploring, we actually would. Prefer you to to just. 85 00:04:53,040 --> 00:04:55,920 Read and. Study purely what were. 86 00:04:55,920 --> 00:04:59,440 Put in front of you, which is. Good, but it. 87 00:04:59,760 --> 00:05:04,200 It makes you proficient, but it doesn't make you a student of 88 00:05:04,200 --> 00:05:07,040 the medicine. It just makes you, it, it makes 89 00:05:07,040 --> 00:05:09,680 you regurgitate the medicine that was given to you. 90 00:05:09,880 --> 00:05:13,600 And so it, that's a difficult mind shift for, for students to 91 00:05:13,600 --> 00:05:15,200 pick up. And it, and it took a minute for 92 00:05:15,200 --> 00:05:18,400 me to, you know, it felt like you're going through school 93 00:05:18,400 --> 00:05:21,040 without a safety net. And so we're trying to find 94 00:05:21,040 --> 00:05:22,280 ways. Where we keep that? 95 00:05:22,280 --> 00:05:25,720 Great enhancement of learning. But also. 96 00:05:25,720 --> 00:05:28,920 Helping the students through that process and not feeling 97 00:05:29,720 --> 00:05:32,360 kind of out there alone in in the. 98 00:05:32,360 --> 00:05:36,560 Sea of of scholarly work. I like the fact that all of our 99 00:05:36,560 --> 00:05:41,520 faculty are clinicians. They they practise and they're 100 00:05:41,520 --> 00:05:44,880 not full time with the college. Yes, yeah. 101 00:05:44,880 --> 00:05:48,280 It in it's, it's incredible because it, it's relevant, you 102 00:05:48,280 --> 00:05:50,960 know, you don't sit there and, and talk to somebody who said, 103 00:05:50,960 --> 00:05:54,200 well, you know. I've I've read. 104 00:05:54,200 --> 00:05:57,120 Articles I'm up to date on medicine, but I've not done this 105 00:05:57,120 --> 00:06:00,480 in 15 years you know, you talk to them and sometimes you get a 106 00:06:00,480 --> 00:06:04,000 reply e-mail that says, hey, be patient with me I'm out doing 107 00:06:04,000 --> 00:06:07,480 this work, you know, and it's like what that's kind of neat 108 00:06:07,800 --> 00:06:12,320 you, you know, your, your relevancy is, is today not, not. 109 00:06:12,320 --> 00:06:15,120 Years ago, which is? Common with a lot of programmes 110 00:06:15,120 --> 00:06:19,640 you go into. That allows us to not be overly 111 00:06:19,640 --> 00:06:24,680 expensive. I was I paid $35,000 for my 112 00:06:24,680 --> 00:06:29,480 master's degree in the US 20 years ago and I got cross that 113 00:06:29,480 --> 00:06:32,240 it was that much and and what I got from it. 114 00:06:32,240 --> 00:06:36,880 So by starting quorum, I put it into motion that this whole 115 00:06:36,880 --> 00:06:41,120 concept of no one works full time at this point anyway and 116 00:06:41,120 --> 00:06:43,080 everyone must be clinical. Yeah. 117 00:06:43,080 --> 00:06:44,920 And that that's, that's what I I think. 118 00:06:44,920 --> 00:06:50,040 Is the the beauty? Of Co ROM and the you know the 119 00:06:50,040 --> 00:06:56,160 cost of school nowadays we we limit education purely by cost 120 00:06:56,160 --> 00:07:00,360 and I, you know compare my degree with Co ROM to. 121 00:07:00,360 --> 00:07:03,880 My my brother's. Degree here in the US and he, 122 00:07:04,120 --> 00:07:06,000 he, he got, it's a masters of business. 123 00:07:06,000 --> 00:07:09,680 So it's, it's a bit different, but it was again online. 124 00:07:10,200 --> 00:07:12,600 He, he never went in person at all. 125 00:07:12,960 --> 00:07:17,480 And I I don't know the exact numbers, but it took him about 126 00:07:17,480 --> 00:07:21,920 18 months to complete and it was somewhere between 45 and 127 00:07:21,920 --> 00:07:24,840 $60,000. Which is outrageous to. 128 00:07:24,920 --> 00:07:27,200 To think that. That's what people are. 129 00:07:27,200 --> 00:07:30,720 Putting into 818 months worth of school. 130 00:07:30,760 --> 00:07:35,440 Yeah, so charging 10,000 for our master's degree means that we 131 00:07:35,440 --> 00:07:39,480 don't have enough money to pay our faculty full time. 132 00:07:39,920 --> 00:07:43,400 But I want that because it forces them to also be 133 00:07:43,400 --> 00:07:47,560 clinicians. Yeah, and I think, you know, the 134 00:07:47,920 --> 00:07:52,920 faculty, you end up kidding. It ends up not somebody just 135 00:07:52,920 --> 00:07:55,240 trying to put, you know, to get them through from. 136 00:07:55,240 --> 00:07:57,760 Paycheck to paycheck. And working a job because they 137 00:07:57,760 --> 00:08:01,520 want to, but you end up getting. Faculty that. 138 00:08:02,720 --> 00:08:06,960 Have a passion for this, you know as as working with Phil. 139 00:08:06,960 --> 00:08:09,960 Clark, I I. I receive no pay to do the 140 00:08:09,960 --> 00:08:12,760 student success and and I do it. Pure out of of. 141 00:08:12,760 --> 00:08:16,640 Passion just because I want to help these other students who 142 00:08:16,640 --> 00:08:20,200 who want the same thing that I wanted a good quality education 143 00:08:20,200 --> 00:08:23,280 that focuses in the austere medicine realm. 144 00:08:23,440 --> 00:08:25,880 That is. Affordable and applicable. 145 00:08:25,920 --> 00:08:29,080 So Zach, now that you are part of the student success 146 00:08:29,080 --> 00:08:31,920 department, what are your plans for improvement? 147 00:08:31,920 --> 00:08:35,000 How can we make quorum better? Yeah. 148 00:08:35,000 --> 00:08:38,720 So within the survey, you know, there's a few tweakings that I 149 00:08:38,720 --> 00:08:40,720 found that we can do. To our courses. 150 00:08:41,080 --> 00:08:43,440 And some of it's. Just a little. 151 00:08:43,440 --> 00:08:48,120 Bit more clear guidance and expectations and I think all 152 00:08:48,120 --> 00:08:50,720 that works going on right now. I know the. 153 00:08:51,840 --> 00:08:55,200 The Bachelor's. Programme had a big meeting to 154 00:08:56,120 --> 00:08:58,320 kind of. Level the wave tops. 155 00:08:58,320 --> 00:09:01,480 And make sure that everyone's getting on on the same page with 156 00:09:01,480 --> 00:09:04,880 that and you know the other. Piece that we had. 157 00:09:04,880 --> 00:09:09,240 Too is just communication I. Believe the the staff side of 158 00:09:09,240 --> 00:09:12,120 the college. Did a tremendous amount of work 159 00:09:12,120 --> 00:09:18,400 already and created. SOP's or protocols to to. 160 00:09:18,400 --> 00:09:22,920 Align the communications better with students and I know some of 161 00:09:22,920 --> 00:09:25,240 that went from multiple. Days. 162 00:09:25,240 --> 00:09:27,560 Before students would get. Replies. 163 00:09:27,560 --> 00:09:30,200 To most of the replies now seem to be. 164 00:09:30,200 --> 00:09:33,280 Day of. Or next day and including 165 00:09:33,280 --> 00:09:37,920 enrolling students much quicker and getting them set up much 166 00:09:37,920 --> 00:09:40,560 quicker than before. Because of your feedback from 167 00:09:40,560 --> 00:09:44,240 your surveys, we have changed things on the back end anyway. 168 00:09:45,000 --> 00:09:49,240 And Chabadiya Segi, who is now our Chief Operations Officer has 169 00:09:49,480 --> 00:09:55,840 has implemented changes for returning emails for for knowing 170 00:09:55,840 --> 00:09:59,640 where students are and being better at some of the 171 00:09:59,640 --> 00:10:02,640 deficiencies that you found with your survey. 172 00:10:03,400 --> 00:10:05,880 Yeah, he's. He's done a fantastic job. 173 00:10:05,960 --> 00:10:11,240 I mean he, he. He he has a a professor was was 174 00:10:11,240 --> 00:10:13,360 great. I mean, he was clinically 175 00:10:13,360 --> 00:10:15,760 excellent, loved interaction with him. 176 00:10:15,960 --> 00:10:22,960 But his leadership abilities? Coming through was was amazing. 177 00:10:22,960 --> 00:10:27,360 It was almost unexpected because not every physician has. 178 00:10:27,400 --> 00:10:31,160 That ability to go. From great clinician to leader. 179 00:10:31,160 --> 00:10:34,480 But he took that. And with without really any 180 00:10:34,480 --> 00:10:37,240 prompting, I mean he, he just. Looked at the survey. 181 00:10:38,200 --> 00:10:42,120 And just ran with it and is is creating, created and is 182 00:10:42,120 --> 00:10:46,560 creating, you know extreme change within the college and I 183 00:10:46,600 --> 00:10:47,720 was. Happy to see that. 184 00:10:47,720 --> 00:10:51,160 It was good to know from my side and and good for me to. 185 00:10:51,160 --> 00:10:54,600 Be able to relay back to the. Students of Hey, you've, you've 186 00:10:54,600 --> 00:10:58,880 been heard, you know, we're not going to ignore what you're 187 00:10:58,880 --> 00:11:00,720 saying. And there's there's action 188 00:11:00,720 --> 00:11:04,360 happening today. So looking back over the decade 189 00:11:04,400 --> 00:11:07,880 that Quorum has been open running, we have spent so much 190 00:11:07,880 --> 00:11:12,040 for focus on the hands on the classroom, the the what you're 191 00:11:12,040 --> 00:11:14,800 doing in Malta and with your input. 192 00:11:14,800 --> 00:11:18,560 Now we're looking at the back end of that as well to improve 193 00:11:18,560 --> 00:11:22,560 the students experience with the emails, with the the contact 194 00:11:22,560 --> 00:11:25,600 with direction for what to study and how to study. 195 00:11:26,720 --> 00:11:28,360 Yeah. And I think it's always going to 196 00:11:28,360 --> 00:11:36,120 be a circular kind of pattern that we do, which is good and I 197 00:11:36,120 --> 00:11:38,080 think as. We we get the the. 198 00:11:38,080 --> 00:11:41,200 Back end fine-tuned. I can already. 199 00:11:42,280 --> 00:11:46,640 See the the. Instruction side in the. 200 00:11:46,800 --> 00:11:49,800 The Malta side. Probably already looking at ways 201 00:11:49,800 --> 00:11:53,360 to tighten down also, and I'm sure in you know the next. 202 00:11:53,400 --> 00:11:54,840 Couple years, we'll be back to the. 203 00:11:54,840 --> 00:11:58,480 Back inside and. So it's the the good cyclical 204 00:11:58,480 --> 00:12:02,240 process that. Any institution needs needs to 205 00:12:02,240 --> 00:12:05,600 be doing. So Zach, a fortnight ago we had 206 00:12:05,600 --> 00:12:09,880 a chat during the quorum conversations about setting up 207 00:12:09,880 --> 00:12:14,000 IC US and rough environments in remote and austere areas. 208 00:12:14,920 --> 00:12:16,360 Tell us a bit about your experience. 209 00:12:16,360 --> 00:12:21,000 You have a profound amount of experience of doing this, so 210 00:12:21,040 --> 00:12:23,640 tell us what have you learned? What are some things we need to 211 00:12:23,640 --> 00:12:29,240 know about setting up an ICU in very odd and difficult places? 212 00:12:29,960 --> 00:12:32,320 Yeah. So that's truly. 213 00:12:32,320 --> 00:12:35,720 Where my passion? Arose for critical. 214 00:12:35,720 --> 00:12:39,480 Care medicine. I was lucky enough that I spent 215 00:12:39,720 --> 00:12:47,720 years in the jungles of Central Africa, very much away from any 216 00:12:48,680 --> 00:12:53,560 medical system that, you know, would, would compare with, with, 217 00:12:53,560 --> 00:12:57,400 you know. The the UK or or Europe or the. 218 00:12:57,600 --> 00:13:00,800 US, you know, Canada and any of those and then I also got to 219 00:13:00,800 --> 00:13:02,960 spend a significant amount of time in. 220 00:13:03,320 --> 00:13:06,320 Southeast Asia. And and that's a little bit 221 00:13:06,320 --> 00:13:09,320 different, a little bit more built up, but still many of the 222 00:13:09,320 --> 00:13:11,520 same principles are going to. Apply there. 223 00:13:11,760 --> 00:13:16,000 And so one of the biggest things is when you go out there, you 224 00:13:16,000 --> 00:13:20,160 need to understand your remoteness and how. 225 00:13:20,160 --> 00:13:24,480 Few resources there really. Are in the extreme measures it. 226 00:13:24,560 --> 00:13:29,240 Takes to get a resource. To you and it's not just 227 00:13:29,240 --> 00:13:33,080 distance many times it's it's just it's weather you know the 228 00:13:33,240 --> 00:13:37,600 the rainy season in Africa can take down any. 229 00:13:37,600 --> 00:13:40,200 Possibility of aircraft. Making it up to. 230 00:13:40,200 --> 00:13:44,840 You it's actually quite difficult for. 231 00:13:44,840 --> 00:13:48,120 That and so the planning aspect if you want to be out there. 232 00:13:48,560 --> 00:13:51,560 Is really where? You go from well, I packed my 233 00:13:51,560 --> 00:13:56,040 meds and things like that too, and now I'm doing a full history 234 00:13:56,360 --> 00:13:58,680 on everybody who's going with me. 235 00:13:58,880 --> 00:14:03,160 I'm looking at all the the different chronic. 236 00:14:03,160 --> 00:14:06,840 Diseases that they have. Any, any medications that 237 00:14:06,840 --> 00:14:13,880 they're on any, any possible, you know, issue with the 238 00:14:13,880 --> 00:14:16,120 patients that you might encounter there. 239 00:14:16,120 --> 00:14:18,280 Because the reality. Is is things like? 240 00:14:18,280 --> 00:14:22,680 Surgery or or. Even you know diagnostics in a. 241 00:14:22,680 --> 00:14:25,880 Lot of these places. It is non existent and so. 242 00:14:25,880 --> 00:14:29,320 You have to, really. Know that these patients are put 243 00:14:29,320 --> 00:14:32,480 on you and the other. Aspect is OK. 244 00:14:32,480 --> 00:14:36,000 Those are my patients, but now I need to understand my system and 245 00:14:36,000 --> 00:14:37,120 so. You have to start. 246 00:14:37,120 --> 00:14:42,320 Looking at reports of the medical facilities that that may 247 00:14:42,320 --> 00:14:46,400 be within reach in, you know, you may go to some of these and 248 00:14:46,400 --> 00:14:48,520 you walk in and you go. Oh, I. 249 00:14:49,120 --> 00:14:54,040 I'm not going to allow my, you know, my team to be, you know, 250 00:14:54,240 --> 00:14:56,320 treated long term. Here, but there's still 251 00:14:56,320 --> 00:14:58,880 capabilities that they have. And you know in. 252 00:14:58,880 --> 00:15:00,720 Africa, there's a lot of places that. 253 00:15:00,720 --> 00:15:04,720 Do very good microscopy, you know, even in the rule points. 254 00:15:04,720 --> 00:15:08,040 And so those may be something that you, you know, you utilise. 255 00:15:09,800 --> 00:15:11,360 And then there's the. Places where? 256 00:15:11,360 --> 00:15:12,960 OK. If I do take someone to. 257 00:15:12,960 --> 00:15:14,080 Surgery. Where do they? 258 00:15:14,080 --> 00:15:21,160 Go and what surgical capability can actually do in those places 259 00:15:21,280 --> 00:15:24,400 and if if you're remote enough you may be saying you know like 260 00:15:24,400 --> 00:15:25,600 I was as. If I get a. 261 00:15:25,600 --> 00:15:28,200 Patient out of here. How do I get them out of here? 262 00:15:29,560 --> 00:15:33,280 You know, 911 or 000 or. Wherever you're. 263 00:15:33,280 --> 00:15:36,840 At doesn't quite exist in those places and in the cost of an 264 00:15:36,840 --> 00:15:41,520 emergency evacuation is is extreme sometimes up into you 265 00:15:41,520 --> 00:15:47,280 know 400, you know 500,000 you and so insurance is actually one 266 00:15:47,280 --> 00:15:49,000 of the things that you request. People. 267 00:15:49,000 --> 00:15:51,160 To get on to. Have the the travel. 268 00:15:51,160 --> 00:15:54,480 Insurance and to, to be linked with a company like 269 00:15:54,800 --> 00:15:58,640 International SOS or you know, not a plug for them. 270 00:15:58,640 --> 00:16:00,840 There's many others. I've used them before, but 271 00:16:00,840 --> 00:16:02,400 there's many others that are good too. 272 00:16:03,080 --> 00:16:05,840 But you're going to want to make sure that you even have that 273 00:16:05,840 --> 00:16:08,520 insurance information. Ready to go? 274 00:16:08,680 --> 00:16:11,240 And that way when you call, because they're not going to 275 00:16:11,240 --> 00:16:15,960 start spinning up their partners unless they're going to get paid 276 00:16:15,960 --> 00:16:19,400 or unless your company is going to just pay the upfront. 277 00:16:19,400 --> 00:16:22,120 Cost of it so. Depending you know. 278 00:16:22,120 --> 00:16:24,560 Perhaps how big if? You're doing a Nat Geo mission 279 00:16:24,560 --> 00:16:28,040 I'm sure they have you know all types of things with them and 280 00:16:28,160 --> 00:16:34,000 and another thing is actually cash on hand many. 281 00:16:34,000 --> 00:16:38,000 Places you go to. You don't get the guaranteed 282 00:16:38,000 --> 00:16:44,080 emergency treatment that you're going to get if you go in many 283 00:16:44,080 --> 00:16:47,000 countries emergency, you know departments will. 284 00:16:47,000 --> 00:16:49,360 Treat you regardless. They're going to do life saving 285 00:16:49,360 --> 00:16:51,000 intervention many of these countries. 286 00:16:51,280 --> 00:16:53,440 They'll actually. Put you on a bed and put you on 287 00:16:53,440 --> 00:16:56,960 the side and wait for some form of payment or check your. 288 00:16:56,960 --> 00:17:01,040 Pockets for cash first. And so you know, even something 289 00:17:01,040 --> 00:17:03,760 as simple as that as bringing. Cash for every. 290 00:17:03,760 --> 00:17:07,960 Patient to get treatment started if if you need to even something 291 00:17:08,480 --> 00:17:11,640 you know as life saving as a blood transfusion is isn't going 292 00:17:11,640 --> 00:17:16,640 to happen with without payment and then you get into. 293 00:17:17,040 --> 00:17:21,880 Where you really grow. As a paramedic and I've kind of 294 00:17:21,880 --> 00:17:24,200 lined this out with. People before. 295 00:17:24,200 --> 00:17:27,160 You know, as we're seeing the. Career field grow. 296 00:17:27,160 --> 00:17:30,160 You have advanced paramedics. Who who have this? 297 00:17:30,160 --> 00:17:33,160 Extended pre hospital. Scope but. 298 00:17:33,320 --> 00:17:37,680 Really when you get into the paramedic practitioner range is 299 00:17:37,920 --> 00:17:38,960 is where. We start. 300 00:17:39,160 --> 00:17:43,400 Diagnosing and in treating things that are really not life 301 00:17:43,400 --> 00:17:48,640 saving, you know, but more more encountered microbials and 302 00:17:48,640 --> 00:17:52,040 things like that. And so your Tropical Medicine 303 00:17:52,160 --> 00:17:54,480 has to be on point and in further. 304 00:17:54,480 --> 00:17:58,680 Understood with the last. Diagnostic resources you have 305 00:17:58,680 --> 00:18:04,280 and I had many a septic patient due. 306 00:18:04,280 --> 00:18:06,680 To what we. Had and I had traumatic patients 307 00:18:06,680 --> 00:18:11,280 also due to, you know, different could have been a motor vehicle 308 00:18:11,280 --> 00:18:13,880 accident. Or or whatever had occurred, but 309 00:18:13,880 --> 00:18:15,840 those. The more difficult ones are 310 00:18:15,840 --> 00:18:19,160 really those septic patients due to microbials, and some were due 311 00:18:19,160 --> 00:18:24,120 to malaria, some were due to these, yeah, just unknown skin 312 00:18:24,120 --> 00:18:26,960 infections that we had. I had one patient with a 313 00:18:27,600 --> 00:18:31,920 cephalic presentation of the bubonic plague, which is. 314 00:18:31,920 --> 00:18:35,200 Really rare to. See, I mean that's a minority of 315 00:18:35,280 --> 00:18:39,280 a bubonic plague patients that you even can see and you. 316 00:18:39,280 --> 00:18:43,960 Have to be ready to start. Diagnosing and treating those 317 00:18:43,960 --> 00:18:47,480 patients and you know, with the. Best of what you. 318 00:18:47,480 --> 00:18:51,800 Can is is needing a clinical picture and treatment plan 319 00:18:51,800 --> 00:18:54,240 together even if you can't? Treat to its fullest. 320 00:18:54,240 --> 00:18:57,720 Extent to get that going and then you're going to encounter 321 00:18:57,720 --> 00:19:01,200 things like the wildlife. That's out there. 322 00:19:01,200 --> 00:19:03,480 You know the microbial? Sure they may. 323 00:19:03,480 --> 00:19:07,880 Be the we beasties, but the big beasties are out there also. 324 00:19:08,520 --> 00:19:11,600 And snakes were a significant problem. 325 00:19:13,080 --> 00:19:18,800 Ran into many boomslangs. We had green mambas. 326 00:19:19,440 --> 00:19:20,680 We had puff. Adders. 327 00:19:20,680 --> 00:19:24,640 I mean, we had some of the deadliest snakes around us and 328 00:19:24,640 --> 00:19:26,880 being. Ready to to treat. 329 00:19:26,880 --> 00:19:30,240 Things like that. We're also a significant part 330 00:19:30,240 --> 00:19:35,080 into what you need to look into. And so you really start going 331 00:19:35,080 --> 00:19:40,360 from a domain of emergency medicine and opening up to all 332 00:19:40,360 --> 00:19:43,480 the domains. And one of the the biggest to 333 00:19:43,480 --> 00:19:48,320 grasp onto that we're really not taught as paramedics is getting 334 00:19:48,320 --> 00:19:51,560 into preventive medicine. You know, if you're out of camp 335 00:19:51,560 --> 00:19:54,040 long enough, well, where? Where do? 336 00:19:54,040 --> 00:19:56,520 You, you know, urinate at where do. 337 00:19:56,520 --> 00:19:58,280 You. Wash your hands. 338 00:19:58,280 --> 00:20:02,440 Where do you? How do you deal with trash for 339 00:20:02,440 --> 00:20:04,400 food? You know, and there's a lot of 340 00:20:04,400 --> 00:20:06,840 things that people don't think of you. 341 00:20:06,840 --> 00:20:10,640 They'll think of flies, you know, of course, and disease 342 00:20:10,640 --> 00:20:15,440 transmission from from flies. But flies being frogs, and frogs 343 00:20:15,440 --> 00:20:19,360 bring. Snakes in the flies bring. 344 00:20:19,560 --> 00:20:21,440 Diseases as. Everyone's probably already 345 00:20:21,440 --> 00:20:25,480 thought in their head too or. If you have trash out, the trash 346 00:20:25,480 --> 00:20:27,040 will. Bring field mice. 347 00:20:27,040 --> 00:20:30,160 You know, the field mice seem to be all over the world and this 348 00:20:30,160 --> 00:20:32,960 field mice bring other snakes and predators and things like 349 00:20:32,960 --> 00:20:37,880 that in And so it's a complex situation that you get yourself 350 00:20:37,880 --> 00:20:40,360 into and you need to. Be ready. 351 00:20:40,360 --> 00:20:43,880 To on the medicine side, now you know what, what everyone most 352 00:20:43,880 --> 00:20:49,960 wants to focus on is managing a patient and having a full 353 00:20:49,960 --> 00:20:52,800 understanding of what is going on with your patient with 354 00:20:52,800 --> 00:20:57,360 minimal resources. And you know, even I was lucky 355 00:20:57,360 --> 00:20:59,000 enough many of times to have an I. 356 00:20:59,000 --> 00:21:01,920 Stat where I could pull labs that were pretty. 357 00:21:01,920 --> 00:21:05,360 Significant compared. To what we're used to, but OK. 358 00:21:05,360 --> 00:21:07,920 When you get the labs, what does that mean and what are you going 359 00:21:07,920 --> 00:21:11,040 to do at that point? You know, So yeah. 360 00:21:11,040 --> 00:21:14,040 There's there's. So many lessons learned. 361 00:21:14,040 --> 00:21:18,360 It was really. An educational experience for me 362 00:21:18,360 --> 00:21:22,040 through those years and one of the the most profound 363 00:21:22,040 --> 00:21:24,520 experiences that really changed my medicine. 364 00:21:24,520 --> 00:21:27,120 I would not trade those experiences for anything. 365 00:21:27,160 --> 00:21:30,960 You mentioned the a medical intelligence assessment or, or 366 00:21:30,960 --> 00:21:34,240 just doing a map survey before you get there. 367 00:21:34,240 --> 00:21:37,280 I, I remember on the OD as there in first bench rewards group we 368 00:21:37,280 --> 00:21:41,120 would have an advon an advanced party to physically go and look 369 00:21:41,480 --> 00:21:44,680 at the local hospitals. In this the Street View you 370 00:21:44,680 --> 00:21:47,880 would see of this hospital, but we didn't have it back then, but 371 00:21:47,880 --> 00:21:51,480 now you can see Street View. It might look good but it might 372 00:21:51,480 --> 00:21:54,720 be rubbish. So you do need to have the the 373 00:21:54,720 --> 00:21:57,600 hands on, don't you? You you do. 374 00:21:57,640 --> 00:22:01,040 Actually, there's many surgical. Suites. 375 00:22:01,040 --> 00:22:02,560 I'll I'll use that loosely. I. 376 00:22:02,560 --> 00:22:08,720 Walked into that had one particularly had broken tile on 377 00:22:08,720 --> 00:22:12,000 the floor and actually when you when you walked on it. 378 00:22:13,720 --> 00:22:16,320 You could see the. Dust being kicked up in the 379 00:22:16,320 --> 00:22:19,080 sunlight in the picture. Of it that was. 380 00:22:19,080 --> 00:22:21,960 Online look great, it must have been a picture right when they 381 00:22:21,960 --> 00:22:24,160 first built it and that would have been. 382 00:22:24,160 --> 00:22:26,640 Perfect, but at this. Point then you get in there and 383 00:22:26,640 --> 00:22:30,520 you go yeah, I there's not much I really want my team to get 384 00:22:30,520 --> 00:22:34,520 done here you know and so at that point you really have to 385 00:22:34,520 --> 00:22:37,480 limit of well they have. Surgical capability, but. 386 00:22:37,640 --> 00:22:39,800 What's What's going to be my backstop? 387 00:22:39,800 --> 00:22:43,880 Of depth I allow because the. Complications of the dust in the 388 00:22:43,880 --> 00:22:46,720 air, the you know, what is that going to do? 389 00:22:46,720 --> 00:22:48,840 And you have to go look at everything with them. 390 00:22:49,240 --> 00:22:52,080 How do they sterilise? Equipment, you know, how do they 391 00:22:52,080 --> 00:22:56,240 store their medications? It's a whole new aspect to get 392 00:22:56,240 --> 00:22:58,840 into and. It's it's very. 393 00:22:58,840 --> 00:23:01,840 Time consuming and. It has a. 394 00:23:01,840 --> 00:23:08,160 Bit of of a political sense. With it too. 395 00:23:08,920 --> 00:23:12,760 In, in the sense of you're going to assess them and your people 396 00:23:12,760 --> 00:23:18,120 skills and, and speaking with them have to be good and, and 397 00:23:18,120 --> 00:23:23,200 have an understanding of, of what they can do in, in what you 398 00:23:23,200 --> 00:23:26,320 may need them to do is going to be there too, because a lot of 399 00:23:26,320 --> 00:23:29,240 times as as a westerner, A physician or whoever going to 400 00:23:29,240 --> 00:23:31,000 these. Places they're actually they're 401 00:23:31,000 --> 00:23:34,200 proud to take you. Around and show you everything 402 00:23:34,200 --> 00:23:37,040 and they're they've worked very. Hard to get the. 403 00:23:37,040 --> 00:23:40,440 Place in the situation as it is and they don't want you to go in 404 00:23:40,440 --> 00:23:43,560 there and and tear them down by by any means. 405 00:23:44,240 --> 00:23:46,360 And so you, you kind of have. To to be. 406 00:23:46,360 --> 00:23:49,840 Polite while you're in there and respect that. 407 00:23:49,920 --> 00:23:52,400 It may not be perfect, but they're working hard too. 408 00:23:52,400 --> 00:23:56,400 Zach, you mentioned preventative medicine, you mentioned 409 00:23:56,400 --> 00:23:59,400 dermatology, you mentioned primary care. 410 00:23:59,920 --> 00:24:04,160 It it sounds like setting up a jungle ICU you need to be a Jack 411 00:24:04,160 --> 00:24:07,240 of all trades. You do. 412 00:24:07,400 --> 00:24:10,920 You know, you need to be a Jack of all trades and and that's 413 00:24:10,920 --> 00:24:14,160 quite difficult right now. With the way we. 414 00:24:14,160 --> 00:24:16,520 Focus and we do medicine you don't have. 415 00:24:16,520 --> 00:24:20,320 Jack of all trades. You know, back in the day, you 416 00:24:20,320 --> 00:24:25,320 know, 60-70 years ago, a primary care physician, you know, many 417 00:24:25,320 --> 00:24:29,480 of them would do surgeries, you know, more on the minor side, 418 00:24:29,480 --> 00:24:32,160 but they'd still do them. And, and we don't do that now. 419 00:24:32,160 --> 00:24:34,920 If you have, you know, we have entry ways to medicine. 420 00:24:34,920 --> 00:24:38,680 If you're a General practitioner or family medicine, there's a 421 00:24:38,680 --> 00:24:42,920 limit and then they send you to a specialist, and that's not 422 00:24:42,920 --> 00:24:45,600 really the capability that you're going to have there. 423 00:24:46,920 --> 00:24:49,920 And I know the saying is, you know, you know. 424 00:24:49,960 --> 00:24:54,360 Jack of all trades. Master of of none, but in in 425 00:24:54,360 --> 00:24:56,560 there's kind of a negative. Or positive. 426 00:24:56,560 --> 00:25:00,760 Depending connotation how you look at that, but you're going 427 00:25:00,760 --> 00:25:04,520 to have to self. Evaluate where your gaps are to 428 00:25:04,520 --> 00:25:07,880 be that Jack of all trades. And you know, that's there's 429 00:25:07,880 --> 00:25:11,320 multiple places that that can be, you know, I talked about the 430 00:25:11,320 --> 00:25:16,200 preventive medicine, the medical intelligence side, the the 431 00:25:16,200 --> 00:25:18,160 primary care. Side but if you're. 432 00:25:18,320 --> 00:25:20,280 You know those exist. For if you're a. 433 00:25:20,680 --> 00:25:23,560 Nurse that's going out, you're going to have multiple. 434 00:25:23,560 --> 00:25:27,080 Other sides, too. Many of the same and physicians 435 00:25:27,080 --> 00:25:28,960 you're going to have other sides too. 436 00:25:28,960 --> 00:25:33,880 You may be better trained in epidemiology and preventive 437 00:25:33,880 --> 00:25:38,200 medicine, or you know. Had had that because of a rural. 438 00:25:38,200 --> 00:25:40,840 Medicine focus. But you know, the medical 439 00:25:40,840 --> 00:25:43,600 intelligence probably wasn't hit on very much. 440 00:25:43,600 --> 00:25:49,280 And then you know how, how are you going to perform the lab? 441 00:25:49,280 --> 00:25:52,200 Tests that you. Would normally just order, you 442 00:25:52,200 --> 00:25:54,560 know, microscopy. How do you? 443 00:25:54,560 --> 00:25:55,960 Do that. What do you use? 444 00:25:55,960 --> 00:25:59,480 As your your mordant and your fixer and, and what do you take? 445 00:25:59,480 --> 00:26:00,880 What do you, what do you not take? 446 00:26:00,880 --> 00:26:05,000 Or are you just going to use rapid diagnostic tests? 447 00:26:05,000 --> 00:26:08,800 You know, there's there's a. It's it really? 448 00:26:08,800 --> 00:26:11,240 Is it? Becomes this this mountain of a 449 00:26:11,240 --> 00:26:16,160 problem and those that are brave enough will really like it. 450 00:26:16,160 --> 00:26:19,440 I mean, I I thoroughly enjoyed that I was challenged in 451 00:26:19,440 --> 00:26:23,040 multiple ways to make a cohesive medical picture. 452 00:26:23,040 --> 00:26:26,920 Zach, what did you learn on the Masters of Auster Critical Care 453 00:26:27,160 --> 00:26:29,320 that addresses some of these issues? 454 00:26:30,000 --> 00:26:32,720 Well, you you for. Sure are going to deep dive into 455 00:26:32,720 --> 00:26:38,240 the medicine piece of it and a lot of times you you don't know 456 00:26:38,320 --> 00:26:40,920 what you don't know and I know. That's that's a silly. 457 00:26:40,920 --> 00:26:43,240 Saying and I used to have a friend which. 458 00:26:43,240 --> 00:26:44,960 Would say of. Course, you don't know what you 459 00:26:44,960 --> 00:26:48,800 don't know, but it really opens you. 460 00:26:48,800 --> 00:26:53,880 Up to the. Vastness of medicine and within 461 00:26:53,880 --> 00:26:57,480 the masters and allowing you to to not just say only. 462 00:26:57,480 --> 00:27:01,680 Read this but to. To dive into, wade through the 463 00:27:01,680 --> 00:27:04,280 medicine. You start to pull. 464 00:27:04,360 --> 00:27:07,200 Deeper and deeper aspects. To to. 465 00:27:07,560 --> 00:27:10,120 Bind some of those domains together. 466 00:27:10,680 --> 00:27:13,800 You know and. You also start. 467 00:27:13,800 --> 00:27:18,520 Talking about things like prolonged care and our prolonged 468 00:27:18,520 --> 00:27:21,600 field care, whatever you know that the term you want to use 469 00:27:21,600 --> 00:27:25,120 for it is and especially within that. 470 00:27:25,120 --> 00:27:28,280 You start to see. Multiple difficulties and 471 00:27:28,280 --> 00:27:29,440 realities. To it. 472 00:27:29,800 --> 00:27:31,920 And. There's a whole block. 473 00:27:31,920 --> 00:27:35,920 On Tropical Medicine, which I highly recommend and actually. 474 00:27:35,920 --> 00:27:39,040 There's a graduate diploma. On Tropical Medicine, which I 475 00:27:39,040 --> 00:27:43,840 really recommend through the through the college and that if 476 00:27:43,840 --> 00:27:45,640 you've never. Really. 477 00:27:45,640 --> 00:27:49,000 Looked into Tropical Medicine that's going to open your eyes 478 00:27:49,000 --> 00:27:53,720 to how much more is out there that you're not familiar with 479 00:27:53,720 --> 00:27:55,640 much of the the temperate medicine. 480 00:27:55,960 --> 00:27:58,880 You know, if you're in the US and you say influenza, well 481 00:27:58,880 --> 00:28:02,160 everyone's very familiar with that, even non medical people. 482 00:28:02,320 --> 00:28:07,440 But if you start. Talking about schistosomiasis, 483 00:28:08,680 --> 00:28:10,720 you know, one of the many things that's. 484 00:28:10,720 --> 00:28:14,440 Out to people go what? Well, that's been about. 485 00:28:14,520 --> 00:28:17,320 Everybody of. Water that's out in, you know, 486 00:28:17,320 --> 00:28:20,320 the continent of Africa. So now you start to. 487 00:28:20,320 --> 00:28:23,880 Go oh. And it's this whole other domain 488 00:28:23,880 --> 00:28:28,440 that I've really not reached into in with that you learned 489 00:28:28,440 --> 00:28:29,640 the life cycle. Of. 490 00:28:29,640 --> 00:28:34,160 Diseases and you know, and it starts opening you up into how 491 00:28:34,160 --> 00:28:37,240 you can be truly. Effective there versus just? 492 00:28:37,240 --> 00:28:40,040 Being there and treating emergencies and and 493 00:28:40,040 --> 00:28:44,640 symptomatically you break into that practitioner role a bit 494 00:28:44,640 --> 00:28:46,480 more. So, Zach, at the end of this 495 00:28:46,480 --> 00:28:52,680 month is SOMA Special Operations Medical Associations Symposium, 496 00:28:52,680 --> 00:28:54,400 one of my favourite weeks of the year. 497 00:28:54,600 --> 00:28:57,760 You're you will be presenting the Medic of the Year 498 00:28:57,760 --> 00:29:00,320 scholarship. Can you tell the listener about 499 00:29:00,320 --> 00:29:03,000 that? Yeah, the medic. 500 00:29:03,000 --> 00:29:05,280 Of the year scholarship, which is. 501 00:29:06,840 --> 00:29:08,240 Which is. It is great. 502 00:29:08,240 --> 00:29:09,840 It's it's up, it's a prestigious. 503 00:29:09,840 --> 00:29:11,360 Award for the medic. Who? 504 00:29:11,360 --> 00:29:12,840 Who gets it? And. 505 00:29:12,960 --> 00:29:17,240 What they do is across special. Operations medics in the. 506 00:29:17,480 --> 00:29:20,560 US they. Everyone nominates a candidate. 507 00:29:20,560 --> 00:29:23,320 To to be. The medic of the Year and 508 00:29:23,320 --> 00:29:24,640 there's this committee that that. 509 00:29:24,680 --> 00:29:29,440 Picks it. This individual and the College 510 00:29:29,440 --> 00:29:33,120 of Remote and Offshore Medicine does it has a fantastic 511 00:29:33,120 --> 00:29:37,760 scholarship that is given to this individual and I've no clue 512 00:29:37,760 --> 00:29:39,800 who it is. I don't think they've released 513 00:29:39,800 --> 00:29:40,520 it. I'm sure they. 514 00:29:40,520 --> 00:29:45,760 They hold that very tight, but they get a free scholarship for 515 00:29:45,760 --> 00:29:47,800 the. Masters of austerior critical 516 00:29:47,800 --> 00:29:49,960 care programme, which is phenomenal. 517 00:29:49,960 --> 00:29:53,040 I mean such. Such a great value to to be able 518 00:29:53,040 --> 00:29:57,240 to get. In in very, you know, very neat 519 00:29:57,240 --> 00:29:59,360 for the. School to to honour. 520 00:29:59,360 --> 00:30:02,120 Somebody that way and and recognise. 521 00:30:02,120 --> 00:30:06,000 Their their ability. Within medicine and and to. 522 00:30:06,000 --> 00:30:08,000 Be able to to. Allow them to go. 523 00:30:08,000 --> 00:30:09,960 Further so. You know I. 524 00:30:10,840 --> 00:30:12,040 It's pretty. Exciting. 525 00:30:12,080 --> 00:30:14,800 That a school is. Giving something like that to 526 00:30:14,800 --> 00:30:16,840 the awardee. And you'll be the one presenting 527 00:30:16,840 --> 00:30:18,240 it. Yeah. 528 00:30:18,240 --> 00:30:19,040 So, yeah. And I. 529 00:30:19,040 --> 00:30:20,880 Will I'll be the? The one presenting it. 530 00:30:20,880 --> 00:30:25,920 So happy. Happy to do it, happy to keep 531 00:30:28,360 --> 00:30:31,160 keep a good. Relationship between US and and 532 00:30:31,160 --> 00:30:34,200 soft medics I know that's been the college has. 533 00:30:34,280 --> 00:30:37,480 Has a pretty. Rich background of supporting 534 00:30:37,480 --> 00:30:40,240 soft medics you know worldwide and and especially. 535 00:30:40,240 --> 00:30:41,760 With with your. Background that. 536 00:30:41,760 --> 00:30:44,560 Has of course. You know, been the foundation. 537 00:30:44,560 --> 00:30:46,560 For that so. So I thank you. 538 00:30:46,560 --> 00:30:49,720 For for. You know, really starting the 539 00:30:49,720 --> 00:30:51,480 culture. Of that support. 540 00:30:52,480 --> 00:30:55,040 Zach, my final question for you is this. 541 00:30:55,760 --> 00:30:58,640 What advice do you have for the new medics, the new nurse, the 542 00:30:58,640 --> 00:31:03,160 new Doctor who is just starting out in their career in austere 543 00:31:03,160 --> 00:31:08,920 medicine? You know, I don't know if my 544 00:31:08,920 --> 00:31:12,040 answer has changed from the other podcast here. 545 00:31:13,520 --> 00:31:18,160 You know, be brilliant. At the Basics The basics get you 546 00:31:18,160 --> 00:31:21,960 out of trouble. That the fancy stuff would have 547 00:31:21,960 --> 00:31:26,680 to be employed for being brilliant at the basics, you 548 00:31:26,680 --> 00:31:30,040 know, if we go back to the domains of, you know, the basics 549 00:31:30,040 --> 00:31:33,680 of preventive medicine, the basics of medical intelligence, 550 00:31:33,680 --> 00:31:39,120 the basics of, you know, primary care and emergency treatment, 551 00:31:39,120 --> 00:31:41,200 the. Basics of all those. 552 00:31:41,200 --> 00:31:45,920 Is what's going to keep you from having to have this outlandish, 553 00:31:45,960 --> 00:31:50,360 you know, a treatment plan and and I know some of us that's 554 00:31:50,360 --> 00:31:54,080 kind of what we crave we we want to do those those things, but 555 00:31:54,320 --> 00:31:58,160 you don't want to do that in the remote environment A new fear is 556 00:31:58,160 --> 00:32:00,320 unlocked when. You call for help. 557 00:32:00,320 --> 00:32:05,080 And nobody's coming, not in any, you know, decent amount of time. 558 00:32:05,080 --> 00:32:08,520 So focus on those basics. Look at the basics. 559 00:32:08,520 --> 00:32:12,240 Across all the domains. Wherever your specialty is good 560 00:32:12,240 --> 00:32:13,880 at, that's great. Look where. 561 00:32:13,880 --> 00:32:16,960 It's not good at and make sure that you spend some time there. 562 00:32:17,040 --> 00:32:20,800 Zach, it's fantastic to have you on the podcast again. 563 00:32:21,440 --> 00:32:25,840 It's fantastic to have you on our faculty and thank you for 564 00:32:25,840 --> 00:32:29,240 being our guest today. Absolutely a. 565 00:32:29,240 --> 00:32:33,040 Brick, thanks for having me on. This has been a presentation 566 00:32:33,160 --> 00:32:35,520 from the College of Remote and Offshore Medicine. 567 00:32:36,040 --> 00:32:39,920 If you would like to earn CPD credits for this podcast, you 568 00:32:39,920 --> 00:32:41,800 can join. The Council of members. 569 00:32:42,200 --> 00:32:46,040 Being a member of the College gives you free CPD credit, free 570 00:32:46,040 --> 00:32:49,200 access for our Virtual field guide, and discounts on our 571 00:32:49,200 --> 00:32:52,360 e-learning courses. You can join the team on our 572 00:32:52,440 --> 00:32:56,600 College website at quorum.edu dot Mt.