All right, well, everybody, thanks for taking some time tonight to meet with our representatives from AUGS, ABOG, and ACGME. This is our annual Program Directors Network update, and I'm going to get things started. So, I have a short slideshow that I will share just to go over a handful of things. So, this is our update. So, this is a little bit of our agenda where I'm going to give a little update on the PFD week program director meeting, then ACGME is going to have a chance to give us some updates, then updates on the safe examination, followed by an ABOG update. So, I know people have been emailing, and these are the key application dates that are coming for the. 2024-25 application season, if you will, and essentially very similar to what it had been in the prior years. The only difference that we have made was we're giving them essentially 4 days, because most of the interviews will go out Monday, most Monday morning, but they have until 9 PM programs due and we're giving them until Thursday night at 9 PM. So, if somebody doesn't respond, or chooses to decline that invitation, that gives us the ability to send out secondary kind of invitations or second round invites on that Friday. So, those will be posted on the Augsburg Fellowship Program website. So you don't need to write those down. Just as a note, residency programs are given 48 hours, so we're giving a little over 72. so I think that's perfectly reasonable for somebody to get in and that's what our fellowship training committee agreed on as well. So, for PFD week, it's 4 to 630 PM on Tuesday, October 22nd. They'll be a little bit of welcome. We're going to have an update from the DE&I committee. We're going to get a little update on residency CAS, which for some people who know, some people aren't sure, this is the new OBGYN residency program application. So, current medical students are using this for the 1st time instead of ARIS or ERAS, or however you'd like to say that. So, they're going to give us a little bit of update because at the national level, there's discussion as to whether a fellowship program should explore this as an application kind of processes us. We're going to talk a little bit about the SLOE for fellowship candidates, which is a standardized letter of evaluation. And then we do have something special. I was able to coordinate something. It's really a leadership kind of talent assessment. And essentially, OGS is partnering with a global talent group called Talent Plus, and they really work on leadership development, really focused on larger organizations. So, they work with Ritz Carlton, they work with some big hospital systems and other places. And it's really to give you an idea of what your strengths are. I think there are 15 domains of strength that you get. So, they're giving us access to this online assessment. There are 50 assessments that they offered. So, it's $850 each. So, they're offering up quite a bit. And these have been sent a personalized, individualized link to the first 50 program directors who have registered. I'm asking everybody, we've had about 23 people completed so far. It takes about 30 minutes to complete. You'll have an individualized link, and I'd like to get these done as soon as we can. So, I'd appreciate if people could get this done by the end of the week. And if we haven't seen movement on some, we are going to reassign some of those unused links to other program directors, because we have more than 50 people registered for the program directors meeting on the 22nd. So, please, if you haven't seen that, let us know or reply it away and she can resend a link if you haven't been able to find that. And what essentially this is going to give you is your individualized talent card, which is going to show you your domains, going to show you where your strengths are and what those strengths can be utilized for. Help turn qualities into action. There'll be future opportunities to individualize an in-depth assessment if you choose to do that. But it's, I think, going to really be a novel and something enjoyable. So, I'm hoping people can be willing to do that. So. I'm done with my part, and I think we're going to have ACGME go first with the update as to things coming down the pipeline. Well, good evening, everybody. I'm Meredith Alston. I have the pleasure of serving as the Review Committee Chair for the Obstetrics and Gynecology Committee for the ACGME. And I'm in Laura Huth's office as we speak. She's going to be giving some of the talk tonight as well. Laura is the Executive Director for our committee, and we have a review committee meeting tomorrow, actually. So we are joint today and in the same place. Are you guys seeing my slides okay? Are they showing? Yes. Okay, super. All right, let's see if I'm able to advance them. No. Let's try over here. There we go. Did that move for you? Okay, okay. So no conflicts. And just a quick summary of what we're going to talk about tonight. We're going to just review our committee structure, talk about the accreditation of the urogyne programs, do some subspecialty updates. We're going to run through some information that hopefully you will find helpful in your ADS annual update. We're also going to review some updates from the committee itself that are not necessarily subspecialty specific, but I think are specialty specific and important for you all to know as educators. And then just some ACGME news. So regarding the review committee structures, so all of you are aware, our committee and all committees are volunteer groups, and everyone except for the resident or fellow members serves a six-year term on the committee. We have 16 voting members, 14 of which are physicians nominated by either ABOG, ACOG, AMA, or the AOA. We have one resident or fellow member, as I mentioned, that is a two-year term as opposed to the six. And then we have one public member who serves a very important part of our committee. And then we have three non-voting ex officio members that represent ABOG, ACOG, and the AOA. If an opportunity comes up from one of these organizations, ABOG, ACOG, AMA, or AOA, looking for committee volunteers, I strongly encourage you, if you are at all interested, to self-nominate and try to join the committee. This work is incredibly important, and it feels like the most important thing I've certainly ever done in my career and probably will do. So we encourage everyone to apply if they are at all interested. So here's our current committee, and you can see that we really try to value diversity of geography, different types of training institutions, community versus academic, more rural, although nothing is really rural in OBGYN versus, you know, very urban, military, et cetera. We also try to represent all of our ACGME-accredited subspecialties as well as specialists. So here's our current executive committee. So as I mentioned, I'm the current chair, and I became chair and following Gabby Gossman, who was the former chair, in July of this year. And Tony Ogburn is now the vice chair. And then Laura Huth, who I mentioned we'll be chatting here just in a minute, is our new executive director. Emma Brebert-White has been our associate executive director for quite some time. And then Carly Wyatt, also new to the team, as a senior accreditation administrator. And I say this all the time, but, you know, when I was a junior faculty and a new program director, my DIO was like, oh, under no circumstance should you ever do not contact the ACGME. You know, bad things happen to you if you reach out to them. They put you on some sort of a list or something. Like, none of that is true. We absolutely want you to communicate with us. We are here to support you. We want your programs to be accredited. We want them to be in good standing. We want you to get compliment increases. We want all of those things for you. So please reach out if you have any questions. We are actually not the big bad wolf, I promise. So our committee does meet three times a year, February, April, and September, i.e., we're having our September meeting starting tomorrow. That is important because if you are looking to make a move, either to submit for a new program, to have a compliment increase, et cetera, you want to pay attention to when the deadlines are for the meetings so that you can get everything submitted so you can hit the agenda that you want to. Because sometimes that can be very important, especially for complimenting, I mean, for both of those issues, really. So please just make note of that. So thinking about our Euroguide programs, which I'm just going to call it Euroguide, there are a total of 56. And you can see that all of them are really in great shape. We don't have anybody on warning. There's no one who's on probation. 49 are in continued accreditation. And then we have some new programs. There are a total of seven. They're either under initial accreditation or continued but without outcomes, which means that they haven't graduated any fellows yet. So those are our sort of programs that are in their infancy. But overall, the programs are doing really well. So relevant to Euroguide, you all know this probably even better than I do, which is that the name change from FPMRS to URPS went into effect with ACGME starting July the 1st. And the paperwork has been updated to reflect that. I think you're all probably already aware that the minimums have been approved and are actually now in effect, meaning that we will start looking at them for your 2025 grads. So that means next cycle, we will be starting to issue citations, AFIs versus citations, depending on sort of where we are. But then we will be noting it to you starting in 2025. With this, as we move into some of the ADS information and suggested info for you, I'm going to turn it over to Laura for just a minute. Hi. It's nice to be in person, though, with someone. Okay. So annual program review, you guys have probably seen this slide before. It gives an idea of when we do our data collection, when we do what we affectionately call data drop, and the executive committee reviews every single program, all residencies and fellowships. And then we decide sort of what the plan is. So some programs we review and you'll get your letter of notification, no AFIs, no citations. Some, you may get some AFIs or citations, but we're really looking for who we're going to review by the full committee at our big February and April meetings. As you guys know, all permanent increases are reviewed at full committee meetings, are temporary increases, and we'll kind of get into that on a rolling basis. Again, this is just a different look at the timeline, but it also gives you an idea of everything that's going into our review. It's not just the survey. I know a lot of people are hyper-focused on that, but we're looking at the case logs, the board pass rates. We're looking at attrition over a specific period of time, any program changes. We want to check in on the scholarly activity and so forth. So that all goes into our review. And I did want to talk about the survey, you know, what do we do with your survey? So this is a nice little graphic that helps explain it. So again, we review every program, we review every survey. If there's significant noncompliance, it is flagged during the annual review process. And then we sort of decide where to go from there. So we triangulate isn't even right because it's not three points, but there's several points of data that we're looking at in addition, of course, to the survey. And then we decide, okay, maybe it's not a problem. Okay, we can, you know, cite or AFI sort of like I just referenced, or we really need to, you know, pop the hood on this and see what's going on. And then sometimes we may even need a site visit. So we can have someone neutral come out and check in with your program and report back. Meredith and I, for our affectionately called dog and pony show that we're doing, we're trying to be a little bit more timely in the information we're sharing. So since we're right now in the annual update, we wanted to just talk about major changes and other updates because you guys are filling it out. So this is where you really want to talk to us about the low ratings that we both see on your surveys, how you've addressed any areas for improvement, any issues with clinical volume, what you guys are doing to address that, program changes, program innovations. It's not all, you know, airing your dirty laundry. We want to hear the good stuff too. And of course, pertinent to OB-GYN is any impact that federal rulings and state laws might be having on your ability to educate the residents and fellows. Here's some good points for responding to citations. So, you know, these, keep in mind the audience. So these are physician GME leaders. So they know the verbiage, but they don't know your institution, you know, and they don't know your program. And, you know, they only really have the information that they have in front of them. So we don't assume for good or bad. We really go based on what we have in the reviewer packet. You want to be clear, concise, and frank. We get some people that think they can just throw a bunch of stuff and we'll, you know, our eyes will glaze over and we won't, you know, really dig into it. But we want you to be clear. We want you to be as concise as possible while giving us all the information that we need to know. We want to hear that you've gotten to the root of the problem, or if you haven't, we want to hear about your outline. You know, we want to hear about your plan of action. Tell us any outcomes from anything that you have put into place. And then if you haven't met your goals, just tell us why and outline what the next steps are. It's your narrative. It's your story to tell. All right. So this is, I'll run through these reminders just really quickly. A lot of this stuff I sort of put on here because we'll share the slides at the end and then you guys, you have them for reference. I'm sorry, I'm from Philly. You guys, it's a lot. So I apologize. A reminder that compliment changes, program director, and participating site changes do need to go through ADS. They're reviewed, again, temporary compliments are reviewed on an ad hoc basis, a rolling basis, program directors, and participating sites as well. We have our staff take a peek. They might reach back out and say, hey, we need a little bit more information about this. And then our executive team will make those decisions and the turnaround time's pretty quick on that. Permanent compliment increase requests. So you want to make sure that you have your sound educational rationale that this is the biggest thing. You know, you can't request more fellows because there's a lot of work to do. We really want to hear how this increase is going to benefit trainee education. We want to make sure that you have sufficient patient procedural volume. So both that your fellows are meeting the minimums, that they're logging. This is really important. You know, if they're not logging and it looks like they're not meeting the minutes that, or the minimums, excuse me, that's going to be a concern. Why is that not happening? Is it really just a logging thing or did they not have access to it? And then, of course, we look at the institution procedural volumes. And this can take a long time to get from your institution. So do give yourself time to collect that data. We want to make sure that there's a favorable learning environment already in the program. And then, of course, we do want to see your proposed block diagram. So I say this at every update. The ACGME has a lot of resources, a lot of documentation. Whether or not you can find it is a whole other story. But we do encourage you to check out the complement change request document that is on our website. This, again, this is sort of so you can take back and take a look at. But this is a really good example of educational rationale for a permanent complement increase. So it tells us why they want it. They've got some new faculty. There's a lot of growth. You know, there's cases going uncovered, things like that. So this is a nice example. In that same vein, we wanted to share an example of the process of thesis, something that, you know, one of our reviewers had seen this and said copy and paste this and throw it into a presentation. So it's telling us, you know, that you're giving various options for projects, how they're going to present their work, how you're going to assess progress, you know. So this is a great example of what we're looking for for that process of thesis, which I know could be a little bit tough. And then the next few slides are just some reminders. So for fellow evaluations, these are longitudinal experience that need to be evaluated at least every three months. We should be doing 360 evals, so self-staff residents, you know, doing them of the fellows. Making sure you're doing your semi-annual and summative evaluations, looking at the milestones, the progress on the thesis, clinical experience. We see a lot of AFIs and citations around language on evaluations. So the ACGME does outline very specifically what an evaluation should include. So you can do a quick control F in the program requirements and just make sure you have all the correct language in those evaluations. And then, of course, the summative eval has must document readiness to progress to the next year or ultimately, you know, independent practice. There we go, yeah. So the final evaluation, this is very specific. Dr. So-and-so has demonstrated the knowledge, skills, and behaviors necessary to enter autonomous practice. Supervision policy, so the supervision policy was updated not too long ago, but we are still seeing the outdated supervision levels. So just, again, this is a great control F in the program requirements, just making sure that your supervision policy matches up to the new definitions for the ACGME requirements. All right, and then I'll turn it back over to you for review committee updates. Great. Okay, so some of you may be aware of this already. We made this announcement regarding our flexible procedure experience pilot at the CREOG meeting end of July, beginning of August, and have been sort of announcing it everywhere we're going. And again, this is for the specialty, but I think it is relevant. So as you all are very aware, vaginal hysterectomy experiences are low and dropping, particularly in the resident experience. Operative vaginal delivery has also followed that same trajectory. And as graduates are going into practice, since they have done less, they are less confident, they're doing fewer of them themselves, and they don't feel comfortable teaching them. And so we've got amplification of the issue. So here is what's been happening with operative vaginal delivery over time. And here is what is happening with route of hysterectomy over time with the... TVH has been low for a while, but has continued to decrease. So we believe that these are specialty defining procedures that are very important for the care of the population that we serve as a specialty. And so we want to get these rare, but very important procedures into the hands of those physicians most likely to perform them in practice. And so for the residency, an example would be for vaginal hysterectomy. So right now, the minimum is 15 per resident. So if a program has four per year, then they are required basically to have 60 vaginal hysterectomies that they can serve up to their residents for training. And just as a reminder, that number in no way implies competency. It simply implies the number of procedures that a program needs to potentially get their residents to competency. So that number will not change. If they are required to have 60 now, they will still be required to have 60. What does change is that once residents have matched into fellowship, and it's specifically outlined here which types of procedures, they no longer will need to reach the minimum requirement of 15 for operative vaginal delivery if they're going into G1 oncology, REI, or urogyne, or meet 15 for vaginal hysterectomy if they're going into MFM, REI, or G1 oncology. The program still must basically divert those numbers to their other trainees. So they still have to serve up the same number of procedures, but the goal is to get them into the hands of those who are more likely, as I mentioned, to perform them in practice. And then programs will be able to communicate this to us through their ADS update in the major changes section. This is the first time that our specialty has allowed for any flexibility in the training, in the procedural training experience, and we're not really sure how this will go, hence why it is a pilot. So we're going to be collecting data, assessing sort of the impact to determine if this is something that we need to sort of roll back from if it's not successful, or alternatively lean into more aggressively if we're finding that this is something that's really needed within the specialty. It is expected that everyone will have the same experience until they match, because you are still expected to have had some experience in it and understand these procedures, their indications, the complications, etc. to sit for your certification examinations. So the experience cannot be zero. It may not be 15 and doesn't need to be 15, but it cannot be zero. If it is zero, programs will still receive a citation in that setting. We know that not every program is going to benefit from this. This is not intended to fix all the problems procedurally within the specialty. It is just a place to start. And we really appreciate the support and partnership with ABAG as we venture into this pilot, as they have been on board with the fact that this will essentially change some of the landscape of certification. One thing to mention, and I don't think this has a ton of relevance for you all, but it may, depending on how you all are practicing. There has been a significant decline in abdominal hysterectomy experience, as I demonstrated on the previous slide. There's a lot of reasons why that's great for our patients. And by no means are we suggesting that minimally invasive approaches, including vaginal hysterectomy, is the most minimally invasive approach, should not be valued. But we are concerned about the ability of our trainees to go into practice and perform life-saving hysterectomy via an abdominal approach. We are looking at this, but are concerned that we're going to need to increase this minimum for training. We're not suggesting that programs be converting minimally invasive hysterectomies into abdominal hysterectomies. We are encouraging programs to start thinking about what they might do to ensure that they are optimally utilizing the abdominal hysterectomies that are being performed for resident training experiences, i.e. double scrubbing, making sure that residents are in cases that perhaps they are not having access to now, et cetera, and more to come on this. And this is just a more graphical depiction of what's been happening with abdominal hysterectomy. So just a quick update on ACGME in general. Dr. Tom Naska has been the ACGME president and CEO for the last 17 years, but he will be stepping down from that role in January. And Dr. Deborah Weinstein will be taking that role. She's an incredibly accomplished physician and medical educator. She is a gastroenterologist and has served as a program director, a DIO, the chief academic officer for Michigan Medicine, and executive vice dean for academic affairs for the University of Michigan Medical School. So an extremely accomplished individual who we are excited to have as the new president and CEO for ACGME starting in January. And with that, we will take any questions. Thanks so much. It looks like there is a question from Dr. Becky Rogers in the chat. She says, I'm curious why family planning is not in this program. In the pilot program, I'm guessing? I believe so, yes. That's because there are many family planning docs that are practicing general OBGYN for a substantial portion of their job. I have a couple questions. So first is, I know the case minimums we got explained to us and they've been kind of at least disseminated to us as program directors. It seems like on the ACGME site and when we're printing out our case logs to go over with the trainees, it's still showing the old minimums in our red and green and categories. When is there an anticipated timeline that that's going to be updated for the trainees input? Some of the documents not being updated are my fault as I'm working through it. But we're waiting for the off-cycle folks to graduate so in the fall. So we're here now probably October. Yeah, perfect. Yep. Perfect. It looks like there's a question from Dr. Kowalski in the Q&A. Are the newest procedure minimums and rules regarding teaching assist on the website? So I was selfishly just trying to wait to do everything at the same time in the next month or so. So I would say no because I've not made any updates. You're always welcome to reach out but we will get that cleaned up. Yeah. And I have those, Joe, if you need it. I've got kind of at least the screenshotted versions of that I can send you for temporary timing if you want that. So just email me. Yeah, I don't think the timeline's up there either. That's a good point. Are there duty hour things coming down? I feel like I've been trickling here at the 60-hour work week from 80 and this is just like a sniff in the fall air that I'm smelling. Like, is this something that's coming to us? Is this something being discussed? What's the thoughts on the decreased work hour? The common program requirements are up for revision and there is a process that it is outlined on the website too about sort of how they're going to be going through that. It's a multi-year process to actually make those changes and we have been told that sort of everything is on the table including work hours. There will be a call for specialty societies to submit papers outlining their points of view on a variety of different topics and AUGS was submitted by us as one of those organizations that should be considered to be invited for their comments. I think we don't know. I think it is probably fair to say that they're not going to be increased but I think other than that we really don't know at this point. Do you have other insight? No, that's exactly right. This might be a time to plug that I don't know if you guys saw the institutional requirements are open for public comment so please as a society or as a self take some time to check those out. It looked like somebody had posted about like the VADGIST changes. Do you want I can go through that? Just a quick once over again. I think I understood what that meant but yeah. It's a little confusing. I mean it's not confusing to me because I've been thinking about it for like literally years but that doesn't always mean that that translates you know when you're explaining it. So you know we're probably not going to be increasing the number of vaginal hysterectomies significantly but we think that it is critically important to maintain it as a core procedure within the specialty because it will help us best care for the patients that our specialty serves. In order to do that it does not seem to make sense to have folks who are never going to be doing them in practice continue to be doing them in residency and the same is true for operative vaginal delivery. So once we have matched residents into those specific fields they no longer need to do additional vaginal hysterectomies or operative vaginal deliveries. We do expect them to have the same experience as everyone else up until the time that they match and the reason is that I'm sure you have all seen amazingly fabulous residents that you are 100% sure are going to match who do not or who change their mind at the 11th hour. So everybody is expected to have the same experience up until that point. They are expected to have had some experience with it because they still do need to sit for their specialty certification examinations. So they have to have some familiarity even if they won't be doing those in practice. The programs themselves will still need to provide the same amount of training substrate basically. Again assuming that no one will go into fellowship because you just don't know and then once somebody let's say somebody matches and they've done four vaginal hysterectomies and they're going into REI. We would expect that those other 11 that they would have done will be distributed amongst their fellow residents ideally of the same level of training but in some cases that may not make sense. So that those experiences will get into the hands of those more likely to perform them in practice. Does that I don't know you can put in the chat if that if there's still question about it. I only see one question coming in in chat here. Issue that for some residents that may mean zero tbh if they match in the third year and get the majority. So again they are not permitted to have zero. If they have zero the program will get cited. So I guess theoretically I mean if you look at the data most residents by the end of their third year across the country the vast vast majority of them have a handful. They have somewhere between you know the majority of them have somewhere between three and complete complement. And so everybody is kind of getting not everybody because there are some programs where they are really struggling with vaginal hysterectomy. But in general they're getting a few. They have to have some. So I guess if they've done zero and they match and actually though I mean nobody except urogyne matches in the third year. Everyone else is currently matching in the fourth year. I suspect if the pilot is really successful that might change and the match might be moved earlier so that we can do more individualization in the fourth year of training. But if they if it's a two in oncology person who matches they have done zero vaginal hysterectomies they're going to have to do some. They cannot do none. But they wouldn't need to do 15. Yeah minimum is I know being on the other side the vagueness of the ACGME could be a little bit frustrating but the minimum is not zero. I think yeah it cannot be zero. So they would have to do some. And of course they would still probably do their urogyne rotation in the fourth year just looking at this because they still have to get 25 urogyne cases right. We haven't adjusted that minimum. It just means that you know if it's a combination of you know slings and AMP repairs and that kind of thing maybe they do that and maybe another resident comes and actually does the hysterectomy portion or something of that nature. It's up to the programs to figure out how that might work for them. And we've also heard that maybe some programs want people to accommodate that and that's also fine. We're just simply giving the option for flexibility. Will the slides be available for review? I think yeah we'll send them. For the thesis so we don't need a thesis update in the ADS. We just need to your evaluation should be checking the progress. This is I believe the thesis and I probably didn't say this was in relation to new programs. Oh as far as the application. Yeah yeah I apologize that's important information. So no thesis update in the ADS. And there's been a lot of discussion Tom I see you kind of chiming in there. There's been a lot of discussion about the thesis at the board and I'll defer to them on their plans with the thesis. Other questions? Any last-minute questions for our ACGME hosts here? If not we'll let them. I know they have another commitment so. Thank you so much for accommodating that too. We really appreciate the flexibility. We appreciate your time. It's very helpful. It's always great and these updates are nice for us to see what's coming up and coming down. So great. Well we appreciate being included and thanks for the opportunity to be here and we wish you all a great night. Thank you. Thank you. Take care. And Sally you're going next. Great. Sounds good. Hello everyone. I think we're going to perfect. All right. So this is an update on the SAFE exam. So as far as participation we continue to have more and more fellows participate each year and that is I'm sure in parallel to the growing number of fellowship programs but we're excited about that increase that we're continuing to see. And similarly increasing participation or at least holding study these last couple of years but certainly a big increase over these last few years. So thanks to everyone who is having or whose programs are participating. So the completion time not a timed exam but it's taken people just around 100 minutes to complete. So not a huge not a huge burden of time. We haven't heard a lot of complaints. I don't think about the time of the exam. Score distributions. We are typically seeing this this kind of distribution Some years we're a little bit more in the 70s. Some years it's more in the 60s. But this is this is kind of what we expect to see each year. So these 2024 numbers were pretty similar and that this is by year going back to 2021. You can see that maybe last year was a little bit of a harder exam maybe by a few points but generally that's kind of the trend we're seeing. This is the number of questions in each category. So for things like fistulas we've only got three questions. Congenital anomalies two questions and then prolapse stress incontinence we've got 10 questions. We made some adjustments to this in the last few years based on feedback from you all. So we're going to be doing a little bit more of a review of this. So we're going to be looking at adjustments to this in the last few years based on feedback from you all. So we're certainly open to more feedback about that. If you feel like you would like to see certain topics highlighted more or less you know feel free to reach out and we certainly will take that into account as we develop future exams. This is just percent correct. With these small numbers in some of these categories I don't know that I would take a lot out of these numbers and be for example super concerned that the fellows aren't learning about quality of life and symptom severity but we just kind of look at these just to gauge the difficulty of the questions and kind of help with future exam design. So as far as the feedback we asked the fellows if they think that the questions were representative of the learning objectives and we got good responses there. Do we feel like the program will use the safe results to improve the curriculum? Yes. So that's a good answer. Do you think it's going to impact your promotion? So the answer should be no and I think messaging is really important for that. You know this is not meant to be a high stakes exam. It's not meant to be a make or break exam for advancement. It's more of an educational tool. So make sure we're sharing that with everyone. Is the information provided after the exam helpful? So we always get dinged and again messaging I think is helpful on y'all's end too. We always get dinged for not releasing the questions and I totally understand why the test takers all want the questions released at the end of the exam but reasonably speaking we cannot release the questions because it just takes too long to write questions. So we do try to provide learning objective information as well as some commentary about the question and we've really worked hard over the last year or so to make sure that the commentary is a little bit more robust as a teaching point. So I'm hoping we'll see some shifts that maybe people will be a little happier with the information they're getting but they're never going to get the questions unfortunately. They would recommend it to others. We were happy with that and then we've got our exam dates coming up really soon in March. So registration will open in January. You'll notice that this is a range. So proposed exam dates span some days and hopefully that helps you all with scheduling. Not everyone has to take it on the same day and and so there's a little bit of wiggle room there. So hopefully that makes this a little easier to implement into your schedules. So I'm turning over the SAFE committee to the capable hands of Lindsey Turner starting next year. So this will be my last exam but if anyone has anything that they would like to give us feedback for as we finalize the development of this coming exam please reach out. We want this to be a useful tool for for the program directors and for the for the fellows. Looks like there's one question from Dr. Weber-LeBrun. Can you provide information between SAFE exam results and board certification passage rates? Is that something? I cannot but that's interesting that you asked that. We've had at least two maybe three different groups approach us about doing that kind of work because it would really be interesting but we've had some internal conversations. It's not supposed to be a high stakes exam you know. But in a way, correct me if I'm wrong, the last we kind of heard from it, the OGS board declined to let that research go forward with the last request. But I think is there do you have an update on that way as far as? That's correct. That is still where the board stands in terms of using the SAFE data for research. But I think it is of course up to them at a later stage to make a different decision. But as of right now we're not doing this type of correlation for any other research using the SAFE data. I do want to give a shout out to all for having this examination and having these things. We've been working at the subspecialty level nationally and I think like SGO and other organizations are trying to do this similar type of thing and they realize how heavy a lift this is to get this done annually. Have not basically it be the same exam every year and whatnot. So OGS I think was definitely on the cutting edge in the forefront for our trainees to get this experience. So we appreciate that. All right. All right. Thanks, everybody. Thanks so much. Thank you, Sally. All right, Tom. Take it away. Great. Thanks, John. Hi, everybody. I'm just going to check on the who's here, but I'm Tom Gregory. For those of you who don't necessarily know me, I know probably most of you, but I'm here at Portland, Oregon, Oregon Health Science University, was a program director for the urogynecology program here for many years, actually, even back when it was ABOG certified and accredited. And so I've kind of been part of the process with you all for quite a long time. Now I serve at my role right now is the urogynecology division at ABOG. And I'm now the new incoming chair. As of this year, Matt Barber stepped away from his work here. And so I'm kind of here to provide an update on what's going on with ABOG and Amy Young, who I don't know if she's yet. I see her has popped in on the participants list. The new executive director is also here as tell me when I'm saying things incorrectly. She's been a wonderful addition since George Wendell retired and a lot of new ideas and things that we're kind of been discussing. And I'm kind of excited about all this. And so some of these things I'll share that you may know about some you may not. It's some interesting information. So let me share some things. And I think that Amy, she is here. If she needs to pop in, she can either raise her hand or put something in the chat. And of course, Andrea Rankin is also here to help us again, stay in line. So let me share the right thing here. And then make it big. I assume that's working. Great. So, yeah, these are the things that we're going to talk about tonight, just to kind of talk about division responsibilities in comparison to other place, other groups. Outline some demographic data after talking about the hierarchies of the House of Medicine, something that Amy put together. List some certification and pass rates. Summarize some of the program director reports that you all receive. A little update on the thesis requirements. So where we are and where we're going a little bit. Qualifying examination survey results that some of you all participated in as program directors on a separate one. Preview something called the fellowship portal that will be coming out and describe some program responsibilities. So as you know, we have a bunch of different divisions. This is our division here, Urogynecology renamed. I'm the chair and Kate Bradley, Felicia Lane, Gary Sutkin, Alicia Jarros, and Gina Northington are the team right now. And you can see over here that there's a Pediatric and Adolescent Gynecologic Committee as we think about whether or not they become their own division in the future. I mentioned both Amy and Andrea, who are sort of the wheels behind everything. And they are totally accessible and will respond if you need to. All right, so the responsibilities of the division for EdAbog are to set certification standards for taking the test. Developing, qualifying, and certifying examinations. That is a fair amount of work. We just talked about the safe examination in terms of the work that goes into that. Similarly for these examinations, a lot of work from a lot of different volunteers, including us at the division, goes into all of this. We recommend and monitor the requirements for certification, which sort of is germane, the research training and thesis to our discussions quite a bit. And then, of course, developing the continuing certification or maintenance of certification in the past, which include the lifelong learning and self-assessment, so that Part 2, the articles that we read, we actually write questions for that as well. The assessment, so the Part 3, which most of us don't usually take because we're doing so well with our maintenance of certification and kind of bypass that, but some people still do take that every six-year basis or more frequently if necessary. And then, of course, the Part 4, improvement of medical practice, which has a lot of different ways in which you can satisfy that and growing as we go. So how does the ABOG fit in the picture compared to ACOG and ACGME and OGS? So ABOG is sort of the certifying body, and it might seem like in the past there was a curriculum that was sort of part of the process, but they don't, we don't, they don't create educational materials or curriculum. That's the programs themselves. But standards are set for professionalism and eligibility requirements for the exams are based on evidence, and I can tell you it's based on a lot of psychometric rigor that has sort of grown over the years, which is why we don't necessarily get exam results right away. The blueprint is developed to establish criteria for what is called the minimally qualified candidate for anybody who's been sort of a standard-setting person or been an SME. You've perhaps heard that term, trying to think about what that means. Perhaps maybe better is something we've talked about this sort of sufficiently qualified candidate. And this blueprint is used as a tool, as a floor for when the exam, when the ACGME and the Residency Committee sets their training standards for the different programs. So again, ABOG sets the eligibility criteria and creates the blueprints, and these sort of then inform specialty and subspecialty societies to create curriculum and help with teaching tools for you and the programs and the program directors. And then sort of in a circular logic, these inform the ACGME program requirements. And there's definitely a back and forth between and among them, but there are separate entities, as I mentioned, and that's sort of how this looks. And then if you think about sort of the exam process at ABOG, this is, if you use this, you know, the clinical competence pyramid, you know, this is a way to sort of think about how that would come about. So the sort of bottom framework, the foundation is sort of getting past the qualifying examination. And as you move along through the pyramid, you kind of get to the point where you can get through the certifying exam and you're doing continuing certification. And then all the way to the point where you're, you know, continuing to do the work and you're continuing to certify with the continuing certification. I think it's just a way to sort of think about sort of this framework of what we're trying to assess. And so ABOG sits outside of the curriculum part of all this. And so, you know, the training program itself, that's you guys, us, whatever individually goes through the process of sort of thinking about what the curriculum is going to look like, like how to get the instruction done, how to do the assessments during the part of the training to get to the point where then the individual candidate, individual potential diplomat can sort of become certified by this external body outside of the program, but in conjunction with it. Okay. So it's been an exciting couple of years. As you all know, the building has been redone and it has a new name. It's called the ABOG National Center for Certification and Continuing Education. We've done exams there, we've had meetings there, and I can tell you that it's really conducive to the work that is being done and the exams that are being done. And so for those of you who are potentially being examiners or trying to talk to your candidates about what's going on, it really is a very inviting space to have an examination. Okay. So I'm just going to kind of plow through some information about the demographic data about our subspecialty. So here's the most recent sort of snapshot. We have 1,259 active diplomats. Not surprisingly, most are white, and sort of the representation of racial and ethnic origins on the right here. And the majority are, at this point, female, with other gender categories being represented here as well, based on the questionnaires. And then in terms of how old we all are, the majority of us are between 40 and 60. Again, it's sort of not surprising the first 15 to 20 years out from training, some of whom are, if you are younger, sort of making your way through the early training program, early faculty and junior career. Here's where we all are across the country. And in both Alaska, Hawaii, just one hole in the United States. And then this slide sort of shows not only where we all are individually staged, just sort of from the last slide, but also the nine folks who are ABOG diplomats in Canada. So over the course of time since we've been giving out certificates for diplomats, we've given out 1,328. There's 1,259 active diplomats, of whom 38 have retired, 22 of those certificates have expired, and three of us have deceased. And I know that that's an important thing to kind of keep track of all of our diplomats over the years, and it sometimes is challenging. Here's the, you know, so here's the beginning of our trend here back in 2013, when the senior exam was first given. And you can see after this first sort of wave of us grandpersoning in, it's been a pretty steady rate of anywhere from 50 or so, and here's the year of COVID, where we exam was skipped and then pick up here. But you can see it pretty much 35 to 50 or so people kind of becoming board certified through urogynecology at ABOG. Here is our pass rate for the certifying examination last year. So we, I'm going to show all the difference of subspecialties here, but we had a 94 percent overall pass rate last year, 94 percent in the first time, and the repeat takers was actually three of the people and repeated and passed. So you can see very similar, REI actually had a 98 percent pass rate, and GYN oncology, a 93, 94 percent pass rate, and MFM, 95 percent pass rate. Just kind of go back one, let's see if I can go backwards. You know, we had 50 overall takers last year, so you can see where, but MFM has a much larger group pool of people. Just for your calendars for both your fellows who are perhaps in training and be taking their specialty certifying examinations. Here are the dates. You probably are aware of them if they're getting ready to take them, you're making arrangements for them. And then the urogynecology certifying examination for our fellows who finished will be April 6th through 10th of this year. And usually it's in the first or second week of April. And it's gonna be probably very similar in 2026. Okay, so this is talking about the candidate score reports. And so each one of our candidates after they get their certifying examination completed, they'll get a report like this. It shows their score in relationship to what has been defined as the passing score. And just remember these numbers sort of represent when we're doing the examination, we give every sort of question answer from one to four, one being sort of a person who is insufficient, a two being, sorry, and then a three being competent and four being outstanding. And so you can see sort of the passing score is often sort of just less than this three, recognizing that all the questions are not necessarily going to be answered at the fully competent level for the passing, for the minimally qualified sort of candidate here. And there is a range that if that person is sort of inside the confidence interval of this passing score, they will not, they still are in the passing range. And then the scores are broken down for the candidates based on the different sections of the score. This is actually REI here. And I think that I had another slide with the urogynecology sections here, but this is just sort of conceptually what's going on, sort of the different sections and then the case lists that would be there. And this would be the overall group of people taking this test, and then this would be the individual candidate in their range. And then similarly, this is the information that you all get as the program directors, both current and three-year program rates. And again, this is sort of for MFM that sort of we all see here, but it's the same sort of concept. And you'll get your programs, one-year program pass rates compared to all programs. So this situation, one year, there's one person, that person passed compared to 93% pass rate. The, again, the single year distribution of program pass rates, 61 programs had all their candidates pass. And then some had none. And then sort of the three-year pass rates over time as things go along. So here's the 2018 to 2021, 2019 to 2022 and 2021. So you can see your program compared to all the rest of the programs. And then sort of the 5th percentile cutoff was an important thing for you to know about for your ongoing accreditation through ACGME. And then this is the similarly, the three-year distribution of pass rates showing even the majority of them having most of their candidates passing. And then sort of when there's more than one person sort of potentially not getting through the certifying examination. And then again, sort of per sort of section on the test, sort of where your candidate or candidates, if there are multiple sort of fall in range to the rest of the programs in terms of the range of scores for this sort of, so MFM-1 in this situation is medical complications of pregnancy, but urogynecology would have sort of an amalgam of several things that would be kind of blocked together for that. And this again, sort of saying a little bit of the same thing and how your score, your candidate's score is in relationship to all the programs, medium score for that category. So that you can potentially use it for addressing if they have any needs for your program. And then whether or not your specific candidate passed or not. So back to sort of the thesis here question. So we all know that during COVID and the years afterwards, many of the fellows reported significant disruption in their research rotations and had significant disruptions in laboratory or clinical research. So we're persisting right now with this year with continuing to have the candidates submit their thesis to AABOG and we will, the division members will individually review all the thesis submissions to make sure that they have met the AABOG standards as set out in the bulletin. We've been looking at annual reports over the years. So theoretically, we've been giving a guidance to you and the candidate, whether or not it's on the way to meeting that standard. But as in years, the last couple of years, we're not going to actually review or have the candidate defend the thesis at the examination in April, but rather we'll continue to do five structured cases on study design, clinical care and evidence-based medicine related to what would be research methodologies and things. And we will continue to sort of ensure the continued fairness of this decision for the certifying examination candidates. And having said that then, one of the things that we are considering doing, and I think it's more than a consideration, I think it's a strong move forward is to have the thesis be completed as it has been prior to graduation, but also have that thesis be submitted to AABOG through a to be built or being built portal prior to the graduation from fellowship. And that would mean that not only, so you are supposedly doing a thesis defense prior to their graduation. We are working on updating the thesis defense sort of form to kind of help you evaluate that. And some of the data I'm gonna show here in a few minutes, sort of add a little bit of rigor perhaps to the thesis defense based on some data that I'm gonna show by adding a requirement for somebody external to the program to be part of the thesis defense review committee that you'd have to provide to us that we would take a look at. We would also recognize the top three thesis per division, urogynecology, joint oncology. This would in essence eliminate essentially the work that you do to create a current annual report and it will be replaced with fellow attestations that they would build over the course of the time of their fellowship to sort of show their process and progress along this eligibility criteria. This is an example of how that could look, sort of research benchmarks that they could sort of be able to upload as they went through their process. Maybe it's over the course of three years, maybe it's over the course of one year, depending on how your fellowship sort of works, but it would be an opportunity for them to bring in their information that's kind of in that annual report already and fill it in as things go along so that they can sort of build their, again, their eligibility criteria for sitting for the examinations. And the final thing would be thesis defense at some point that you would attest to. These are the same potentially acceptable theses that we've sort of had in the bulletin for the last several years, adding to them over the last several years. So nothing specifically new here, but that is something, they still do remain the sort of the thesis study designs that we would look to see. Okay, so I want to sort of, I think I gave you some information. Now I kind of want to back it up with a little bit of information from a survey that you all participated in as program directors, and that was separately also sent to the fellows in the course of the finishing their qualifying examination that kind of clarifies sort of why we're going this direction. So it was, as I mentioned, this survey was administered to you all as program directors and also to some leaders through AGOS and the chairs committees. It was seeking to understand your views and our fellows' views on research and the thesis requirement. And so I'm going to share kind of how this bit of information was, what became of it. Now, I think that the survey that the fellows got after their examination had strongly disagree on the far right of the Likert scale. So after agree, but it was in order. So I think just a little grain of salt on that, but I think the folks who took it probably understood what they were answering. So here are the number of people who answered these surveys. So 394 total of which 64 were the urogynecology examine takers. And I'll sort of go through some of these questions here. So the first question was, would they be willing to engage in a payment plan to sort of pay for the examination? And a fair amount of people, it's kind of half and half. Many people would potentially would want to take advantage of that. The sort of, these are the, who took the exam. So most people consider themselves at an academic program. 9% felt that for urogynecology, they were at a community-based program. So here's some of the questions. So the fellowship, I think everybody agreed that their fellowship program is performing important research. So what you see here, this is the fellows result, answers that are sort of in this Likert scale from strongly disagree to strongly agree. And you, as the program director, is actually answered sort of more on like a visual analog scale where you had a little bit more. And so that's why these look a little bit different. But in general, you both agree that we're performing important research at our institutions for the fellowships are. The vast majority of program directors and about 50% of the fellows felt that submitting a thesis was an important part of the certification process. But I think there was a little bit less of a support that the actual testing on the thesis at the time of the certifying examination was an important part of the path of certification. Most felt like we were gonna continue doing research in a future career. Both you and the fellows felt the same way. Asked a little bit different way. So sort of a wider blanket, disseminating scholarship also felt, people felt like that was gonna be continuing in their future. People felt that they were gonna continue to conduct research that will advance the subdiscipline. Fellows and you all felt that it was mostly important to continue to do a minimum of 12 months of research as part of their fellowship. And the thesis itself is an important aspect of this fellowship requirement for most of us. Certainly the program directors feel that way as well. The people, both program directors and the fellows felt that they receive consistent structured training and research design methodology during the course of their, their fellowship. And that there was institutional support for the most part from the institution to provide the structured training and study design and methodology so that's a good sign. There was a question about whether or not we could get some common fellow educational expectations and get some alignment. And so most of us, and most of the fellows felt like they that would be a great idea, something to sort of potentially strive for we started talking about that at the GME summit this this summer. And, you know, the fellows felt like they have sound knowledge and experience and research study design and methodology as a result of their, their training, and you feel like you're providing it that way. However, you know, again and similarly, a common national core curriculum in things outside of research perhaps would be would be useful and something you know that augs has, I know that is working to try to help maintain and so. And similarly, so these are just similar questions so this is actually just specifically on the national research curriculum that would improve fellowship research education, again that people feel that that continues to be an important thing. So this, we just talked about the safe examination, a few moments ago and so we actually are your gynecology teams were not surveyed on this because we already have our safe examination, but there's kind of a wider feeling about whether or not that would be a useful thing for their other sub specialty divisions. So here, so this kind of like the. So we provide the thesis defense at the end of a fellowship, and it does seem for across all the different sub specialties that the perception of the structured thesis defense at the, you know, at the time of their finishing fellowship that did not feel potentially rigorous at all. And so it's something to sort of think about as we move forward with our, our recommendations about changing when the thesis is is submitted and fully defended. So this is kind of where the, you know, where we think about how the fellowship, the fellows can sort of build their certification eligibility over the course so they'll, you know, they already, so they would begin providing that the data right here in their a bug portal. The residents have this available to them, it would provide continuity from the residency portal that they will have access to. It'll mean connection with the fellows throughout their, their training through a bug maintain connection. It could promote mastery through a bug continuing certification so they will have access to our euro guy and and all the maintenance of certification questions from the very beginning. It'll facilitate professionalism through the connection providing provided by a bug for our voice for the specialty of OBGYN and sub specialties. And it, you know, the idea here for you guys is it'll make the role of the program director and the program manager for your fellowship easier by decreasing the burden at the very end of the training to kind of get everything together for the fellows. So something like this, it'll look a lot like the dashboard that we have with tasks to be done. Theoretically, if things have been done over the course of the residency, most of this will already be sort of position and uploaded already, they'll be get a chance to complete articles like I mentioned, and some other videos that they can take a look at And they'll be, it'll be built as, as we go along to kind of take advantage of the sort of the eligibility requirements for the thesis, as we talked about. They'll be placed for on a yearly basis monitoring leave residents or fellows leave reporting so that it's sort of tallied over the course of their fellowship. Again, the articles and quizzes that they'll do as part of the sort of their, their certification maintenance process. Again, videos that will be available for them to take it, take a look at. And you'll see their, their tasks as it progresses along the way here. So here's sort of, there'll be sort of just another look at how this would look here but each year there would be an opportunity for program managers to sort of verify and sign off about all the leave reporting. And again, the thesis that you could be able to sort of fill out complete the process of over the course the entire fellowship so it's the, again, theoretically, you could have the fellow complete their fellowship thesis and defend it in their in their first year potentially, but this would all be available in the, in the fellowship portal that. This is just a screen that shows all the different ways in which the different subspecialties sort of set their programs up. And ours is a little MFM is very complex here. Again, I think I've said some of these things already but a fellow would build their eligibility portfolio for all the different things that they need to do over the course of their fellowship time case logs as well will be uploaded on a regular basis, and their thesis, and then by the end of their, their third year fellowship. June, they will have completed all the required attestations which I'll show you here in a second. The program manager will sign off, and then the program director will make sure that they sign off in this portal for this particular individual fellow that that the program director will attest to all the things. So, something like this, the, the, the fellow will say hey I met these educational objectives of my training program. I, I personally can provide autonomous clinical care. The case log is true and accurate of my clinical training during fellowship. So all these are being attested to directly in this portal. The program manager will make an attest to the professionalism professional standing and professional conduct policy right here right then, at that, and repeatedly. They'll have to register and add and maintain fellows in the program portal that will happen over the course of the October through April, and make sure that these fellows would be registered and set up early to kind of be able to complete the portal tasks as part of their eligibility portfolio. They'll be changes will be need to be placed in here as well. And, okay, this is just a step but just just let you know that for you all, you automatically will get part four credit if as part of your roles as program directors. So, in order to do that you will need to submit a copy of the annual program evaluation that you do to to mocabog.org to receive that credit. Just a reminder that there are plenty of opportunities for you to be part of the work we have done at a bug, you may have you haven't looked at your a bug portal and last recent past, you can see opportunities to do your self nominations. If you want to be a specialty subspecialty examiner, or even a subspecialty division self nomination which we will take the a bug, we'll take a look at and we as well to try to bring on more and more volunteers. Here's where you can, you know, get some of your, these questions answered I'll answer some of them tonight as well, Amy will I see her here now. But I just wanted to say that this is a thank you very much. This is a just stop sharing here I think that's it. Yeah. So that's the, that was a 70 slide of update of what's going on a bug with a lot of questions from. I have a question about the annual program of our update. I talked, I didn't I don't know if anyone else has tried this run into this, but, like, our institution consider that kind of business confidential and, like, sending your aid to a bug. They weren't super excited about. And so I was wondering if there's any thought on, or if there's a work around for that for the part for credit. Andrea can probably post something about that but the reality is that if you, if you, if your institution won't let you just submit the annual report if somebody could just provide confirmation that the annual report has been submitted. That's good enough. We're, we're here to help you not to be available. Thank you so much. Anyone have any additional questions for Dr. Gregory and Dr young. I might just add, I think Tom did a great job of going through quite a bit of material, but, you know, our goal is to be really supportive and helpful to you guys as program directors. I was never a subspecialty program director, but I was a program director for a large program for a long period of time. And I understand how much work that is. I don't know if that's a real word, but the onerousness of being a program director and so what we're trying to do is alleviate some of the burden for you guys, and also build the tools that make surveillance for you much easier. When do you foresee that kind of thesis change where more external validation or having somebody on that. You know, I'm a thesis advisory committee or whatnot. Like, what's the timeline for a lot of the, the changes. That you discussed tonight as it goes, I mean, the thesis and the fellow portal is the biggest. Kind of things when do you see those coming live your fellowship portal should be live in January. We rolled up the resident portal 1st, and so that became live in July. So, hopefully, I'm happy to know that we worked up the kinks on the residents 1st before we got to the fellows. Okay. And then the fellowship will roll out in July. Please look at it and ask your fellows to get on it and let us know if there's problems, right? Because there's always problems when you start a new project like this. And we're aiming to refine this thesis piece by 2026. And essentially the thesis would become an eligibility requirement for the qualifying exam. So moving from the specialty exam back to the qualifying exam and have a more rigorous thesis defense, but not to be part of the exam. Any longer, so we're putting that to rest. I think Tom did a good job of that, but. The idea that somebody's going to be quizzed on their thesis, we found out from you all and we found out from the fellows that that probably wasn't a good idea. And so we're trying to shift that and pivot in a new direction. It looks like Dr. Rogers has a question. Dr. Rogers, you can go ahead and speak your question. Thank you. My question is. Is there going to be any criteria for the. Is it the fellowship director who decides who the external person would be or. So, there's going to be suggestions. I'm just curious. So, so I think that's still a bit of a work in progress. Um, we have a. I think near final version of the thesis review. Our hope was that we could work with specialty societies and come up with a list of volunteers that could be chosen. Tom, do you want to add anything more to that? Becky, I do think that's a really key question that we've, we've been talking through exactly what defines a external reviewer. And so I think that the concept is that if we can, and we did it in the course of talking with AUGS and SMFM and stuff like that, trying to figure out a way to, like, as Amy was saying, to have a pool of people that we can kind of reach into and actually perhaps even provide sort of some incentives for them to do that beyond being a good citizen. But I think, I think sort of fundamentally, it needs to be somebody who's essentially not part of your group, not part of the work that's being done. Potentially, it's at the institution, but more than likely, you know, if we can get it to somebody who's external, the thesis would be submitted separately as a manuscript or as a written thing. But there would be an oral presentation that somebody who is essentially unbiased to a certain degree could weigh in on what is going on. So I think the details are still being worked out. But we also don't want to have a situation where you are set, you set the thesis defense date for, let's say, June 1st or something like that. And that person that you thought was going to be there doesn't show up and you're unable to sort of have that person kind of have that external review. So there'll be a lot of different ways in which it can happen. But we do want to have external, we want to increase the rigor, I guess, is the point. But I don't, I'm just checking, but we don't want it to be like a PhD thesis per se, right? I mean, I think adding some rigor, but not where it's a. I mean, I've sat on PhD thesis committees, I've listened to fellows thesis projects for many years. It is, rigor is good, but we don't want it to be so stressful that, you know, bonkers that point was made loud and clear, right? This isn't a PhD defense. This isn't somebody that spent. You know, several years working on their thesis, right? These are clinician researchers or clinician scientists that. Have taken a portion of their time dedicated to this. I think that isn't lost on everybody. That's why we don't have. That many more details in this particular space, except for to listen to you and get that input from you. Okay, that's reassuring. Thank you very much. I think it's a great idea, but I think we also need to be careful not to. You know, we have a lot of type a fellows that might. Get a little crazy about it, I think Leslie, Ricky had a question. Yeah. Thank you. Tom. Good to see you guys. And thanks for the presentation. I had a question. I think I missed the part until the very end about something about submitting quality improvement projects. Or did I miss hear that I think that was part of when Andrea answered my question about not necessarily sending your whole ape. That you could send pieces, like, we submitted our, a, who's the PD, a, P. D. you have ongoing projects. I think that was what that. Was talking about, so is that part of what we're supposed to now be submitting every year? I'm a little confused. I think that was if you wanted part for credit. Got it by submitting your a to a bug for you personally. Got it. So it's not necessarily a program director. Task that's correct. And if you guys haven't looked at your part 4, I don't know. So just a reminder for everybody who has not signed up for your. The application has moved up 1 month to October the 15th. So the traditional date of November, the 15th has changed October the 15th. And I will tell you that next year it's going to change to August the 15th. The due date will stay at November 15 for when your has to be completed. So just. I'm trying to make sure everybody's actually aware of that. So nobody gets caught off guard. But there are quite a few new opportunities. So, you will see that or, for example, if you recertified that counts towards your criteria program directors that submitting your acres, how you get credit for some adulterated version of that. That we discussed previously with John, but there are the modules are there if you've done your mandatory 8 hours of training that gives you credit. So, if you haven't looked, there's actually quite quite a few more things that will satisfy your part for. Hopefully that's good news. Well, thanks for letting us come and give you an update and John, do you have anything? No, we appreciate your time. Dr. Young, thanks for coming out. I know your time is valuable certainly and we appreciate you kind of being a representative for us tonight, so thank you. Well, thank you so much for including me and thanks for including Ava.

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