Jennifer DePrizio + Stephen Hayes

Dr. Lisa Belisle:

Today I have with me Jennifer DePrizio and Dr. Steven Hayes. Jen is the Director of Learning and Interpretation at the Portland Museum of Art. Dr. Hayes is a physician with Maine Medical Partners who teaches in the Main Track Program, a combined medical school program between Tufts University and Maine Medical Center. For the last two years, he and Dr. Joe Linder have brought second year medical students to the Portland Museum of Art to work on visual thinking strategies with Jennifer d'. Abrizio. Thanks so much for coming in.

Stephen Hayes:

Thank you.

Jennifer DePrizio:

Thank you for having us.

Dr. Lisa Belisle:

So I just love this program in no small part because I have a son who's starting with a Tufts Track program coming up this fall and I love this idea. I mean I just what you're doing, integrating something outside of medicine into medicine I think is so important. This isn't something that you would have foreseen in your training?

Stephen Hayes:

No, not really. I think we we had an opportunity to go down to Tufts when they had a grant to start a program with Alexa Miller, whom we'll probably talk about later. So we went down and had an opportunity to do a training program and then brought that back to the main track and brought students last year and then again this year right to the gallery to do the exercise.

Dr. Lisa Belisle:

And it's interesting because it often seems that if you are a medical student, you go down the path of science, so you don't necessarily get to do anything with art. Although I think that's changing. More and more students are coming in with a varied background. But to you, you've always known, Jen, that art's important, right?

Jennifer DePrizio:

Yeah, for me, you know, art is a way that we can talk about the most important things about being human. And when you think about what physicians are working towards, it's to make us better physically, mentally, emotionally and all of those things. And so if we can use art in the open ended discussions that we can have about art, way to tap into that humanity piece, I think it just opens up many possibilities. And art has always been, for me, the way that I can connect most closely with other people. And so this technique that we use really allows you to not only do all those important things like develop observation skills, empathy, talk about implicit bias, but also just get to know your colleagues as human beings by the way that they talk about art.

Dr. Lisa Belisle:

So tell me about your experience, Steve, with this program. What are the sort of, the sort of. The nuts and bolts?

Stephen Hayes:

So as I said, we went down to the training and then brought it back up to Maine. And so we've, I've had an interest in the humanities and so how we utilize humanities for our work, so literature and medicine, for instance. I've been involved with that program for several years and we had a couple of, a couple of times that we brought Outside the Wire, which is a sort of a nationally known art or acting group, to bring classic theater and utilize that for discussions around end of life issues, for instance, domestic violence issues. So this was sort of a bridge or sort of a next step in that. And so I became interested when learned about this, you know, the overall program itself and then and working with Joe to try to find a time that we could get students and students that want to do this and bring them, you know, as part of their really orientation to clinical medicine. So it's that bridge. They come as part of their bridge from the first to second year. And so it's a month long. And this exercises or this activity is one of the, I think one of the valuable aspects of it.

Dr. Lisa Belisle:

So what do they actually do at the museum?

Jennifer DePrizio:

So, so we use a technique called visual thinking strategies, which was developed in the early 90s by a former educator at MoMA, Philip Jenawein and Abigail Housen, who's a cognitive psychologist. And what they were trying to figure out is what happens when people look at works of art. How do people make sense of works of art, particularly people who may not be familiar with looking at art? Because most art museums traditionally are tailoring to people who are, who already know about art. But to make museums more accessible, we actually need to reach people who may not feel comfortable. So they developed this curriculum, Visual Thinking Strategies, which is an open ended, learner centered way of learning how to look and talk about art and decipher what you're looking at, basically. So as a facilitator, very much not like your traditional art museum tour, I, as a facilitator, don't give any information, but what I do is I move a conversation forward through three questions. So you ask, you're looking at an image and you say, what's going on in this picture? And then the group puzzles through based on what they can see, what they think is happening. And whenever anyone offers an idea that's open to interpretation, you say, what do you see that makes you say that? And so I'm not asking them why do they think that? But it's what do you see that makes you say that? So grounding it in the visual. So I think for medical education, it really hones in on those critical thinking skills, those interpretations based in evidence. So you can't just say, because I think so, there has to be something, and whether or not you can always articulate it, that sparked you to have a memory, to interpret something in a certain way. And that's where a lot of conversation, at least that we have, comes out about implicit bias and the judgments that we make based on all the experience that we bring to looking at a work of art, to see, seeing a patient, to going into a new coffee shop, how do you figure out what to do? You use the knowledge you already have and then the conversation just can go on for 20 minutes. I mean, we were having last week, I mean, I shut it down at probably about 20, 25 minutes and we could have kept going. So as the facilitator, you are paraphrasing and just asking the same questions to keep the conversation going. So really the group decides what they want to talk about and what direction they want the conversation to go, which is very different than a traditional way of teaching where I as the teacher would tell you what you should think about

Dr. Lisa Belisle:

and how many medical students are involved at this at a time and how long does this go on?

Jennifer DePrizio:

So we have about an ideal group. We had about 20 something students total, but we divided up into two groups. So eight to 10 people is a good number less than that. And people might feel like they have to keep contributing even if they're not ready. And more than that, there's a chance that everyone doesn't get to contribute multiple times. And so one work of art can go means advised to be 15 to 20, 30 minutes. I've been in conversations that have gone on for 45 minutes because the group just didn't want to stop talking about it, which is really incredible. Also, in terms of sustained looking and thinking about works of art, there's lots of studies in the field that tell us people. The average visitor spends maybe 10 seconds looking at a work of art, which is nothing. What do you get in 10 seconds? So if you sit there quietly, and sometimes it's quiet, sometimes no one says anything for two, three, four minutes. I've developed great patience by learning this teaching technique. I can stand there quietly because it takes a while sometimes to develop an idea and be brave enough to raise your hand and put your idea out there. Especially when what's really interesting is we often have divergent ideas, Right. So one person starts the conversation with a particular interpretation, and then halfway through, someone will come in and say, you know, I actually have a different idea. And they have their reasoning of why they're looking at the same picture, but they have different. The evidence is different to them than to someone else. And that's, I think, when it opens up and becomes this really rich conversation. And I think then for the students, gets them to think about why did they have one interpretation versus another. And I imagine there's relevancy to diagnosis, Right. Sometimes you may be looking at similar bits of evidence.

Stephen Hayes:

Well, I think so, yeah. And actually the last time it struck me that we asked people to. We asked patients to sort of go through interview after interview. And, you know, I was struck by the fact that really what we're asking is different observers to look at the same information and maybe even not the same information, maybe get different angles on the information, and to use that to interpret and say, so it's bringing that back. And so that was kind of an interesting. The last time we did it, that was sort of an interesting thing that I noted with the group.

Jennifer DePrizio:

Yeah. And we actually sometimes will have students move, right. So everyone was sitting in one spot. And after about 12, 15 minutes, I was like, why doesn't everyone get up and get a different spot to look at the work of art. And people had, you know, saw different things because they were actually literally in a different perspective. But it kind of gets back to that idea that we have to look at things from all different angles to get the full picture of it.

Stephen Hayes:

And it's really a collaborative exercise, which I think is the other big part of it. It's recognizing that as a group, you might have more ability to sort of think about something differently. And so it's bringing in those other opinions, those other thoughts about it that I think, you know, when you watch a group work for 15 or 30 minutes on a piece, you kind of see that happening.

Dr. Lisa Belisle:

So as one of the physicians involved, do you also lend your insights?

Stephen Hayes:

Yeah, we do. And I. So for this last one, for instance, we had two faculty members that were participating actively. So, you know, it's. Generally, when we do it with the students, the intention is the students are the sort of focus, and it's there. You know, it's their exercise. It's their. It's their time to sort of think about this and work through it. But I worked with one of the. Actually, the ethicist from MainMed was in the group last time. So, you know, he had even probably a different angle on how we think about this and how we deal with it. So. So that was fun. That was actually a good construction, I think, or a good group to have together.

Jennifer DePrizio:

Because it is really interesting when you have a group that has a variety of perspectives and experiences, because someone can add something in that the other group may not even be aware of. So I think sometimes the misconception with something like this is that people say, well, you can't add any. I know something about art, and I'm not supposed to say anything about what I know. Whereas when I begin the conversation, I say, everything is possible. Add in and bring in anything you want to add to the conversation. So if someone looks at the picture and they actually may think they know who the artist is, saying that is, okay? And they say, oh, well, I think this is by Philip Pearlstein, because I've seen other paintings by him or because it looks like one I saw at another museum. That's all relevant information. And then as the facilitator, you also are neutral. Use conditional language. So I never say whether someone's right or wrong, because sometimes people have interpretations that are very different than the art historical interpretation. So I say, so one possibility is it's this or another idea is this. So I'm not judging anyone's comment, and I know that when the students and we have debriefings, they often talk about feeling like that felt really good, like everyone's idea is validated, but I never made a judgment and whether or not one was right or wrong. So I think it just makes it clear that there are many possibilities to how we could interpret that particular work of art.

Dr. Lisa Belisle:

If you're doing this, I believe you said between is it the first and the second year, is this a longitudinal thing where you have so many sessions that happen over time, or is this once or twice? How many times do students have the opportunity?

Stephen Hayes:

So we've done it as a one time exercise. It's an evening activity. And I think the idea and the ideal would be to, to extend it beyond that. So one of the visions we have is that as I think in the plan for the future of our education program, that the students will actually be based more in Maine as they through the second year. And so that might give an opportunity to do this more as like a seminar or a series of presentations. So more to come on that, more to come how we'll work that. And it's right now it's a voluntary activity and the students sign up for it and you know, come in the evening to do this program. So that's good. I mean, I think people are really interested in it and the students want to come and sort of explore something different.

Jennifer DePrizio:

And we've also been working with other faculty, I mean other, excuse me, we've been working with other physician groups at Maine Med. So I did a similar session with all the surgical residents with the entire cath lab. So there are different pockets within Maine Med. And so the PMA and the museum is really interested right now in how we can use the resources that we have to better the community and mainmed. And working with physicians and the students as well is something I'm really passionate about and want to figure out how we can do that. So we have a number of little projects. And so I think we're at that point where we want to talk about what are the next steps to really make it something that's really impactful across both the museum and the institution of Maine medium.

Dr. Lisa Belisle:

It's an interesting idea because I think a lot of medicine is based around this possibility that there is a right and a wrong. And what you're describing is there is absolutely no right and no wrong. And in fact, the longer you practice medicine, as I know you know, the more you realize there's not always a right and there's not always a wrong right Right. So broadening it out and creating that open space so medical students can kind of play around in that field, I would think would be very useful before they go into that.

Stephen Hayes:

I do, and I think so. We talked about observation, that it really helps people build observation and build a language around what they're looking at. But it also gives you that. I think that feeling that as you study something and think about it and look at it from different angles or walk around or collaborate with someone else, that different aspects of it become more important. And so as patients tell their story, you know, more things come to light, so you might have more information that you can use to help you help the patient. And the same thing with this is that. Is that you're building on sort of your own impressions, but also listening to the group and sort of thinking through the. But you're right. There are some situations where there is a right and there is a wrong or there's, you know, a black and white answer that's not always the case. And so, you know, things happen in evolution. And so. So I think this actually helps people realize that the first glance may not give you the information that you need or may not provide the answer and that you really need to come back to it and think about it more or get more information.

Jennifer DePrizio:

And a good example of that is, as part of the session that we did with the students is we used. So we had these pure discussions where it's just those questions I mentioned, what's going on in this image? You know, what do you see that makes you say that? What more can we find? So we use this activity called the Second Look Protocol. And so you start with just very immediate reactions of, you know, what are your first impressions? And then you move on to sketching. And so looking at how drawing can be a way to get you to look more closely at details, and then a little bit more writing, then a group discussion. And so it just broadens that possibility of how you can look at a work of art. And then you always talk about. So the other part of this process, particularly with medical students and physicians, is we do the discussion about the work of art, and then we kind of step back and have this metacognitive. Okay, what was that like? You know, what did you learn? How does this apply to your work? And so in doing that, it was so interesting with our group, we were looking at Winslow Homer's Wild Geese in flight, and the things that the students noticed from sketching were things they may not have ever noticed. If we were just talking about it. You know, they were talking about the wings. The attention to detail that Winslow Homer puts into those wings, because you have to translate it onto paper, is a very different way of looking than if I'm just talking to talk with Steve about a work of art. So that protocol has really been useful, particularly in this medical context, to really get you to think about what are three different ways you can look at the same thing, and what do you learn from each of those, and that you actually may need all three or more than three ways to get a full picture of something, and that connects to what you were saying.

Stephen Hayes:

Right, right. And I think. And, you know, speaking as someone that can't draw very well, when I do that, the sketching piece of it can be stressful. It doesn't really speak to me because I have trouble doing that, trouble imposing that or interposing that. But it really does give you that sort of opportunity to think about it in several different ways. So you're thinking about it, you're interpreting it, and you're trying to put it down on paper. What are the features that you see in it? Some people do really good sketches, and

Jennifer DePrizio:

it's not about the finished product.

Stephen Hayes:

No, I know.

Jennifer DePrizio:

It's the act of trying to translate the visual onto paper.

Stephen Hayes:

Right, right.

Jennifer DePrizio:

Because I have the same stress as you do. Even though I work in an art

Dr. Lisa Belisle:

museum, I can't draw either. So as we're all talking about this, I'm just gonna put it out there. But I think there is something interesting about that also that you are. How many years have you been practicing as a doctor now?

Stephen Hayes:

Oh, 30 years.

Dr. Lisa Belisle:

So you're 30 years in, and you're still finding new and interesting things about the way that you process information, and you're still feeling vaguely uncomfortable with the drawing process, but still. Still it's opening something up for you.

Stephen Hayes:

Yeah. And I think this has been a real opportunity for me, I think, to sort of. To think about how you think and then to think about how we work together. And I think that's something that I've been looking at over the last several years with different activities. It's how as a group of people with different talents or different ability levels can actually cooperate or. Or create something in that kind of an encounter.

Dr. Lisa Belisle:

I love that idea because I know that when I started in medicine, it was kind of more of a linear way of dealing with patients. You have doctor, nurse, medical assistant. And then it was very. The way that we interacted was not as team oriented as we have now come to be. I mean, I now work very closely with my nurse, my medical assistant, the front office staff, the social worker. And it's a team. It's not like one person is better. We're all just. We all just have our skill set. And so what you're describing is people listening to each other, people processing, people accepting that other people may somebody can be a better drawer, or somebody else might process things in a more written way, which directly impacts our ability to care for patients, I believe.

Jennifer DePrizio:

And what's really interesting too, is when sort of the next step of it. And so some of the work that I've been doing with physicians is training the physicians in the role of facilitator. So not not only being the ones that sit and have that conversation, but being that facilitator because it teaches you the listening skills. So I think I have learned the. I've learned everything I know right now at this moment about listening through vts, primarily because if you're going to paraphrase, so a key part of it is paraphrasing. So when you're speaking, if I can, if I need to understand what you said, find other words and give it back to the group and not change your meaning. I have to really have listened to what you said. And so it teaches you to not gloss over while someone else is talking. I'm sure we've all been in that situation where you're thinking, what am I going to say next? You're more in your own head as opposed to listening to someone else. And I know from work with physicians that they have said that that's a really valuable skill that they want to improve so that they can work better with their teams. How do we listen to each other and how do we make sure understood what the other person said? And sometimes you don't get it right. Sometimes. And I can tell as I'm paraphrasing, like, the look on the person's face is like. And so I can have an opportunity to say, did I get that right? Did I not understand you? And then they have the opportunity to say, no, what I really meant was. And they can repeat and I paraphrase again. So that listening skills that you get as a facilitator is critical to the process and I think also to anyone that wants to better communicate with a team and with their colleagues. And the other part of it is you learn so much about how someone thinks about the world based on how they talk about something they've never seen before. You get things about people's cultural background you get things about their personal histories because we can't look at anything without bringing the whole weight of the lived experience that we've had. So I think for team building, it's also something that a lot of organizations, and I have a colleague who works with banks, major big corporate organizations who actually want to better the collaboration and team work of their employees. So I would learn so much about Steve. I would learn so much about you, Lisa, if we had this conversation, because I would just hear all this stuff about your life that you might never just tell me if we were sitting in an office next to each other. So how then, I think, you know, it connects to medical, the medical industry and the way that things have changed, the way that people work in teams and you're not just an individual. It also really helps in that way

Dr. Lisa Belisle:

with all of the different things that people believe doctors should be doing. We should be doing chart audits on a regular basis. We have quality measures we're trying to meet. We have patient satisfaction surveys, we have numbers that we're trying to get through the door. This is another layer, another something that's being introduced not only into the medical student realm, but also, it sounds like, into the hospital realm. How are doctors and other healthcare providers and other members of the healthcare team, how are they responding to this idea?

Stephen Hayes:

Well, you know, like with the students, it's voluntary, so people are given the opportunity if they want to try to do this. We did our first. I actually wasn't able to participate, but we had our first group of attendings from May Med come over last week and do an exercise, do this very same program with Jen. And so the people that did it really liked it. And, you know, they feel like it adds value. And I think when I look at a program like this, you know, I think it adds value to my life. I think, you know, thinking about things, using art, using literature, medicine, those different things add value to me. But they also, they also help me hone my own thinking. And so I think patients would want you to do that. They'd want you to be reflective, they'd want you to be, you know, critical and look at things critically. And so perhaps something like this isn't for everyone, but I think for people that are attuned to that, that you can really use it to help you with those skills.

Jennifer DePrizio:

And one of the physicians that was there, this attendings group that we worked with, she's a neurologist, and she said what she was going to take away was those three questions that are part of the VTS process. So what's going on in this picture? But in her case, what's going on with this patient? What do I see and what do I know that's making me say that come to that diagnosis and then really looking closely to see if those match up really well, if there's any holes in it. That third question of the process is, what more can we find? So then going back, so she was really seeing like a one for one, how those questions in that process of having an idea, having the evidence to support it, and then digging a little further to see what other evidence you can find was something that, you know, I didn't say to anyone, this is what you're here to do. But we were sort of like, what do you think you'll get from this? And she saw a very clear one to one correlation that may at first seem like, oh, here's, as you said, here's one more thing I have to figure out how to do. But if you step back, it's not something you're not doing already or shouldn't be doing already. It just may be a different way of framing the way you ask those questions and slowing down just for a moment to have the opportunity to ask what more comes we find and see what else, what other evidence there might be.

Stephen Hayes:

Well, I think a big aspect now in clinical medicine is clinical reasoning and how we think as physicians. So that was really interesting because there's popular press about different types of thinking, type 1 thinking, type 2 thinking, and how you would go back with the information you have and sort of test your own hypotheses or test your own thinking about what's going on around you or what's going on with the patient. And so I think it really speaks to some of that as well. Well, and you mentioned earlier about some of the things about some of the traps people fall into of sort of closing off early or framing it, you know, based on the title or based on something, framing your own thinking about something. And so stepping beyond that. And I like that, I like the idea that you would, you would sort of ask yourself those three questions in a patient encounter and be sure you're testing back against what you're seeing and make sure it fits with that.

Dr. Lisa Belisle:

That's true. Especially in this day and age where our patient encounters are getting seems like shorter and shorter. You know, sometimes there's this rush to be finished, you know, just I just got to get to the next person. And that could be a problem, especially if you're introducing your own bias into the situation, you know, so you're, it's kind of a double trap that you want to close down early, but you're also bringing so much of your own background into it that maybe you're not fully open to what's really going on.

Jennifer DePrizio:

Yeah.

Stephen Hayes:

And I think you really need to know when to turn on different types of thinking because there are situations where, you know, you can make a judgment relatively quickly and it's correct and you deal with it. But there are other situations where you sort of have to keep testing it. You have to keep going back and testing your thinking against what's going on and making sure that you've got the right information to make a decision.

Dr. Lisa Belisle:

Yeah, it's true. You don't want to spend like, you know, half an hour dealing with a heart attack victim. You can't just reasoning through all the possibilities. Sometimes you do need to actually make a quick decision. So you're right. That's really important. Yeah, yeah.

Jennifer DePrizio:

And the other thing that I have noticed for myself and for other colleagues and other people I've worked with, with this technique is that it also just helps you be aware of your most comfortable and the types of thinking that you always naturally fall back on. And then the minute you're aware of it, not the minute, maybe a little bit into it, when you, once you're aware of it, you then may question your own thinking. But until it's brought to light and you realize, oh, I always think about things in this way. And when you do those discussions, people tend, people fall into their natural pattern of thinking and reasoning. When you're, when you encounter something you don't know what to do with. And so by doing it a few times with a group, I mean, even just with those students last week and the ethicist that was with us, like he had a particular way of looking at that work of art and he kept coming back to the same processing mode. And that was in 15 minutes. I got a sense of, oh, this is how this person thinks or this is how this student thinks. And when you do it in a group and then you talk about that, okay, what was that like for you? How did that experience fold out for you? People tend to start to realize, oh, that's how I approach it. Especially if you hear other modes of thinking, you realize everyone doesn't think about things the same way I do. And we're all on some level egocentric and it's all about us. So when you do this kind of open ended thing in a group, you actually start to realize, oh, wait a minute, I know people think differently, but now I'm actually hearing it, and I know what it sounds like. And maybe then you can start to think and process things in different ways.

Dr. Lisa Belisle:

I was in Paris recently, and of course, the Mona Lisa is at the Louvre. And although we were there late in the day, there was still an enormous swarm of people around the Mona Lisa. And when I told this story to other people, they were kind of like, well, isn't that too bad that all people really want to do is take the photo of the Mona Lisa and then be off? And I thought, well, but this is a whole group of people who wanted to see the Mona Lisa. I mean, a whole group of people who actually took the time to go to an art museum and search out this particular piece. That can't be a bad thing. Is there anything about the art itself and bringing healthcare providers, medical students, residents, whoever it is, into the art museum that has some intrinsic value?

Jennifer DePrizio:

Hmm. You want to go?

Stephen Hayes:

Yes. And I think it's really, you know, really has to do with how you look at the world, I guess, in terms of being open to that and being open to looking at things that maybe you don't look at regularly. So some people, I'm sure, that go on this exercise, don't go to the art museum regularly. But even if you do, you know, it's that opportunity to look at something that is different and, you know, something that you don't look at every day. And hopefully you'll spend a little bit of time sort of thinking about it. I mean, you're right. We sort of do. People do sort of race around galleries, but this kind of gives you that chance to step back and think about it. And one of the other things that's interesting is when you go to look at something is, you know, do you look at the label first or do you look at the artwork first? And, you know, how does. How does that decision influence what you're thinking about it? And so I think that's another, hopefully, lesson people take is, you know, you can look at something and there might be a title to it, but, you know, knowing the title ahead of time or not thinking about the title ahead of time gives you a different way of. Each of those gives you a different way of looking at something.

Jennifer DePrizio:

And, you know, and I will answer your question, but to connect to what Steve was just saying about the label and bits of information, it's interesting often in these conversations because there is a label next to most of these works of art and a Title. And so sometimes in conversation, if I say, what's going on in this image? Someone says, well, it says this. And so I say, okay, so there's a label there. And it gives us some information about what this work of art is. And so when someone says, oh, well, that's just what it is, we actually bring that back to the conversation and we say, so here's a title. Here's an artist's name. Here's 75 words that a curator wrote that isn't the be all end all about this work of art. It's 75 words that they chose to put on there. How does that actually influence how we look at this? So now we know that. Let's go back and look at this work of art. And that actually happened with the student group we were looking at. They were puzzling over this relationship, these figures. And the race and ethnicity of the figures isn't clear in this picture. And it's actually a painting that has a lot to do with race relations. And so I broke from the pure protocol where the facilitator doesn't give any information, because there's nothing wrong with information. The founders of ETS don't think art historical information is bad. It's just figuring out when you introduce it, when it's relevant to their question. Because traditionally we give answers to questions in museums that people aren't even asking. So I felt like in that moment, that group needed to know what the title was and what that title meant. So it's a work called the Drop Sinister. And so I introduced this bit of information. I said, okay, now that we know that, let's go back and look at the picture. And it actually just enriched the conversation. And they dug in deeper. So there's some moments where that information actually helps, and sometimes it doesn't help if it's an artist's name and you don't know who the artist is. Well, that doesn't necessarily mean anything. But to your question originally, of course, I think going to museums, I mean, I've worked in museums for almost 18, 18 years. And I think that artists have always, through the history of time, from the earliest cave paintings to what contemporary artists are doing. Doing, are trying to give a window into the human experience. And so for anyone, no matter what your job is, no matter what you do, when you're not in a museum building, it can give you a better sense of what it means to be a human being. And I think then that just naturally enriches the experience that we can have with one another every day.

Dr. Lisa Belisle:

I've been speaking with Jennifer Diprizio, who is the director of Learning and Interpretation at the Portland Museum of Art, and also with Dr. Steven Hayes, who is a physician with the Maine Medical Partners who teaches in the Main Track Program, a combined medical school program between Tufts University and Maine Medical Center. Thanks so much for coming in and having this conversation with me today. I'm excited to see what you're doing and excited to see what the future holds.

Jennifer DePrizio:

Thank you for having us.

Stephen Hayes:

Thanks very much.