Narrator - Dr. Abel 00:00 Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. Narrator - ? 00:11 This podcast is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy. Narrator - Dr. Abel 00:17 This podcast contains general information for educational purposes only. This is not professional advice, and should not be used in lieu of obtaining advice from a qualified health care provider. Narrator - ? 00:27 And now on to the show. Dr. Sean Kane 00:31 Welcome to HelixTalk. Episode 133 I'm your co host, Dr. Kane. Dr. Khyati Patel 00:36 I'm Dr. Patel, and today with us, we have our guest contributor, our very own co faculty at RFU, Dr. Srivastava, Dr. Srivastava. Thank you for being back Speaker 1 00:46 again today. Thank you for having me. I'm excited to be here Dr. Khyati Patel 00:49 with that note that introduced the topic of today's podcast, this much awaited topic, and the title is, tell me more exploring covid 19, vaccine hesitancy and solutions. And in this episode, we are hoping to explore the depths of the covid 19, vaccine hesitancy. How is vaccine hesitancy defined? How to identify it, how to address it, and then some related helpful resources. But Dr. Kane and Dr. Srivastava, before we get started, I have to thank our listeners and supporters who helped us taking the survey and helped us design the content for this episode. So thank you again, so much for doing that. We owe it to you to kind of summarize what we found in your responses. And so most of you said that there were many encounters of vaccine hesitancy that you have experienced in this survey remind you was taken about about a month ago. Over the course of month or so, those numbers are about to change as we kind of go more into, you know, vaccinating more population there was kind of like the average category of were people's vaccine hesitancy is, was, you know, willing to get the vaccine, but kind of hesitant at the same time, was about the average category. The prominent reasons for vaccine hesitancies were first and foremost, lack of long term data that was quickly followed by too quick approval of all these vaccines, as well as being afraid of vaccine reactions, the adverse reactions of the vaccine, what we were pleasantly surprised, or maybe we shouldn't say we weren't surprised, in a good way, is the ability to have confidence in the vaccine. And so most people were confident, or extremely confident, as far as engaging with people who have vaccine hesitancy, most of the survey responders said that they were comfortable. That was the average, but some even said extremely or somewhat comfortable. And this is where Dr. shavastava, we're going to spend most of the time is to how to tackle vaccine hesitancy. And the audience who took the survey was right on. They said that what is your approach to somebody who is expressing the hesitancy? They said that they wanted to explore that hesitation further, and then the next thing was to then provide facts to perhaps resolve some of those hesitancies or reasons behind them, and then we will discuss resources that could be helpful to provide to patients or family members who are on this boat. And people have considered CDC recommendations their own personal experiences with the covid 19 vaccine, especially when it comes to side effects and stuff. I know, I have talked to my family members about how my vaccine reaction was, and it always followed up with the tagline saying it might not be the same for you, right? Important to say everybody is to each of their own as well as some of the professional organization guidelines. So without further ado, let's dive right into talking about the background and where we are in the United States with the current vaccine efforts. Dr. Sean Kane 04:09 Yeah, so there have been surveys done of pharmacists, so given that we are pharmacists, it's kind of interesting to see where pharmacists sit in terms of their vaccine hesitancy or lack of hesitancy. Perhaps. So from APhA they did release a nationwide survey of pharmacists. They found that 88% at the time of the survey of respondents who were pharmacists were fully vaccinated, and 92% said that they plan to or have already been vaccinated. 98% of them said they were comfortable addressing vaccine confidence and vaccine hesitancy concerns with their patients or other individuals. So at least in our small group of you know, pharmacy professionals, generally speaking, we're pretty good about getting the vaccine, and we feel fairly comfortable in talking to others about being hesitant or being confident in getting that vaccine. Dr. Srivastava, where we at nationwide in terms of. Hesitation to get the vaccine, or lack of hesitation. Speaker 1 05:03 So, you know, before we get to the exact number, two months ago, our administration had talked about wanting to get to at least 70% of people in the US adults, to have received at least one dose of the vaccine, and having 160 million adults fully vaccinated by by July 4, which you know, was just a couple of days ago, we did not quite get there yet. So Doctor Kane, exactly, where are we at today? Dr. Sean Kane 05:32 So as of today, July 6, when we're recording this episode, according to the CDC, among adults, the first vaccine rate is 67% so 67% of adults in the US have received at least one injection, and then for fully vaccinated, we're at 58% so again, our goal was 70% we're at 67% as of July six. So we have a couple of percentage points to go, but we're actually fairly close Dr. Khyati Patel 05:56 to that goal. And keep in mind, when we are talking about these numbers, these are averaging the entire country. Our country is very large, and the vaccine efforts are led by the individual state. So if you kind of take a look at your state and see where the spread comes, everybody is everywhere. And there are some nice infographics available, we'll put a link to it for our audience to kind of take a look, and it might be evolving as the vaccine efforts are ongoing, but know that not all the states have this average number. Some are ahead of this and some are behind, but this is kind of where we are. Speaker 1 06:34 You know, it's not just the States, but in addition, it's also the geographic locations within the states that may be driving up or down the numbers. Each community within each state is so different and about all of you, but anytime I just, you know, turn on my phone, there's at least three or four different news articles that are talking about different talking about their different efforts to increase those numbers. Do you guys see that too? Yes. Dr. Khyati Patel 06:58 Dr. Srivastava, you're right. As I can speak of Illinois. Everybody who's in Illinois and gotten covid vaccine have been enrolled in the lotto, and so one day, there will be a draw and somebody will win. And there are a lot of these incentive programs created for people to get the vaccine. Dr. Sean Kane 07:17 And what's interesting is, you know, despite these efforts in terms of marketing the vaccine and incentivizing the vaccine, based on polls that are out there, roughly about 30% of adults say that they have not gotten vaccinated and they definitely or probably will not get vaccinated. So this is a pretty good chunk of our country that has no plans and are pretty adamant that they don't want to get the vaccine, despite these incentives and other efforts as well. So this is definitely something that is going to come up for the next year or two as it relates to covid vaccinations. And I think Dr. Khyati Patel 07:51 the gist of this conversation boils down to that the unvaccinated population is is at a higher risk of getting infected with some of these variants that are out there, right? And so that's where we want to fill in the gap and move people from not getting the vaccine or the hesitancy to getting the vaccine and fully vaccinated. Speaker 1 08:14 So we keep talking about vaccine hesitancy. What is it? Dr. Khyati Patel 08:18 Exactly? So I think, though the word hesitancy, you know, it basically is either refusal or maybe a delay or some sort of hindrance in accepting the vaccine despite the vaccines being available. That's like the formal definition. But something tells me that it's not that simple, right? Dr. Srivastava, Speaker 1 08:38 yeah, it's can be very complex, right? And it's very context specific. It varies over time. It varies over place. You know this concept of vaccine hesitancy? It's something we may hear a lot more now, but has been around with other vaccines as well, and there's so many different factors that may influence us, and that includes this convenience, competence and complacency. Dr. Khyati Patel 09:04 And so there's a group of public health people kind of creating a survey to analyze word as a nation we are in expressing this vaccine hesitancy and sort of like this, you know, the small survey that we asked our audience to do, they're doing it at a bigger level, and we have data since, you know, April 2021, and they kind of categorize people into it, hesitant, hesitant or unsure, and then strongly hesitant. And that data is going to change. We'll also put a link to that information if you're ever interested. And the picture look it looks colorful. Again, it's a large country, the education and exposure efforts are state led and community led. And there are different as community and state is different. Dr. Sean Kane 09:53 And if you think about it, you know what is driving that? So why is it that there are certain areas of our country? That have higher or lower hesitation rates or vaccination rates. You know, what are some factors that play a role in any given individual deciding to vaccinate or being unsure or being adamantly opposed to it? What are some of those factors? Speaker 1 10:13 And I like how you place that, because it's not just communities, but it's really individual or person related factors, right? And you know, we all think differently. We absorb information differently, and we're also exposed to information differently. And so there are so many different factors that we need to consider. One thing is the power of anecdotes versus fact. You all maybe have heard just the power of storytelling. It is so impactful, right? Versus just saying 25% or one in four. But if somebody that you know and you trust comes to you and says, Hey, you know either I had the vaccine or my best friend had the vaccine and she had this horrendous side effect, and so I will never get it, that person may be more willing to trust that person that they heard the story from, versus knowing that, yes, side effects can happen, but they're not as common as they may think right now. Dr. Sean Kane 11:07 Dr. Srivastava, I love this as a reason, because this is like pure human nature. This has nothing to do with covid. It has nothing to do with education level. As humans, we are programmed this way, and everything that comes to my mind are things ranging from reading that one negative Amazon review despite having 98% five star reviews for a given item, all the way to like on rounds or in, you know, discussing clinical care with someone. You know, when someone says, In my clinical experience that that that's an anecdote, right? As opposed to fact based decision making. So this is human nature to act this way, and we need to be aware that this is very normal for someone to incorporate this as part of their decision making process. Speaker 1 11:53 And speaking of those 1000 reviews, have you heard of a term called infodemic? I have not. So basically, it's an overabundance of information, and some of this information may be accurate and some of it may not be, and this especially occurs during an epidemic. So even taking us a year back, or a year and a half back, when you know all of this was beginning, information was coming at us from all different and some of that information either was completely wrong. Some of it, we just didn't have enough information to make such statements. And some of the time, people just have different agendas, right? And so they give this information out there, and then, depending on the person that's hearing it and the experiences they've had, it can cause many, many different concepts. So that's anything from, you know, stigmatizing. So if we think about like people that just think the vaccine is actually going to cause more harm, they actually feel that by people telling them to get it, that they are being thought of as lesser because they're choosing not to. Of course, we know the impact of MIS and disinformation. It leads to public health efforts being unattained and undermined. It can cause harmful physical health. And so I really think, as we're, you know, really looking at all this, our purpose isn't to convince people, but it's to limit misinformation, or how to help make sure the most accurate information is out there, and so just like the pandemic, we want to flatten this infodemic, right?. Dr. Sean Kane 13:27 And what's kind of neat about the thought of an infodemic Is that just like a pandemic, that it spreads, right? So it's not just one person who hears one thing, they can now spread that misinformation to a second person, and and then that second person will spread it to two more people. And then you end up with this problem where kind of blossoms and turns into this widespread issue where, as opposed to it kind of being segregated into this one specific segment of a population. Dr. Khyati Patel 13:55 And so, you know, talking about infodemic, you know, we have vaccines to hopefully curb the pandemic. What are some of the ways people can curve the infodemic? I think it takes the right person in that chain communication to pose the right question or ask the right thoughtful question to kind of say, Okay, let's take a pause and see where this you know that where this information's coming from, there's lots and lots of resources to identify rumors and fake news. You know, being aware to as to where the source of information is and whether you can trust that source or not, it's the first step to kind of say, Yes, I can trust this information and I cannot. What are some of the other ways somebody can flatten this and from an infodemic curve? Speaker 1 14:47 One way I can think of, and maybe it's another anecdote, but it's, you know, within your WhatsApp group, right? So many people use it as kind of a form of social media to keep in touch with family and friends. And so somebody for. Along an article about something which isn't completely true, and then that next person, and then you see it's been sent many, many times, or it's been forward many, many times, but maybe sometimes it takes that one person to stop, like you said, and just say, I'm not going to forward this. And also I'm going to ask this group to say, how do we know that this is real? So that's one way I can think of that I've personally experienced so Dr. Khyati Patel 15:23 great examples of how we can, you know, stop the chain of fake news in our WhatsApp conversations. But there is another factor that plays a role in understanding the importance of vaccine, and that's health literacy. And I know Dr. Srivastava, you can talk about health literacy, that's your favorite topic. So tell us how it's relevant to the covid 19 vaccine and and health literacy. Speaker 1 15:47 So we know that low health literacy in general leads to poor health outcomes. And so it's no different with covid 19, and if we think about it, so much information came out very fast. And so we're asking people to find use and apply this information at this fast, fast pace. And it is difficult for any one of us to just kind of process all that. And if you are somebody with lower health literacy, it makes it even much more difficult, especially when language is being used, like, medical jargon is just being thrown out there. And these, like, just numbers are like, Oh, by getting this dose, you're going to reduce your chance by X, Y and Z and like, there's just a lot of medical information that's out there that isn't necessarily communicated in a person friendly way. And so what we're seeing with preliminary data is that higher health literacy may lead to less fear and anxiety overall, and more likelihood to follow recommendations. And lower health literacy sometimes is associated with lower vaccine rates as well. Dr. Sean Kane 16:56 So I feel like we have a pretty good understanding that we've made really good strides in the US of getting vaccinations delivered mostly to adults, but there is a good percent of the population who are going to be hesitant, and there's a variety of reasons why they're hesitant. I think the logical next question is, for any healthcare provider, pharmacist or otherwise, when you encounter that person who is hesitant or is unwilling to even consider the covid 19 vaccine. What are some strategies that are recommended or approaches to that person? Is it worth talking to them or or not? And if it is worth talking to them, what are some do's and don'ts of doing that? Speaker 1 17:34 I think the first thing we need to do is focus on this. Why like? Why? 100% back to your question. It's worth talking to the person. We just got to remember what our goal is, and we're not here to we're not here to convince somebody right. So just to focus on the why, what's driving the decision and understanding these roots of vaccine hesitancy is what's going to allow us to tailor our message in a way that's most, most impactful. Dr. Khyati Patel 18:01 And I think that's one way of saying Dr. Srivastava, that we want to personalize their concerns. You know, there could be slides of information available of why vaccines are helpful and why they should get it, but if that one specific concern or the why is not addressed, nothing that you bring in front of that person is going to convince them Speaker 1 18:23 absolutely, exactly. So, you know, we might assume somebody's why, and then you start talking about that, and now the person just feels that a they weren't heard, and the conversation basically stops right there. And so, I mean, all of us, it comes back to human nature. We want our views to matter. And so understanding the why behind it allows for just a more powerful conversation, a more relevant conversation. Dr. Khyati Patel 18:48 And so the health literacy wise, you know, what are some of the strategies that we can perhaps tackle, you know, patients health literacy at the moment, or try to improve their understanding of the covid 19 vaccine, but keeping their health literacy in mind. Can you provide some examples? Sure. Speaker 1 19:06 So you know, part of it's a universal precautions. We always want to talk to everybody not knowing maybe where their health literacy levels are. So we use plain language and speak clearly. We want to make our environment, physical environment, comfortable. And so that might seem unrelated, but it's very related. Like, if you're somebody who's already kind of feeling hesitant about that vaccine, and then you come in maybe either for your appointment or to pick something else up, but see the sign, and somebody comes to talk to you, but they're not really making eye contact, and they're standing behind the counter and busy like that potential impact that you could have made in that in that person who is hesitant may go away because of that physical environment not being fully comfortable, and then other things are encouraging, questions, we're all different. So somebody with low health literacy, like where we all learn differently, and so some people may prefer graphics or conversations. Some people may prefer like you if they're hesitant, like some resources that might be on YouTube, like a short video, right? And so everybody learns and understands and comprehends things differently, and so tailoring messages in different ways will also be very helpful. Dr. Sean Kane 20:15 I think, from my standpoint, one key is to read the body language of the person that you're talking to, right? So you know, if you feel like you're getting a little luxury as opposed to having a conversation, and you see the person checking out or checking their watch or kind of backing off, you know you have to read that body language and adjust appropriately. This is not a one size fits all conversation. And of course, you're starting with the why to help tailor your conversation, and then as you're having that conversation, you're thinking about what, especially nonverbal cues are you receiving, that you can use that to help better tailor that conversation as you're as you're speaking to another person. Dr. Khyati Patel 20:53 Or a third example, if I could provide, is somebody, let's say, is in the hospital getting discharged after a long stay, and they haven't gotten their covid 19 vaccine. And as a pharmacy student, you know, you were in the room talking about medications, you're like, hey, what about that vaccine? One Stop Shop. You can get it done here. Their mind probably is just not there. You know, they just recovered from something long term, and they're in the hospital and they just want to get out. They want to go home. And perhaps this is not the right time to strike, you know, maybe it's the next time that you can explore when they're in a better environment, ability, physical and mental place to to receive and process the information Absolutely. Speaker 1 21:34 And maybe that goes back to another consideration as well, is that it's not a one and done. So you have a conversation with somebody. And if somebody just like, yeah, not today, or I don't think so, it's still worth bringing it up again in the future, not five minutes later. Dr. Khyati Patel 21:49 So those are some of the examples of how to tackle, perhaps health literacy concerns. But what about the misinformation? How can we tackle, or how can we kind of go after tackling the misinformation? Speaker 1 22:04 Great question, you know, there's a great toolkit which we can include in the resources as well, but it's things that, you know, we may all think of, but aren't exactly sure, right? When somebody says something that you're like, that is just completely, completely not true, and so you're trying to respond, but you're not exactly sure how to, right? And so sometimes it's just taking the step back and finding some common ground, being very civil, and just take taking the time and having patience. So, you know, things such as, I get it, you just want to be extra careful, or there's so much stuff online, or, Hey, that's really interesting. Where did you find that information? And so then that continues for that conversation to move forward, and then gives you room to do the next step, which is, would you mind if I just take a couple of minutes to tell you what I found or what I know about this? Dr. Sean Kane 22:57 So I love that, and I think the key there is that you're continuing the conversation so that you have this open dialog, as opposed to saying, Yeah, that's actually not true, and if that person believes it's true, you saying it's not true may not be that effective, right? So continuing that thread of the conversation, I think, is more important than trying to be standoffish or judgmental, you know, to be able to understand their point of view, where that information came from, and then hopefully, you know, develop a rapport where you could potentially provide alternative information, you know, against that misinformation. Dr. Khyati Patel 23:32 And you know, as as I'm listening to this conversation in Dr. Kane and Dr. Srivastava, you know, we've been in this position, and sometime, I'm thinking right now. It's like it takes patience. You know, keep in mind the Goal, goal is to make them one step closer to the facts, and not convince them to get the vaccine today, right here, right now. And so I think we have to cultivate as healthcare providers, or even as a family member, talking to your brother, your cousin, your friend, you have to kind of create that patience. And like you said, Let's continue the conversation and not just strike them down absolutely. Speaker 1 24:12 And like some of the ways we do it, is concepts of motivational interviewing. And really the big part right now with what we're talking about with misinformation specifically, it's this resisting this righting reflex, where we want to say, actually this is true, because then it's just gonna almost get you into an argument versus the conversation moving forward, right? And so resisting that, that desire, even if it comes from a great place, to correct it right away, having acknowledgement, reflectively, listening, asking open ended questions, having them share their concern, and then asking for permission to share information, I think, will go a much further way. Dr. Sean Kane 24:50 And you know, from my standpoint, you know, we talked earlier about the power of an anecdote, right? Me, being an ICU pharmacist, the power of my anecdote is the fact that we've seen. To dramatically lower adults with covid 19 infections and what we saw, you know, during the first or second wave. That is a very powerful anecdote to talk about how terrible it was and how much it's improved, largely because of the vaccination, you know. So I think that, again, human nature with the anecdote, you can also use that anecdote to help tell your story about your personal point of view about the benefits of the vaccine as well. Speaker 1 25:25 Absolutely, I think strong personalized recommendations, especially in this context, go a long way. You know, saying I understand it's your decision to decide whether you want this vaccine or not, but considering that you have and so I'm thinking of a patient that may have many chronic conditions. Like, you know, considering you that you have these different conditions, I'm really afraid that if you get covid, it could be very dangerous. And so I really, I really think the vaccine may be, may be a great idea for you, right? And so it's okay to link, maybe, what, what your reasons are for your particular person, while still acknowledging that their decision is in their own hands, because you as their health care provider, they do trust you. And so if you're saying something and linking it back, it could go, it could go a long way. Dr. Khyati Patel 26:14 Yeah, and I think I like, I like the proactive conversations. You know, as we said earlier, the goal is to move them one step closer to the vaccine, and not necessarily get the vaccine today. So for example, if that one step closer is getting that signed up with the county level vaccine registry, so they can at least be in the queue and they don't have to get it today, even they don't have to get it when their number comes and they're called to say, hey, schedule your appointment. But at least they're, you know, that part is done with. And then switch flips on and they say, Okay, today is the day I decide to go. They're halfway there. Speaker 1 26:54 And I think sometimes like to your point like it's having this proactive conversation is so important, because sometimes when somebody says that they're hesitant, or we're feeling that they are it, we might think it's just easier just not to have that conversation, either because we we don't want to sound disrespectful, or we just don't think we're going to make a difference. But I think like that's just not what we should think about in those moments. What we should think is, I'm going to have this conversation. We will see where it goes, and if it even, even just allows us to have two minutes of conversation. I don't know what's going to happen once they go home and process this information, right? Dr. Khyati Patel 27:31 And you have to, you have to also understand the power of fact. You know, maybe, maybe they're not already to make an action, but maybe they'll take that fact, go home, talk it out with their loved ones. Perhaps they'll share that information with their loved ones, which then you know you are indirectly impacting their decision making as well, and not just for your patient. And so conversations are always going to be helpful, whether it turns into an outcome of vaccine or not, it's always going to, you know, remove that misinformation. It's always going to be helping patient understand information in a, you know, friendly language. So all all the efforts and time that you engage in addressing this hesitancy is going to be fruitful. Dr. Sean Kane 28:21 And of course, it's also important to think about, you know, during that conversation, you know, especially if that conversation is going well, you might need to anticipate questions coming up, and then be equipped to be able to answer those questions within that conversation period, right? So someone wants to know a specific fact about one of the vaccines, for example, as a healthcare provider who is now, you know, suggesting that someone get the vaccine, hopefully you would have the medical information you need to be able to answer those questions. And then, depending on the educational background of the patient, you might even direct them to a variety of resources that they could look at to get more information on their own in the comfort of their own home. So CDC, local public health authority websites, there's a ton of resources out there, and we'll have some of those in the show notes. But I think the key here is that you're able to answer their questions at the time of that conversation, and then, when appropriate, you're able to provide them with high quality, recommended resources that they can learn more about the vaccine when it's comfortable for them. Yeah. Speaker 1 29:25 And then the other thing that I want to say is that I know all our listeners work and are from all different communities. Have lots of different different hats that you may wear, and different places where you work, and so partnering with your community, especially if you're in a community with lower vaccine rates, figuring out what are different ways to go to the people, right and to go to the communities. A lot of times, I think when we started out, we were finding ways to. Um, to have these vaccine clinics, and where would they be best suited? But I think what we learned very quickly is that sometimes you have to go to where the people are, and that actually makes much more of a difference. And so I do think even if it's not within the workplace that you're at, but within the community that you are, if you're able to partner in different ways, that would be incredible. Dr. Sean Kane 30:23 So to wrap up today's episode, what are some key concepts that you'd love our listeners to take home? Dr. Patel, Dr. Srivastava, what's one or two things that come to your mind in terms of strategies and tools for healthcare providers to address vaccine hesitancy? Dr. Khyati Patel 30:40 I think, you know, to kind of summarize this wonderful discussion with Dr. Srivastava, I think the first thing to learn, and this is what our audience, who took the survey, said, too, is, whenever somebody expresses their hesitancy, we we want to understand the why behind it, right. Further explore it. Engage them in a conversation. Start a conversation. That's the most important thing we can do, Speaker 1 31:04 absolutely and then, you know, once we understand a little more of the why, depending on what we've learned, we're able to better provide a personalized response. And you know, there's different tools that we can use in different communication strategies, motivational interviewing, being one of one of the more impactful communication strategies, especially, especially for this so we can ask those open ended questions, having them share their concern, reflective, active, listening, truly engaging and acknowledging the person speaking to us without any judgment, and then asking for permission to share information. Dr. Sean Kane 31:40 I think that's great. I think one thing for me is the concept that the goal of that conversation that you're going to have with that hesitant patient, your goal isn't necessarily that they have the vaccine today. The goal is that you open the door for that, that you're one step closer for them to consider the vaccine. It isn't a failure if they don't get the vaccine today, but you're starting to combat misinformation. You're starting to understand that their rationale behind what they believe. You're continuing that conversation and not closing it off. So I think again, one key element here is that a vaccine today is not the overall end goal. The end goal is to get one step closer to the patient being agreeable to it and being comfortable with that decision. Well, Dr. Srivastava, I wanted to thank you for your participation again today in another HelixTalk episode. We love having you on for the listeners. If you would like to see show notes with some references or resources, go to HelixTalk.com episode, 133 we're also on Twitter at HelixTalk, and we love the five star reviews and Apple podcasts or iTunes, so keep those coming. It helps us climb those charts. So with that, I'm Dr. Kane, Dr. Khyati Patel 32:50 I'm Dr. Patel, and I'm Dr. Srivastava. Thank you, Dr. Srivastava, and thank you to our audience who took the time to complete the survey. And as always, study hard. Narrator - Dr. Abel 33:02 If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store. Search for HelixTalk and place your review there Narrator - ? 33:13 to suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.