The Case for Including LGBTQ+ Care in the Medical School Curriculum

Podcast Transcript

Dr. James K. Stoller:

Hello, and welcome to MedEd Thread, a Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Anthony Tizzano:

Hello. Welcome to today's episode of MedEd Thread on a deep dive into the Cleveland Clinic Lerner College of Medicine's diversity efforts: building an LGBTQ+ curriculum. I'm your host, Dr. Tony Tizzano, he/him, Director of Student and Lerner Health here at Cleveland Clinic in Cleveland, Ohio. Today I'm very pleased to have Dr. Jason Lambrese, he/him, Assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and Assistant Dean of Student Affairs at Case Western Reserve University. Also joining us is Saloni Lad, she/her, a fifth-year medical student at the Lerner College who is also involved with the LGBTQ+ curriculum review, here to join us.

Jason and Saloni, welcome to the podcast. To get started, can you tell us a little bit about each of your backgrounds, your education, what brought you to the Cleveland Clinic, and your role here. Saloni, we'll start with you.

Saloni Lad:

Yeah. So, I'm currently a fifth year at the Cleveland Clinic Lerner College. I did my undergraduate at Case Western Reserve University, so I've been here in Cleveland for eight years now. I- I'm interested in going into family medicine, so I'm really interested in community medicine and advocacy kind of in general; specifically, I'm really interested in continuing OB afterwards, and then also just care for different marginalized groups, whether it's under resourced or LGBTQ populations.

Dr. Anthony Tizzano:

Excellent. And Jason?

Dr. Jason Lambrese:

Sure. So, I'm Jason Lambrese. I'm a child and adolescent psychiatrist, originally from Rhode Island, and I went to Brown for medical school and trained in Boston. I did a residency in adult psychiatry, and then a fellowship in child and adolescent psychiatry. I've been at the Cleveland Clinic for about six years now. So, I work as an outpatient child and adolescent psychiatrist, primarily based in our Center for LGBTQ+ Care.

Dr. Anthony Tizzano:

And what brought you to that point in your career where you're heading up these efforts within the curriculum?

Dr. Jason Lambrese:

Yeah. So really, ever since probably college I've really been sort of passionate about working with LGBTQ+ communities and moving into medical school thinking about the importance of providing good care for LGBTQ+ patients. So, when I was in medical school a few years ago now, we realized there's very little education about LGBTQ+ health care topics. And so, even as a medical student, my friend and I decided to create an elective course for medical students to learn more about this, and really sort of the value of educating students about this important topic early on.

Since then, I continued to develop this interest as I moved into psychiatry and seeing the importance of mental health care for this community. This is a population who has a lot of undue mental health burden, and really wanted to make sure mental health providers, psychiatrists and child psychiatrists know about how to provide good care to this population.

Dr. Anthony Tizzano:

Fabulous. And every time we have one of these conversations, I feel that I get more and more enlightened. So, in this segment, as we've probably gathered by now, we're going to take a deep dive into one of the Cleveland Clinic Lerner College of Medicine's diversity efforts whereby LGBTQ+-specific topics are embedded across the curriculum, and the implications of these efforts for an academic medical center such as ours.

So, what is the impetus for this work for us as an organization, Jason?

Dr. Jason Lambrese:

Yeah. So, the literature tells us there's not a lot of teaching about these topics in traditional medical school curricula. There are some medical schools that don't even touch on this at all, and many who just teach it for a few hours over the course of a four-year medical school curriculum. But we know there's a lot of real health needs, both medical and mental health needs, in this marginalized community. So, our future physicians are going to be taking care of a patient population with a lot of unmet medical needs, and we want to make sure they feel equipped to do that. What is the language to use, but also, what are those health care needs? And we realized a lot of these topics often get sort of delegated to traditional doctoring kind of courses, which is really important: communication skills, how to ask these questions, including take a sexual history in a competent way is really important.

But there's a lot of cores, basic science, clinical and medical topics, related to this population that weren't getting talked about. And so, we realized that there were probably very manageable sort of strategies that we could think about doing here at the Cleveland Clinic Lerner College of Medicine to start exposing our students to these topics early on in their medical school career so they can continue practicing and reinforcing these skills, and then leave medical school more educated in the health care needs of the LGBTQ+ community.

Dr. Anthony Tizzano:

Fabulous. And you know, it's not lost on me as an obstetrician/gynecologist that even discussing sexual topics with women is difficult, and in fact, even using words like "vagina." 60 percent of OBGYNs do not use the word "vagina;" it's the pelvic exam, it's, "We're gonna check you down there." So, we're not good at this. When we look at the population in general that we're addressing, the LGBTQ+ population, what percentage, just rough, recognizing it's gonna be plus or minus 3 percent, are we talking about?

Dr. Jason Lambrese:

I think it depends on how you're defining it and what terms you use, but I think it's probably a- as much as 10 percent of the population may identify somewhere on the LGBTQ+, a sort of inclusive of all identity spectrum.

Dr. Anthony Tizzano:

Right. So, I think it should not be lost on any of us that if we're ignoring that kind of percentage of the population, we've got some work to do.

So, Saloni, what are some of the initial curricular objectives when you looked at these, and- and how did you identify them?

Saloni Lad:

Yeah. So, I was one of the first classes to be involved in this. I think Gus actually, he's one of my colleagues, one of my classmates, who started, kind of spearheaded this with Dr. Lambrese, and I think one of the things that was quickly noticed was that there was an LGBTQ pre-clinical curriculum elective, and that people could take if they were interested in learning more, and that that allowed people to kind of get into some of these topics. But it was very self-selected; people who were interested would take those. But none of that was standardized throughout the rest of the curriculum. So, people who needed to take it, people who, um, you know, maybe are not quite as familiar with this population, even at baseline, were not getting some of this really critical information.

So, the goal is really to take some parts of that elective and really standardize it and make it part of the the full curriculum that every single student would see and go through before graduation. I think one of the strengths that our group has is that Dr. Lambrese is in fact the course director for the psychiatry block of our curriculum, and so, you know, from that standpoint, for- for that block, we kind of already had a way set up in order to work directly with course directors to facilitate this type of inclusion of materials.

Dr. Jason Lambrese:

Early on, we identified who are our key stakeholders and who are our champions, and we were really fortunate to have lots of support within the administration of the medical school. So as sort of our small grassroots student and faculty sort of group came together with me and a couple of students, we were able to talk with the medical school and say, "Now, we think this is really important. We want to embark on this project to be able to look at our curriculum and identify ways that we can teach this better," and I think one of the things that made our project really successful was that we built that coalition from the start.

And I think that having sort of key champions in medical education and in the administration and in the DEI, office allowed us from the start to be able to work closely with those folks to make sure what we were doing was going to be feasible and was something desired by the- the school community.

Dr. Anthony Tizzano:

Sure. I'm always impressed when I am doing any kind of program with the medical school here, that it is obvious their interest in diversity, equity and inclusion. Do you think that having this as part of the curriculum across the board helps it to be looked at as more this is the norm, just like we would study heart, or we would study this or that? I think it's really important not to have it be an elective, but to have it embedded. Did you want to add something, Saloni?

Saloni Lad:

I did. I think one of the strengths that we also had was timing. The timing of which this group kind of formed and really took off was really in line with the rest of the administration in terms of increasing a lot of other diverse efforts, both in terms of advocating for more faculty development, culture change. There were a lot of different pushes from a lot of different areas to increase diversity and inclusion efforts across the board, and I think our group really fit in really nicely with that push.

Dr. Anthony Tizzano:

Yeah. I couldn't agree more. I kind of look like a kind of medical history buff, I think, gee, in the 19th century, we were working on procedures and instrumentation. In the 20th century we evolved to where we had therapeutics that actually worked. We weren't doing bloodletting and so on and so forth which we can look back and laugh at. And also though, we began to put the patient on the pedestal instead of the provider being on the pedestal, and we started to flatten the hierarchy within our system, so that physicians and nurses and students were all looked at on the same playing field. And I feel like the 21st century, we're now starting to look at the psychosocial aspects of health care that c- are so impactful, but take a huge paradigm shift in our way that we look at ourselves and medicine, and then we look at ourselves as a culture, and wanting to reflect the tapestry of our communities. Do you think we're getting there? Are you satisfied with the progress that you, see?

Dr. Jason Lambrese:

I do, I think we're getting there, and I think one of the things that I'm hoping this work that you're describing does is it really imparts the importance of thinking about the social determinants of health really early on in medical training when you're trying to learn physiology and memorize medications, but actually what's so important for good patient care is understanding the psychosocial needs of our patients. And I think that- that sort of focus in some of our diversity, equity and inclusion efforts sort of highlights that to say this is as important, if not even more important sometimes, than some of the basic science topics that are really important to learn to be a good doctor. But if you cannot connect with your patients and they do not feel comfortable opening up to you, all that basic science you learned, you can't apply it.

Dr. Anthony Tizzano:

Yeah, I feel like the program is a source of wisdom that usually comes slowly, but boy, if you're willing to open your ears and listen. So, Saloni, how do you track progress within the curriculum?

Saloni Lad:

Yeah. So, our group is really robust in the sense that we've got two students from every year. So, from years one through five, we've got students from every year, and essentially the older students are able to kind of go through the curriculum for the first time and really identify the gaps in the curriculum. So, Gus and I were really kind of the first class to be able to go through this, and having been through the pre-clinical years, we were able to look at some of the gaps, and now going into third, fourth and fifth year, again, figuring out where are there still places for inclusion.

And then all of the classes underneath us have been able to do an iterative process of every time they go through the curriculum, they're able to say, okay, these are the things that we have changed, and these are the things that we n- still need to add, we need to modify, we need to improve. And so, it's been really cooled to see how this interdisciplinary, interclass collaboration really has made significant changes that can be tracked.

Dr. Anthony Tizzano:

And do I understand correctly that you've actually even provided some content in the form of slides and so forth, so that, you know, you've done the homework?

And even though I have an interest, I still would find it very helpful to have some other group looking that has greater expertise than I. Is that something you've done? Do I understand that correctly?

Saloni Lad:

Yes. So, we've actually used the AAMC guidelines to help kind of guide, essentially, what we're looking for in terms of where are the gaps, and we've used that to, okay, we've found the gaps; we don't talk about this topic. Where would it fit in? Okay, it'll fit into this block during this seminar. Let's add a slide, let's do the research, let's go on PubMed. Let's find out what the information is, the critical pieces of information that are needed. Let's make the slide. And then we take that, everything that we've done in that block for all of the different seminars; we present it to the course director, and we say, "We've kind of done the work for you. Are you comfortable presenting this? Do you have any additional questions? Is this something that's feasible to include in your block?"

Dr. Anthony Tizzano:

Excellent. Jason, do you have something to add to that?

Dr. Jason Lambrese:

Yeah. Because one of the things you pointed out a few minutes ago is the importance of this material landing in the standard required curriculum, right? And so, one way that could be done is to add more LGBT hours, is to have more LGBT 101s or 201s. And there's some value to having some stand-alone LGBT sessions, particularly around language and terminology and communication skills. But actually, most of the very sort of medical or science topics don't need their own stand-alone lecture, and we know from the literature course directors say, "I don't have time to add more topics in. My curriculum is already crunched." So, we realized as a group that so many of these teaching points were very discrete teaching points that were relevant to this community but could be integrated into a preexisting seminar or patient case.

So, we don't need a whole lecture or seminar or case on a specific LGBT topic. As Saloni described, we're sort of adding these slides into a preexisting seminar that exists, and by that, we're not asking for a lot more time. And we're offering to provide the resources to either help the seminar leader create their own slide, or to even draft the slide for them, so for folks who feel uncomfortable with their level of expertise in the topic, we're willing to help them as content expert. And by providing the literature to them, we're really sort of imparting upon them how relevant this is to their course.

Because sometimes they'll, "Well, is this, does this really fit into my course?" And by looking at the literature into the AAMC guidelines, we can say, "This actually really does fit nicely into your course," and we can teach this. And then we're not othering it; it's not, "Well, this is the LGBT Day." It's sort of, I'm learning about cervical cancer, I'm learning about infectious disease, I'm learning about major depression, I'm learning about cardiovascular risks, and within that there are some specific points that are relevant to the LGBTQ+ community, and we can put that in there. So, we're learning, but in the disease context and not in this separate sort of other time that I think can be easy to sort of discount these sorts of other sort of lectures, but also requires a lot more time that we don't always have in the curriculum.

Dr. Anthony Tizzano:

Saloni, would you like to add to that?

Saloni Lad:

One of the other key efforts that we've had is using the patient cases and trying to randomize their identities, and that's been something that's been kind of an ongoing discussion. So, one of the things that we do in our curriculum in small group learning sessions, we take a case study, and we break it down into whatever block that is, whatever disease process we're meant to learn that day. And a lot of the times, you know, somebody's gender identity, sexual orientation is only mentioned if it's relevant to whatever the disease is. A lot of the times in my experience it's been, "Oh, they have HIV. Oh, they have depression. Oh, they're gonna commit suicide." So, it's all of these very negative things that are typically related to them.

So, one of the things has been to randomize patients, so mentioning gender identity and sexual orientation even if it's not necessarily relevant to the disease process, because one, not only does it, again, normalize, standardize, randomize all of our patients, but it also has led to some really interesting presentations on topics that initially would not have been thought of, but are now thought of. And I think that it has been really interesting for our students to do and think about when they're learning the material as well.

Dr. Anthony Tizzano:

Yeah, and I think doing that, and- and perhaps in Epic we should have at the very beginning that we identify she/her, he/him, so that persons who are affected feel comfortable.

I think, you know, making someone comfortable in the office is really a key. So, Saloni, I understand that you are taking this work that's been done and you're publishing it. So, you've had some success, and all very interesting. So, tell us about this work in publishing this, and where in hope to have this presented.

Saloni Lad:

So, one of the students who has been kind of leading this- this group from the beginning, Gus, has been working to publish this and create a manuscript for this. And so, one of the things that we've really been doing is we have an annual survey that goes out to all of the students in our class to assess how prepared they feel understanding and interacting with LGBTQ patients, how their attitudes are in terms of the LGBTQ health topics, where they feel like a lot of these topics are coming up in the curriculum, whether they're going off and looking it up independently, or if they, you know, are able to actually find this in the curriculum itself.

And so, we've actually been trying to annually administer this survey to see how things have changed over time. And so, now with that we have two iterations from it. We essentially have a baseline, and we've got kind of the first round of edits, so to speak. We are looking at that data and we're kind of aggregating some of the results for publication for it.

Dr. Anthony Tizzano:

Excellent. Well, I think it's really important, because sharing this, and I often feel that Lerner College is at the cutting edge of a lot of things and a very novel medical school, and it's good to see this going forward. 

So, Jason, the next step. So, I understand the didactic portion. How do you begin to have the practical side of this, and- and begin to embrace actually working with patients from the LGBTQ+ community?

Dr. Jason Lambrese:

Yeah, in some ways that's the million-dollar question, is how we take what's been a very pre-clinical first- and second-year focused intervention, because that's sort of an easy place to start. There are seminars that have slides, there are cases that have identities. But how do we take that into the clinical curriculum, and how are we ensuring that the topics and the ideas that we're teaching early on get perpetuated through the third, fourth and fifth year of medical school? And that's been a bit of a challenge, because that's a bit more of an unwieldy environment. There are many more clinical preceptors than there are pre-clinical course directors to try to convince of the importance of this work.

So, we're looking for ways to teach it, but also, how do we infuse it sort of throughout the clinical experience and clinical training? How do we target the hidden curriculum? We can tell students, "Ask every patient about their pronouns," but if they don't see their preceptors doing that in their third-year rotations, the message is sent, "We don't actually have to do this in real life."

And so, we're really trying to now say we've had a good sort of sense of the pre-clinical curriculum. In the first two years, we identified 60-some-odd teaching points, have been able to integrate 70% of those into the curriculum. We'll continue refining that. But now our big step is how do we take this next step on, and then how do we assess students' abilities to do that? The surveys are a really great way to look at knowledge, attitudes and beliefs change over time, but it's a self-report survey. We recognize the limitations of that. So, I'd love to say, are students actually asking these questions in the office, are they actually screening pronouns? Are they taking an i- an inclusive sexual history, are we asking that in a structured clinical exam? Are we observing them in clinical space? How do we make sure that what we're teaching and what students report on a survey is impacting their knowledge, attitudes and beliefs, actually has translated to patient care?

I think that's really what the sort of next step of this project is taking us, is trying to really think through that in a way that we can really measure, and then target. How do we continue to convey these teaching points sort of throughout the clinical years in potentially a different way, a different modality than we did in the first two years?

Dr. Anthony Tizzano:

Yeah, I can only imagine that it's going to get better and better. Uh, Saloni, you know, I also understand that you have some independent research that you're doing. Maybe you've just wrapped it up, 'cause you've completed your fourth year. What- what was that all about?

Saloni Lad:

Yeah. So, as part of the Cleveland Clinic Lerner College of Medicine, we're required to take a extra year for research between our typical third and fifth year. So, my research has largely been in the field of transgender medicine over at MetroHealth, and it's looking at some of the changes in social needs over time in the last three years in a cohort of transfeminine and transmasculine individuals who are taking gender-affirming hormone therapy at MetroHealth.

Dr. Anthony Tizzano:

Excellent. So, a question for both of you: You're both obviously very educated around this topic, and as you look at where you've come from the beginning of this effort in the curriculum to now, do you get the sense that we are building more LGBTQ+-competent care among, you know, your peers?

Dr. Jason Lambrese:

Yeah, I do. I see the conversation changing. I think what for the start of this project was our group talking to course directors, talking to seminar leaders, pushing out content, and really leading the effort, I've seen now that because the conversation has been going on now for a few years this project is going on, course directors are reaching out to me saying, "Hey, I found this article about calculating r- renal clearance in transgender patients and how that goes into the GFR equation." I said, "That's great. Let's utilize that in your blog." So, the conversations have been ongoing that course directors and teachers and educators are starting to think about this now sort of on their own, which is great.

One of my goals for our group is that we don't have to exist anymore at some point. I'd love to change the culture and the curriculum enough that we don't need a work group to keep track of this. We're getting there; we're not there quite yet, but I think you're really seeing just the dialogue, the culture and the conversations changing. And I've really seen that our group has been successful, I think, over these last now going into our fourth-year sort of working on this. We're would say our two probably keys, sort of to me, the two takeaways would be our team of students and faculty, like, that's what made this successful. Me coming at students and faculty less familiar with the curriculum would not have worked. I think students leading the charge without as much faculty support and buy-in would have been a really important effort that wouldn't have been as successful. I think we've seen teamwork be really important. So, getting interested faculty and students together I think is really key.

The other part of this is this approach I think can be applied to so many other areas as well. We've successfully applied it to LGBTQ health, but I think for any topics that similarly cross over organ system blocks that are the traditional organizing structure for medical school curriculum, thinking about doing the needs assessment and integrating discrete points into the curriculum I think can really work with... through that support of the school, which is what we have here, and with the support of the team.

Dr. Anthony Tizzano:

Fabulous. Saloni, what would you say? Among your peers, do you see that this is being well-received? Do you see some growth?

Saloni Lad:

Yeah, absolutely. I think it's a little bit hard not to see growth when it's so prevalent in our curriculum and in our education. I think our class, or my class probably got the least of the five classes currently, just because our group kind of took off when I was done with pre-clinical curriculums. But, again, the conversations that I hear in kind of the clinical setting; you know, we don't call them pregnant women, we say "pregnant people;" we, you know, we say "menstruators." Just these very gender-neutral terms that are now being used.

And I think as we go forward, what I'm noticing is that the classes below me are much more vocal about being like, "Okay, no, I'm gonna say pronouns. Even if I don't see my preceptor saying to them, I know that this is what I do, and this is I know how to do it," and they feel very comfortable in themselves. And I think as they become physicians, I think that culture is gonna change slowly, but I think just seeing that is very inspiring to watch.

Dr. Anthony Tizzano:

Yeah, I think that's really important, and I, you know, I feel like the old dog trying to learn new tricks. And using pronouns properly and so forth and introducing myself that way. And I appreciate your efforts, as even before this talk today, we went over that and altered what we were going to say. And I think it's important; you've got to learn somewhere.

So, as we look at governing bodies, the ACGME and so forth, and testing, are we seeing this find its way into standardized testing for students?

Dr. Jason Lambrese:

I think to some degree. I mean, I think we see effort in question banks in USMLE exams and where there is sort of introductions of LGBTQ+ patients. I- I think that the really important place where this is going to need to show up from an assessment standpoint is in clinical assessments, where we can certainly include a multiple-choice question around these topics. So, I think it's important to know that factual knowledge is there.

But to the discussion we were having a few minutes ago about how this changing clinical performance is, you know, is this an expectation? Is this a milestone for medical students, for residency programs, to ensure that they have assessed that their trainees and their learners are able to take a comprehensive sexual history or utilize gender-neutral language, or to build a proper rapport with LGBTQ patients? 

We're at a point now where that is a discrete sort of milestone that we're looking at, but I think it's gonna be really important. Because as we're teaching this at the medical school level, we need to sort of see how this continues on over time, because we're sometimes at a point where our students know more than our teachers in some of these areas, and how do we sort of level that playing field I think as folks are going through training, but also for those of us still in practice. How do we make sure that we are keeping up on this, that we are sort of educating ourselves, and that we are sort of open to feedback when maybe we could improve in some of these areas?

Dr. Anthony Tizzano:

Yeah, Saloni, please.

Saloni Lad:

I think it's also really important not only at the medical school level, but to continue it on into residency. And I think I mean, I'm very lucky, because family medicine is very diverse in terms of the different thing's programs offer. But one of the things that I have asked programs when I'm looking for what kinds of opportunities, they offer me is, what kind of LGBTQ care do you provide? Do you have specific clinics? Do you have faculty who are trained? What do you have? And I think that is a really important conversation too, because it's great to learn it in medical school, but there is so much stuff from medical school to residency to attending that you forget.

Dr. Anthony Tizzano:

Yeah, I couldn't agree more. And I think that, you know, the American Board of Medical Specialties is beginning to key in on these things. You know, for me, I do roll board certification for the American C- College of Obstetrics and Gynecology, the American Board. And so, what they've begun to do is say, "We want you to submit 10 charts; details on 10 charts around a variety of topics, and we want to see if you've actually included key points." 

And one of the things I had done when talking about elective sterilization, I did not discuss regret with any one of my patients. And so, they said, "We want to see the next 10."

"We want to see it," because they want to show that by having these exams and these requirements and these clinical guidelines, that we're actually beginning to include them in how we practice day-to-day. So, I think, well, I'll tell you. This has been very enlightening. I'm curious for either of you, what lies on the horizon? What are the next steps, or something that I just missed entirely that we should be talking about?

Dr. Jason Lambrese:

I think we're just seeing the conversation continue to grow. I think for our specific project, we're seeing this topic thought about and talked about more and more. We're seeing other groups who are interested in integrating topics sort of look to our model as a model of success for integrating these topics into the curriculum. And so, I'm really hoping that we get to a point where this has become second nature; as course directors and learners and teachers are working together, that this really sort of becomes a second-nature topic.

So, I'm really excited to see that, and I think what we'll see, my hope for all of this, is we're training students who are gonna become really excellent and competent physicians who can provide great patient care, where patients no longer fear coming to the doctor's office, where none of our patients would come into the doctor's office and not be treated appropriately and compassionately with accurate language. That scares them away. So, they... There are lots of missed opportunities for prevention. Patients are presenting later in the course of disease. So, that's where we see a lot of these differences in sort of morbidity, is because patients aren't coming to the doctor, so there's missed opportunities for screening and prevention. 

My hope is by students being more educated on these topics, they're picking up on it more, they're talking to patients more, we'll ultimately see some of the disparities start to be reduced in this population, because we'll have better-educated physicians.

Dr. Anthony Tizzano:

And perhaps even communicate at their front desks, be responsive and receptive to these individuals when they call, and- and set the stage that we are a welcoming environment. Saloni, would you add to that?

Saloni Lad:

Yeah. I think the biggest thing is just making it more standardized, not just amongst our institutions, but across the nation. Having people just not in one particular place be really, really knowledgeable about these specific topics, but also just having any student graduating from medical school should have at least some of the basics in terms of how to understand, how to you know, the language with this population; any of- of the kind of just discrete health disparities that we've kind of been talking about today.

Dr. Anthony Tizzano:

Fabulous. Well, thank you both so much, Jason and Saloni. This has been a fabulous podcast. I feel enlightened. I hope our listeners are too. And I'm looking forward to the next podcast, and we hope we see you there. Have a wonderful day.

Saloni Lad:

Thank you so much.

Dr. Jason Lambrese:

Thank you so much.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.