#455 - [Neo News] - Is Communication a Procedural Skill We're Failing to Train?

Hello friends 👋

What if communication were treated as a procedure, something we train for and get feedback on, just like an intubation? In this episode of Neo News, Eli Cahan talks with Dr. Jessica Fry of Northwestern University and Lurie Children's Hospital about her NeoReviews piece, "Recognizing Communication as a Procedural Skill in Neonatology." Dr. Fry shares the personal loss that shaped her career, the ethical stakes of getting family communication right, and how trauma-informed care can guide something as simple as how we address parents on rounds. They discuss the critical first 48 hours after admission and how simulation-based training can build real skill over time. A candid look at a skill every NICU provider uses daily, and how we can all get better at it.

Link to episode on youtube: https://youtu.be/VB6jSuThOtg

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The transcript of today's episode can be found below 👇

Eli Cahan (00:02.651)Hello everybody and welcome to a special episode of Neo News. This is the podcast where we try to keep you up to date on what's buzzing in the news today. In this special edition, we'll be talking about a different kind of news, the news that only we pay attention to, but we think that this fits in the theme of things that we talk about with every stinking Neo News podcast.

So with no further ado, I'm thrilled to welcome to the podcast Dr. Jessica Fry. Dr. Fry is an associate professor in pediatrics at Northwestern University and Lurie Children's Hospital. She wrote a wonderful piece in NeoReviews titled "Recognizing Communication as a Procedural Skill in Neonatology." Dr. Fry, thank you so much for joining us on Neo News.

Jessica Fry (00:54.53)Thank you so much for the opportunity, Eli.

Eli Cahan (00:57.039)So we have a variety of listeners who tune into Neo News, as well as the Incubator more broadly, lots of people in various different roles in the NICU (Neonatal Intensive Care Unit), not just physicians, but certainly a critical mass of physicians. And within that, a number of trainees who are always interested in hearing about the career paths of the people that we have on the podcast. So I wondered if you could say a little bit about your journey and how it brought you to become interested in the issues that you wrote about in this piece that we'll discuss.

Jessica Fry (01:31.554)I'd be happy to. I'm not sure if this will venture into territory that's a little too personal, because it took me a while to recognize this in myself. But I had a family member, my cousin, who was born when I was in high school, underwent a fetal surgical procedure. And then unfortunately, my aunt had a placental abruption at 26 weeks gestation. I think many of us come to the fields that we come to through some sort of personal experience that drives our curiosity, our empathy, our desire to learn more. But it took me quite some time. Unfortunately, my cousin did not survive his NICU course. He lived for about 11 weeks before passing away.

Eli Cahan (02:10.885)Sorry to hear that.

Jessica Fry (02:30.539)Thank you so much. know, it's been a long time now. I was a senior in high school when that happened. But I think understanding the family aspect, even in that sort of slightly different, distant way from what many of our patients and families go through, reverberates throughout a family. And I think it inspired me from a very early age to want to make things better, to want to improve the experience, and to prevent other families, first of all, from ever having to go through that. But if they do, to think about how to holistically support a family in that sort of situation.

Eli Cahan (02:49.465)And what do you remember hearing, if not verbatim, what was the tenor of the kinds of things that you remember hearing from your aunt about the experience in the NICU? What were the vibes associated with that?

Jessica Fry (03:07.831)So many moments. I think as many of us would suspect for families, especially when things are tough or uncertain, there's fear, sheer terror, struggling to connect, thinking through ways that you could connect though. And in one particular way, I remember my aunt with a freezer full of breast milk, pumping as a means of connection.

And unfortunately, I also remember the experience of my mother cleaning out that freezer after my cousin passed away. There are just so many little and big moments in which it really does send shockwaves through a family, because it's that distance and yet connection, that desire to support, but the feeling of inadequacy in some of the tough moments. All of that was definitely fundamental in the early stages of my journey.

Eli Cahan (03:57.201)Yeah. So you decide to set out on this path to pursue specialization in neonatology. As you were going through your training, learning all the practical things that you need to know and need to know how to do in NICU training, where was this sort of bug in your brain about your family's experience? And what were you seeing in terms of the families that you were interacting with, both potentially the conversations in which you were leading and also those fair share of conversations where maybe you were bearing witness, but weren't exactly in a position to interject at any moment?

Jessica Fry (04:46.158)I think it's interesting because actually for the early part of my training, I probably suppressed my own experiences and didn't really realize that internal motivation. If anything though, I think that going through many of those early conversations and bearing witness to things, I felt like I was probably inadequate in my own skills in managing a conversation like that. Because I think it's hard to feel adequate in the face of so much pain and worry, no matter what. And so it sort of drove a desire to strengthen my own skills as things grew over time.

Eli Cahan (05:25.231)Yeah, I guess it speaks to your level of insight that you would feel that inadequacy, because to feel inadequate starts with a recognition that this is something you should or should not be good at. And I guess it's going to get into a little bit the piece you wrote, but how have we thought about communication training in neonatology? What is the history of us saying this is something we want neonatologists to know how to do? And what is the level of investment, financially and programmatically, that we have seen over time in terms of training people like you, like me, and many others to develop those skills?

Jessica Fry (06:17.578)What I would focus on in answering that is that it's quite variable. We recognize as a profession, I think over the past decades, there's been growing awareness that this is a key part of what we do in little and big ways every day, in the small updates and in the big conversations. The words that we choose really matter and really do have a direct, both positive and negative, impact on families. And there are so many opportunities to build those skills, to strengthen and grow.

But I think there have been the development of some really neat formal curricular programs by individual institutions, programs like NICU Talk, or Neonatal Critical Communication, or NC3, that invite trainees from around the country to their local institutions to participate in simulation-based training. There are also some institutions where it's just more part of the informal curriculum, and there's not dedicated time for that.

So I think that broad variation very much so is an issue within our field and something that we should be collectively considering.

Eli Cahan (07:20.753)Great. So I want to get into NICU Talk. I want to get into NC3. Let's just back up for a second. Why did you write this, and why now? And why communication as a procedural skill? That was such an interesting framing on something that has not been written about a ton, but it has been written about a little bit.

Jessica Fry (07:40.655)When I think back to my own journey, those early feelings of inadequacy in the face of what felt like incredible pain and stress and frustration, I slowly worked to build my own skills and to feel comfortable in my own skills. And over time, what I came to realize is that it shouldn't just be dependent on the individual skill of a practitioner. The experience of families, and really receiving trauma-centered care within the NICU, really is dependent on our systems. So that's dependent on our educational systems and our ability to practice. This really does need to be more of a formal focus for the field.

Eli Cahan (08:20.197)Why a procedural skill? Procedure is an interesting word for this, it suggests a really deliberate, direct intervention, and you provide evidence to substantiate that in the article. What made you want to put that word in the title?

Jessica Fry (08:43.16)Because I think that having some of these conversations, we learn from each and every one, and they're all slightly different. But the more you practice, and then you practice, and then you practice again, the more skilled you become, the more flexible you become when you come up against boundaries. And that really is akin to a neonatal intubation. The more you do, the more proficient you become, and the more skills you develop to draw upon when things get tough.

Eli Cahan (09:09.999)Yeah, okay. Let's go to what I read as the framing of this article. I kind of thought this article would start with patient outcomes, a deliberate demonstration of the effectiveness of this procedural intervention, or the lack of proficiency and the impact of that lack of proficiency. You do talk about those things, but it strikes me that at the top, you kind of frame this in the realm of ethics. And maybe as someone who works in bioethics, you're holding a hammer and everything looks like a nail, but you wrote very early in the piece that breakdown in communication during such a decision-making process, shared decision-making, can lead to a myriad of ethical concerns, including impediments to shared decision-making, mistrust, and the introduction of bias. Why did it feel important for you to highlight the ethical imperative of getting communication right?

Jessica Fry (10:20.846)Because I do think of it as an ethical imperative. Just as we need to prove our facility in the procedural skills that qualify us to be a neonatologist, communication really is of the utmost importance. If we don't communicate effectively with families, and there's a way that causes mistrust or those collaborations to really break down, it can have such long-lasting impact, not only on decision-making, but think about, for a family, for example, considering whether to move forward with a gastrostomy tube placement. How are you going to trust teams to provide a surgery like that for your newborn infant if there's not that level of trust? So if you can't communicate effectively about it, then you can't really partner with patients. So just as you need to prove your facility again in a procedural skill, I think there's an imperative to prove your facility within communication.

Eli Cahan (11:20.867)And I don't think the timing of this piece, and you writing about this, is particularly coincidental. Obviously we're in a landscape where, let's see, shared decision-making, mistrust, and the introduction of bias are three things that we are talking about a lot. They came up a lot at the American Academy of Pediatrics meeting this last fall.

What is the broader landscape about why you think, in this moment, getting communication right is critical?

Jessica Fry (11:58.433)Well, I'll admit that for us, a little bit of it is coincidental, because this is work that we've been partnering on locally for over a decade now. It's always been something that's been quite important to my partner, Natasha Hunter, and to Stephanie Marshall, Shane Ahiblet, my other local partners. The other author on the piece with us was Shannon Adams, who's one of our trainees. We all share a passion for this work. And yet it does feel as though mistrust, very reasonably in some ways, is almost breeding within medicine. Communication is really a skill that can help break down some of those barriers, that can really turn every clinical opportunity into an opportunity to build trust. So emphasizing and highlighting this work that has been ongoing for us, thinking through ways that collectively, as a field, we can share this responsibility of building our collective communication skills. We've just been looking for opportunities. This felt like the time, and the right one.

Eli Cahan (13:00.485)Yeah. Well, I hear you suggesting that academic publication may be a slow-moving machine, but I won't say it too loud, because our lovely dear colleagues at NeoReviews may be listening in elsewhere. Certainly we want to make sure we get it right in the literature, so it's important to have all those checks and balances to move things along gradually. Let me ask, after you provide this ethical framing beyond the outcomes, you center on the patients' and parents' experience, which I love that you started with, as opposed to starting with the background of how we have done communication training historically, which seems like the natural way most of these articles would be written. In particular, you cite a 2010 study by Dr. Lefkowitz that reports a shared experience of intense fear, horror, or helplessness in parents, similar to acute stress disorder and PTSD (Post-Traumatic Stress Disorder), following the traumatic event of admitting their newborn to the NICU. In that study, they interviewed parents and found that about two-thirds of mothers and fathers reported at least one clinically significant symptom of acute stress disorder, and one in six mothers and about 10% of fathers met criteria for PTSD one month post-admission. So I wonder if you can just say a little bit about the lived experience of parents in the NICU, which we probably talk about, but looking at those stats, maybe we don't talk about it enough, to be honest.

Jessica Fry (14:49.698)So another one of my passions is for partnering with families to engage in true patient- and family-centered care. Because I think that there are many things that, from our perspective as clinicians, we are humbled to walk with families in these journeys throughout our NICUs every day. And yet when I walk into a NICU, it's my workday. It's my workplace. It's my everyday. When parents walk into a NICU for the first time, it's traumatic. It's a black swan event. It's a once-in-a-lifetime thing for them. And even if the symptoms that bring your baby to the NICU might be something we as professionals think of as minor, for families that's still a life-threatening critical illness. And it's still an experience that really is marked by trauma. So even benign NICU stays have the potential for long-lasting outcomes. And that's something that I know is sometimes hard for clinicians to sit with and hard to recognize, but is an important part of our everyday.

Eli Cahan (15:55.289)Yeah, so continuing on. You have this ethical framing, then you talk about parents' experience of this profound, impactful, unimaginable, horrifying, terrifying, confusing, sad, frustrating, all the emotions, experience mixed with moments of joy.

Jessica Fry (16:18.114)Mixed with moments of joy.

Eli Cahan (16:22.937)Hopefully moments of joy that are provided through interactions with the care team, and with fabulous nurses and these sorts of things. I think, to try to cultivate moments of joy, one of the things that you talk about right after this section on parents' experience is the importance of not just communication abstractly, but in this framework of trauma-informed care. And it's interesting, because I remember learning about trauma-informed care at various stages of my training, in med school, when I was doing my psychiatry rotation, my adolescent medicine rotations, treating patients with severe eating disorders or other morbidities that were really infused with trauma. I'm not sure that we routinely think about trauma-informed care as part of our remit as neonatologists. Certainly we have an absolutely fabulous NICU psychology team at my institution, and whenever I can, I try to ambush them and learn from them. I know it's something they think about a lot, but I'm not sure that's something we have always thought about a lot. Can you talk about the decision to introduce quite a formal lens and framework for thinking about this communication, by virtue of trauma-informed care, and why you think neonatologists and the extended NICU clinician community should think about this as part of the skill set they need to have?

Jessica Fry (17:58.253)I think if we accept that the admission of an infant to the NICU is a traumatic experience, and one that has long-lasting impacts for our families, then I think we're drawn to try to mitigate that. And what mitigates that, I think, among the many principles of trauma-informed care, is trying to promote autonomy, trying to give families concrete information in a way that's empathetic and accessible, that gives them access to that information and the power to make choices and to really feel like parents within the NICU setting.

Eli Cahan (18:40.591)Well, sure. And I feel like that's something we can do just by sitting with them and asking about the lunch they brought in from home, but that's different from trauma-informed care, which is quite a deliberate and intensive framework of conversations. So again, why introduce the idea of trauma-informed care, and how do you think NICU providers can begin to include this in their daily practice?

Jessica Fry (19:21.624)Because again, I think once you recognize that trauma, when you're trying to figure out how to mitigate it in the long term, just looking at the principles of trauma-informed care and diving in there, thinking about how the way you communicate might align or not align with those different principles, goes quite some way in thinking about how you structure these conversations. I think that yes, talking to someone about their day, chatting, building personal rapport and relationship, those promote moments of connection in a way that could be considered trauma-informed care, but it's so much more than that. Really trying to understand where a person's understanding lies, where their own deep-seated beliefs and values about the care for their infant might be, what their hopes are, what their fears are, and bringing all of that together in a trauma-informed care type of framework. That's a way to partner with patients. That's a way to build long-term connections and to empower them in parental roles.

Eli Cahan (20:24.537)And so when you think about a trauma-informed framework, are there little things that we can all start doing that would pull from best practices of that framework?

Jessica Fry (20:35.064)That's a great question. I think to some extent, personalization, trying to understand in small ways how to humanize the NICU experience for families. We all walk into a room, and it's common, especially when you don't know the family, you don't know the baby yet, you're just walking in as a care provider in these brief moments. But how common is it for any of us to refer to a parent in the room as mom or dad? Yet they're not "mom" or "dad" to us, and using that language colloquially, to some families, distances from the experience. They might not feel like mom or dad. That might in fact aggravate their trauma response to feeling disconnected from their NICU baby. So finding ways to personalize the experience: what does this family member want to be called? How do they want to be addressed? What kind of information are they ready to hear and ready to process? Giving them some control over those conversations. Some families might walk in and want to hear all of the medical updates. Some families might get overwhelmed by the detailed level of information and the things that we talk about on rounds. They might choose to step away. So I'd say, wherever you can, personalizing to the experience of the family, I think, is an important first step.

Eli Cahan (21:47.109)I love that so much. And I think, you know, that can look like calling the parents by their first name, calling the baby by their name, because of course they have a name most of the time, or in due time they have a name. But it can also look like storing in the back of your mind that one little nugget about each family. I always try to write down one thing, one peculiar thing about every family that I can hopefully bring up repeatedly and maybe poke fun at them about. But I always try to pick up on one little thing. Maybe it's the sports team they like. Maybe it's the cartoon they're watching. Maybe it's the baby blanket they brought in. Maybe it's the nickname they've developed for the kid. I appreciate your discussion of personalization so much, because we know that part of trauma-informed care is making people feel that they're part of a community. And certainly, part of community building is inclusion of the whole person, rather than as a sort of phenotype of mom, dad, or victimhood in the setting of this unimaginable NICU admission.

Jessica Fry (23:27.584)Even down to the small details — instead of referring to a patient when you're presenting on rounds as "this is a 23-weeker," it's "this is my patient, an infant who was born at 23 weeks' gestation and is now this many days old." Just that subtle change in language, defining someone not by their diagnosis, but by who they are, and then discussing their diagnosis and how that affects their care.

Eli Cahan (23:51.409)I love that. One of the other really nice pearls that people can pick up on and start introducing into their practice is what felt to me almost like its own golden window. This felt like a golden window of communication. You say that studies have found that the first 48 hours of an infant's hospitalization may represent a period of significant vulnerability and uncertainty for parents. During this time, proactive communication from the medical team provides significant value to parental understanding and remains essential for the delivery of optimal medical care. And I love that the literature has established a bit of a timestamp, potentially — if in fact communication is an intervention, maybe this is like we think about needing to start therapeutic hypothermia within six hours, or maybe if you're doing late cooling, a little bit longer — but within a defined window we can say, hey, these are the patients that we should just go back to that room once more after rounds, or these are the patients that, if you're setting a shot clock during rounds, get 10 or 15 minutes instead of five minutes. How do you think about managing and helping patients navigate that deeply intense, deeply uncertain first 48 hours?

Jessica Fry (25:20.686)I think as neonatal clinicians, we're sort of called to be the guide to families entering into this uncertain territory. When a family experiences the shock and awe of an unexpected admission — think about it, the whole team runs in, cares for the baby, might say some words, and then brings the baby to the NICU, and everybody leaves. For a family experiencing that, it's a whirlwind. And I'll confess that I do some research in decision-making surrounding maternal-fetal surgery, and as part of that, I've been reviewing qualitative interview data on families describing their experience. One mom described delivery, thankfully weeks after a maternal-fetal surgery, saying it seemed like a hundred people came into the room, scooped my daughter away, the room was empty and quiet, and someone offered me a turkey sandwich. I think that gives some insight into what that whirlwind can feel like. I think we have an opportunity there instead, when we really take the moment to show families the baby in the delivery room, to let them see, to let them touch, to explain what our steps in care are — which don't have to be very long. That can be done within 30 seconds to a minute: here's your beautiful baby, let's take a few pictures. I think that builds a moment of connection and establishes those first early steps of parents feeling like parents. And going on then to talk further about what these next steps in medical care mean for the baby, both now and in the future — what do we expect, what are we seeing, and building upon that. I think it's important to set out on a path on which you intend to go. So that early investment in time, in helping families break down some of those barriers, from feeling like everything's a whirlwind and their baby is whisked away, is a really important investment to make, both for the rest of the NICU stay and beyond.

Eli Cahan (27:15.397)Yeah, and we could spend a whole other podcast talking about the "beyond" part of that. But we will not, other than to say that we know trust in medical teams that starts early on, especially in the current healthcare ecosystem, is critical for ensuring long-term patient engagement, which is one of the most important predictors of longer-term outcomes of sick and vulnerable newborns and children with medical complexity, to say nothing of parents' self-efficacy and health literacy, which also correlate with patient engagement. So there are lots of longer-term outcomes we could get into, but we won't, because we have a lot more to cover and we're on a shot clock ourselves, because I know things are busy on this beautiful Monday morning.

So, we've kind of established there's a really compelling ethical and quality improvement case for doing this. There is a really harrowing, humane, intimate set of experiences that parents are having that we have an ability and a responsibility to intervene on. There are some clear opportunities and pearls that we can adopt to do that through the lens of trauma-informed care, adopting principles from that during this golden window of communication. Where are we in terms of training requirements from the ACGME (Accreditation Council for Graduate Medical Education) and other standards? What do we know in terms of what the literature says are the core competencies that ideally we would want? And you spoke very early on about some of the variability. What is the variability across training programs and institutions in thinking about how to train these skills in a deliberate way?

Jessica Fry (29:15.32)Yeah, well, I think that's really important for us to be thinking about as a field. And I do think that the ACGME in particular has set out some specific skills and competencies that involve communication. Part of that is recognizing the emotional impact on the family of having a child who needs NICU care that we've been talking about. And part of it is understanding the psychosocial implications of some of these disorders, both on the infants themselves long-term, but also on the family dynamics, and others related to fellows and trainees demonstrating interpersonal and communication skills that result in effective communication exchange. But that's about as far as it goes — that these things must be demonstrated. So you can imagine that that's somewhat vague, and there's not necessarily one best path.

So for many of our trainees, both in the physician world but also in other subspecialties that practice neonatal medicine, or in other clinical roles that practice neonatal medicine, the experience might be quite variable. That might include didactic training on some of the topics we've been talking about, including some of these pearls. It might be, as commonly happens in medicine, "see one, do one, teach one" — seeing what an antenatal consultation at an early gestation looks like, practicing one yourself, and then sharing that information. But I would argue that limits the experience somewhat, because at any time when you're having some of these complex conversations with families, we've all said something where, even in the course of this conversation, you think, did that land? Was that the right thing to say? Were those the words I really wanted? And you can't pause a conversation with a family and ask that in real time, unless you have a very well-established rapport, and I wouldn't recommend that — a family in trauma shouldn't be expected to give us that kind of feedback. So being able to create a deliberate, safe space to practice some of these skills, I think, really is something that should be more regularly incorporated into training programs. And I would argue that one of the easiest and most effective ways to do that is through the use of communication simulation.

Eli Cahan (31:32.239)Yeah, so do you want to say a little bit about the work you're doing with simulations, both these half-day didactics, as well as the flash sims that you mentioned?

Jessica Fry (31:43.759)Absolutely. As we talked about earlier, there are different programs across the country trying to build those. The model that we've used locally is to try to reinforce some of these skills, both in bigger sim sessions with standardized patients, in half-day models that involve both didactic and simulation-based sessions. Those are sessions where our neonatal trainees get together with obstetrics trainees to practice joint counseling within sessions, and they work through a case in multiple steps with standardized patients. For each case, it's one standardized patient, one clinical scenario, but with twists and turns in the journey along the way. Each fellow will take a part, and after each part, or sometimes in between, because they can pause themselves out of a session if they feel stuck or want feedback on something, they receive feedback from both their colleagues in the room, from one of us as facilitators, and from the standardized patients. That chance to practice, to ask how someone felt when you said whatever it was you just said within the space of a conversation, our trainees have said is pretty invaluable.

We follow that up, in addition to having big annual half-day sessions for all of our trainees, with a series of what we think of as flash simulations, designed to be much briefer, somewhere between about 15 to 20 minutes, covering high-yield topics in neonatology — things like disclosing a medical error. We use the example of the wrong breast milk being given to a baby. There's been lots written previously about many of these smaller topics, literature evidence on what families might want to hear in those moments and some best practices. So we share an article associated with some of those topics to talk through things. But they're really meant to be just short practice of some of these high-yield communication topics that can be repeated throughout fellowship training, with a chance for feedback and again some play in the conversational elements.

Eli Cahan (33:49.093)Yeah, I love that also, because it squares with how we think about training for every other procedure we do. At our institution, we have monthly NRP (Neonatal Resuscitation Program) sims, we have regular didactics for other skills, we have biannual procedure days. Why should communication be any different?

Jessica Fry (34:14.732)That's our argument. I don't think it should.

Eli Cahan (34:16.689)The last thing you mentioned is the potential for bringing families into this and allowing families to teach us how to do this better. Do you want to say a couple of words about that?

Jessica Fry (34:27.958)Absolutely. I think I said this earlier on in the interview, but as clinicians we're used to our own perspectives, our own local cultures of practice. And to some extent, we don't know what we don't know. So I think that all of our practice in communication is that much stronger if it aligns with the needs of families, and we might not always recognize what those needs are, what that language is exactly. So I think working with families — and we've done this in the development of our curriculum — to understand the topics that we think are high-yield, what do families think about that? What twists and turns might families add to some of these cases? What specific language might be helpful or not helpful? We've worked together on those, both from local parent partners and from literature representing some of these things. But I think as our field evolves in how we think about outcomes and how we characterize disability in conversations with families, we need to learn from families what matters most to them.

Eli Cahan (35:29.985)And in the spirit of not knowing what we don't know, is there anything I should have asked you that I didn't? Any parting words for our listeners beyond what we've already covered?

Jessica Fry (35:43.006)I think that we're humbled to walk with families through this every day. And I think that part of that humbling is to recognize in ourselves that we will make mistakes, and it's okay. We can go back and try again. We've all had those conversations where things feel awkward or feel strange. Know that you'll take a piece of that — it's easy to shame yourself or to feel inadequate in those moments. Take a piece of that, learn from it, practice, and try again. That's what we're here for.

Eli Cahan (36:15.249)Yeah. And go back to that room, talk to that family, say, "I know that didn't go well." You know, we had an intubation yesterday morning that took two attempts and was a little squirrely, and my attending was tempted after the first attempt to say, "This is a very sick kid who's been pretty tenuous, maybe I'll take over." And thankfully we have a very good working relationship, and I said, "Well, I got a really good view. I think if we just curve the stylet a little bit more, we can get anterior into that airway." She gave me another shot, and we got it. It's so routinized for us to say, well, if you don't get it on the first try, try again. And again, if we're going to compare communication to every other intervention, that means when we're not successful, or when we could do better, it's part of our job to go back and address that.

Jessica Fry (37:09.442)I agree.

Eli Cahan (37:11.301)Dr. Jessica Fry, thank you so much for joining us on Neo News. Thanks for the work you do, and thanks to all the listeners for tuning in. We'll see you next time.