Accessibility in Healthcare and Healthcare Continuing Education

ACCME President and CEO Graham McMahon, MD, MMSc, welcomes Dr. Kristina H. Petersen to the podcast for a discussion about accessibility in healthcare and healthcare continung education. 

Formerly of New York Medical College, Dr. Kristina H. Petersen is now Assistant Dean of Student Success & Access and Associate Professor of Biochemistry & Molecular Biophysics at Washington University in St. Louis School of Medicine. Her scholarly work primarily focuses on inclusive instruction, course and assessment accessibility, and creating curriculum to teach clinicians about persons with disabilities. In 2022, she received an award for Excellence in Scholarly Work from the Coalition for Disability Access in Health Science Education and the AAMC/Alpha Omega Alpha Robert J. Glaser Distinguished Teaching Award. She is currently an Alpha Omega Alpha Fellow in Leadership.

Transcript

00;00;00;00 - 00;00;36;01
Mimi Sang
Hi everyone, and welcome back to Coffee with Graham, a podcast brought to you by the Accreditation Council for Continuing Medical Education. I'm your host, Mimi Sang, and I will be joined by ACCME president and CEO Dr. Graham McMahon as we discuss important topics brewing in the world of continuing medical education. For this episode, we're joined by Dr. Kristina Peterson from New York Medical College as we discuss the importance of accessibility in healthcare and continuing education. So grab yourself a cup of coffee or tea and join us for this discussion.

00;00;36;04 - 00;01;01;25
Graham McMahon
Hi, everybody. This is Graham McMahon here, President and CEO here at ACCME And just delighted to have you join us to talk about accessibility and disability in healthcare and healthcare education in particular, and to help us along that journey. I'm delighted not just to be facilitated by our colleague Mimi Sang, whose voice you're probably familiar with if you're a podcast listener so far, but also Kristina Petersen.

00;01;01;27 - 00;01;52;04
Kristina Petersen
I am so excited to be here. Dr. McMahon, thank you so much for having me here. So I'm an associate professor of biochemistry and molecular biology at New York Medical College. I have been in education for more than a decade, but it's also my scholarly work, so I primarily focus on inclusive instruction, course accessibility, and then creating curriculum for clinicians, teaching clinicians about how to best treat people with disabilities, and I would just say I was very grateful to be honored for some of my work by the WMC and the Alpha Omega Alpha, organization by getting a distinguished teaching award. And that was in 22. So that's one of the things I can I can say I'm grateful for it. And having a platform to kind of, enhance accessibility throughout the nation. So I'm really excited to be here and to learn from you and learn from your experiences and, and continue this discussion.

00;01;52;07 - 00;02;01;17
Mimi Sang
So, Kristina just to start off, would you be able to give us a broad definition of what the term disability means and what that refers to?

00;02;01;24 - 00;03;51;26
Kristina Petersen
So that's a great question. And there's a lot of ways I could approach that question. what I will say is that probably from the standpoint of education and, the audience that we're talking to today, we might want to look at the legal definition. And that's, you know, what's protected under the law. And so it's, we can read the language of the Ada, but I'm going to I'm going to sort of paraphrase it here, and conversationally and just say, you know, it would be where a person that has a functional impairment, that's the language from the law, that impacts their major life activities. So, the reason why I chose the legal definition is, again, because as providers, we are required to make sure that our educational, activities are fully accessible. And so what does that mean? That means that anybody who has a functional limitation that affects or impacts their major daily life activities, that could include, I'll just mention that the Ada, was a little bit more narrowly defined when it first passed in 1990, and then in 2008, the, definition expanded. And so now it actually is much more explicitly clear that it includes concentration and learning as daily activities, whereas before it was less clear. And so now we're much more clear that we do include neurodivergent, we do include learning disabilities, etc. in the definition of disabilities. but it is, to your point, really important to recognize just how broad or heterogeneous for those of us that are scientists. This group is, it really does represent a lot of different types of folks, from non apparent disabilities to apparent disabilities, from chronic illnesses to psychiatric to mobility impairments to hearing impairments, to learning disabilities. So there's just a lot of folks that are included in that definition.

00;03;51;28 - 00;04;10;04
Mimi Sang
Great. Thank you Kristina. I think if you wanted to start off by providing a really broad answer for our audience and telling them what is accessibility and then which individuals or groups you think benefit from its implementation.

00;04;10;06 - 00;06;12;23
Kristina Petersen
That's a great question. So first of all, I think we often are making a distinction between compliance and access. And what we would hope people are going to aim for is, is full accessibility as opposed to just compliance? Compliance is really a minimum standard. We hope everyone is in compliance with the laws, but we would love to see people gearing toward moving the the needle toward full accessibility. So what does that look like? We often talk about in disability, education or disability studies. We think about universal design, which originated in architecture back in the 1980s when they were doing all these building, all these new buildings, but also at the same time, the same folks were being asked to retrofit other buildings to make them accessible. And so Ronald Mays said, gosh, what are we doing here? Why aren't we just building these new buildings so that they are accessible from the outset? And so those principles, the universal design principles, have been then been applied in many other fields, including education and including medicine. I think we still have some room for growth in both of those areas, but I'm excited to chat a little bit more about what that might look like. If we were able to put more universal design principles into both education and, in particular medical education, and also in health care in general. But you had mentioned how does this might actually help different types of populations? Certainly when we think about the needs of people with disabilities, it does absolutely, help those with disabilities. But at the same time, there are often other populations that also benefit. So, for example, when curb cuts became the norm, of course, that helps people like my aunt who's a wheelchair user, be able to easily navigate the sidewalks and get to parking and etc. but it also helped me when I had a child and I had a stroller that I was pushing, or I have a bag that I can wheel and I can move easily and navigate the street. So it definitely has, applications for many different types of individuals when we think about moving toward accessibility.

00;06;12;26 - 00;06;29;13
Mimi Sang
Great. Thank you so much. If you wanted to discuss a little bit more in detail the significance of accessibility in health care, particularly concerning patients who may have disabilities or other diverse needs. And, Kristina, if you would want to start us off.

00;06;29;15 - 00;08;02;00
Kristina Petersen
I would love to start us off on that. That is one of if that's an issue that's very close to my heart. And I think we need to be teaching our clinicians about disabilities. And as I mentioned earlier, that's really one of my big passions. And one of the things I just will talk about anywhere, at any time. And I have a lot I could say. What I will say, though, is that, you know, I didn't realize until 2017 when there was a paper that came out that reported that only about half of us medical schools actually teach any disability curriculum. And so it was really that, realization on my end that got me very interested in being involved in helping to change that. So I think we're making improvements. There are a lot of organizations that are helping to do that. and I appreciate this platform as well with the ACCME. So thank you for being involved in making this positive change. We need to try and make sure that where we have the accessible clinical equipment and that our clinicians are well versed in understanding how to communicate with patients with disabilities who sometimes have different ways of communicating. And we also need to think about the equipment that's available, as well as the skills that people have to be able to use the equipment. And one of the challenges is that if people are not being trained how to know, to recognize or utilize accessible equipment, then how will how will a clinician know when they walk into an office or they come into an office that something isn't accessible? I mean, really, it would be trial and error and that's really just not good enough, I think. I think we have we we can do better. We we can set some better standards for best practices and, and do better about educating.

00;08;02;04 - 00;10;07;24
Graham McMahon
Well, I see this in my clinic all the time. As many of you know, I specialize in diabetes care and complex, patients with, diverse needs. And in their case, you often have a combination of physical limitations that the individual has. But there is also often, cognitive limitations or communication limitations that are present and sometimes intellectual ones, too. And as a result, as a clinician, it's not just about looking at a lab report and deciding what to do or and telling a patient or their caregiver what to do. It's about engaging that patient and engaging a patient, and really requires you to understand how to communicate with them in a way that is able to be received. It's not about what I teach, it's about what they learn. Same in in behavioral medicine or in engaging a patient. It's not about what you say, it's what they hear and or what they perceive as a result of the communication issue. So you have to be sensitive as a clinician about what the limitations of your of your patient are or what their preferences are so that you can meet those. And, I think sometimes when we think about disabilities and health care, we think about is our clinic accessible to a wheelchair, which is just scraping the surface of what it means to be accessible as a clinic, as a physician, as a health care professional for that individual patient and their family or their or their caregiver, etc.. I think there are much bigger issues, as we will talk about as it pertains to education, because you think about the role of education is almost entirely rooted in communication and getting somebody to play with you and do cognitive simulations with you and engage with you in a conversation. And that is fundamentally about how somebody hears you, whether they can hear you, whether they can read what's put in front of them, whether they can see whether they can process the information in the way that's, that's most typical or in a more neurodivergent way and accommodating to the way in which that person learns or perceives information. So that you can get them the information they need to be the best clinician they can be.

00;10;07;27 - 00;10;17;22
Mimi Sang
And, Graham, to that end, what role do you believe accessibility plays in creating, trusting relationship between clinicians and their patients?

00;10;17;24 - 00;11;10;14
Graham McMahon
Well, trust is so fundamentally based on communication and empathic communication at that, that unless you're understanding what a patient needs to hear from you and are clarifying whether they're understanding you and are following you, that is a core responsibility of a health care professional. Both listening to the individual needs and then using techniques like teach back to see if somebody has absorbed the information and bring it back to you so that you understand that they process it correctly, and then using supportive aids, whether it's written instructions or other ways to guide the patient into getting the information they need in the way they need it, so that they can do the things they need to do to take care of themselves. That's going to affect fundamentally, whether a patient is going to trust me, if they feel like I have been ignorant of their needs or not accommodated those needs or made my care to them accessible.

00;11;10;16 - 00;11;29;16
Mimi Sang
And I think this leads us into our next question for you, Kristina. So most accessibility discussions do center around, you know, how healthcare providers can provide accessible care to their patients, which of course is very important. But how do you think accessibility can also help clinicians who may have disabilities?

00;11;29;18 - 00;15;02;23
Kristina Petersen
I think I think they are sort of two sides of the same coin in many ways, because we have a population of clinicians, which fortunately we see that there's underrepresented in in the number of people who openly identify as having a disability. the last paper was written in the last few years, stated that it was 3.1% of the physician population, whereas, of course, the CDC reports that's 1 in 4 people in the population in the US reports having a disability. So you can see that there's a pretty big discrepancy there. So as we get more aware, become more aware of the needs of patients with disabilities. I think it also helps the cohort of people as they're learning. So for an example, when I'm teaching my class or one of my many now sessions on disability inclusion within the undergraduate medical education curricula, I often have students who have disabilities coming up to me and disclosing that they have a disability and saying how grateful they are that this curriculum is part of of their education and how they really value it. And also, I think it helps also for folks who are sitting in the room who may not have a disability to. Then I talk a little bit about their their colleagues, and I talk about some of the assistive technology, for example, that their colleagues can use and that they will be encountering colleagues with disabilities. And so we kind of are able to talk about both in the classroom in the context of patients, but also thinking about the, clinicians themselves who may also have disabilities. Now, I just want to mention as well that one of the real strengths that many clinicians with disabilities bring to the table is huge amounts of empathy. It's definitely been demonstrated that people who have had experience with illness, especially with chronic illness of some kind, or have relied upon assistive technology that are often really able to relate and get really high patient satisfaction ratings. And there's something really valuable about that. And I think we all need to acknowledge and learn from that and think about some of the value that they're bringing. There are, of course, needs or accommodations in certain circumstances. Right. One example would have been potentially with Covid 19. A big discussion was brought up over, you know, clinicians with certain disabilities. Should they be on the front lines, should they be allowed to do telehealth for a period of time? What are the most appropriate ways to accommodate now? Every disability is different. This is part of the challenge. talking about disabilities is it's such a huge umbrella. You know, this is where we have to really look at each patient on a case by case basis or in the context of education, each student on a case by case basis in terms of what they might need to accommodate their needs so that they can best access either the educational activity or in the clinic that health care, that they need. I should disclose that I do have a disability. So I do consider myself as part of this disability community. It is not apparent. So you wouldn't be able to necessarily, from meeting me, glean that I have a disability, but I do I have a non apparent disability. And I'm grateful for all that I've learned from so many other individuals who have been sharing with me about their experiences. And again, each person's experience is so different, and that's one of the one of the opportunities. And yet somewhat sometimes the challenges that we have with this population is to try and help to, better understand the nuances and the, the context. I know there's been a lot on contextualization in medicine and contextualizing care. And so I think that's the kind of things that we need to be considering when we're looking at each patient as an individual.

00;15;02;25 - 00;15;58;29
Graham McMahon
Well, I think one of the things that's important is that there is a tendency to think of people with disabilities as other, but they they're not other. They're us, and they're just as much a part of our community as people who are able bodied or who are not neurodivergent or have other learning needs. And we do ourselves a favor by including those amazing people in our education. But also we have responsibilities to be inclusive as to who our health professionals are and not discriminate against those who might have one limitation or another, so that their skills and expertise can be shared with a broad community that that needs their services. And to Kristina’s point, the empathy and the lived experience that they have that is so informative and helpful to help the community be able to benefit from the expertise of a health care professional.

00;15;59;02 - 00;16;18;04
Mimi Sang
When it comes to continuing education, how can educational providers make learning activities more accessible to those who maybe are neurodivergent? Or they might need physical accommodations to support their learning? And if you'd be able to provide maybe 1 or 2 examples for both live and online education,

00;16;18;06 - 00;19;42;26
Kristina Petersen
Absolutely. So you bring up in the latter part of the question, something really important is to think about the setting. So what is the learning setting? Are we talking about an online or an asynchronous kind of recording in which case we need to think about accommodations that we appropriate for that setting? If we're talking about an in-person setting, then I think often the considerations are going to be quite different. So I'll start with the online setting. So with the online setting where we're verbalizing and we have audio, we have to have captioning or we should have captioning. And depending upon what kind of learners we have, it's possible that we may also need to think about an ASL interpreter. There's there's also the considerations of potentially in my context, if I'm giving a lecture live and it's being streamed live, also recording it and allowing after the fact people to go back and relisten because, you know, if if I have a challenge or a processing difference, if I'm neurodiverse and I might just need to go back and listen. But you know what? Somebody who doesn't have a disability might also benefit from that as well. So having access to the recordings also ideally having access to any of the printed copies of the PDFs and all that, so that if somebody does require taking a PDF and putting it, let's say, on to a tablet so that they can use screen reading technology, or there are some folks that prefer to print them and actually handwrite notes and for other reasons. So there's a real benefit to kind of thinking ahead and having your materials available to your learners 24 hours or more in advance, which I know can be challenging as a professor myself. So but the more that we are able to prepare and make those materials available to our students and our learners, it does help. And then when we think about in-person learning, of course the space is really important. So a few things to consider would be are there stairs in the particular lecture hall or classroom that you're in? Who are the folks that are more likely to come? How close is the room to a restroom, for example? And you know, where is the chalkboard? How close is the chalkboard to? Is it viewable, or are there additional screens throughout the room that sort of will show what's being done on the chalkboard or on that whiteboard? Is it a huge PowerPoint screen? What kind of technology is available in the room? So being able to hear questions and answers, obviously the microphones become really important. If you do know that you have a hearing impaired person attending, do they require ASL? And I already mentioned that in the context of online learning as well. But also you may think about if there's somebody who's hard of hearing, is there somebody who is going to come and require the use of, let's say, something like an RRM hat, which is a digital version, or the FM unit, which is, an older version, but still quite good, a lot less expensive. And many educational units still use them where you have a transfer, basically a, you can hook up an item to your hearing aid and then all of those things need to be considered. And ideally, you will have given your learners an advance notice that you're excited to have them. Here's what we're doing and we value accessibility. Please, we ask you to let us know what special accessibility considerations we may need to take into account in order to make sure that you're fully able to participate. So talking about how much you value accessibility, having that part of your statement and then giving people an opportunity to disclose their needs, for accommodations ahead of time so that you can plan for it, that would be the best case scenario.

00;19;42;28 - 00;20;19;25
Mimi Sang
And I think, Kristina, to that point, I was really impressed by ACCME’s annual meeting last year, Learn to Thrive 2023. That was the first time that I attended a meeting that had live captions. So as speakers were talking and presenting, the captions were coming up at the bottom of the screen. And I know that we got a lot of feedback that that was really useful and helpful, because if you look away for one second or you, you know, start daydreaming for a moment as we all are prone to doing, you can make sure you've caught up with the important things that are being said. So I know at ACCME we do try to lead by example with a lot of these practices.

00;20;19;27 - 00;20;21;14
Kristina Petersen
That's awesome, I love it.

00;20;21;16 - 00;20;36;04
Mimi Sang
And then switching over, switching gears a little bit to talking about Web Accessibility, could you talk a little bit about those minimum standard standards for compliance and the certifications that might represent that compliance?

00;20;36;07 - 00;23;17;05
Kristina Petersen
Sure. So there are web content accessibility guidelines. They are referred to as WCAG or W-CAG. That stands for Web Content Accessibility Guidelines. There's been a couple of versions of them. So we look at the most recent one, which is the WCAG 2.0. The four principles that they are looking at is to make sure that websites are perceivable. So text alternatives for any non text content needs to be provided. Creating content that can be presented in different ways. So like having a simpler layout without losing information or structure. And definitely making sure this is really important, that it's easy for users to see and hear content, including the separation of the foreground from the background. So having that contrast so color contrast is something that's really important in website design. The second principle. So that was perceivable the first principle the second principle is operable. So making all functionality available from a keyboard. So let's say I am not able to utilize a mouse but I can use the keyboard actions my hands, my fingers, or any perhaps a different appendage to move the arrows on my on my keyboard. Then, you know, making sure that everything is able to be navigated in that way is important. Definitely taking into account sort of anything that's flashing, you definitely do not want to do anything that might exacerbate somebody who has symptoms, that might include a seizure or something similar, and just making sure that people can have easily navigable ways of finding content. Sometimes having multiple ways of getting to the content can be helpful, but just making it so that people can operate the website as easily as possible, and you can get as many folks able to do so as possible. Understandable is the third principle. So making the text content readable, making sure that people can understand it. Definitely having some some pictures. But if you have pictures or images having alt text, alternative text for folks that maybe are utilizing a screen reader so that they will be able to still participate and understand what the image is depicting and definitely trying to make it so that it's predictable in terms of how to operate it and how to move things around and and how to navigate. So that's that's part of understandable. And then robust is the last the fourth principle. So maximizing compatibility with current and future technologies. So you know as new technologies become available making sure that we're updating it and taking those things into account, that would be part of robust. So it's kind of, you know, ongoing review is is a good way of summarizing it.

00;23;17;07 - 00;23;55;21
Mimi Sang
Great. That's very helpful. It's great that discussions about accessibility in websites have become much more commonplace. And I know they even have plug ins you can add to your site to check accessibility, which can be really useful. So apart from ensuring that continuing education itself is accessible for learners, how can accredited education address the importance of accessibility in its activities? So what kind of courses might you like to see on this topic that you think would be really useful or impactful for health care professionals? And Kristina if you'd like to start us off there.

00;23;55;23 - 00;26;41;06
Kristina Petersen
Sure. So I think this is a really important topic. I was excited to be invited to the ACCME meeting last year in August, to the workshop to be able to talk a little bit about enhancing accessibility in this context. And so, you know, some of the things that we discussed, of course, included, when you're teaching, thinking about from the outset, using these universal design principles, thinking about how I can make my course as accessible to as many learners as possible and planning that ahead. Right. So that it's, you know, always with accessibility, planning ahead is really critical. I do understand that that can be challenging at times, but nevertheless, that the more that you can plan ahead and then once something is rendered accessible, trying to utilize it, you know, from year to year and update as much as you can, but then you can kind of build up the, accessibility bells and whistles, we'll say within your content areas. So I think having inviting people to come and speak about accessibility and how doing how to guides kind of thing. So I've done a few a webinars for the WMC as well as the, Association of Biochemistry Educators, because that's kind of my my group of folks that teach similar things to me. But, you know, thinking about, you know, how can we make our slides more accessible or if we're using PowerPoint, how can I make sure that my PDF is accessible? Just these these how to's? That might seem simple, but you know, as educators, we're often not trained in those things trying to partner with your educational media kind of or educational technology groups within your organizations because they're often wonderful resources for helping you to render things accessible. And they're often very enthusiastic about helping. So reaching out to the librarians as well, you know, getting folks involved and allowing there to be partnerships across different departments can also be really wonderful, because then it hopefully doesn't cost us as much as trying to create new resources. So I think, you know, I've mentioned already sort of alt text and thinking through how I create my slides, I'm a much more thoughtful for sure now, about always making sure that I have captioning available if someone needs it. I always caption my videos. Zoom is actually been quite helpful in many ways because there is a captioning option. Now I will mention it's not always accurate if you choose in your courses to use something like a zoom kind of captioning or a different eye captioning, you really do ideally want to try and commit to going through the transcripts and making sure that it's accurate. In particular, if you're using any scientific jargon or medical jargon because the zoom isn't really trained to know about oxidative phosphorylation. Sorry for the throwback for you MDs who, haven't seen biochemistry.

00;26;41;06 - 00;26;43;22
Graham McMahon
I’m an endocrinologist, you're speaking my language!

00;26;43;24 - 00;27;55;28
Kristina Petersen
Excellent. but, you know, so that often does not translate well in captioning. So just, you know, being being aware that, gosh, there is there is this transcript that's really convenient. But I also, as the instructor, need to be committed to going back and kind of just double checking, making sure if there's something that didn't quite translate well that I can go in and I can fix it, and then ideally releasing that to my learners subsequently. So they have a transcript, making sure that you encourage students to seek the accommodations that they require, because I think that we can do better, as a group with making sure that we are sending an inclusive message to all of those that are studying to become clinicians that have different needs and require accommodations in order to fully access the curriculum. And so, you know, the the place to go will look a little different depending on which part of the medical education continuum you're in, but nevertheless finding out whichever organization you're in. Who do I disclose to in order to make sure that my needs are met? Making sure that you do receive the accommodations that are necessary so that you can fully thrive, and that we can benefit as a community from your knowledge.

00;27;56;00 - 00;28;03;04
Mimi Sang
Great. Thank you so much. And Graham, is there anything you'd like to add? I'm sure there is.

00;28;03;06 - 00;31;04;16
Graham McMahon
Have you met me? I mean, I think I think there's a lot there, but there's... and I really appreciate, Kristina’s expertise in this area. But there's a couple of things that cross my mind. The first, at their kind of, like steps for a CME provider who might be facing into this and wondering about it. I think the first thing is to first be determined to be inclusive. I think if you make the decision that you feel like both your faculty and your learners deserve this gesture of respect and inclusion, then you've got past the first barrier because, your instinct in many cases, if you know someone with a disability or a need is coming to a meeting or a conference or an online event, is to sometimes freak out and think it's going to be extremely expensive and you just have to catch yourself if that is your initial reaction and say, I'm bigger than that, and this person has just as much of an entitlement to learn from me and in my community, or to teach in my community as anybody else. So the first thing is be determined to be inclusive because it's the right thing to do for us in the educational world. I think the second thing is to be clear, by publishing something like an accessibility statement, because an accessibility statement says, I'm determined to do this, and if you have a need, you should tell me, because I will do my best. I may not be able to do everything, but I'll do my best to at least make it as best I can for the circumstances that we're in. I think the third thing I would do is make sure that if there are individuals that you know or tell you that they will be there who have needs, tell your faculty and help them develop a strategy to ensuring the activity can be as inclusive as possible. And we just heard lots of strategies to do that, whether it's producing captioning or transcripts or slide presentation or language or dubbing or recording, all of those things are prudent and appropriate for whatever the individual needs are that are attending your event, whether it's one person or 200. And I think the the fourth thing to think about, beyond being determined and having an accessibility statement and informing the faculty and then deploying these strategies, the first thing is to be ever learning and listening to your community so that if you don't get it right the first time, you'll do a little bit better the next time. Not to listen to the advice of the people with the disabilities or the challenges that they face as to how they would like to be accommodated and not make assumptions about this very diverse community of needs, so that you can help them the most and make sure that they can be active participants as faculty or as as learners in the activities that you you are privileged to be able to put together. Those are the ways I would kind of summarize what I would like CME providers to be taking away from this conversation is a determination, a recognition. It doesn't have to be as difficult as sometimes they might think it is, and that it's their responsibility to be as inclusive as they can be, and that there's lots of tools, advice, including from those with the challenges out there to help you do your work. as best as possible.

00;31;04;18 - 00;31;53;16
Kristina Petersen
I just want to, again, kind of give the ACCME a shout out and say that in many ways, I feel like you were demonstrated in your commitment by captioning in your annual meeting and showing folks how much you value accessibility. In addition, the other thing you're doing is saying, we expect that there are people who are going to have hearing impairments or who do require the, you know, the use of captions. We expect that they will be in our audience. And so that also in by doing that, that's a universal design piece, right? You're you're sending that inclusive message and saying, we welcome you here. And so I love that the you also shared that the audience had such a positive response to it. again, I think in my estimation, part of that is also because you were just sending such a nice inclusive message by providing that service.

00;31;53;19 - 00;32;27;08
Graham McMahon
One thing that crosses my mind is, is just a reminder to folks that, we have that course and our online academy that Kristina has so ably helped us with. So if you want to learn more about some of these actual tactics and strategy around improving accessibility, that's a free course available to all of our accredited providers out there. So go on into the academy, find that. And, and utilize it. And there's also a variety of additional resources on our website about how to accommodate people with differences and make sure that your activities are maximally inclusive. Kristina?

00;32;27;10 - 00;32;50;09
Kristina Petersen
I mean, I just I just want to thank you so much for highlighting these important principles and for providing a platform. And I'm always available to help answer questions. You all can find me. I'm at New York Medical College, so you if you have questions about how I can support, please send me an email. And I'm happy to to chat or help in in raising awareness of access as much as I can. So thank you.

00;32;50;11 - 00;32;58;06
Mimi Sang
Thank you so much, Kristina, for joining us. And thank you, Graham, of course, for joining in this very interesting discussion.

00;32;58;09 - 00;33;04;14
Graham McMahon
The pleasure's mine. Take care.

00;33;04;16 - 00;33;34;27
Mimi Sang
Well, thank you, Graham, and thank you, Kristina for discussing this topic today. And thank you to you, our listeners, for joining us. You can check out previous episodes of Coffee with Graham on Spotify, Apple Music, or Buzzsprout. And if you have any questions about today's episode or suggestions for topics that you'd like us to cover, you can write to us at info@accme.org. Thank you for listening and as always, learn well.