Today we're talking with Doctor Rishi Bakshi from the University of Michigan. Dr. Bakshi tell us a little bit about your practice? >> Sure Cheryl. I'm a PONR trained and I perform interventional spine procedures, along with clinic and rehab of the spine and the muscular skeletal system. >> Well we've been learning about the BID model and we know it can be successful in a number of context. But I'm curious as to how you might use it in your practice. In part because your patients are awake. Do you think this would be difficult to use, this model? >> I don't think so. I think the model of the interopt component of it, the middle, the eye, will be helpful in terms of teaching explaining during the procedure, while the patient's awake, like you say. I think if I treat everybody in the world as though they're a trainee and explain everything to the patient as I would the trainee, they're going to benefit from it. I'm allowed to then do the interop training that I'd like to do, and I think everybody's going to feel comfortable that they know what's going on during the procedure. >> I also have a question about the B part of the model, the briefing. In surgery we're fortunate enough to have some scrub time where we spend some time alone with anyone we choose, but in particular the learner. In a procedural unit, do you have that time? And how do you think you could create that time, if not? >> So we don't. We don't have a formal scrub and in fact, I don't think we have two sinks that are next to each other. But I do think that that's extremely valuable. And I'm trying to find a way in my mind to incorporate the briefing part into our procedures. And I think what I can do is find a way to have a situation arise where the trainee and I are both going to be next to each other physically and involved in some pre-planning portion of the procedure. Whether it's even just bringing the charts together or maybe even discussing consents, or even getting materials, just getting the trays out, where we're forced to be together, we can do that briefing part. >> Lastly, I'm thinking about a fast paced unit like you have, and you're doing multiple procedures in a day Is it feasible to debrief at the end of each procedure, or would you do it at the end of the day, or how would you approach that? >> Sure, we do one procedure every 30 minutes, and in that 30 minutes, we get a consent, we set up the tray, we talk to the patients, we prep, clean, and then we do the procedures. So in between procedures, I don't think there would be time to do a fulldeep-brief. However, at the end of the day, considering that the procedure are all of a similar nature, they might be in different locations of the spine, or the neck, or the low back, joint injection versus epidural. The themes can be either written down during the day, or I can just create a log, and then we can discuss things at the end of the day. I can ask the resident or trainee what they thought went well for them. I can give my own opinion of what I think went well and they can tell me where I could use some work too. >> Fantastic. Thank you so much for those great insights Doctor Bakshi.