 Well, first I have to thank Mark. I had no idea how complicated this could be. So this highly concentrated group, maybe didn't prioritize as much as we were supposed to, but I think you'll see that we came to what I think were a handful of actionable items. We took this sort of paradigm as our way forward, which is when you think about education and workforce, there are different sort of layers that you need to consider. The genomics professionals, that could be physicians, counselors, nurses, laboratory geneticists, informaticists, you can go on and on. So we had to, in the short time, we had packaged it into a single category. Other healthcare providers, physicians, nurses, and so on. And then the public. We actually toyed with adding policymakers, administrators, insurance executives as a fourth layer. And we just didn't have the time to get into that, but it may well be one that should be revisited. So then we tried to define what were the priorities, what were the opportunities, and what were the actions in each area. So this is what we came to for the professional genomics workforce. The priorities, first of all, were to be sure that we had an adequate workforce. And there was a little debate among members of the group exactly how many such people you need. One view of it is that there'll never be enough geneticists to do all the genetics and genomics, and therefore you need to train everybody else to do it. Another perception is, well, if it's that important, you should train more people to be prepared to do it. And I personally think the truth lies somewhere in between those two. But that was an issue. And then the point was made that the discipline is not recognized equally in all parts of the world. So in some countries there is a very well-defined training path for a geneticist, others not. Then there's the issue of the generalist geneticist versus the specialist. So for example, do you need a group of people who are expert in cancer genetics, and you need a group of people who can interpret a genome sequence wherever it happens to take you, which means you need to be capable of responding across many different specialties. And to what extent does a professional geneticist serve to interpret the cancer genome versus an oncologist, and what kind of training does it take to do it? And it comes to the idea that there could be various sort of paradigms for what constitutes a genetic professional. Point was made that in some countries it might not be sort of culturally acceptable for a genetic counselor to provide information because people expect to hear from a physician when it comes to medical information. In other countries, the culture is such that people are more accustomed to absorbing medical information from non-physicians. So those were deemed the priorities in terms of what we thought were opportunities to actually compare and catalog what are the training paradigms that exist for geneticists in different parts of the world, where this may not be so well-defined to identify what might be viewed as models and best practices and to disseminate them to areas that may not be as far along the curve in terms of training. There have been some workforce surveys, I'll come back to that point. Actually, the word survey is a bad choice of term, workforce studies, which is a formal sort of discipline to create those. And some places have done that, probably not updated to the genomic era really, but still it's been done in some places and probably not in others. And to summarize what those are, realize that there may be new paradigms for providing services, telemedicine in the broad sense of electronic means of collecting and then disseminating genomic information to end users. And then there was the point of defining what the certification pathway would be for somebody who would be providing lab services, again, customized to the culture of the individual country in terms of what the sort of authorities are for permitting particular activities to happen in a medical context. So we kind of parsed all this into a set of next steps. The first of collecting data on the professional workforce and training paradigms in different countries. So who has a formal training pathway in medical genetics, whether it's for the lab or for the clinic, who does not and what do those pathways look like? And then to conduct formal workforce studies, you know, in many disciplines, they can tell you to three decimal places how many surgeons you need per capita in a given population. And there are places that have looked at that question in genetics, but it needs to be done probably in this genomic era now, because I don't think too many of them have been updated for that. To share competencies, because competencies are a way to cut across the different specific training paradigms, because you could say, well, what does somebody need to know how to do? And then you can decide what kind of somebody that is. It might be a physician in one culture and it might be a genetic counselor in another, but to define the things that have to happen, I'll mention that the American College of Medical Genetics and Genomics has done this in the US to define the competencies for the physician medical geneticist that was published in genetics and medicine a couple of years ago and now has surfaced as what are called milestones that are used to judge the medical genetics training programs. So things have come a fair distance. And then finally, to develop some kind of genomics academy because the problem that many of us are beginning to realize is that, I think at least that medical geneticists know more than most providers about interpretation of genomic information. They at least have the idea that not all mutations are pathogenic, a kind of basic notion that may not be in currency among all health providers, but that being said, most were trained in the single gene paradigm and the paradigm is obviously shifted and so again, ACMG is looking at setting up a genomics academy to try to bring those professionals up to the next level and this may be something that would have currency outside the US as well. Now as to other health providers, I think all of us would agree that however many geneticists there ever are, you need to change the competency and also the attitudes of health providers who are not professional geneticists because they certainly would be in a position sometimes to recognize patients who may benefit from testing or from other kind of genomic interventions to support individuals in whom these have been done and maybe even sometimes to initiate and interpret things. And at the least, they have to have as much knowledge and literacy as their patients do and a recognition of where this can contribute to care. So the priorities here, first of all were to define what exactly are the competencies expected of health providers who are not professional geneticists and as Terry pointed out, a working group has actually defined these competencies for the generalist physician if there's such a thing as a generalist physician and it was intended that that would serve as a foundation then to do this for various kinds of medical specialists. So that in some ways, I don't know that we can say done exactly but we've taken a pretty significant step towards doing it. And then I guess the other point of this was that there may be things that are unrealistic to ever expect physicians to actually be able to do without a lot of point of care handholding. So the notion of point of care decision tools becomes important, something that came up in the last group. So some opportunities, examine curricula at all different levels, medical school, residency, postgraduate, whatever, to determine where genetics competency training can be accommodated, realizing there are very different training paradigms. For example, in the US where there's usually a four year undergraduate experience and then a four year medical school experience, you can expect matriculating students to come in with a certain competency maybe in basic science at least. Whereas in a system where you come out of high school directly into medical school for six years, those expectations would presumably be different. Then to define what genomic competencies a matriculating and a graduating medical student should have. Now some efforts been made along this line, again in the US through the WAMC, HHMI competencies in basic sciences for the physician. That kind of effort though would need to be customized to particular educational paradigms in different countries. And then we kind of stuck in here a point that really could be another layer which was to advocate for policies that encourage implementation of genomic medicine services. This really comes to the point of talking with the policy makers and others who are defining reimbursements, the idea being that just about nothing will happen if nobody is willing to pay for it. So next steps that could be imagined, one would be to deploy novel educational approaches. One of the things this addresses is the notion that some places are better equipped than others to incorporate genomics into a curriculum wherever it might be. That is a medical school, pre-medical or post-graduate or residency. But if we were to develop tools that could be customized to the local environment but then used in this way, the idea for example of online courses that could be accessible anywhere in the world and customized perhaps to the particular needs of a given region, but using materials produced by people who have a lot of experience and in places where this is already up and running could be a valuable resource to help bring those up to speed who are not in that kind of situation. But then also it was recognized that some of the materials you develop in one area just may be not suitable for use in another. We could imagine that you could create a case that reflects a disease that is very common in one part of the world and never seen in another part of the world. Meanwhile, missing a medical condition that is very important in some areas that I, for example, would never think of. So one way around this is to develop templates and sort of paradigms for how you create case-based learning materials and then try to train people in different regions to actually deploy those but modify them so that they're relevant to the population at large. Then it really comes down to somewhat the third point which is to use that workforce that might exist in various places to help educate other physicians. An example is trying to develop courses that can be given at professional subspecialty society meetings, for example. So the third layer that we considered is that of the public and the priorities here are for people to be, in general, better informed and more literate and it's really very similar to the issues faced by their physicians. I guess you could argue their physicians should know at least as much about genomic medicine as their patients do and their patients, meanwhile, should be equipped to make wise personal decisions once presented with genomic information. So a lot of the issues are similar to ones already discussed to adapt products that may exist to different cultures, to extend it across as broad as possible a sort of array from undergraduate or even secondary and even primary school on up and also to engage lay support organizations, patient advocacy groups, for example, in educational activities that would be public facing. So among the next steps that were identified was to provide a clearing house for already existing educational approaches that have been used for the general public and then to showcase the application of novel kinds of approaches, developing apps, for example. Some of what we saw this morning would be an example of novel kinds of things that could be adapted to other environments. Then be sure that materials that are generated are customized to the culture of the target audience that needs a lot of local input. So this can't be just all centrally directed. One thought was to extend DNA day to be, I guess it's really meant to be international educational event. I think it probably already is to a degree, but certainly capitalizing on the attention that one can draw to that particular day would be an opportunity. So we didn't try to, we didn't employ the principles of democracy here. And so we haven't voted on priorities and I would argue we've probably put more on the table than is gonna be digestible. And so we can leave it to the group later to decide which of these to put the highest priority to. But anyway, this is what our group came up with in the short time we had. Thanks Bruce. I guess let's ask the audience about things that the group may not have considered as anything obviously missing from this framework. That would be a resounding no. And so learning from the experience of the last one just shows that we are adaptable. I don't think we're gonna take a vote in the, but I would ask if you as the leader of this group were to give us a sense of what we're doing. Of where should we start? Because this is a very broad aspirational set of initiatives. Where would the focal point, and I'm not saying that in any of these things that we're taking anything off the table, it's just we need a starting point and I'd like your guidance as to where the starting point might be. All right, so now you're asking me personally not speaking for the group. Well, or at least translate what I thought. I think there's a synthesis there I hope. I would have put the kind of stars on a couple of things. One is trying to define the workforce needs, I think would be a very important area. And I know there's a formal process for doing that. It's been done, as I said, I think it probably needs to be done on a wider scale, but if you don't have data on what the needs are, it's a little hard to advocate for change. So I personally think that trying to define the workforce needs would be a high priority. And the second priority, I guess in my mind, would be to take existing or encourage the development of new educational tools that can be disseminated as widely as possible, so as to empower groups and people that may not have direct access to things so that you can make their work easier. Is that okay with other members of the group? I assume that's... Are committee okay with that? I miss anything that should be added? Okay. And those, sorry, those existing and new... The existing and new educational tools were for the public or for anybody? Well, in principle, anything. I guess if I had a point to where the greatest priority is, well, arguably, it would be the general kind of non-professional physician. You can get different perspectives on that, but if you have a group of geneticists and nobody calls them, you're gonna have a not terribly effective approach. Truth is, it's very hard to dissect out, these are three intertwined things. If the public isn't interested, it's not gonna happen. If the general medical profession doesn't believe in it, it's not gonna happen. And if there's nobody who knows how to do it, it's not gonna happen. So therefore, I think you need to be looking at all three. Thanks, Bruce. The next is Evidence Generation. Is it hiding or a round of applause for that? Thank you. Not for lack of appreciation. Thank you.