The Future of Massage Therapy: The Shift to Evidence-Based Practice

Massage therapy in BC is changing with the recent announcement of a new practice standard for RMTs, evidence-based practice. With the College of Massage Therapists of British Columbia (CMTBC) charting a bold new direction, I discuss how the adoption of this new standard come January 2024 could transform the professional landscape for therapists. With an enhanced focus on patient-centered care and focusing on the use of relevant research evidence, this should allow for a staunch rejection of pseudoscientific approaches that have lingered in the field for far too long. Join me, as we explore the commitment to integrating research, patient perspectives, and therapists' expertise, reshaping the definition of what practice competence could look like in our industry.

With the EBP new standards, this signals a departure from the old guard, mandating a clinical practice underpinned by robust research and continuous professional development. I share insights on the essential role of up-to-date research in shaping treatment plans that truly benefit the patient, not the bottom line. This episode highlights the surge of accountability as therapists are now expected to perpetually sharpen their knowledge and skills with a deep dive into evidence-based educational resources.

In a candid reflection, I recount my journey as an educator and the lessons I have learned from moving beyond outdated practice narratives. As we wrap up, I extend a warm invitation to all listeners to join the conversation on evidence-based practice, with a commitment to nurturing a community where professionals can confidently implement these progressive approaches. .

Transcript

Speaker 1: 0:12

Hello and welcome to another episode of Purvist Versus. My name is Eric Purvis. I'm a massage therapist course creator, continuing education instructor, curriculum advisor and general advocate for all things evidence based in the massage, manual and movement therapy professions. This episode is going to feature a discussion on the CMTVC's new standard of practice, on evidence based practice, and we're looking to see what that means for us as a profession in not just our clinical environment but also in our new quality assurance requirements. So I hope you enjoy this episode and if you do like it, please share it on all your social media platforms or you can check us out on YouTube by just searching Purvist Versus. Alright, so this episode I'm really excited about, actually, because it's just going to be me again just a solo episode. In the future we will have some more episodes with some guests. I have a bunch of those recorded for you and I'm looking forward to those, and I have a bunch more planned for 2024. But for this one today, I wanted to talk a little bit about something that just came out in BC, and this is, I think, such a great thing that they're doing, and I really hope that other associations and other regulatory colleges will see the work that the CMTVC is doing and hopefully they can start to make similar decisions and similar progressions to advance our profession, to kind of bring us out of the old school 1980s science and bring us into what current evidence and best practices are suggesting. So just some background For those people that aren't familiar with this.

Speaker 1: 1:50

The CMTVC recently came out with a new standard of practice and this one is called evidence-based practice, and that's the new standard. So for those of you that aren't familiar with what does the standard of practice mean? Well, from the website, just reading word for word on the CMTVC's website, it says practice standards define the minimum level of expected performance for registered massage therapists and therefore define what constitutes safe, ethical and competent delivery of care by RMTs. And when I read this it's actually funny, because one thing I do notice is that it used to say effective delivery, and I don't know when they changed that, but it used to be safe, ethical and effective. Now it just says competent. I don't know if there's some legal rationale for that, but I thought that's something worth mentioning. It says here also, to expand on that, that RMTs are responsible for exercising their professional development to apply the standards to the situations that they face in practice, and this new evidence-based practice standard of practice will go into effect January 15, 2024. So I'm assuming that as of that day, january 15, there's going to be some requirements for RMTs to abide by what this practice suggests, and I'm going to go into a little more details about what this might look like for our continuing education, as well as for how we practice and the way that we practice and interact with our patients or clients, depending on where you look and BC patients is what the term does. So I'm just going to just give me a minute here, as I'm just going to bear with me for a minute here, as I'm just going to read what this says. So it says the definition Evidence-based practice is an approach to professional practice that integrates information from four areas to support an RMT in providing safe, ethical and competent care to patients.

Speaker 1: 3:42

An RMT incorporates an evidence-based practice approach during all aspects of massage therapy care, including, but not limited to, assessment, treatment, patient education and home care, by integrating the following Research evidence specific to the condition being treated or approached to treatment. This context, including RMT's scope of practice, is defined by the massage therapist's regulation patient perspective, so including the patient's values, experiences, preferences, expectations and concerns and the RMT's own knowledge, skills and experience, which includes information obtained by an RMT in practice through the assessment of outcomes in the practice setting. And it goes on to say that an evidence-based practice requires RMTs to critically assess all information, focusing on facts and observations rather than beliefs, opinions and traditions. In massage therapy. Evidence-based practice also requires that RMTs are responsive to new knowledge throughout their career. Once an RMT is collected and assessed information from all sources, they are then tasked with integrating the information to inform their clinical decision making. When integrating information, rmts must consider the impact that the application of the information will have on an individual patient.

Speaker 1: 5:05

Now that's a lot of words, but I want to just break that down a little bit just to kind of make some sense and highlight where I think this is really really good. And the one thing I want to say that's really really good with this is that previously, for the last few years, the CMTBC was using a evidence-informed practice. That was the term that they were using, rather than evidence-based. I think that this evidence-informed practice definition, which is kind of a it's not a well-recognized term in the kind of healthcare world, but it was developed or is first used in Ontario, the CMTO brought in an evidence-informed, and it was kind of like what we would call like evidence-based light or kind of like a watered-down evidence approach, because what it did is it seemed that the evidence-informed the way it was worded kind of felt like it could allow some pseudosciences to make its way into the evidence or into the clinic, which is something that we don't want, also to evidence-informed.

Speaker 1: 6:10

When you look at the research and you look at how many papers are written out there that use evidence-based versus evidence-informed, and you actually dissect the difference between the two, it is actually not as subtle as some people might think. The evidence-based has been used for a long time. It's a little more rigid in terms of its definitions, whereas evidence-informed is rather vague. What I would do want to say, though, is that I think it takes a lot of courage and a lot of willpower to stand up and say no, we're going to use evidence-based. Thank you for the CMTBC for taking a stand and going with a term and a definition that is consistent within the healthcare world.

Speaker 1: 6:54

I think that's fantastic when we look at this, the way they're describing evidence-based and this is something I just want listeners to be mindful of, if you're not sure aware of this already is that evidence-based practice doesn't mean you're just Reciping the research. It's not about just looking at evidence and following a script. It's not. That's a very common misunderstanding or misinterpretation of evidence-based practice. We're using the evidence To help inform our clinical decision-making, but we're using the evidence as a way to provide. You know what's. What's it mean when someone comes like what's the best practices for someone with low back pain? What's the best practice for somebody with rotator cuff surgical repair? What's the best practices for, like, an acute strain or sprain? These kind of things like the evidence is going to give you what the data suggests is probably the least wrong answer. But what we also have to understand about evidence-based practice is that there's the.

Speaker 1: 8:00

Your clinical expertise is highly valuable. Now, your clinical expertise it doesn't explain mechanisms, it doesn't tell you why people got better with your intervention, but it gives you an idea that, like when I've seen this before and I've done this thing with people, they tend to get better. So your clinical expertise is part of the evidence based practice framework and also, too, we got a. We have to put the patient first right. So the the patient perspective, including the patient's values, experiences, preferences, expectations and concerns are also part of evidence-based practice and I would say that's probably the biggest part of it the patient. It's patient-centered care, person-centered care. What does the person want, need, expect? We use their goals, their expectations, and then we use our clinical experience, combined with the research on their presentation, to try to come up with a clinical decision to provide a treatment plan that works best for them. So that's a very brief outline of what evidence-based practice is, something we probably a lot of us do already, but we might not always Be sure about the evidence-based the evidence part, the research evidence part and that's what I like about what they've done here is they talk about relevant research evidence specific to the presentation, and this is the part I think that that I like the most is it says that an evidence-based practice Requires RMT to critically assess all information focusing on facts and observations rather than beliefs, opinions and traditions, and massage therapy.

Speaker 1: 9:43

This is huge, because most of us that pay attention to this things, this information, or pay attention to what's going on in our industry, realize that the vast majority of the curriculum that's being taught out there, the vast majority of Continuing education courses that out there, are based on beliefs, opinions and traditions Rather than what the evidence suggests. And this, I think, is a problem, because what's happening is we're just kind of passing on knowledge From generation to generation without really much change If I talked to somebody that went to massage school 20 or 30, 40 years ago versus what a lot of the grads are learning now, obviously some schools are doing better job than others. The information is kind of still the same. It's still very much a lot of myths, a lot of beliefs, a lot of assumptions that are made, but there's no evidence to support it. If you look at some of the common ones which I can counter, all the time on my courses I always do this kind of skeptical hour. I ask people, give people an opportunity to ask me questions about what are some things that you you're not so sure about. Things that come up all the time are things like increasing circulation, about the dangers of massaging the lower limb of pregnant ladies, the, the risks of massaging people with cancer. There's all kinds of things that people have about the different modalities and how they work and the stories behind them, and these are things that are based on beliefs, traditions, the way things always have been, rather than based on science and these things are still being taught and perpetuated in the school. So this is, I think, a very strongly worded statement where it's now a standard of practice, where the RMT has to focus on facts and observations rather than beliefs, opinions and traditions.

Speaker 1: 11:28

This is huge. Now if this is going to get translated into the curriculums, that is a wait-and-see thing, but I'm optimistic that this is a first step in the right direction. Now, that is the definition. Now I'm going to give you there's kind of four requirements that the CMTBC has laid out. The first one is it says an RMT incorporates a patient-centered and evidence-based practice approach to massage therapy practice when providing massage therapy services, by integrating the following Now, first thing I want to say is I'm so happy that they used patient-centered. I don't know if this is I'd have to take a look and see what the other regulated healthcare professions are saying and doing but the fact that it says patient-centered to me is amazing. I love that so much. Big bias to mine, but I think it's great that they have that in there. So that's one.

Speaker 1: 12:16

And one A says research evidence specific to the condition being treated or approached to treatment. So you're looking for research on the condition. I mentioned that before. Is this a low back or surgical or sprain strain? Is it somebody that's got a L or statin locer or some hypermobility? Is it somebody that's got some type of pelvic pain condition? What is it? Is it rotator cuff? Is it whiplash? Whatever it might be? So it's specific, which I think is fantastic. It says the person. The RMT also incorporates includes practice context, the patient values and they use their own clinical knowledge and skills. So that's the requirement. That's requirement one. Requirement two says an RMT incorporates an evidence-based practice approach to support clinical decision making when determining an appropriate treatment plan for an individual patient.

Speaker 1: 13:06

This is nothing treatment planning. What is optimum treatment planning? This is something I too, I don't think is well taught and well understood in our profession as much as it should be. Is a treatment plan? Somebody is coming in every week forever, probably in some cases maybe, depending on the person. But that if your treatment plan is just to maximize how many times people come in and see you for treatment, I would say that's probably not a good treatment plan that's working in the person's best interest all the time. Obviously, some people maybe have some chronic conditions and they benefit from ongoing massage. We're not talking about that. We're talking about people that just kind of being sold. You've got to keep coming in because I'm going to prevent you from injury. I'm going to. You know, if you don't keep coming in, things are going to build up and you're going to get injured and you're going to fall apart and you're going to break that type of approach. And I see that all the time in clinic. People tell me these things that they've been told by other healthcare providers. That is not evidence-based and that's not appropriate treatment planning.

Speaker 1: 14:09

Now number three it says an RMT takes reasonable steps to remain up to date on research evidence to support an evidence-based practice. It is now a requirement for RMTs to remain up to date on research evidence. Now, for those of you that are familiar with the competency documents, it actually does say in the competency documents that massage therapists have to be evidence-based. But it really had no teeth before. It says that in the competency documents, but you can still practice and not know any of the evidence and there's been no recourse for it. So now and this is a standard it's up to massage therapists to be mindful of the research.

Speaker 1: 14:48

Now, this doesn't mean you have to read 10,000 research papers. This doesn't mean you need to start subscribing to professional journals. This just means that you should start small by paying attention to some research, some clinical practice guidelines or some systematic reviews, meta-analyses for specific populations, fibromyalgia, geriatrics, osteoarthritis, neck pain, shoulder pain, generalized chronic pain, systemic inflammatory diseases. You can go online right now and Google any of those things in Google Scholar and you will find evidence that you can read to give you some less wrong ideas of what you should and shouldn't do with those populations. So it's not as scary as it should be, or as it could be, I should say, for some people.

Speaker 1: 15:38

And this is number four, this talks about an RMT engages in learning activities that A are informed by research evidence. This is huge. A lot of people out there claim that their things are informed by research evidence, but just because something might have some anatomical connection to some body part doesn't mean that treating that helps with the person's pain or doesn't mean that the stories that are taught by these structural interventions and these structural approaches are evidence-based. So it's going to be up to RMTs and RMT educators and continuing education providers to be more aware of what your research that you're using actually means and what it's actually saying. And for B it says present an RMT engages in learning activities that present information with an RMT scope of practice. So that's the same. We have to stay within our scope.

Speaker 1: 16:42

And for C it says an RMT engages in learning activities that are taught by an instructor or presenter who holds appropriate knowledge and expertise to instruct RMTs in the context of a regulated health profession. Now, there's probably a lot of this is kind of gray and there's probably a lot of reasons for that because they can't be too prescriptive. But what I think is great about this is that it's easy to go out there and teach a course Any. If you're an RMT and you have some experience, you can teach the course. But what I read but when I look at this is what I think is I think, well, you know it's there's more emphasis on instructors now to increase their knowledge and to increase their awareness of evidence, because you now have a requirement to teach RMTs evidence-based stuff, so you have to hold appropriate knowledge, and that appropriate knowledge can't be from a textbook written in the 90s. This can't be stuff that was published 30 years ago. It can't be from your course notes. This has to be up-to-date stuff and I think this is really, really, really important, and this is something that in other healthcare professions we do see a certain standard that instructors or presenters need, and because our profession unfortunately doesn't have an academic pursuit as part of something that is available to most of us.

Speaker 1: 18:13

This does, though, say hey, you know what? If you're going to be teaching RMTs, you've got to pull up your socks, you've got to start learning more, and you can't just pass off knowledge because you've learned this in another course. I think that is fantastic, and I'm really excited to see what the next steps are with this. Like, how is the CMTBC going to enforce this? Or to they're probably not going to enforce it, but how are they going to make these requirements have some strength and, like I said before, have some teeth? Now, when this first came out, I, admittedly I probably received about a dozen emails or DMs through Instagram or Facebook. People asking me questions about are kind of freaking out about it. I think this is a good thing. I think that we are still, as of today, waiting to hear what the new quality assurance program looks like, but I am cautiously optimistic that this new standard of practice evidence-based practice will be very, very important with their new quality assurance requirements for RMTs and BC, meaning that you are going to now have to justify and defend the content that you're using to satisfy your learning requirements with something that is certified or maybe not certified but is evidence-based in some way, or not it can be. It has to say look, this is what you've learned. That doesn't really sound. It might be considered something that's close to scope of practice, but it might not sound like there's any evidence to support that. So maybe you should. That's not going to be required. Maybe you should pursue some other learning opportunities.

Speaker 1: 19:55

I have mixed feelings about the change of the way that our continuing education program was provided in BC. I think the old way of just having mandatory credits, you know it was probably not that great because people would just sign up for things, get their piece of paper, submit it and then maybe they did, they participated in the course or not. Maybe they learned something, maybe they didn't. It was a financial and time constraint on a lot of people that probably didn't always work as well as it was intended. With the new program and like I said, we're still waiting to hear what that's going to look like it should hopefully be a little more flexible, so maybe it will be, courses will be part of it, but it will hopefully be more options for people to take conferences or to engage in other things that move away from just a specific two-day workshop that's worth 14 or 16 credits, as has been the standard, and that still is the standard for many healthcare professions and massage therapy associations across the country. So I'm, like I said, I'm going to be cautiously optimistic about what that means for continuing education.

Speaker 1: 21:05

Now, probably what matters more than that is what does this mean clinically? So, clinically, what's it mean? If you have to follow this evidence-based practice, standard of practice? Now my hope is is that you will no longer be allowed to say stupid things to people that are not evidence-based. You could. We can no longer make claims for things based on pseudoscience, you know, and we can no longer follow very outdated structural, patho-anatomical, tissue-based rationale for everything that was taught previously. Hopefully this means clinically that we can still do the same cool things, the same amazing things with our hands and get people moving and rehab and stuff we can. It's not going to change, I don't think, a lot of how we practice in terms of what we do, what our practice looks like with our hands, but hopefully it'll change a lot about the stories and the narratives and the things that people hear, and this is something that you know.

Speaker 1: 22:07

When I first started teaching ConEd back in 2016, I believe it was was I did a course and it's still my most, probably my most popular course on chronic pain management and that course what we did is we, you know, spent a lot of time and I still do this in my other courses too. We spend a lot of time discussing kind of myths and and and unhelpful ideas and the power of the words and the beliefs that we give to our patients, and I don't think that people realize the potential negative outcomes that can happen when we start communicating in ways that don't really have evidence behind them. So a common one is posture right. The evidence for perfect posture is not strong. There's no good evidence that says you need to have optimum posture in order to be out of pain, right? There's lots of people in very perfect, straight, completely upright posture strong core, strong muscles, flexible that still have pain. And there's people that have terrible posture, that slump all the time and don't have pain. So the idea of posture as being causative or strongly related to pain is not. There's very little to no evidence to support that. Actually, I would say there's probably no evidence to support it. I think when we look at some of the postural evidence stuff, it actually tells us the opposite. It says actually, you know what? People with slumpy postures have just as much or no pain as people with very upright postures. I remember reading a thing a number of years ago about tech snack and it actually found that people that had more slump and head forward posture actually had less neck pain than those people that were super rigid and had ideal postures. Don't quote me, don't ask me for the exact reference for that. I could be full of BS, but I'm pretty sure there's something that was out there that I read that was similar to that.

Speaker 1: 24:06

Now I'm hoping that what this means is that we will now have a responsibility to be mindful of the things that we're saying and doing. So maybe there's no evidence to say that people need to strengthen their core or that people don't need to get their shoulders in line with their ears and sit up straight all day, because the evidence for those things are weak. But maybe we can change, we can flip the script on that and say, hey, I used to be really concerned about correcting every raised posture, but maybe now I can give people some different options, some different ideas of how to sit and stand and move, rather than having these rigid guidelines of. This is how I always practice, based on tradition, beliefs and ideas. So I think, clinically, this is gonna put more responsibility on us as a massage therapist to be mindful of what it is that we're doing, not so much with our hands, I'm gonna say, but more about the stories and ideas and beliefs behind what we do. I'm hoping to see a big change on this in the coming years as people start to question their own biases and beliefs before. For me, I'm somebody that questions my stuff all the time and if I look back at the way I used to teach, the way I used to think, I would say that I I made a lot of mistakes. I think a lot of us do but we need to be mindful of those mistakes and learn from them and try and move forward and be more comfortable with what the science says. I also hope to see with this too, that when we're looking clinically is I'm hoping to see people stop putting non-evidence based stuff on their clinic websites Things about, like massage therapy come and see me to correct your postural imbalances, come see me to increase your circulation or, to you know, disengage.

Speaker 1: 26:01

Or, to you know, break down all your scar tissue and all these kind of things. Unless there is evidence out there to say those things, we now have an obligation that we can't and those examples I just gave you. There's not evidence to support those. Yet those things are commonly used on people's websites for marketing purposes and that's probably a topic for actually another podcast I'd be curious about to see do patients, clients, do they actually look on your website to see what techniques you do? Do they go to your website and look to see all the things that you can fix? I'm not so sure that they do.

Speaker 1: 26:44

In my years as a clinician and the clinic that I used to be an owner of, we were very adamant that we didn't focus on language, about techniques, or language on things that we fixed. But our language is more about what populations do we serve? What populations do we have interest in? Are we interested in athletes? Chronic pain that was my area of interest, still is an area of interest of mine, and I find it fascinating to try and understand chronic pain. Do we have interest in neurological disorders or do we have interest in regional things like necks and shoulders and TMJ, focusing more on regional areas of interest, more on populations that we like to treat, rather than techniques and the things that we fix?

Speaker 1: 27:34

I would love it if our profession would move towards that direction, because I would say that is a more evidence-based approach. Now it's easy for me to sit here and just talk to whoever is going to listen about. You know, these are all the problems and stuff, but I think there's room for solutions here too. What I have been advocating for for years, I feel like it's finally there might be some influence from a stakeholder probably the most powerful stakeholder in BC, in the CMTBC here to advocate for change, for change to happen. Now it's still going to be the role of our professional associations, as well as the numerous massage schools here in BC, but as well, if you're listening to this, in one of the other 15 countries of people that have downloaded this podcast over this last year. There's still room for improvements there as well.

Speaker 1: 28:32

Now, for me, my way, I have tried to advocate and to change and to influence in what I see are positive ways, and our profession is through the use of education, and my goal from the very beginning was to try to influence the masses by trying and teaching courses and providing workshops and providing communities and environments for massage therapists to learn, for massage therapists to collaborate and communicate and to hopefully try and create a critical mass of people that are starting to ask those hard questions of the schools and the stakeholders in the college, and maybe there's been enough murmurs that are starting to reach the people, the powers that be, the people that make the decision. So this is great. Now, the one thing that I have found other than my courses, I think the one thing I found personally and professionally to be the most valuable to massage therapists has been my manual and movement therapist community, so the MMTC for short. I created this back in 2021 and this was a way for me basically just to bring a bunch of thought leaders, educators, clinicians and researchers all together to learn together. So really, what I found was that I was going to conferences.

Speaker 1: 29:59

I've been to lots of conferences, some good, some not good. Really good ones, san Diego, pain summit, not good ones, I'll just leave those out, but I've been to some really good ones and San Diego was the one I got the most from, particularly in the early days when I was really starting to get exposed to a lot of this information, and what I found was that expensive conferences are expensive. You've got to pay a lot of money to go there because they're not cheap. To host hotels, travel you're eating out every night. They got to be pricey and it was not something that everybody could access. Maybe you live in a rural community or you're a one income household, or whatever might be.

Speaker 1: 30:41

It became hard, it's not easy, for people to access this information. Those are things I heard all the time as I was teaching in my early days was well, where did you find this information? How do you find? How do you get these papers? Who do you learn from? And it kind of planted a seed in my head that I should one day maybe create a community where I can. It's gonna be like a one stop hub where people can come and learn from the individuals that I feel have a lot of value, and so when I created the MMTC back in 2023, it was the idea of bringing like leaders and thought leaders in the profession to you so you could access it virtually on a private course page without having to leave the comfort of your home, and that was kind of the main idea behind it.

Speaker 1: 31:32

And what I do every year for this is I do a big push for it in January. So by the time you're listening to this, if you listen to this in January or January 31st is when I close the doors. But what you get in the community is in the last three years is I've accumulated over 65 hours of content from over 30 different presenters, and of these presenters there's a million different topics. I've got some world leading researchers Tasha Stanton's in there, melanie Knowles in there, melissa Farmer was in there, and these are kind of some of the academics I've had in this year, in 2024. I have a couple other academics and then one of them being Peter Stillwell, who some of you might know, and I have one other researcher from Australia I'm just keep my fingers crossed, just waiting to get confirmation that he will be presenting and then also, on top of that, I have a lot of clinicians and people that have a lot of clinical and practical experience and providing information on tons of different topics, everything from hypermobility spectrum disorders to working with people in grief, to palliative care, to cancer care, to working with people with pelvic and low back pain, shoulder pain.

Speaker 1: 32:53

We've done stuff on movement and exercise and how to do dosing for those. There's a million different topics that are on here. We even have people on Bring Coming and Telling their patient stories. So these are actual patient advocates. So people that live with health concerns have come in and presented on their story, on their journey and some of the research that they've done. So there's a little bit of everything for everybody here.

Speaker 1: 33:18

I love this community. It has been fantastic to meet and learn from so many different fantastic people, as well as to see the community grow steadily over the year. So if this is something that you are interested in, this is kind of my big push to getting people access to good quality, evidence-based content is inside the manual movement therapist community. So if you're interested in your listening to this podcast, you can send me a message hello at ericperviscom. You can message me on Instagram or Facebook at ericpervisrmt, or you can just go to my website, ericperviscom, and click on courses online courses and you can see the link there to register.

Speaker 1: 34:02

What I'm doing this year, which I haven't done in previous years, is I'm actually giving everybody the option of testing it out for free. I know the economy and life is expensive these days, so I wanted to give people an option to check it out before you have to pay. So if you, once you log in, you can use the coupon code MMTCfree and check it out for free. See if this is something you wanna do. But I'm happy to answer any questions, so please don't hesitate to reach out to me.

Speaker 1: 34:34

I did wanna say also a big thank you to those people that listened to my last episode and reached out to me. Thank you very much for that. It was good to know who was listening and that you enjoyed the podcast. So thank you to everybody that did that. So that's it for this episode. If you are listening and you do have questions about evidence-based practice, what that means and what this might mean for you as a clinician, again please reach out to me. I'm happy to answer your questions and try and turn you in the right direction so you can help to advance your career and learn more about best practices for whatever it is that might interest you. So thanks to everybody for being here today. I appreciate your time and until next time, take care.