Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills
to build their own research program, whether or not they have a mentor.
As clinicians, we spend a decade or more as trainees learning to take care of patients.
When we finally start our careers, we want to build research programs, but then we find
that our years of clinical training did not adequately prepare us to lead our research
program.
Through no fault of our own, we struggle to find mentors, and when we can't, we quit.
However, clinicians hold the keys to the greatest research breakthroughs.
For this reason, the Clinician Researcher podcast exists to give academic clinicians
the tools to build their own research program, whether or not they have a mentor.
Now introducing your host, Toyosi Onwuemene.
Welcome to the Clinician Researcher podcast.
I'm your host, Toyosi Onwuemene, and I'm super excited to be talking with you today because
I have a special guest.
Actually, Leila is not new to the show.
She's been here before.
She is a wonderful and amazing medical information specialist, also known as a librarian.
And she in particular is here today because of her expertise in systematic reviews.
In fact, she is chair of the Systematic Review Caucus for the Medical Library Association.
And so she's here to talk to us today about systematic reviews.
Leila, welcome to the show.
Thank you so much for having me again.
This is super fun, and I love talking about systematic reviews.
Well, systematic reviews is definitely what we're talking about today.
And I'm so glad that you're here because sometimes it seems as if it should be intuitive.
You're doing a systematic review.
Just search the literature, pull the papers together, write the paper.
It seems like it should be straightforward, but it's a lot more complicated than that.
So I will start by saying when we first started working together, I had no idea about systematic
reviews and how long it would take.
My first thought when someone told me that it would take about six months to do a good
systematic review was to laugh and say, why would anybody need so much time?
I feel like a little bit wiser now, but I want you to just talk about what does it take
to do a good systematic review, not just in terms of the time, the effort, but also the
resources that you need in personnel and all things.
Okay.
Wow.
This is a big question.
So you may have to refocus me as we cruise through the answer to that.
So maybe we can break it up into parts.
So we kind of joke that systematic reviews are one of the research methods that nobody
seems to go to the manual for.
There's manuals and checklists and things to tell you how to do them, but nobody does
that.
They just decide that they're just going to launch themselves in.
And then as they sort of cruise down the road, we're doing things, they're surprised by what's
involved in it.
So some of the things that we say, and you remember this at our first consultation where
we sit down with a new team is we ask people how many people are on their team.
So we encourage the minimum, minimum, minimum would be two people, but we encourage you
to include a librarian or team to help you with your searches because you would prefer
to have an expert do that than to do it yourself.
It really ends up, we can talk about that a little bit later, ends up being very complicated.
You're going to need, and we usually say six months at the minimum for an experienced team
with a really tight question and enough like hands on deck because right, you could end
up with fed teams of like 18,000 things to screen.
So on an average, we actually say it takes about 12 months and on the outside, kind of
like 18 is not unusual.
So that's because you have to figure out what your question is.
You have to do the searches.
You might end up having to refine your question depending on how big your question is.
It might be, you know, like 18,000 things and that's about 200 things an hour.
So if you divvy that up amongst your right, it could take months and months and months
just to get through your screening.
Then you have to read the papers and then you have to, and you probably know this, but
nobody thinks about it is when you get to where you actually have to pull the data from
the papers you've selected.
That's the most time consuming piece.
And I feel like we should spend more time talking about like, what are you going to
collect and how are you going to collect it?
How do you plan to normalize your data?
And so like all these things.
And in the meantime, you've got software and you have manuals and you have reporting guidelines
of things that you have to meet in order to publish the work that you've done.
There's just so many things in that whole process.
Is that a good overview?
Yes.
No, it's good.
It's good because what I'm hearing you say, and I'm so glad that you're communicating
to the audience is that this is not just a walk in the park.
This is not just a pull a couple of papers together and do a review.
It really is systematic.
There's a process to it and it takes time and it takes energy.
It takes people to do it as well.
So speaking about people, your librarian, why should you involve your librarian in the
systematic review?
Aren't we just putting a few keywords into PubMed and finding a couple of papers?
I love this.
I mean, you can, but what we usually warn people.
So a systematic review is a very defined methodology.
And one of the reasons it is at the highest level of the pyramid of your evidence pyramid
is that what you've said is we have gone out there and found all of the studies about this
particular topic and we've done things to them.
One of the things that also defines a systematic review is evaluating the quality of the article
so we can talk about that a little bit later.
But you go out and you have to find all of that and it's really embarrassing if you go
to publish something and you have not found it.
It's also a little bit dangerous because your audience trusts that you have found everything
and that the recommendation you are giving with your paper is accurate because you have
found everything.
And you have worked with me and with other librarians and we're just used to, just like
clinicians are, we're used to thinking about the problem within our scope of expertise
in a really specific way.
So we're used to thinking about the other ways topics are talked about.
We're really, we have to do at least three databases for a systematic review so we know
the language and syntax for each one.
We know how to pull back enough stuff but not more than you can handle.
There's all these little tips and tricks that come just with the expertise of searching
for information.
And that's your data that you base the rest of your paper on.
So all the methodologies and stuff say we really recommend working with some sort of
informationist in order to get the data that you then work on for the paper.
So we have to collect your data.
Yeah, that's awesome.
So you talk about the need to be systematic.
So this is a research methodology.
Systematically searching the literature is a unique skill set.
It takes expertise to be able to do it well and make sure that you're systematically capturing
all articles on that topic.
And so in the same way as clinicians we spend a long time trying to figure out how to do
our clinical specialty.
Well, as librarians you take time figuring out how to do these systematic searches to
the best of your ability.
Yes, and I could teach someone if they wanted to spend the time practicing just like any
sport or skill if you had the time and the opportunity to practice then you could be
just as good at it.
It really does take months to years to really learn all the tips and tricks and skills to
end up doing that.
And I continue to learn things from other experts who have figured stuff out.
And we're just like you guys in a way.
It's a clinical skill.
Absolutely, absolutely.
So we started with team and as part of your team you want at least two people but probably
more and your librarian needs to be part of that team so that you can do a good systematic
search.
So we've got the team assembled.
Now let's talk about the protocol.
Why do you need to write a protocol before you get started?
Why not just define the question and go?
Yeah, so I liken it to making a decision about where you go before you start the car and
driving, right?
So you type in your GPS and if you're smart you'll have a quick look to make sure it's
taking you someplace that makes sense, right?
Instead of just being like okay and then getting to where the bridge is out.
How did I get here?
Or the traffic's terrible or whatever, right?
So a protocol is your roadmap or your planning document for your project.
So just like you would do a clinical trial, any kind of experiment you would set up how
you plan, execute all of those things.
So then you have to stop every time you hit a place and say now what do we do?
Okay we've done the search, now what?
Okay now we've loaded it in the software, okay now what?
All right now we're onto the next step, right?
So you end up if you don't have a protocol kind of coming with screeching stop and it
really slows down your flow and I just feel like kind of knowing where you're going, what
data you plan to collect, how you plan to evaluate the articles, all of that makes you
actually better at the earlier steps.
So really having a good idea of your final destination and that's not just well I plan
to do X but like the things that you plan to collect and the way you plan to do it really
makes a huge difference early on in the process.
Have you found that to be the case now that you know where you're going?
So your protocol is that roadmap and also it's a little bit to keep you from cheating.
I mean this in the like nice way, just something you can't just as you're cruising along and
you realize this is not going the way I expected it to which is like 50% of science maybe more.
You can't just pivot, it's supposed to keep you honest, you know so this is what I said
I was going to do and because it's not working out the way I wanted it to you can either
quit and just opt not to but you can't cheat and change it, right?
The protocol keeps you honest.
Absolutely, absolutely and I love the what you say about it being the roadmap.
What it allows you to do because you're answering these questions as you're going through the
protocol it allows you to think early about challenges that you might face and address
and decide how you're going to address them before you get to those challenges so it's
definitely very helpful.
Now you can't just you so you put your protocol together but you also have to register it.
What is this thing about registering protocols?
Can you speak to that?
Yes, so there are a protocol is also helpful because it helps you plant your flag in your
topic, it lets people know hey don't even bother we've already started working on this
here's our question here's what we plan to search and so you can go in and look at these
registries and say oh Toyosi is working on this already I'm going to find another aspect
of this topic that I'm particularly interested in so it saves you from wasting any time on
a topic somebody else is already working on.
It also saves you from having like a competing paper out there it's just that's better all
around so the registries are a little bit like registering a car I mean there's nobody
really policing the quality of the protocols there is a organization called Prospero they
are out of the University of York in the UK and they will give you like a registration
number for your protocol and they do do like a quick look through to make sure that everything
looks legit you know did you talk about what kind of data you're collecting did you say
you were going to search certain number of databases it doesn't mean your systematic
review is going to be any good but they are checking to make sure you fit all the high
points so there is Prospero they only accept systematic review registration so there are
other evidence syntheses like scoping reviews rapid reviews there's a ton of other types
of evidence syntheses and those will go into another registry the most common one I use
is the OSF which is the Open Science Foundation I believe I can never remember what the F
stands for but they also accept registration and will give you a number and a DOI and copyright
for it and all that good stuff so that is a way for you to say look here is my a priori
project this is how I planned to conduct it we didn't talk about another thing that protocols
do which is a lot of journals now require protocols if you're nodding your head I actually
had some poor team say that they tried to get their manuscript published and they hadn't
registered a protocol and the journal that they wanted to publish in was like no you
needed that to do one can we do one now and I'm like no that has to be done ahead of time
or you're out of luck you're just going to have to find another journal and that's happened
enough times now that I try to warn people because it seems annoying right you know why
should I just like to get on with it but yeah so a lot of journals do it keeps you honest
keeps you on track lets you plan things out it helps you with plant your flag on your
topic yeah they're terrific I'm a huge proponent of doing them absolutely and my experience
they also give you feedback they'll say well think again about your analysis you haven't
included X Y Z so it actually is is helpful feedback so it's definitely the turnaround
gosh I feel like is a couple of weeks to months depending on how busy they are they will get
feedback that's really nice I have not heard you've gotten the most useful feedback I've
heard a lot of times they're just like this is not a good question and you know and zoom
it out but it sounds like you got some really I like hearing that yeah yeah I would say
that one experience we've had is where I think they rejected the protocol and then when we
asked and said what was the problem then they listed the issues and we were able to go back
and fix those which is great that's fabulous I'm gonna let my teams know that that I had
not heard that so that's great there is actually a like a reporting that there are actually
resources out there to help you do a protocol so this again and your librarian will help
you again you don't have to go into this not knowing what's going on I heard from another
clinician that I work with we were asking him you know like do you do protocols now
what is a barrier to this and he said that if as a brand new person to systematic reviews
I had asked him to do a protocol he would have that would have been just too big of
a hump to get over that that was just too scary but I'd like to tell people in your
audience that it actually isn't that big of a deal and maybe you can reassure them it's
literally just kind of like an outline with things that you've decisions you've made and
thoughts you've had about your project did you want to talk about that a little bit absolutely
I will say that the most helpful resource I found which I always go back to and our
library website is where there's a systematic review protocol template and it's a series
of questions and you just answer the questions and it makes it so easy it helps you think
about every aspect so you're not really creating a protocol from scratch as much as answering
a series of questions and that becomes your protocol template so that's that's been really
helpful yes and it doesn't it's like a couple of hours right it's not days and days or months
or months right absolutely absolutely so now when I work with trainees who are working
on systematic reviews that's the first thing I give them is here's the template go fill
this out and then we have conversations around it which is great yeah it's it's really I
love hearing you talk about it because it's sometimes a struggle to get teams to want
to do it again it's the reading the manual there's the people who read the manual and
the people who do not and and I know about this because you taught me well let's talk
about let's talk about the conversation with the librarian when you say I want to do a
systematic review and I have this protocol what information do you need to get to your
librarian other than the protocol we don't always actually require the protocol from
the get-go it's nice if you do if you've done that work ahead of time and you have lovely
teens that almost always do this so but a lot of people just arrive on my doorstep but
they're like little bag that says you know I want to do a systematic review we almost
always talk about their question so that is probably it you might agree with this probably
the biggest struggle is really refining your question I always warn people you're not writing
a textbook this isn't the Moby Dick of systematic reviews you have to include all the things
in fact it's actually better at least in my opinion is these like sports car systematic
reviews small and fast so that you can then have another one and you can get that published
right you can get it done in six to twelve months get that published you can start working
on another one but the people who want to do these like big warship of systematic reviews
I'm like oh it's gonna take you forever and by the time you finish that somebody else
will have published it's full it's let's try to keep it fast like a sports car so we talk
to them about their question and like find out what's how much information is out there
should we make the question bigger sometimes we have to where do we have to make it smaller
we ask them for what papers they already know exist for their topic that is exceptionally
helpful for a lot of reasons one it lets the librarian we use it a lot we use it to sort
of get to know your topic we use it to gather search terms both those mesh terms that everybody's
always talking about the subject headings and also other ways your topic is talked about
it lets us check our searches so we can make sure that the articles you know you want to
include in your systematic review are and pulled up in the search there's just so many
ways we can use it it's very very helpful so we'll ask for the question we'll ask for
those example article maybe like exemplars or what I usually tell people is articles
you expect to include in your in your final set and more than five would be helpful but
if you've got three you've got three did you know that you can publish a systematic review
with nothing in it I mean more I know isn't that interesting so we just published one
you can this usually happens when a team is asked to do a review on a particular topic
and then they go digging and they don't find anything that meets their criteria and so
it ends up being a empty review what this particular team just recently happened did
is they it was a mental health one so they used it as a call to action look nobody is
doing this work we should be you know developing studies and testing if this if this works
if this intervention works so that was fascinating so don't be scared off and I've also had
a review with I had three articles in it don't be scared off by a small amount of of reviews
now it has to be an interesting enough topic that people be interested there's nothing
like that was if you know so what about salamanders I guess you know but that particular thing
was really really I thought a glaring hole in the research and so they did get that published
and it was very interesting so yes you can have zero and I would not encourage you to
do more than how many of you have you had a lot in your reviews if you had like more
than 50 rarely rarely I think that I feel like the numbers in my head are anywhere from
11 to probably the most you've had is 32 yeah I try to encourage people to like stay under
the 50s if you're like there are hundreds of papers out there about this particular
question then I would usually tell people you might want to break your question we might
want to focus more part of that is you're going to have to mention let's say there's
a 250 papers this has happened to one of my teams we have 276 papers they said in our
final set and I'm like you're gonna have to write about all 276 papers in your manuscript
that's gonna have to go in a table in your manuscript you're gonna have to quality assess
all 276 we're gonna have a data extract it that's gonna have to go in your references
where your journal even allow you to have 276 things in your references and they're
like oh so we talked about like what you could do to narrow their topic and one of the things
they did was they actually decided on their follow-up time for this particular thing and
once they decided on a narrower follow-up time that scooched right down to 35 papers
which is perfect in my opinion that is great so one of the things I hear you talking about
is really a librarian as your partner in this process not not just the person who comes
and searches and then it's done but really a partner and so in thinking about the partnership
so you help with the search your co-authors run off and they do the title and abstract
screening and then they're like wow we found these maybe 72 articles that we think meet
inclusion criteria and now we actually have to go find the articles how are you helpful
at that point so one of the things that we can do is we can use software to help pull
articles for that for your manuscripts so let's say there's 76 of them so we can use
and know or Zotero to use our proxy to pull as many of those as it can as you may have
experienced it's not always super accurate at that so we usually figure it gets about
50 percent of that and then there's like another 50 percent that you have to go pull by hand
or in order via document delivery interlibrary loan if there's a lot of papers what will
we all usually do is we'll sort of divvy it up amongst the team and so everybody goes
and pulls 20 papers or something like that so that it not it doesn't land all on one
poor person so that's one thing that we do also the library provides a free document
delivery so if we can get the paper for you from somewhere else besides Duke that we will
and and you should do that when you're doing a systematic review if it's not at Duke you
are sort of obligated to go get it if you possibly can at another institution leaving
it out just because we don't have it in full text is is not a legitimate thing and I actually
do I'm a reviewer for a lot of journals I'm right I'm the librarian methodology expert
and if I see that in a manuscript it's a very quick reject now speaking of leaving out papers
one thing that I see that that I struggle with is the language the language thing so
if something is not in English how do you decide what to do with that what is the best
practice versus kind of like what's most practical okay so I am a huge fan of including as many
people as you can on your team so and a multi-disciplinary multi-national team is fantastic because then
you have native speakers that can then go and translate those papers we always keep
all languages in the search and this is so that you're not doing you know a western bias
in your search for information great research is done in China great research is done in
Africa great research is done in Germany you can't just because they don't speak English
is a primary language that they can write a scientific paper in doesn't mean it isn't
good science so it's a very rude of us to be like yeah they wrote it in German and it's
probably not worth looking at right let's so we try not to have that sort of English
language bias so we included in the search so that you can at least have a look at it
what most people do is they don't end up unless they have someone on their team that speaks
the language they don't end up using those papers because it's very expensive to have
them translated several thousand dollars a paper I have a friend who does this so I've
got the skinny from her and she's like yes very expensive so we don't usually do that
but you've shown you're like look there's this paper in Polish and there's this paper
in Afrikaans and they really seem because the title and abstract are in English they
really seem to address our question but we didn't have the resources now if you know
you're going to be doing it maybe scoop a little bit of money in your grant off to do
translations but if this is a surprise SR and you didn't have funding for it what you
can say is here are the papers that we really think would be useful and if someone in your
audience wants to spend the money to translate they can or if they speak the language they
can go have a look at it but you're that you're addressing that it's there and not just ignoring
it I usually encourage people to put in like a little table that said these are some papers
that were interesting and we couldn't translate them but look we found them and I think that
just makes the team look great because you're trying really hard to minimize the bias in
your review.
That's awesome thank you thank you for that perspective for giving us the ideal and the
practical now the I think last question I want to ask is about authorship okay your
librarians done all this great work and then you go to write the paper how should you be
thinking about including your librarian as a co-author with you in the process?
I love that you asked this bless you so we're right that if you think about and I guarantee
that if anyone works with a librarian you're going to definitely want to give them authorship
because we do quite a bit of work we're not just you know it doesn't take us five minutes
to run the search and then you never see us again we help you with all your methodology
we help you make decisions about what risk of bias tool you might want to use right all
those things plus we will write up your methodology for you for the bits that we do so we can
say this is how we conducted our search we provide you reproducible searches that are
transparent that can go in your supplementary material I offer a lot of advice for a lot
of other pieces of the review I offer a lot of advice on data extraction here's what I
would do here's best practices so we usually just say you know we're a team member we don't
have to be in on all the nitty-gritty things because I don't know anything about hematology
or whatever your particular topic is you don't want me screening you don't want me data collecting
because I don't know what I'm doing but I will be there to help you with the entire
like process of doing a review so I think that work I think genuinely a lot of times
are even part of conceptualizing your question so I do think that that helps us deserve being
part of the author team and most of my teams have said oh absolutely you we feel like you've
deserved it I sometimes every now and again I'll have one that was just super super easy
and they didn't need me and I'm like you don't have to include me so if I feel like I didn't
do the work come say have at it you don't need me on this but I feel like it also makes
your review look really good look we used a professional librarian so there's been someone
here sort of keeping an eye and then one of the things that I do is I go through the manuscript
at the very end because I'm also a reviewer and I say this is what I look at when I'm
asked to look at a review what things did you hit what things are missing and so I feel
like just that helps us sort of get over the finish line of publication absolutely absolutely
thank you thank you so I'm thinking my final question has to do with tools what are some
favorite tools software tools those kinds of tools gosh we have some really cool ones
so at Duke we subscribe to software called covenants which is a systematic review screening
software but also helps with the data extraction it doesn't do it for you we have not gotten
there yet people always ask me that they're like does it do it for you and I'm like not
yet not yet but what people are working on it they're trying but it does really help
with the sort of data management of your systematic review so helps you your yes and no's tagging
things deciding on your criteria all that stuff and it provides a really pretty prisma
flow diagram for you at the end and all the good stuff plus forms for keeping all your
collecting all your data and keeping it all in one ecosystem so we love that software
there is other software out there we just happen to have this when we find this to be
the most user friendly other tools I really like to use are there is this is super nerdy
but there is a software out there called the polyglot translator which allows us to take
the initial search that we do and it will translate it for you it doesn't do a spectacular
job there's things it doesn't do for you but it does actually save some time with syntax
so I teach some of the students about this and I say here's the things you're going
to have to look out for but if you don't want to work with a library and this will sort
of get you halfway there there is a super cool tool out there called citation chaser
so one of the things that you're expected to do is when you get your final set of papers
so let's say we have 10 papers at the end you're expected to look through the references
of that we used to be called hand searching but what they now call it I've heard a lot
of different things I call it forward and backward citation searching so you look through
the papers just to sort of make sure that there isn't anything living in the references
that might fit your topic but then there's also papers out there since let's say there's
a paper that was done in 2004 and it's been cited by 15 other papers you'll want to make
sure that you've looked at those 15 papers to see if they have if they answer your question
so there's a software out there there's a couple of them the one I like is called citation
chaser and you can actually just put in the doi of the papers and it will go get all the
references and all the cited papers and and then you can just turn around and drop it
into that software that covenant software and it keeps track of everything I just it's
really really nice and it's super easy to use so yes those are some faves there's some
other ones I like to use those are the ones that I think are probably used the most often
that's awesome citation chaser is one I had yeah so that's that's pretty awesome thank
you next time when you hit that spot we will we will touch it we will touch it I'll show
you how now for anyone who's as they're coming to the end of the podcast I'm just wondering
what major thing about about systematic reviews haven't we talked about that you want to highlight
or maybe we've talked about it you just want to emphasize it we haven't really talked about
the process of doing a risk of bias or quality assessment with papers that we mentioned it
super briefly but that's one of the defining characteristics of doing a systematic review
and I find that a lot of teams don't realize that that has to be done you can choose to
do a review and not do the quality assessment risk of bias but you may not call it a systematic
review at that point so you can call it a literature review a narrative review a state
of the art something but you may not call it a systematic review without doing that
risk of bias portion and what that is is just looking at the paper and and making sure you
can only tell what they reported but there it's relatively easy there are a checklist
usually that says you know did they ask a good question did they I'm going to use randomized
control trials as an example did they randomize was the allocation blinded you know how did
they crunch the data was you know all those kinds of things just so you can look at how
well conducted this is really just how well reported a study was and so that way when
you're summarizing everything at the end you can say and you have to include I've seen
this done but people will throw out the poor scores and I'm like no no no no no because
you don't do that either it's a little bit like getting rid of patients that don't do
well in your study that this is no no bueno no you still want to report on them because
someone might say well I thought that Smith article was great you're like no actually
we looked at the Smith article and there's a really some weaknesses some really a high
chance of bias creeping into the paper because of X Y or Z so that portion is actually really
really important and then you can say look the quality of the research done on this topic
is really quite good or it's a middle in or you know nobody's doing really high quality
research on this yet so it's just another portion of a review that makes it a systematic
review that makes it super valuable if you do a scoping review you do not have to do
it but that whether or not is a scoping or a systematic review really depends on your
question and a librarian can help you sort that out.
That is super awesome I've learned new things today Leila thank you.
You're welcome.
Well yeah that's been a it's been a great great discussion about systematic reviews
I want to thank you for coming on and sharing your expertise I wonder why is there a caucus
for systematic reviews what makes it so so so impressive because you told me it's a it's
the second largest group relative to other committees or other groups that you have within
the library association.
Yeah we have almost 700 members I think the reason one systematic reviews are super fun
to do this is also a skill that librarians are really reviews as you probably know just
getting more and more popular and medical professions are showing up at a lot of universities
and also at you know pharmaceutical companies and right there's lots of places that people
are doing literature review type research and so and librarians are really important
to that process and so more and more librarians are being asked to participate and so we want
to be good at this for our clinicians for our researchers and so there's a lot of sharing
of knowledge we are doing a whole one of our librarians here I invited her to come speak
about including gray literature and their systematic reviews and like how to find that
so it's just a way for us to a little bit of shop talk and a little bit of some commiseration
and also this is what's happening on the sort of bleeding edge this is what people are doing
like is AI there yet can we use AI yet to do a systematic reason not yet I've had a
couple teams asked me recently and I like not yet it's getting there but we're a couple
years out so those kinds of things now that's really awesome I think systematic reviews
are very valuable and so having the right people in the room to do them especially your
dedicated amazing librarian is important so I want to thank you for coming on the show
to talk about it today thank you so much this is really fun I will come back and talk as
long as you want me to I will invite you again okay all right everyone you've heard it from
Layla Ledbetter talking to you about how to do systematic reviews in the best way possible
Layla if people have questions and they just want to connect with you how can they reach
you you may go to the Duke University Medical Center Libraries website and you may find
me there in the staff list we also have a guide on systematic reviews it's pretty popular
if you google Duke systematic reviews you can reach us that way and we are happy to
answer any questions that you have about the process and direct you to resources on how
to learn how to do that there's a Coursera course done by Johns Hopkins that's fantastic
so there's lots of places we can direct you if you'd like to learn more sounds good well
thank you so much Layla you're welcome bye all right everyone have a great time we'll
see you again on the next episode
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