Does practicing medicine involve teamwork, individualism, or both?

Discussion in 'Allopathic' started by dingbat14, 10.30.14.

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  1. dingbat14

    dingbat14 2+ Year Member

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    As an incoming medical student, I was wondering what your experiences have been so far in medical school/residency. Do you find yourself working heavily in a team-work setting, or working as an individual making decisions on your own? I'm sure this is different for everyone, so I'd love to hear about your experiences.
     
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  3. DermViser

    DermViser 5+ Year Member

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    This differs greatly by medical specialty, but by the time you'll be practicing chances are medicine will be largely practiced in teams. The era of the individual physician being completely autonomous and responsible as an individual for patients is coming to an end. It's why med schools are now actively incorporating inter-professional education in medical school rotations :vomit::vomit:.
     
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  4. circulus vitios

    circulus vitios 7+ Year Member

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    I like how they keep reminding us that medicine emphasizes teamwork, as if none of us have ever held jobs before. WHAT IS THIS TEAMWORK YOU SPEAK OF?
     
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  5. DermViser

    DermViser 5+ Year Member

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    That's bc medical education for the longest time emphasized physicians as individuals and it's what the public believes them to be and why many people go for medicine. That is changing which means in caring for a patient you're part of the group, with everyone being "important" from you all the way down to the social worker. It's why fields that inherently don't have this bs component will become more competitive in my belief.
     
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  6. seminoma

    seminoma 2+ Year Member

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    Is it that time of year already? Damn.

    In my limited experience you need to think for yourself and integrate your ideas collaboratively with the team.
     
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  7. DermViser

    DermViser 5+ Year Member

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    It's the time of year when med schools start feeding their students utter garbage and students start questioning it (rightfully so). Thank God, I graduated. I can't imagine having to do interprofessional **** on rotations, where as a med student I have to not only rotate with residents and attendings but now PAs, NPs, etc. The smart ones will go into specialties in which they don't have to deal with that crap. Just sad that they're ruining certain specialties with that claptrap.
     
  8. Psai

    Psai ヽ(´ー`)ノ 2+ Year Member

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    Team based care is what they call it when someone without half of your education or understanding of the patient questions your management
     
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  9. DermViser

    DermViser 5+ Year Member

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    AND you can't call them out for their stupidity or accurately describe their education or you're being "unprofessional".
     
  10. ChiTownBHawks

    ChiTownBHawks 2+ Year Member

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    Serious question here (pardon my ignorance) but which fields, in your opinion, would these be? This onslaught of "healthcare team" is most prevalent in non-specialized medicine, correct (save for EM and Gas)?
     
  11. DermViser

    DermViser 5+ Year Member

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    Optho, Derm, Rads, outpatient Psych, PM&R maybe, Path, any surgical specialty.
     
  12. Jabbed

    Jabbed 2+ Year Member

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    I'd wager that most incoming med students have never held a real job. Ironically, I also think that they're the ones most likely to embrace the BS aspects of academic medicine.
     
  13. ChiTownBHawks

    ChiTownBHawks 2+ Year Member

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    Well, that blows.

    At any rate, thanks for the input Dermnasty.
     
  14. DermViser

    DermViser 5+ Year Member

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    I'm not sure why you thought namecalling was called for. Certain fields are more amenable to team-based care, that's the reality. Physicians tend to be an individual lot who want to be known to be the one in charge and as the major contributor. Fields that have that quality will be more wanted by med students, thus making them more competitive. More competitive specialties will be matched into by med students who are closer to the top of the class. Why this is a huge shock to you is beyond me. If you're ok, working with a team of a PA, NP, social worker, dietician, etc. all of whom you're responsible for, have at it.
     
  15. Jabbed

    Jabbed 2+ Year Member

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    I could believe that outpatient psych will eventually have mid-level encroachment as well. Pathology and radiology job market has been on the decline. I'd say derm, ophtho, and uro are the new ROADs.
     
  16. ChiTownBHawks

    ChiTownBHawks 2+ Year Member

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    Total communication error here. It's basically a term of endearment where I'm from. Apologies.

    I was saying it blew because I have 0 interest in any of those specialities. I wasn't trying to stir the pot or anything, I apologize it came off that way.
     
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  17. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    Psych might not be attractive to them... I am sure most of these people want prestige--hence the DNP doctor... I think the path and rad market might rebound in a few years (people should not counting on that anyway)... I remember reading somewhere in SDN that some hospitals are teaching NP to do endoscopy and colonoscopy. Therefore, a lot of specialties that we thought were safe are not anymore...
     
  18. VisionaryTics

    VisionaryTics Señor Member 7+ Year Member

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    I die inside on interdisciplinary rounds.
     
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  19. DermViser

    DermViser 5+ Year Member

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    I could be wrong, but he wasn't referring to encroachment but more team based care models. If we're talking about encroachment, Derm already has that with PAs and NPs (who have their own created derm residencies - although it's not required for them).
     
  20. DermViser

    DermViser 5+ Year Member

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    Interdisciplinary or interprofessional rounds?
     
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  21. DermViser

    DermViser 5+ Year Member

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    Yes, Hopkins with a GI fellowship for NPs.
     
  22. Jabbed

    Jabbed 2+ Year Member

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    My bad. I see mid-level encroachment everywhere :confused:
     
  23. seminoma

    seminoma 2+ Year Member

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    Neurosurg. No one else is safe.
     
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  24. VisionaryTics

    VisionaryTics Señor Member 7+ Year Member

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    Our hospital calls them interdisciplinary rounds. Never thought of that. We aren't different disciplines; we're different professions.
     
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  25. Psai

    Psai ヽ(´ー`)ノ 2+ Year Member

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    It's hard to tell sometimes with all the imitation going on
     
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  26. DermViser

    DermViser 5+ Year Member

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    So in melanoma, for example, we have interdisciplinary conferences: i.e. a Pathologist, Surgical Oncologist, Medical Oncologist, Derm, Rad Onc, etc., all of whom are physicians come together to come up with a coherent treatment plan. Interprofessional usually means different professions, so you'd have Nursing, Medicine, Pharmacy, etc. coming and working together (in theory): http://interprofessional.ucsf.edu/our-approach

    I didn't know ENT has interprofessional rounds.
     
  27. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    Are you sure physicians will be comfortable treating patient with a NP pathology or rad report?
     
  28. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    What is next? Train them in patho and rad!
     
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  29. VisionaryTics

    VisionaryTics Señor Member 7+ Year Member

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    Nah, we don't. I'm on ICU right now which has them.

    Otolaryngology just has multidisciplinary tumor board once weekly with medical and radiation oncology, path, neuroradiology, and prosthodontics.
     
  30. TooMuchResearch

    TooMuchResearch i'm goin' to Kathmandu... Lifetime Donor 7+ Year Member

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    In EM, it's a team. I can't get the job done without effective nurses and techs. Also need responsive hospitalists/surgeons to move the patients upstairs.
     
  31. seminoma

    seminoma 2+ Year Member

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    Doesn't matter. If the hospital hires a bunch of NPs the docs that work there will have to go with it or find a new place to work.
     
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  32. DermViser

    DermViser 5+ Year Member

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    Are you a Gen Surgery prelim?
     
  33. bc65

    bc65 2+ Year Member

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    Throughout your medical career, regardless of your practice situation, you will be a member of a team, both as a leader and as a follower.

    During your training as a medical student and a resident, you will be a member of a team. As a student, you will be assigned to a service within a specialty. You will be responsible to your intern, and to the entire team. As an intern, you are responsible to the residents, who are your leaders, and you are responsible for the education of your medical student, and you are responsible for their actions. This continues as you move up as a resident. As a chief resident, you are responsible for the actions of everyone under you. In turn, you are responsible to the attendings. As an attending, you in turn are responsible for your staff, and you answer to the chief of the department and the hospital. If you are the primary attending, then you will call in consultants for help, and in turn you will be called in as a consultant for others. Nurses and medical assistants and therapists care for the inpatients, not the doctors. If you're a surgeon, you can't function without surgical techs, anesthesiologists, nurse anesthetists, anesthesia techs, transport, housekeeping, material management. . All doctors need other specialists: radiology, pathology,etc . If you're a resident working less than 81 hours a week, it's because your hospital hired PAs and NPs to do your work for you.

    So yes, it's a team effort.
     
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  34. DermViser

    DermViser 5+ Year Member

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    I don't think it's the team component that is an issue but having to work with other professions that might be the issue, esp. certain ones that are cocky like NPs, but whom you have to respect as an equivalent colleague. No one minds being head honcho.
     
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  35. bc65

    bc65 2+ Year Member

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    Your comment is very interesting! If you read OP's question, you will see a general question about teamwork. Nothing was said about working with nurse practitioners, so it's interesting that so many commenters saw that as a question about allied care providers. That question seems to have been something of a Rorchach test. I have noted a great deal of hostility towards NPs and PAs on these forums, and in my opinion it's unwarranted.

    NPs and PAs are not in competition with physicians. They are HIRED by physicians. And when you go into private practice, you too will hire one, or two, or more to work in your offices. Why? Because if you are successful, one day you will find that your schedule is full, and in order to see more patients, you will have to either add another dermatologist to your practice, which will eventually only marginally help you financially by sharing expenses, or you could hire and train a NP or PA. Then, you will see the patients on their initial visits, and then, for the follow ups, the NP will see the acne, the rosacea, the hives, the eczema, etc. You will double your gross income, but your extra expense will only be the NP salary and some overhead. The NP won't have your depth of knowledge or experience, but will eventually be able to take care of the routine problems as well as you can. You will teach them what they need to know, and you will supervise them accordingly. The same thing happens in the hospital. The hospital hires PAs to be, essentially, permanent residents. They are there because the doctors want them to be there.

    My department was recenetly given the option of hiring either one new physisican or two PAs. They voted unanimously for the PAs.

    Now, I don't know what your exact experiences have been, or what the NPs in your hospital are like, but the NPs and PAs that I work with are knowledgable and delightful people. They know what they know, and they know their limits. The PAs in my department are all wonderful. Otherwise, we wouldn't have hired them , and we wouldn't keep them. Perhaps things are different where you are, or perhaps the cocky and obnoxious behavior is coming from the med students and residents. Medical students know nothing about patient care, and residents early in their training, know little more. So, as a student and PGY 1 and 2, it is likely that the specialty specific NPs and PAs ( and nurses and medical assistants, for that matter ) do know more that the residents, and it is a wise resident who will learn from them. Later, when you know more, you can teach them. But in my experience, if you show them appropriate respect, you will benefit a great deal in many ways. Don't compete with them. Learn from them and teach them.
     
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  36. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    There is not that much hostility towards PA here... and I don't think the hostility towards NP is unwarranted.
     
  37. DermViser

    DermViser 5+ Year Member

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    NPs are not in competition with Physicians? Really? You don't think fighting for independent, autonomous practice at the state level means anything? How about the rhetoric about going into primary care bc of the so-called "primary care shortage" but going into specialties? Also, if you work in a hospital setting, they aren't hired entirely by physicians, but more by hospital administrators esp. in places in which physicians don't wish to go there in huge numbers. I feel sad for you that you actually think NPs/PAs know more than your own PGY-1/PGY-2 residents. Please don't be disingenuous.

    Sorry, I actually care for my patients and don't wish to pawn off my patients who would come to my practice to a midlevel. Patients come in and want the biggest bang for their premium by seeing a physician, not an NP or PA.
     
    Last edited: 10.31.14
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  38. DermViser

    DermViser 5+ Year Member

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    Esp. when they say stuff like this:
    http://observer.com/2009/12/the-nursecrusader-goes-to-washington/2/
    For her part, Ms. Mundinger readily concedes that there are some things nurses are not educationally equipped to do: oncology, surgery, things that call for medical specialists. But she argues that, if anything, primary care physicians are overeducated. “I spoke to the Federation of State Medical Boards, the people who run all board certifications, and a primary care physician stood up and said, ‘Are you saying I wasted my time going to medical school?’” recalled Ms. Mundinger. “I wanted to say, yeah.”
     
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  39. W19

    W19 SDN Gold Donor Gold Donor 2+ Year Member

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    ......
     
    Last edited: 10.31.14
  40. KnuxNole

    KnuxNole Sweets Addict 10+ Year Member

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    There are quite a few people(greater than a third) who haven't worked a job, ever.
     
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  41. VisionaryTics

    VisionaryTics Señor Member 7+ Year Member

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    No, I'm an ENT intern. Otolaryngology is an integrated 5-year program where the intern year has a max of 3 months of ENT. According to the American Board of Otolaryngology: "at least nine months of basic surgical, emergency medicine, critical care, and anesthesia training within the first year". My non-ENT rotations are thoracic, plastics, SICU, gen surg x2, vascular, neurosurgery, trauma, and anesthesia.
     
  42. DermViser

    DermViser 5+ Year Member

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    Oh, ok, so the interprofessional stuff is on your non-ENT months.
     
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  43. Perrotfish

    Perrotfish Has an MD in Horribleness 7+ Year Member

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    As I near the end of residency I'm honestly not sure how I would compare the knowledge base of an NP to an MD. Questions:

    1) How do you normalize for time out of training? Am I comparing a PGY-2 to an NP with 4 years experience (time since undergrad), 2 years experience (time since graduating) or do I compare a new NP to a new attending? The fact that we label the first 5 years of our career training and they label theirs work makes it harder to compare.

    2) Do you compare their general knowledge bases, or just their knowledge of the area where they practice? If there is one thing that both my medical school and residency have exceled in, its been training me to do things that I will never, ever do, but I'm not sure that ICU trivia knowledge is a good way to judge someone seeing outpatient clinic.

    3) Do you care about cost? Bang for your buck is a ratio of bang to bucks.

    4) Do you normalize for intelligence? This is a big one: med school has rigorous admission standards compared to NP school. You could argue, reasonably, that if the (my estimate) 20-30% of NPs/PAs who could have gotten into medical school have an equivalent knowledge base to physicians, the training pathway is equivalent in terms of results.

    In my experience an NP who is similarly far from Undergrad at a given PGY will likely be functioning at a higher level than that PGY in the environment they work in, mainly because they have had the luxury of actually learning to do the job that they are going to do for a lving, while the PGY has spent half a decade accumulating useless or at best tangentially related knowledge by rotating in different work environments and, in medical school, in entirely different specialties. When comparing NPs to attendings I think the attending's knowledge base catches up to the NPs and on average surpasses it as the admissions standards begin to show, but the ones who are as smart as doctors tend to function at a level equivalent to physicians indefinitely.
     
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  44. KinasePro

    KinasePro Das it mane 5+ Year Member

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    Ladies and gentlemen: if you're curious why medicine has gone to hell in the last 2-3 decades, look no further. Hate to say it, but you sound like you're from the generation of doctors that has been asleep at the wheel for the last 30 years.
     
  45. BurghStudent

    BurghStudent lurker 7+ Year Member

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    I like how you think.
     
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  46. BurghStudent

    BurghStudent lurker 7+ Year Member

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    When all is said and done, I'd rather have the knowledge of the biochemical etiology of a disease than a superficial understanding: we all prefer that, that's why we attended medical school rather than the NP/PA route.

    If anything needs to change in physician education, it's not to decrease the difference between us and midlevels. That difference is our claim. Instead, I'd love to see an option in the U.S. to complete premed in 2-3 years.
     
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  47. DermViser

    DermViser 5+ Year Member

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    There already is. They're called BS/MD programs (the ones that are 6-7 years).
     
  48. Kahreek

    Kahreek 2+ Year Member

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    short answer: both
    long answer: It involves both.
     
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  49. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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    Whether an NP or PA can outperform a PGY-1 is more dependent on the background of that NP or PA than anything else. Most NPs and PAs have years of clinical experience prior to practice, which makes them more useful out of the gate than your average PGY-1. Sure, the PGY-1 has more knowledge, but it is scattered and they lack the ability to effectively apply it to their practice environment. By the end of residency, physicians are certainly superior, but at the beginning... Oh god, the dumb things I've seen interns do...
     
  50. seminoma

    seminoma 2+ Year Member

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    So would you rather be treated by an NP/PA or a PGY-1? You don't get to add any qualifiers like "experience level".
     
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  51. VisionaryTics

    VisionaryTics Señor Member 7+ Year Member

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    One of the quickest things I learned on night float was to NEVER trust the day interns if the attending or chief hasn't seen the patient yet.

    "Oh, the guy in 7 is just here with a malfunctioning AV graft, I don't even know why he's admitted. Next patient..."

    Walk in the room, patient is septic from pussed out graft. Delirious, no fluids fluids running, no abx.

    That same intern did the same thing like 4 times last month where he signs out patients in unrecognized sepsis/septic shock whom he restarts on their home statin and that's it.

    I started making sure I saw every patient in the unit myself when I came on for nights rather than just waiting for a nurse to give me a call when something went wrong. Learned to do that quick after some moron intern was running KVO fluids on a septic patient, and he went into florid shock with anuric renal failure and MODS about 2 hours into my first or second shift.

    I'm not some great genius or rockstar intern, but I've noticed some that just have zero ability to spot trouble and deal with it (and call the ****ing senior).

    All that being said, I've seen plenty of "veteran" NPs do equally stupid ****. That's why I think interns should be heavily supervised and NPs should be heavily supervised.
     

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