The Sim Cafe~

The Sim Cafe~ Interview with Elizabeth Horsley

December 18, 2022 Season 3 Episode 11
The Sim Cafe~
The Sim Cafe~ Interview with Elizabeth Horsley
Show Notes Transcript

Elizabeth is a very proud transplanted Canadian and former hockey mom. She is a graduate of Queen’s University (Arts ’89) and McMaster University (BScN ’93). She began her healthcare career as an Operating Room Nurse then transitioned to nursing education in 2003. In 2005 she was the lead on overseeing a half-million dollar grant from the province of Ontario to develop and implement a clinical simulation program in an undergraduate nursing program. In April of 2017 she was recruited to the position of Director of Simulation at The Brooklyn Hospital Center. She has transformed a forgotten simulation lab and random pieces of equipment in to a robust and thriving space in a community hospital. Her role runs the gamut from implementing deliberate practice modules for residents and medical students to incorporating simulation in staff education to enhance the patient experience to developing simulation activities for nursing education.

Elizabeth has pursued many advanced training opportunities in simulation including the Comprehensive Simulation Instructor Workshop at the Center for Medical Simulation at Harvard (2015), The Mastery Learning Course at Northwestern University (2017) and The Master Debriefer Course from The Debriefing Academy (2020). In 2016 she was in the first graduating class from the Master of Science in Medical and Healthcare Simulation at Drexel University. She is a Certified Healthcare Simulation Educator (CHSE) and facilitates on-line and in-person readiness review courses for this designation. She is currently serving her second term as Vice-Chair of the Society for Simulation in Healthcare Hospital-Based Section. Elizabeth was a member of the writing teams for two of the Healthcare Simulation Standards of Best Practice - Prebriefing and Simulation Design. She has an adjunct role with the University of St. Augustine where she facilitates simulation faculty development courses across their five campuses.

She is a self-admitted “hoarder of simulation resources” and her passion is helping novices learn best practices for developing and implementing their own simulation programs.

Elizabeth currently splits her time between Brooklyn and her family home on the Niagara Escarpment in Vineland, Ontario.
 
Email: Elizabeth: EHORSLEYtbh.org
SSH membership page: https://www.ssih.org/Membership-Engagement/Find-A-Member?Alpha=H

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This week's episode is brought to you by Innovative Sim Solutions. We are a team of simulation subject matter experts and consultants. With over 50 years of experience designing simulation centers and programs, we are here to help you save time and money. Innovative Sim Solutions is your one stop shop for all your simulation needs. Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host, Deb Tauber as she sits down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in, and learn something new from The Sim Cafe.

Deb:

Welcome to another episode of The Sim Cafe. And today we are truly blessed to have Elizabeth Horsley. Elizabeth is a very proud transplant and Canadian and former hockey mom. She's a graduate of Queens University and McMaster University of nursing. In 1993, she began nursing education in 2003. And in 2005, she was the lead on overseeing a half a million dollar grant from the Providence, Ontario to develop and implement a clinical simulation program. Elizabeth, would you like to start and tell our guests a little bit more about you then we'll get into, our interview.

Elizabeth:

All right, thanks. I am so thrilled to be here. I am such a fan girl of you, Deb, this program. I cannot believe I'm like on the illustrious list of people that you've had of guests. I like, as I said, I feel like the Sesame Street song, one of these things is not like the other is running through my head. So I am just thrilled to be here and I hope people, much like after simulation, they take one little nugget of something I say that they can take forth into their practice.

Deb:

Thank you. Thank you very much. And I think one of the things I've learned on this journey, being so blessed to have the opportunity to meet different people from around the world, and the Canadians are an extremely kind people. Just getting to know Ferooz Sekandapoor, Kevin King, Greg Vist, Meg Verkuly, Collette, you know, some of the guests that we've had on. And I just, I feel so fortunate to have gotten to know so many people virtually and just feel so empowered by them. And thank you very much for being a loyal listener. So very, very kind of you to

Elizabeth:

It's my pleasure. And I, I said I'm just thrilled to be here.

Deb:

Thanks. Okay. Why don't you share with our, with our friends your journey into simulation.

Elizabeth:

All right. Well, I think many of us have stories of more or less accidentally falling into simulation. Well, I can take it back a step further. And I accidentally fell into nursing. I went off to Queens University in Kingston, Ontario in 1985 with every intention of being a lawyer. Well, about three years in, I realized that it probably was not going to be the glamorous career portrayed weekly on LA Law, which we watched faithfully at school and doing a self-assessment. I just did not have a very much of a competitive or that killer instinct or neat nature that I would need to be truly successful. So I switched gears and decided to go to teacher's college, which required me for an application to get some good volunteer hours under my belt that I could put on a resume. I signed up to be a child life volunteer in the program at the Hotel Geo Hospital in Kingston. I immediately loved the environment and decided right then and there, I wanna be a nurse. Now, let me tell you, never ever had I ever considered nursing or any healthcare profession, ever the shocked look on family and friends faces when I made this pronouncement that I was going to be a nurse, like you could knock everyone over. Now, this was a time before compressed program, second degree programs, master's programs, you could enter if you already had a bachelor's degree. They were very few and far between. So I ended up going off for another four year degree to McMaster University, or which my brother refers to as Elizabeth's University Tour of Ontario. Now, another completely unexpected path for me in my fourth year of nursing school, I chose the operating room as my pre-grad placement. To this day, I have no idea why, because I had observed in the operating room when I was in second year, and I remember standing there going, who would wanna work here counting things for the rest of your life? But for whatever reason, this is what going back in the day, we had this computer disc and we could see the reviews of the clinical placements, the OR in the McMaster Hospital got this fantastic review as a learning opportunity. So I chose it. And of all things, I happened to get the most amazing preceptor. She was, I would say, doing forms of simulation long before it was a thing. She innately knew how to teach, how to educate. She knew what a learner needed. And I mean, I'm saying this is the early nineties and she was doing this, she's retired from nursing now and I of, I often say, you should have been, she would've absolutely rocked the simulation world. She's an outstanding educator and clinician and I couldn't be help but be swept up in all things or related. Another thing is when I graduated from nursing school, and this is the most shocking thing to say today, there were no jobs in Ontario. And so I was one of that mass exodus of Canadian nurses. I went down to Florida for a year and a half, and then I eventually went back to Ontario. So, you know, went down there first job in a 14 room, or it was a bit overwhelming to say at least I have some great stories to draw upon when I do work with our new hire nurses. So that was good. But I have to say, I always feel like the operating room was the best training ground for eventually going into simulation. Because I know airway, I know what anesthesia needs. I'm not afraid to open up a mannequin, get its insides. I know all my instrumentations and my trays. So certainly it was a great training for what was to come in my life. So 2003. Now, fast forward a little bit, the university near where I lived had an ad in the paper and they were looking for a nursing learning resource center coordinator for their new baccalaureate nursing program. And at that point I had two little boys and I decided, you know, take time off, look after the boys and do a little bit of work in my husband's business. But well, this job posting it might as well have had my vital statistics and a picture of me in the posting, cuz I had everything in it. I had community experience, I had a degree, I had medical surgical experience, I had all of these things they wanted and I had it all. And then some soap, I ended up, I applied and I got the job. And you know, it started out very well, 2000 3, 4, 5. But in 2005 the call went out from the province of Ontario to fund every program of nursing, whether it was in a university or a community college for funding so that you could develop an implement a sim simulation program. At that time, the chair of my nursing program was an absolutely incredible leader who asked me to take the lead on this initiative. So I put together a simulation lab not really knowing exactly what I should be getting. And you know, you mentioned Kevin King at the beginning and I met Kevin because I went up to, he, he would know that York University, and I believe he was with, was it medi at the time? And they had a simulated helicopter there showing off. I went up to see it and I believe I met him there. But oh gosh, do you remember back like 2004, 2005, 2006, Deb, everybody had a video recording system, right? Like we were all producing television shows in our labs and, well, one thing I wish, I wish I had that 50 grand back I'd spent on that. What I ended up getting was a cumbersome, glorified security camera system that was not even remotely user friendly. And it took nearly an hour to produce a watchable disc. So again, all those things we did back then before we knew any better. But I do remember the day the crates from Larado started arriving and I couldn't wait. I had Vital Anne up and outta the box before lunchtime and I went live with my first SimMan. And I'll always remember this, it was my 40th birthday on August the second, 2006. And my ladol rep took me out for birthday lunch too. So it was a very good day,<laugh>. So I worked along doing my best as a one woman show for a number of years. I tried to keep up with the literature and a 10 conferences when it all possible, but something was missing. I wasn't seeing these great aha moments among the students that I kept hearing about. If anything, our students, it was almost like they were frog marched into the lab, they went through this scenario, they couldn't understand and then somebody would yell at them that they should have known this cuz they were lectured about it. And I was kind of on the periphery, like how, what was something just wasn't going right. Around 2014, I was feeling very discouraged and I just pretty much resigned myself that I would be just pushing the buttons in the sim lab until retirement. Well, if anybody has ever been in that mood with your career, it only lasts so long until you really need more. So one very serendipitous day, and if I recall it was a Friday afternoon and one of those, you know, all those simulation newsletters we get, and to this day, I could have sworn I had unsubscribed when I was in my malaise about my career. I could have sworn I'd unsubscribed to it, but regardless, it popped up in my email and I saw an ad for a master's in simulation program from Drexel University in Philadelphia. Well, I thought that looks interesting, but what the heck good is that gonna do me here in Ontario? Then I read the small print. It was going to be online. Yes, online before online was cool, like a lot of things in my life, I just barreled right in without much thought, got my applications together and had my first class in August of 2014. Without a doubt, this was the best professional or educational experience of my career. You know, I remember at the end of our first one week block in Philadelphia, we were all sitting at our desk talking and no one wanted to leave. Oh, I so looked forward to our online sessions. I looked forward to posting in the forums and of course all of our in-person sessions. And you know what, yeah, I was a pretty devoted hockey mom, but our sessions were the nights of most of my son's home games. I did the Drexel sessions,<laugh>, wow,<laugh> forward on to 2016. I graduated from the program. Now by this point we had a new chair of the nursing department and she did not have much use for simulation. She referred to my role as me playing with toys. And her perspective was that simulation was a nice little add-on. We could do it the end of term if there was time, or what we often had was in this winter term, these days built on the end in case we had to take snow days. So if we had didn't use up those days, maybe we could do simulation then. Or if a local politician wanted a nice photo op at the university, the sim lab made a great backdrop. So I remember that June, I returned from an axle. It had been in Texas that year, and I was brimming with enthusiasm. I'd formed a small interest group with some new faculty that had come on board and just an interest group to look at simulation. And I began drafting an implementation plan for us based on the latest iteration of the Ann Axle standards. Well, that went over like the proverbial lead balloon. I'll skip all the ugly details, but eventually it was made very clear to me. There was no place for me in that department unless I agreed to be solely a lab instructor, no simulation. After some sleepless nights, I made the decision to resign. Now, in another bit of good coincidence, our lawyer happened to call my husband about another issue the night before I was to meet with human resources and I was planning to submit my resignation. At that time, I had that whole, I'm going to quit before they fire me mentality, you know, my pride getting in the way of anything else. I explained the situation to her and she told me, just let yourself get fired. You'll be entitled to severance. After all, I had 13 years and 13 exemplary performance reviews on my file. They had to give me something. And so that's what I did. I let myself get fired. Now, this is a topic for another LinkedIn post. The whole concept around getting fired, that's a really emotionally charged word, isn't it? Until that point, I just mistakenly thought anyone who got fired, it meant they were incompetent or lazy or they'd embezzled something. My frame on that topic certainly has changed. I was now joining the ranks of people who'd been fired. I was, as they say, walked out. I was accompanied by human resources and security on the walk of shame to the sim lab where I was carefully watched. I was given a few minutes to grab my purse, some personal items. Then basically told to get off the property. And the only thing my boss communicated to me through human resources on the way out after 13 years was, what's the password to get into SimMan? Oh, I wish I had changed it to something a little more colorful before I left. Now, funny enough, I was never ever worried I wouldn't land on my feet. In another serendipitous event, Suzie Kardong- Edgren happened to be in the Niagara region where I lived that week and took me out to dinner. As you can imagine, she gave me a huge pep talk and words of encouragement. A couple of weeks later, I went down to Albany to what I believe, and someone can correct me if I'm wrong, but I believe may have been one of the first SSH in NASCL, ASBY best practice workshops if memories serves me, I met Jared Kutzin for the first time. That workshop happened at just the right time. It cemented my thoughts. There was more to the practice of good simulation than what I had been doing. I just knew there was a place for me in this big simulation world. So in the meantime, I had a nice paid break. I cooked all the recipes that I'd pinned on Pinterest. I organized and ran the first aid tent for my son's CrossCountry meats, and I cleaned my basement. Later that fall, the chief of medicine at the Brooklyn Hospital Center contacted Sharon Griswold, who was the director of my master's program, looking for someone to come to his hospital and get some simulation going. He'd worked with Sharon in Philadelphia and he'd heard of her program he wanted one of her graduates while there were six of us in that class. Four had gone back to their employers The fifth, a friend of ours, Deb Matt Charnetski, Uhhuh<affirmative>, he was already in Kazakhstan. So that left me, I remember Sharon calling me at home. It was a Saturday afternoon. She said, would you ever consider moving? So the end of November, I flew down here to Brooklyn to have a look around the sim space was a small room with a lot of random pieces of equipment. If I remember correctly, one of those old, you know, those big old lait, all compressors was running. And I leaned over and I shut it down right away. I knew this was a fit and this was a place where I could make contribution on the home front. My oldest was away at university. My youngest son was looking into doing his grade 11 year abroad. So my husband and I decided I should try it for a year. Heck a year living in New York City. What could be so bad about that? And here we are nearly six years later, I'm out of renewals on my work visa. So I will be returning home sometime next year. It's going to be hard to leave, uh, but it's time. I've been allowed to do so much here. Plus I've had the time to get involved in the simulation extracurriculars, like facilitating chess courses. I was on the NASCL Plant conference planning committee for two years. I vice chair of the SSH hospital-based section and not, plus all the things I've been able to do at work. Very involved with patient experience training. Yesterday I ran a fabulous little workshop for the ambulatory clinic staff on basic code blue and rapid response skills. I've developed an empathy and communication workshop for our new hires. And quite frankly, I have achieved and accomplished more here than I ever, ever would have had. I stayed back where I was. So it's onward to the next chapter of my simulation career.

Deb:

Thank you for sharing your story and act on the walk machine too. That's what got me into simulation. I was fired from the assisted living facility I was working for. And at the time my daughter said she was going to Chamberlain. She said, you know, I'm going to school. And it just feels different. She had gone somewhere before for undergrad. And so I had one interview the night before I got fired, and then the next day I had my second interview and I got the job and I never looked back.

Elizabeth:

You know what, we had a woman, she was a consultant working in our hospital when I got here. It was 20 17, 18, 19. And she'd had a long and established healthcare career up and down the eastern seaboard. So she came to see me to see how we could use simulation. And that time I was still a little, I was fired. What will people think? So I said to her, well, I was fired. And she looked at me and she said, well, you haven't been fired at least once in your career. I'd have to wonder what you'd been doing,<laugh>. And I thought, well, there you go.

Deb:

There you go. There you go. Yep. So why don't you share with our listeners your favorite or most impactful simulation story?

Elizabeth:

All right. Well, one of my successes here was implementing simulation and effort to enhance our patient experience. Now, first off, there was a pretty steep learning curve for me with this. I had zero idea what an HCAP was, and I had to learn that when people said c m s, they were not referring to Jenny Rudolph and the amazing crew at the Center for Medicare Simulation at Harvard, but rather the Center for Medicaid and Medicare. So we designed a number of simulation based activities for every department in the hospital, from transport to nursing, to physicians focused on communication and interaction with patients one day. And anyone who's ever taken a class from me has heard this story because it is my best example of frames. We could not get our dietary staff to speak with patients when they're dropping the trays. So finally in the debriefing one one moment and spoke up and said that they'd all been trained at this food conglomerate where they were all told never speak to patients. Talk about your aha moments. There's the frame. Now let's close that performance gap.

Deb:

Wow,

Elizabeth:

<laugh> simple. But there it is. No one had found that out. I remember us all just oh,<laugh> finding that out.

Deb:

Wow. That's amazing. You can't make this stuff up though.

Elizabeth:

No,

Deb:

Right? No, no, you can't make it up. So what did you learn during the pandemic? What were you doing and what happened? And do you have a story from

Elizabeth:

Yes, I do. Well, let me go back a bit. In 2020, um,

Deb:

Can I just share something with you for right now, if for our guests who, who are not, you can't see us. I love watching your hands talk<laugh>. And I'm sure people who know you are gonna are are gonna be

Elizabeth:

Laughing<laugh>. Yeah, they they will. I they they're seeing hands in their head. Yes, I'm pretty sure they are. If anybody who knows me, yeah, I watched Zoom back of myself and I'm just all over<laugh><laugh>. All right, so Covid, let me go back a bit. When I returned to Brooklyn after Christmas break in January of 2020, I began the process of renewing my H one B visa for another three years. Once that process starts, cannot leave, the US seemed fine. My husband came down for 10 days in February. When he left, I said, I'll see you at the end of March, mid-March. My work visa was renewed, and I believe it was a Tuesday when I got the official notification right away. I booked some tickets for that weekend to go home for a few days. By Thursday, COVID had completely exploded through the Brooklyn Hospital. And two of our ICU docs looked at me and said, you're not flying this weekend, are you? I guess I wasn't so well now you know how this story went. My hospital was hit hard and we were one of the faces of the Covid pandemic. I ended up being redeployed to our newly created incident command center where I covered the night shifts. Basically, we set up one central phone line where any unit could call for any request, lab, housekeeping, transport, more P P E, whatever it was. They just called us, told us what they wanted, and then we dealt with the problem. I remember one night running low on IV tubing. I ran to the SIM lab where I found some unexpired packages that I was able to quickly get into circulation. It was quite a time indeed. And one of our transporters who had been so helpful, he was such a big fan of simulation. In fact, when I made my video in the, I think the 2018 Simulation Week video contest, he was the star of it, really got his transporter's loving simulation, and unfortunately he died of covid. So that was a really huge loss for us. People asked me why I didn't just pack up and leave when all this started, but I was a part of the team here. I just, that was not me to just bail on everyone. So I just pitched in where I could. Meanwhile, while we came out the other side, the travel restrictions, and then as the covid started to get its foothold in Canada, I still could not go home. The hardest day was October 28th, which was my 25th wedding anniversary. That was a very hard, I mean, if you knew me, I planned parties for everything. So I had this whole party in my head and thought, surely this won't go. I can still have this party, but my 25th wedding anniversary. And as I said, nowhere on my wedding day could I have foreseen 25 years down the road where we wouldn't be together. But finally I got home to Canada on November the 26th, 11 months after I'd last been there.

Deb:

Wow. That story gave me the chills,<laugh>, and I'm sorry for your losses. And it's always,

Elizabeth:

Oh, I think we all had a lot of, you know, it was just, just a straight, I mean, I got a, I say though, you know, technology between FaceTime with home and, you know, talking and FaceTime and texting and everything, we, we did our best. So it was a long, it was a long haul, you know, 11 months to not be home. And so there you go.

Deb:

Can you share with our listeners the biggest thing that you'd like them to know? Something that when you learned it, it changed the way you practice. It's like a personal aha moment.

Elizabeth:

Well, I have two if that's okay.

Deb:

Yes, of course.

Elizabeth:

Number one, I was at a conference and I went to a debriefing workshop and the facilitators asked about strategies that the learners aren't responding. His answer was not the usual about styles of learning and drawing people out or that eye roll. Students are just lazy anyways, aren't they? No, he said maybe the scenario wasn't right for them. And that changed my perspective right there. It brought into focus the importance of the needs assessment and appropriate learning objectives. I thought back to my very early days of simulation when a faculty member designed a scenario for first year nursing students who'd maybe been in clinical two or three weeks at that point, it was on diabetic ketoacidosis. Seriously, it was a disaster. And looking back, well, of course it was, those kids barely knew what a pancreas was or how to properly identify an insulin syringe. They should have been practicing health, teaching about diabetic foot care and counting carbohydrates so that this day, anyone who has ever taken a course from me knows I am all about the needs assessment. My second one, though, one of my instructors at Drexel, Dr. Sharon Kalman, said about designing and debriefing simulations. You need to ask what do you want them to know before they walk out the door? And that has stayed with me to the extent that is in bold letters on a paper, on a clipboard in my workspace. And it's the first thing out of my mouth when anyone approaches me for anything.

Deb:

Awesome. Awesome. I love that. And I'm have the honor of working with Dr. Beth Mancini, and she kind of taught me about that yesterday, about the leveling learning objectives for where the, where the students are. And I am so glad to hear that you say that because I think you're a hundred percent right. We don't, you know, have we considered the le the level that the learners at, are they ready for this?

Elizabeth:

Yeah. Right. What we, what are we using this for? Like, let's, you know that whole concept, it's the first week of nursing school, let's throw them all into a mega code just to see what happens. And then they just end up hating simulation. Yes. So she's awesome. She, if you ever heard her talk about feedback, and I, I've written this down, most important things. I heard her speak, it was up here in the Bronx at a simulation symposium. Most thing, most important thing we should be teaching healthcare professional students is how to receive feedback and how to give feedback. You've ever heard me talk about feedback? You've heard me quote Beth Mancini say that exact thing.

Deb:

I found out I was gonna be in my first SSH accreditation, and I remember Tom LeMaster saying, yep, just watch and learned how to just watch and learn

Elizabeth:

<laugh>. Oh, exactly. Oh my goodness. Yes. Yes. She was, uh, I saw her, I think it was 2019, I heard her speak and I was sitting there going, how have I not heard this woman speak before I, I don't know how I missed it. She was just absolutely incredible.

Deb:

Yeah, she is. And Elizabeth, where do you see the future of simulation going?

Elizabeth:

I think the future of simulation is part of a bigger picture of the future of teaching and learning in the health professions. I think, or at least I'm hopeful that that whole see one, do one, teach one has run most of its course. I'm hopeful that the school of thought of berate and humiliate, which is how those of us of a certain age we're taught, has also run most of its course. I'm thinking about simulation more globally, whether it's a mannequin, whether it's a standardized patient, whether it's a virtual activity. I think we're really and truly learning the best way to design and facilitate, quite simply do simulation. I've seen such a change in, in this, remember the early days in simulation when if you could program a handler, oh my goodness, that was just the absolute gold standard of performance. Or we went through that phase where everything but the kitchen sink went into a scenario. How could we make this as complex as possible? And of course, everything had to end in a cardiac arrest or a transfusion reaction, or both. Right. Trust me, I was never a theory person. All I can remember from nursing school is Dorothea Orum self-care deficit theory. But over the last decade, I have embraced and definitely gone down the rabbit holes of cognitive load, miller's pyramid currents, curriculum development model, constructivism, you named it. I feel like there's finally this alignment of knowledge of how people learn and how and where to simulation best fit in. We're not just doing things for the sake of doing it or because we have a fancy piece of equipment or somebody's as very cool virtual excursion or game or just because we can, we're doing things thoughtfully and purposefully.

Deb:

I, I agree. Thank you. Thank you for that.

Elizabeth:

I know most people answer that question with a virtual kind of thing, but I, I just see it a little differently.

Deb:

That's what these interviews are about. It's about seeing things from a different perspective. I have glasses on here and I can see through them, but if I gave you my glasses, you probably wouldn't be able to see

Elizabeth:

Frames

Deb:

<laugh>. Right. Anything else that you'd like to leave our listeners with?

Elizabeth:

I've just always, and I can never state this enough, the simulation world is just the most collaborative and sharing group ever. I don't know how many times now I get an email or something, I heard you do this, or somebody told me you this. Or even the, the sim connects form on the s s h, you know, I need a malignant hypothermia scenario, and by two o'clock that afternoon, you'll have half a dozen people giving you ideas. So I just think it's been the most wonderful, the path that got me here. I certainly didn't wake up in 1987 and say, you know, I think I wanna be a simulationist and I also, you know, use this. My kids are 21 and 25 and still finding their ways in the world, and I say, you know, my career didn't even exist when I was your age, so how do you know what's coming? So it's just been a great experience. All the people I've met, and I truly believe everything happens as cliche as it is, you can't see it at the time, but it does happen for a reason. I wouldn't trade anything to not have had this experience here at the Brooklyn Hospital Center. I've grown so much and developed so much, so I don't like how I got here necessarily. But de the journey wasn't great, but the destination's been awesome.

Deb:

Thank you. Thank you for sharing. And if our listeners wanna get ahold of you, where would they, where would they go to get to?

Elizabeth:

My email is at, if you put up EHORSLEYtbh.org, I'm listed in the find a member on SSH. Um, I don't think I'm too hard to find, not hiding from anyone.

Deb:

<laugh>. All right. Well thank you so much.

Elizabeth:

It was so fun to think about these answers and go back. I just, this has been wonderful. This is wonderful what you do. I love these.

Deb:

So, oh, you're so kind. Thank you so much. It's, uh, an honor for me to do. It gets me into that quote unquote flow moment where I kind of forget about some of the rest of the things that are going on in the world.

Elizabeth:

Yeah. Maybe we put together a presentation down the road when you have disruptions in your career.

Deb:

Right, right.

Elizabeth:

You know, like overcoming that. I mean, that's a, that was a huge emotional like thing, right. Trajectory. I love the word trajectory, but you always think it means shooting straight up. It's the little bumps along the way.

Deb:

Okay. Well thank you so much and happy simulating.

Elizabeth:

Thank you, Deb.

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