Kristen Carnahan's unique path to becoming a clinician will inspire you as she shares her journey of moving from clinical practice to academia and back into private practice. We talk through the critical principles of lower limb prosthetic alignment. Kristen also touches on her specialty, active vacuum suspension systems, which have evolved significantly over the last two decades. Bringing this episode to a close, we look to the future exploring the potential of 3D printing, scanning in practice, and their promise.
Kristen Carnahan's unique path to becoming a clinician will inspire you as she shares her journey of moving from clinical practice to academia and back into private practice. We talk through the critical principles of lower limb prosthetic alignment. Kristen also touches on her specialty, active vacuum suspension systems, which have evolved significantly over the last two decades. Bringing this episode to a close, we look to the future exploring the potential of 3D printing, scanning in practice, and their promise.
Welcome to season six of the prosthetics and orthotics podcast. We are absolutely thrilled to have you on board. We're talking to experts who know their stuff, the patients who've experienced these technologies firsthand, the vendors who provided the tools and the thought leaders shaping the future. Together, we will uncover the ways to make the lives of those relying on these incredible technologies even better. We hope these discussions are going to be the highlight of your day.
Speaker 2:Hi everyone, I'm Joris Peels and this is another episode of the prosthetics and orthotics podcast with Brent Wright. How you?
Speaker 1:doing Brent. Hey, Brent, hold on a second.
Speaker 2:Wait a second, I'm Joris, you remember? Yes, thank you, joris.
Speaker 1:Well, hey, joris, I meant to say why didn't you introduce saying hey, we're live from Berlin?
Speaker 2:Okay, okay, we're live from Berlin. I guess I like the high Brent, though we should keep that though.
Speaker 1:Oh, my goodness, what a disaster. We'll keep it just because you requested it.
Speaker 2:Is this an emergency day at work, brent, is it?
Speaker 1:Well, you know, what's crazy is we're doing a bunch of demo because we're actually bringing in two more color machines, and so my office is no longer, and so, literally, I'm on a stand-up desk in a corner somewhere away from it and we've just had it's just been crazy, yeah lots of orders, lots of interest in 3D printing and such, and so it's weird, as far as just it's starting to snowball a little bit of people truly interested in 3D printing like hey, this could be a thing. So I think that's exciting.
Speaker 2:Is it like word of mouth? Is it how you're getting your customers?
Speaker 1:I think some of it is word of mouth. I think some of it is literally. People have been watching for four or five years, waiting for this fad to go away, and now it's like not going away and they're like okay, maybe I need to at least look into it a little bit.
Speaker 2:I think that makes a lot of sense. It makes a lot of sense. But that's good news, man, super good news. Well, not good that you don't have an office, but it's good that it's because you guys are expanding and getting new machines in. So, yeah, I was on the podcast today.
Speaker 1:Yeah, well, I'm really excited to have Kristin Carnahan on the show. She is a certified prosthetist or orthotist and she has done a bunch of things. She has done a bunch of stuff in the vacuum world with ProCare, which was out of Atlanta. She was also a professor at Northwestern University and then she now is at Michigan, the University of Michigan prosthetics and orthotics center, where she'll be doing some clinical stuff, some R&D stuff and all that. So I'm really excited. She's experienced, been in the field for a while, so I'm very excited about getting her perspective on the field in general where things are going A little look into some of her specialty, which is elevated vacuum. So I'm really excited to hear her journey.
Speaker 2:Sounds good that sounds good.
Speaker 3:Welcome to show, Kirsten. Thank you so much for adding me.
Speaker 2:So, kirsten, first of all like so how'd you get started in OMP?
Speaker 3:Okay, well, I'll try to keep this somewhat concise, but I think it's helpful to kind of share the whole story a little bit. I actually had considered pursuing medical school when I was an undergraduate, and so I had like a minor in pre-med or a focus in pre-med, had all those prerequisites whatever. And then when it came time for graduation, I was like, well, kind of done with school for a little while, I think I'm going to go ahead and get a job. So I did as an engineer and after about five, six years started to think back a little bit to this desire to work in the medical field. And at that point medical school seemed like a bit much to get into in my late 20s.
Speaker 3:So I started looking at you know what are some other options in the medical field that I could pursue, and so I investigated several different career options and sort of stumbled on orthotics and prosthetics.
Speaker 3:And the way that that happened is I was actually clicking around on the Georgia Tech website looking at their rehab engineering graduate program and trying to understand what type of research they were doing, and through their program website I clicked on something that landed me on the orthotics and prosthetics program website and it wasn't really anything flashy I don't know how many people maybe remember from those years like looking at the Georgia Tech program website and nothing against Georgia Tech or their program, but you know, just had a couple photos showing people you know working with others. Most of it was like faculty working with students or students with each other, and it showed a few orthoses. And it caught my attention because I could tell right away that this was something that would blend my love of engineering and problem solving with patient care and working with people. And so I started to investigate it further and confirmed, after spending some time with a few practitioners in their offices, that this was something I really was interested in and wanted to pursue.
Speaker 2:Everyone's journey is pretty much unique, but it's pretty much like one thing that keeps coming back is people like to either tinker or kind of more maker type people, or craft type people, or engineers or maybe you haven't been engineered but kind of should have been engineered, kind of and they're kind of getting into this. They find this kind of fusion of this thing. So this, you know this really succinct thing, helping people and engineering or helping people and some medical stuff that kind of keeps coming back. But I love that every time we ask people and it's like completely, it's like almost completely random, whatever you already got here, so, and then did you also fall in love with this?
Speaker 2:Did you also, like? We're always like, oh my God, this is going to be like my life consuming passion. Was there a moment, as well, when you had that?
Speaker 3:You know I yeah, I do love the profession and I've loved working with patients.
Speaker 3:Seeing the difference that we make in the lives of people has been extremely rewarding.
Speaker 3:So, yeah, I guess you can say that I've fallen in love with it and made a decision to dedicate, you know, my career and life's work to this profession. At this point it's interesting when I made the decision to leave clinical practice and enter into the world of education and teaching, it was really hard. It felt like I was walking away from that love to an extent, you know, giving up on my patients or kind of letting them down in a way. But what I've learned is that those patients and my colleagues clinically were really supportive and saw the same vision that I saw, which was teaching gave an opportunity to have a different and even broader impact on the profession. And what drew me to it was not only that but also the opportunity for me to learn more, to have a broader view than just what I was seeing in my own little clinical world, which was great. But I definitely have experienced that just being able to see more, see different types of clinical settings, what people are doing across the country and the world, which has been really interesting.
Speaker 2:It's interesting to me because everyone is pretty much very hands on here. Even if you have your own practice or even if you have a chain or something like that, you're pretty much more hands on than you would be in a lot of other managerial positions, a lot of other jobs, and there's also no purely academic path really, but there could theoretically be. There's a few people that are purely academic, do ortho-arch research forever or something. I don't think that really exists. So to me it's really interesting like the switch between working with patients every day and also understanding in front of a classroom must be really, really hard. It must have been much more so than in other disciplines, right?
Speaker 3:It wasn't as hard as you might think, and I think the reason is that kind of going back to what you asked me earlier, yours, which is do I love this profession? And the answer is yes, and that passion is really what I think provided a foundation to me for teaching and being able to do so with some level of confidence, even as I was learning new things and experimenting and deciding, after trying some different things, what could be improved upon. That process of learning and growing is similar to clinical practice, but I would say that what fueled my teaching the most was my passion for what we do and for doing it really well. Okay, that's cool.
Speaker 2:That sounds very logical as well. But then how do I know if you can find the person who's a career practitioner? How would I know that teaching is right for me? Because I have a passion for the profession. Tons of people have that. What's the real way that I could know? Is it that I like to tell stories or I like to train people? What are the ways that I can know that teaching might be right for me?
Speaker 3:Yeah, that's a really good question in yours, and I would say there are a couple of things that I would ask someone who's considering this idea of transitioning to teaching, and one of them is do you love sort of the digging into the hard questions of why Not just how we do things, but why and that's a challenge across our profession we don't have a long-standing history of providing really weird and convincing arguments for why we do many of the things that we do. We sort of have this approach, a tend to have an approach of well, I've tried this and I know that it works and there's nothing inherently wrong with that approach and that mindset, but that doesn't really give you a solid foundation for then training someone else, and so being comfortable with and even enjoying the pursuit of why is really important, I think, to ensure not only that you will enjoy teaching but that it will be a good fit for you in terms of your skills and interests. So that's the first thing is really loving to ask the question why and digging for those answers.
Speaker 1:So, Kristen, I was just curious though on the question of why and I know that's a big part of also residency side of things, and I love that there is that perspective instead of, hey, you do it this way because we've been doing that and making copies of the same textbooks for you know since what? The 30s and 40s and 50s, even seeing some of those go around. But as far as the why question, when you got into teaching and such and you start diving into some of this, do you have any examples of where your perspective has changed, or even your opinion of how something should be done or should not be done, changed?
Speaker 3:Yeah, that's a really good question, brent. I would say that one thing that I personally spent a lot of time digging into when I started to teach more than I had, admittedly, more than I did in practice is understanding the why behind our lower limb prosthetic alignment principles and practices. So you know, there are a couple of ways that one when you're learning that you can approach alignment, and one really anything that we learn. One approach is to memorize the information that's put before you get through the exams and all of that and then get into practice and kind of figure out some practical way to make that work for you.
Speaker 3:And I would say that to some extent that's kind of what I did, maybe with a little bit more inquisitiveness, but I would say, admittedly, I kind of took that route and I realized, when I was faced with this challenge of teaching, that this is not sustainable and I'm not comfortable getting up and trying to walk somebody through something that I can't defend and explain really thoroughly.
Speaker 3:So I spent a lot of time going back to you mentioned the textbooks from the 30s, 40s, 50s. I went back to some of the original publications that gave us our foundational principles for alignment and I found that many of them were written by engineers and they did provide some really sound reasoning and explanation for the principles that we still use today related to lower limb prosthetic, alignment and many other things. But that's one area, brent, that I did explore and would say you know kind of. As I'm going back into clinical practice now, I feel much more confident in being able to approach that with a sound understanding of the foundational principles rather than just relying on my practice and what I've been shown, if that makes sense.
Speaker 1:Can you? So? What would you say, is your overall philosophy now on alignment? Hop into the weeds with us just a little bit on that.
Speaker 3:Yeah, I don't really have necessarily a totally different philosophy, but I guess I would say one takeaway for me from that journey of exploration is that the principles that we use are based on seeing the alignment at a particular moment in time, and typically that is at mid-stance for the prosthetic limb, thank you.
Speaker 3:And the bench alignment that we talk about is intended to simulate that point in time during the gate cycle, and so if you keep that in mind when you're observing what you see in gate, then you can kind of you can understand and troubleshoot quite a few things that are happening elsewhere in the gate cycle.
Speaker 3:If you first focus on what's happening at mid-stance and I would even say, backing up from that, you want to first actually assess that alignment statically before the person starts walking, and there are a couple things to look for statically. One of the things that will come as no surprise to anyone, I don't think, but that for me was not a primary focus before I started teaching alignment is that all of the principles that we use are they assume that not only we're working on setting up the patient or the user for success at mid-stance, but also we're assuming that there is a weight shift occurring through the hips towards the prosthetic side at mid-stance or through-stance phase. If that isn't occurring, then we have to make different assumptions essentially, and so that is a critical thing to look for when we're thinking about lower limb alignment for prosthesis.
Speaker 2:And just from my benefit a little bit what's the controversy here? I mean, is it really random? Is it different for every single person, or how does that work? I know nothing right.
Speaker 3:I don't think there's a controversy. I would just say that we definitely have some principles that are rooted in some very clear assumptions, and if we aren't really aware of what all those assumptions are, then we can kind of get lost at chasing some alignment challenges that maybe aren't as complex as they seem. So I would say we can really simplify the process by first understanding the person, their strength and looking for those clues, particularly, as I mentioned, looking for that weight shift to occur over the prosthetic limb at mid-stance. So no controversy here. I would just say that when we start, when we're in the process of assessing particularly dynamic alignment, and you get to a point where things seem a little confusing, it's hard to pinpoint one problem, for example. The best approach at that point is to go back and assess the starting point and assess your static alignment and what your goals were and why you had those goals. So there aren't that many different principles that we're employing in this process and so some of the goals that we have in lower limb prosthetic alignment are related to the componentry and some of them are related specifically to the person and you are asked to answer your question.
Speaker 3:The primary thing we'll see that's different in people for, let's say, trans-tibial alignment, is when they are at mid-stance. What is the position of the residual limb in space and we typically talk about that as being adducted. Abducted or neutral, neutral is somewhat rare, and so observing that and taking that into account in your initial alignment and then assessing it early on in your static alignment, before you start getting into walking and dynamic alignment, is really important, and when things seem a little bit difficult to discern, going back and reassessing that statically is really helpful. Also helpful to remember that that angle is affected by, or can be affected by, the placement of the foot in the coronal plane. So whether the foot is sufficiently or insufficiently inset can impact what we're seeing and assuming about the angle of the limb in that same plane.
Speaker 1:So, joris, a couple of examples of this and it's super great for actually new clinicians and clinicians that are residents is like what Kristen was saying is that there are some engineers and some basic foundational principles behind alignment and it's a great place to start.
Speaker 1:And what I find interesting sometime and I was guilty of it very early on in my career too is you start making these big alignment changes and then it just doesn't look right and you keep on.
Speaker 1:We call it kind of like chasing your tail, like you make one alignment change and then something else happens and then when you take the prosthesis off and step back and you go, oh my goodness, I'm really far away from my foundational alignment. So then it's a couple of things. One is it is it the patient that has had some sort of traumatic type of injury or something where the anatomy is different than what it normally is, or is it the way that I fit my socket, and my socket actually is not fitting the way I expect it, and so those two things definitely affect alignment. But what you wanna do is remember to come back if you're start chasing your tail, come back to your original alignment and we call it the bench alignment and then move on from there, because you can go round and round and you'll keep on chasing problems, because the angles that we're dealing with are not just vertical angles and right angles, they become compound angles and those compound angles become really, really hard to chase.
Speaker 3:Yeah, brent, you said that really well with regard to going back to your starting point, and then you also brought up something else that I failed to mention, which is the absolute foundation before we could even begin to think about alignment is the socket fit. So thank you for mentioning that and not letting us forget. To kind of go back to that is really the primary foundation, and you shouldn't be working on your alignment at all if there's issues with your socket fit.
Speaker 2:Okay, and these things again. There's no test or anything. Is there a definitive, or do you have to kind of do it by eye all the time?
Speaker 3:So, yeah, the test is really the prosthetist's professional observation and opinion, based on the things that were taught in school and in practice and residency. So we're looking to achieve some specific goals in the person's gate and typically the goal is to have them achieve the you know, I guess you can't really see this, but ultimately the goal is to have the person walk with the least amount of energy usage that's required for them to use that prosthesis. We know that anyone wearing a prosthesis is going to be using more energy to do the same things that we do without a prosthesis, and so the goal is typically to minimize the amount of energy that's required. And often what that will look like is getting as close as possible to something that looks symmetrical, and that's not always going to be the ultimate goal, but that's certainly one principle that we use is looking for symmetry with the other side, assuming the person has a unilateral involvement.
Speaker 1:Yeah, I think that's a good point. And Yorah said I mean, I don't know if you've ever seen anybody just limping in general, not necessarily because, they have a prosthesis, but you notice they're limping right off the bat, right Because we're used to seeing symmetry.
Speaker 1:So a little bit of a funny story. We've had Faisal on. He's above the near Nidus articulation amputee and he was talking about how symmetry was really important to him, not only because he does the lifting and all this stuff, but he had a funny story. He went weightlifting with some buddies of his wearing shorts, had a prosthesis on, so very visible. But he is walking, lifting and running with symmetry and all of a sudden his buddy goes down and goes hold on a second. You have a prosthesis on.
Speaker 1:I can't believe it. Well, he never even noticed because Faisal was acting or working with symmetry. So nobody's going to look kind of down and see what's wrong unless they see some sort of limb. And so I think that's that is. The real key is what Kristen was saying is symmetry, and that's the goal for all amputees. Now there's ways to get to it and there's definitely theories around that and alignment stuff to get there and definitely very. You know it's tweaks, it's combinations of components and the patient walking and that sort of thing, but that's the ultimate goal is symmetry.
Speaker 3:Well, I think we have to keep in mind too, to Brent that yes, that is certainly a goal that we try to attain, but we have to keep in mind that not every person is physically going to be capable of that goal. It may not be the best solution for every single person that we work with, and so, you know, being aware of that person's particular strength, range of motion, limitations, if there are any, is really important. Considering the level of amputation and the implications of that on the ability to achieve symmetry is important, and so I think, yes, it's a great goal to have and something we work towards, but we have to acknowledge that it isn't always possible to achieve, and so getting close to that is potentially going to be the best solution for different people. So just wanna kind of acknowledge that. You know, yes, symmetry is nice, but it isn't always going to be the gold standard for every person.
Speaker 2:Yeah, and then if we're talking about like fit, right, the next step, then right, is there any way to judge someone's comfort? Because, like, everyone has a different, do you have a vocabulary for that, or do you, because I can imagine everyone's patient is different, everyone's legs different, the biomechanics are a bit different, you know, how do you judge that comfort, how do you kind of try to translate that back into improving that experience for that person?
Speaker 3:Oh yeah, you're opening up a whole can of worms here with that question. So, yeah, I think, yes, fit is actually first before alignment, but we just happened to talk about alignment first. So, yeah, socket fit and comfort how do we assess that? I think the first thing to keep in mind as a prosthetist is assessing the fit is going to be dependent on what the goals are and the goals are influenced by the design and vice versa. So each system that we design and by system I mean the whole socket, so that includes the design of the socket, so the shape in relationship to the person, the suspension mechanism and then any interface material and the materials of the socket itself. So there are a lot of factors that influence this whole socket system that we design and fabricate and fit. And how we do that, how we assess it, should be dependent upon what our initial goals were at the beginning of the process. So, for example, if our goal is kind of going back to something that's been taught since the 50s, as Brent alluded to earlier, and is still taught today and used perhaps more in other countries than in the US, still the PTB socket design. So we have some specific goals with the PTB socket, some specific suspension mechanisms that work well with it and interface materials, and when we're assessing that design, we're looking for different things than if we have a socket system that is made with different goals, for example, a total surface bearing socket design with vacuum suspension and a gel liner interface. Now we have different goals and we're going to assess that differently. One example is that you know the.
Speaker 3:I would say one way to describe this is the tolerance of fit. With a socket that is utilizing vacuum suspension as part of the system, I think we all know at this point that tolerance of fit is very, very small. There is almost no margin for error and to the extent that we use flexible materials in some aspects of the socket, we can accommodate a little bit more tolerance of fit, for example. But in a PTB socket we have a larger tolerance for error, for example, the goals still must be met. So maybe error isn't the right word, but we don't have quite the same expectation of the fit being matching the limb to the exact specifications as we do with a TSB and vacuum system.
Speaker 2:Okay. Okay, let's talk a little bit about these vacuum systems then. Okay, so that's a relative ball and it depends on the time frame, I guess. Tell us about vacuum systems, what's the state of the art of this vacuum world?
Speaker 3:let's say yeah well, active vacuum suspension has been around now for I guess over 20 years and was introduced by the late Carl Casper's and developed by him. There were quite a few early adopters I'll call them of this system, and one of those was Stephen Schulte, who I worked for and with for many years, as well as the late Russell Walker, who worked with him and learned alongside him as well. Those guys were not the only early adopters, but they certainly were, and they were working with Carl to investigate, try different things. They were kind of like the what Brent Wright is to 3D printing. They were to vacuum systems, I'll say so. They were pushing and using and not really not as active on social media, I'll acknowledge but in a sense they were trying new things and willing to take the risks that are involved with something that hasn't been established yet. So, in terms of answering your question, you're like, what is the state of the art? I think the principles of active vacuum are pretty well established at this point in terms of how to apply it and how to apply it safely and effectively.
Speaker 3:There are a few things that we're still questioning to some extent, and that has to do with what are the specified and measurable or quantifiable benefits of active vacuum. We have quite a bit of evidence that helps us understand what some of those benefits are. The maintenance of limb volume has been, I'll say, somewhat controversial, but the studies that find different results are approaching that question in different ways, which is really great. We need to approach any type of theory or question and research from different directions so that we can really fully assess the question that we're asking, and so that particular aspect of vacuum systems has been evaluated quite a bit and we've seen that in most cases that this principle has been maintained, that the volume of the limb doesn't fluctuate as much or is maintained at a larger volume with the use of vacuum. Then, without A few other things that we've seen reported in the literature, we've seen that the vacuum systems can and have shown to heal wounds while being utilized. There is no other socket system that has been able to produce this type of result, and so that's really encouraging. Despite knowing some of these benefits, and I'll mention one other benefit that's been reported in the literature, which is that the amount of motion or piston-ing piston-ing being one of those motions within the socket is minimized by using active vacuum versus any other suspension, including passive suction or locking liner or any other anatomical suspension system. So if you want to minimize piston-ing, then active vacuum is the suspension that should be considered. There are other factors to consider as well, but we've seen all of these benefits reported in the literature In terms of state of the art as application.
Speaker 3:There are some principles that we've seen that are very effective and there are multiple options, I would say, in terms of socket materials and approaches. Some people really support the use of sleeves and some people really avoid the use of sleeves in terms of creating that sealed space. But regardless of the how or the materials that you're using, the underlying principles that drive the use of active vacuum I think are well understood, and myself and some others over the last four or five years we've presented a few times at academy meetings and held different sessions to bring up this discussion to help those who are interested in using this system learn how to use it effectively. I would say, just in closing this topic, one of the things that I always recommend to someone who asks me well, how do I get started with vacuum?
Speaker 3:I would say don't do it in a vacuum, pun intended. Don't try this alone. Make sure that you have a mentor, whether it's somebody present with you in your office, which is preferable, or someone that you can call. Make sure that there's someone who has demonstrated effective use of this system that you can count on to help you troubleshoot and work through challenges, because they will come, and there are certainly many people who have attempted to use active vacuum, run into issues a few times and then just decided it wasn't worth their effort or trouble, whatever they want to call it, and I would tend to want to have a discussion with those people and try to understand what the challenges were, because the system, when approached and designed and implemented according to the principles that we have in place, it works really well.
Speaker 1:Yeah. So now that you're moving from this world of academia to private practice, what are some of the things that do get you excited about practicing again? Are there some things that you're wanting to dive into, find out more about, or is it just seeing patients again, or what is it?
Speaker 3:Yeah, I'm actually excited about quite a few things, brent, and one of those is just getting back into the relationships that we build with our patients.
Speaker 3:You know I've experienced a totally different type of joy in developing relationships with students, and I still stay in touch with a number of former students, and so there hasn't been necessarily a void, so to speak, with that, but the patient relationship is certainly different, so I am looking forward to getting back to that.
Speaker 3:Additionally, you know I'm excited about being in a clinical environment that is very busy. We'll be seeing a diverse population of patients and there will be a lot, of, a lot of variety, but also a lot of the same types of patients, and what that leads to is the ability to collect information, data and to perform some level of clinical research within that clinical setting, and University of Michigan has some great research resources to support that within the clinical setting. So those are two things and along the lines of kind of maintaining my love of teaching and mentoring. University of Michigan is well known for their residency program. I actually was a resident there an orthotics resident many years ago, and so I'm excited to be able to serve as a residency mentor to some of the current and future residents going through that program.
Speaker 2:That sounds like really exciting moving back and forth. And for you, we haven't talked about 3D printing and the digitization thing yet, because you have so much to talk about. So what's your take on that? I mean, are you like a super fanboy like Brent? Or are you kind of like more cautious, or are you saying, hey, it's something that we could use in some places? What do you think the role is of like additive manufacturing 3D printing, for example?
Speaker 3:Yeah, I'm glad you brought that up Because prior to going into my teaching role, the practice that I was in really wasn't adopting 3D printing or scanning. I had some very limited exposure to scanning in my orthotics residency, actually back at U of M. They were early adopters, particularly for cranial remolding orthoses and for some of the spinal orthoses as well, but in University of Michigan I just continued to kind of move forward with adopting more scanning, carving printing, and so I'm excited to learn from the practitioners there who have been using this technology and I'm excited to try out some things. Am I a little bit nervous about it? Absolutely, because it's different for me. It's not my comfort zone, so to speak. So I'm going to have to experience some of the discomfort of learning to adapt and hopefully adopt some of those practices.
Speaker 3:And it's interesting because over the last several years, as I've been teaching as a member of a pretty large faculty, we talk a lot about what can we be doing, how can we teach these new techniques and still teach the older, more traditional techniques?
Speaker 3:And I think that's a question that I'm hoping to be able to help contribute to as I experience learning a bit more about this in practice.
Speaker 3:I think that our gut reaction as practitioners particularly in kind of my age range and maybe even older, those of us that learned everything non-digitally we have a tendency to think that the best approach is to do everything that we did and then learn how to do the newer approaches or implement the newer technologies, and I'm not sure that that's really going to be effective and sustainable. We don't have the time in the training process to teach what we have been teaching and then add more, and so we're going to have to learn and figure out how to teach the fundamental principles that we need to achieve the goals that we have for our patients, but also kind of learn to use the newer technologies in that process. And so all of our educational programs are asking these questions and certainly, as I'm going back into practice and hopefully learning to embrace the newer technologies more, I hope to be able to offer some perspective and input into helping answer those questions and create some solutions for not only practice but how we're teaching and training future practitioners as well.
Speaker 2:That sounds wonderful. I love the fact that you're qualifying this. You're not like oh yeah, teach everything. It's amazing. I love the fact that you said look, we have constraints and this is a new thing but there's lots of other stuff going on, so I think that's a really realistic approach. I think it's going to really benefit everyone. So thank you so much for your time today.
Speaker 3:Absolutely. Thank you for having me on your podcast.
Speaker 2:And Brent, thanks for being here again.
Speaker 1:Yeah, this was great and thanks Kristin for hopping into the weeds just a little bit on some of this stuff the vacuum, and also sharing the perspective around education and here at the end of 3D printing. I think that's all good and great perspective for our listeners. So thank you.
Speaker 2:So, everyone else, thank you for listening today and have a wonderful day. This is another episode of Perception on the lecture podcast.