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#IAMSECafe Archives & COVID-19 Resources for Medical Science Educators

IAMSE Cafe Virtual Sessions

3/31/2020 MedEd Mailbag: The Virtual Teacher with Kelly Quesnelle
4/2/2020 Leading by Example: Practicing Self-care in a Time of Crisis with Adi Haramati
4/7/2020 MedEd Mailbag: Being Productive in Your Own Space with Kelly Quesnelle
4/9/2020 How Re-thinking and Re-designing Anatomy Instruction Into the Online Space Can Lead to Better Classroom and Cadaver Lab Learning Experiences with Jon Wisco
4/14/2020 MedEd Mailbag: Free Resources During COVID-19 with Kelly Quesnelle. Resources discussed and shared during this session can be found below.
4/16/2020 Q&A with the IAMSE President with Neil Osheroff
4/23/2020 IAMSECafe Welcomes Medical Science Educator EIC with Peter de Jong
4/30/2020 MedEd Equity During COVID-19 with Heather Christensen
5/7/2020 COVID-19 and the New Medical School with Amber Heck and Michael Lee
5/14/2020 Evolving Anatomical Education during the COVID pandemic: What will this mean for the future of anatomy teaching? with Jon Wisco, Richard Gonzalez and Lane Fortney
5/21/2020 Faculty Development in the COVID-19 Era with Alice Fornari
5/28/2020 IAMSE Ambassadors – Mexico, China, Caribbean with Raul Barroso, Sateesh Arja and Zhimin Jia
6/11/20 Communities of Practice in a Virtual World with James Pickering
6/25/20 The Future of Medical Education Conferences: What SHOULD it look like? with Bonny Dickinson
7/9/20 Partnering with medical students to discover educational solutions for on-line learning with Emily Bird
7/23/20 The Disappearing Pathology Instructor with Amy Lin and Regina Kreisle
8/13/20 IAMSE Ambassadors – Pakistan, Australia, and Finland with Di Eley and Yawar Hyatt Khan
8/27/20 Mentoring to Make a Difference with Katie Huggett – Literature references can be found here.
9/1/20 Networking 102 – Networking Outside the Box with Kelly Quesnelle
9/15/20 Team-Based Learning in the Virtual Environment with Drs. Raihan Jumat, Irene Lee and Peiyan Wong
10/6/20 Technology and Education with Edgar Herrera Bastida
10/20/20 The future of education programs for residents and medical students with Lourdes Lopez
11/3/20 Teaching Race and Medicine: Unlearning what we think we know with Staci Leisman
Links from the conversation during this session can be found here.
11/17/20 Learning During and From a Crisis: The Student-Led Development of an online COVID-19 Curriculum with Abby Schiff and Katie Shaffer
Links from the conversation during this session can be found below.

Resources for Educators During COVID-19

Harvard Medical School Medical Student COVID-19 Curriculum
One of the greatest difficulties facing everyone nowadays is a lack of clarity about what is going on and what lies ahead. We students especially feel a need to deepen our knowledge of the situation, as we are often viewed as resources by our friends and family. However, it soon became clear how challenging it was to process the wealth of information coming our way. A team of us at Harvard Medical School set out to quickly collate and synthesize accurate information about the pandemic to share with those who do not have the time or resources to research it themselves.
Additional resources include: Curriculum for Kids, an article written by the team discussing the curriculum and an opportunity to give direct feedback to the developers.

AAMC COVID-19 Resource Hub
The AAMC continues to monitor guidance from federal, state, and local health agencies as it relates to the coronavirus (COVID-19). Find information and updates from AAMC on this emerging global health concern.

Acland Anatomy
Acland’s Video Atlas of Human Anatomy contains nearly 330 videos of real human anatomic specimens in their natural colors.

MedEd Portal Virtual Resources
This collection features peer-reviewed teaching resources that can be used for distance learning, including self-directed modules and learning activities that could be converted to virtual interactions. As always, the resources are free to download and free for adaptation to local settings. The collection will be reviewed and updated regularly.

BlueLink Anatomy
From the University of Michigan Medical School

Aquifer
Aquifer is offering free access to 146 Aquifer signature cases, WISE-MD (Surgery), and WISE-OnCall (Readiness for Practice) through June 30, 2020, to all current Aquifer institutional subscribers in response to the COVID-19 outbreak.

Kaplan iHuman
With i-Human Patients, students experience safe, repeatable, fully-graded clinical patient encounters on their devices anywhere, anytime.

Online MedEd
The unprecedented COVID‐19 crisis has upended the medical and medical education landscape. Our aim during this difficult and confusing time is to support you with what we do best—concise, high–yield videos to help you get up to speed efficiently and effectively—so you can feel confident with however you’re being called on to adjust.

ScholarRX Bricks
In response to a request for assistance from a partner medical school impacted by COVID-19, ScholarRx has agreed to make its Rx Bricks program available at no cost to M2 students for the remainder of the 2019-20 academic year. This comprehensive, online resource can assist schools implementing contingency plans necessitated by the COVID-19 outbreak.

Osmosis
You can raise the line by training healthcare workers who don’t have experience treating COVID-19. Encourage healthcare workers you know to complete this free CME course on COVID-19 so they’re prepared to fight the virus.

AnatomyZone
Top quality anatomy videos, all for free.

Harvard Macy
Crowdsourced List of Online Teaching Resources Collated by the Harvard Macy Institute (@HarvardMacy)

Anatomy Connected

Chronicle of Higher Education

Dartmouth SOM Interactive Rad/Anatomy

Firecracker
We understand some of the unique challenges you are facing due to the COVID-19 pandemic and, as a company, are putting together resources to help you keep up with your courses as well as stay up to date with the latest research and evidence-based practices for addressing this new coronavirus.

LWW Health Library

Bates’ Visual Guide

5 Minute Consult
Primary health care is important to everyone, and now more than ever it’s important that you have access to evidence-based diagnostic and treatment content. To help you with caring for all of your patients, we are offering 30-day free access to 5MinuteConsult.com. Use code 5MC30DayAccess73173 to sign up.

Say Hello to Our Featured Member 2019 Annual Meeting Site Host Rick Vari

Our association is a robust and diverse set of educators, researchers, medical professionals, volunteers and academics that come from all walks of life and from around the globe. Each month we choose a member to highlight their academic and professional career and see how they are making the best of their membership in IAMSE. This month’s Featured Member is our 2019 annual meeting site host, IAMSE President Rick Vari.



Rick Vari, PhD
Professor & Senior Dean for Academic Affairs
Virginia Tech Carilion School of Medicine
Roanoke, Virginia, USA

Why was the Virginia Tech Carilion School of Medicine the right choice for the 2019 IAMSE meeting?
We are the right choice for the meeting this year because we did a fabulous conference several years ago and we were already in the queue for a future IAMSE meeting. We had some scheduling issues with our original site for 2019 and we were able to step in and fill the void. We have a wonderful hotel site (at the Hotel Roanoke), and the people who came from all across North America for the Collaborating Across Borders V: An American-Canadian Dialogue on Interprofessional Healthcare and Practice, in 2015 really enjoyed it. As a relatively new medical school, we are excited about continuing our growing success in medical education; hosting the IAMSE meeting is a real honor for us.

What opportunities will attendees see in Roanoke that they’ve not seen in years past?
Roanoke is a beautiful city to have a conference. We’ve localized the venue, which is a major goal for IAMSE. Attendees and exhibitors will appreciate the layout of the conference site. We are adjacent to the Roanoke Market Square with restaurants, breweries, and shopping featuring local items. There are just lots of opportunities for networking and entertainment. The program is outstanding with presentations and sessions on current and future challenges facing health sciences educators. International abstract submission is up, so more colleagues from other parts of the world may be attending. Increased student participation will be another highlight. This year, IAMSE is also hosting a Taste of Roanoke Street Fair which will replace the annual gala dinner. IAMSE 2019 is going to be a very easy conference to attend. If you can stay for the Grand Extravaganza on Tuesday afternoon it is going to be very special with a hiking trip to a beautiful location on the Blue Ridge Parkway and a visit to the Ballast Point brewery (East Coast operation) for dinner. 

Can you tell me more about this new event?
We are blocking off the Market Square in downtown Roanoke. We will have tastes of local food, beverages, and music. This is a chance to interact in a casual fun setting with lots of local food and a live band! It’s going to be a lot of fun.

What session or speaker are you most looking forward to this year?
I’m looking forward to, of course, the Board of Directors and Committee Chairs meeting.  I’ve enjoyed being president and interacting with the Board and Committee Chairs in this planning session provides IAMSE with a sense of solid direction.  The plenary sessions also look very strong. I’m interested in the Gen Z session (Generation Z: The New Kids on the Block) and How to Use Disruptive Technology to Make Education Better – Not Just Different.

It sounds likes there is much to look forward to this year. Anything else you’d like to share?
The local response from the other medical schools in the area in support of the IAMSE meeting in Roanoke has been very strong.  As a new school, this is a tremendous opportunity for us and the other medical schools in the area to get better acquainted.

To learn more about the 2019 IAMSE Annual Meeting, including the plenary speakers, workshops and networking opportunities, or to register, please visitwww.IAMSEconference.org.

Reserve your spot before March 15 to ensure the Early Bird Discount!

IAMSE at GRIPE 2019 in New Orleans

The IAMSE booth will be exhibiting at the annual winter meeting of the Group for Research in Pathology Education (GRIPE) in New Orleans, LA on January 24-26, 2019. IAMSE Association Manager Julie Hewett will also be delivering a pre-conference workshop titled, “Using Social Media to Disseminate Your Scholarly Work.” If you plan on attending this meeting, don’t miss this session and do not forget to swing by the IAMSE booth and say hello!

Information on the GRIPE Meeting can be found here. We look forward to seeing you there!

Registration for the 23rd Annual IAMSE Meeting is Now Open!

We are pleased to announce that registration for the 23rd Annual Meeting of IAMSE, to be held June 8-11, 2019 in Roanoke, VA, USA, is now open. At this annual meeting of the International Association of Medical Science Educators (IAMSE) faculty, staff and students from around the world who are interested in medical science education join together in faculty development and networking opportunities. Sessions on curriculum development, assessment and simulation are among the common topics available at the annual meetings.


Featured plenary speakers include Don Cleveland, Claudia Krebs, Craig Lenz and Geoff Talmon.


Additional meeting details and registration can be found at http://www.iamseconference.org.

*Reminder* Pre-Applications for IAMSE Excellence in Teaching Awards Still Being Accepted

Since 2007, IAMSE has honored medical educators from its membership with two prestigious awards to recognize and promote teaching excellence and educational scholarship in the medical sciences. We are still accepting nominations for the 2021 Excellence in Teaching awards, which will be presented at the annual meeting in June 2021. Qualified candidates may self-nominate or be nominated by an IAMSE colleague. 

Details regarding each award, required application materials, and deadlines can be found here. Member login is required.

Please submit the pre-application packet for the Early Career and Distinguished Career awards to support@iamse.org by December 31, 2020.

Thank you for your continued support of IAMSE!

We want to say a big THANK YOU for your continued support throughout this challenging year. Because of you, we are able to bring a broad and diverse representation of non-profit and commercial entities forward for consideration during multiple times at our annual meeting each June.

We hope that you will consider exhibiting with us at our virtual meeting, to be held from June 12-17, 2021. The IAMSE meeting is a perfect place to display educational products and services and engage with meeting participants from around the world. We look forward to meeting our much-valued previous exhibitors again, as well as welcoming our first-time exhibitors.

We will have specific information regarding exhibiting opportunities to share with you in the coming weeks. Registration for the event will open in early 2021. If you have any questions about exhibiting with or supporting IAMSE, please feel free to reach out to us at support@iamse.org.

#IAMSE21 Call for Poster & Oral Abstracts Deadline Extended

In light of the shift to a virtual-only conference in 2021, IAMSE would like to remind you that the call for poster and oral abstracts has been extended! Abstracts are now due December 8, 2020! The IAMSE meeting offers opportunities for faculty development and networking, bringing together medical sciences and medical education across the continuum of healthcare education.

Deadline: December 8, 2020

There is no limit on the number of abstracts you may submit, but it is unlikely that more than two presentations per presenter can be accepted due to scheduling complexities. Abstract acceptance notifications will be returned in March 2021.

#IAMSECafe Hosts to Hold Open Discussion on Resilience

Stay connected with your colleagues around the globe and join us for this week’s IAMSE Cafe round table discussion. Please join our hosts, Francisco Raúl Barroso Villafuerte from the School of Medicine in the Health Science Division of Anahuac University of Mexico as well as Kelly Quesnelle and Wendy Lackey-Cornelison of WMU Homer Stryker M.D. School of Medicine, for an open conversation about resilience.
 
Tuesday, December 1, 2020 at 10AM EST – Resilience: An open discussion with IAMSE Cafe Hosts. Resilience and adaptability have been recognized as important attributes of successful medical students and clinicians. These traits may be even more important today as both students and faculty have to cope with the additional stresses associated with learning, teaching, and practicing during a pandemic. How do we help build resilience in ourselves and our students? How do you model resilience for others when you are struggling? 
 
To join the meeting please click here. The meeting password is IAMSECafe or, if you are calling in from a phone, the numeric password is 778130.
 
We look forward to seeing you this week!

An Important Update on the IAMSE 2021 Conference

#IAMSE21 Now Exclusively Virtual

The IAMSE Board of Directors, based on input from the IAMSE membership and our meeting partners, has decided to shift all events associated with the 2021 Annual Meeting, Global Perspectives on Health Sciences Education, to an online format. Although we may be able to gather in small groups by next June, the cascade consequences of the COVID-19 pandemic, including ongoing safety concerns, restricted travel, budget allotments, and availability, have forced IAMSE to make this difficult but necessary decision. 

I want to recognize and thank so many of our members for the work that they have put into the 2021 Annual Meeting over the past year. The IAMSE Board is especially grateful to Mark Hernandez, who is leading the meeting planning, and to the Annual Program Committee for their work. They have responded graciously to our announcement to transition the in-person meeting to an online format and are in full support of the decision. They are currently back at work to bring you an amazing online version of our Annual Meeting.

We recognize that many of you have been debating whether to present your work at the 2021 IAMSE Annual Meeting due to uncertainties and concerns regarding travel. Therefore, we are extending the abstract deadline for oral and poster presentations from December 1st to December 8th, 2020Click here for more information!

Even though we will not be meeting in person this year, we have shifted our focus to create a virtual event that promises to be just as robust and educational as any IAMSE event you have attended or heard about in the past, with several exciting new opportunities to complement the virtual venue.

  • Virtual Plenary Presentations – Each of our four plenary speakers will deliver their planned presentation with live Q&A. Each evening, our plenary speakers will join us once again for a rebroadcast of their presentation and a second live Q&A session for our colleagues around the globe who were not available to attend the original session.
  • Workshops and Focus Sessions – We are excited to announce that we will be offering the same synchronous educational opportunities through pre-conference workshops and focus sessions as you would expect at an in-person meeting. 
  • Poster and Oral Presentations – We anticipate a record number of poster and oral presentations for our 2021 Meeting and we plan to provide participants both synchronous and asynchronous opportunities to interact with authors and their content. You will enjoy live and virtual poster presentations and live oral presentations just as you would at an in-person event. 
  • Abstracts – As with previous meetings, all accepted and presented poster and oral abstracts will be published in a special issue of Medical Science Educator, which is the journal of IAMSE.
  • Exhibitors – There will be opportunities for participants to interact with exhibitors, both individually and as part of group presentations.
  • Awards – The awards and grants normally associated with the Annual Meeting will still be conferred. Individuals will be recognized through online announcements and will be honored live at the virtual meeting.
  • Business Meeting – Consistent with our bylaws, each June we hold our annual business meeting as a public event to inform members about the current state of IAMSE. We will still hold this meeting and will send along more information as it becomes available

For the past several months, IAMSE has been working closely with our partners at AMFEM (Mexican Association of Faculties and Schools of Medicine) to collaborate on combining our intended in-person meetings in Cancun in June. While we are no longer working toward that specific end, our partnership with this exceptional association will simply take a new direction. We look forward to the great work we can do together safely in the future. In this regard, I am pleased to inform you that we are planning to come to Cancun as the site for our Annual Meeting in 2023 and we hope to work with AMFEM to bring you the in-person meeting that we had planned to have in 2021.

I understand that attending the IAMSE Annual Meeting in a virtual manner may not have been your original intention, but it is my hope that you will join us as we continue a tradition of rich, engaging and worthwhile educational discourse at the 2021 IAMSE Annual Meeting.

Please be on the lookout for additional information regarding the meeting in the coming weeks.

Take care of yourself and your communities.

Sincerely yours,

Neil Osheroff, PhD
President, IAMSE

IAMSE Administrative Office Closed for Thanksgiving

As those of us in the United States prepare for Thanksgiving, we would like to extend a sincere THANK YOU for being a part of our success and daily lives.

The IAMSE Administrative Office will be closed on November 26-27, 2020 for Thanksgiving. We will resume normal business hours Monday, November 30, 2020.

We are truly grateful for the support you have provided to us at IAMSE. As we look forward to 2021 we are excited for the new opportunities that may lay ahead.

Thank you,
IAMSE Admin Team

Last Call for IAMSE 2020 Board of Director Nominations

As a reminder, nominations and self-nominations for the IAMSE Board of Directors are due by November 20, 2020 at 5 PM EST. The formal “job descriptions” for IAMSE Director are posted here. To submit your nomination or self-nomination by November 20, 2020 at 5 PM ET, please click here to login and view the submission page.

#IAMSECafe Welcomes Harvard’s Abby Schiff & Wolfram Goessling

Learning During & From a Crisis: The Student-Led Development of an Online COVID-19 Curriculum

Stay connected with your colleagues around the globe and join us for this week’s IAMSE Cafe round table discussion. Join our host, Kelly Quesnelle from Western Michigan University Homer Stryker M.D. School of Medicine as she welcomes Abby Schiff and Wolfram Goessling (Harvard Medical School, Boston, MA, USA).
 
Tuesday, November 17, 2020 at 10AM EST – Learning During and From a Crisis: The Student-Led Development of an online COVID-19 Curriculum. In mid-March 2020, a group of students at Harvard Medical School came together to synthesize existing information about the COVID-19 pandemic into a unified learning resource, which is faculty reviewed, frequently updated, and freely available online. It is now used by readers in 132 countries and for credit at 32 medical schools. Drs. Schiff and Goessling will share key insights into the development process, the challenges of presenting rapidly changing subject matter, and the model of student-led curriculum design.

https://curriculum.covidstudentresponse.org/

To join the meeting please click here. The meeting password is IAMSECafe or, if you are calling in from a phone, the numeric password is 778130.

We look forward to seeing you this week!

Zooming far and wide to learn about medical education? Do tell!

As you may know, IAMSE maintains a listing of medical education conferences on our website. We’d like to expand our listing of conferences, but to do this, we need your help!

Will you be attending any in-person, virtual or hybrid conferences this year or next year? If you are, please let us know! You can send this information to us via email at support@iamse.org.

Currently, the listing of conferences is located on the IAMSE website under the Events heading as Events of Interest. Here, you will be able to find information on other conferences that may be of interest to you.

A Review from Medical Science Educator from Dr. Kurt Gilliland

This month the IAMSE Publications Committee review is taken from the article titled Reviewing the Role of Instagram in Education: Can a Photo Sharing Application Deliver Benefits to Medical and Dental Anatomy Education?, published online in Medical Science Educator, (July 2019), by Naomi Katherine May Douglas, Max Scholz, Matthew Alex Myers, Shivani Margaret Rae, Ahmad Elmansouri, Samuel Hall & Scott Border .

Douglas and colleagues conducted an audit investigating current Instagram accounts focusing on anatomy education and found a variety of successful teaching styles. Their work was a collaboration of the University of Bristol, Brunel University London, University of Southampton, and Southampton General Hospital, all of the UK.

With reduction in curriculum time devoted to anatomy education, faculty have begun to incorporate social media such as Facebook, Twitter, YouTube, and Instagram. While these various forms of social media have advantages (e.g., encouraging collaboration/revision, creating enthusiasm, providing quick feedback, and sharing other media easily), they also have disadvantages (e.g., distraction, privacy/safety, need for constant instructor engagement, potential professionalism issues, and possibly no impact on student performance). The authors recognized that Instagram in particular is ultilized more and more by students and thus decided to review its role in medical and dental anatomy education.

Instagram, which was launched in 2010, allows users to share photographs and short videos and to browse images shared by others very easily, expressing comments about and approval of those images. Instagram has become particularly useful for image-based disciplines such as radiology, surgery, pathology, and of course anatomy/histology. The strength of this article is its Instagram evaluation, which was conducted in the fashion of a literature review. Using keywords (e.g., anatomy education, dentistry, medicine, etc.), they discovered and categorized 80 anatomy-related Instagram sites according to search code, page title, date of first post, number of posts, country of origin, discipline/subject area, content type, number of followers at two different points in time, profit status, institutional vs. individual, and staff vs. student.

The authors conclude that Instagram could be helpful for anatomy education in medicine and dentistry due to benefits such as ease of use, hashtags, and effectiveness in conveying visual topics. They also point out, however, that there is a lack of performance data to determine a true impact on education, and they indicate that there are limitations such as passive learning and the requirement of committed staff to oversee the use.

This paper presents an excellent comparison of Facebook, Twitter, YouTube, and Instagram and in a very detailed fashion describes utilization of Instagram in anatomy education in medicine and dentistry with a discussion of pros and cons of its use.

Kurt Gilliland, PhD
Associate Dean of Curriculum
Associate Professor of Cell Biology and Physiology
University of North Carolina School of Medicine
Member, IAMSE Publications Committee

Reminder #IAMSE21 Call for Poster & Oral Abstracts Due December 1

The International Association of Medical Science Educators (IAMSE) would like to remind you that the call for poster and oral abstracts is still open for the 25th Annual IAMSE Conference to be held June 12-15, 2021. The IAMSE meeting offers opportunities for faculty development and networking, bringing together medical sciences and medical education across the continuum of healthcare education. New in 2021, IAMSE will be offering registration for the in-person event as well as virtual-only registration.

Deadline: December 1, 2020

Have you always wanted to submit a poster but you can’t attend the meeting in person? No problem! IAMSE encourages abstract submission for posters and orals even if you are unable to attend the face-to-face meeting in Cancun. All accepted posters and orals will be hosted on our conference website for viewing.

There is no limit on the number of abstracts you may submit, but it is unlikely that more than two presentations per presenter can be accepted due to scheduling complexities. Abstract acceptance notifications will be returned in March 2021.

Register Now for the IAMSE Winter 2021 Webcast Audio Seminar Series!

The debate about the pros and cons of the United States Medical Licensing Examination (USMLE) Step 1 score reporting has been ongoing for over a decade. The issues are complicated and both positive and negative aspects of score reporting can be cited, depending on where you are positioned in the UME-GME continuum. In March of 2019, the Association of American Medical Colleges (AAMC), American Medical Association (AMA), the Educational Commission for Foreign Medical Graduates (ECFMG), the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) convened a multi-stakeholder Invitational Conference on USMLE Scoring (InCUS) to explore issues and concerns regarding the USMLE Step 1 exam and to consider recommendations specific to USMLE score reporting and the broader system of transition from UME to GME. A general consensus emerged: the current UME-GME transition system is flawed and not meeting the needs of stakeholders. As a result of further stakeholder discussions, the USMLE decided that beginning with the administration of Step 1 in 2022, the exam will be scored as pass/fail and no numeric score will be reported. Join IAMSE beginning January 7, 2021, as they present:

USMLE STEP-1 is Going to Pass/Fail
Now what do we do?

In this five-part series beginning Thursday, January 7, 2021, recognized experts from the various stakeholder groups will present and discuss the impact of this decision, identify challenges to their respective programs and explore creative ways to address the consequences of this important medical education milestone. These thought-provoking sessions will include the perspectives of allopathic and osteopathic residency program directors, basic science faculty, undergraduate medical education curriculum designers, clinical educators, and programs that involve international medical students matriculating to the United States.

Sessions in the Winter 2021 series include:

  • January 7 at 12pm EST – Mark Jordan and Justin La present “The Challenges of Resident Candidate Assessment and Selection”
  • January 14 at 12pm EST – Doug Gould presents “Pass/Fail Step 1: Implications for a Foundational Science Department”
  • January 21 at 12pm EST – Jonathan Amiel presents “USMLE Step 1 P/F: A UME Curriculum Dean’s Perspective”
  • January 28 at 12pm EST – Brenda Roman and Bruce Morgenstern present “Step 1 Going Pass-Fail: Are We Just Kicking the Can Down the Road?”
  • February 4 at 12pm EST – Jack Boulet and Bob Can present “USMLE Step 1: Osteopathic and International Perspectives”

As always, IAMSE Student Members can register for the series for FREE! Email support@iamse.org for more information.