LAURA KAVANAGH: I don't know that I can reassure you. I think you have to look at this issue from so many different levels. You have to look at it from a self-improvement standpoint. What can you as a training program do to improve your outcomes individually?  And I don't think that should cause you to pause or even to take a deep breath cause you do that everyday. And you're improving your management systems the best you can within the organizations in which you work. At the level of individual training programs, I think there've been some innovations in looking at assessment and it's been a hard road. The Pediatric Pulmonary Centers are one of the few groups that have looked at this across the program and done an assessment of trainees. What are they doing now?  How are we measuring success over time?  And I really struggled with it. But I think that they would, I mean, I'll turn this over to the PPC's who are here. I think you would agree that that was a good experience over all. It helped to bring you, turn you in different directions in terms of what you are emphasizing within your programs. We cannot continue as nationally as an MCH training program to pretend that performance measures don't exist and they're not going to be used over time to, for us to defend our programs over time.

When I first started working on the training evaluation before I came into the federal government, I asked *Woody *Kessel and Ann, so what kind of assessments have been done at the MCH training program previously?  How are you defending these when Congress comes to you, and says, they had no data? That, we can't, that can't continue. We will not survive if we don't have outcomes data that show, and when I say outcomes data it's not all quantitative. I fully appreciate the value of stories, the value of, it's always my favorite part, pardon me faculty, but it's always my favorite part when we do site visits to talk the current and the former trainees. I love talking to you too but I really do love talking to the trainees because you hear the impact that this training program is having on them on a daily basis in the midst of their training and then as you talk to the former trainees, they reflect on it a bit more and they talk, I mean, it becomes a bit more insightful over time, of course, as all of us are able to.

We have to struggle with this issue. I want you to view this as a partnership for us to come up with outcomes. It makes sense to both of us. I don't want you to be, I had a conversation with Kate *McClain in the elevator as we were both going to, where's Kate?  There she is. Talking about progress reports last night. I don't want you to be collecting data that isn't meaningful to you. I don't want my staff to be reading progress reports that aren't meaningful to them. I mean, we need to, we need to have, be collecting the data and reporting data to Congress, within her, so within the department it makes sense to us and this is a partnership for us to move forward. I don't know if that helps to reassure but I see this as a partnership. It's not something that's going to come down on high to force you to report on measures that aren't meaningful to you. I hope that the existing performance measures that we're struggling to develop and they need work, but they're, I hope they're moving us in a direction that helps us to tell the story about what MCH training is achieving. Thank you.

UNIDENTIFIED SPEAKER: Just a follow up to that, I mean, I think a fundamental difference between this sort of thing in an organization being, you know, Volvo, or Nokia or whatever and what we're doing is that, you know, Nokia and Volvo's revenue is not going to be cut off all of a sudden if they don't get a Baldrige award, you know. So if our reporting and our outcome measures have a lot more at stake. And I guess one way to think about this is maybe we ought to look at, you know. What you're saying is what we don't need to be—

LAURA KAVANAGH: Right spending our time on—

UNIDENTIFIED SPEAKER: --and, you know, what's something really meaningful—

LAURA KAVANAGH: Right.

UNIDENTIFIED SPEAKER: --because I think all of us spend an awful lot of time and money compiling huge amounts of data that—

LAURA KAVANAGH: Right.

UNIDENTIFIED SPEAKER: --that are, you know, accumulate dust somewhere. Not really being meaningful input.

LAURA KAVANAGH: Right, right. Government doesn't work fast enough for performance measures to have an effect on your funding in the, I mean.