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Gold, incentives and meh

Stop med school GP 'banter' to boost recruitment, says RCGP

The RCGP and Royal College of Psychiatrists have teamed up to call for an end to stigmatising ‘banter’ in medical schools, which they claim is contributing to the shortfall of GPs and psychiatrists and stifling efforts to put mental and physical health on a par.

College chiefs Professor Maureen Baker and Professor Sir Simon Wessely warned the ‘systematic denigration’ of general practice and psychiatry is putting medical students off these specialties - and said all doctors should take a stand against it.

It comes as latest figures revealed only 100 extra GPs have joined the workforce over the past six months, despite Government aims to boost recruitment and retention of GPs, and the RCGP’s own efforts to raise the profile of general practice amongst students.

In an editorial published today in the British Journal of General Practice, Professor Baker and Sir Simon noted that recent research has shown general practice and psychiatry are the most derided specialties during medical school training, and that medical students are rejecting careers in each ‘because of the stigma attached to them’.

They said a 'hierarchy' that has developed across all medical schools ‘puts physical health over mental health, hospital care over community care, specialism over generalism, and "medical" specialties over "non-medical” ones’.

This also ‘perpetuates the view that hospital-based specialties offer more excitement, clinical challenge, and prestige’ than general practice, which is seen as a ‘back-up’ option, the College leaders argued.

And they warned the stigma around psychiatry – including throwaway comments referring to psychiatrists as ’pest controllers' – is hampering the drive to achieve parity of esteem between physical and mental health.

The editorial concluded: ‘The systematic denigration we are seeing in medical schools is founded on misperceptions that maintain a negative impression of both general practice and psychiatry, and a lack of respect for the importance of these specialties.

‘It is exacerbating a shortage of GPs and psychiatrists in the NHS, and directly contravenes efforts to achieve parity of esteem between physical and mental health, causing a negative impact on patient care.’

The RCPsych is already pushing a #banthebash campaign, to ‘address Badmouthing, Attitudes, and Stigmatising in Healthcare’, and Pulse understands the RCGP is in the process of developing a GP version of the campaign, with the help of members and medical students.

But Professor Baker and Sir Simon insisted their campaigns are not about ‘prohibition of banter’ but about ‘fostering respect between specialties and an understanding that the NHS is predicated on having sufficient numbers of all medical specialties, so that we can keep patients safe and well'.

Professor Baker, who has consistently complained about medical schools’ ‘toxic anti-GP culture’ during her time as chair, said it was ‘depressing’ how little attitudes had changed.

In a separate comment, she said it was ‘very concerning’ that ‘this “banter” is yet another barrier we are up against when trying to recruit enough GPs to ensure a safe and robust service for the future of patient care’.

She added: ‘It has to stop. The College is doing what we can to challenge misplaced and archaic stereotypes, and our Think GP campaign aims to show what a fantastic career choice general practice can be – but it’s clear that more needs to be done from within medical schools, and medicine as a whole.'

Br J Gen Pr 2016; available online 29 September

How medical school ‘banter’ is putting medical students off general practice

Professor Baker has previously raised the College’s concerns about the ‘toxic anti-GP’ culture with medical school leaders, and called on them to each individually tackle what she called ‘blatant bigotry’ against general practice.

But evidence of prejudice against general practice has continued to surface, with one medical school dean telling students they 'must work hard to avoid failing and becoming GPs'.

More recently the head of the RCGP in Wales claimed junior doctors were too scared to tell trainers they intended to go into general practice in case they were barred from experience on secondary care procedures or clinics, with NHS England primary care commissioning chief Dr David Geddes acknowledging the stigma around general practice.

NHS England chief Simon Stevens has also waded into the argument, accusing Oxford and Cambridge Universities of failing to promote general practice to medical students. GMC research from last year found that 'elite' universities are shunning general practice.   

 

Readers' comments (51)

  • never noticed it beyond a few jokes that were just that

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  • The reason that General Practice used to be valued by medical students was:

    1. Autonomy - not being told what to do
    2. Reasonable income and pension
    3. Manageable workload
    4. Continuity of care

    Look at GP now...a very sorry state...

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  • 4.09am.Hear hear,all of the above being debased by our employers and our supposed leaders.

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  • Ivan Benett

    It doesn't help if we're all negative about it. How about some positive stories from Pulse? A series on 'Why I'm a GP and what I get out of it'? or similar
    The negativity, especially in these comment pages would put anyone off. I despair sometimes at some of the 'anonymous' stuff that gets printed. We provide a first rate service (by and large) and get great rewards. OK it's not perfect, but it's better than any other public sector employment I can think of.
    PS not just monetary rewards.
    I know GPs would moan even with a silver spoon in their mouths, but really it's time to big our profession up, not slag it off.

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  • Ivan Benett

    PS what are you doing commenting a 4am?? Get some sleep

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  • and those naughty silly GPs in NI who are threatening mass resignation when its all so nice and dandy.

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  • Ivan

    I think positive talk works for people in marketing and politics and other make believe parts of life.

    Most medics pride themselves on intellectual honesty.

    Medics overall have been self critical about some of the the failing of medical school and training and the impact it is having on young dr's. But we are clear that political leadership ( or the lack of ) is destroying the core benefits of general practice.

    Someone mentioned continuity of care - most young doctors's now refuse to recognize how important it is - because it conflicts with their choice of medical lifestyle - i,e to be part time.

    We should not construct fake positive stories - there's BS around without us contributing to it.

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  • Can't this woman take a joke? We have to everytime the college churns out its latest crackpot ideas. Talk about clutching at straws.

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  • GP is a shit job.why anyone would want to do it?

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  • I venture to suggest there a few other more pressing issues that exist with regard to recruiting and retaining GP's than medical school banter.

    However I cant commit them to this response as the moderator would be very busy.

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  • Once GPs stop being wet walk-over cardigans then maybe med schools will stop taking the pi$$.

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  • It is only a shit job because the politicians made it so.

    Emigrate and practise in a country that values you and tries to make your life easier.

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  • On the other hand, RCGP, maybe you should also stop trying to persuade people that it's better than it is, with your "never been a better time to be a GP" nonsense and your colouring book bollocks.

    Spin works both ways you know.

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  • does that mean we can't make jokes about the literacy of orthopods or the communication skills of surgeons any more either?

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  • A few years ago when QOF was introduced the juniors were tripping over themselves to get GP job. If GPs are paid well with a manageable workload then there will be no problem.

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  • I remember the same banter when I was at med school in London not too long ago. I had no intention of doing GP then. I recall a lecturer stating that 50% of us would be GPs. When the realities of life hit you after med school and being treated like shit in hospitals on-call rotas, weeks of nights, moving around so much geographically percieved 'prestige' suddenly became completely insignificant and GP became very appealing high income (have been on 6 figure salary since reg year), can settle in one area, can choose where you want to be (for me near London). Despite recent pressure still much happier than I was in hospital medicine, earning much more money and settled in nice area wife kid and big house. My advice to med students and junior doctors would be to look around at the lifestyles of your senior colleague in hospital medicine and GP. You will find consultants can do very well in high earning specialties (mainly surgical) but need to work very hard in PP to make good income (only a minority are making mega bucks and that is after a lot of very hard work). You will also find a lot of very well off GP partners on a very good income 120K+ which is achievable soon after VTS.

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  • I started GP training in August and I've already noticed a marked difference in the attitude of my Medical Consultants and Registrars towards me. They aren't bothered about teaching me anything because they say you "well, you don't really need to know this". They give the impression that we are not worth their investment. I did acute medicine for three years before going into General Practice and I never had this experience then.

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  • Hogwash! Lack of insight by these colleges, blame "others" eg medical school.
    Stop subscribing comrades!

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  • I have said for many years that general practice is the hardest job in medicine to do well and the easiest to do badly.

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  • So, it's the "banter" that pushes general practice down the chute.
    Nothing to do with underfunding, doing hospitals' dirty work, CQC inspections, bureaucracy and litigation.
    I wonder if Lady Wessely has any comments to make.

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  • Not a result of medical school banter, more a result of inadequate leadership, hoist by your own petard at last, have waited almost 40 years for this. Set yourself up as better than others then the only way is down. Suck up to politicians the only way is down. RCGP needs to be dissolved as a self centred money making enterprise that should never have been given royal patronage considering it cost £20 to join initially. They have no credible teaching body, although they may think they have. I cannot comment on psychiatry but I suspect the same... look at Freud and his offspring.

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  • @Ivan

    Take it you missed the Good News issue of Pulse then???
    Think Pulse are doing their best to promote good news.

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  • Not convinced banter has much to do with it.
    When I started around 25 years ago GP was good "fun", although not quite Golden Age
    Now it isn't (but I don't think our hospital colleagues are having much fun either!)

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  • I know several GPs who've advised their medical student children not to bother with GP land.

    I wonder why?? GP land is "so great" as in "Oh, Great!!"

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  • Banter is very different to the institutionalised dismissiveness of the consultants and medical school deans that we're supposed to be teaching us as undergraduates. Too much medical school is lead by the "clots" in bow ties who were such nerds all they had was there delusions of academic superiority. GP is a great job but being ruined by people who don't appreciate it

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  • try and improve work conditions for GPs or blame 'banter' - suppose blaming banter is easier to so.

    the only mystery is why does the RCGP have so many members when there is no one that i know who admits to being a member ?

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  • I think that the "closed world" allegation applies to GPs, too. Some feel we are lucky / privileged and do not appreciate our pay and conditions. Lots of people in the UK work hard, but none harder,but if you look at other people's workload, lifestyle and levels of responsibility, ther RCGP should not be trying to say it is all roses. Perhaps the RCGP should get out of London: al;l that Nitrous Oxide has finally got to you. Get out and look about:similarly hard working professionals have much better conditions and lives than we do. It is not just the patients who have become institutionalised by the NHS!

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  • THIS IS ALL RUBBISH. WHEN I WAS A MEDICAL STUDENT AT THE START OF THE 1990s, STUDENTS REGULARLY TOOK THE **** OUT OF GP CAREER CHOICES BUT MANY BECAME GPs (LIKE ME)-THE DIFFERENCE IS NOT THE BANTER BUT THE PRESS AND THEIR HATRED AND OBESSIONAL FIXATION WITH DERIDING, HUMILIATING, RIDICULING AND TERRORISING GENERAL PRACTICE AT THE DEMAND OF GOVERNMENT SPIN DOCTORS.
    JEREMY HUNT SHOULD BE HELD PERSONALLY RESPONSIBLE AND ACCOUNTABLE FOR THE SHORTAGE OF GPs AND START MUZZLING HIS SPIN DOCTORS.

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  • 1-20 I agree. I think the current working conditions justify the negative portrayal. Our local VTS has less than 25% recruitment for this year. It is probably too late..if we want General Practice to survive, we need a thermonuclear change right now: retention is going to hit even faster than recruitment. Oh look, its 1939, where did all those tanks come from? (we watched in idleness then, too!)

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  • Is there an actual substantive and quantifiable basis for this focus on undergraduate teaching. As far as I'm aware, the derision and debasement occurs in a post-graduate setting to a much greater degree - by secondary and primary care colleagues to an equal extent. I've met students who want to be GPs during teaching sessions, but it's FY1/2 experiences that will decide their outcome. Altering the perception doesn't alter the reality.

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  • I love listening to the banter of medical students, they are bright, young things having the time of their lives. Leave them be, reality will hit home soon enough.

    And when the RCGP sends out colouring-in books and felt-tip pens to newly qualified GPs, what other possible reaction is there?

    Enjoy your milk and biscuits at breaktime guys (banter, obv!)

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  • I really don't think it's the banter that puts people off these careers.
    With psychiatry it's probably the fear that you might ' catch' the mental illnesses going around and with GP it's because it's generalist not specialist. Both jobs are hard.
    I think that this story is old news. It may have been relevant even 5 yrs ago but now no one wants to go into medicine at all; relatively poor pay; no respect; risk of GMC etc hanging you out to dry; negative publicity etc etc etc. I don't know any medic who would encourage their children into the job. That speaks VOLUMES

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  • My kids had good A level results and I didn't need to put them off Medicine. They said "no way are we going to do what you do " , alluding to the long hours, dwindling income and general feelings of being responsible for Jeremy *unt's random decisions in the public's perception!

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  • Ivan @7.14

    Hi Ivan, Please remember O/seas GPs thinking about coming back to the Uk are also reading these posts. 4 am in the Uk is the middle of the working day for doctors in Australasia and the Americas. Don't patronise us. It is more than enough reading these comments

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  • My son goes to Oxford medical school and despite its academic elitist undertones he has never heard ANY negative attitudes to general practice on the wards or from within the medical school. His negative attitudes towards GP come from his time spent in GP seeing GPs ground down by patient volume, snowed under by pointless bureaucracy and the constant denigration of GP by the press.

    Indeed Ivan we also dont do ourselves any favour......
    "Dr Ivan Benett told delegates at the event in Liverpool that most GPs 'do not listen' to patient concerns and the service was 'no more democratically accountable than the greengrocer".

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  • To think that banter is the main factor influencing bright medical students' postgraduate career choices is an insult to medical students and to GPs. But this is from those who would give colouring books to adults so it shouldn't be a surprise if we're treated as children.

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  • where is the evidence that banter has an effect?

    have we just given up evidence based decisions - if so can we get rid of NICE?

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  • 11.07,
    I had a very similar experience. A/E Registrar used to call VTS trainees as
    "you lot". In Obs/Gynae rotation, the midwives would call GP trainee for venflons. It reached a point when I complained to the deanery.

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  • Golden handshakes should be offered to everyone who joins GP training.That will boost GP recruitment.

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  • Negative banter is not responsible for poor recruitment to general practice. To suggest so is to vastly inflate the power of banter and amazingly patronising. Medical students aren't idiots. General practice is grossly under funded and massively dumped on. That's the reality of the current situation. This isn't an issue that can simply be fixed by spin and positive advertising. It's the result of real issues that are actually happening, not negative press. Wake up you bleedin idjits at the RCGP

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  • Vinci Ho

    (1) First of all , frozen ice deep down to three feet is not down to one day cold ,as Chinese said. And more importantly , ' Every matter has its origin and ramification(s).Every incident has its beginning and its end . One can only find ''the right path'' if one really understands the sequence of order.' Book of Great Learning.
    (2) If a restaurant has good food and services , the reputation will grow despite people so called deliberately spread denigrating , derogatory remarks. Then the opposite of this also applies. The banters as well as 'negative comments' are reactions and 'consequences' . One must always go back to the 'origin' and start challenge the hierarchy with real questions about why we are where we are.
    (3) Sadly , one must recognise that MB was making joint statements with Simon . The arrow would never be pointed towards the government and the SOS. An establishment will always tend to defend another establishment for ' common interests'.
    (4) The comments on this platform are valuable . As we concluded , not long ago , that annonymous or not , they represent and respect freedom of speech as well as freedom from fear. Of course , pro-government protagonists can always blame us for so called negativity destroying the 'good work' of attracting and retaining GPs. But we are only the consequences of the origin. People will naturally stay and come if the 'origin' is properly repaired instead of sticking plasters on the surface . The old fashioned 'take this and it will work' is insulting intelligence. We should understand far better than anyone else for our training in the art of consultation with our patients.
    (5) By the way , what was a Man United fan doing in Liverpool? The big match is not due until two weeks time.

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  • Vinci Ho

    And if you read the interview with Dr Iona Health , foemer RCGP president , she shed some light about the 'origin':
    ''Jeremy Hunt has such bizarre ideas. I don’t think he’s a stupid man but he’s made no attempt to understand the nature of healthcare, and at the same time he’s alienated a whole generation of doctors. He has a fiduciary responsibility to NHS staff to support their morale, to look after them, but I think he behaves in exactly the opposite way. I don’t see how that’s forgivable.''
    This cannot be just 'negative' comment

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  • Vinci Ho

    And as a scholar , she at least showed the integrity and resoluteness to stand up against the government and its SOS rather than dancing with the politicians/bureaucrats :
    ''There is no evidence health checks make any difference to the population’s health. People have found this hard to believe so there have been repeated trials that don’t show anything. And then there is the hypocrisy of it all. One of the low points of my virtual relationship with health secretary Jeremy Hunt was when he wrote to GPs saying it was time they tackled health inequalities, just as the Government was introducing the bedroom tax and slashing benefits, which we know harms the health of the poorest and most vulnerable. So their policies make people sicker and they expect the health service to sort it out. It’s outrageous; you cannot sort out health inequalities against a background of worsening socioeconomic inequalities.''
    Personally , I think we have a duty of candour to oversee that the politicians are not harming people's lives and health . This may not be everybody's cup of tea in choosing a career. If the strategy is to throw as many negatives as possible . So be it........
    Those with no virtues sitting in high positions in the hierarchy spread evils through the most......

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  • Ivan, positivity is a good thing and probably that's kept most of our colleagues going till now.
    However, what great rewards are you talking of ? The only great reward for most is that they are doing what they are passionate about, the rewards are going to some selected few living in perfect harmony with the establishment. Maybe you could explain why the more patients I take the greater is the discrepancy in weighted list size.
    At least, I'm glad you are sleeping well.

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  • Ivan, positivity is a good thing and probably that's kept most of our colleagues going till now.
    However, what great rewards are you talking of ? The only great reward for most is that they are doing what they are passionate about, the rewards are going to some selected few living in perfect harmony with the establishment. Maybe you could explain why the more patients I take the greater is the discrepancy in weighted list size.
    At least, I'm glad you are sleeping well.

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  • Much to the chagrin of Dr Ivan Bennett I will make this post anonymous.

    I'm sure most will recognise that banter, by virtue of it having a smidgeon of truth within it, can serve as a source of mirth when exaggerated. Speaking from the position of someone who has worked as a medical registrar some years ago, and commenting on medicine and not psychiatry, it is clear to me that, as unpalatable as it may be to hear on a forum such as this, the scorn poured upon GPs is somewhat deserved when their superficial and shoddy practise is considered dispassionately and with a degree of objectivity. Moreover, a Royal College which incorporates actors instead of patients with proper clinical signs as part of its Membership exam cannot really be regarded as robust, or indicative of clinical excellence or acumen. GPs are not academically inferior to their specialist counterparts but are undoubtedly lacking in the skills which allow the fullest extraction of relevant information from a clinical scenario whilst displaying a tendency to be self-congratulatory on their prowess in considering vague concepts such as ideas and expectations in 10 minute slots.This may be quite harsh but the phrase pertaining to the one-eyed man being king when in the land of the blind springs to mind.

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  • Much to the chagrin of Dr Ivan Bennett I will make this post anonymous.

    I'm sure most will recognise that banter, by virtue of it having a smidgeon of truth within it, can serve as a source of mirth when exaggerated. Speaking from the position of someone who has worked as a medical registrar some years ago, and commenting on medicine and not psychiatry, it is clear to me that, as unpalatable as it may be to hear on a forum such as this, the scorn poured upon GPs is somewhat deserved when their superficial and shoddy practise is considered dispassionately and with a degree of objectivity. Moreover, a Royal College which incorporates actors instead of patients with proper clinical signs as part of its Membership exam cannot really be regarded as robust, or indicative of clinical excellence or acumen. GPs are not academically inferior to their specialist counterparts but are undoubtedly lacking in the skills which allow the fullest extraction of relevant information from a clinical scenario whilst displaying a tendency to be self-congratulatory on their prowess in considering vague concepts such as ideas and expectations in 10 minute slots.This may be quite harsh but the phrase pertaining to the one-eyed man being king when in the land of the blind springs to mind.

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  • Good god, sir... I was thrashed at my public school every night of the week, except Sunday, and it made me the person that I am.
    This hierarchical banter stuff is good for the morale of the lower orders and keeps them from getting opinions and aspirations above their place in society. Without those methods of control we'll be having comprehensive school trash doing OUR jobs.
    And women with Birmingham accents infesting the wards and operating theatres pretending to be surgeons when they should be home carving the Sunday roast.

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  • Why stop the banter?
    When the med students come to a GP clinic and see it in action they know what work goes on here and they are in AWE. The profession needs to take this as a positive and a source of motivation.

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  • 8.48 - not thrashed on Sundays? Clearly a minor public school then.

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