H.A.R.M Analysis London has Fallen

Objective Structured Clinical Examination Nursing Essay

Share this: Facebook Twitter Reddit LinkedIn WhatsApp “The control of the licensing power is the most important function of the medical boards. Acting on behalf of the state, it is their duty to see that all candidates for license are properly qualified. They stand as guardians of the public and the profession, and here their responsibilities are indeed great.” Osler’s statement at the Canadian Medical Association annual meeting in 1885 is still valid. Assessment is an integral part of medical education. The primary aim of assessment is to evaluate an individual’s competence in a particular area of practise. Is this the only aim of assessment? Mackintosh and Hale (1976) suggest six possible purposes of assessment, which are: diagnosis, evaluation, grading, guidance, selection and prediction. Assessment in medical education can be formative or summative. Formative assessment helps students to develop skills and encourages learning. It is supportive and provides feedback which in turn facilitates deeper learning. The disadvantage of formative assessment is that not all students take it seriously. The summative assessment is used to judge whether an individual is competent enough to progress to the next level. It can be threatening and usually there is no feedback, however, students tend to take this form of assessment more seriously. It stimulates last minute superficial learning as opposed to the deeper learning that occurs with formative assessment. There is no single assessment tool that can reliably assess medical students. Different methods are available to assess their knowledge, skills, attitudes and professionalism. As part of this assignment I have designed two OSCE questions, which I have attached as an appendix. I will reflect on assessment methods with particular reference to the OSCE questions that I have designed. Miller (1990) proposes a pyramidal framework for clinical assessment. The base of this pyramid represents a knowledge component (knows) followed by application of knowledge (knows how). This is in turn followed by performance (shows how) and the apex of the pyramid represents actions (does). Medical students are tested on their knowledge, application of knowledge and in vitro performance whereas work based assessment, which assesses in vivo performance, occurs after graduation and forms the final step. As a medical student my knowledge and application of knowledge was tested by written essays. Unfortunately assessment using this method is subjective. Objective approaches to test knowledge and its application include multiple-choice questions (MCQs) and extended matching questions (EMQs). Oral examinations (also known as viva voce) and long case clinical examinations were used to assess my clinical skills. Assessments of this nature are often criticised because they are unstructured and subjective. At present objective structured clinical examinations (OSCEs) form the backbone of performance assessment in medical schools throughout the United Kingdom and many other countries throughout the world. Harden et al (1979) describe the use of Objective Structured Clinical Examination (OSCE). OSCE has changed the assessment of clinical competence because it uses actors and scenarios. In OSCE the clinical competence is assessed in a planned and structured way with attention given to the objectivity of the examination. It is a ‘focused’ examination with each station focusing on one or two areas of competence. This is a performance assessment in that it assesses student’s performance rather than their knowledge. Unlike the traditional clinical examination the objectivity of OSCE is ensured by candidates being examined by more than eight examiners, agreeing assessment criteria in advance, confronting all students with the same task, standardising patients and training examiners. The emphasis is in testing what they can do rather than what they know. In my opinion, communication skills are essential for all doctors. History taking is a basic form of communication skill, whereas breaking bad news is a more challenging communication skill. Based on the above statement, I have designed my two OSCE questions for a history taking station and an explanation station for breaking bad news. The General Medical Council stresses the importance of good communication in its document ‘Good Medical Practice’. I firmly believe that a good clinical history and examination are crucial in establishing diagnoses and planning appropriate management. By eliciting an appropriate history, the clinician can gain insight about the illness and concerns of the patient. The art of obtaining a good history is often forgotten. Methods suitable for assessing history-taking skills are traditional long case examinations and OSCEs. Unlike OSCE, the process of obtaining the history is never observed in long case examinations. The presentation skills of the student take centre stage in the long case method. The examination format that would assess advanced communication skills, such as breaking bad news, are live observations as in OSCE or video assessment of the consultation for practising doctors. Van der Vleuten (1996) described five criteria to assess the utility of assessment methods. Those criteria were reliability, validity, educational impact, acceptability and cost (feasibility). He defined the utility of an assessment as a multiplicative of these five factors. If any one of these values is zero, then the assessment becomes useless. For example, a test which is reliable and valid with high educational impact is unlikely to be used unless it is acceptable and feasible. There is no assessment method which scores highly in all of these components. Reliability is the ability of a test to produce a consistent and reproducible result. Van der Vleuten (1996) suggests that tests containing a small sample of items, such as essays, stations, patient problems or tasks, produces unstable or unreliable scores, and sample size requirements vary with the efficiency of testing methods. Traditional long case and viva voce examinations are unreliable due to limited sampling. Although OSCE is an efficient assessment method the reliability is questionable for a two-station communication skills examination. As part of multi-station examination it has been shown that OSCE stations can assess history taking and communication skills with acceptable reliability (Hodges et al 1996). Obstacles to reliability could be related to the examiner, the standardised patient, or the student. Possible solutions could include training examiners, structured guidance to the examiners and proper guidance and explanation of the clinical scenario to the standardised patient. Validity refers to the ability of an assessment tool to accurately measure the desired endpoint. In other words, to which extent the findings of the assessment are closer to the real world. Validity is a conceptual term. There are four types of validity: face validity, content validity, construct validity and predictive validity. History taking skills and communication skills are components of the medical undergraduate curriculum that ensure content validity. In communication skills testing, history taking OSCE questions could be used primarily for third and fourth year medical students, reserving breaking bad news OSCE questions for final year medical students. Construct validity refers to the ability of an assessment to differentiate between novice and expert. There are no studies that analyse the construct validity of communication skills OSCEs. There are certain factors that could adversely affect the validity of these stations. This could be related to time constraints, because in real clinical situations breaking bad news will often require more than the allotted eight minutes in the OSCE station. Hodges (2003) argues that total lack of other health care professionals in OSCE scenarios questions validity, especially because of current emphasis on multi-disciplinary health care delivery. I do not think it will be possible to generalise a good or a bad performance in particular communication skills OSCEs to predict similar behaviour in other communication settings. Colliver et al (1998) have shown that to assess empathy in a standardised patient reliably, as many as thirty-seven different scenarios could be required. Harden (1992) has described the educational impact of assessment on learning. He used a bicycle as a model when considering the relationship between learning and assessment with the front wheel representing learning whilst the rear wheel represents assessment. Van der Vleuten (1996) has documented that assessment could drive learning through its content, format and through the feedback that follows assessment. Feedback is a feature of formative assessment. Hodges (2003) questions the validity of OSCE on the grounds that the examination itself could contribute to changes in a student’s behaviour. For example, if students knew that communication skills are tested, would their performance reflect the real life outside the examination? The educational impact of assessment is an important consideration and I personally feel that history taking skill and communication skill OSCE stations in the examination will encourages students to practice them and this will have beneficial effect in the long run. Acceptability is an important consideration in designing an assessment method. In traditional examination methods, the process of assessment is lead by the examiner. The examiners are allowed to use their expertise. Unfortunately this makes the assessment subjective. In OSCEs the examiner marks the candidate using a structured marking sheet, which makes the assessment more objective. In history taking and communication skills OSCE stations the role of the examiner is mainly as an observer. This has led to the use of the standardised patient as assessor in the United States Medical Licensing Examination (USMLE). I was an OSCE examiner for a communication skills station few months ago and I have noticed that the standardised patient’s opinion about the performance of each candidate concurred with my own assessment. There are many studies on this topic but none of them are conclusive. The Postgraduate Medical Education Training Board (PMETB) in its consultation document stressed the importance of using lay people in the assessment process for areas of competence that they are capable of assessing. If the same principle applies to undergraduate medical education, OSCE stations like history taking and communication skills, standardised patients can be used as assessors. Further studies are needed to implement such a strategy in “high-stakes” summative assessments such as final year undergraduate medical examinations. However, in formative assessment, with feedback from students and standardised patients, this could be implemented. This will reduce the manpower required to organise the assessment and reduce the cost of running some OSCE stations. Feasibility of an assessment method is determined by the time, cost and other resources that are required. Although it may be possible to complete a history taking or a communication skills OSCE station for undergraduate final year medical students in the prescribed 8 minutes, the same may not be possible in postgraduate settings such as psychiatric examinations. The recruitment of many highly trained standardised patients and examiners for OSCE stations involve considerable cost. The cost could be reduced by running examinations throughout the day. However this may cause fatigue and could adversely affect the reliability and validity. Other resources that may be required include a large examination hall that could accommodate ten OSCE stations and ancillary aids like an X-ray viewer. Of the two scenarios, the history taking skill could be examined with a traditional long case method involving a lower cost to the organisers, but the explanation OSCE station for breaking bad news will certainly involve a standardised patient as the sensitive nature of the scenario will preclude using real patients. Conclusion Good communication skills are essential pre-requisite for all doctors. Both the OSCE questions I have designed assess medical student’s communication skills. The history taking OSCE station is designed to assess basic communication skills whereas the explanation OSCE involving breaking bad news tests more advanced communication skills. They can both be used in formative and summative assessment. They can be used to assess medical students with varying levels of experience. The reliability of two-station OSCEs is debatable. However, when used in combination with other OSCE stations in a multi-station examination format they become more reliable. They are valid when assessing communication skill for undergraduate medical students. The educational impact of communication skills OSCE stations will be positive, and I believe that this will encourages students to improve their communication skills. They are an acceptable and feasible assessment method. Two important questions that remain unanswered are: “does performance in an OSCE station predicts performance in the real world?” and: “does performance in one scenario in a communication setting generalise similar performance in other scenarios?” I would like to conclude with the words of sociologist Erving Goffman (1959) ”Life itself is a dramatically enacted thing the world is not, of course a stage, but the crucial ways in which it isn’t are not easy to specify.” Share this: Facebook Twitter Reddit LinkedIn WhatsApp

pm Assignment 8 Essay

essay writing service free Develop a risk management plan for your project. Use the Risk Management Plan Template, and Business Case attached to complete this assignment: Analyze the project introduction and project risk principles. Identify project risks (both positive and negative). Create a Risk Matrix Legend. Probability Level / Criteria / Color Code. Impact Level / Criteria / Color Code. Create your Project Risk Matrix. Identify a minimum of 10 potential risks (positive or negative). Consider cost, schedule, performance, legal and regulatory, governance, strategic, market, and operational. For each risk: ​​Describe the risk. Identify the probability rating. Identify the impact of the risk to the project. Identify response or solution for the risk. Explain the action plan for the response or solution to the risk. Identify the responsible person for each action. Identify the status of each action. Create your Risk Monitoring and Control Strategy: Define the Review and Action Plan for identified and unidentified risks. Establish a Review process. Establish a Reporting process.

Green Consumers Are Defined As Consumers Marketing Essay

Nowadays, the spa industries are becoming more aware of environmental issues and because consumers are focusing more on environmental traits of goods and services, the industry are therefore willing to change their services by moving towards a more sustainable approach. The industry has evolved and is now moving towards a new direction. Their main concern is to be able to satisfy the green consumers’ demands since people are becoming more eco-conscious and they do not opt for “pampering” treatments now but rather expect services like wellness education and lifestyle programs in an “eco-friendly” environment. Spas industries who carry out green practices are now trying to look for ways to reduce the impacts on the environment as well as to create awareness among their customers. Consumers who value “green” are now only willing to purchase organic spa meals and will only purchase the products and services only if they are practicing recycling,waste minimization and other eco-friendly activities. In addition to monitoring traditional variables such as price, quality and convenience, spa goers are now searching for more affordability but also for spas that are environmentally conscious. As per the article Spas see greener days ahead, one main disadvantage is as follows: Lack of promotion strategies and therefore the spa industry needs to promote more their green activities in regards to green consumers’ demands. : A definition of consumer behaviour, used by Arnould et al. (2004: 9), defines consumer behaviour as “individuals or groups acquiring, using, and disposing of products, services, ideas, or experiences.” Green consumer behaviour can also include purchase and consumption avoidance.” (Peattie 1995: 84) Hence, green consumer behaviour can be defined as ‘the purchasing and non-purchasing decisions made by consumers, based at least partly on environmental or social criteria’. (Peattie 1995: 84) To further specify who and what a green consumer is, a definition of green consumption is appropriate. “In response to the environmental concern of the early 1970s, concepts such as Fisk’s (1973) theory of ‘responsible consumption’ and Mead’s (1970) concept of ‘responsible simplification’ reflected the concern about limits to growth with calls for a decrease in consumption. At the same time, the social pressure on business was reflected in studies of the ‘socially conscious consumer’ (Anderson and Cunningham 1972). Environmental marketing involves providing consumers with more sustainable and socially acceptable products; therefore green consumption must involve consuming in a more sustainable and socially responsible way.” (Peattie 1995: 83) Elkington and Hailes (1989: 5) define green consumers as people who in general avoid products which are likely to: endanger the health of the consumer or of others cause significant damage to the environment during manufacture, use or disposal consume a disproportionate amount of energy during manufacture, use or disposal cause unnecessary waste, either because of over packaging or because of an unduly short useful life use materials derived from threatened species or from threatened environments involve the unnecessary use – or cruelty to – animals, whether this be for toxicity testing or for other purposes adversely affect other countries, particularly in the Third World As per the article many disadvantages have been found and which are as follows: There is a gap between home and hotel behavior According to Baker and Davis, consumers are compelled to act as being more eco conscious in their local community than at a tourist destination There is a strong trade off between contribution and the sacrifice of comfort and luxury as some consumers believe that engaging in green practices may affect their experience and stay at hotels. Lack of educational programmes on environmental issues for consumers by the hotel industry A key element of green consumption is the desire for more information about the relationship between products and the environment. (Peattie 1995: 87) As per Swarbrooke and Horner (2007), green tourists are considered as those who refuse or prohibit tourism services which are not eco-friendly and those who make sacrifices because of views and benefits in environmental matters. As per the article, on the other hand, green tourists, can be defined as those who hold a particular interest about the environmental traits of the tourist destinations they visit. Eco-tourists will choose a destination based on its environmental condition and the type of experiences which they may expect there It is foreseen that green consumers who are aware of environmental issues would not visit a destination if it is experiencing environmental problems. As such Swarbrooke and Horner put emphasis that tourists’ behavior should be established not only by examining their attitude towards environmental problems in everyday life but as well as by getting information about the environmental situations at different tourist destinations. Thirdly, motivations that influence green tourists include not only self-interest but also self-sacrifice. Cornes and Sandler (1994), Andreoni (1989), and Kotcen (2005, 2007) It is difficult to tell whether a visitor is an eco-tourist as visiting a destination involves spending on tourism services, including attractions, accommodation and hotels. Eco-tourists as green consumers versus non eco-tourists or dirty tourists Tourists may show a mix of behaviors the green consumer To further specify who and what a green consumer is, a definition of green consumption isappropriate. “In response to the environmental concern of the early 1970s, concepts such as Fisk’s(1973) theory of ‘responsible consumption’ and Mead’s (1970) concept of ‘responsiblesimplification’ reflected the concern about limits to growth with calls for a decrease inconsumption. At the same time, the social pressure on business was reflected in studies of the’socially conscious consumer’ (Anderson and Cunningham 1972). Environmental marketinginvolves providing consumers with more sustainable and socially acceptable products; thereforegreen consumption must involve consuming in a more sustainable and socially responsible way.”(Peattie 1995: 83)Even though green consumption, as described by Peattie above, seems only to incorporate positivevalues from an environmental point of view, there was and is still much debate about the role andimportance of green consumption and green consumerism. Critics argue that green consumption isonly a way of slowing world degradation, and not a tool to end it. Durning (1992) argued that: “Atits best green consumerism is a potent new tactic for environmental advocates, allowing them tobypass the halls of parliaments and send their message directly to boardrooms. At its worst, greenconsumerism is a palliative for the conscience of the consumer class, allowing us to continuebusiness as usual while feeling like we are doing our part.” (Peattie 1995: 83)However, even though the critic appear sound it is important to realise that green consumption isonly one part of a greater effort needed to steer industrialised countries towards sustainability.Peattie (1995) argues that green consumption will have an effect only as part of a wider process of change, but that wider change process will not be able to happen without the focus on greenconsumption.

Review a case study on Business Intelligence platform and write a report of 300-400 words answering following questions.

Review a case study on Business Intelligence platform and write a report of 300-400 words answering following questions.. I don’t know how to handle this Computer Science question and need guidance.

The case study: Chapter 4: OPENING VIGNETTE: Self-Service Reporting Environment Saves Millions for Corporate Customers. [Page 136]
Please refer to attached textbook for case study.
The questions to be answered in your report:
1. What does Travel and Transport, Inc., do?
2. Describe the complexity and the competitive nature of the business environment. What were the main business challenges faced in that business environment?
3. List and comment on at least three main benefits of the implemented system. Can you think of other potential benefits that are not mentioned in the case?

Report should follow APA writing guideline. Please cite any external or internal [textbook] references as per APA guideline.

Review a case study on Business Intelligence platform and write a report of 300-400 words answering following questions.