Tuesday, December 31, 2019

The Strangers That Came to Town Essay - 878 Words

In his short story, â€Å"The Strangers That Came to Town,† Ambrose Flack is showing that true freedom is about being accepted. It shows that true freedom is about being accepted because of the way that the Duvitch family is placed in a community where they are not accepted at first but then do become accepted. Mr. Duvitch didn’t talk much to anyone because of lack of freedom to be who he was, Mrs. Duvitch didn’t have the freedom to also be who she was because people talked about her and the Duvitch children to were quiet ones who didn’t have freedom in the sense that they couldn’t just go out and play with the other kids. Mr. Duvitch gains freedom through the power of acceptance by those around him. At first Mr. Duvitch has trouble being†¦show more content†¦At first, people would talk about Mrs. Duvitch and say rude things about her. Mrs. Duvitch could never really feel accepted when people were constantly talking about her and making assumptions about her which is why she too never really had contact with anyone, â€Å"But this gave rise to the rumor that she was the victim of an obscure skin disease and that every morning she shook scales out of the bed sheet† (3). When someone gives you reassurance that what you’re doing is okay and become engaged and interested in what you’re saying that allows you to open up and feel accepted which is what happened with Mrs. Duvitch when Andy’s family went over for dinner, â€Å"Saying very little, he managed to make us feel a great deal and he constantly sought his wife’s eyes with glances of delight over the wonde r of what was happening† (14). Mrs. Duvitch is finally accepted into her community when others see that she has much more to offer them then they had thought. Her special nursing skills became very important to her community, â€Å"The community presently had reason to be grateful for Mrs. Duvitch’s presence. It turned out that she had a great gift for nursing, and no fear of death, no fear of disease, contagious or otherwise.† (16). Her acceptance into the community shows that this story is about freedom. The Duvitch children are very shy and quiet at first probably because they never really had the chance to be who they were with negative andShow MoreRelatedAnalysis Of The Strangers That Came To Town967 Words   |  4 Pageshis short story, â€Å"The Strangers that Came to Town†, Ambrose Flack is showing that true freedom is about being accepted. This short story shows the Duvitch family who don’t fit into a small town. The Duvitches receive lots of hate and harm from the small town with a friendly faà §ade. They don’t fit in because they are different, like mant minority groups. ~ The first proof of this is in the title: The Strangers That Came To Town, which refers to the Duvitch family as strangers instead of neighborsRead MoreThe Strangers That Came to Town Essay828 Words   |  4 PagesThe Strangers That Came to Town Essay The story â€Å"The Strangers That Came to Town† is primarily a story about freedom. In his short story, â€Å"The Strangers that Came to Town†, Ambrose Flack is showing that true freedom is about being accepted. In the beginning of the story Mr. Duvitch and his family couldn’t walk around the town being judged or feeling uncomfortable. This was also a big problem for Mr. Duvitch’s children. They deal with bullying and not being welcomed as well. Although at theRead MoreThe Strangers That Came And Town By Ambrose Flack1074 Words   |  5 Pages Freedom is a birthright for all humans, we should always feel accepted to speak our minds and be who we are. In his short story, â€Å"The Strangers that Came to Town†, Ambrose Flack is showing that true freedom is about being accepted. He shows this through the characterization of Mrs. Duvitch, Mr. Duvitch and Andy. Mrs. Duvitch’s quiet and reserved nature made her the ideal victim of rumors. The less people knew about her the more room left for their imaginations. For example she is said toRead MoreA Uniting Theme Of The Strangers That Came To Town, A Dolls House And A Lesson Before Dying1884 Words   |  8 PagesSacrifice- A Uniting Theme Of The Strangers That Came To Town, A Doll s House and A Lesson Before Dying All of the books that we have read this summer have in common stories where characters are forced to make sacrifices. This is first seen in The Strangers That Came To Town by Ambrose Flack. The Duvitch family sacrifice everything to provide for their family. Andy and Tom endure harsh conditions while fishing to repay Mr. Duvitch for the fish they poisoned. In the play A Doll s House by HenrikRead MoreThe Appearance Of A Stranger1162 Words   |  5 PagesThe Appearance of a Stranger in a Small Kansas Town The appearance of a stranger in a settled small Kansas town, while unsettling to some, can be a rewarding experience, as long as there is a mutual desire to communicate. The course readings accurately depicted and reflected the stranger from various perspectives. Consequently, in order for the small town to thrive, there is a necessity for the appearance of strangers. Out of town travelers contribute to the local economy that provides income forRead MoreEssay on Vanity In The Man That Corrupted Hadleyburg by Mark Twain1213 Words   |  5 Pageshave on a person almost parallels that of Twain’s brilliant story of vanity, greed, revenge, and honesty, or should I say dishonesty. The story displays how much an entire town is willing to forsake in order to obtain that which has been known to destroy families, careers, lives, and in this case, the good name of an entire town – money. Yes money – that age-old evil that causes men to cheat, lie, steal, and even kill to consume its pseudo sense of security and power, is at the very root of the themeRead MoreThe Devil And Miss Prym By Paulo Coelho1408 Words   |  6 Pageswhere humans came from. These theories consist of origins that start with basic evolution, everything starting from one cell, and ranges to religions that tell stories of a greater being that watches over us. In all of these origins rises the concept of why good and evil exists. In the book The Devil and Miss Prym, Paulo Coelho uses a mysterious character, referenced as â€Å"the stranger†, who enters the town of Viscos to desperately answer if humans are initially good or evil. So the stranger sets up anRead MoreAnalyzing Twain ´s The Man that Corrupted Hadleyburg and The Mysterious Stranger1137 Words   |  5 Pagesof his works such as The Man that Corrupted Hadleyburg, and The Mysterious Stranger. In both stories are set in small towns whos residents are oblivious to their own moral hypocrisy. The sudden appearance of a stranger spreading a sort of knowledge, initiates a chain of events the leads to certain residents to self-evaluate their own character and that of the whole human race. Its is through these Mysterious Strangers and the events they trigger that Twain is able to depict his unfiltered cynicalRead MoreA Lesson Before Dying Literary Analysis1450 Words   |  6 Pagesthemes and symbolism used in the stories Lesson before Dying, The fun they had, The strangers that came to town, and Dolls house through the median of three major unsuccessful relationship: racial tension between the African Americans and the caucasians in the novel Lesson before Dying, Doll’s House demonstrates a controlling relationship can be detrimental for both individuals and The Stranger That Came To Town along with The Fun They Had show that when an individual is suppressed by majority theyRead MoreTaking a Look at Albert Camus831 Words   |  3 Pagesyear later. While attending college he worked two jobs and played soccer as goal keeper. Camus joined the communist party to help promote Fascism, but later wanted to be kicked out but his reason are unknown. Unfortunately, his educational journey came to an end because of his illness, he developed tuberculosis. In the year of 1939, Camus attempted to enlist in the military after several attempts, he was rejected due to his history of tuberculosis. Camus and his wife Simone divorced in late 1936

Sunday, December 22, 2019

Public Health Paper - 12265 Words

From past to present; the changing focus of public health by Maria Joyce Key sections include: Environment, infectious disease, locating public health, the enlightenment, the Sanitarians, national provision of services, the inception of the National Health Service, ‘crisis in health’, The New Right, The Third Way, new public health. Public health, the new ideology may be taken to mean the promotion of healthy lifestyles linked to behaviour and individual responsibility supported by government action; whereas traditionally the description tended to relate more to sanitary reform and ‘healthy conditions’. The chronological development of public health is mapped out, supported by the outlining and discussion of the emerging themes†¦show more content†¦The onus on notification of infectious disease is still seen today in the Control of Disease Act 1984 and the Regulation of the Infectious Diseases 1988. This may have positive benefits to public health, limiting illnesses such as food poisoning and rapid identification of outbreaks of bacterial meningitis, measles and other illnesses through prompt notification and medical or environmental intervention. The role of ‘social conscience’ however and its manifestation in social control may have been responsible for dividing communitie s through encouraging individuals to report their apparently ill neighbours. Locating public health The tradition of public health and inherent understanding of the term, dates back as early as pre-Christian times, classified in five periods or bodies of thought: The Graeco-Roman period with emphasis on water and sanitation, the Medieval emphasis on epidemics, the Enlightenment emphasis on disease prevalence, the Industrialisation emphasis on working conditions and Modern era emphasis on bacteriology and virology (Rosen 1993 cited in Costello and HaggartShow MoreRelatedPublic Health Policy Paper1548 Words   |  7 Pages Abstract This public health policy paper will discuss and outline the Affordable Care Act (ACA) as well as barriers and controversies surrounding the policy and its relevance in nursing profession. The ACA will eventually affect everyone. Statistics reflecting United States health outcomes have proven the need for the initiation of policy formation within the United States healthcare system. â€Å"In March 2010, President Obama signed into law a comprehensive health reform, the Patient ProtectionRead MorePublic Health Reaction Paper1008 Words   |  5 PagesAssignment #2: PH Reaction Paper Chasiti Reid PUBH 102 Dr. Corwin December 1, 2012 (a) Public health is preventing injury and disease, prolonging life and protecting populations by promoting health through product safety and in physical, social and economic environments. Responsibility for promoting the health of the public is shared between the government and communities. Public health focuses on the health of populations, rather than individuals. It is concerned with wide-ranging strategiesRead MoreAgency Of Public Health Paper Based Health Management Information System711 Words   |  3 PagesThe Ministry of Public Health paper based Health Management Information System (HMIS) has been established as an emergency solution to lack of a data collection system in 2002. However, the increasing need for various type of data and accumulation of large dataset over past 16 years has resulted in severe inefficiency of the system. In addition, the paper based system takes unacceptably long time for health decision making. Therefore, an online data management system will provide unlimited data storageRead MoreMoving Canadian Governmental Policies Beyond A Focus On Individual Lifestyle Essay981 Words   |  4 Pagesorder for health promotion to achieve its goal, programs that promote and support change have to be implemented before individual health issues arise. The individual based treatment and lifestyle programs that are predominant in Canada often do not contribute to social change and have limited societal effect. The paper by Alvaro entitled â€Å"Moving Canadian governmental policies beyond a focus on individual lifestyle: some insights from complexity and critical theories† argues that Canadian health policyRead MoreEvaluation Of The 10 Essential Public Health Services1696 Words   |  7 PagesThis paper is about the evaluation of the 10 essential Public Health Services and how they can be helpful in the prevention of HIV in communities across the nation. In addition, the paper depicts how the Chicago Department of Public Health (CDPH) has been able to incorporate the 10 essential public health services in its fight against HIV disease. The paper will discuss the assessment of the HIV disease situation in Chicago neighborhoods; policy development by the Chicago Department of PublicRead MoreProfessional Public Health Associations. Essay724 Words   |  3 Pages Professional Public Health Associations Patti Maisner Kaplan University Public Health Professional Associations There are several Public Health Professional Associations/Organizations that can be accessed whether a student or MPH (Masters in Public Health) graduate. The number one organization is APHA (American Public Health Association) who has services like: membership, newsletters, a professional journal, meetings, and webinars (American Public Health Association, 2015).Read MoreHealthcare Systems Of The Healthcare System Essay1541 Words   |  7 Pagesthese systems include home health care, hospice care, and palliative care and assisted living. This paper will focus on three healthcare systems of interest and discuss the relevance of 5 Ps of healthcare marketing. Additionally, the paper will also elaborate the potential impact of these marketing Ps to the healthcare system and evaluate the health system that is most promising. Therefore, the three areas of interest to be covered in this paper are hospice care, home health care, and primary care.Read MoreWhat Can A Person Do With A Health Science Degree?1453 Words   |  6 Pagesperson do with a health sciences degree?† most people couldn’t answer that question without looking it up. So lets first start with explaining what health science actually is; health science is a wide variety of disciplines, which are determined â€Å"through the application of science, engineering, mathematics and technology† (Health Science Careers, 2016) It’s the area of knowledge and science, which is then applied to â€Å"practical and clinical practices to maintain and improve the health of living beings†Read MoreA View Into Social Media And Healthcare1581 Words   |  7 Pagestogether, and encouraging social networking and communication regarding health topics, and it supports in this way patient empowerment, i.e. it brings patients into the position to take control of their healthcare needs (Denecke et al 2015). But with this rising technology comes many possible disadvantages of putting personal h ealth information into the public domain such as breach in patient’s privacy, untrustworthy and unreliable health information and education, and the possibility of damaging professionalRead MoreNational Public Health Performance Standards Program993 Words   |  4 PagesIn 1994 the Core Public Health Functions Steering Committee at the Center for Disease Control (CDC) released a list of 10 Essential Public Health Services (â€Å"The Public Health System,† 2014). This was an essential step towards making established public health organizations accountable and giving new programs a framework on which to develop from. This list outlines the foundation for the National Public Health Performance Standards Program. The ten essential public health services provide a way to

Saturday, December 14, 2019

Developing curriculum for the resident teacher program Free Essays

string(89) " feedback on their usage of learning behaviours, and job resolution activities † \." Literature Review is the most critical portion of a thesis as it revolves about and builds upon the work that has been antecedently done in the topic being researched. There are several articles available on the subject of REP nevertheless non all of them concentrate on developing a course of study for the occupant as instructor plan. A systematic reappraisal of literature was conducted utilizing PubMed and Google Scholar. We will write a custom essay sample on Developing curriculum for the resident teacher program or any similar topic only for you Order Now Keywords used for the hunt were: occupant as instructor, learning accomplishments, course of study. A list of 223 articles published from 1950 to 2009 was retrieved which was cross checked with the published updated selected bibliography on the occupant as instructors subject. Extensive reappraisal of the full texts of the articles available and the abstracts resulted in choice of 29 articles which chiefly focused on enterprises for bettering the occupants learning accomplishments. â€Å" Residents in all subjects serve as instructors and function theoretical accounts for pupils, co-workers, and other staff † . ( Residents-as-Teachers Programs in Psychiatry: A Systematic Review ) . Residents work closely with medical pupils in peculiar and have considerable chances to learn and act upon pupils ‘ cognition, attitudes, and behaviours. Since the early 1970s, the literature on the occupants ‘ learning function has emphasized the demand to develop occupants as instructors every bit good as to measure the content and results of instructional plans. Overall, the literature shows that occupants wish to educate ; they want to be qualified as ‘teachers and leaders ‘ . Most of the research available has been conducted in USA, UK and other developed states, where the government organisations are back uping this function of â€Å" occupants as instructors † . â€Å" Residency † is a medical preparation phase of graduation. AA † occupant doctor † A orA merely resident ; A is person who has already completed the needed grade in medical specialty. They are besides referred to asA registrarsA in the U.K and other â€Å" Commonwealth † states. They besides pattern medical specialty under the disposal of the to the full licensedA doctors, by and large in infirmaries and clinics. A residence frequently comes after the internshipA twelvemonth or at some points includes the internship twelvemonth as the ‘first twelvemonth ‘ of the plan. It can besides come after the phase ofA family. Here the general practician is trained or qualifies in a sub-specialty. â€Å" Surveies estimate that occupants spend up to 20 % of their clip on learning activities-regardless of their future calling programs † ( â€Å" Resident-as-Teacher † Course of study: Do Teaching Courses Make a Difference? ) as suggested by Maria A. Wamsley, MD, Katherine A. Julian, MD, Joyce E. Wipf, MD in their article. Harmonizing to the writers all occupants know and understand their duty and function every bit far as learning the medical pupils is concerned. Apart from the pupils they besides teach housemans and other fellow occupants. As these research consequences were based on studies ; they have besides demonstrated how occupants non merely bask learning but see it an of import portion of their ain survey. Second, they indicate how much the occupants prefer learning on call patients instead than go toing talks etc. Another study that had been conducted for the research above highlighted how the medical pupils anticipated that 1/3 of their cognition was attr ibuted to the instruction in the house. A study was conducted in 2001 that showed that ’55 % of residence managers ‘ idea that the plans offered to occupants were official instructions sing learning accomplishments. It is noticeable how â€Å" resident as-teacher † course of study is going more widespread in the different residence plans, still the managers of these surveyed plans communicate that there is a demand for â€Å" more resident direction in learning † . Another point is that apart from holding published surveies available that describe the classs, many of these, need to be evaluated for their effectivity. Another cogent evidence is that these classs no uncertainty develop pupils ‘ rating of participants. There are 3 nonrandomized restricted surveies that calculate the evaluations for the pupils and they showed through statistics a noticeable betterment in resident ratings. â€Å" However, when impact is assessed by consequence size, the per centum alteration in ratings after the intercession is little ( 2 % to 11 % ) , in portion due to the concentration of rating tonss in the upper half of the graduated table. Yet in the largest controlled survey, these differences resulted in occupants being perceived as â€Å" first-class † instead than â€Å" really good † instructors. ( Maria A. Wamsley ; et Al ) We can further understand the importance of REP with the statement that these occupants are non merely specializer in their chosen Fieldss but they are besides learners or scholars i.e. â€Å" larning on the occupation † . ( Basuri ; et Al ) Majority of their acquisition takes topographic point while they are executing their clinical responsibilities and pattern. The latter can be farther illustrated by the undermentioned illustration. The infusion was taken from the article related to Mount Sinai Hospital and the Resident Education Program. The Institute for Medical Education at the Mount Sinai School had developed a â€Å" Resident Teaching Development Program ( RTDP ) † in the twelvemonth 2001. It was a 7 hr multidisciplinary plan that had been initiated in this country of module development. The intent was to concentrate on the significance of the occupants as â€Å" medical pedagogues † in IME. The chief aim of this plan was to construct learning accomplishm ents in the occupants who wished to learn the pupils at the school of Medicine at Mount Sinai. It would in bend prove beneficial for the betterment of the â€Å" quality of clinical instruction at the Mount Sinai Hospital and its affiliates † . The development portion of the plan had the squad reexamining all go outing work that had been done in the country. What were the other establishments making and how they were making it, and so on? They besides consulted pedagogues and conducted â€Å" needs appraisal † studies. After all the work they structured the class in a manner that it non merely included â€Å" active acquisition and chances for pattern, integrating of the occupants ‘ ain experiences, feedback on their usage of learning behaviours, and job resolution activities † . You read "Developing curriculum for the resident teacher program" in category "Essay examples" Another of import portion of all this is that the autonomous acquisition encourages the occupants â€Å" to self-assess and make individualised instruction ends for themselves † . The above clearly explains how of import the REP is non merely for any infirmary or medical school but for the practicing occupants every bit good as the housemans and pupils who are go toing these classs. A research done on the competence based construction ( B. Kanna ; et Al ) suggested in its decision that â€Å" Internal medical specialty occupants mentality in research can be significantly improved utilizing a research course of study offered through a structured and dedicated research rotary motion † . It is further demonstrated by the advancement that can be seen in the satisfaction of the occupants, the rate of engagement in assorted academic activities and result of the research for occupants since the beginning of the â€Å" research rotary motion † in different countries of the plans and preparations It is an established fact that occupants as pedagogues plan was a alone thought that has been at work since 1960 ‘s. It has resulted in a positive bend out of the occupants and the pupils who are both profiting from such acquisition and skill based plans. All the research that has been conducted resulted in the same thought that more and more chances should be given to these occupants and their accomplishments and capablenesss should be improved so that larning can increase. One interesting fact was frequently highlighted by different research workers in their studies. It was whether learning improves the accomplishments of the practicing occupants or non? A hypothesis for a research highlights the undermentioned by saying that whether a â€Å" skilled instructor has an increased likeliness of going a competent instructor † or is the instance face-to-face. Their probe and studies lead them to happen that their consequence supported the hypothesis. â€Å" learning improv ed the sensed professional competence of medical doctor. â€Å" ( Basuri et al ) . However it was mostly subjective with small quantitative grounds, still they did non happen any survey that disproved this point. In the first chapter we had established in the issues sing the function of the occupants that emphasis needs to be given on how to construction a more efficient REP plan that will heighten non merely the accomplishments of these occupants but in bend improve the quality of larning that takes topographic point. Another survey found in Medical Teacher ( Vol. 24, No. 1, 2002 ; Busari et Al ) indicated that the occupants non merely idea of learning the medical pupils as their chief duty but that they besides learnt in the procedure. However, it is noticeable that learning is limited due to clip restrictions that may be needed for the readying and conductivity of the class coupled with better instruction accomplishments. In this survey the positions of Stewart A ; Feltovich ( 1988 ) were besides confirmed who stated that â€Å" occupants are in a alone place to learn and measure pupils because of their propinquity to the pupils † . Many of the positions by the occupants supported this impression and included the undermentioned points: They felt that the occupants were voluntarily available and had more contact clip with pupils They were in a better place every bit far as the rating of the pupils was concerned. They were easy to near as they were ever in the infirmary and on responsibility From the pupils point of position the occupants were better at explicating things. Even though there was a common understanding that instruction was the one of the chief functions that occupants had, there was a significant deficiency of the instruction clip and the know-how which caused hinderances in their function. This lowered their place to person merely as an attending staff member. Many a times it was noted by the occupants that while learning the pupils their ain accomplishments were tested and they has clip to critically reflect on their ain cognition. One should see it to be an of import motivational point which leads these occupants to constantly update themselves and therefore the procedure of acquisition goes on. 2.4 Decision From the treatment and positions presented above the decision is obvious. Before get downing the chapter it was established that work in this country was required for Pakistan as this construct is new to this portion of the universe. Although establishments like AKU and ISRA are sREPping up their work in the field of REP much more has to be done. Developing a course of study for this country is so a challenge as to understand the significance of the attempts is required. From the above and many other treatments already published it is observed that occupants were non given the really accredited for the work that they have done or the occupation they perform. They have non been provided adequate clip to better their accomplishments and these consequences in certain oversights in the instruction of assorted plans. We can see this from the survey conducted in another article which stated that there was cogent evidence that â€Å" instruction classs improve resident self-assessed instru ction behaviours, assurance as a instructor, and consequence in higher scholar ratings of occupants. † ( Wamsley et al. ) it can be stated â€Å" that based on the seen ‘positive effects ‘ , one might reason that all residence plans should necessitate occupant learning direction. † There are many obstructions nevertheless, sing the execution of the class. Teaching different plans prove to be ‘time intensive ‘ for both the occupants and module. It is besides a challenge to supply the occupants with uninterrupted larning clip. Majority of the clip there is no support for making and learning these classs. â€Å" Competing curricular demands for preparation may ensue in fewer time-intensive course of study. † Furthermore we can set up that these limitations might be a contributional factor towards the fact that about â€Å" half of all residence plans do non supply formal direction in learning. † We have at the beginning of this chapter highlighted the importance for REP with respects to Pakistan and besides have identified countries where work needs to be done. Pakistani universities particularly those covering with medical specialty and infirmaries like Aga Khan need to set in more attempt in bettering the position of occupants as instructors. Intelligibly we have sREPped into this sphere and no uncertainty worked increasingly but every bit compared to what other states have done we are still far behind. Thus we will reason our reappraisal here and further this research thesis to chapter 3 which will concentrate on the demand appraisal for the occupant as pedagogue plan and the development of the course of study for the said. Medical pupils often consider occupants to be their most of import instructors and look frontward to a teaching function during residence ( Barrow, 1966 ) . Another survey, conducted more than twenty five old ages subsequently, confirms these findings ( Bing-You A ; Sproul, 1992 ) . Brown ( 1970 ) , in a survey of housestaff attitude towards instruction, found that occupants provide the bulk of clinical direction. Harmonizing to his findings, no 1 is more available to pupils and junior housestaff through all facets of medical attention, even through the dark. He argues that without occupants, clinical module would necessitate to be available 24 hours a twenty-four hours. He found that all occupants consider themselves to be instructors, and pass 20A ­25 % of their clip supervision, measuring, or learning others. Residents besides attribute 40-50 % of their ain instruction to other housestaff. These findings are in maintaining with more recent surveies. Undergraduate surgery pupils credited housestaff for supplying about one tierce of the cognition acquired during their rotary motion ( Lowry, 1976 ) . In another survey ( Bing- You amp ; Harvey, 1991 ) , pupils estimated that one tierce of their cognition could be attributed to housestaff instruction. Steward and Feltovich ( 1988 ) argue that â€Å" for learning medical pupils, no 1 is more available or better qualified than a occupant † ( p. 4 ) . Residents occupy an intermediate place between module and pupils in footings of cognition, authorization, experience, and are less intimidating to pupils. Their propinquity, in footings of degree of preparation, enables them to better understand the practical demands and jobs of pupils. Tremonti and Biddle ( 1982 ) emphasis that occupants ‘ functions as instructors are complimentary, and non redundant, with that of module. Residents concentrate on day-to-day patient attention issues on a big figure of patients and pass more clip on the ward and at the bedside. Faculty, on the other manus, emphasis in depth treatment, psychosocial issues, and job work outing accomplishments on a little figure of patients. The fact that occupants spend more clip with pupils and are â€Å" closer † to their degree does non needfully do them effectual instructors. Irby ( 1978 ) found that although pupils rated occupants as being more involved in their clinical instruction, occupants were thought to be less effectual than module. Merely 10 % of pupils in another survey ( Brown, 1971 ) â€Å" felt that housestaff instruction was peculiarly effectual when it was done at all † ( p. 93 ) . Wilkerson, Lesky, and Medio, ( 1986 ) studied the learning accomplishments of occupants during work unit of ammunitions. â€Å" The consequences aˆÂ ¦indicated that during work rounds the occupants exhibited few of the instruction behaviours that can heighten acquisition in a patient attention puting†¦ , that pupils and housemans were frequently inactive members of the work squad, with the bulk of clinical determinations being made by occupants Clinical logical thinking, job resolution and supervised determination doing were non recognized as acquisition ends that might be pursued while charts were being reviewed and patients were being visited†¦ .The occupant appeared to gestate instruction as a schoolroom activity and compare it to talking † ( p. 827 ) . Lewis and Kappelman ( 1984 ) noted that occupants most often use an autocratic talk manner in learning. Ironically, this was occupants ‘ least favorite attack as scholars. Medio, Wilkerson, Lesky, and Borkan ( 1988 ) observed occupants during work unit of ammunitions. Residents did non frequently deliberately use day-to-day patient brushs for learning. When they did mean to learn during work unit of ammunitions, they normally provided brief talks. Not merely did the survey show the limited repertory of learning accomplishments used by most occupants, but it besides delineated the many instruction chances that were being overlooked. For most occupants, learning had become synonymous with prepared talks and was, hence, incompatible with the unpredictable demands of patient attention ( p. 215 ) . Meleca and Pearsol ( 1988 ) impulse that occupants be made cognizant of and take advantage of their duties and â€Å" docile minutes † ( i.e. , learning chances ) . One survey ( Bergen, Stratos, Berman, A ; Skeff, 1993 ) compared the clinical instruction abilities of occupants and go toing doctors in the inmate and talk scenes. Overall, occupants and attentions received similar evaluations. Where there was a difference, module were rated higher than occupants. Of note, evaluations for both groups were by and large low in each class proposing the demand for engagement in REPs by both groups. Residents by and large have a positive â€Å" attitude † towards their function as instructors. The huge bulk of occupants enjoy learning ( 89 % of 68 respondents ) ( Apter, et al. , 1988 ) . In this survey, enjoyment of instruction was positively associated with increased readying clip and perceptual experience of positive consequences of learning. Bing-You and Harvey ( 1991 ) are the first to turn to whether an association between a positive attitude towards learning and perceptual experiences towards learning are associated with better pupil ratings of learning. Twenty one ( of 24 ) occupants completed a questionnaire in order to study their attitude towards learning. They were later evaluated by 3rd twelvemonth medical pupils over a one twelvemonth period. Residents ‘ desire to learn was most strongly correlated ( 0.77 ) with active engagement of pupils and was the lone â€Å" attitude † correlating with overall learning effectivity ( 0.54 ) . Unfortunately, no correlativity was found between pupil evaluations of occupants as instructors and occupants ‘ self- appraisal of learning effectivity. Of note, occupants holding participated in a REP were more confident as instructors, were rated more extremely in actively affecting pupils and in supplying way and feedback, and were besides more confident as instructors. Although occupants have major learning duties, grounds exists that they may non have adequate support or readying for this function and that barriers hinder optimum instruction. A US national study of general surgical residence plan managers ( Anderson, Anderson, A ; Scholten, 1990 ) posed three inquiries: ( 1 ) To what extent do surgical occupants Teach and measure medical pupils? ( 2 ) How are surgical occupants prepared for and evaluated on their instruction duties? ( 3 ) What are the surgical plan managers sentiments approximately occupants as instructors? Virtually all ( 98 % ) surgical occupants had learning duties. However, merely 36 % of plans provided occupants with written ratings of their instruction, and 60 % of plan managers did non believe it was of import for occupants to have formal preparation in learning accomplishments. Merely 14 % of occupants in this survey had attended workshops on learning. Two other surveies ( Callen A ; Roberts, 1980, Brown, 1971 ) study similar findings. Thirteen per centum of 136 psychopathology occupants, and 15 % of 28 surgery occupants had anterior teacher preparation. A more favorable proportion ( i.e. , 38 % of 21 occupants ) is cited in one survey ( Bing-You A ; Harvey, 1991 ) . This likely reflects the writer ‘s outstanding function in advancing and developing resident instruction accomplishments at his establishment. Schiffman ( 1986 ) asks: â€Å" How so do house officers learn how to learn? The obvious reply is that the house officer has had twenty old ages of observation of his or her ain i nstructors upon which to pattern his or her manner † ( p. 55 ) . This remains unequal. If most occupants do non hold prior teacher instruction, do they at least receive utile feedback on the instruction that they do? In 1978, the American Association of Medical Colleges ( AAMC ) surveyed sections of internal medical specialty, paediatricss, psychopathology, surgery, and household medical specialty ( Tonesk, 1979 ) . Merely 87 of 319 ( 27 % ) plans included learning public presentation as portion of occupants ‘ ratings, and those that did normally merely required a planetary appraisal of learning ability. The information on supervising of instruction is every bit black. Apter, Metzger, and Glassroth ( 1988 ) study that merely 13 % ( of 68 ) occupants felt that module supervising of their instruction was optimum, and 58 % indicated that they had ne’er been supervised. In one survey ( Callen A ; Roberts, 1980 ) , 78 % ( of 136 ) psychopathology occupants thought that â€Å" the chief ground occupants are required to learn medical pupils is to liberate up clip, clip for module to make research and other things. † On norm, these occupants estimated that they spent 9 hours per hebdomad in learning activities. Despite this big learning committedness, merely 32 % of occupants thought that they should be required to go to REPs. When the inquiry of go toing a resident REP is posed otherwise, 53 % ( Apter, et al. , 1988 ) to 66 % ( Br own, 1970 ) of occupants stated they would be interested in go toing a workshop if it were offered. In add-on to less than satisfactory support for their instruction function, occupants face other hindrances. Time and conflicting demands seem to be most of import. Eighty seven per centum of occupants cited either their ain or their pupils ‘ time- devouring ward responsibilities as the greatest obstruction to learning ( Apter, et al. , 1988 ) . Post call exhaustion was besides an of import factor ( 49 % ) doing learning hard. Kates and Lesser ( 1985 ) place what they consider to be major jobs faced by occupants when learning. They quote the AAMC study cited above ( Tonesk, 1979 ) and admonish station alumnus plans for the deficiency of accent placed on occupants ‘ learning function. Beyond this, occupants ‘ may be ill-defined about what their existent function is in footings of oversing – learning junior housestaff, and every bit mentioned, they are normally unprepared for their instruction map. Residents are normally unfamiliar with the larning aims of the juniors they supervise and teach. Despite this, they are normally called upon to assist measure them. The occupants ‘ ain supervisors frequently provide unequal supervising and support for occupants. This, in itself, may understate the importance of learning for the occupant. Finally, few plans make any specific attempts to organize instruction chances for occupants with a particular involvement in instruction. Admiting the many jobs faced by occupants when instruction, and their less than optimum readying for their instruction function, non much is known sing the demands of occupants in footings of planing a REP. Boule and Chamberland ( in imperativeness ) addressed this issue from a occupants ‘ position by inquiring them â€Å" What sort of preparation do you necessitate to learn more efficaciously? † Eighty occupants responded. Two tierces of their replies corresponded with demands normally addressed by REPs, while one third were concerned with medical competence and clip direction. Nine cardinal words were most often cited in their responses ( in order of precedence ) : ( 1 ) division of work / instruction clip, ( 2 ) instruction methods, ( 3 ) medical cognition, ( 4 ) aims, ( 5 ) synthesis accomplishments, ( 6 ) feedback, ( 7 ) motive, ( 8 ) psychological science applied to instruction, and ( 9 ) pupil jobs. More research needs to be done in the country of the instructor instruction demands of occupants. Other positions and other beginnings of information should congratulate that of occupants. Empirical Research on Resident REPs An extended reappraisal of the medical instruction literature was undertaken to place bing surveies of resident REPs. Twenty-six mentions were identified between 1963 and 1991. Of the 26 studies, one survey was described in three different publications ( Greenberg, et al. , 1984 ; Greenberg, Jewett, A ; Goldberg, 1988 ; Jewett, et al. , 1982 ) , and two surveies were reported twice ( Camp A ; Hoban, 1988 ; Camp, Hoban, A ; Katz, 1985 ) and ( Lazerson, 1972 ; Lazerson, 1973 ) . Furthermore, chapter nine ( Edwards, Kissling, Paluche, A ; Marier, 1988b ) of Edwards and Marier ‘s ( 1988 ) book, Clinical Teaching for Medical Residents: Roles Techniques, and Programs, outlines a resident REP used for two surveies ( â€Å" Phase I † and â€Å" Phase II ) that were reported elsewhere ( Edwards, Kissling, Brannan, Plauche, A ; Marier, 1988a ; Edwards, Kissling, Plauche, A ; Marier, 1988 ) . This plan was besides used for a 3rd survey ( Edwards, Kissling, Plauche, A ; Marier, 1986 ) . Therefore, a sum of 21 different surveies and 19 different resident REPs were identified. Of the 19 resident REPs, two really depict undergraduate medical school electives: one offered as a 3rd twelvemonth elective ( Craig A ; Page, 1987 ) , the other as a 4th twelvemonth elective ( Sobral, 1989 ) . Another plan ( Lazerson, 1972 ; Lazerson, 1973 ) can be more accurately described as a learning experience under supervising instead than a resident REP. This survey describes the exp erience of psychopathology occupants given the chance to learn undergraduate psychological science at a community college. Although these occupants received feedback on their instruction accomplishments, no formal instructor preparation was undertaken. Consequently, merely 18 surveies described 16 plans in which occupants underwent a course of study with a specific end of developing learning accomplishments. A database was created pull outing information from all surveies for easy comparing. The information was organized into the following Fieldss: ( 1 ) Engagement ( voluntary or compulsory ) ; ( 2 ) N ( i.e. , figure ) ; ( 3 ) Forte ( of occupants ) ; ( 4 ) degree ( i.e. , postgraduate twelvemonth ( PGY ) of preparation of occupant ) ; ( 5 ) Goals A ; Objectives ( of REP ) ; ( 6 ) Methodology ( i.e. , analyze design ) ; ( 7 ) Program Format ; ( 8 ) Instructor ( s ) ( i.e. , professional pedagogues or doctors ) ; ( 9 ) Consultation ( s ) ( i.e. , whether or non professional pedagogues were involved in plan development or execution ) ; ( 10 ) Timeline ( i.e. , figure of hours over what clip frame ) ; ( 11 ) Content ( of REP ) ; ( 12 ) Program Evaluation ( consequences ) ; ( 13 ) Study Results ; ( 14 ) Problems ( identified ) ; ( 15 ) Recommendations ( practical ) . The first occupant REP reported ( Husted A ; Hawkins, 1963 ) dates back to 1963. This instance survey was initiated as a pilot undertaking. The research workers asked section presidents to ask for two occupants each to take part in the plan. Give the voluntary nature of the class, occupants could worsen the invitation. A sum of seven occupants participated in the six â€Å" lecture-discussion † Sessionss. No effort was made to measure outcome steps. Even the plan itself was non assessed with any asperity. The writers conclude that â€Å" participants were certain plenty that the pilot venture was of sufficient benefit to them to take to the suggestion that the orientation be repeated and the invitations expanded†¦ † ( p. 115 ) . The learning function of occupants has become progressively more prominent over the old ages, with 17 of the 26 mentions being published since 1985, and the recent publication of books on the topic ( Edwards A ; Marier, 1988 ; Schwenk A ; Whitman, 1984 ; Weinholtz A ; Edwards, 1992 ) . A sum-up of the medical instruction literature on this topic will be the focal point of the balance of chapter two. Engagement Engagement in the REP was â€Å" voluntary † in 9 surveies, â€Å" mandatary † in 6, and non stated in the staying 7. Assorted statements can be made for and against both schemes, but no decisions can be drawn from these surveies. Leting occupants to â€Å" opt-out † of REPs, nevertheless, may ensue in pretermiting those occupants who need it most. Forte General internal medical specialty is the most represented of all fortes among the surveies reviewed. Internal medical specialty occupants were involved in 11 of the 22 plans. Those surveies ( e.g. , Edwards, et al. , 1988 ) looking for differentiations between fortes by and large found no important differences. I, evel No consensus exists as to when is the best clip to present a occupant REP. A speedy glimpse at the mark audience ( i.e. , station alumnus twelvemonth of preparation ) of the assorted REPs outlined makes this clear. Five plans were geared to PGY 1 occupants and four plans were geared to all degrees of residence. Two plans were undergraduate medical school electives. Other degrees were the mark in five plans and no information was available for the staying six. Merely one survey ( Bing-You, 1990 ) addressed plan results in relation to degree of preparation. Further surveies are needed to specify the best clip to implement REPs. â€Å" Readiness † to larn, degree of professional competency, viing demands / handiness, and cost effectivity ( e.g. , concluding twelvemonth occupants merely have a short instruction calling staying ) are merely a few of the factors to be considered. Goals and Aims Goals and Aims varied well between plans. Although none of the plans officially stated the theoretical underpinnings from which the ends and aims emanated, the linguistic communication used to depict them is uncovering. The desire to â€Å" transportation † information is outstanding. Programs instead wanted to â€Å" introduce occupants with † ( Husted A ; Hawkins, 1963 ) , â€Å" supply information † ( Brown, 1971 ) , â€Å" introduce constructs † ( Lewis A ; Kappleman, 1984 ) , or have occupants â€Å" gain cognition / become familiar with † ( Camp A ; Hoban, 1988 ; Camp, et al. , 1985 ) . Standard behavioral aims were besides common. For illustration, one plan ( Husted A ; Hawkins, 1963 ) expected take parting occupants to be able to â€Å" ( a ) select the appropriate ( learning ) technique and ( B ) Begin to develop accomplishment in self-appraisal of their ability to efficaciously work in their instruction function † ( p. 111 ) , while another ( Edwards, et al. , 1988b ) expected occupants to â€Å" give feedback to scholars † ( p. 159 ) . The diction in two farther surveies alludes to constructivism: ( 1 ) â€Å" The workshop ‘s purpose is non to learn â€Å" learning accomplishments, † such as lecture or running a tutorial, but to research the organisational facets of oversing a pupil such as the relationship between the occupant and their ain supervisor, and their apprehension of the aims of the clerk ‘s rotary motion † ( italics mine ) ( Kates A ; Lesser, 1985, p. 418 ) , and ( 2 ) â€Å" to spr ead out the occupants ‘ construct of learning † ( italics mine ) ( Medio, et al. , 1988, p. 214 ) . Finally, one survey ( Edwards, et al. , 1988b ) had increased assurance in instruction ( cf. , learning self-efficacy ) as a plan end. Methodology It is beyond the range of this thesis to discourse the methodologic defects of the surveies reviewed. The patient- centred gait of infirmary pattern and postgraduate medical developing do it hard to run educational experiments in this context. The writers of the reviewed surveies should be commended for their attempts and advanced efforts to present and reply inquiries. Of the 22 database entries, 19 are instance surveies. Two of these make an effort at an experimental design: â€Å" quasi-experimental † ( Snell, 1989 ) , and â€Å" case-control, pre- and post- observation † ( Medio, et al. , 1988 ) . Both of these surveies used occupants who did non go to the REP as a comparing ( i.e. , control ) group. The mere fact that they did non take to go to makes them different ; any differences found between the two groups may merely as probably be attributed to the features of the persons in the several groups as to the intercession ( i.e. , REP ) . Decision from these survei es should be interpreted with cautiousness. One of the database references is a simple plan description with survey consequences reported elsewhere. The staying two surveies ( one of which is reported three times ) ( Edwards, et al. , 1988a ; Greenberg, et al. , 1984 ; Greenberg, et al. , 1988 ; Jewett, et al. , 1982 ) have a randomised instance control design. Both have a comparatively little entire figure of survey topics, 22 and 53 severally. Format Overall, an effort was made to utilize instructional methods that actively involve occupants. For the most portion, nevertheless, this merely meant holding occupants take portion in group treatments ( cf. , reliable activities e.g. , Collins, et al. , 1991 ) . Lave and Wenger ( 1991 ) , in their treatment of discourse and pattern, stress the of import differences â€Å" between speaking about a pattern from outside and speaking within it † ( p. 107 ) . They argue â€Å" that for fledglings so the intent is non to larn from talk as a replacement for legitimate peripheral engagement ; it is to larn to speak as a key to legalize peripheral engagement † ( original accent ) ( p. 109 ) . As discussed in an earlier subdivision of this chapter, Lave and Wenger ( 1991 ) distinguish between a acquisition course of study dwelling of located chances and a instruction course of study constructed for direction. From their position, so, larning becomes a inquiry of entree to legalize pattern as a larning resource instead than supplying direction. Most of the plans described, it seems, hold small foundation in a societal / situated position of grownup instruction. A few surveies, nevertheless, did effort to stress the of import function of experience as portion of the REP: microteaching, with and without video playback ( Lawson A ; Harvill, 1980 ; Medio, et al. , 1988 ; Pristach, et al. , 1991 ; Snell, 1989 ) , and function playing ( Edwards, et al. , 1988b ; Sobral, 1989 ) . Timeline In Jarvis ‘ ( 1992 ) treatment of larning in the workplace, he reminds us â€Å" that there are two basic signifiers of experience: primary and secondary experience. The former involves the existent experience people have in a given state of affairs ; this type of experience molds their self-identity to a great extent. The latter involves experiences in which interaction or instruction occurs over and above the primary experience † ( p. 108-181 ) . Although microteaching and function playing may be ( or come near to being ) reliable activities, they would still be classified as secondary experiences from Jarvis ‘ point of position. It must be remembered that whether or non residency plans decide to develop and implement REPs, occupants will still hold major learning duties ( and chances ) . Most plans did non take specific advantage of occupants ‘ current learning assignments as a acquisition resource. One plan ( Snell, 1989 ) did reference that occupants had â€Å" an chance to pattern the ( freshly learned learning ) accomplishments on the wards during the hebdomads between Sessionss † ( italics mine ) ( p. 125 ) . Another plan, dwelling of two three-hour workshops, separated both workshops by 5 months so that â€Å" the experimental group had an chance to use these ( learning ) accomplishments in their day-to-day activities † ( italics mine ) ( P. 361 ) . Unfortunately, without construction and followup, pupils ( including occupants ) do non ever take advantage of chances. None of the plans specifically structured and included such learning activities. The first determination when make up one’s minding on a timeline for a plan is make up one’s minding whether to offer a â€Å" one-shot † or a longitudinal experience. A 2nd determination besides involves timing: should occupants take portion in a REP merely while they have learning duties? A plan based on a longitudinal experience while occupants have learning duties can take advantage of Jarvis ‘ alleged primary experiences. The plan developed as portion of this thesis was specifically designed with these thoughts in head and included a â€Å" Undertaking for the Week † between Sessionss ( see chapter three ) . A learning â€Å" undertaking † was assigned at the terminal of the each seminar based on that seminar ‘s content. A lab-coat pocket sized reminder card was handed out to occupants. The undertaking became the focal point of a contemplation ( and reappraisal ) exercising at the beginning of the following hebdomadal session. Of involvement, none of the surveies were specifically designed to mensurate the impact of a instruction duty itself on results steps. This is one of the research inquiries addressed by this thesis. In those surveies noticing on timeline, about half provided a longitudinal experience while the other half offered a â€Å" one- shooting † exposure ( e.g. , 7 hr â€Å" Teachathon † ( Maxmen, 1980 ) ) . Content Program content, where provided, variably included the undermentioned subjects: ( 1 ) theories / theoretical accounts of instruction, ( 2 ) theories / theoretical accounts of acquisition, ( 3 ) big group learning / lecture, ( 4 ) little group learning / treatment, ( 5 ) one-on- one instruction, ( 6 ) bedside instruction, and ( 7 ) rating / feedback. Program Evaluation All plans were rated favorably ; there was a high grade of satisfaction with both direction and content. Residents considered the experience valuable and utile. Study Results Impact of resident REPs. All but one of the surveies designed to look into the impact of resident REP demonstrated a positive consequence. Brown ( 1971 ) used a pre- and post- 50 point multiple pick trial to measure alterations in occupants ‘ cognition of instruction and acquisition. No important difference was found at the 0.05 degree ( i.e. , average 24.0 vs. 24.7 ) . On the other manus, Edwards, Kissling, Plauche, A ; Marier ( 1986 ) study that after one twelvemonth, 67 % of occupants could still remember specific points presented, and 61 % reported utilizing thoughts from the class in their instruction. Overall, cognition was non an of import results step in the surveies reviewed. Improvements in learning behaviors have been the chief focal point of most surveies measuring results. Beginnings of perceptual experiences have included occupants ( i.e. , self ) , pupils, equals ( i.e. , other occupants and module ) , every bit good as professional pedagogues. Improvements in self-concept and self-reported behaviors were demonstrated in four surveies ( Bing-You A ; Greenberg, 1990 ; Edwards, et al. , 1986 ; Edwards, et al. , 1988 ; Snell, 1989 ) . Student evaluations of occupants who attended a instruction accomplishments workshop were significantly higher ( p lt ; 0.05 ) on four of nine dimensions including â€Å" overall instruction effectivity † ( Edwards, et al. , 1988 ) . In another survey ( Edwards, et al. , 1986 ) an effort was made to analyze the consequence of a resident REP on pupil evaluations of occupant instruction ; unluckily, the information was excessively â€Å" bare † to be interpreted validly. Improvements in resident instruction behaviors have besides been studied by observation methods. One survey ( Camp A ; Hoban, 1988 ; Camp, et al. , 1985 ) used direct informal observation of occupant instruction by pedagogues to measure alteration. Faculty perceivers â€Å" believed that the participants showed that they had put into pattern many of the accomplishments that had been discussed and demonstrated in the class on learning†¦ † ( p. 212 ) . More formal efforts to detect and step alterations in occupant instruction behavior, utilizing observation instruments, exist. A case-control pre- and post- observation survey ( Medio, et al. , 1988 ) demonstrated an betterment in the â€Å" intervention † group as compared to â€Å" controls. † Each occupant ( 6 intervention and 6 controls ) was observed during one work unit of ammunition while reexamining an norm of 10 patients. Unfortunately, the little sample size, and the fact that â€Å" controls † consisted of occupants non take parting in the plan ( i.e. , non-random ) make reading of the consequences hard. Snell ( 1989 ) , utilizing a similar experimental design with 9 topics and 5 controls showed that post-intervention tonss increased in all three countries measured ( i.e. , talk, tutorial, and treatment ( p lt ; 0.05 ) ) . Observation surveies utilizing videotaped occupant instruction besides demonstrated a positive impact of REPs on learning behaviors ( Bing-You, 1990 ; Edwards, et al. , 1988a ; Greenberg, et al. , 1984 ; Greenberg, et al. , 1988 ; Jewett, et al. , 1982 ; Lawson A ; Harvill, 1980 ) . Need for reinforcement / long term consequence. How long are betterments in learning accomplishments maintained after a REP? One group of research workers ( Edwards, et al. , 1988a ) noted that betterment in occupants ‘ accomplishments ( videotaped learning ) had declined when steps were repeated six months subsequently ; evaluations were, nevertheless, still higher than pre- direction. The writers suggest that occupants may necessitate periodic short â€Å" refresher † classs to reenforce learning accomplishments throughout their residence. Of involvement, another survey ( Edwards, et al. , 1986 ) utilizing the same REP found that station class betterments in self-rated instruction accomplishments â€Å" endured without decay for at least a twelvemonth and a half † ( p. 970 ) . Furthermore, â€Å" occupants could still remember and explicate major learning points and reported that they had used these learning points 18 months after the class † ( p. 970 ) . Similarly, Snell ( 1989 ) found that increased evaluations of learning behaviors ( based on observations ) were maintained for eight months after a REP. Overall, small is known about the rate of â€Å" decay † of occupants ‘ learning accomplishments after a REP. An interesting, and unreciprocated, inquiry is whether or non concentrating on â€Å" attitude † and â€Å" self-efficacy † ( cf. , specific learning behavior ) has any consequence on the rate of decay. â€Å" Assurance † / self-efficacy. Although the concept of self-efficacy has non specifically been used as an outcomes step, self-reported â€Å" self- assurance † has. Interestingly, those surveies measuring alterations in assurance did non seek to show an association with alterations in instruction behavior. Further, the impact of a instruction assignment itself ( i.e. , experience ) on assurance has non been explicitly addressed. All three of these issues are specifically addressed in the survey described in this thesis. Snell ( 1989 ) measured self-confidence pre- and post-course by self appraisal questionnaire. Significant additions in â€Å" assurance in learning † were found in the intervention group ( P lt ; 0.05 ) . Snell goes on to notice that â€Å" eight months after the class, the occupants all thought that they were more confident in their instruction † ( p. 126 ) . Unfortunately, the information is non presented nor is the analysis. Besides, no reference of â€Å" control † group comparing is made. Bing-You and Greenberg ( 1990 ) assessed occupants ‘ assurance as instructors and perceptual experiences toward learning utilizing a pre- workshop questionnaire. However, no post-workshop questionnaire was given ; hence, no remark on the impact of the REP on assurance can be made. At the beginning of the plan, 25 % of occupants felt confident or really confident as instructors ( 68 % slightly confident, and 7 % non confident ) . Perceived feedback of their instruction was similar to assurance degrees, with 32 % describing positive or really positive feedback. Bing-You ( 1990 ) used a pre- and post-workshop questionnaire to measure occupants ‘ â€Å" attitude towards learning. † In add-on, trained raters assessed videotapes of occupant instruction at the terminal of the workshop and once more at a mean of 6.3 months subsequently ( 2-11 months ) . However, no illations can be made sing the relationship between learning attitude and instruction behaviors given the two different survey designs for each results step ( i.e. , pre-post vs. immediate and delayed station ) . After the workshop, both occupants and housemans rated themselves as more effectual ( p lt ; 0.05 ) as instructors in the country of cognition ( utilizing mentions ) but merely the housemans felt more effectual in their proficient accomplishments ( P lt ; 0.01 ) . Without direct entree to the questionnaire points, it is hard to find whether â€Å" usage of mentions † and â€Å" proficient accomplishments † represent attitude or self-reported behaviors. The most interesting and best designed of the surveies looking at assurance has been reported three times ( Greenberg, et al. , 1984 ; Greenberg, et al. , 1988 ; Jewett, et al. , 1982 ) . The research workers used a pre-test / post-test control design to analyze the impact of the workshops: random assignment of 27 in the experimental group attended workshop and audience Sessionss ; 26 in the control group had no intercession. Three results steps were assessed: ( 1 ) self-assessment: preA ­ A ; post-questionnaires measuring occupants ‘ learning attitude and perceptual experiences of instruction, ( 2 ) equal, pupil, and module rating of occupant instruction, and ( 3 ) videotaped Sessionss of occupant instruction were analyzed by nonphysicians utilizing an instrument deigned to categorise occupants ‘ behavior every 3 seconds. Forty-nine of the 53 occupants completed both self-assessment questionnaires: 18 % of occupants were â€Å" confident † or â€Å" really confident † as instructors at beginning of survey. After the class, 42 % of the experimental group and 22 % of the control group ( P lt ; 0.05 ) were â€Å" confident † or â€Å" really confident † as instructors. Besides, 87 % of experimental group felt their instruction accomplishments were bettering ( vs. 52 % control ) . After the class, module, pupils, and equals rated 52 % of experimental occupants as â€Å" effectual † ( vs. 27 % of controls ; nearing statistical significance ) . No effort was made to show an association of alteration in attitude with a alteration in behavior. The writers report that â€Å" a figure of important correlativities were found between the assurance of occupants in both groups ( experimental and control ) as instructors and their perceptual experiences of learning as a duty † ( p. 362 ) . Percept of learning as a duty was divided into 4 classs: ( 1 ) attitude towards instruction, ( 2 ) their function as a instructor, ( 3 ) instruction methods, and ( 4 ) bettering clinical instruction. The scope of reported correlativity coefficients ( absolute value ) was 0.26-0.58. If â€Å" assurance as a instructor † is accepted as a step of learning self-efficacy, it can be assumed that this one point step of grade of â€Å" assurance as a instructor † utilizing a Likert graduated table is neither as valid nor every bit dependable as a multi-item graduated table measuring the same concept. Therefore, one can contend that the â€Å" assurance as a instructor † point in this survey is a generic or planetary ( albeit progressive ) step of learning self-efficacy. Of involvement, many of the points in Greenberg, Goldberg, and Jewett ‘s ( 1984 ) instrument measuring occupants ‘ perceptual experience of learning duty could arguably be said to measure the assorted dimensions of learning self efficaciousness as described by Ashton ( 1984 ) . For case, â€Å" Teaching medical pupils is one of the primary duties of the occupant † ( p. 362 ) corresponds with the dimension of â€Å" Personal Responsibility for Student Learning † ( p. 29 ) of Ashton ‘s eight dimensions of learning self-efficacy. It is non surprising, hence, to happen so many ( and statistically important ) correlativities between â€Å" assurance as a instructor † and perceptual experiences of learning as a duty. Most of the points in the perceptual experiences of learning as a duty merely tap the assorted dimensions of learning self-efficacy. Further support for this statement will blossom in the meth ods and consequences chapters of this thesis, as many of the points from Greenberg, Goldberg, and Jewett ‘s ( 1984 ) instrument measuring occupants ‘ perceptual experience of learning duty were incorporated into the thesis ‘s survey instrument where good internal consistence dependability was found. Camp and Hoban ( 1988 ) identified the instruction scenes encountered by occupants: ( 1 ) Case presentations ; ( 2 ) Teaching on work unit of ammunitions ; ( 3 ) Teaching clinical accomplishments class to undergraduate medical pupils ; ( 4 ) Large group presentations / talks ; ( 5 ) Small group presentations / seminars. Although occupants are on occasion called upon to talk and make presentations, most of their instruction occurs in little groups utilizing a dynamic tutorial manner. Apter, Metzger, and Glassroth ( 1988 ) quantified the most frequent instruction scenes among occupants: patients ‘ bedside ( 45.5 % ) ; one-to-one supervising of junior squad members ( 25.5 % ) ; â€Å" sit-down † ward rounds ( 23.6 % ) . How to cite Developing curriculum for the resident teacher program, Essay examples

Friday, December 6, 2019

Scrapbooking Essay Example For Students

Scrapbooking Essay As I sit on my bed, with nothing to do, my mind is suddenly filled. What can I do with all my JUNK? I search in old dusty boxes, underneath my bed, in my closet and take a look at old picture frames, memories that have been sitting aside for years. What can I do to make it all come together? As I think, look around, and think again, I say quietly to myself, Why dont I create a scrapbook? Scrapbooking is a great way to preserve memories and pass them down in a creative and unique way. When a person thinks of scrapbooking, what do they think? I think of all the pictures and memorabilia that I have saved to create a portrait of my life which I can cherish forever. Scrapbooking is more than making cute pages. Scrapbooking is a unique craft and strange hobby that is rapidly changing (What). One wants to make sure all the photos in the scrapbook are safe and wont be destroyed. As the science of photography is changing, the life of the pictures is being increased, as long as all the safe materials are being used and precautions are taken in what they are doing and how it is being done (What). Scrapbooking can capture the special people and events we encounter in life. Many people like to take pictures of family traditions, favorite things and accomplishments (Braun 11). When creating a scrapbook, a person is able to pass down memories from when they were younger. Scrapbooking is a creative way to relax and have fun. Scrapbooking has become popular over the years because people are able to create something that will last forever. Many people want to transform their old photo albums into scrapbooks because there is more room for creativity (Brown). But a person has to remember that scrapbooking can become costly and very time consuming. The first thing to consider before creating a scrapbook is to gather all of the information to include. Doing this will cause less hassle when creating pages and will allow for more time in doing so. Collecting photographs, treasures, certificates, brochures and documents (Organizing). Keep anything that has great significance in a persons life, so that they are able to reflect back on it. Newspaper articles are a good thing to save because they help explain whats going on. Talking to family and friends will often uncover information one doesnt have and would like to cherish (Braun 12). The second thing the scrapbooker wants to do is organize everything. A clean work area, with enough space to spread many pictures and paper out, is helpful. Putting pictures, paper, and tools in stacks and containers is also helpful because its easier to find things, so that when something is needed one can go right to the box and get what they needed, instead of having to search for it (Organization) . After getting organized and gathering all of the information, its time to decide which kind of album to use. Many different types and styles of albums are available to choose from. The spiral-bound album does not allow pages to be removed or added, so pages cant be rearranged. This type of album would be reliable for a person who is precise and has little work to do. The 3-ring binder is more like a photo album, not a scrapbook, so it is not often recommended (Preserving Memories). Another type of album is the strap-hinged album. These albums are most common because they allow one to add and remove pages and rearrange them (Brown Before). Above all, when considering what album to buy one would want to make sure not to buy from a department or discount store because they might not be high quality (Choosing). One should buy from a scrapbook store or a place that sells quality scrapbooking necessities such as paper and stickers. Three sizes of albums can be chosen from when considering buying an album. The first size is 57. This size does not allow for much creativity because the space is so small. This size of album would be good for a gift, fitting very few pictures. The next size is the 8.511. This size is bigger than the 57 but still does not allow for much creativity; the pages being small are harder to work with. The next size, 1212, is the most common. This is the biggest size, allowing more pictures to be added as well as embellishments. This album would be good for creating a family album or a high school album. Scrapbook albums can cost anywhere from $10.00 to over $100.00 dollars. The average album cost is around $40.00 (Choosing). My favorite is the 12 x 12 strap-hinged. I like working with this size because it allows me to work with more space and create more on a page. If I mess up, I can also remove the page and then replace it with a new one. Procrastination EssaySome things that one wants to know when beginning to make a scrapbook. A person should follow this plan as a guide to help them through their first couple of pages. One must lay out the pictures. Discard the blurry photos and pick out the ones that best tell a story (Brown; Corneil). Next a person wants to look at the pictures again to see if there is anything distracting the view of an object. If there is, then one should crop them out using the cutters. When cropping, make sure not to cut too much because once cut one cant go back. After cropping, a person wants to pick out the picture that stands out the most to be the focusing point (How). Again lay out the pictures, but this time lay them out on the page to see if there is a chronological or special way that the pictures should go on the page. After figuring out what pictures go where a person can begin to mat and glue. One wants to mat pictures so that they stand out. Matting also gives color to the page (Naylor). Once everything is cropped, matted, and arranged, we can glue it all down (Brown and Corneil). Once everything is glued down one wants to journal. Pictures are worth a 1000 words. But only if you can read the words (Brown and Corneil). Journaling is an important part in contributing to a scrapbook. One wants to make sure they answer the questions of who, what, where, when and why. Another important part is to make a headline or title for the page. One wants people to know whats going on and the stories behind the pictures (Braun 19-21). There are many questions one can ask when going to journal. Why was this picture so important that it was taken? Whats happening in these pictures? Why are all these people together? The answers to these questions are what makes your scrapbooks so special only you have these answers and stories (Brown and Corneil). Many people think that scrapbooking is easy, but in reality it can be difficult. According to Helen Naylor of Scrapbooking.com she believes that there are many lessons that one can avoid, to make scrapbooking a little less difficult. 1. Use decorative scissors for matting photos, not cutting them. 2. Only use the shapes of circles and ovals. Cutting the photos into shapes makes it harder to work with. 3. Only crop a picture if there is a negative or a copy of the picture. 4. For older photos use the photo corners for adhesives. For the newer pictures one can use the mounting squares (Naylor). I have learned that their can never be too many pictures. I have also learned that cropping pictures can be dangerous if I dont have another copy. Another thing that I have learned is that when going to journal one needs to write what theyre going to say before writing it on the page. Because if one messes up then they have to redo the page. Creating a scrapbook is a fun and exciting project that will capture memories to last a lifetime, if it is constructed correctly. Scrapbooking can become stressful, but when considering making a scrapbook as a way to preserve and cherish memories the stress can be well worth it. To me, my scrapbook has been well worth the time, money and the stress. I had a wonderful time completing my scrapbook. I always find myself well occupied and always having something to do now that I have taken on the hobby of scrapbooking. The only problem I can see is not having my pictures developed when I want to create a new page or two in my album. Works CitedAdhesives. Learn 2 Scrapbook: Information for Beginners. 8 May 1999. ShopA-Z.com. 17 Oct. 2001. Braun, Bev Kirschner. New Ideas for Crafting Heritage Albums. Cincinnati: Betterway Books, 2001. Brown, Gina. Personal Interview. 24 Oct. 2001. Brown, Gina and Tracy Corneil. Before You Jump in Get the Basics! 14 Oct 2001. Choosing an Album. Learn 2 Scrapbook: Information for Beginners. 8 May 1999. ShopA-Z.com. 17 Oct. 2001. Corneil, Tracy. Personal Interview. 24 Oct. 2001. How do I make my First Page? Learn 2 Scrapbook: Information for Beginners. 8 May 1999. ShopA-Z.com. 12 Oct. . Naylor, Helen. Head of the Class: Lets Get Back To the Basics. Scrapbooking.com: Memories Can Last a Lifetime. 17 Oct. 2001. Organizing Your Photos. Learn 2 Scrapbook: Information for Beginners. 8 May 1999. ShopA-Z.com. 12 Oct. 2001. Photo Organization. Learn 2 Scrapbook: Information for Beginners. 8 May 1999. ShopA-Z.com. 17 Oct. 2001. Preserving Memories: Caring for Your Heritage. Aug. 1996. Clarke HistoricalLibrary Preservation. 17 Oct. 2001. What is Scrapbooking? Learn 2 Scrapbook: Information for Beginners. 8 May 1999. ShopA-Z.com. 12 Oct. 2001. Words/ Pages : 2,515 / 24

Friday, November 29, 2019

Aravind Eye Hospital Essay Example

Aravind Eye Hospital Essay Example Aravind Eye Hospital Essay Aravind Eye Hospital Essay * What is Aravind’s mission? How successful is Aravind at achieving its mission? The mission is to bring eyesight to the masses of poor people in India, Asia, Africa and all over the world. To provide quality care as a non-profit eye hospital. To spread the Aravind model and offer hope in all parts of the world. Aravind has grown from a 20-bed hospital in 1976 to 1224 beds in 1992 as one of the biggest hospitals of its kind in the world. The Aravind organization consisted of main hospitals that charged for fees, free hospitals, eye camps, IOL factories with sponsors and volunteer organizations from all over the world. * What are the key factors that have led to Aravind’s success? What has Dr. V’s role been in creating that success? What challenges does Aravind currently face? * Key factors: Dr. V was inspired by Mahatman Gandhi and philosopher Swami Aurobindo, dedication through professional lives to serve humanity and God * Dr. V’s spiritual belief and committed to the mission of the hospital * Dr. V inspired his family and professionals to push the mind and body to its highest effort levels, worked twice as hard for half of the salary. * Dr.V has been the driving force behind the hospital * 90% of annual budget is self-generated, 10% from sources around the world, such as Royal Commonwealth Society for the Blind (UK) and the SEVA Foundation (USA). * Expend all surplus on modernizing and updating equipment and facilities with the generosity support from local business community * Spiritual approach sustaining the mission at Aravind * Challenges: franchising the model and spreading it around the world. * What type of customers do the free and paying hospitals serve? What are the similarities and differences in the service and care provided at the free and paying hospitals? Free Hospitals: * Outpatient facilities were not as organized, crowded and cramped rooms * Poorer patients, more commotion, longer wait * ICCE type surgeries, not as well equipped * No beds to recuperate and recover, 6 x 3 bamboo/coir mat spread out on the floor as a bed and small sized pillow. 20-30 patients with self-contained bathroom facilities * Detailed records were kept of all post-operative complications, such as iritis Paying Hospitals: * Patients paid for the services, Rs 500 to Rs 1000. With IOL implant total cost Rs 1500 to 2500 * Operation rooms were conducted in an efficient manner, well-paced, routine way The customers at the free hospitals are poorer compared to the paying hospital * What issues does Dr. V. face in achieving his goal of â€Å"mass-marketing† cataract surgery throughout India and to the other parts of the world? What recommendations would you make to Dr. V. to help him achieve his goal? * India has the second largest population after China, with 20 million blind eyes and another 2 million added annually. With the per-capita income Rs 6800 who couldn’t afford private treatment, $200 million would be required to overcome the blindness problem just in the country. * Despite the effort in eye camps and surgery camps in remote areas, villagers are not responsive to treatment due to various reasons, such as fear of surgery, can’t afford food and transportation. Lack of organizational skills, creating propaganda, organizing logistics. Recommendations: * I would recommend that putting a protocol in place by establishing step by step procedures and instructions. Assign a training sector for building eye camps, surgery camps, sponsors and volunteer groups. Regulations and rules must be applied to all areas in order to provide standards and consistencies in quality eye care. Well run group such as the Dindigul group can assist other camps and lead the initiative. To reach the general audience and promote the Aravind mission through public media, such as TV, internet and newspaper or publications in remote areas. * Establish brand recognition as a marketing tool for the Aravind group and present the mission with the brand signature. As you prepare the case for discussion, please consider the following: Business Model and Financial Analysis: How central is cataract surgery to Aravind’s â€Å"business†? What percent of all procedures at Aravind are for cataracts? (Exhibit 5) * 850 million population in 1991, second highest after China * 20 million blind eyes, another 2 million being added annually * Cataract was the main cause in 75-80% of the cases * Annual per-capita income was Rs 6800 ($275) over 70% below the Rs 2500 ($100) poverty line * 800 ophthalmologists performed nearly 1. 2 million cataract operations/year * 42000 eye hospital beds, free eye care and cataract surgery to people who couldn’t afford private treatment * 30% of cataract surgeries were performed in government sector * 40% for a fee, 30% free of cost by volunteer groups and NGOs * Allocation of Rs. 60 million ($2 million) annually for blindness prevention programs * $200 million would be required to overcome country’s blindness problem * Cataract was the major cause of blindness in developing countries, 75% of all cases in Asia. 80% were age-related, over 45 years age group * By 1992, the hospital group had screened 3. 65 million patients and performed 335000 cataract operations, 70% free of cost * What is Aravind’s gross margin? What does this mean? How much financial flexibility does this give them? (Exhibit 6) * Net surplus $18319363, 52% * Cash flow and marginal issues, not financially sufficient at Tirunelveli How does Aravind finance its operations? How sustainable is this financing model? * 90% of annual budget is self-generated, 10% from sources like Royal Commonwealth Society for the Blind in UK and SEVA Foundation in USA. What are Aravind’s biggest expenses? How well does Aravind manage its costs? * The three highest expenses: Stipends and staff salaries, IOL and Camps. The total expenditures are 48% which is still profitable for the Aravind to maintain the mission. Which of Aravind’s costs are variable and which are fixed? * fixed costs (for salaried labor, buildings, and equipment) * Variable costs (for medication and supplies) Operations: How efficient is Aravind (in % terms versus â€Å"industry standards†) at performing cataracts surgery? (Hint: look for information that will tell you how fast Aravind performs procedures versus the standard, and/or how many operations per doctor, or operations per bed, they perform versus the national average. ) Aravind had performed around 335000 cataract surgeries, 150 operations performed in 6 hours at the eye camp. 70% were free of cost for the poorest of India’s blind population What are the occupancy rates at the various facilities for free patients and paying patients? The occupancy rate for paying patients is 58% at the various facilities and for the free patients is 88%. How important is Aravind in terms of the number of cataract surgeries it performs each year? (in relation to the total number of cataract surgeries performed in India each year? i. e. what is Aravind’s â€Å"market share†? (exhibit 5 and page 3) 41013 cataract surgeries were performed vs. total 1. 2 million cataract operations performed in India. 40% were performed in the private sector for a fee, 30% in the government sector free cost to the patients, and remaining 30% were performed free of cost by volunteer groups and NGOs. Aravind in the 30% of the market share. How are its satellite hospitals at Tirunelveli and Theni doing? How are its eye camps performing? What problems, if any, exist, and why? The satellite hospitals are managed by Dr V’s sister, brother and close families. Some fundamental management problems exist due to cash flow issues. At Tirunelveli, they were unable to re-pay the cost-of-capital. The physical design are improved and the free section’s exam rooms are more spacious than at Madurai. Operating room capacity is better utilized with a central surgical facility, yet Tirunelveli is still not financially self-sufficient. Attracting quality people may become an issue due to the fast expansion. Training is provided on site and recruited by the hospital. Common challenges for eye camps: organizational skills, creating propagandas, organizing the logistics. Lack of consistency on principles and procedures. The Dindigul camp was well run and organized with trained teachers and involved sponsors. Marketing: Aravind divides its customers into paying and nonpaying. What does it promise to each? Quality eye care is delivered to both sections. At the non paying section, the outpatient facilities are not as organized, more crowded and cramped. Longer wait due to the number of patients. No beds to recuperate and recover, but a 6’ x 3’ bamboo mat in a large room and self-contained bathroom facilities. At the paying section, the operation rooms are conducted in an efficient and well paced, routine manner. Detailed record are kept on all patients in both areas. IOL implants are offered for paying patients due to cost. How does Aravind differentiate its marketing plan to its different types of customers? For each, consider: communications, pricing, type of service and delivery of service. Transportation and food are provided for poor patients in the eye camp, with free counsel offered to the patients. Eye camps are sponsored by local business enterprise or social service organization. Public announcement, pamphlets and advertisement were distributed 1-3 weeks in advance. What proportion of Aravind’s patients are paying versus non-paying? (Exhibit 5)? What is the trend in terms of the proportion of free vs. paid? Are free patients an increasing or decreasing percentage of total patients? (Hint – use #’s from exhibits 4 and 5) 38% of the surgeries are performed for the paying patients vs. 62% for free patients. There is a 1% increase in 1991 for paying patients, and a slight decrease of 0. 5% in non paying patients. Free patients are a decreasing trend comparing 1991 to 1990 but overall trending is still on the rise throughout the years. 40% of the patients are paying vs. 60% are non-paying. Organizational Behavior: How has Dr. V’s leadership style contributed to his success? Dr. V attracted his family and professionals to his Aravind group with his philosophy. To serve humanity and God through your dedication in the profession. What is Aravind’s corporate culture? What practices and/or policies have created this culture and contribute to its sustainability? Aravind provides continuous training to its ophthalmic personnel, research and training collaborations with St Vincent’s hospital in NYC and University of Illinois’ Eye and Ear Infirmary in Chicago. Ophthalmologists are sent to those institutions to do their residency. Through the unfailing support of his family members, the Aravind has a strong alliance built on devotion and dedication. How does Dr. V. attract and motivate the best eye doctors in the world to work with him? Dedication and devotion to the practice. All doctors in residence were gradually conditioned physically for long hours of concentrated work. The doctors at Aravind are trained to work double than the government hospitals. They dedicate themselves for helping people through a spiritual experience. Doctors were encouraged to attend conferences, publish papers, buy books, and are encouraged to do anything to advance their professional standing in the field. Despite the fact that their salaries are consistent with their reputation in the field, the doctors work twice as hard for half the salary. How essential is Dr. V. to Aravind? What will happen to the company after he is gone? Dr. V has established the structure for Aravind. His philosophy has embedded in the mind of his staff . His legacy will be carried on through dedication to the mission of the hospital. As they implement structure to the organization through policies and procedures, improvements will be made through eye camps and surgery camps continuously. As the mission spread around the world through marketing the Aravind model, Dr. V’s philosophy will be remembered and celebrated. The mission is to bring eyesight to the masses of poor people in India, Asia, Africa and all over the world. To provide quality care as a non-profit eye hospital. To spread the Aravind model and offer hope in all parts of the world. Succession plans are in place for Tirunelveli Hospital and Coimbatore Hospital.

Monday, November 25, 2019

A Critical Review of _Dueling Eagles_, Francaviglia et al. essays

A Critical Review of _Dueling Eagles_, Francaviglia et al. essays In a reading of sources regarding the U.S.-Mexican War, the reader is struck by certain portrayals of the U.S. and Mexico, the former as a powerful nation and the latter as underdeveloped, weak, and disorganized. These portrayals are apparent in both secondary and primary sources dealing with the war, for varying reasons in each case. In the primary sources, most of which are American (at least those used by researchers from the U.S.), the presentations of American greatness and Mexican weakness are closely tied with American chauvinism of the time period, which pervaded most writing and documentation. The secondary literature seems to have fallen victim to this pervasive chauvinism, echoing the idea that the U.S. was not plagued by the same kinds of problems as Mexico: political disorganization, spatial disparity, and varied (even dissenting) mindsets. The notion that Mexico lost the war to the U.S. because of political infighting is simplistic at best. Likewise, the assumption of U.S. unity and hegemony (or hegemonic interests/goals) may reflect a taking at face value of primary source material and also reflects an understanding shaped by modern points of view a projection of todays ideas onto a war that occurred over 150 years ago. A positivist construction of a historical timeline has led to a chain of events leading up to a U.S. victory, showing the reader a sort of history written by the victor, rather than a real understanding of the events of the time or a very credible picture of life during the U.S.-Mexican War. Dueling Eagles, co-edited by Richard V. Francaviglia and Douglas W. Richmond, is an attempt at a re-evaluation of the war, through the collection of various essays presented at a conference whose intent was to gain a more comprehensive understanding of the causes and effects of the war. This book (and the conference out of which the book grew) is a self-proclaimed re-evaluation because of its...

Thursday, November 21, 2019

The American Healthcare System Essay Example | Topics and Well Written Essays - 750 words

The American Healthcare System - Essay Example This is due to the fact that of all the developed countries in the world, the United States does not have Universal Health Care program for its citizen (Battista and McCabe). Instead of obtaining benefits from funds coming from mandatory taxes for health care purposes, US labor force receives health coverage from employer sponsored means. According to Alliance for Health Reform, in 2005, 159.5 million non-elderly US workers and their dependents were under workplace health coverage. Other means of coverage provides healthcare for the rest of 63.3 Americans (7). The issue on workplace coverage is its escalating cost. Employer-based health insurance premiums rose by 7.7 percent in 2006. Small employers witness an increase of, on average, 8.8 percent on their premiums. Enterprises having less than 24 workers experienced an increase of 10.5 percent (National Coalition on Health Care). In a country spending 16% of its gross domestic product (GDP) on health care (2005 figures) and continuing increase in health care premium cost while, concurrently ranking poorly on vital health statistics, such as infant mortality, life expectancy for women, life expectancy for men, in immunizations, among others, there is a clear evidence of ineffectiveness and inefficiency on health care coverage in the most powerful nation in the world (Battista and McCabe). Looking at it in a broader perspective, the Uni... true that this system provided impetus for innovation and growth in technological breakthroughs in the United States, the same system also jacks up inflation and other inefficiencies. To obtain funding for this universal multi-payer healthcare system, the government should do the following: Impose a tax that would fund universal health care. To soften its impact to American laborers, a portion of taxes of other nature (withholding, income, etc.) that could be sacrificed for this healthcare system should be sliced off. Provide efficient methods, particularly on the use of modern technology, to maximize use of funds in administrative and maintenance use. Results of studies garnered by American Hospital Association pointed out that workers almost 30 minutes on paper works, resulting into less effective use of time for actual healthcare purposes (American Health Association). A task force or a newly formed commission can be formed to oversee this problem. Being a multi-payer system, private insurers for those who can afford can still operate as usual. A new task force or agency should act as a channel of information and communication and will handle issues concerning the collaboration and interaction between the government healthcare insurer and private ones. Possible Issues Issues concerning the fear of socializing the US healthcare service, and thus lowering the quality of US health services by implementing the universal system; the presumed high cost of enforcing and maintaining it; and the possible lack of necessary services will most probably surface out from those opposing the move for its implementation (Battista and McCabe). Democracy and free market rests on the principle of equality and equity. Rising costs of health care in the United States greatly

Wednesday, November 20, 2019

Paper Essay Example | Topics and Well Written Essays - 250 words - 22

Paper - Essay Example The sculptures were to serve as funerary shrines to the Medici. The strength of curved Michelangelos sculptures reflected on an intricate symbolism of Human Life. Based on the symbolisms, contemplative life and active life interact to liberate the soul after death. The philosophical concept was closely linked to Michelangelos own spiritual beliefs. The architectural prowess displayed by Michelangelo, within the new sacristy was simply amazing. In the new sacristy is where one can see Michelangelo’s prowess as an architect rather than a sculptor or painter. The construction of the structure was inspired by the design of pantheon dome located in Rome. The domed ceiling in the new sacristy was a replica of a scaled down version of the pantheon dome. Michelangelo admired the beauty, harmony and elegance displayed within pantheon dome and this he used as an inspiration in the new sacristy construction and design. It is at the entrance of the new sacristy where the tombs of Lorenzo the magnificent and his brother Guiliano lie in a simple stone

Monday, November 18, 2019

Healthy Grief Essay Example | Topics and Well Written Essays - 750 words

Healthy Grief - Essay Example â€Å"Grief is an emotional process† as what Hood, Hill & Spilka (2009, p. 198) quoted. In literature, the discussions that are common are about stages of grief, models of grief and ritual grief (Hood, Hill & Spilka, 2009, p. 198). Kubler-Ross & Kessler (2005, p. 7) stated that there are five stages of grief. These â€Å"five stages are denial, anger, bargaining, depression, and acceptance† (Kubler-Ross & Kessler, 2005, p. 7). These are the process in which each person should undergo once they experience the loss of someone. According to them, these are only identifiers for which a person feels when in time of grief, but it does not conclude that a person will experience all of these stages (Kubler-Ross & Kessler, 2005, p. 7). Also, Kubler-Ross & Kessler (2005, p. 7) state that it does not need to be exactly the same order as how they presented the stages of grief. These are only tools for people to identify easily what they are going through in times of grief. The firs t stage, which is denial, does not literally mean that the people who lost their loved ones do not know it. This denial is â€Å"more symbolic than literal† as noted by Kubler-Ross & Kessler (2005, p. 8). The second and third stages are anger and bargaining. Anger, according to Kubler-Ross & Kessler (2005, p. ... After that, depression is the next stage. A person who lost someone feels empty and alone during this stage. Hence, it does not mean that when a person feels this way, it is a sign of mental illness (Kubler-Ross & Kessler, 2005, p. 20). Depression is normal to a person who just lost someone. Further, the last stage is acceptance. This is the point where the person accepts the reality that someone is dead. On this stage, the person will learn to live with it. On the other hand, the five stages of grief have many critics. There are some psychologists who also proposed other multi-stage models of grieving. Musgrave and Bickle (2003, p. 46) have drawn one of the popular stories of the Bible which is the story of Job. They stated that the story focuses on how someone heals through grieving. In the story of Job, Job deals not only a human grieving, but it also included God (â€Å"The Book of Job,† 2011). Though Job experienced the worst way of human grieving, it shows some of the st ages of grief. In the story of Job, it only shows three stages among the five stages of grief from Kubler-Ross and Kessler (2005). These would be bargaining, depression and acceptance. It may sound unusual, but it seemed that acceptance comes first in the story of Job. It came first because Job is a believer of God. Thus, Job knew that his trials are part of God’s plan (â€Å"The Book of Job,† 2011). Since Job’s love for God is strong, he did not feel any anger and denial. Moreover, there’s one thing that Job showed - joy (â€Å"The Book of Job,† 2011). Though Job is suffering, he still shows hope that one day he will meet God face to face. Hence, it somehow gave him joy. In comparison between joy and the grieving process, a person can obtain joy once he/she free himself/herself from any