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Le Petit Chef needs to use synchronous innovation, to make sure their. Cost , Costs , First-mover advantage 1189 Words | 4 Pages. as a kid. I love to cook a variety of foods. There have only speeches Stenden University of Applied Sciences, been a handful of psychological bulletin Admiral Academy, dishes that I have prepared that were not up to par. I chose to take a cooking . class in write article Chigwell, high school over other electives. So let see as to why I was destined to Admiral, become a chef from a child. How To Write A Journalism Article Chigwell School! I love to cook. Growing up, I would always be in the kitchen, and bulletin Admiral, it didn’t matter as to how to a journalism article School, whose house that I was in. I would always ask if there was something that I could do to help out. Admiral Farragut Academy! I remember one Thanksgiving when I was at my. Writing Rossall School! Chef , Cooking , Culinary art 620 Words | 2 Pages.

The career I have chosen is to be a chef because I love to cook. I always help my mom, grandma, and psychological bulletin Farragut Academy, aunt when it comes time to cook a meal for . a family event we are having. I enjoy cooking because it is speeches University Sciences, art you can create as many different things as you want with one recipe by just changing one ingredient. I also like to Admiral Academy, see people’s faces when you cook something they have never tried before. Sometimes you get a good reaction and sometimes their like ewww that’s gross. In this career field there. Brigade de cuisine , Chef , Chefs 855 Words | 2 Pages. Baking Pastry Program: A Career in how to write a journalism article School, Baking. ?PROGRAM Program Overview In the Baking Pastry program, you’ll gain hands-on baking skills.

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Should essays and other “open-ended”-type questions retain a place in psychological Academy written summative assessment in clinical medicine? © Hift; licensee BioMed Central. 2014. Published: 28 November 2014. Written assessments fall into two classes: constructed-response or open-ended questions, such as the essay and how to write a journalism article Chigwell School, a number of variants of the short-answer question, and selected-response or closed-ended questions; typically in the form of multiple-choice. It is widely believed that constructed response written questions test higher order cognitive processes in a manner that multiple-choice questions cannot, and consequently have higher validity.

An extensive review of the literature suggests that in summative assessment neither premise is evidence-based. Well-structured open-ended and multiple-choice questions appear equivalent in their ability to assess higher cognitive functions, and performance in multiple-choice assessments may correlate more highly than the open-ended format with competence demonstrated in clinical practice following graduation. Studies of construct validity suggest that both formats measure essentially the psychological Admiral Farragut Academy, same dimension, at least in mathematics, the physical sciences, biology and medicine. The persistence of the open-ended format in summative assessment may be due to the intuitive appeal of the belief that synthesising an speeches Stenden of Applied, answer to an open-ended question must be both more cognitively taxing and similar to bulletin Farragut Academy actual experience than is selecting a correct response. I suggest that cognitive-constructivist learning theory would predict that a well-constructed context-rich multiple-choice item represents a complex problem-solving exercise which activates a sequence of cognitive processes which closely parallel those required in medical reviews clinical practice, hence explaining the high validity of the multiple-choice format. The evidence does not support the proposition that the open-ended assessment format is superior to the multiple-choice format, at least in exit-level summative assessment, in terms of either its ability to Farragut test higher-order cognitive functioning or its validity. This is writing explicable using a theory of mental models, which might predict that the multiple-choice format will have higher validity, a statement for which some empiric support exists.

Given the superior reliability and cost-effectiveness of the multiple-choice format consideration should be given to phasing out open-ended format questions in summative assessment. Bulletin Admiral Academy. Whether the same applies to College non-exit-level assessment and psychological bulletin Admiral Farragut, formative assessment is a question which remains to be answered; particularly in terms of the educational effect of testing, an area which deserves intensive study. Learning and the stimulation of essay writing my school School, learning by assessment. Modern definitions of learning, such as that attributed to Siemens: “Learning is a continual process in which knowledge is psychological Admiral transformed into something of meaning through connections between sources of information and the formation of useful patterns, which generally results in something that can be acted upon write Chigwell, appropriately, in a contextually aware manner” [ 1 ],[ 2 ] essentially stress two points: firstly, that learning requires a much deeper, effortful and purposeful engagement with the material to be learned than the acquisition of factual knowledge alone; secondly, that learned knowledge does not exist in a vacuum; its existence is inferred from a change in the learner’s behaviour. This has led transfer theorists to postulate that knowledge transfer is the basis of all learning, since learning can only psychological bulletin Admiral Farragut be recognised by observing the learner's ability to display that learning later [ 3 ],[ 4 ]. It is now generally accepted that all cognition is built on domain-specific knowledge [ 5 ]. Content-light learning does not support the ability to transfer knowledge to custom coursework The Baptist School new situations and a comprehensive store of declarative or factual knowledge appears essential for transfer [ 4 ]. Furthermore, a high order of understanding and contextualization must accompany the declarative knowledge if it is to bulletin Farragut be successfully applied later. Where transfer – in other words, the successful application of knowledge to new situations – has been shown, the common factor appears to Stenden of Applied be deep learning, and the abstraction of general principles [ 6 ]-[ 8 ]. Miller’s pyramid of assessment of clinical skills, competence and performance [ [ 15 ] ].

Assessment is central to the educational process, and has benefits beyond that of measuring knowledge and competence alone; principally in directing and bulletin Admiral Academy, stimulating learning, and in providing feedback to teachers and learners [ 17 ]. Recent research supports a critical role for assessment in consolidating learning, and strengthening and facilitating memorisation and recall. There is article Chigwell School accumulating evidence that the process of stimulating recall through testing enhances learning and retention of learned material. This has been termed the testing effect , and several hypotheses have been put forward to Academy explain it, including increased cognitive effort, conceptual and semantic processing, and increased attention to the properties distinguishing the learnt item from similar items, which strengthens the a journalism article School, relationship between the cue which triggers the memory and the memory item itself [ 18 ],[ 19 ]. It appears to be principally the act of retrieving information from memory which strengthens knowledge and knowledge retention [ 20 ],[ 21 ], irrespective of whether retrievable is psychological bulletin Farragut Academy covert or overt [ 22 ]. Importantly, high-level questions appear to stimulate deeper conceptual learning and based argument Bromsgrove, better learning retention then those pitched at a lower level [ 23 ]. Admiral. A number of custom coursework Saint High, strategies have been proposed to psychological bulletin Admiral exploit this in educational practice, including those recently summarised for use in medical education [ 24 ]. This is in a sense related to the “generation effect”, where it has been shown that spontaneously generating information as opposed to learning it passively improves subsequent recall [ 18 ],[ 19 ]. Assessment in writing of Westminster educational practice. It is accepted that standards of assessment are inherently variable. There is therefore an obligation, in summative assessment, to ensure that assessment meets certain minimum criteria [ 25 ]. Psychological. Achieving this in the individual instance is article writing styles The University challenging, given the wide range of skills and knowledge to be assessed, marked variation in Academy the knowledge of assessment of those who must assess and the highly variable environments in of Westminster which the Academy, assessment takes place. Styles. There is now an extensive literature on assessment, in terms of research, guidelines and Admiral, recommendations [ 26 ],[ 27 ]. Importantly, modern approaches recognise that no single form of assessment is suitable for every purpose, and stressed the need for programmatic assessment , which explicitly recognises that assessment is best served by a careful combination of write article School, a range of instruments matched to a particular purpose at each stage of the learning cycle, such as for formative, diagnostic or summative purposes [ 25 ],[ 26 ],[ 28 ]. Despite the proliferation of assessment methodologies which attempt to test the competence of medical students directly, such as OSCE, OSPE, case-based assessment, mini-CEX and workplace-based assessment, written assessments remain in widespread use. Much of the knowledge base required by the clinician is not necessarily testable in the performance format.

Additionally, in comparison with most practical assessment formats, written tests are easier to organize and deliver, requiring little more than pen and psychological Farragut, paper or a computer, a venue, question setters and markers who need not be physically present. In general, all forms of written assessment may be placed into Stenden of Applied Sciences, one of two categories. Constructed response or open-ended questions include a variety of bulletin, written formats in which the student is required to generate an answer spontaneously in response to a question. The prototypical example is the coursework Saint The Baptist Diocesan School, essay. There are many variants including short answer questions (SAQ), mini-essay questions, single-word and single-sentence questions and the modified essay question (MEQ). The selected-response or closed-ended format is typified by the multiple-choice question (MCQ) assessment, where candidates select the bulletin Farragut, most appropriate answer from a list of options rather than generating an answer spontaneously. Many variants of the argumentative Stenden University, multiple-choice format have been used: current best practice recommends the use of one-best-answer (of three, four or five possible answers), and extended matching item (EMI) formats [ 29 ]. Bulletin Admiral Academy. In this debate I shall use the term open-ended when referring to the constructed-response format, and multiple-choice as a synonym for the selected-response format.

All high-stakes assessments should meet an adequate standard in terms of quality and fairness, as measured by a number of parameters, summarised recently in a consensus statement [ 30 ]. Principal among these are the writing, classic psychometric parameters of reproducibility (reliability or consistency; that a result would not essentially change with retesting under similar conditions), and psychological bulletin Farragut Academy, validity or coherence, which I describe in detail below. Other important measures by which assessments should be judged are equivalence (assessments administered at different institutions or during different testing cycles produce comparable outcomes), feasibility (particularly in terms of efficiency and cost effectiveness), educational effect (the student who takes the assessment is of Westminster thereby motivated to undertake appropriate learning), catalytic effect (the assessment provides outcomes that, when fed back into the educational programme, result in better teaching and learning) and acceptability to both teachers and learners. It is generally accepted that the multiple-choice format, in contrast to the open-ended format, has high reliability and psychological Academy, is efficient, a consequence primarily of wide sampling, and to a lesser extent, of its objectivity. Essay Writing My School Rossall. In support of the open-ended format, it has been widely held that this format is superior at testing higher cognitive levels of psychological Admiral, knowledge and has greater validity. University Sciences. This belief is intuitively appealing and appears to represent the viewpoint of many of psychological bulletin Admiral Academy, those involved in article writing styles The University medical assessment, including those with extensive knowledge and experience in Academy medical education.

In an attempt to gain the best of argumentative speeches Stenden University of Applied, both formats, there has been a shift from the psychological bulletin, prototypical essay towards newer formats comprising a larger number of short, structured questions, a development intended to retain the perceived benefit of the open-ended question with the coursework John The Baptist Diocesan High, superior reliability of the MCQ. Thus the psychological, two formats are generally seen to be in my school School tension, MCQ being significantly more reliable, the open-ended format having greater validity. Psychological Bulletin Admiral. In this debate I will compare the performance of the open-ended format with MCQ in summative assessment, particularly in final exit examinations. I draw attention to the large body of evidence which supports the view that, in summative assessment, the multiple-choice format is intrinsically able to write provide all the value of the open-ended format and psychological bulletin Admiral Farragut Academy, does so more reliably and cost effectively, thus throwing into question the justification for the inclusion of the argumentative of Applied, open-ended format in summative assessment. I will suggest a hypothesis as to why the multiple-choice format provides no less information than the open-ended format, a finding which most people find counter-intuitive. A critical concept is that assessment is not only of learning, but also for learning [ 27 ],[ 31 ]. In the first case, the purpose of assessment is to determine whether that which is psychological bulletin Admiral required to be learnt has in fact been learnt. In the second case, it is acknowledged that assessment may in itself be a powerful driver for learning at the cognitive level. This is how to a journalism School supported by psychological bulletin Admiral Farragut Academy, a body of evidence indicating the powerful effect of assessment on strengthening memorisation and recall [ 20 ],[ 22 ],[ 23 ]. In this debate I concentrate primarily on summative assessment in its role as assessment of learning ; one must however remain aware that those methods of assessment best suited to such summative assessment may not be identical to those best suited to essay writing assessment for learning ; indeed, it would be surprising if they were.

For the first part of the 20 th century, written assessment in medicine consisted largely of essay-writing [ 30 ]. Multiple-choice assessment was developed for psychological testing by Robert Yerkes immediately before the First World War and then rapidly expanded for the testing of army recruits. Admiral Farragut. Yerkes was interested in argumentative speeches Stenden University of Applied Sciences assessing learning capacity—not necessarily human—and applied it to bulletin Farragut Academy crows [ 32 ] and pigs [ 33 ] as well as psychiatric patients and Stenden University of Applied Sciences, mentally challenged subjects, a group among whom it was widely used for psychological Admiral, a number of medical reviews Wandsworth, years thereafter [ 34 ],[ 35 ]. Application to educational assessment has been credited to Frederick J. Kelly in 1914, who was drawn to psychological bulletin Academy it by of Applied, its efficiency and objectivity [ 36 ]. Throughout its history, the multiple-choice format has had many detractors. Their principal arguments are that closed-ended questions do not stimulate or test complex constructive cognitive processes, and that if the ability to construct rather than choose a correct answer is not actively assessed, there is a potential that it will be neither taught nor learnt [ 37 ]-[ 41 ]. As Rotfield has stated: Students proudly show off their high grades, from multiple-choice exams, as if their future careers will depend on knowing which choice to psychological Farragut Academy make instead of discerning which choices exist [ 42 ]. Self-evidently competence demands more complex cognitive processes than factual recall alone.

The ability to invoke these higher levels of cognition is clearly a skill which should be explicitly assessed. Is multiple-choice assessment inherently unable to do so, as its detractors have claimed? The belief that open-ended questions test high-order cognitive skills whereas multiple-choice questions do not and that therefore by inference open-ended questions evoke and test a reasoning process which is more representative of real-life problem-solving than multiple-choice, is a serious concern which I address in this review. We begin however with a comparison of the two formats in terms of reproducibility and feasibility. Reliability and efficiency of article writing The University of Westminster, open-ended and multiple-choice question formats. Wider sampling greatly increases reproducibility, compensating as it does for unevenness in a candidate’s knowledge, varying quality of questions and bulletin Admiral, even the personality of examiners [ 43 ],[ 44 ]. That the reproducibility of the multiple-choice format is how to write a journalism Chigwell School much higher than that of the open-ended format is borne out in numerous studies comparing the two formats [ 45 ]-[ 47 ]. Psychological Bulletin Admiral Academy. Recognition of these shortcomings has led to the design of research argument essay School, open-ended-formats specifically intended to increase reproducibility and objectivity, while maintaining the bulletin, supposed advantages of this format in terms of validity.

A widely used format in medical assessment is the modified essay question (MEQ) . The format is of a clinical scenario followed by a series of sequential questions requiring short answers. This was expressly designed to how to a journalism bridge a perceived gap between multiple-choice and SAQ as it was believed that it would prove better at testing high-order cognitive skills than multiple-choice while allowing for more standardised marking than the Admiral Academy, standard open-ended question [ 45 ]. Yet where these have been compared with multiple-choice, the advantage of the multiple-choice format remains. A large number of questions and multiple markers are required in order to provide acceptable reliability for MEQs and essay questions [ 45 ]. Research Based Essay. Even for well-constructed MEQ assessments, studies have shown poor inter-rater reliability. Thus in an MEQ paper in a final undergraduate medical exit examination marked in psychological bulletin Farragut Academy parallel by several assessors, statistically significant differences between the scores of the different examiners were shown in 50% of the custom Saint John The Baptist, questions, as well as significant differences in the median scores for the examination as a whole [ 47 ]. Nor were these differences trivial; a substantial difference in outcome in terms of bulletin Academy, likelihood of essay my school School, failure were shown. This is Admiral Farragut Academy cause for article The University of Westminster, concern. Schuwirth et al . have stressed the necessity for Admiral Academy, interpreting reliability in terms of outcome, particularly in terms of pass/fail misclassification, and research based argument essay, not merely in terms of numeric scores such as Cronbach’s alpha [ 27 ]. In this and other such studies the open-ended questions were of the highest possible quality practically achievable, typically MEQ's carefully prepared by skilled question writers working in teams, reviewed for appropriateness and scored using an psychological Admiral Farragut Academy, analytic scoring scheme designed to speeches Sciences minimise inter-rater variability. These conditions do not hold for the standard essay-question or SAQ paper where the reliability will be much lower, and psychological bulletin Farragut Academy, the contrast with multiple-choice correspondingly greater [ 47 ]. Open-ended items scored on writing Rossall, a continuum, such as 0-100%, have much lower inter-rater reliability than those scored against a rigid marking schedule.

Therefore the discrepancy in reliability for the graded essay marked on a continuum versus multiple-choice is much larger than it is for more objectively scored open-ended formats. In contrast to the open-ended question format, the multiple-choice is objective and allows multiple sampling of a subject. The result is bulletin Farragut high reproducibility. Furthermore it substantially reduces the potential for Wandsworth, a perception of examiner bias, and psychological Admiral Farragut, thus the speeches, opportunity for legal challenge by the unsuccessful candidate [ 48 ]. The multiple-choice format is efficient. Lukhele et al . studied a number of national university-entrance examinations which included both multiple-choice items and essay questions [ 49 ]. They found that 4-8 multiple-choice items provided the psychological bulletin Admiral Farragut Academy, same amount of information as a single essay, and that the essay’s efficiency in providing information about the candidate’s ability per article Chigwell minute of testing was less than 10% of that of an Admiral Academy, average multiple-choice item. For a middle-level examinee, approximately 20 times more examination time was required for an essay to obtain the same information as could be obtained from a multiple-choice assessment. They reported that a 75-minute multiple-choice assessment comprising 16 items was as reliable as a three-hour open-ended assessment. Though the relative gain in efficiency using multiple-choice in a journalism Chigwell preference to essay questions varies according to subject, it is an invariable finding [ 49 ].

Though the initial development of an psychological bulletin Academy, multiple-choice assessment is labour-intensive, this decreases with increasing experience on the part of argumentative Stenden University Sciences, item-writers, and decreases further once a question bank has been developed from which questions can be drawn for re-use. The lower efficiency of the open-ended question is not restricted to examination time but also the requirement for grading by examiners. Typically an open-ended test requires from bulletin Admiral Academy, 4 to 40 times as long to administer as a multiple-choice test of styles of Westminster, equivalent reliability [ 50 ]. In one study, the cost of marking the open-ended items was 300 times that of the multiple-choice items [ 49 ]; the relative cost of bulletin Admiral, scoring the papers may exceed a factor of 1000 for research based Bromsgrove School, a large examination [ 50 ]. The multiple-choice format thus has a clear advantage over open-ended formats in terms of reproducibility, efficiency and cost-effectiveness. Why then are open-ended questions still widely used? Principally this is because of psychological Farragut, a belief that essay-type questions, SAQ and article of Westminster, their variants test higher-order cognitive thinking in psychological bulletin Admiral Farragut a manner that MCQ cannot, and research essay Bromsgrove, consequently have higher validity. It has been repeatedly stated that the MCQ format is bulletin Farragut Academy limited in its ability to test deep learning, and is suitable for assessing facts only, whereas open-ended questions assess dynamic cognitive processes such as the strength of interconnected rules, the use of the mental models, and the mental representations which follow [ 37 ]-[ 39 ]; in short that open-ended questions permit the assessment of logical and reasoning skills in a manner that multiple-choice does not [ 40 ],[ 41 ]. Is there evidence to support these assertions? The ability to research School test higher-order cognitive skills. The revised Bloom's taxonomy of learning [ 9 ]-[ 12 ] is helpful in bulletin Admiral evaluating the essay my school School, level of cognition drawn upon by Admiral Academy, an assessment (Figure 1 ). By convention, assessment questions targeting the first two levels, are regarded as low-level questions, the third level as intermediate, and the fourth to sixth levels as high-level. Those who understand the principles underlying the article writing styles The University of Westminster, setting of high-quality multiple-choice items have no difficulty in accepting that multiple-choice is capable of assessing high-order cognition [ 10 ],[ 13 ],[ 14 ]. Psychological Bulletin Admiral Farragut Academy. The shift from write article, true-false questions, (which in order to avoid ambiguity frequently test factual information only) to the one-best-answer and EMI formats have facilitated this [ 29 ]. Indeed, there exist well-validated instruments specifically designed to assess critical thinking skills and to measure their development with progress through college-level educational programs, which are entirely multiple-choice based, such as the California Critical Thinking Skills Test [ 51 ],[ 52 ]. Farragut. Schuwirth and Van der Vleuten [ 48 ] make a distinction between context-rich and context-free questions.

In clinical assessment, a context-rich question is typically presented as a case vignette. How To A Journalism Chigwell School. Information within the vignette is presented to candidates in its original raw format, and they must then analyse, interpret and evaluate this information in order to provide the answer. The stimulus reflects the question which the candidate must answer and is therefore relevant to the content of the psychological Farragut, question. Argumentative Of Applied Sciences. An example of a final-year question in Internal Medicine is shown in the following example. Admiral Farragut Academy. Such a question requires analysis ( What is the argumentative speeches Stenden Sciences, underlying problem? ), application ( How do I apply what I know to the treatment of this patient? ) and evaluation ( Which of several possible treatments is the most appropriate? ), none of which can be answered without both knowledge and understanding. Farragut Academy. Thus 5 of Bloom’s 6 levels have been tested. Example of how to write a journalism article, a context-rich multiple-choice item in internal medicine.

Platelet concentrate infusion. None of the options offered are obviously unreasonable or easily excluded by the candidate who attempts to shortcut the cognitive processes required in answering it by searching for clues in the options themselves. All have a place in the therapy of patients presenting with a variety of similar presentations. Answering this item requires: Analysis . In order to Admiral Farragut answer this item successfully, the how to write a journalism article Chigwell, candidate will have to recognise (1) that this patient is highly likely to psychological bulletin Admiral Academy be HIV-positive (given the lymphadenopathy, evidence of oral candidiasis and the high local prevalence of HIV), (2) that the presentation is suggestive of immune thrombocytopenic purpura (given the epistaxis, skin manifestations and very low platelet count), (3) that other commonly-seen concomitant features such as severe bacterial infection and write article, extensive esophageal candidiasis are excluded by a number of psychological Admiral Farragut, negative findings. Evaluation . Further, in order to answer this item successfully, the candidate will have to (1) consider the differential diagnosis for the principal components of the a journalism Chigwell, clinical vignette and, by process of evaluation, decide which are the most likely; (2) decide which of the diagnoses require treatment most urgently, (3) decide which form of therapy will be most appropriate for this. Knowledge, understanding and application . It is utterly impossible to “recognise” the correct answer to this item without having worked through this process of bulletin Farragut, analysis and evaluation, and the knowledge required to coursework The Baptist School answer it must clearly be informed by deep learning, understanding and application.

Hence five of the six levels of Bloom’s taxonomy have been tested. Furthermore it would appear an eminently reasonable proposition that the Admiral, candidate who correctly answers this question will indeed be able to manage such a patient in practice, hence implying structural validity. Though guessing has a 20% chance of article styles of Westminster, providing the Admiral Farragut Academy, correct answer, this will be eliminated as a factor by essay writing my school School, assessing performance across multiple such items and psychological Admiral Academy, applying negative marking to incorrect answers. As a general conclusion, it would appear that the open-ended format is not inherently better at assessing higher order cognitive skills than MCQ. The fundamental determinant is the medical Lord College, way in which the question is bulletin Farragut Academy phrased in order to stimulate higher order thinking; if phrased inappropriately, the open-ended format will not perform any better than MCQ. A crucial corollary is how to write Chigwell that in comparing formats, it is essential to ensure that MCQ questions crafted to elicit high order thinking (particularly those which are context-rich) are compared with open-ended questions crafted to the same level; it is inappropriate to Admiral compare high-order items in one format with low order items in the other. Several studies have investigated the effect of the stimulus on thought processes in the open questions and article writing The University of Westminster, have shown that the stimulus format is more important than the response format . Scores on questions in open-ended format and multiple-choice format correlate highly (approaching 100%) for context-rich questions testing the same material. In contrast, low correlations are observed for different content using the same question format [ 48 ]. In response to psychological bulletin Farragut the low objectivity and reliability of the classic essay-type questions, modified open-ended formats have evolved which typically combine short answers, carefully crafted questions and rigid marking templates.

Yet this increase in reliability appears to come at how to write a journalism article Chigwell, a significant cost to the presumed advantage of the psychological Admiral Academy, open-ended format over the multiple-choice format in testing higher orders of cognition. Feletti and essay my school Rossall School, Smith have shown that as the number of items in Admiral Farragut Academy the open-ended examination increases, questions probing high-order cognitive skills tend to be replaced by questions requiring factual recall alone [ 46 ]. Hence as accuracy and reliability increase, any difference between such an assessment and a multiple-choice assessment in terms of other indicators tends to disappear; ultimately they converge on an essentially identical assessment [ 47 ],[ 49 ]. Palmer and Devitt [ 45 ] analysed a large number of how to write a journalism Chigwell School, multiple-choice and MEQ questions used for summative assessment in a clinical undergraduate exam. The examination was set to a high standard using appropriate mechanisms of review and quality control. Yet they found that more than 50% of both MEQ items and MCQ items tested factual recall while multiple-choice items performed better than MEQ in the assessment of higher-order cognitive skills. They reported that the psychological Admiral, modified essay question failed in its role of consistently assessing higher cognitive skills whereas the multiple-choice frequently tested more than mere recall of knowledge”. In a subsequent study of a rigorously prepared and Stenden University of Applied, controlled set of exit examinations, they reported that the proportion of questions testing higher-level cognitive skills was lower in the MEQ paper then in the MCQ paper. Farragut Academy. More than 50% of the multiple-choice items assessed higher level cognition, as opposed to medical just 25% of the MEQ items.

The problem was compounded by a higher frequency of item-writing flaws in psychological bulletin Farragut Academy the MEQ paper, and flaws were found in medical reviews Wandsworth College the marking scheme in 60% of the psychological Farragut Academy, MEQ's. How To A Journalism Chigwell. The authors conclude that “The MEQ paper failed to achieve its primary purpose of assessing higher cognitive skills” [ 47 ]. We therefore appear to psychological bulletin Admiral Farragut be dealing with a general rule: the more highly open-ended questions are structured with the intention of increasing reliability, the more closely they converge on an equivalent multiple-choice question in terms of performance, thus negating any potential advantage of the open-ended format over the closed-ended [ 53 ]; indeed they appear frequently to underperform MCQ items in the very area in which they are believed to hold the advantage. Thus the shift to these newer forms of assessment may actually have had a perverse effect in diminishing the potential for the open-ended assessment to evaluate complex cognitive processes. Saint The Baptist Diocesan High. This does not imply that open-ended items such as SAQ, MEQ and psychological bulletin Farragut Academy, key-feature assessments, particularly those designed to speeches University of Applied assess clinical reasoning, are inherently inferior to MCQ; rather it is a warning that there is a very real risk in practice of “dumbing-down” such questions in an attempt to improve reliability, and empiric observations suggest that this is indeed a consequence frequently encountered even in carefully crafted assessments. Combining multiple-choice and psychological Farragut, open-ended tests in Stenden University of Applied Sciences the same assessment, in the belief that one is improving the strength of the assessment, leads to an overall less reliable assessment than is constituted by psychological Admiral Farragut Academy, the multiple-choice section on its own [ 49 ], thus causing harm rather than adding benefit [ 50 ]. The second argument, frequently advanced in support of the open-ended format, is that it has greater validity; that spontaneously recalling and reproducing knowledge is a better predictor of the student’s eventual ability to handle complex problems in real-life then is the ability to select an answer from Lord, a list [ 54 ]. Indeed, this argument is intuitively highly appealing. The case for the retention of open-ended questions in bulletin Farragut Academy medical undergraduate and postgraduate assessment largely rests on validity, with the assumption that asking the candidate to describe how they would diagnose, investigate and treat a patient predicts future clinical competence more accurately than does the ability to a journalism article Chigwell select the right response from a number of options [ 55 ],[ 56 ]. The question of validity is central. If the open-ended format is genuinely of higher validity than the multiple-choice format, then there is a strong case for retaining essay-type questions, SAQ and psychological bulletin Farragut, MEQ in the assessment protocol. If this contention cannot be supported, then the justification for retaining open-ended items in summative assessment may be questioned.

Is the contention true? Essentially, this may be explored at two levels. The first is to correlate outcomes between the two formats. The second is to perform appropriate statistical analysis to argumentative speeches Stenden determine whether these formats are indeed testing different dimensions or “factors”. Validity is an indicator of how closely the assessment actually measures the quality it purportedly sets out to psychological bulletin test. It is self-evident that proficiency in many domains, including clinical practice, requires not only the ability to recall factual knowledge, but also the writing School, ability to generate and test hypotheses, integrate knowledge and apply it appropriately as required. Modern conceptualisations of validity posit a single type; namely construct validity [ 57 ]-[ 59 ]. This is based on the premise that ultimately all validity rests on the fidelity with which a particular assessment reflects the underlying construct, “intangible collections of abstract concepts and principles which are inferred from behaviour and explained by educational or psychological theory” [ 60 ]. Construct validity is then defined as a process of investigation in which the constructs are carefully delineated, and evidence at multiple levels is sought which supports a valid association between scores on that assessment and the candidate's proficiency in Admiral terms of that construct. For example, five types of evidence have been proposed which may provide support for such an association [ 60 ],[ 61 ], namely content, the response process, internal structure, relationship to other variables and consequences. In this discussion we highlight the essay writing Rossall School, relevant to the last two methods; convergent correlations between the psychological bulletin Admiral Farragut Academy, two forms of assessment, and the impact of test scores on later performance, particularly that requiring problem-solving under conditions encountered in the work situation. This “is particularly important to those employers more interested in hiring competent workers than good test takers” [ 62 ]. Direct comparisons of the open-ended and multiple-choice formats.

Numerous studies have assessed the correlation of scores between the medical, two formats. Bulletin Admiral Academy. If scores are highly correlated, the two formats are essentially measuring the same thing in which case, in terms of validity, there is writing my school Rossall School no advantage of one over the other. With few exceptions, studies indicate that scores on the two forms of bulletin Admiral Academy, assessment are highly correlated. Norman et al. compared the two formats prospectively and showed a strong correlation between the two sets of how to article, scores [ 63 ]. A similar result was found by Palmer et al. who suggested that the two types of examination were essentially testing similar characteristics [ 47 ]. Similarly Norcini et al. found that written patient management problems and multiple choice items appeared to be measuring essentially the same aspects of clinical competence, though the multiple-choice items did so more efficiently and with greater reliability [ 17 ]. Similar results have been obtained in bulletin Academy fields as diverse as economics and marketing [ 64 ],[ 65 ]. In general correlations between the two formats are higher when the coursework Saint John Diocesan High School, questions in each format are specifically designed to be similar (stem-equivalent), and lower where the items in the two formats differ. However, the difference is psychological bulletin not great: in a meta-analysis, Rodriguez found a correlation across 21 studies of 0.92 for research argument School, stem-equivalent items and psychological, 0.85 across 35 studies for non-stem-equivalent items. Article Styles The University Of Westminster. The scores may not always be identical, but they are highly correlated [ 53 ],[ 65 ].

Factor analysis: do the formats measure more than one construct? Identification of the psychological bulletin Admiral Farragut, actual constructs measured in an assessment has proved challenging given the how to a journalism, lack of congruence between the simple cognitive assumptions on Admiral Academy, which testing is often based and the very complex cognitive nature of the constructs underlying understanding [ 66 ]. A number of studies have used confirmatory factor analysis and principal component analysis to argument Bromsgrove School determine whether the constructs tested by the two formats lie along a single dimension or along two or more divergent dimensions. Bennett et al . compared a one factor model with a two factor model to examine the relationship of the open-ended and closed-ended formats and found that in general the single factor provided a better fit. This suggests that essentially the bulletin Academy, two formats are testing the same thing [ 67 ]. Similarly Bridgeman and essay Rossall School, Rock found, using a principal components model, that both formats appeared to load on the same factor, implying that the open-ended format was not providing information on a different dimension [ 68 ]. Psychological Bulletin Academy. Thissen and Wainer found that both formats could largely be ascribed to a single shared factor but did find some specific open-ended factors for medical reviews Wandsworth College, which only the open-ended items contributed [ 69 ]. Psychological Bulletin. Though Lissitz et al . [ 70 ] quote a study by JJ Manhart, which found a two-factor model generally more appropriate than a one factor model, this study has not been published and the significance of the divergence cannot be assessed. In a study of Diocesan, high school assessments using confirmatory factor analysis, Lissitz et al. showed a correlation of 0.94 between the two formats in the domains of algebra and psychological, biology; a two-factor model provided a very slight increment over a one-factor model in terms of fit. In the case of an English language assessment the correlation was lower at 0.74 and a two-factor model provided a better fit.

In a test of US government, intermediate results were found with the correlation of 0.83 and a slight superiority of a two-factor model. This suggests that the addition of styles The University, open-ended items in biology and bulletin Academy, algebra provided little further information beyond the multiple-choice items, whereas in other domains—English and government—the two formats are to some degree measuring different constructs [ 70 ]. Indeed, the how to Chigwell, literature in general suggests that differences in format appeared to be of little significance in the precise sciences such as biology and mathematics, but may have some relevance in fields such as history and languages, as suggested by Traub and Fisher [ 71 ]. In summary, there is little evidence to support the belief that the open-ended format is testing dimensions which the multiple-choice format cannot [ 53 ],[ 70 ],[ 72 ]. Construct validity was specifically assessed by bulletin Academy, Hee-Sun et al . [ 73 ], who attempted to measure the depth of understanding among school-level science students revealed by write Chigwell School, multiple-choice and short written explanatory answers respectively. They reported that students who showed higher degrees of knowledge integration were more likely to score highly on multiple-choice, though the reverse did not hold true. Academy. They suggested that the multiple-choice items were less effective in distinguishing adjacent grades of understanding as opposed to distinguishing high-performance from writing my school Rossall, low performance, a finding similar to that of Wilson and Wang [ 74 ] and psychological Admiral Academy, Ercikan et al . [ 75 ]. Styles. Unfortunately the generalisability of these results is limited since the multiple-choice items were poorly standardised, both in format and in difficulty, and the circumstances under which the testing was conducted were essentially uncontrolled. Lukhele et al . performed a rigorous analysis of Farragut Academy, high-quality university placement exams taken by thousands of candidates [ 49 ]. They found that both formats appeared to argument essay be measuring essentially the same construct. There was no evidence to suggest that the open-ended and multiple-choice questions were measuring fundamentally different things—even in psychological areas as divergent as chemistry and history.

Factorial analysis suggested that there were two variant dimensions reflected in the scores of the multiple-choice and open-ended sections, one slightly more related to multiple-choice and the other to the open-ended format. How To Write A Journalism. However these were highly correlated, whatever the factor is that is bulletin specifically measured by the open-ended format, multiple-choice would measure it almost as well. Thus for all practical purposes, in writing my school School such summative assessments, multiple-choice assessments can satisfactorily replace open-ended assessments. Stylized depiction of the contrasting ability of the presumed open-ended and multiple-choice formats to assess recognition and recall as opposed to higher forms of cognitive learning. Bulletin Farragut. Ideally, multiple-choice and open-ended questions would measure two different abilities (such as recall/recognition versus reasoning/application) – this may be shown as two divergent axes (shown on left). The error variance associated with each type of question is indicated by the shaded blocks, and is much greater for the open-ended question, given its inherent lower reliability. In practice, it appears that the two axes are closely aligned, implying that the two types of questions are measuring essentially the article of Westminster, same thing (shown on right). Psychological Admiral. What little additional information the open-ended question might be giving (as shown by a slight divergence in axis) is offset by its wide error variance, which in effect overlaps the information given by the multiple-choice question, thus significantly reducing the The University, value of any additional information it provides.

In summary, where studies have suggested that the open-ended format is measuring something that multiple-choice does not (particularly in older studies), the effect has tended to be minimal, or possibly explicable on Academy, methodological grounds, or indefinable in a journalism Chigwell terms of what is actually being measured. In contrast, methodologically sound studies converge on the conclusion that the bulletin Admiral Farragut Academy, difference in validity between the two formats is trivial. This is the conclusion drawn by Rodriguez in a meta-analysis of 21 studies [ 53 ]. Demonstrating an essential similarity for the two formats under the conditions of summative assessment does not necessarily mean that they provide identical information. It is possible and indeed likely that open-ended questions may make intermediate steps in thinking and understanding visible, thus serving a useful role in diagnostic as opposed to summative assessment [ 73 ],[ 75 ],[ 76 ]. Such considerations are particularly useful in using assessment to guide learning rather than merely as a judgment of competence [ 77 ]. In summative assessment at a stage prior to final exit from a programme, and particularly in formative assessment, the notion of John High School, assessment for learning becomes important; and considerations such as the psychological Admiral, generation effect and the potentiation of memory recall by testing cannot be ignored. Article Chigwell School. Interestingly, a recent publication suggests that multiple-choice format testing is as effective as SAQ-format testing in potentiating memorisation and recall [ 23 ], thus supporting the contention that well-crafted MCQ and open-ended questions are essentially stimulating the same cognitive processes in the learner. Some authors have raised the concern that students may constitutionally perform differentially on the two forms of psychological bulletin Admiral Farragut, assessment, and might be disadvantaged by a multiple-choice assessment should their strengths lie in medical Wandsworth the open-ended format. Studies in this area have been reassuring. Bridgeman and Morgan found that discrepant results were not predictive of poor academic performance as assessed by other parameters [ 78 ]. Ercikan et al . reported that discrepancies in the outcome between open-ended and multiple-choice tests were largely due to the low reliability of the open-ended component and inappropriate testing strategies [ 75 ]. Psychological Bulletin Admiral Farragut Academy. A study which correlated the two formats with each other and with other measures of student aptitude showed a high degree of correlation and was unable to identify students who clearly had a propensity to perform consistently better on one format than the other [ 79 ]. Thus the belief that some students are constitutionally more suited to open-ended questions than to multiple-choice would appear to be unfounded. An important question is writing styles The University of Westminster whether the psychological bulletin Farragut, format of assessment effects the reviews Wandsworth, type of learning students use in bulletin Admiral Farragut preparation for it.

As early as 1971, Hakstian suggested that anticipation of a specific form of examination did not result in my school Rossall any change in the amount or type of preparation, or any difference in performance in subsequent testing [ 80 ]. He concluded as follows: “The use of various types of tests to foster various kinds of study and learning, although widely advocated would seem to be a practice based on intuitive appeal, but not convincingly supported by empirical research. In particular, the contention that the superiority of the essay examination is its ability to psychological Farragut Academy promote more desirable study methods and higher performance on tasks requiring organisation, and deeper comprehension analysis of information should be re-evaluated in School light of the evidence in the present study of no differences between groups in terms of study methods, the essay examination, or items from the bulletin Admiral, higher levels of the cognitive domain”. In fact, the relationship between assessment format and learning styles remains ill-defined. Custom Coursework Saint John The Baptist Diocesan High School. Though some studies have suggested that students tended to make more use of surface learning strategies in preparation for MCQ and deeper learning strategies in preparation for open-ended questions [ 81 ],[ 82 ], other studies have failed to show such an association [ 80 ],[ 83 ]. Some studies have even failed to show that deep learning approaches correlated with better performance in applied MCQ’s and a written course project, both of which required high level cognitive performance [ 84 ],[ 85 ], though, a significant finding was that a surface learning strategy appeared deleterious for both factual and applied MCQ scores [ 85 ]. Indeed, a review of the bulletin Farragut Academy, literature on learning strategies suggests that the notion that one or other assessment format consistently calls forth a particular learning strategy is write Chigwell School simplistic, and much of the evidence for this may have been misinterpreted [ 86 ]. The student’s choice of psychological bulletin Academy, learning style appears to be dependent on argumentative University of Applied Sciences, multiple interacting and to psychological bulletin Admiral Academy some extent, confounding factors, most importantly the student’s innate learning motivation and preferred learning strategy. This is however subject to modification by other factors, particularly the custom coursework Saint John The Baptist High, student’s own perception of whether the psychological Admiral, assessment is directed at assessment of factual knowledge or of understanding, a perception which may frequently not coincide with the intentions of the examiner [ 87 ]. Individual differences in learning strategy probably outweigh any other consideration, including the assessment format, though this is not constant and students will adapt their preferred learning strategy according to their perception of the requirement for a particular assessment [ 88 ]. A further study has suggested that the approach to learning the student brings into the course is the strongest predictor of the learning style they will employ subsequently and, irrespective of the essay my school Rossall School, instructor’s best efforts, the psychological bulletin Academy, only factor significantly correlated with the change in learning style is a change in the student’s perception of the how to write article Chigwell School, cognitive demands of the assessment. Psychological Bulletin Academy. Thus students are frequently strategic in their choice of learning strategy, but the strategies may be misplaced [ 87 ]. Custom Saint John The Baptist Diocesan School. The student’s academic ability may be relevant; one study has shown that more academically able science students correctly identified the MCQ as requiring deep knowledge and adopted an Farragut Academy, appropriate learning strategy, whereas less able students interviewed the assessment as principally a test of argumentative of Applied, recall and used a counter-productive surface-learning strategy. Hadwin et al . Psychological Bulletin Admiral Farragut. have stressed the major influence of context on choice of assessment strategy [ 88 ]. There is for example evidence that students will modify their strategy according to argumentative speeches Stenden University of Applied whether the assessment is perceived as a final examination or as an interim assessment, irrespective of format [ 81 ]. So-called construct-irrelevant factors such as female gender and increasing maturity tend to bulletin Academy correlate with selection of a deep learning strategy [ 85 ] independent of assessment format, while the association of anxiety and other emotional factors with a particular assessment will impair performance and how to a journalism article Chigwell School, thus operate as a confounding factor [ 89 ],[ 90 ]. In discussing their results, Smith and psychological Admiral Academy, Miller stated that “Neither the based argument essay, hypothesis that multiple-choice examination will promote student use of surface strategy nor the hypothesis that essay examination will promote student use of deep strategy were supported” [ 91 ]. As a general conclusion, it would appear valid to say that current evidence is Admiral Farragut insufficient to suggest that the open-ended format should be preferred over MCQ or vice versa on Saint Diocesan, the grounds that it promotes more effective learning strategies. It is also important to be aware that open-ended assessments may bring confounding factors into play, for psychological, example testing language mastery or skills rather than the custom John The Baptist Diocesan School, intended knowledge domain itself [ 70 ], and hand-written answers also penalise students with poor writing skills, low writing speeds and poor handwriting [ 65 ]. In comparison with the multiple-choice format, is the open-ended format superior in predicting subsequent performance in the workplace? This has been assessed and the answer, surprisingly, is that it may be less predictive.

Rabinowitz and psychological Admiral Farragut Academy, Hojat [ 92 ] correlated the single MEQ assessment and five multiple-choice assessments written at the conclusion of a series of custom coursework Saint John The Baptist Diocesan High, six clerkships with performance after graduation. Results in multiple-choice assessment consistently demonstrated the Farragut Academy, highest correlations with subsequent national examination scores and with objective assessments of performance in the workplace. The MEQ questions showed the lowest correlation. Wandsworth College. Wilkinson and psychological Farragut Academy, Frampton directly compared an custom coursework Diocesan School, assessment based on long and short essay-type questions with a subsequent assessment protocol containing short essay questions and two multiple-choice papers [ 56 ], correlating these with performance in the subsequent internship year using robust rating methodologies. They found no significant correlation between the scores of the open-ended question protocol and assessments of psychological bulletin Academy, performance in the workplace after graduation. In contrast they found that the combination of the SAQ paper and how to write article School, two multiple-choice papers showed a highly significant correlation with subsequent performance. This study showed that the predominant use of multiple-choice in the assessment resulted in a significant improvement in the structural validity of the assessment in Academy comparison with essay-type questions alone. It was unable to answer the question as to whether the open-ended questions are necessary at all since the John The Baptist Diocesan High School, multiple-choice component was not compared with the performance rating independently of the bulletin Farragut, essay questions. Writing The University. These authors conclude that that the change from the open-ended format to the multiple-choice format increased both validity and reliability. Recommendations from the literature. Wainer and Thissen stated that: “We have found no evidence of any comparison of the efficacy of the two formats (when a particular trait was specified and skilled item writers then constructed items to measure it) in which the multiple-choice item format was not superior” [ 50 ]. Lukhele et al . concluded: “Thus, while we are sympathetic to… the arguments… regarding the advantages of open-ended format, we have yet to see convincing psychometric evidence supporting them.

We are awash in psychological Admiral Farragut Academy evidence of their drawbacks”, and further, “… We are forced to conclude that open-ended items provide this information in more time at greater cost than the multiple-choice items. This conclusion is surely discouraging to those who feel that open-ended items are more authentic and, hence, in my school Rossall School some sense, more useful than multiple-choice items. It should be” [ 49 ]. Palmer et al . have suggested that the MEQ should be removed from the Admiral, exit examination [ 47 ]. Given that MEQ's are difficult to argumentative University of Applied write to bulletin Admiral a high standard and in such a way that they test high-order cognitive skills, and given the time required and the subjectivity in writing of Westminster marking, their use does not represent an efficient use of resources. Indeed, they state “… MEQ's often do little more than test the candidate's ability to recall a list of facts and frustrate the examiner with a large pile of psychological bulletin Admiral Farragut Academy, papers to be hand-marked”. They conclude there is no good measurement reason for including open-ended items in writing Rossall the high-stakes assessment, given that the MEQ performed poorly in terms of psychological, testing high-order thinking in comparison with the multiple-choice despite considerable effort to produce quality questions. Schuwirth and Van der Vleuten too have suggested that there is no justification for the use of SAQ in assessment, since the stimulus of most SAQ can also be applied with multiple-choice. They recommend that SAQ should not be used in any situation except where the spontaneous generation of the article styles The University of Westminster, answer is absolutely essential.

Furthermore, they believe that there is little place for context-free questions in medical assessment as the context-rich stimulus approximates clinical practice more closely [ 48 ]. Why does the bulletin Admiral Farragut Academy, open-ended format persist in medical assessment? Hence the evidence suggests that in Stenden Sciences written summative assessment the multiple-choice format is no less able to test high-order thinking than open-ended questions, may have higher validity and is superior in reliability and cost-effectiveness. Remarkably this evidence extends as far back as 1926 [ 53 ],[ 93 ], and the reasons underlying the persistence of the open-ended format in assessment are of some interest. I suggest a number of bulletin, factors. Coursework John The Baptist Diocesan High School. Studies bear out the common-sense expectation that questions designed to test factual knowledge only—irrespective of whether these are presented as open-ended or in multiple-choice format—do not test the same level of reasoning as more complex questions [ 94 ]. Bulletin Farragut Academy. Indeed, a recurring finding in the literature is that the so-called deficiencies of the essay writing, multiple-choice format lie more with the quality of the individual question item (and by inference, with the question-setter), than with the format per se . This leads to a self-fulfilling prophecy: examiners who do not appreciate the versatility of the bulletin, multiple-choice format set questions which only test low-order thinking and not surprisingly achieve results which confirm their bias. Palmer et al. state that criticism of multiple-choice as being incapable of University, testing high-order thinking is in fact criticism of bulletin Farragut, poorly written questions, and that the same criticism can be directed at open-ended assessments [ 45 ]. There is indeed evidence that stem-equivalent items tend to behave similarly, irrespective of whether the item is phrased as an open-ended question or in MCQ format. It is medical reviews Lord Wandsworth College therefore essential that in making comparisons, the Academy, items compared are specifically crafted to assess the essay writing my school, same order of psychological Admiral Academy, cognition.

As Tanner has stated, any assessment technique has its limitations; those inherent in argument essay School multiple-choice assessment may be ameliorated by psychological bulletin Admiral Farragut Academy, careful construction and thoughtful analysis following use [ 95 ]. Second, it would appear that many educators are not familiar with much of the literature quoted in this discussion. The most persuasive material is found in the broader educational literature, and John The Baptist Diocesan High School, though there are brief references in psychological bulletin the medical education literature to Stenden Sciences some of the studies to which I have referred [ 47 ],[ 48 ], as well as a few original studies performed in the medical assessment context [ 17 ],[ 45 ],[ 47 ],[ 63 ], the issue does not appear to have enjoyed prominence in debate and has had limited impact on actual assessment practice. In their consensus statement and recommendations on psychological bulletin Farragut, research and coursework Saint John, assessment, Schuwirth et al. stress the need for reference beyond the bulletin Admiral Farragut Academy, existing medical education literature to relevant scientific disciplines, including cognitive psychology [ 27 ]. In the article styles The University of Westminster, teaching context, it is Farragut remarkable how the proposition that the open-ended format is more appropriate in testing the styles, knowledge and skills ultimately required for the workplace has been repeatedly and bulletin Admiral Academy, uncritically restated in the literature in the absence of compelling evidence to support it. Third is the counter-intuitiveness of reviews Lord College, this finding. Indeed, the Admiral Farragut, proposition that the open-ended format is more challenging than MCQ is intuitively appealing. Furthermore, there is the “generation effect”; experimental work has shown that spontaneous generation of information, as opposed to reading enhances recall [ 18 ],[ 19 ]. Although this applies to learning rather than to assessment, many teachers implicitly attribute a similar but reversed process to the act of recall, believing that spontaneous recall is more valid than cued recall.

However, validity at face value is an unreliable proxy for true validity, and the outcome in practice may contradict what seems intuitively correct [ 48 ]. As the literature on Lord Wandsworth College, learning increases, it has become apparent that evidenced-based practice frequently fails to coincide with the intuitive appeal of a particular learning methodology. Examples include the observation that interleaved practice is Admiral Academy more effective than blocked practice and distributed practice is more effective than massed practice in promoting acquisition of skills and knowledge [ 21 ]. There is a need for assessment to be evidence-based; to an extent assessment would appear to lag behind learning and teaching methodology in this respect. Rohrer and Pashler have suggested that underutilisation of how to write Chigwell School, learning strategies shown to psychological bulletin Admiral Farragut be more effective than their traditional counterparts, such as learning through testing, distributed practice and interleaved practice, remain so because of “the widespread (but erroneous) feeling that these strategies are less effective than their alternatives” [ 21 ]. Fourth and perhaps most defensible is concern that there is much that as yet remains unknown about the nature of writing Rossall, assessment; particularly seen from the viewpoint of psychological bulletin Admiral, assessment for learning, and given very interesting new insights into the cognitive basis of memorisation, recall and reasoning, a field which is as yet largely unexplored, and may be expected to have a significant impact on the choice of assessment format. For diagnostic purposes, the open-ended format may hold value, since it is better able to expose the students intermediate thinking processes and therefore allow precise identification of how to a journalism article Chigwell School, learning difficulties [ 72 ]. Newer observations such as the generation effect [ 18 ],[ 19 ], the testing effect [ 20 ],[ 23 ], the preassessment effect, where the act of psychological bulletin Farragut Academy, preparation for an assessment is itself a powerful driver of learning [ 96 ], and the post-assessment effect, such as the effect of feedback [ 96 ] are clearly important; were it to be shown that a particular format of assessment, such as the open-ended question, was superior in driving learning, then this would be important information which might well determine the choice of assessment. At this point however no such reliable information exists.

Preliminary work suggests that MCQ items are as effective as open-ended items in John The Baptist Diocesan High promoting the testing effect [ 23 ]. None of psychological bulletin, these considerations are as yet sufficiently well supported by essay Bromsgrove, experimental evidence to argue definitively for Admiral Farragut, the inclusion of open-ended questions on the basis of their effect on learning, though the possibility clearly remains. Furthermore, this debate has concentrated on Stenden University Sciences, high-stakes, summative exit assessments where the learning effects of assessment are presumably less important than they are at other stages of learning. Certainly, open-ended assessment remains appropriate for those domains not well-suited to multiple-choice assessment such as data gathering, clinical judgement and professional attitudes [ 92 ] and may have value for a particular question which cannot be presented in psychological Admiral any other format [ 48 ]. Though the evidence is less compelling, open-ended items may be superior in distinguishing between performances of candidates occupying the two extremes of performance [ 75 ]. Cognitive basis for the observation. The need for assessment of research to move beyond empiric observations to studies based on a sound theoretical framework has recently been stressed [ 27 ],[ 96 ]. There is as yet little written on the reasons for the counter-intuitive finding that MCQ is as valid as open-ended assessments in how to article Chigwell predicting clinical performance. I suggest that the observation is highly compatible with cognitive-constructivist and situated learning theory, and in particular the theory of psychological bulletin Admiral Academy, conceptual change [ 97 ]. Fundamental to article styles The University this theory is the concept of bulletin Farragut, mental models. These are essentially similar to schemas, but are richer in based essay Bromsgrove School that they represent knowledge bound to bulletin Academy situation and essay writing Rossall, context, rather than passively stored in the head [ 98 ]. Mental models may therefore be thought of as cognitive artifacts constructed by an individual based on his or her preconceptions, cognitive skills, linguistic comprehension, and perception of the problem, which evolve as they are modified through experience and instruction [ 99 ]. Conceptual change is postulated to represent the mechanism underlying meaningful learning, and is a process of progressively constructing and organizing a learner’s personal mental models [ 100 ],[ 101 ]. It is suggested that an effective mental model will integrate six different aspects: knowledge appropriately structured for a particular domain (structural knowledge), pathways for solving problems related to the domain (procedural knowledge), mental images of the Academy, system, associations (metaphors), the ability to know when to activate mental models (executive knowledge), and assumptions about the problem (beliefs) [ 102 ]. Therefore increasing proficiency in custom Saint The Baptist Diocesan High any domain is psychological Admiral associated not just with an enlarging of store of knowledge and research, experience, but also with increasing complexity in the extent to which knowledge is organised and the manner in which it is stored and accessed [ 103 ], particularly as complex mental models which may be applied to problem-solving [ 104 ]. A counterpart in the domain of medical expertise is the hierarchy of constructs proposed by Schmidt et al . elaborated causal networks, knowledge encapsulation and illness scripts [ 105 ],[ 106 ]. Conceptual change theory has a clear relationship to our current understanding of expertise, which is postulated to emerge where knowledge and concepts are linked as mental representations into Admiral Farragut, propositional networks which allow rapid processing of information and the omission of intermediate steps in reasoning [ 107 ],[ 108 ]; typically the research argument essay, expert’s knowledge is grouped into discrete packets or chunks, and manipulation of these equates to the manipulation of a large amount of information simultaneously without conscious attention to any individual component [ 104 ]. In comparison with non-experts, the representations of experts are richer, more organised and abstract and are based on Farragut, deep knowledge; experts also recognise the writing School, conditions under which use of psychological bulletin Admiral, particular knowledge is appropriate [ 109 ]. Custom Coursework John Diocesan. As Norman has stated, “expert problem-solving in medicine is dependent on (1) prior experiences which can be used in routine solution of problems by pattern recognition processes and (2) elaborated conceptual knowledge applicable to the occasional problematic situation ” [ 110 ]. The processes of building expertise and that of constructing mental models are essentially parallel [ 99 ].

Therefore any form of assessment intended to psychological Admiral Farragut measure proficiency must successfully sample the candidate’s organisation of and writing, access to knowledge, and not just content knowledge alone [ 99 ],[ 111 ]. I have reviewed the empirical evidence which suggests that the multiple-choice format is indeed predictive of proficiency, which provides important evidence that it is valid. This is explicable in terms of mental models. An alternative view of a mental model is bulletin Farragut Academy as an internal representation of writing School, a system that the learner brings to bear in a problem-solving situation [ 103 ],[ 104 ],[ 112 ]. The context-rich written assessment [ 48 ] is essentially an exercise in complex problem-solving, and fits the Academy, definition of problem-solving as “cognitive processing aimed at accomplishing certain goals when the solution is unknown” [ 103 ],[ 113 ]. Zhang has introduced the Stenden of Applied, concept of a “distributed cognitive task”: a task requiring that information distributed across both the internal mind and the external environment is processed [ 114 ]. If we extend Zhang’s concept of external representation to include a hypothetical patient, the subject of the psychological Farragut Academy, clinical vignette, who represents the class of all such patients, then answering the argument, context-rich multiple-choice item may be seen as a distributed cognitive task. The candidate must attempt to call forth an appropriate mental model which permits an effective solution to the complex problem.

In a sequence of events which parallels that described by Zhang, the candidate must internalise the information provided in the vignette, form an accurate internal representation (an equivalent concept is that of the problem space, a mental representation of the problem requiring solution [ 115 ]); this in turn activates and interacts with the relevant mental models and is followed by externalization: the return of the Farragut, product of the interaction of styles of Westminster, internal representation and mental model to the external environment, and psychological Admiral, the selection of Stenden of Applied, a solution. In effect a relationship has been defined between environmental information, activation of psychological bulletin Admiral Academy, higher level cognition and externalisation of internal representations [ 114 ]. Assessment items which require complex problem-solving call on my school School, mental models appropriate to psychological Admiral Farragut that particular context, and the item can only be answered confidently and correctly if the mental model is present at the level of proficiency. There is coursework Saint John The Baptist Diocesan High School therefore no such thing as the student with generic expertise “in answering multiple-choice questions”, which explains the findings of Hakstian [ 80 ], Bridgeman and Morgan [ 78 ], Ercikan et al. [ 75 ] and Bleske-Rechek et al . [ 79 ], none of whom found convincing evidence for the existence of bulletin Farragut Academy, a class of student with a particular skill in answering multiple-choice questions. Recent observations that retrieval of knowledge improves retention, and may be enhanced in the learning process by frequent testing [ 20 ],[ 21 ], and in particular a recent publication summarising four studies performed in an authentic learning environment which demonstrates that that testing using MCQ format is as effective as SAQ testing [ 23 ], supports the hypothesis that the MCQ format engages with high order cognitive processes, in both learning and research essay Bromsgrove School, retrieval of memory. This is further supported by their finding that high-level test questions stimulate deeper conceptual learning and better learning retention then do low-level test questions [ 23 ]. In summary, the multiple-choice item is psychological bulletin Farragut Academy testing the integrity and appropriateness of the candidate’s mental models, and in doing so, is in fact assessing proficiency.

If the item is designed to test factual recall only then it will fail for this purpose, since it is the how to write a journalism Chigwell, solution of psychological Admiral Farragut Academy, a complex problem which tests the strength of the mental model and the cognitive processes which interact with it. Saint John The Baptist Diocesan School. Yet even a low-quality assessment based on factual recollection will correlate significantly with proficiency. Bulletin Admiral. Firstly, all mental models are based on a foundation of structural knowledge. The subject with sound mental models must therefore possess a good knowledge base. Secondly, possessing effective and appropriate mental models facilitates the retention and recall of knowledge [ 103 ]. Argumentative University Of Applied. Not surprisingly therefore, even on a fact-based assessment, good students will correctly recall the information and excel; students with deficient mental models, are less likely to be able to recall the information when needed.

This is supported by the work of Jensen et al . [ 116 ] who found that high order questions stimulated deep conceptual understanding and retention, and correlated with higher performance on psychological Admiral Farragut Academy, both subsequent high order assessment items and low-order assessment items. Indeed, recognition and recall are highly correlated [ 50 ]. There is research based School evidence that the cognitive processes evoked by the multiple-choice format are not influenced by cueing [ 117 ], though the reasons for psychological bulletin Admiral Academy, the frequent observation that MCQ scores are higher than those for equivalent open-ended item assessments raise concern that cueing may yet have a role [ 118 ]. However, where the stem and options have been well-designed?particularly such that the John The Baptist Diocesan, distractors all appear attractive to the candidate without the requisite knowledge? cueing should not be an psychological bulletin Admiral Farragut, issue [ 29 ],[ 48 ], and the common argument that it is easier to recognize an answer than it is to generate it spontaneously would appear not to hold true. Problem-solving skills are poorly generalizable [ 41 ]. This is explicable in that mental models are essentially domain-specific, representing a particular set of writing School, knowledge and circumstances, but the psychological Admiral Farragut, actual process of developing them is highly dependent on domain-general processes including metacognition, self-regulation and cognitive flexibility [ 99 ]. I suggest that the problem with many assessments in the MEQ format is that they are essentially linear. By requiring the speeches Sciences, candidate to think one step at a time, the assessment effectively misses the bulletin Admiral Academy, crux of the problem-solving process, which is to look at Stenden, and respond to a complex problem in its entirety, and not stepwise. The context-rich vignette-based multiple-choice item by contrast presents a complex problem which must be holistically assessed. Bulletin. Thus it requires a form of cognitive processing which mirrors that associated with actual proficiency.

Hybrid formats such as key feature assessments in effect also break down the clinical reasoning process into a sequence of sequential steps; whether this is regarded as a drawback will depend on the relative importance ascribed to decision-making at critical points in the decision tree and global assessment of research based argument Bromsgrove, a problem viewed holistically. Psychological Bulletin Admiral Academy. This is article a critical area for future research in clinical reasoning. Educators who mistrust the multiple-choice format have tended to concentrate on the final, and cognitively the least important, step in this whole process: the selection of a particular option as the answer, while ignoring the complex cognitive processes which precede the selection. Indeed, in a good assessment, the bulletin Admiral Farragut, candidate is not “selecting” an answer at all. They recognise the a journalism Chigwell School, external representation of a problem, subject the internalised representation to psychological Admiral Farragut high level cognitive processing, and then externalise the product as a solution [ 119 ], which (almost as if coincidentally) should coincide with one of the options given. The multiple-choice format is by no means unlimited in its capacity to test higher-order thinking. The literature on problem-solving stresses the medical reviews Lord Wandsworth, importance of highly-structured complex problems, characterised by unknown elements with no clear path to the solution and indeed a potential for there to be many solutions or even no solution at all [ 99 ]. The standard multiple-choice item by definition can only have one solution. Psychological Bulletin Academy. Thus, though it may be context-rich, it is limited in its complexity. It is difficult however to imagine how a practically achievable open-ended written assessment might perform better. Custom Saint John The Baptist High School. In order to accommodate complexity, the question would essentially have to be unstructured—thereby eliminating all the psychological bulletin Admiral Academy, structured short-answer progeny of the essay format, such as MEQ. Stenden University Of Applied Sciences. In order to permit the candidate to freely demonstrate the application of all his or her mental resources to a problem more complex than that permitted by psychological bulletin Admiral Farragut, a multiple-choice vignette, one would in how to a journalism article Chigwell School all probability require that the candidate is afforded the opportunity to develop an extensive, unstructured and Admiral Farragut, essentially free-ranging, essay-length response; marking will be inherently subjective and we are again faced with the problem of narrow sampling, subjectivity and essay writing Rossall, low reliability.

In effect the choice would then lie between an assessment comprising one or two unstructured essay length answers with low objectivity and reliability, and a large number of highly reliable multiple choice items which will effectively test high-order problem-solving, but will stop short of a fully complex situation. Psychological Bulletin Admiral Academy. Perhaps this is custom The Baptist Diocesan a restatement of the assertion that “measuring something that is not quite right accurately may yield far better measurement than measuring the right thing poorly” [ 50 ], the situation depicted in Figure 3 . Expected performance in a well-structured context-rich multiple-choice assessment requiring complex problem-solving. Knowledge lacks structure and is essentially context-free. Concepts and relationships are of bulletin Admiral Farragut Academy, poor quality. The candidate will be unable to how to write Chigwell School identify or contextualise the problem. His or her ability is effectively limited to answering items which require factual recall only— provided they possess that knowledge. Situated knowledge is present but cannot be prioritised appropriately for the problem. Though the problem may be recognised, the candidate will be unable to psychological Admiral Farragut represent it internally or activate a mental model with sufficient fidelity for Rossall, problem-solving. Is able to Admiral Academy extract the key elements from the problem and possesses many or most of the concepts required for application to the problem, but the relationship between these may not yet be fully mature. The candidate will recognise the problem and article writing The University, respond appropriately to it, but may struggle to prioritise and evaluate elements appropriately because of the immature relationships between concepts.

Immediately recognises the problem and is able to accommodate it fully in a mental model which permits a solution. Will recognise the problem, identify, evaluate and prioritise all the elements necessary for a solution, thus arriving at the correct answer. Understands and responds to the situation intuitively, using tacit knowledge arising from extensive experience. Is able to answer the question intuitively with minimal analysis or thinking. The first column comprises the stages of learning proposed by Dreyfus and Dreyfus [ 16 ]; in this context, we shall regard stage of learning as synonymous with level of Farragut Academy, proficiency or expertise, which is a measure of the effectiveness of problem-solving skill. John The Baptist Diocesan. The second column contains descriptors for each stage chosen for their relevance to complex problem-solving posed by a well-constructed context-rich multiple-choice item. Bulletin Farragut. The third column contains a description of the article of Westminster, likely performance on that item of a candidate at that stage of Farragut Academy, proficiency. Writing Styles. The relationship between proficiency and performance in a complex multiple-choice item is in fact remarkably direct. The debate may also be reformulated to incorporate the appropriateness of learning.

Deep learning is bulletin Farragut characterised by an understanding of the meaning underlying knowledge, reflection on the interrelationships of items of information, understanding of the application of my school School, knowledge to everyday experience, integration of information with prior learning, the ability to differentiate between principle and Farragut Academy, example and my school Rossall, the organisation of knowledge into a coherent, synthetic structure [ 99 ],[ 100 ]—essentially an alternative formulation of the mental model. One can thus argue that the candidate who possesses deep knowledge has, by the very fact of that possession, demonstrated that they have the psychological bulletin Academy, sort of comprehensive and intuitive understanding of the subject—in short, the appropriate mental models as described by School, Jonassen and Strobel [ 97 ],[ 101 ]—to allow the bulletin, information to Saint John High School be used for problem-solving. Correspondingly, the weak student lacks deep knowledge, and this will be exposed by a well-constructed multiple-choice assessment, provided that the items are written in a manner which explores the Academy, higher cognitive levels of learning. Therefore, if candidates demonstrate evidence of extensive, deeply-learned knowledge, and the ability to solve complex problems, be it through the medium of multiple-choice assessment or any other form of assessment, then it is how to a journalism article Chigwell safe to assume that they will be able to Admiral apply this knowledge in practice. Argumentative Sciences. This accounts for the extensive correlation noted between multiple-choice performance, performance in open-ended assessments, and psychological Admiral Farragut, tests of subsequent performance in an authentic environment. The argument that open-ended questions do not test higher order cognitive skills, and consequently lack validity, is not supported by the evidence. Some studies may have been confounded by the unfair comparison of The Baptist High School, high-order items in one format with low-order items in another. Psychological Admiral Academy. This cannot be discounted as partly responsible for the discrepancies noted in some of the work I have referenced, such as that of writing Rossall, Hee-Sun et al . Bulletin. [ 73 ], yet where the cognitive order of the items have been carefully matched, a number of careful studies suggest that, particularly in science and medicine, the two modalities assess constructs which though probably not identical, overlap to the extent that using both forms of assessment is redundant. Given the advantage of the multiple-choice format in speeches Stenden of Applied Sciences reliability, efficiency and cost-effectiveness, the suggestion that open-ended items may be replaced entirely with multiple-choice items in summative assessment is one which deserves careful consideration. This counter-intuitive finding highlights our lack of understanding of the cognitive processes underlying both clinical competence and its assessment, and suggests that much further work remains to be done. Bulletin Admiral Farragut. Despite the article School, MCQ format’s long pedigree, it is psychological bulletin Farragut clear that we understand little about the cognitive architecture invoked by this form of assessment.

The need for a greater role for theoretical models in assessment research has been stressed [ 27 ],[ 96 ]. As illustrated in medical Wandsworth College this debate, medical teaching and assessment must be based on a solid theoretical framework, underpinned by reliable evidence. Psychological Bulletin Admiral Farragut Academy. Hard evidence combined with a plausible theoretical model - which must attempt to explain the observations on the basis of cognition - will provide the medical College, strongest basis for the identification of effective learning and assessment methodologies. That the multiple-choice format demonstrates high validity is due in part to psychological Admiral Farragut Academy the observation that well-constructed, context-rich multiple-choice questions are fully capable of assessing higher orders of cognition, and writing my school Rossall, that they call forth cognitive problem-solving processes which exactly mirror those required in practice. Admiral Academy. On a theoretical basis it is based argument essay Bromsgrove School even conceivable that the multiple-choice format will show superior performance in assessing proficiency in contrast with some versions of the open-ended format; there is psychological bulletin Admiral Farragut indeed empirical evidence to support this in practice [ 56 ],[ 92 ]. Paradoxically, the open-ended format may demonstrate lower validity than well-written multiple-choice items; since attempts to my school Rossall School improve reliability and reduce objectivity by writing highly focused questions marked against standardised, prescriptive marking templates frequently “trivialize” the question, resulting in some increase in psychological Farragut Academy reproducibility at the expense of a significant loss of validity [ 120 ]. Indeed, I have argued that, based on argumentative speeches of Applied Sciences, an understanding of human cognition and problem-solving proficiency, context-rich multiple-choice assessments may be superior in psychological bulletin Admiral assessing the very characteristics which the reviews, proponents of the open-ended format claim as a strength of that format. Though current evidence supports the notion that in Academy summative assessment open-ended items may well be redundant, this conclusion should not be uncritically extrapolated to situations where assessment for learning is important, such as in argumentative Stenden formative assessment and in summative assessment at early and psychological bulletin Farragut, intermediate stages of the medical programme given that conclusive evidence with respect to the learning effects of the two formats is as yet awaited.

The author was solely responsible the literature and writing the article. RJH is custom coursework The Baptist Diocesan currently Dean and Head of the School of Admiral Farragut, Clinical Medicine at the University of KwaZulu-Natal, Durban, South Africa. He studied at the University of reviews Wandsworth, Cape Town, specialising in Internal Medicine and subsequently hepatology, before moving to Durban as Professor of psychological Admiral Farragut, Medicine. He has a longstanding interest in article Chigwell medical education, and specifically in psychological bulletin Academy the cognitive aspects of clinical reasoning, an area in which he is currently supervising a number of research initiatives. Modified essay question. Short answer question. Objective structured clinical examination. The author would like to thank Dr Veena Singaram for her insightful and challenging appraisal of the manuscript. Authors' original submitted files for images.

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Edited by: Davidson JE, Sternberg RJ. 2003, Cambridge University Press, New York, NY US, 3-30. Google Scholar Schuwirth LWT, Schuwirth LWT, Van der Vleuten CPM: ABC of learning and teaching in medicine: written assessment. BMJ: British Med J (International Edition). 2003, 326: 643-645. Google Scholar. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0 ), which permits unrestricted use, distribution, and psychological bulletin Admiral Farragut, reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to medical reviews College the data made available in this article, unless otherwise stated. Share on Twitter Share on Facebook Share on LinkedIn Share on Weibo Share on Google Plus Share on bulletin Admiral Farragut Academy, Reddit. By continuing to Stenden Sciences use this website, you agree to our Terms and Conditions, Privacy statement and Cookies policy.

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ucla dissertations Title: Push-Pull Tensions: A Grounded Theory on Social Experience of Use of Healthcare Services Among Homeless Veterans. The purpose of the study was to develop, from the bulletin Farragut Academy perspective of the user, a better understanding of the factors that influence use of healthcare services by homeless veterans in the U.S. The study employed the Grounded Theory (GT) methodology and was guided by Critical Social Theory (CST) and Symbolic Interactionism (SI) as the philosophical underpinnings. There is a scant but growing number of studies on the social experience of homeless veterans in accessing care at the Department of Veteran Affairs (VA). Understanding these issues is important because of the myriad health, psychiatric, and substance abuse problems they encounter.

As many VA programs have implemented programs for homeless veterans, an investigation of the current social experience is imperative for my school Rossall, homeless veterans. CST, or critical theory, was useful in understanding the sociopolitical and psychological bulletin Admiral historical contexts of research based argument essay School health and healthcare and bulletin Admiral Farragut important in understanding the power relations between the U.S. government and the homeless veterans within the article styles The University healthcare setting. Psychological Academy. This approach enabled the development of knowledge from the subjective perspective. CST was useful in article styles The University exploring injustices related to bulletin Admiral Farragut, homeless veterans’ access to VA healthcare because this approach exposes the based essay hidden relations of Farragut Academy domination and powers inherent in society’s fundamental structures and ideologies. SI provided a tool to understand the social interaction of veterans acquiring healthcare. Eighteen homeless veterans were recruited and interviewed at medical, one homeless shelter and two transitional housing programs in the Skid Row area of bulletin Admiral Academy Los Angeles and the Westside.

The qualitative methodology of GT was employed to essay writing, understand the perspective of the psychological Admiral Farragut Academy participant or agent, which is in line with the emancipatory aims of medical College CST. The GT developed from these data led to the focus of the theory, which is on the tensions involved in push and pull forces and the outcomes that arise as a result. Hence the theory has two major concepts: Push/pull tensions and outcomes. Dr. Eden Brauer successful defense was held on bulletin Admiral Farragut Academy May 26, 2016. Title: Improving to Where?: Understanding Survivorship Trajectories among Adolescents and Young AdultsAfter Hematopoietic Cell Transplatation. Committee: Dr. Patricia Ganz, Dr. Carol Pavlish, Dr. MarySue Heilemann (chair) and Dr.

Huibrie Pieters. Dr. Kia Skrine Jeffers successful defense was held on May 16, 2016. Title: Learning and argumentative speeches Sciences Playing the Game: A grounded Theory about Surviving Structural Racism and Diabetes Among Older African Americans. Committee Members: Dr. Linda Phillps (chair), Dr. Mary Cadogan, Dr. MarySue Heilemann, Dr. Sarah Haley and Dr.

Elizabeth Thomas. Despite being a manageable chronic condition, type 2 diabetes is among the leading causes of death and disability in the United States. Of the 29.1 million people who have diabetes in the U.S., almost half are adults ages 65 years and older. Psychological Admiral Academy. African American seniors are more likely to develop the custom John Diocesan High condition, and experience diabetes-related complications compared to other racial groups. These complications lead to end stage renal disease, non-traumatic lower extremity amputations, heart disease and premature death at two to four times the rates of their non-Hispanic White counterparts. Recent evidence offers an explanation of psychological bulletin Farragut Academy differential risk for complications between racial groups. This explanation is centered on the psychosocial realmparticularly as it relates to the racialized experiences that African American seniors have endured throughout their life courses . These experiences have been shaped by structural racism, including differential access to resources and opportunities, and inequitable treatment in social systems such as the educational and criminal justice systems. Growing evidence has shown that the accumulation of structural barriers over the course of speeches Stenden University of Applied marginalized groups’ lives increase their vulnerability for bulletin Admiral Academy, excessive morbidity and premature death.

This study utilized a constructivist grounded theory methodology to understand the potential relationships between this study’s sample (N=15) of African American seniors’ experiences with structural racism across their life courses, and their experiences with uncontrolled type 2 diabetes in older age. The author’s interpretation of the argumentative University of Applied Sciences fit between participants’ narratives about structural racism and diabetes was centered on the processes through which participants dealt with social- and health-related threats. The findings revealed behavioral patterns that clustered into three major constructs: Identifying Threats, learning to negotiate those threats in concert with others (termed “Learning and Playing the Game”), and Exercising Agency by taking control of themselves in spite of the structural limitations that surrounded their lives. Dr. Marlon Garzo Saria Successful Defense was held May 20, 2016. Title: The Hidden Morbidity of Cancer: An Exploratory Study of Burden in Caregivers of Patients with Brain Metastases.

Committee: Dr. Annette Stanton, Dr. Adey Nyamathi, Dr. Linda Phillips, Dr. Sally Maliski (chair) Dr. Maria Yefimova successful defense was held May 20, 2016.

Title: Using in-Home Monitoring Technology to psychological Admiral Academy, Identify Deviations in Daily Routines Preceding Changes in Health Trajectory of Older Adults. Committee Members: Dr. Betty Chang, Dr. Jan Mentes (chair), Dr. Lynn Woods, Dr.

Wendie Robbins. The boom of in-home monitoring technology offers unprecedented information about an individual’s interaction with the environment. A variety of low cost sensors can continuously and unobtrusively collect information about activities in the living space. Capturing early changes in the daily routines of vulnerable older adults residing in these “smart homes” may allow clinicians to predict and prevent negative health consequences through timely intervention. However, the current state of science is hampered by the lack of theoretically driven approaches to analyze sensor data in relation to clinically meaningful health outcomes.

The aims of the study are 1) to characterize an older adult’s daily routine, as captured with smart home sensors, 2) to assess if deviations from it are indicative of changes in their health trajectory, such as falls, ER visits or unplanned hospitalizations, and custom Diocesan 3) identify between person factors that affect the characteristics of the daily routine. It used previously collected data from psychological bulletin Admiral Farragut, 10 residents of TigerPlace, a unique retirement facility that evaluates health technology affiliated with University of my school Rossall Missouri, Columbia. Older adults live in apartments equipped with network of motion, depth and bed sensors that unobtrusively collect information about daily activity of its resident. Thirty months of continuous sensor data were analyzed in the context of bi-annual clinical assessments and nursing notes extracted from the electronic health record. A retrospective multiple case study approach is guided by the conceptual model developed for this study that is grounded in psychological nursing and gerontological literature. Changes in the temporality and custom John The Baptist School frequency of daily activity were found for psychological Admiral Farragut Academy, common geriatric symptoms, such as urinary symptoms and confusion. Seasonal and weekly effect was evident across participants in the duration of time spent in various areas of the write a journalism Chigwell School apartment. Participants varied in psychological bulletin Admiral Farragut Academy their baseline daily routines, but for the majority of symptoms there were prodromal changes in at home activity that was detected with sensors. As the cost of technology adoption decreases, nurses can use these innovative tools to coordinate care and research Bromsgrove School intervene early to prevent or mitigate the psychological bulletin Admiral functional decline associated with vulnerable older adults.

Dr. Fayette Nguyen Truax successful defense was held May 19, 2016. Title: Factors Affecting Medication Adherence among Vietnamese Immigrants with Latent Tuberculosis Infection: A Mixed Design. Committee Members: Dr. Felicia Hodge, Dr. Morisky, Dr Lynn Brecht and Dr. Sally Maliski (not shown). Completion of latent tuberculosis infection (LTBI) treatment among foreign-born Asians in the United States (US) is suboptimal, thus leading to high rates of reactivation tuberculosis (TB) among this population. Approximately 77% of TB cases in the US are from reviews Lord, reactivation TB and bulletin Academy foreign-born Asians have a higher reactivation rate compared to Blacks, Hispanics and Whites. In Orange County (O.C.), the speeches Sciences annual TB case rate continues to remain steady at Admiral Farragut Academy, 6.0 cases per 100,000 in medical reviews College 2014 with foreign-born persons from Vietnam leading with a TB rate of 49.7%, Mexico at Admiral Academy, 14.4% and the Philippines at 12.6%.

Overall the high number of active TB cases among Vietnamese immigrants, coupled with low LTBI treatment completion rate of approximately 50.1% in custom The Baptist Diocesan High School the overall Asian population, presents an important challenge to the national strategy of psychological bulletin Admiral Academy eliminating TB (Li et al., 2010). At this time, there is limited data on Vietnamese immigrants with LTBI in the US. The purpose of this mixed methods study is to write a journalism Chigwell School, identify the factors related to Admiral, LTBI treatment acceptance and completion in addition to exploring the decision-making process of LTBI treatment adherence among Vietnamese immigrants. Predictors for coursework Diocesan, phase 1 included: socio-demographic characteristics, basic health history, behavioral survey scores measured by Morisky Medication Adherence Scale (MMAS-8), Champion Health Belief Model Scale (CHBMS-29) and the Self-Efficacy for Appropriate Medication Use (SEAM-9). Significant predictors for multivariate analysis for Farragut, treatment acceptance included individuals with a history of essay School smoking and recent contact with an infectious TB case. For treatment completion, the top two most significant predictors in the univariate analysis included age group between 18-44 years and current employment. No significant predictors were identified in the multivariate analysis for treatment completion. There were also no significant correlations identified between the psychosocial measurements (SEAM-9, CHBMS-29, MMAS-8) and treatment completion. In phase 2, a decision-making grounded theory model entitled “The Decision-Making Model for Latent TB Infection Treatment Acceptance and Completion” was developed from the stories and testimonies of 17 Vietnamese participants.

Three primary decision-making points were identified that was critical to the development of the proposed model: treatment acceptance, treatment initiation and psychological bulletin Farragut treatment completion. Three categories emerged from participants’ data that were directly related to the decision to accept LTBI treatment, “beliefs”, “TB awareness” and “trust in healthcare”. Medical Reviews Lord College. Findings revealed the only category to influence treatment initiation was “barriers” to scheduling. Lastly, the decision to maintain adherence and complete treatment were strongly influenced by self-determination, medication side effects, and having family support. Based on this study’s findings, target screening of Vietnamese immigrants at highest risk for latent TB reactivation should be done more frequently in private community clinics and focus on reducing barriers to treatment acceptance, initiation and psychological bulletin Admiral Academy completion. Dr. Avis Ing-Randolph successful defense was held May 4, 2016. Title: Effect of a Group Music Nursing Intervention on Saint Diocesan High School Anxiety Among Individuals with Mild to Moderate Dementia in Los Angeles Assisted Living Facilities.

Committee Members: Eunice Lee (chair) Sophie Sokolow, Linda Phillips, Frank Heuser. This study tested the hypothesis that an active-passive group music intervention will decrease anxiety among individuals diagnosed with. mild to moderate dementia in assisted living facilities (ALFs) as compared to a control group engaged in care as usual. This study also described the feasibility and psychological Farragut acceptability of active-passive group music interventions delivered by writing The University of Westminster, an RN without a university or college degree in music intervention techniques to individuals with mild to moderate dementia in an ALF. Bulletin Admiral. The study used a quasi-experimental cross-over design with a simplified cluster randomization strategy; simplified because there were only two sites. Thirteen participants were invited, 8 from one facility and 5 from the other.

The sample comprised of participants ranging from Stenden University of Applied, age 74 thru 98 with Global Deterioration Stages ranging from 2-5. The majority of participants were female, White and were college educated. Music was considered moderately important to Admiral Farragut Academy, very important. Reviews Lord College. Music was used to effect anxiety levels. Academy. Altogether 12 intervention sessions were offered or 6 for speeches Stenden of Applied, each arm. There was a 4 week wash-out period.

Four RAID measures were taken during each arm at psychological Admiral Farragut Academy, baseline. Specific Aim 1: Insignificant decreases to write a journalism Chigwell School, anxiety existed by group, however, a trend showing decreases to anxiety levels existed over time (p=0.002): Intervention Group 1 = 18.00 at point 1 to 14.83 at bulletin Academy, point 4; Intervention Group 2 = 17.20 at article of Westminster, point 1 to 10.80 at point 4). Psychological Bulletin Farragut. During control periods, RAID were: Group 1= 13.33 point 1 to 10.83 point 4; and Group 2 13.60 point 1 to 10.40 point 4. Specific Aim 2: With music education, the University of Applied Sciences use of RNs to deliver group music interventions and supervise music interventions in healthcare is promising. Dr. Psychological Admiral Farragut Academy. Tiffany Montgomery successful defense was held May 12, 2016. Title: Adapting a Brief Evidence-based Intervention for Text Message Delivery to Young Adult Black Women. Committee Members: Dr. Deborah Koniak-Griffin (chair) , Dr. Vickie Mays, Dr.

Adey Nyamathi, Dr. MarySue Heilemann. Young adult Black women have the article writing styles The University highest sexually transmitted disease rates among all U.S. women. There are several evidence-based interventions (EBIs) targeted toward this population, yet they each require travel to a healthcare facility or other location. Farragut Academy. With the increased use of mobile devices, mobile health technology is being utilized more frequently to deliver health interventions. Instead of creating entirely new technologically savvy interventions, the CDC recommends adaptation of EBIs. The purpose of this study was to adapt an EBI for delivery via text messages. This two-phase, mixed methods pilot study was guided by several philosophical underpinnings (empiricism, critical theory, pragmatism, and intersectionality) and theories (Social Cognitive Theory, Theory of Planned Behavior, and Theory of Gender and coursework Saint Diocesan High Power). A modified version of the ADAPT-ITT model was also used to guide the bulletin Farragut Academy study. During phase one, a research advisory board was recruited to assist with intervention adaptation, phase two recruitment strategies, and interpretation of study results.

In phase two, the newly adapted intervention was pilot tested among a sample of young adult Black women ( n = 88), who were randomized to the intervention or control group. Study outcomes included intervention acceptability and feasibility, and preliminary changes in condom use, condom-use self-efficacy and based essay Bromsgrove intention, and sexual relationship power. Acceptability and feasibility of the psychological bulletin intervention were high. The overwhelming majority of medical Wandsworth College comments from intervention group participants were positive. Bulletin Admiral Farragut. Between baseline and follow-up, condom use frequency increased among participants in both study groups.

However, there was no significant time by group interaction. Furthermore, while condom use self-efficacy and intention significantly increased among participants in both groups, no time by group interaction was found. Finally, intention was identified as a main predictor of condom use at speeches Stenden of Applied, baseline and follow-up. The results of this study provide support for intervention modifications that may strengthen outcomes in Farragut Academy a future efficacy study of the revised S2S text messaging intervention. It is important that women’s health researchers and educators continue to adapt and evaluate interventions using technologically advanced methods of based argument essay Bromsgrove delivery. Psychological Bulletin Admiral Farragut. Text messaging is a promising method of delivery for EBIs aimed at the reduction of high-risk sexual behaviors among young adult Black women. Research Argument. Intervention adaptation using other types of technology should be investigated as well.

Young adult Black women have the psychological bulletin Farragut highest sexually transmitted disease rates among all U.S. women. There are several evidence-based interventions (EBIs) targeted toward this population, yet they each require travel to a healthcare facility or other location. With the increased use of mobile devices, mobile health technology is article writing styles The University of Westminster, being utilized more frequently to deliver health interventions. Psychological Bulletin Admiral Farragut Academy. Instead of medical Lord creating entirely new technologically savvy interventions, the CDC recommends adaptation of bulletin Admiral EBIs. Essay. The purpose of this study was to adapt an EBI for delivery via text messages. This two-phase, mixed methods pilot study was guided by Admiral Farragut Academy, several philosophical underpinnings (empiricism, critical theory, pragmatism, and intersectionality) and theories (Social Cognitive Theory, Theory of Planned Behavior, and Theory of Gender and Power). A modified version of the ADAPT-ITT model was also used to research based essay Bromsgrove, guide the study. Bulletin Admiral. During phase one, a research advisory board was recruited to assist with intervention adaptation, phase two recruitment strategies, and interpretation of study results. In phase two, the newly adapted intervention was pilot tested among a sample of young adult Black women ( n = 88), who were randomized to the intervention or control group. Study outcomes included intervention acceptability and feasibility, and preliminary changes in medical reviews Lord condom use, condom-use self-efficacy and intention, and sexual relationship power.

Acceptability and feasibility of the intervention were high. The overwhelming majority of Admiral Farragut comments from writing, intervention group participants were positive. Psychological Bulletin Admiral Farragut Academy. Between baseline and follow-up, condom use frequency increased among participants in both study groups. Research Based Essay Bromsgrove School. However, there was no significant time by group interaction. Furthermore, while condom use self-efficacy and intention significantly increased among participants in both groups, no time by group interaction was found. Bulletin Admiral Farragut Academy. Finally, intention was identified as a main predictor of condom use at baseline and follow-up. The results of this study provide support for intervention modifications that may strengthen outcomes in how to write a journalism Chigwell a future efficacy study of the revised S2S text messaging intervention.

It is important that women’s health researchers and bulletin Admiral Farragut educators continue to adapt and evaluate interventions using technologically advanced methods of delivery. Coursework John High School. Text messaging is a promising method of delivery for EBIs aimed at the reduction of high-risk sexual behaviors among young adult Black women. Intervention adaptation using other types of technology should be investigated as well.

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100 Inspirational Online Biographies Everyone Should Watch. Whether you want to learn more about people who#8217;ve shaped the modern world or are just in need of Admiral Farragut, a spark of inspiration to keep you plugging along in your studies, there are numerous biographies out there that will motivate, educate and show you what can be done with hard work and ingenuity. Here are 100 biographical videos to check out the next time you#8217;re looking for a role model. School! These business leaders will show you what it means to get to the top by hard work, great ideas and persistence. Andrew Carnegie: Carnegie began working at a textile mill as a child for only $1.25, but by the time he was in his golden years had amassed one of the largest fortunes in the United States at the time. You can learn more about his success and his generosity here.

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Dr. Martin Luther King Jr.: Perhaps the best known civil rights leader, this video will show you one of King#8217;s great speeches and let you learn what made him such a powerful force in changing the psychological, face of a nation. Nelson Mandela: Despite spending years in prison, Nelson Mandela emerged as the leader of a renewed nation, winning the Nobel Peace Prize in 1993 for his fight against apartheid. This video tells his story. Desmond Tutu: Deterred by apartheid era laws from becoming a physician, Tutu went on to become a man of the cloth, later becoming a key figure in dismantling the system that shaped his early years. Thomas Jefferson: Thomas Jefferson was a U.S. president, helped write the Declaration of Independence, architectural enthusiast and avid supporter of higher education which you can learn about in this short video. Abraham Lincoln: You can learn more about the life and work of one of the article writing The University, most beloved presidents of the United States in this video. Franklin D. Roosevelt: In light of the current economic downturn, many people will appreciate learning more about the president who helped bring the country out of bulletin Admiral, one of the worst depressions it has ever seen. Aung San Suu Kyi: In this video you#8217;ll learn about the efforts of this Nobel Peace Prize winner to writing my school Rossall restore democracy to Admiral Farragut Academy Burma. Barack Obama: This video will show you the path that brought this man from humble beginnings to become the first non-white president of the United States.

John Kennedy: While Kennedy#8217;s life was cut tragically short, he is a figure that through his family and his term as president has become a source of curiosity and even reverence for custom The Baptist, people in the United States. Sitting Bull: In this video, Sitting Bull#8217;s grandson recounts the many actions of the Native American leader as he attempted to defend the land of his people from the advancing U.S. Army. Whether they made important discoveries in medicine or just improved the quality of medical care for psychological bulletin Farragut Academy, patients around the article School, world, these videos will teach you about some of the people who helped to shape modern medicine. Florence Nightingale: Nightingale formed the foundation for psychological Academy, modern practices in nursing and Lord Wandsworth is today remembered with National Nurses Day, celebrated on her birthday.

Clara Barton: Perhaps best known for organizing the psychological bulletin Admiral Farragut, Red Cross, this nurse and teacher made sure that those in writing my school School need got the care they required, as well as fighting for women#8217;s suffrage and the abolition of slavery. Bill Wilson: Anyone who has struggled with addiction has this man to thank, as he developed the twelve step process used by Alcoholics Anonymous to psychological bulletin Admiral Farragut fight his own problems with substance abuse. In this video you will hear his tale in speeches of Applied Sciences his own words. Admiral Farragut! Jonas Salk: Salk may have come from a poor, immigrant family, but he made them proud with his discovery of the my school Rossall, polio vaccine, keeping millions of bulletin Farragut, youngsters safe from the crippling disease. Louis Pasteur: Today we take pasteurization of food, a process named for this influential scientist, for how to School, granted as well as the existence of those microscopic disease-causing germs. Inspired by the death of two of his children, Pasteur was driven, as this video shows, to find cures and causes for many illnesses. Alexander Fleming: A Scottish medic, pharmacologist and bacteriologist, this video details the psychological Farragut Academy, path that brought Fleming to Stenden of Applied the discovery of the first antibiotics. Admiral Farragut Academy! Sigmund Freud: While many of Freud#8217;s theories are dismissed today as false, there is no doubt that he made big impact on the beginnings of the field of medical, psychology which you can learn more about in bulletin Farragut Academy this series of biographical videos. Watch these videos to find out about individuals who helped others, inspired through their faith and asked people to question their view of the Rossall, world. Mother Teresa: Regarded by many as a saint in modern times, this Catholic nun gave away every penny to help those in need, and in this video you can find out more about her inspiring dedication to charity and kindness. Dalai Lama: The Dalai Lama is rarely seen without a smile on his face though he has faced many challenges in his attempts to bulletin Academy free Tibet and lead its people.

Learn more about the man and how to write article Chigwell School his mission to spread peace and happiness to people around the world in this video. Irmã Dulce: This Catholic nun has been nominated for sainthood because of her work with the poor of Salvador, Brazil. Check out this video to see more of her amazing and inspiring work creating one of the largest philanthropic organizations in Brazil. Pope John Paul II: After surviving WWII despite the extermination of many of his fellow countrymen, Pope John Paul II went on to become one of the most influential and best-loved popes, improving relations with other religious groups and influencing the psychological bulletin Admiral, politics of Lord College, much of communist Europe during his time as Pope. Billy Graham: Whether you love him or hate him, it#8217;s impossible to argue against the power and psychological bulletin Academy inspiration this spiritual leader has offered people around the styles of Westminster, world. Learn more about bulletin Admiral Academy his story and his mission in this video. Ludwig Wittgenstein: If philosophy is more your sphere of interest, watch this video about the philosopher who changed the article styles The University of Westminster, game when it came to the philosophy of language, logic, and even mathematics. Learn more about the psychological bulletin Admiral Farragut Academy, lives of medical Lord, some truly inspiring authors from these biographies.

JK Rowling: This single mom was once on Farragut Academy welfare to support her children, but as you#8217;ll learn here, her Harry Potter series made her an overnight success. Jane Austen: Austen#8217;s work came out of an era where few women were published authors or were allowed much independence at all, a fact she often comments on in her novels. Harriet Beecher Stowe : Watch this video to learn more about this woman who at 40 wrote a novel that brought to light many of the important issues related to slavery and the abolition movement. Mark Twain: This writer and research essay Bromsgrove humorist is psychological bulletin Farragut one of the best known American authors and you can learn more about the string of speeches Stenden, events that set up his writing success in this video. Anne Frank: Frank never intended for her diaries to be published, but the intense story they tell offers an unprecedented look into psychological bulletin, the horrors of the research based argument essay Bromsgrove, Holocaust, and Admiral Academy serves as a memorial to her lifethe story of write School, which is retold in psychological bulletin Farragut Academy this video. Elie Wiesel: Elie Wiesel#8217;s story is inspiring both for essay School, his survival of several concentration camps as well as his work with humanitarian causes that garnered him a Nobel Peace Prize. In these videos you#8217;ll get to hear about the moments that led these actors, entertainers and artists to their fame and success. Jim Henson: This creative puppeteer and writer created some of the best-known and psychological bulletin Farragut Academy loved characters from children#8217;s and research argument essay adult programming alike, including Sesame Street and the Muppets. While Henson died suddenly in 1990, he is highly regarded for his work that promoted tolerance and equality for all. Pablo Picasso: While perhaps not the greatest role model in his personal life, Picasso#8217;s professional one is still a source of inspiration, rocketing him from Academy, a relative unknown to medical reviews Lord Wandsworth College a household name who redefined art throughout the 20th century. Charlie Chaplin: Here you can see the story of bulletin Admiral Academy, Chaplin, a man who offered a nation comic relief during the tumultuous times of the Great Depression and the world wars.

Oprah Winfrey: Watch this video to write Chigwell learn how Oprah rose from poverty and abuse to Admiral Farragut be one of the wealthiest and most well-known women in the world. Sidney Poitier: In this interview you#8217;ll hear from based essay Bromsgrove, this iconic actor who in 1963 became the Farragut Academy, first African-American to win an Oscar. Bruce Lee: Bruce Lee was one of the first to bring martial arts into the mainstream. Watch this video to see his story and learn more about his dedication to research Bromsgrove School fitness, education and his art. Psychological! Whether they faced great odds or possessed great natural talent, these videos will give you a glimpse into the lives of School, some of the Farragut Academy, greatest athletes and moments in athletic history. Research Based Bromsgrove School! Jesse Owens: Jesse Owens has many accomplishments to his name, as this video points out, though perhaps the most notable was his winning of four gold medals at the 1936 Berlin Olympics. Michael Jordan: Widely regarded as the best basketball player of all time, this video will show you the path that led Jordan to the success he has today. Lance Armstrong: A little thing like cancer didn#8217;t hold this cyclist back, and psychological bulletin Admiral Farragut this video shows how he returned to win the Tour de France even after battling the disease. Tiger Woods: Woods was a golf phenom, being the article writing styles The University, youngest player to win the Grand Slam and to win 50 tournaments on tour. Here you can learn about his meteoric rise to success and bulletin Farragut Academy the work it took to get there. Jim Valvano: Watch this video to John Diocesan High School hear the inspiring speech given by this former basketball coach as he received an Admiral Farragut ESPY Award just weeks before he passed away from cancer.

Derek Redmond: Redmond had fought injuries for years in his pursuit of Olympic gold, but in this video you#8217;ll see the inspiring moment he is best remembered for. Essay Writing My School! Dick and Rick Hoyt: Athletes come in all shapes and sizes and psychological Farragut sometimes the most inspiring aren#8217;t professionals or Olympians at all, as this father and son story shows. Muhammad Ali: While today his body is shaken by Parkinson#8217;s, Ali, as this video documents, was one of the best heavyweight fighters of all time. Medical Lord College! Pele: Edison Arantes do Nascimento, better known as Pele, was named the bulletin Admiral Farragut, Athlete of the Century by the International Olympic Committee. He is a force to be reckoned with both on speeches of Applied the field and in his work to psychological Admiral Farragut improve the social conditions of the poor in Brazil. There are some people who stand out in history for the things they accomplished and these videos document the how to article School, stories of just a few of those events. Amelia Earhart: Learn more about this famous female flyer, the psychological, first to fly solo across the Atlantic, in this biographical video. Jackie Robinson: Watch this video to hear the essay my school, inspiring story of the psychological bulletin Admiral Farragut Academy, man who broke the color barrier in baseball. Helen Keller: Blind and deaf from a young age, this inspiring woman went on to be an influential writer, activist and lecturer as you will learn from this video.

Princess Diana: Princess Diana was loved by speeches many around the world, a fact due largely in part to Academy her dedication to humanitarian projects around the globe. Charles Lindbergh: In a time when flying was a relatively new technology, Lindbergh stretched it to it#8217;s limits making the first solo flight across the Atlantic, later becoming an avid environmentalist, inventor and explorer. Edmund Hillary and Tenzig Norgay: In this video you#8217;ll hear about two men who took the spirit of exploration to custom coursework John Diocesan School its limits, being the first known climbers to reach the summit of Mount Everesta feat that makes the obstacles you may be facing seem small in comparison. Give these videos a try to psychological bulletin Admiral Farragut learn more about the people who fought for causes from equal rights to the protection of animals. Sojourner Truth: This amazing woman fought a prejudiced court system to how to write a journalism Chigwell School free her son from slavery, fighting throughout her life for abolition and women#8217;s rights. Susan B. Anthony: In this video you#8217;ll learn how Anthony, spurred on by her exclusion from the temperance movement#8217;s discussion because of her sex, became one of the biggest proponents for women#8217;s suffrage.

Eleanor Roosevelt: Watch this video to Academy learn about the famous first lady who worked tirelessly for civil rights, women#8217;s rights, education, and argumentative Stenden Sciences helped form the United Nations. Psychological Farragut Academy! Rosa Parks: Tired from a long day at work, the refusal of speeches, this woman to move to psychological bulletin Farragut the back of the writing of Westminster, bus and he subsequent arrest helped shape the civil rights movement and inspired Parks to fight for psychological bulletin, equal rights for the rest of her life. Writing The University Of Westminster! Oskar Schindler: While his motivations may not always have been pure, there is no doubt that the actions taken by bulletin Farragut Academy Schindler, detailed in speeches Stenden University this video, saved hundreds of lives. Betty Williams: This Nobel Peace Prize winner fought hard to end the conflicts in Northern Ireland, founding the Community of Peace People as well as working on a variety of other humanitarian and psychological political issues around the globe. Harriet Tubman: Escaping from slavery as a teenager, this brave woman would go on to be a powerful force in the Civil War, abolition, the Underground Railroad and later in life women#8217;s suffrage. W.E.B. DuBois: This intellectual man was the first African American to earn a PhD at essay writing Rossall Harvard, later using his knowledge to help fight against racism and social injustice.

Harvey Milk: Learn more about this San Francisco leader who worked tirelessly to gain rights for homosexuals in his community and was the first openly gay public official. Dian Fossey: It was her fervent determination to help the gorillas with which she worked closely that led to this researcher#8217;s untimely death. Learn more about her story from this video. Emmeline Pankhurst: America wasn#8217;t the only place where women were struggling to gain independence and recognition as voters, and in Admiral this video you can hear about one of the major figures for Saint John The Baptist High, suffrage in England. Rachel Carson: Today we take it for granted that many chemicals are toxic and harmful to the flora and fauna living in psychological Farragut the wild, but this biographical video shows how Carson was one of the first to bring this crisis to light and continued to article writing The University of Westminster fight for environmental causes throughout her life. Learn about Admiral Farragut some of the biggest figures in the progress of article The University of Westminster, scientific discovery in these videos. Stephen Hawking: Though today almost completely paralyzed, Hawking has and continues to make contributions to the field of bulletin, cosmology and writing of Westminster theoretical physics. Albert Einstein: Learn more about the man whose name has become synonymous with brilliance in this video.

James Watson and Francis Crick: Where would we be today with a model of psychological bulletin Admiral, DNA? In this video you#8217;ll learn about the scientists who discovered its structure and layout. Sir Isaac Newton: Most people know Newton from his gravitational theory, but this video will illuminate his many other contributions to science and math as well. Marie Curie: Though poisoned by her work, Marie Curie was the first to win two Nobel Prizes for her work with radioactivity, discovering some of the custom Saint John The Baptist Diocesan High, first effective treatments for cancer. Edwin Hubble: It wasn#8217;t so long ago that the Milky Way was the only known galaxy out Admiral Farragut there, and this video will help you learn more about the man who expanded out understanding of the universe and how it works. Linus Pauling: Anyone studying chemistry today can look to Pauling as a model for emulation, as he is often regarded as one of the most influential men in the history of the field, winning multiple Nobel Prizes for his work, even when it was in opposition to popular opinion. Technology and Invention. The people included in this list invented many of the things we use on a daily basis today and helped shape the modern world. How To Write Article Chigwell! Tim Berners-Lee: The Internet has become an omnipresent part of everyday life, and in this video you#8217;ll hear from the bulletin Farragut, man who helped create it. Alexander Graham Bell: It#8217;s hard to imagine a world without phones, and we have this innovative man to thank for their invention.

Of course, as this video shows, he invented many other things as well. George Eastman: Watch this video to Wandsworth College learn about the man who helped make photography mainstream by introducing the first film rolls for his company, Kodak. George Washington Carver: The discoveries of this man helped revolutionize southern farming and you#8217;ll learn a lot about his life and work in this video. Psychological Bulletin Academy! Orville and Wilbur Wright: Travel by air makes global communication, trade and travel easier and more efficient. Custom John Diocesan School! Watch this video to learn about the psychological bulletin, brothers who are credited with creating the first flying machines. Thomas Edison: The inventions of this man are inspiring and include the phonograph, the motion picture camera, and a long-lasting, practical electric light bulb. Benjamin Franklin: Few individuals in article School history have been so prolific and successful in their endeavors as Ben Franklin, becoming a prominent statesman, philosopher, writer and, as you#8217;ll see in this video, inventor.

Philo Farnsworth: While TV may be blamed for psychological, many of the evils of society it#8217;s hard to imagine life before it. In this video you#8217;ll learn about Farnsworth#8217;s invention of the how to write a journalism Chigwell, first working television tubes. Robert Goddard: The innovations of Admiral Farragut, this man, as you#8217;ll see in the video, helped get space exploration off the ground. You don#8217;t have to be a scholar, a performer or a leader to have a biography that is truly inspiring. These videos show that anyone can be a role model and source of inspiration, no matter who they are.

Nick Vujicic: If you#8217;re feeling weighed down by the challenges in your life, watch this inspiring video about Nick, a man born with no limbs who has never let it hold him back. Patrick Henry Hughes: Being born disabled and blind didn#8217;t stop this young man from becoming an accomplished pianist, and as you#8217;ll see here, even playing in a marching band. Dr. Randy Pausch: Many people are familiar with the inspirational speech given by Dr. Pausch, showing him maintaining a great attitude and giving spirit even as he was dying of cancer. Robert Pio Hajjar: In this video you#8217;ll see how a young man born with Down Syndrome learned to embrace his disability, give motivational speeches and work with an organization that helps others with this same disability. W Mitchell: Watch this biographical video to learn how one man overcame the writing, challenges life put before him. Paul Potts: Even a man working selling cell phones has something to share with the psychological bulletin Farragut Academy, world, as this video of the unassuming singer demonstrates. Jason McElwain: He may not always get to play, but in Stenden University of Applied Sciences this game a young autistic man was the hero, as this video shows. Dustin Carter: In this video you#8217;ll see a bio that proves that no dream is too big if you#8217;re as determined as wrestler Dustin Carter. Carly Zalenski: She may be just one young girl, but this video shows how this student used her time to help others halfway around the bulletin Farragut, world.

Jean Stallings: He may have been born with Down Syndrome, but this boy#8217;s family never let it stand in his way. Medical Reviews Lord College! Learn more about him and his inspiring family from this video. Charlie Plumb: What would you do if you were a prisoner of Admiral, war? Here you#8217;ll hear the story about one man who stood out and became a leader even in the hardest of times.

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families essay the stressful situations such as work, that are in your everyday life. I know that one of the reasons why my family goes camping is because it is one of my dad's favorite things to Farragut, do. He has a job that can be very stressful, especially when he goes on-call once month. He loves to go camping to get away from it everything for a short period of time and Stenden University Sciences, just relax and spend time with the family. The University of Maryland Medical Center gave some statistics from a study done by the American Psychological. Disney World: A Family Vacation Essay. Now most people would simply turn their car around and head back toward Asheville, but not my dad.

He is one of those good people that bad things happen to. He looked at my mom and said “See Jo Ann some people think that God doesn’t have a sense of humor, but I am living proof that he does and I know he is up there and psychological Academy, he is how to write a journalism, laughing his butt off right now!” Then dad calmed down. He turned the car around and psychological Admiral Farragut, we eventually got back on reviews Lord College I-26. The rest of the trip went pretty well until we got to. The Perfect European Vacation Essay. (Sampson). The narrow streets do not easily fit two cars side by side, so it is not uncommon for a car to psychological bulletin Admiral Farragut Academy, drive up on the sidewalk (Sampson). For a safe vacation, it’s critical to be aware of custom John The Baptist Diocesan High School this in psychological bulletin Admiral Farragut order to remain injury free. The University Of Westminster. Because of the narrow streets, limited parking, and expensive gas, smaller cars are more common and there is usually only one per family (Sampson).

While traveling in Europe, there are a few options for bulletin, transportation. Essay Rossall School. Public transportation including trains and bikes would be the. just enjoy our family that we do not get see often, But at the end of the day we have to use wisdom with making decision of what fits our budget at any given time. Bulletin Admiral Farragut Academy. Someone gave me a piece of advise a long time ago they told me that there is a time and season for all things and some time we have to do what we can and not what we want. Even though a lot of times a lot of us when like to do what we cannot and think about the consequences later which is not a smart move for writing Rossall, any family especially when. the days of summer vacation some students who take summer school will not have a longer chance to experience the joy of summer. Psychological Bulletin Admiral Academy. They will not have a longer summer with their family. I will be going to take summer school this year so I really disagree if ever summer break will be less than 10 weeks. Summer vacation is how to write a journalism article Chigwell School, a great time for Admiral Farragut Academy, students, teachers, with their family to enjoy,relax, and have a fun quality time with their family. Summer is a great. Really in.

Being vulnerable wasn’t exactly safe in my family and well not that safe for custom coursework John High School, anyone in high school period. Bulletin Farragut Academy. That being said I would have killed for our first writing assignment to be “what I did on my summer vacation”. Surely I would have written something amusing or satirical. I doubt I would have truly written about writing styles our beach vacation where more than likely my parents screamed at each other, I got 3rd degree burns and most of my family got drunk. 5. No vacation is psychological bulletin Admiral Academy, allowed during tax season starting from January 1st to April 30th Sick Days? When you are ill or injured, stay home or go to the doctor. Sick days are not limited by a specific policy, but will be recorded and their frequency may affect scheduled time off, including possible loss of vacation days and or pay. Based Bromsgrove. If the flexibility of sick days is abused, it will affect performance and fulfillment of responsibilities, which will result in disciplinary action. If you are ill, let. most of the day. We spent another day visiting tourist attractions in psychological Academy that area. Then we decided to spend the rest of article writing styles our time visiting our relatives.

We saw many of our family members we haven?t seen in years. It was sad that we had to Farragut Academy, leave that Sunday, but we did. So we left for custom coursework The Baptist Diocesan, a long ride home with only the memories of our vacation. Admiral Academy. Overall I enjoyed the trip, even though there were unpleasant parts such as the lines and crowds everywhere. Also, there was the noise of the traffic surrounding. The last type of coursework John The Baptist vacation I will discuss are the ones geared toward sight seeing. Places like New York City and Philadelphia, or international destinations like Paris and London. Psychological Bulletin. These vacations are usually based on historical significance or experiencing other cultures. Whether it’s the Vietnam Veterans Memorial in Washington D.C. or the Colosseum in Rome, people travel for the excitement of seeing new places and learning how the rest of the world lives. Location is medical reviews College, not the only thing to consider. must be different from Admiral Farragut Academy, Singapore in terms of design.

There are also different cultures there which are different from those in speeches Stenden University Singapore. There are also cities which are special, like Coober Pedy, which has its buildings underground. This makes my vacation unique and psychological, lets me experience different types of cities. The second factor is the farms. By going to the farms, I can learn more about the Australian way of life and know more about article writing The University of Westminster Australia through cultural exchange. The third factor is psychological bulletin Farragut, the. my favorite summer vacation getaways Essay.

Wildwood known as Wildwood Crest and our family has enjoyed may summers there. The trip is about a three-hour car drive from my house and Stenden University Sciences, we usually try to leave late at night when there is not a lot of traffic. There is bulletin Farragut Academy, no need for us to get a hotel when we vacation in Wildwood since there is research based argument, always plenty of room for us all at my grandparent’s house. They live right across the street from the beach. Last summer, we spent a week in Wildwood for our family vacation It’s very fun going to the beach to. lava cave,and anything that is related with volcano.I also saw the lava coming out from active the psychological, volcano and flow to argument essay School, the ocean.I feel great and it attract a lot.The behavior of Hawaii people are very polite,kind and psychological bulletin Admiral Farragut, welcome. This is the brief vacation on Hawaii islands.I got a lot of experience and knowledge from this vacation.I saw many beautiful scenes and School, those are still in my memory.I will never forget those time.I saw many nature things including real volcano,true underwater lives and psychological bulletin Farragut, many. return back home to research argument essay Bromsgrove, visit should not be called a return, but merely a passing by. By changing from bulletin Farragut Academy, “Dee” to writing my school Rossall, “Wangero”, it is as if she has never existed in psychological bulletin Academy the first place. Another similarity I found is a bit complex, but also relates to a sense of family. It occurs when Dee says, “I couldn’t bear it any longer, being named after the people who oppress me.” (280).

This means that Dee feels she is being held back from her culture not being named something more close to what her background is and that. clear example of the supporting and togetherness in my life which result a happy family back living with their kids. Happiness brings patience and research based essay Bromsgrove School, supporting brings happiness which is the basic factor or a single size family. Supporting argument Point 1 The painting of the Norman Rockwell Freedom from want also brings the bellow ideas to my mind that the Norman Rockwell painting presents a big or multi-size family that may be not living together under a roof but serving together in a very open. Essay on Book Critique Family to Family. In the final chapter of the bulletin Admiral, book, the writers detail the research essay, importance of Biblical based evangelism for all of those persons involved in the family unit. The writers advocate what they call the FIRM approach to evangelism, which involves: F - ask about family, I - ask about bulletin Admiral Farragut Academy their interests-listen, R - ask about religion-listen, and M - share the message (114-115). Lastly, the writers provide some practical methods for sharing the Gospel, which include some scripture memorization and custom Saint Diocesan High, tips on a salvation-testimony. Though I cannot speak for other families, I can cite my own family life as being part of the reason for the problems that I work through today. As Ehrenreicht says the Family is the psychological bulletin Academy, place where we go for comfort and to relax, but it is that very notion of family being a safe haven makes it all that much worse when problems inevitably arise. The popularity of speeches Sciences therapy groups that Ehrenreicht refers to really show that there is a major problem with our ideas about psychological Admiral Farragut family.

Knowing that there is a problem. American Family and Traditions Essay. 2. CHAPTER 1: The American Family 2.1 A Definition of the Family Family is forever. Family is comfortable, fun, loyal. It is the most important thing for every American. Family is the one place on earth where we should always find forgiveness, understanding, happiness and a lot of love. This does not mean that the family should encourage or aid unethical behavior of one of its family members. Love, support, tolerance and caring must always be the basis for the relationship. Functionalist View of the research essay, Family Essay.

mobility, this is where the family moved to Farragut, where the work would be, and a nuclear family could move easier than an extended family, and Social mobility, this is how to a journalism Chigwell School, where people could move from their ascribed status to bulletin Farragut Academy, their achieved status. Consequently the extended family was replaced by argumentative Stenden of Applied Sciences the nuclear family in order to fit the psychological Academy, needs of society. Two functionalists who believed that the family was important and studied the family were Willmott and Young. They believed that the write Chigwell School, family was becoming a joint. The model is a large circle representing the family. Psychological Admiral Farragut. Around the outside of the large circle are small circles representing church, work, school, extended family and friends.

The strength and nature of how the family interacts with these outside forces is demonstrated using different connecting lines. Medical Lord. This family has a strong connection with work as both parents are very career oriented. Dad especially is up for bulletin Farragut Academy, a promotion. The connection with school would be tenuous and stressful for the F.B. kids. discontinuation of the family name is an extremely strong suggestion that they cannot be deemed a family at all. For the two rarely come into contact; very much satirized in the novel and a subject of Lord irony. Frank had never visited his father in his home and it is heavily suggested that Frank’s later residence is only because of the convenient location of his lover, Jane Fairfax, who is also situated in Highbury.

The evident weakness of family relationships within the discussed families can be used. The rules of every family operate to a set of principles. An example may be that when dad talks, everyone listens, and this rule differs from bulletin Admiral Farragut Academy, culture to culture. The role of every individual in the family varies and each family member has a role they must adhere to. Many families alter the rules and roles as time changes within life. Both verbal and non-verbal communication is important in family structure because this is the way information is essay writing my school Rossall School, passed between one another. Proximity plays a large.

Family Dollar should either offer more brands of psychological Farragut each product or remain consistent with their brand names so that their consumers know what to expect when entering the stores. In order to speeches University of Applied, get rid of the bulletin Academy, image of being old, cluttered, and medical reviews Lord Wandsworth, dirty, Family Dollar may want to look into more advertising. Family Dollar could get very creative with new advertising slogans on psychological bulletin the internet, on billboards, and article writing of Westminster, inside their stores in Farragut Academy order to argumentative Stenden University Sciences, change this image. Advertising is a way of telling your consumers that. Idleness would also leads to more frustrations.

While examining and interacting with the family members, therapists should maintain good records of the proceedings and progress. The best of Admiral paper work that could be used is note taking; note taking is usually private and confidential and simple to use. The notes taken must be concise and clear for future reference in the analysis since they offer a summary of the therapy sessions conducted The therapists’ should be aware of all the ethical issues. depression and acceptance. When a family is informed of the child’s disability, they may reject the idea since the stigmatism is still prevalent. They may become frustrated with this change and lash out at those around them. In a last attempt to “fix” the disability, the family may seek different support systems, to “rectify” the issue. Essay. The family members may also feel alone in this time of transition because they are each facing different challenges. Eventually, the family is able to see past the disability.

Social Theories and the Family Essay. individual parts that work together as a whole. Admiral Academy. The family system is speeches Stenden University Sciences, a lot like a watch each member has a job to do, mothers give birth to children, children learn from their parents and the other institutional systems in their environment. Psychological Bulletin. The children grow up to be productive citizens and essay Rossall, the cycle continues moving forward with the future generations to follow. Academy. They also believe that if something goes wrong that it will affect the whole family and this is the change that is not accepted. According. type of family; I need every day in my life. Not when something tragic happens. I need their support as well as they need my support. This is where the interdependence system plays a major part with my family. They are very concerned when someone in my family has been through a tragic situation or even when someone gets a promotion on their job, they are happy.

Secondly, I will discuss who’s in and who out write School approach of boundaries of my family. Boundaries are defined as mark limits in the family. It. Marriage and Family Therapy Essay. (2010), is rapidly becoming the preferred mode of treatment by many mental health providers. Introduction to Marriage and Family Counseling Marriage and family therapy is psychological Admiral, a specialized field that is regulated by State laws. It has been identified as one of the five core mental health professions along with social workers, psychologists, psychiatrist and psychiatric nurses (AAMFT, 2012).

Therapists have a master’s or doctoral degree and are required to complete a period of two years of supervision. Understanding of “family businesses” in writing my school Rossall the national context In Germany family enterprises are defined as enterprises where the owner or a member of the owner family also manages the Admiral Farragut Academy, enterprise. Condition is that the person or the family in a journalism question holds at least 50 % of the votes of an enterprise. These enterprises are called “Mittelstand”. There is a so called wider definition of family enterprises. The term of control is the same but it is not necessary that a member of the owner family manages. The Family as an Agent of Socialization Essay. norms became less important and impacted the structure of the Admiral Academy, nuclear family. More couples are getting divorced, than they were decades ago, when the belief of society was to frown upon divorce. Then they were same sex marriages that have become part of the accepted norm, unlike decades prior.

There are many other factors that contribute to the change in views and beliefs, replacing what was the argument essay, responsibility of the family. This is especially true in this 21st century technological era; we are. filled many of the positions my great-grandfather was hoping to fill. Psychological Admiral Farragut Academy. I can still recall many of the stories I heard when I was little. Essay School. My grandpa would always talk about psychological bulletin Admiral Farragut Academy how rough things were when he was little, and how his family struggled as he was growing up.

My grandpa's family assimilated to the society of America at that time and lost almost all of their Scottish traditions. Research Based Essay Bromsgrove. In fact, the only Scottish tradition that I can ever recall is the playing of bagpipes at my grandpa's funeral. My grandpa. understanding families in this model, and that it can be used as a prevention and intervention model when dealing with family systems. I think this model is psychological Farragut Academy, quite similar with Adlerian assumptions because the use of techniques such as engagement and motivation establishes a family-focused perception of the Stenden University of Applied, presenting problem that serves to psychological bulletin, increase the family members hope and expectation of change, decrease resistance, improve alliance with one another and create greater trust between family and how to article, therapist.

on night shift so feels she has no time for an exercise program as this would eat into bulletin Farragut, her sleep hours. Both children are active with school sports such as football, cheerleading, volleyball and my school School, track. On weekends sometimes the psychological bulletin Admiral Farragut, family will go camping or kayaking. The family has a pool which Mom uses daily when the styles of Westminster, weather permits. Cognitive and bulletin Admiral Academy, sensory perception is the custom coursework High, assessment that focuses on the ability to comprehend and use information and on sensory function (KrieglerHarton. Essay on Television Family Review. Ultimately, after a few arguments, brake ups and misunderstandings, the daughter and boyfriend were back together and Farragut, the son kept his tutor as a result of the sister giving in to custom coursework Saint John The Baptist Diocesan, help family. Laughter is always used to bring the family together for a prank on an individual member or when someone is having a bad day, or not physically feeling well. Negative influences the Academy, show has are the way the mother is always putting someone down in a subtle way by dressing it up with sarcasm, expression. The changing American Family Essay. determined that even when all of the family members were at home and awake together, they were in the same room only article writing styles The University of Westminster, 14 percent of the time.” She continues to say this is due to, “American families are outliers in their fixation on children’s needs and bulletin Farragut, children’s success.” When both parents are concerned with work they become withdrawn from argumentative, what is going on in their children’s lives.

All family members become independent from one another. Therefore the dual career family consists of both parents working. for his family and blames himself for his children's failing marriages, the psychological bulletin Farragut, natural world, represented by the mountain itself, the cherry tree in the yard of his house, the flights of birds and insects in the early summer evening, or two pine trees he sees from the window of his commuter train each day, comes alive for him in a whole new way, provoking meditations on life, love, and companionship. In japan, as in many societies, it is considered essential to the continuation of a family to have. Essay on Structural Family Therapy.

scapegoating)” (Todd, 2006) in which a union is formed against another family member who is labeled as 'bad' receiving the blame in full. Further there are the relationships that are described as detouring, protecting (Todd, 2006) in which two of the reviews Lord, parties in conflict join to assist or help another in the family who had been labeled as defenseless, sick, and helpless and is a pattern noted in families that are psychosomatic and in psychological Admiral Farragut families that have children who are known to be psychotic. Finally in. Family Perspectives Essay example. appropriate behavior within the society.” (Anonymous (2007) Pg. 2) “Some people believe that the family is the most important social institution because it is our first encounter with socialization processes. From a sociological perspective, the family is not only argumentative Stenden, viewed as an psychological Farragut Academy, institution, but also as a social system and a social group.” (Eshleman, J.R. (2000) Pg. 380). “While it is medical reviews College, true that the family unit in the United States is Admiral Academy, no longer a major economic producing unit, it is a significant economic.

Importance of Family Dinners Essay. less time together as a family and more time in work, school, or other activities dinner can be the best time to essay writing my school School, catch up with everyone's lives. It also offers a time to reconnect. Families can sit around the table and psychological bulletin Farragut Academy, have face-to-face time with their loved ones. These days we mostly see family members in passing, on the way out to based essay School, work, school and other activities. At dinner we have the bulletin Admiral Academy, chance get to know each other again and bond. Another important benefit of having family dinners is preventing. greatly impact in a negative way the family unit converting it into a dangerous one. However, when she says “Parents abuse sons – allegedly at speeches Stenden University, least, in the Menendez case – who in turn rose up and kill them.” I remembered a similar and psychological Farragut Academy, very shocking case that happened in Puerto Rico, The Aguada?s Matricide”. Reviews Wandsworth College. Lillian Enid Medina Hernandez was a fourteen year old girl when she killed her mother.

Many people described her as a talented student from a good family. Allegedly, Lillian Enid was under. Family is psychological bulletin Admiral Farragut Academy, also important. Family keeps one going refraining one from giving up. With the support of family, one can reach their goals and custom coursework Saint John, dreams. For Pausch, his family played a great part in his achievements. Pausch had a good relationship with both of his parents. He writes “For a million reasons, my dad was my hero” (Pausch 21). In a child’s life, love and attention are needed.

Pausch had a happy childhood, which led him to achieve his goals and psychological Farragut Academy, dreams. He states “The smile on that kid’s face. Deterioration of the article writing of Westminster, Nuclear Family Essay. left home or other extended-family members may feel obligated to return and help placate their family members. All members of the family experience the disruption and confusion that go along with separation of spouses.

The loss of one parent from the household, the many changes in family functioning, and the stresses on bulletin Admiral each parent affecting his or her ability to parent all contribute to the impact on speeches Stenden Sciences the children. A “Teen Health and Wellness” article, “Dysfunctional Family,” describes the impact of. Technology Affecting Family Essay. If we can count the pros of psychological bulletin Academy texting to article writing styles of Westminster, bringing families close: we can point out psychological bulletin quite a few, texting family members can get quick answers, fast response time, spare the drama, space invader, and teens bonding. Speeches Of Applied Sciences. Parents having issues with this should be sitting down with children and discussing the limits can help resolve this issue. They should be initiating text message conversations with their children. As mentioned before, Snow’s observation about technology proves that over abusing it can cause.

story that widely influenced many people. This is the story of The Odyssey. Psychological Farragut. There are many relationships in this story that influence, or that show other people in the way in which they should act. Many noble men of that time were looked upon by article styles of Westminster many families, to show there youth the Admiral Academy, way in which they should be. Noble men were looked up to, leaders of their time, role models if you will. I believe the most interesting relationship in The Odyssey is the father-son relationship between Odysseus and Telemachus.

The twelve work week period is measured backwards on a rolling basis from the reviews Lord Wandsworth College, date when the employee first used any FMLA leave (Halbert, 2010) Explain whether the size of the business can have any effect on whether Tony is eligible for family leave under the FMLA. Yes, in order to qualify for the mandatory FMLA, a worker must be employed by a business with 50 or more employees within a 75 mile radius of his or her work site, or a public agency, this includes schools, state, local, and federal employers. this study, it’s because the researcher also belongs to a broken home. Theoretical Framework According to LifesiteNews.[3]com that the children from non-intact families (children living in a situation other than with their own married father and mother) have significantly higher rates of difficulty with all levels. Family structure was consistently found to be the psychological bulletin Admiral Academy, deciding factor in a wide range of child behaviors that directly influence academic performance, including emotional and psychological.

“The ideas that provide guidance for individual growth are contained in the Twelve Steps of argumentative speeches Stenden Sciences Recovery.”(3) Al-Anon is an open program to psychological Academy, all family members and friends of alcoholics. The recovery process for the Al-anon member involves recognizing that alcoholism is a disease that affects the whole family and that you are powerless over it. Al-Anon is not allied with any sect, denomination, political entity, organization, or institution. Styles The University. It is not a religious program but a spiritual way of life. you and vice versa. This is the best example of Academy love in a family. It is true that young people tend to rebel against their parents and that the parents cannot understand their children at a certain age. You as the writing The University of Westminster, young ones should understand your family with empathy.

Put yourself in psychological bulletin Admiral Academy the place of your parents, would you like to feel hurt? Certainly not and I'll say it again that's the article of Westminster, best proof of bulletin Admiral Farragut love in a family. As you have just seen the sketch presented by my friends. infidelity, stress, coping, intimacy, anger and depression in this family. Their neighborhood is medical reviews Lord College, average and psychological bulletin Academy, busy there are restaurants on research every block: McDonalds, Burger King, pizza, wings, red lobster, Chinese, Japanese and soul food, you name it they have it so DJ did not have time to cook. There are schools and parks around the bulletin Academy, area, an amusement park and zoo located nearby numerous activities that a kid can enjoy. Writing The University. The Jones’ are a healthy family the father just diagnosed with diabetes, mother hypertension. Family Systems Intervention Essay. a dictionary that includes the use of such words as empowerment, skills, hope, support, ability, and knowledge Assessment and intervention will be more effective if the bulletin Farragut, family social worker keeps the following considerations in mind: • Be keenly attuned to argumentative Stenden Sciences, culture and adhere to culturally sensitive practices • Focus on psychological bulletin Admiral Farragut family needs • Respect client autonomy • Avoid fostering unnecessary dependency • Reassess and re-interpret client resistance as avoidance of pain • Keep healthy professional.

Eleven per research argument School, cent of those children whose families broke up had emotional disorders, against 3 per cent among those whose families were still together. Bulletin Farragut. Nearly a third of children found to have mental disorders in 2004 still suffered from them three years later. The Department of Health said: ‘The Government is committed to helping children and young people experiencing mental health problems.’ But academic Patricia Morgan, author of several studies on family break-up, said: ‘This does not come as.

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Customer Loyalty – What is it? How Can You Measure and Manage It? Customers make decisions about where to spend their time, money, and effort every day. Psychological Farragut. They might be business buyers between 9 to 5, but consumers the rest of the time. In either case, the scenario is always the same for writing my school Rossall School the seller – to make their product or service offering the preferred choice.

They do this by building offers that will: Differentiate them from competitors Generate significant demand by Admiral Farragut customers Demonstrate superior value Build customer loyalty. It is a fallacy to Saint Diocesan High, assume that a customer is loyal just because they continue to buy from you. There are many reasons why a customer repeats purchasing which have little to do with being really loyal. Psychological. Consider the article writing The University following: There is a contractual arrangement with your company It takes too much effort or money to change suppliers You are currently the low cost provider Their relationship is psychological Admiral Farragut Academy with one of essay my school Rossall your employees and not with your company Habits are hard to break They may actually be in the process of finding an alternative supplier. If any of the above is the case, what do you think is likely to bulletin Admiral Farragut Academy, happen should a desirable competitor come around and John The Baptist Diocesan High, seek out your customer’s business?

The easier and bulletin Academy, more attractive they make it for the customer to switch, the less appealing the above reasons are. Customer loyalty is far more than repeat business. Loyalty can be defined as a customer continuing to based argument essay Bromsgrove School, believe that your organization’s product/service offer is their best option. It best fulfills their value proposition whatever that may be. They take that offer whenever faced with that purchasing decision . Moreover, loyalty means hanging in there even when there may be a problem. This occurs because the organization has been good to them in the past and addresses issues when they arise.

It means that they do not seek out competitors and, when approached by competitors, are not interested. It also means being willing to spend the time and effort to psychological bulletin, communicate with the organization so as to build on past successes and overcome any weaknesses. In a nutshell, loyalty means a customer wants to do business with you and does. The challenge for organizations is custom John The Baptist High School taking this definition and translating it into actual practice, where specific actions are defined and ideal customer relationships are envisioned. It also means identifying a means for taking this loyalty construct and putting it into measurable terms so that success and failure can be assessed and progress or decline tracked. Customer Loyalty can be Measured and Monitored. Loyal customers believe the psychological Admiral Academy products and services purchased from essay my school Rossall School their supplier are superior to those of the competition.

Frequently, they are customers who view their interactions as more than simply transactional . They believe there is a relationship that is bigger than just the products or services they buy. Measuring loyalty means measuring the strength of this relationship between buyer and seller, between the organization and its customer. It is challenging to Admiral Farragut Academy, measure the level of writing my school customer loyalty within the relationship, which is bulletin why companies so often succumb to Saint John The Baptist Diocesan High, simply defining loyalty as the number of purchases made or a continuing pattern of buy behavior. And asking the bulletin customer directly about whether or not they are ‘loyal’ does not provide a valid measure. Customers will often say they are loyal – simultaneously– to multiple providers. What we are looking at is measuring those attitudes as well as behaviors that we know make up this concept of based School loyalty.

For example, some of the important attitudes and Farragut Academy, behaviors expected of a loyal customer include: Likelihood to based argument essay Bromsgrove School, recommend your products and services to others Likelihood to psychological Admiral Farragut, continue purchasing your products and services, at writing my school Rossall minimum, at the same level Likelihood of purchasing other products and services you offer Believing your products and services are superior to others offered in psychological Academy, the marketplace Not actively seeking alternative providers to replace you Providing your company with opportunities to correct problems and not using these as a basis for compromising the relationship. Based on customers’ responses to questions such as these as well as others that evaluate specific aspects of their relationship with your company, a loyalty profile of your customers can be created. Writing Styles The University Of Westminster. Loyalty segments categorize customers as Loyal, Neutral and psychological Admiral Academy, Vulnerable. The basis for loyalty segmentation should be sufficiently flexible in writing, that it recognizes and accounts for the uniqueness and special challenges of any one business or organization as well as the environment in in which it competes. And yet must also be based on sound, well-tested research principles and validated modeling. Business success means having desirable customers who are strongly tied to your organization. Bulletin Academy. Monitoring the number/percent of your customers in the Loyal segment and argumentative Stenden of Applied, doing what it takes to increase loyal customers while decreasing those who are vulnerable should provide the focus of any organization.

Profiling Loyalty Segments. Once the customer loyalty segments are formed, complete profiling based on meaningful customer descriptors, is provided. Admiral Farragut. (Such information is usually available from organizations’ customer databases and other internal customer data sources). Writing Styles The University. Comparison of the psychological Farragut Academy segments across the loyalty profile can reveal significant – and potentially valuable – differences which would otherwise have remained hidden. The example shown here is a business to Stenden University of Applied, business customer loyalty profile. Note that the diversity across loyalty types is not unusual.

For this company, it was very helpful to psychological bulletin Farragut Academy, learn, for instance, that their West coast customers were far more vulnerable. While at a very early point in their analysis, this finding — coupled with the market share potential– suggested the a journalism School possible need for organizational restructuring. But demographic and bulletin Farragut Academy, descriptive profiling is just part of the information required for organizations to manage customer loyalty. Speeches Stenden. Organizations need to psychological Farragut, know why loyalty segments exist – why are some customers loyal and others vulnerable or just plain in reviews Lord Wandsworth College, between neutral towards you? And they need to hear this information directly from the customer – not management’s best guesses or gut level feelings. Without customer input, organizations are held hostage to a loyalty goal that has no answers. Understanding the Loyalty Segments.

So what causes one customer to be loyal and another to be almost out the door? The creation of the loyalty segments assigns each customer to Farragut, a segment but does not provide any explanation as to custom coursework Saint John The Baptist Diocesan, why they are in that particular segment. To implement change that is directed towards improving customer loyalty — in other words to manage loyalty – requires in-depth understanding of: Customers’ underlying preferences for the products/services being considered What customers value in those products and bulletin Academy, services under consideration Customers’ experiences, perceptions, and beliefs about the organization itself as well as about its products and services – particularly in areas that are highly valued. The Loyalty Research Center has developed a model that describes how daily interactions (as perceived by styles The University of Westminster the customer) between customer and bulletin Admiral Farragut Academy, provider will ultimately drive overall company perceptions and lead to attitudes of loyalty (or not) and behavior. Applying this loyalty model to individual companies requires breaking down the customer relationship into based argument essay its various aspects – starting with day to bulletin Farragut Academy, day activities and ending with important attitudes, known to medical reviews Lord College, influence loyalty. Identification of organization-specific model elements generally begins with an psychological bulletin Admiral Investigative Phase . This phase identifies all potentially relevant reasons for customer loyalty and becomes the basis for subsequent qualitative measurement. Understanding how customers perceive all aspects of company performance and quantifying the impact of Stenden University of Applied Sciences each on overall customer loyalty is vital to identifying critical actions to take. The basic model elements appear in bulletin Farragut, the accompanying diagram and represent these interactions, experiences and attitudes that ultimately drive your businesses’ success. In addition to gathering performance feedback and writing The University of Westminster, perceptions, customers are asked to share any problems they may have experienced, as well as the extent to which they were resolved.

The following table includes actual results for one company. Note that several pieces of important information are included: Loyalty impact priority, performance ratings (ratings of Excellent and Very Good ), and problem experience for psychological bulletin Admiral Farragut Academy each Loyalty Segment: From this one chart, there were many learnings our client gathered; but first and foremost they learned that… “Loyal customers’ experiences and perceptions are distinct from those of medical Lord Wandsworth Neutral customers. Bulletin Farragut. There is speeches of Applied Sciences yet an even greater gap between those identified as Loyal versus Vulnerable.” Here are just a few of this client’s discoveries: Problems are experienced and remain unresolved far more often by the Vulnerable segment in comparison to others. Loyal customers have a low percentage of outstanding problems. This is not an unusual finding.

Note that it is not zero. Psychological Farragut. Some loyalty customers experience significant problems. That means that the Stenden of Applied overall strength of relationship and the company’s performance in other areas is able to retain these customers’ loyalty. Interactions are listed in priority order in terms of their impact on loyalty. It was a surprise to find that Order cycle time carries the impact that it does and that it scores so weakly across all segments, but especially among vulnerable customers.

Other areas of interaction also revealed considerable differences among the bulletin segments. Consistently, Loyal customers’ perceptions are most positive. Also noted by our client was the fact that the majority of customers did not fall into the Loyal category! The previous chart provides just an inkling of the rich information that is research based potentially available from customers. As in the case above, companies are likely to find vast differences among their customer loyalty segments in psychological Admiral Farragut, terms of perceptions, experiences, and reviews College, attitudes. The question now becomes – What do you do with all this good information? Undoubtedly, the psychological bulletin Farragut Academy first thing to do is to understand why differences exist.

Variations among segments can be the result of: Inconsistent levels of The University service and/or product quality provided Customers have different priorities Customer needs or expectations vary. In each of these cases – whether it be actual performance differences on the part of the provider, or different demands on bulletin Farragut Academy the part of the customer, customer loyalty levels are likely to be affected. In the first two scenarios, the provider is able to self-correct by focusing on those areas of weaker performance – especially where it counts the argumentative of Applied Sciences most – as revealed in psychological bulletin Admiral Farragut, the customer feedback results. However, if customers’ needs/expectations are sufficiently different from what the provider is capable of offering, then improving the performance of custom Saint The Baptist Diocesan High School current offerings may not be the answer.

A provider’s business model may not coincide with the demands of bulletin Academy every customer segment. Needs-based segmentation technique will be required to determine whether or not you are serving the wrong customers for your business model. Needs-based segmentation is discussed in writing styles The University, a separate piece. For now, let’s assume a simpler scenario where all customers have similar needs and the actions to Admiral, take are related to performance improvement. Using the earlier example, we know that their actions focused on: Increasing the base of loyal customers Improving weaker areas of University of Applied Sciences greatest importance to customers across the board Reviewing identification of specific customers in Admiral Academy, the Loyal and Vulnerable segment Determining which customers are most important – to the business- and assuring that their performance concerns were addressed. A plan to increase the base of loyal customers was put into place along with specific targets. They would start by improving those areas most important to customers where loyal customer perceptions reveal that there is room for performance improvement.

Their message out to the entire company was: Overall, results clearly point to the fact that while the Loyal segment generally scores highest across the board, it is also true that Loyal customer scores could be even better. In no area do all Loyal customers give either an Excellent or Very Good rating. Or, how about setting an expectation for how to a journalism article Chigwell School reaching all Excellent? Special, targeted efforts to bulletin Admiral, achieve the above were designed, sometimes, around each identified loyal customer. There were also plans to research based argument essay Bromsgrove, further investigate which customers fell into psychological bulletin Farragut the Neutral or Vulnerable groups. That, in turn, helped determine next actions. What would it take to address a Vulnerable customer’s specific concerns and custom coursework The Baptist High School, was the effort worth it? It was important that improvement efforts were considered reasonable given the psychological Farragut Academy desirability of argumentative Stenden of Applied Sciences that customer to their business.

As a general rule, a good plan of Admiral Academy action includes reviewing (especially within the Vulnerable segment) lower performing areas with an eye toward the following: Customers – Are these the wrong customers for your business? Are there customers who do not value the business model under which your organization operates? Will the writing styles of Westminster customer ever change their negative perceptions and what would this take? Perceptions – Do management and employees believe that scores should be higher, i.e., customer perceptions should be better?

And what do prospects believe? Drill down – Is there sufficient and specific enough information such that there is an understanding of what customers are expecting/asking for? Is there need for further clarification from psychological bulletin Farragut Academy customers in order to better understand their perceptions? Could qualitative discussion groups help the level of understanding? Performance – Is performance lacking in one or more areas? Is there a well-defined process? Is the process being implemented correctly? Do employees understand the process?

Have the right managers and Wandsworth, employees been hired to execute the process? Can technology improve the quality and/or speed of the process? Who is responsible for the process? Is it time for an overhaul? Competition – Are some customer perceptions being driven by what others are able to psychological Farragut Academy, provide within or outside this industry? How are our competitors able to provide a better experience? Migrating Loyalty Segments. The ultimate goal of your actions should not only be improvement of performance perceptions but, in the end, increasing the percentage of your customers who are loyal to your company/organization. Why increase your percentage of loyal customers?

Go back to coursework Saint John High School, the first table and look at the annual revenue spend. In this example the Loyal customer segment spends an average of about $6,000 – $8,000 per Farragut, year more than the other segments. While not shown here, annual profit margins are typically higher as well. It is argumentative University of Applied usually the case that loyal customers: Buy more Buy across your product lines Will pay for value add services/products Require less product usage instruction Do not need sales support Are more likely to sole source Make referrals on psychological bulletin your behalf. It is financially beneficial for the business to a journalism Chigwell School, retain and psychological bulletin Farragut, grow a loyal customer.

Successful companies manage customer loyalty by making improvements based on customer input, identifying desirable customers, and setting goals for increasing the percentage of their customer base that is loyal. A customer loyalty migration plan is called for. Customer loyalty migration requires strategies that will move lower level loyalty segments to higher levels, while maintaining and protecting loyal segment members. Not every customer is desirable. Understanding your customer ROI as a basis for determining future investment in the relationship is writing The University of Westminster important. What level of resourcing is required today?

What will it take to improve their perceptions and either migrate this customer to the next segment level or for the loyal customer, maintain their loyalty? Migrating customers to the next level usually means adding more or different resources, but only at appropriate levels – the right amount, on the right things, for the right customers. It does not mean losing money in the process. An appropriate migration plan for a high revenue but costly Vulnerable customer may be one of out migration. Unless companies regularly seek input from their customers – by using objective and valid measurement tools and Farragut, techniques – they really know very little about them. It’s amazing, because it is the customers who keep a company in business! Think about research essay, it. Do you really know… What’s important and what is valued in the relationship? Whether what customers tell your sales people and account managers truly is what they mean? What is said behind your back?

Whether their continued business means they really want to bulletin, do business with you? Do you know who the truly loyal customers are? How does the my school competitor’s offering affect what they think about yours? The true costs of serving your customers relative to their loyalty and bulletin Admiral, revenue/profitability? And most important of all: are you treating your loyal customers as loyal customers should be treated?