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Troops to nurses presentation
- 1. Running head: TROOPS TO NURSES PROJECT Troops to Nurses Project Chaluza Kapaale and Tammie J. Coffman NURS 6450/673 Education Practicum Patty Hanks Shelton School of Nursing Graduate Program In Partial Fulfillment of Nurse Educator Practicum Dr. Jeanne Tucker, PhD, MSN, RN May 1, 2012
- 2. Troops to Nurses
- 3. Troops to Nurses • Objective Explore the design for a Troops to Nurses program • Model Schlossberg’s Model of Transition The four S’s
- 4. Mission Statement • Transition to nursing for those with healthcare related backgrounds or degrees • Use military experience to enhance transition • Expedited transition • Graduate nurses to meet growing demand for nurses world wide
- 5. Transition • Why Schlossberg’s Model of Transition? Applicable to the target population Applicable to program Addresses factors that influence transition success Has been used in similar transition programs like Boots to Books.
- 6. Schlossberg Transition Model • Dr. Nancy K. Schlossberg Bernard College 1951 B.A Sociology Colombia University 1961 Ed.D Counseling First woman executive at the American Council of Education Former faculty Wayne, Howard, Pratt and Maryland Universities
- 7. Schlossberg Transition Model • Dr. Nancy K. Schlossberg NASPA Outstanding Contribution to Literature and Research recipient Former president National Career Development Association Author of several books on Adult development Currently retired Professor Emerita University of Maryland
- 8. Schlossberg Transition Model • The Four S’s Situation Situation Self Self Support Strategies Support Strategies
- 9. Situation • Budget cuts • Conclusion of Military engagements • Increase in education Benefits for veterans
- 10. Situation • Need for support in accessing benefits • Need for post military career • Demand for nurses
- 11. Self Who are these veterans?
- 13. Self • Military life experience Team work Dedication/Loyalty/advocacy Traumatic experiences • Academic credit for life experiences Concerns
- 14. Support • Faculty and staff training • Need to optimize support systems
- 15. Strategies • Low residency expedited transition Pros and cons • Enrollment Increase veteran specific services to boost enrollment Simplify enrollment procedures for veterans Screening and self identification
- 16. Strategies • Mentoring and Advising • Financial services • Academic credit for life experience Utilizing life experience Testing and awarding credit American Council on Education
- 17. Curriculum COURSE CALENDAR • Accessibility WEEK DATE VENUE CONTENT Drug Action: Pharmaceuticals, Pharmacokinetic Face to Face and Pharmacodynamics Phases. CHAPTERS 1,2,3,4,5 Faculty and *introductio Nursing Process and Client Teaching. n to class Principles of Drug Administration Medication Calculation Concepts The Drug Approval Process 6,7,8,9,10, Transcultural and Genetic Considerations 12,13 information 1 6/4/2012 Online Drug Interactions and Over the counter Drugs Drugs of Abuse Herbal Therapy with Nursing Implications availability Medication Administration in Community Settings Geriatric Pharmacology Adult immunizations 6/8/2012 Face to Face Med calculation test 1 & TEST 1 Technology 2 6/11/2012 Online Adrenergic and Adrenergic Blockers Cholinergic and Anticholinergic Central Nervous System Stimulants 18,19,20,2 1 Central Nervous System Depressants and 6/15/2012 Online Anticonvulsants TEST 2 22,23,49,5 Drugs for Neurologic Disorders 0,51,52 delivery 3 6/18/2012 Online Disorders of the Eye, Ears and skin Drugs for Neuromuscular Disorders Endocrine Drugs Antidiabetics methods 6/22/2012 Online TEST 3 Penicillins and cephalosporin Macrolides, Tetracyclines, Aminoglycosides and 29,30,31 Fluroquinolones Antituberculars, Antifungals, Peptides and 32,33,34 6/25/2012 Online 4 metronidazoles Antivirals,Antimalarials and Antihelmintics Drugs for Urinary Tract Disorders MED CALCULATION TEST 3 (Face to Face) 6/29/2012 Face to Face TEST 4 & Med Calc #2
- 18. Curriculum • Accessibility WEEK DATE VENUE CONTENT Vitamin and Mineral Replacement CHAPTERS 15,16,17,2 Fluid and Electrolyte Replacement 5,26,47,48 Faculty and 5 7/2/2012 Online Nutritional Support Drugs for Gastrointestinal Disorders Antiulcer Drugs Opioid and Non Opioid Analgesics information 7/6/2012 Online Antiinflamitory Agents TEST 5 Drugs for Upper Respiratory Disorders 40,41 availability 6 7/9/2012 Online Drugs for Lower Respiratory Disorders Pediatric Pharmacology 11,59 Adult and Pediatric Emergency Drugs Technology 7/13/2012 Face to Face TEST 6 & Med Calc #3 Cardiac Glycosides, Antianginals and 42,43,44 Antidysrythmics Diuretics and 7 7/16/2012 Online Antihypertensives Anticoagulants, Antiplatelets and Thrombolytics 45,46 Antilipidemics and peripheral Vasodilators delivery 7/20/2012 Face to Face Anticancer Drugs TEST 7 35,36,37,3 Targeted Therapies to Treat Cancer 8,39 methods 7/23/2012 Online 8 Biologic Response Modifiers HIV and AIDS 7/27/2012 Online TEST 8 7/30/2012 Face to Face REVIEW FOR EXIT 8/3/2012 Face to Face PHARM EXIT EXAM
- 20. References American Association of Colleges of Nursing (AACN), (2012). Nursing Faculty Shortage. Fact Sheet. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage Baechtold, M., & De Sawal, D.M. (2009). Meeting the needs of women veterans. New Directions for Student Services,126, 35-43. Brinke, D., Sluijsmans, D. A., & Jochems, W. G. (2009). Self-Assessment in University Assessment of Prior Learning Procedures. International Journal of Lifelong Education, 107-122. Burnam, M.A., Meredith, L.S., Tanielian, T., & Jaycox, L.H. (2009). Mental health care for iraq and afghanistan war veterans. Health Affairs, 28(3), 771-82. Retrieved from http://hsuezproxy.alc.org:2048/login?url=http://search.proquest.com/?url=http://search.proquest.com/docview/204514837?a ccountid=703228(1) DiRamio, D., Ackerman, R., & Mitchell, R.L. (2008). From combat to campus: voices of student-veterans. NASPA Journal(45)1, 73-102. Douglas, Nora (2006). The supply of and demand for registered nurses and nurse graduates in Texas: a report to the legislature, Texas Department of State Health Services, Texas Center for Nursing Workforce Studies (November 2006), pp. 1-2, (Last visited January 4, 2008.)
- 21. References Effectiveness Of Undergraduate Course Delivery Modes. Journal of College Teaching & Learning, 7(2), 17-24. Lokken, J.M., Pfeffer, D.S., McAuley, J., Strong, C. (2009). A statewide approach to creating veteran-friendly campuses. New Directions for Student Services,126, 45-54. MacKusick, C Koenig, R. J. (2010). Faculty satisfaction with distance education: a comparative analysis on. I., & Minick, p. (2010, December). Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. Medsurg Nursing, 19(6), 335-340. doi:56601755 McEwen, M., & Wills, E. M. (2002). Theoretical Basis for Nursing. Philadelphia: Lippincott Williams & Wilkins Programs and Services. (2011, December 14). Retrieved from American Council on Education: http://www.acenet.edu/Content/NavigationMenu/ProgramsServices?MilitaryPrograms/index.htm Ryan, S.W., Carlstrom, A. H., Hughey, K.F., & Harris, B.S. (2011). From boots to books: applying Schlossberg's model to transitioning American veterans. NACADA Journal,31(1), 55-63. Schumacher, K., & Meleis, A. (1994). Transitions: a central concept in nursing. IMAGE: Journal of Nursing Scholarship, 119-127.
- 22. References Spaid, R., & Duff, E. (2009). Working adults in accelerated cohorts: more than a learning community. Journal of Continuing Higher Education, 57(2), 104-109. doi:10.1080/07377360902967437 Tatum, B. (2010). Accelerated education: learning on the fast rack. Journal of Research in Innovative learning, 3(1), 35-51. doi: 48917414 Waters, A. (2005, April). Nursing is the most emotionally rewarding career. Nursing Standard, 19(30), 22-26. doi: 2005076421 Wihak, C. (2011). Prior learning assessment and recognition: emergence of a canadian community of scholars. International Review of Research in Open and Distance Learning, 12(1), 116-122. Yammarino, F., Mumford, M., Connelly, M., & Dionne, S. (2010). Leadership and team dynamics for dangerous military contexts. Military Psychology, 22, 15-41. doi:10.1080/08995601003644221 All images obtained from Google images . Retrieved on April 29 2012
Notas do Editor
- The proposed military budget cuts and the conclusion of several military engagements create a situation where options for military careers are lessened. This, along with the funding for education in the GI Bill post-9/11, provides a unique opportunity for new careers and a unique resource for nursing. The influx of military personnel into higher education, nursing education included, necessitates a conduit to help with the transition from military roles to civilian ones. The intent of this project is to explore the design for a troop to nurse program. Such a program would facilitate the transition of troops to nurses. Schlossberg’s model of transition is utilized as a framework in identifying factors that may enhance or hinder the progression of troops to nurses. Some factors that favor the transition include legislation for funding, veteran military experiences and a growing demand for nurses. While life experiences promote the transition from troop to nurse, they also present obstacles that need to be addressed. The four S’s from Schlossberg’s model are explored in consideration of an effective transition program.
- The mission of the Troops to Nurses program is to transition former military personnel that have a healthcare background or other related degree into nurses. We will use experiences from their military years to transition them in an expedited manner into a role of nursing. It is the goal of the program to graduate nurses that meet the growing demand for healthcare around the world.
- Our primary target group is retired military personnel with healthcare backgrounds. Despite this focus our program will gradually be open to enlisted and non-healthcare background personnel with degrees in other fields. To help understand the candidates and ease the transition a decision was made to use the Schlossberg model of transition as a framework. The concepts of the Schlossberg Transition model will be employed in guiding students through the transition process.
- Situation- What kind of transition is it? Is it a positive, negative, expected, unexpected, desired, or dreaded transition? Did the transition come at the worst or best time possible? Is it “on time” or “off schedule”? Is it voluntary or imposed? Is the individual at the beginning, middle or end of the transition (moving in, through, or out)Self- What kind of strengths and weaknesses does the individual bring to the situation? Does he or she believe there are options? Is he or she optimistic? Personal and demographics characteristics (gender, age, health socio-economic status, race, etc.) Support - Does the person have support from family, friends, co-workers, and supervisors? In what ways do people give support? In what way do they hinder the person’s efforts to change? Strategies- Does the person use several coping strategies or just one? Can the person creatively cope by changing the situation, changing the meaning of the situation or managing reactions to stress?
- Transition of veterans into the nursing profession is beneficial and necessary. The proposed military budget cuts and the conclusion of several military engagements provide a unique source of potential nursing professionals. This influx of military personnel necessitates a conduit to help with the transition from military to civilian roles. After the attacks of September 11, 2001, the numbers of service personnel entering the United States military increased dramatically. Many of these persons (375,000 in 2008) are now completing their commitments and returning to civilian life (McBain, 2008). Educational benefits to veterans were greatly increased by the Post-9/11 Veterans Educational Assistance Act of 2008, also known as the Post 9/11 GI Bill. In addition to the benefits mentioned, each branch of the armed services offers at least $4000 per year for attendance of college classes during active duty (Military.com, n.d.).
- According to U.S. Department of Veterans Affairs data, only 6% of veterans exhaust their educational benefits despite 71% of veterans utilizing at least part of their benefits. This may be partly due to student-veterans need for guidance as to what their benefits actually are. Cook, Kim and King (2009) quote a veteran of Columbia, South Carolina, who states,"...We just kind of know the generalization of okay, yeah, we get educational benefits." In the same document, another veteran states, "...the military tells you you've got this and you've got that. But then once you get out, they don't tell you how to go about getting this stuff..." As these quote clearly demonstrate, veterans need clear and concise direction in order to make wise decisions and use of the benefits that they are due. Development of a program that successfully transitions veterans into nursing will meet the growing need for nurses and provide professional incomes for post-military individuals.The transition from troop to nurse should come naturally to most because both are fundamentally careers of service. According to Schumacher and Meleis (1994), attaching positive meaning to a transition helps ease the transition. It is likely that most people changing between careers that share a foundation will attach the same value to both careers. For nursing, as with the military, that foundation is service to others.A civilian nursing career is challenging and rewarding. Program graduates will have the opportunity to tackle unique issues that arise during the care of patients. At the end of each day they get to go home feeling that they made a difference. Findings of Nursing the Future campaign inspired A. Waters (2005) to write ‘Nursing is the Most Emotionally Rewarding Career’.The campaign involved interviews with experienced stake holders and a one day summit involving experts from various fields.Career choices are not always an exact science. The transitions theory tells us that people may and may not know what to expect from a transition (Schumacher & Meleis, 1994). The hopes held by individuals for the transition may not be realistic. Part of the current nursing shortage is a result of nurses leaving practice. MacKusick and Minick (2010) explore the various reasons nurses exit from clinical practice. The reasons discovered from the investigation can largely be summarized as job dissatisfaction. The dissatisfaction mentioned in the article stems from emotional toll, hostile work environments, fatigue and exhaustion. The long hours and emotional toll of nursing may not be tolerable for some even though it might initially seem like a good career choice. The hope is that the program provides another opportunity for retired and enlisted military personal. The projections for the continuing nursing shortage make it necessary to find new sources for potential nurses . From 2009 to 2030 there will be an anticipated shortage of nurses in the nation with the southern and western states being affected the most (AACN, 2012). Texas Center for Nursing Workforce Studies estimates a shortage of 71,000 full time nurses in the state by 2020 (Douglas, 2006). The American Association of Colleges of Nursing (AACN) informs us that by 2020 the number of employed nurses will grow by 712,000. The AACN also points out the need for 495,500 replacement nurses to fill the void produced by nurses leaving the practice. A projected 1.2 million nurses will be needed by 2020 to support growth and replenishment (AACN, 2012).
- Student-veterans are a unique population of students with life experiences unlike the general student population. Retired military provide a group of individuals with high moral character, experience in team work, and possibly leadership. Yammarino, Mumford, Connelly, and Dionne (2010) exemplify the importance of team dynamics and leadership in the military. The article takes an in depth look at team building in the military and the resulting dynamics and leadership which ultimately lead to optimal performance. Collaboration is a major component of providing healthcare through a holistic approach. Over the years working on teams has become essential to nurses due to the shortage and specialization of care provision. In the past one nurse provided care for a patient. Today the care of a single patient may require a nurse, physical therapist, respiratory therapist, nurse aid, social worker and others working together . Understanding the importance of collaboration is an example of how military life inadvertently prepares troops for a successful nursing career.The fierce loyalty that is instilled in military service personnel will translate into advocacy for persons experiencing illness that leaves them vulnerable to situations outside their control. DiRamio, Ackerman, and Miller (2008) state, Because students who are veterans of combat are very mission-oriented a tendency learned in the military, they are excellent candidates for service learning opportunities. Student life professionals should view this student population as an untapped resource on campus, one that is ready "for mobilization" in a variety of ways. (pp. 95-96)The transition may not come easy to some because of issues stemming from experiences occurring during their military years. Schumacher and Meleis (1994) inform us that emotional and physical wellbeing are other characteristics that influence transitions. Positive emotional and physical wellbeing favor good transition outcomes. If the factors are negative they tend to hinder transition. The wounds, physical, mental, and emotional, that have been inflicted upon the veteran will need be healed in order for the veteran to transition into the role of a caring nurse. If such wounds are suppressed, the potential for future eruption of unresolved issues may make effective professional practice difficult to maintain.In addition to the generalized mental health issues, gender specific mental health concerns exist. Women veterans returning to civilian life must restructure their identity to fit into civilian society. The attributes that were desirable during military experience may be desirable only in that setting. Feminine characteristics were likely stifled in an attempt not to appear weak; thus, help that should be sought or welcomed may be shunned. Sexual assault or harassment experiences may become apparent and assistance with resolution of these issues will be necessary in order for the female veteran to be comfortable and successful in the academic setting and in the workplace (Baechtold & De Sawal, 2009).The vision of the program is to utilize the experiences of military personnel to successfully transition them into nurses. While this experience provides a good basis, it does bring about a unique problem. The methods of awarding credit for previous academic work have been tested, but how does one give credit for life experience? Two people can have the same experience at the same time and each take something different from it. Some may argue that the same can be said of a lecture. The difference is that a lecture is tailored to provide a focused experience narrowing the lessons one may take from it. Life experiences on the other hand are broad in the lessons they teach. An example of this would be two medics stationed in the same place for a year; despite being stationed in the same place at the same time for the same duration, their level of knowledge and expertise might be very different. The situation then raises the question whose experience deserves credit and whose does not? The previous question is one pondered by many in academia today and has led to the invention of the term, prior learning. Wihak (2011) defines ‘prior learning’ as the knowledge and skills that learners gain through experiential or self-directed learning instead of formal education.
- Vulnerability during a transition could yield undesirable outcomes. Meleis and Schumacher (1994) believe that identifying threats to successful transition helps prepare individuals adequately. Student-veterans potentially carry remnants of wounds of varying visibility. Veterans, who would have died from their injuries in previous conflicts, are returning home to live the remainder of their lives with disabilities. University faculty and staff need specialized preparation in order to assist these students through their transition into civilian and academic life. Cook, Kim, and King (2009) surveyed over 700 institutions finding numerous deficits in available support for student-veterans. Transitional support will be necessary regardless of whether such support is provided by government veteran support services or services provided within the healthcare system. This support will strengthen ‘self’ and ‘support,’ two of the four Ss in Schlossberg's transitioning theory (2009). Burnam, Meridith, Tanielian, and Jaycox (2009) mention the numerous advancements in the care of mental health problems in veterans. The knowledge acquired during the progressions can be applied to help veterans live productive lives. Funding is available to help lower the amount of debt accrued by veterans while they are in school. The system for distributing funding for veterans needs to be revised to avoid complications. Veterans at Minnesota State University experienced delays in disbursement of GI educational funds, which ultimately did become available (Lokken, Pfeffer, McAuley & Strong, 2009). DiRamio et al. (2008) learned through their interviews with student-veterans that funds from the GI bill are typically not adequate to fund both tuition and living; consequently, student-veterans work, attend classes, attend to family matters and try to deal with transition to school and civilian life concurrently.
- Differences of opinion exist with regard to acceptable length of study for preparation for career change. These differences are noted and explored here. An accelerated low residency program is ideal for the student-veteran group because course completion is rapid and allows scheduling flexibility. The use of accelerated cohorts is a proven method of catering to student populations that have other commitments outside the academic arena. Spaid and Duff (2009) not only identify accelerated programs as practical substitutes for traditional programs that are not conducive for the working population, but share optimal techniques for administering and developing such programs. The target group would receive credit for course work already completed for which there are proven comparison tools to assess the adequacy of the programs through which the courses were completed.However, acceleration in the transition might set the candidates up for failure. Accelerated programs have been associated with the massed practice or cramming phenomenon. Tatum (2010) reports the phenomenon of massed practice has been studied and replicated since 1964. The conclusion of the studies has always been that optimal learning occurs when information is distributed over a longer period of time versus the same material delivered over a shorter period of time. Time has to be adequateto accommodate a smooth transition. If the transition time span is forced, then the transformation might be overwhelming and the goal unattainable (Schumacher & Meleis, 1994). Continuous evaluation is important in order to monitor student response to the transition. The idea of transition at an accelerated pace is ideal especially due to high demand for nurses. To combat the disadvantages of mass practice while maintaining the integrity of an accelerated program; the material must be spaced out to permit expedited completion without compromising comprehension. Built-in checks such as frequent testing or quizzes serve to identify if the pace of the program is too strenuous.Cook et al. (2009) informs us that there is a correlation between veteran-student enrollment numbers and the available veteran specific services at institutions of higher learning. The program must therefore provide services that are specific to the target population. The services will be aimed at ongoing assistance to veterans regarding preexisting and prospective issues. Cook et al. (2009) report that 62% of higher education institutions require that students returning to their educational endeavors post deployment complete the standard re-enrollment process; 16% require reapplication and acceptance in order to enroll. "Student veterans have voiced frustration toward these administrative obstacles and hardships that seem to delay or thwart their return to normalcy on campus.” As a component of a veteran-friendly environment, policies and procedures should be implemented to streamline re-enrollment for veterans who have temporarily suspended academic endeavors in order to fulfill their service commitments. Most of the potential issues that may arise with the program can be addressed by proper screening of candidates that includes self-identification at the time of registration. The process of screening can serve several purposes. Screening can be used to help candidates determine if the program is the right fit for them. Screening may also be used to determine the level of support needed for the candidates that are selected. Faculty and staff awareness of the special circumstances faced by student-veterans and connection with individuals in this student population are imperative in an environment in which veteran-students transition to nurses. Helping program enrollees in setting realistic goals and knowing what is expected of them will help them succeed.
- Advising of student-veterans is expected to be an ongoing process, one that occurs in each faculty office and not just in the academic advisors office. In providing a listening ear and wise counsel, faculty and staff members will influence Schlossberg's Ss of situation and strategies (Ryan et al, 2011). Employing retired military faculty members or having an onsite retired military advisor available to the students will prove extremely useful in their transitioning to a civilian role. The advisor or faculty would work as mentor to the members of the program and help them in resolving personal or social conflicts that might hinder the transition. Mandatory faculty/staff education regarding the needs of student-veterans should be provided annually prior to arrival of each group of student-veterans (Cook, et al., 2009).With regard to funding, deferments of payment deadlines may be needed as was the case at Minnesota State University (Lokken, et al., 2009). Policies for such deferments may benefit other student populations as well. Financial aid is essential to many students and the ability to work with veterans on financial matters is critical to attaining military friendly status. Despite the program being aimed at second-degree-seekingstudents in the military with healthcare backgrounds, it might not be possible to grant them credit based on their experiential work. This is because it is not an easy task to quantify experience. Rather than giving credit for experience the program will be better served by utilizing the various experiences as a resource to strengthen learning and unity in the class. Pairing students within the cohort that have different experiential backgrounds might prove useful. Tying to each course a presentation based on previous experience and related to the material would be an extremely beneficial exercise. As an alternative, students could be given the opportunity to test out of certain classes in their areas of expertise. Self-assessment as a tool for assessing prior learning has been tested in various studies. One such study presented in the International Journal of Life Long Education tested the validity of self-assessment in measuring prior learning. The study concluded that self-assessment was probably a suitable tool for evaluating prior learning. (Brinke, Sluijsmans, & Jochems, 2009). It is evident that better tools to convert experience into common academic worth are needed. Until then self-assessment coupled with competency evaluation are the most widely used tools. One organization that is working toward creating optimal tools for evaluating experience is the American Council on Education (ACE). According to their website, ACE has been working as the link between institutions of higher learning and the military since 1945. These efforts are aimed at reviewing military training and experiences with the goal of translating them into civilian academic credit.
- The vision of the program is based on producing nurses in an expedited manner from troops with a healthcare background. To achieve this goal, curriculum must meet the needs of students and the requirements of accreditation agencies. The significance of an accelerated program is the ability to successfully advance a group through the program rapidly. A variety of teaching tools will be utilized in each course with the goals of providing easy access to material, monitoring student progress and facilitating that progress. Ease of access means that the student has the ability to obtain information in the course at any time of the day or night. Accessibility will be made possible by faculty having posted office hours when they will be completely available to students by video chat, messaging, phone and/or email. Phone hours will have to be reasonable outside the office hours. Email will have a 24-hour-response policy to acknowledge receipt if concern cannot be addressed within 24 hours. Walk-ins during the posted office hours will be welcome, but appointments will be required for video chat, messenger and outside office hours consideration. Optimal results can be realized if the program is designed to leave no one behind. This concept is ideological; but the high expectations hopefully insure that, if one is left behind, it will not be from lack of effort. All lectures will be available by face-to-face and by online live interactive classroom lecture beginning on the assigned day and throughout the duration of the course. Video conferencing on its own has been shown to be less effective than classroom and online delivery. Koenig (2010) reports that faculty and student satisfaction were lowest when video conferencing was used alone compared to other methods of delivery. The dissatisfaction was due to technological issues and the lack of face-to-face contact. The concerns presented in the article by Koenig can be resolved by combining video conferencing with live interaction. Identifying suitable software for the content and proper end usertraining is critical to the success of technology based delivery. There will be a planned face to face session each week. A signup sheet at the beginning of each week to show intent to attend a face to face session will be required. The signup sheets will be made available online and onsite. The material in each course will be distributed over an eight week session as shown in appendix A, an extract from an eight week pharmacology course.The template in appendix A provides for weekly assessments either in the form of a quiz or a test. Continuous assessment allows for real-time evaluation of teaching effectiveness. If a particular course requires presentations then that class will meet face to face on presentation day. Lab simulation as deemed necessary by the course requirements will also require a face to face encounter. Face to face meetings will be kept down to necessity as long as that does not compromise quality. For the courses that require clinical time arrangements will be made as facilities and opportunities avail themselves. There will however be a mandatory observation by course instructor over a set number of hours to ensure integrity of the clinical experience.