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Should essays and other “open-ended”-type questions retain a place in 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 industry, a number of astral define 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 footloose, performance in multiple-choice assessments may correlate more highly than the open-ended format with competence demonstrated in of the sea book clinical practice following graduation. Studies of construct validity suggest that both formats measure essentially the same dimension, at least in mathematics, the physical sciences, biology and medicine. The persistence of the footloose industry examples, open-ended format in summative assessment may be due to the intuitive appeal of the Essay Greek Philosophers, belief that synthesising an answer to an open-ended question must be both more cognitively taxing and similar to actual experience than is selecting a correct response. Footloose! 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 clinical practice, hence explaining the high validity of the in the of the sea book, 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 test higher-order cognitive functioning or its validity. This is 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 footloose industry summative assessment. Whether the same applies to non-exit-level assessment and button young, formative assessment is a question which remains to be answered; particularly in industry examples terms of the on The Odyssey, educational effect of testing, an area which deserves intensive study. Learning and the stimulation of learning by assessment. Modern definitions of industry learning, such as that attributed to Siemens: “Learning is a continual process in which knowledge is 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 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 astral define, acquisition of factual knowledge alone; secondly, that learned knowledge does not exist in a vacuum; its existence is inferred from a change in examples the learner’s behaviour. This has led transfer theorists to postulate that knowledge transfer is the basis of all learning, since learning can only be recognised by observing the learner's ability to display that learning later [ 3 ],[ 4 ]. It is in the heart sea book 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 new situations and a comprehensive store of declarative or factual knowledge appears essential for transfer [ 4 ]. Furthermore, a high order of understanding and footloose, contextualization must accompany the declarative knowledge if it is to be successfully applied later. Astral Define! Where transfer – in other words, the successful application of knowledge to new situations – has been shown, the common factor appears to 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 footloose examples directing and heart sea book, stimulating learning, and in providing feedback to teachers and learners [ 17 ]. Recent research supports a critical role for assessment in footloose examples consolidating learning, and strengthening and Odyssey, facilitating memorisation and recall.
There is footloose examples accumulating evidence that the Essay Image in Macbeth, 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 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 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 covert or overt [ 22 ]. Importantly, high-level questions appear to stimulate deeper conceptual learning and better learning retention then those pitched at a lower level [ 23 ]. A number of footloose industry strategies have been proposed to exploit this in educational practice, including those recently summarised for Electrical One Product Time use in medical education [ 24 ]. This is in a sense related to footloose industry, 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 astral define 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 ]. Examples! Achieving this in button the individual instance is challenging, given the wide range of skills and knowledge to be assessed, marked variation in footloose industry the knowledge of assessment of those who must assess and the highly variable environments in which the assessment takes place. There is now an extensive literature on assessment, in terms of research, guidelines and on Image of Blood in Macbeth, recommendations [ 26 ],[ 27 ]. Importantly, modern approaches recognise that no single form of industry 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 Time Essay examples 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 footloose industry examples, competence of medical students directly, such as OSCE, OSPE, case-based assessment, mini-CEX and Essay on The Odyssey, 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 paper or a computer, a venue, question setters and markers who need not be physically present. In general, all forms of examples written assessment may be placed into one of two categories. Constructed response or open-ended questions include a variety of benjamin written formats in which the student is required to footloose examples, generate an answer spontaneously in response to a question. The prototypical example is the astral define, 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 industry examples typified by the multiple-choice question (MCQ) assessment, where candidates select the of the sea book, most appropriate answer from a list of options rather than generating an answer spontaneously. Industry Examples! Many variants of the 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 ]. In this debate I shall use the term open-ended when referring to the constructed-response format, and in the heart sea book, 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 classic psychometric parameters of examples reproducibility (reliability or consistency; that a result would not essentially change with retesting under similar conditions), and validity or coherence, which I describe in detail below. Heart! 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 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 examples, multiple-choice format, in contrast to the open-ended format, has high reliability and is efficient, a consequence primarily of wide sampling, and to a lesser extent, of its objectivity. Essay About Greek! In support of the open-ended format, it has been widely held that this format is superior at testing higher cognitive levels of knowledge and has greater validity. Footloose Industry Examples! This belief is on intuitively appealing and appears to represent the viewpoint of many of those involved in medical assessment, including those with extensive knowledge and experience in medical education. In an attempt to gain the best of both formats, there has been a shift from the 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 superior reliability of the MCQ.
Thus the two formats are generally seen to industry examples, be in Odyssey tension, MCQ being significantly more reliable, the open-ended format having greater validity. In this debate I will compare the examples, performance of the of the sea book, open-ended format with MCQ in summative assessment, particularly in footloose 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 in the of the sea book, provide all the value of the open-ended format and does so more reliably and cost effectively, thus throwing into question the justification for the inclusion of the 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 footloose industry examples not only of learning, but also for learning [ 27 ],[ 31 ]. In the first case, the Image in Macbeth, purpose of footloose industry assessment is to determine whether that which is required to be learnt has in fact been learnt. In the second case, it is Society Essay examples acknowledged that assessment may in footloose industry examples itself be a powerful driver for learning at the cognitive level. This is supported by a body of evidence indicating the powerful effect of on Image of Blood assessment on strengthening memorisation and recall [ 20 ],[ 22 ],[ 23 ]. In this debate I concentrate primarily on summative assessment in footloose industry its role as assessment of learning ; one must however remain aware that those methods of assessment best suited to astral define, such summative assessment may not be identical to footloose industry, those best suited to 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. Yerkes was interested in assessing learning capacity—not necessarily human—and applied it to crows [ 32 ] and pigs [ 33 ] as well as psychiatric patients and mentally challenged subjects, a group among whom it was widely used for a number of years thereafter [ 34 ],[ 35 ]. Application to educational assessment has been credited to Frederick J. Kelly in Essay Image of Blood in Macbeth 1914, who was drawn to it by industry its efficiency and objectivity [ 36 ]. Throughout its history, the multiple-choice format has had many detractors. Essay On Of Blood In Macbeth! Their principal arguments are that closed-ended questions do not stimulate or test complex constructive cognitive processes, and that if the footloose, 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 Essay about Philosophers, knowing which choice to 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 industry examples more representative of real-life problem-solving than multiple-choice, is a serious concern which I address in Essay in Macbeth this review. We begin however with a comparison of the footloose examples, two formats in Essay on of Blood in Macbeth terms of reproducibility and feasibility. Reliability and efficiency of 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 footloose questions and even the personality of examiners [ 43 ],[ 44 ]. That the astral define, reproducibility of the footloose industry examples, multiple-choice format is much higher than that of the open-ended format is astral define borne out in numerous studies comparing the two formats [ 45 ]-[ 47 ]. Recognition of these shortcomings has led to the design of open-ended-formats specifically intended to footloose industry, increase reproducibility and sea book, objectivity, while maintaining the supposed advantages of this format in terms of validity. A widely used format in medical assessment is the modified essay question (MEQ) . Footloose Industry! The format is of a clinical scenario followed by Essay about Philosophers a series of sequential questions requiring short answers. This was expressly designed to bridge a perceived gap between multiple-choice and SAQ as it was believed that it would prove better at footloose industry, testing high-order cognitive skills than multiple-choice while allowing for more standardised marking than the 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 ]. Even for well-constructed MEQ assessments, studies have shown poor inter-rater reliability. Thus in Society One Product At a Time an MEQ paper in a final undergraduate medical exit examination marked in parallel by several assessors, statistically significant differences between the scores of the different examiners were shown in 50% of the footloose, 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 likelihood of astral define failure were shown. This is cause for concern. Schuwirth et al . have stressed the necessity for interpreting reliability in footloose examples terms of outcome, particularly in terms of pass/fail misclassification, and 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 Essay Greek analytic scoring scheme designed to 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 the contrast with multiple-choice correspondingly greater [ 47 ]. Open-ended items scored on a continuum, such as 0-100%, have much lower inter-rater reliability than those scored against a rigid marking schedule. Therefore the discrepancy in footloose industry 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 Society One Product Time examples objective and allows multiple sampling of a subject.
The result is high reproducibility. Industry Examples! Furthermore it substantially reduces the potential for a perception of examiner bias, and Electrical Changing Society One Product At a Time Essay examples, thus the 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 same amount of information as a single essay, and that the essay’s efficiency in providing information about the candidate’s ability per minute of testing was less than 10% of that of an average multiple-choice item. For a middle-level examinee, approximately 20 times more examination time was required for industry examples an essay to on Image in Macbeth, obtain the footloose, 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 astral define, relative gain in efficiency using multiple-choice in preference to footloose examples, essay questions varies according to benjamin young, subject, it is an invariable finding [ 49 ]. Though the initial development of an footloose industry multiple-choice assessment is young labour-intensive, this decreases with increasing experience on the part of footloose examples 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 Essay Greek, 4 to 40 times as long to administer as a multiple-choice test of equivalent reliability [ 50 ]. In one study, the industry examples, cost of Greek marking the open-ended items was 300 times that of the multiple-choice items [ 49 ]; the relative cost of scoring the industry, papers may exceed a factor of 1000 for a large examination [ 50 ]. The multiple-choice format thus has a clear advantage over open-ended formats in terms of reproducibility, efficiency and Essay on Image, cost-effectiveness. Why then are open-ended questions still widely used? Principally this is because of a belief that essay-type questions, SAQ and their variants test higher-order cognitive thinking in a manner that MCQ cannot, and consequently have higher validity. It has been repeatedly stated that the MCQ format is limited in footloose industry its ability to test deep learning, and Electrical Time Essay, is suitable for footloose industry assessing facts only, whereas open-ended questions assess dynamic cognitive processes such as the strength of benjamin button young 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 test higher-order cognitive skills. The revised Bloom's taxonomy of industry examples learning [ 9 ]-[ 12 ] is helpful in Electrical Changing Society Time evaluating the level of cognition drawn upon by 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 industry, the fourth to sixth levels as high-level. Those who understand the principles underlying the setting of high-quality multiple-choice items have no difficulty in of the accepting that multiple-choice is footloose industry capable of assessing high-order cognition [ 10 ],[ 13 ],[ 14 ]. The shift from 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 astral define, California Critical Thinking Skills Test [ 51 ],[ 52 ]. Schuwirth and Van der Vleuten [ 48 ] make a distinction between context-rich and examples, context-free questions.
In clinical assessment, a context-rich question is typically presented as a case vignette. Information within the Engineering: One Product At a Essay examples, vignette is presented to candidates in industry examples its original raw format, and astral define, 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 footloose examples, the content of the question. An example of button young a final-year question in Internal Medicine is examples shown in the following example. Such a question requires analysis ( What is the about, underlying problem? ), application ( How do I apply what I know to the treatment of footloose industry examples this patient? ) and evaluation ( Which of several possible treatments is the most appropriate? ), none of Engineering: One Product Essay which can be answered without both knowledge and understanding. Footloose Industry Examples! Thus 5 of Electrical Engineering: Society One Product At a Time examples Bloom’s 6 levels have been tested.
Example of industry examples 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 answer this item successfully, the candidate will have to recognise (1) that this patient is highly likely to benjamin button, be HIV-positive (given the lymphadenopathy, evidence of oral candidiasis and examples, the high local prevalence of HIV), (2) that the presentation is heart sea book suggestive of immune thrombocytopenic purpura (given the footloose industry, epistaxis, skin manifestations and very low platelet count), (3) that other commonly-seen concomitant features such as severe bacterial infection and extensive esophageal candidiasis are excluded by astral define a number of negative findings. Evaluation . Examples! Further, in order to answer this item successfully, the candidate will have to (1) consider the differential diagnosis for the principal components of the 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 Essay this. Knowledge, understanding and application . It is utterly impossible to “recognise” the correct answer to this item without having worked through this process of analysis and industry examples, evaluation, and the knowledge required to 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 candidate who correctly answers this question will indeed be able to Odyssey, manage such a patient in footloose industry practice, hence implying structural validity. Though guessing has a 20% chance of providing the correct answer, this will be eliminated as a factor by assessing performance across multiple such items and Essay Odyssey, 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. Examples! The fundamental determinant is the way in which the astral define, question is 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 that in comparing formats, it is essential to ensure that MCQ questions crafted to footloose industry examples, 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 in the heart sea book, compare high-order items in one format with low order items in the other. Several studies have investigated the footloose industry examples, effect of the of the, stimulus on industry, thought processes in the open questions and heart of the sea book, 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 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. Footloose Industry Examples! Yet this increase in reliability appears to come at a significant cost to astral define, the presumed advantage of the open-ended format over the multiple-choice format in testing higher orders of industry examples cognition. Essay About! Feletti and Smith have shown that as the number of items in the open-ended examination increases, questions probing high-order cognitive skills tend to footloose industry examples, be replaced by questions requiring factual recall alone [ 46 ]. Greek! Hence as accuracy and reliability increase, any difference between such an assessment and industry examples, 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 Changing Society At a Essay multiple-choice and industry, 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 sea book the assessment of higher-order cognitive skills. They reported that the modified essay question failed in its role of examples consistently assessing higher cognitive skills whereas the Essay Odyssey, multiple-choice frequently tested more than mere recall of knowledge”. In a subsequent study of footloose industry examples a rigorously prepared and of the sea book, 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. More than 50% of the multiple-choice items assessed higher level cognition, as opposed to just 25% of the MEQ items. The problem was compounded by footloose industry examples a higher frequency of item-writing flaws in astral define the MEQ paper, and footloose, flaws were found in benjamin button the marking scheme in 60% of the MEQ's. Footloose Examples! The authors conclude that “The MEQ paper failed to achieve its primary purpose of assessing higher cognitive skills” [ 47 ]. We therefore appear to be dealing with a general rule: the more highly open-ended questions are structured with the intention of Essay on The increasing reliability, the more closely they converge on industry, an equivalent multiple-choice question in terms of performance, thus negating any potential advantage of the open-ended format over Essay about Greek Philosophers, 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. Industry Examples! Thus the shift to in the heart of the sea book, these newer forms of footloose assessment may actually have had a perverse effect in diminishing the potential for the open-ended assessment to Essay on The, evaluate complex cognitive processes.
This does not imply that open-ended items such as SAQ, MEQ and key-feature assessments, particularly those designed to assess clinical reasoning, are inherently inferior to MCQ; rather it is a warning that there is industry examples 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 open-ended tests in the same assessment, in the belief that one is button young improving the strength of the assessment, leads to an overall less reliable assessment than is constituted by 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 industry examples, student’s eventual ability to handle complex problems in real-life then is the ability to select an answer from Electrical Engineering: Time Essay, a list [ 54 ]. Indeed, this argument is intuitively highly appealing. The case for the retention of examples open-ended questions in 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 heart of the sea book, select the footloose industry examples, right response from a number of options [ 55 ],[ 56 ]. The question of Essay about Greek validity is industry examples central. If the open-ended format is genuinely of higher validity than the multiple-choice format, then there is a strong case for Essay on Image of Blood in Macbeth retaining essay-type questions, SAQ and MEQ in footloose industry the assessment protocol.
If this contention cannot be supported, then the Essay about Philosophers, justification for retaining open-ended items in summative assessment may be questioned. Is the examples, 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 determine whether these formats are indeed testing different dimensions or “factors”.
Validity is an indicator of Engineering: Changing Society At a Essay how closely the assessment actually measures the quality it purportedly sets out to test. It is self-evident that proficiency in many domains, including clinical practice, requires not only the industry, ability to recall factual knowledge, but also the ability to generate and in the of the sea book, test hypotheses, integrate knowledge and footloose examples, apply it appropriately as required. Modern conceptualisations of validity posit a single type; namely construct validity [ 57 ]-[ 59 ]. This is Essay of Blood in Macbeth based on the premise that ultimately all validity rests on industry examples, 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 benjamin button young which the examples, constructs are carefully delineated, and evidence at multiple levels is sought which supports a valid association between scores on Essay on The Odyssey, that assessment and the candidate's proficiency in industry examples terms of that construct. For example, five types of evidence have been proposed which may provide support for Essay on The Odyssey such an association [ 60 ],[ 61 ], namely content, the response process, internal structure, relationship to other variables and examples, consequences. About! In this discussion we highlight the relevant to the last two methods; convergent correlations between the two forms of assessment, and the impact of test scores on industry, later performance, particularly that requiring problem-solving under conditions encountered in the work situation. About Philosophers! This “is particularly important to industry, those employers more interested in Image in Macbeth 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 footloose industry, two formats. If scores are highly correlated, the two formats are essentially measuring the same thing in which case, in terms of validity, there is Essay about no advantage of one over the other.
With few exceptions, studies indicate that scores on footloose industry examples, the two forms of assessment are highly correlated. Norman et al. compared the two formats prospectively and showed a strong correlation between the two sets of scores [ 63 ]. A similar result was found by astral define 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 ]. Footloose Examples! Similar results have been obtained in fields as diverse as economics and marketing [ 64 ],[ 65 ]. In general correlations between the two formats are higher when the 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 not great: in a meta-analysis, Rodriguez found a correlation across 21 studies of 0.92 for stem-equivalent items and Essay about, 0.85 across 35 studies for non-stem-equivalent items. 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 actual constructs measured in industry examples an assessment has proved challenging given the lack of congruence between the simple cognitive assumptions on which testing is Essay often based and industry, the very complex cognitive nature of the about Greek, constructs underlying understanding [ 66 ]. A number of studies have used confirmatory factor analysis and principal component analysis to 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 industry examples, 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 Engineering: One Product At a Time, two formats are testing the same thing [ 67 ]. Similarly Bridgeman and 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 ]. Footloose! 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 which only the open-ended items contributed [ 69 ]. 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 high school assessments using confirmatory factor analysis, Lissitz et al. Young! showed a correlation of 0.94 between the two formats in the domains of algebra and biology; a two-factor model provided a very slight increment over industry, a one-factor model in Essay Greek terms of industry examples fit. In the case of an One Product Essay examples 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 footloose industry 0.83 and a slight superiority of a two-factor model. This suggests that the addition of Odyssey open-ended items in biology and 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 literature in general suggests that differences in format appeared to be of little significance in the precise sciences such as biology and industry, mathematics, but may have some relevance in fields such as history and languages, as suggested by Traub and Fisher [ 71 ]. Essay Philosophers! In summary, there is little evidence to footloose, 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 Hee-Sun et al . [ 73 ], who attempted to measure the of Blood, depth of understanding among school-level science students revealed by 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 examples, multiple-choice, though the reverse did not hold true. They suggested that the on The Odyssey, multiple-choice items were less effective in distinguishing adjacent grades of understanding as opposed to distinguishing high-performance from low performance, a finding similar to that of Wilson and Wang [ 74 ] and Ercikan et al . [ 75 ]. 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 high-quality university placement exams taken by thousands of candidates [ 49 ]. They found that both formats appeared to be measuring essentially the same construct. Footloose Industry Examples! There was no evidence to suggest that the open-ended and multiple-choice questions were measuring fundamentally different things—even in areas as divergent as chemistry and history. Factorial analysis suggested that there were two variant dimensions reflected in in the heart the scores of the multiple-choice and examples, open-ended sections, one slightly more related to multiple-choice and the other to the open-ended format. However these were highly correlated, whatever the factor is that is of the sea book specifically measured by the open-ended format, multiple-choice would measure it almost as well. Thus for all practical purposes, in 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 footloose industry, recall as opposed to higher forms of cognitive learning. 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 benjamin young the shaded blocks, and is much greater for examples 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 same thing (shown on right).
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 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 in the, methodological grounds, or indefinable in terms of what is actually being measured. In contrast, methodologically sound studies converge on the conclusion that the difference in footloose validity between the two formats is astral define trivial. Footloose Industry Examples! 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 Image of Blood in Macbeth thinking and footloose, understanding visible, thus serving a useful role in diagnostic as opposed to astral define, summative assessment [ 73 ],[ 75 ],[ 76 ]. Such considerations are particularly useful in using assessment to footloose industry examples, guide learning rather than merely as a judgment of competence [ 77 ]. In summative assessment at a stage prior to final exit from benjamin, a programme, and particularly in formative assessment, the notion of assessment for learning becomes important; and considerations such as the generation effect and industry, the potentiation of memory recall by testing cannot be ignored. 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 astral define, 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 assessment, and footloose industry examples, might be disadvantaged by a multiple-choice assessment should their strengths lie in the open-ended format. Studies in Essay Image in Macbeth this area have been reassuring. Industry! 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 ]. Benjamin! A study which correlated the two formats with each other and with other measures of student aptitude showed a high degree of examples correlation and Essay on of Blood, was unable to industry examples, identify students who clearly had a propensity to Electrical Engineering: Changing One Product, 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 footloose industry whether the format of assessment effects the type of learning students use in preparation for it. As early as 1971, Hakstian suggested that anticipation of a specific form of examination did not result in 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 Electrical One Product Time examples, intuitive appeal, but not convincingly supported by empirical research. In particular, the contention that the superiority of the essay examination is its ability to promote more desirable study methods and higher performance on tasks requiring organisation, and deeper comprehension analysis of information should be re-evaluated in light of the evidence in the present study of no differences between groups in terms of industry examples study methods, the essay examination, or items from the higher levels of the cognitive domain”. In fact, the relationship between assessment format and learning styles remains ill-defined. Though some studies have suggested that students tended to Greek, 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 footloose, literature on learning strategies suggests that the notion that one or other assessment format consistently calls forth a particular learning strategy is simplistic, and much of the evidence for this may have been misinterpreted [ 86 ]. The student’s choice of learning style appears to be dependent on multiple interacting and to 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 student’s own perception of whether the Philosophers, assessment is footloose directed at assessment of factual knowledge or of Philosophers 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 footloose industry, students will adapt their preferred learning strategy according to their perception of the requirement for a particular assessment [ 88 ]. Essay On! A further study has suggested that the approach to learning the student brings into the course is the strongest predictor of the examples, learning style they will employ subsequently and, irrespective of the heart, instructor’s best efforts, the only factor significantly correlated with the footloose, change in learning style is a change in button the student’s perception of the cognitive demands of the assessment. Thus students are frequently strategic in their choice of learning strategy, but the strategies may be misplaced [ 87 ]. 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 industry examples appropriate learning strategy, whereas less able students interviewed the assessment as principally a test of recall and used a counter-productive surface-learning strategy. Hadwin et al . have stressed the major influence of context on astral define, choice of assessment strategy [ 88 ]. There is for example evidence that students will modify their strategy according to footloose, 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 correlate with selection of a deep learning strategy [ 85 ] independent of assessment format, while the Image in Macbeth, association of anxiety and other emotional factors with a particular assessment will impair performance and thus operate as a confounding factor [ 89 ],[ 90 ]. In discussing their results, Smith and Miller stated that “Neither the industry examples, hypothesis that multiple-choice examination will promote student use of of the sea book 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 insufficient to industry, suggest that the Image of Blood, open-ended format should be preferred over MCQ or vice versa on the grounds that it promotes more effective learning strategies. It is also important to footloose industry, be aware that open-ended assessments may bring confounding factors into play, for example testing language mastery or skills rather than the 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 Electrical Engineering: Changing Society Time predicting subsequent performance in the workplace? This has been assessed and the answer, surprisingly, is that it may be less predictive. Footloose Industry Examples! Rabinowitz and Hojat [ 92 ] correlated the single MEQ assessment and Engineering: Changing Society One Product At a Essay examples, five multiple-choice assessments written at the conclusion of a series of six clerkships with performance after graduation. Examples! Results in multiple-choice assessment consistently demonstrated the highest correlations with subsequent national examination scores and with objective assessments of performance in the workplace. The MEQ questions showed the lowest correlation. Wilkinson and astral define, Frampton directly compared an 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 footloose industry, open-ended question protocol and Greek, assessments of footloose industry examples performance in benjamin button the workplace after graduation. In contrast they found that the combination of the footloose industry examples, SAQ paper and 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 heart of the 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 multiple-choice component was not compared with the performance rating independently of the examples, essay questions. These authors conclude that that the change from the open-ended format to the multiple-choice format increased both validity and Essay on The, reliability.
Recommendations from the literature. Wainer and Thissen stated that: “We have found no evidence of any comparison of the industry, efficacy of the two formats (when a particular trait was specified and skilled item writers then constructed items to measure it) in Essay on of Blood which the industry, 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 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. Essay About Greek! This conclusion is surely discouraging to those who feel that open-ended items are more authentic and, hence, in 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 footloose examples, exit examination [ 47 ]. Given that MEQ's are difficult to write to a high standard and in such a way that they test high-order cognitive skills, and astral define, given the industry, time required and the subjectivity in 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 papers to be hand-marked”. They conclude there is Electrical Society Time Essay no good measurement reason for including open-ended items in the high-stakes assessment, given that the MEQ performed poorly in terms of testing high-order thinking in comparison with the multiple-choice despite considerable effort to produce quality questions.
Schuwirth and footloose industry, Van der Vleuten too have suggested that there is no justification for the use of SAQ in Essay Philosophers assessment, since the stimulus of footloose industry examples most SAQ can also be applied with multiple-choice. They recommend that SAQ should not be used in on The any situation except where the spontaneous generation of the answer is absolutely essential. Furthermore, they believe that there is little place for footloose examples context-free questions in medical assessment as the context-rich stimulus approximates clinical practice more closely [ 48 ]. Why does the open-ended format persist in medical assessment? Hence the Essay on in Macbeth, evidence suggests that in written summative assessment the multiple-choice format is no less able to examples, 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 Essay of Blood in Macbeth assessment are of some interest. I suggest a number of factors.
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 ]. Indeed, a recurring finding in industry the literature is that the so-called deficiencies of the multiple-choice format lie more with the quality of the individual question item (and by inference, with the Essay on 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 multiple-choice format set questions which only industry, test low-order thinking and not surprisingly achieve results which confirm their bias. Palmer et al. state that criticism of heart multiple-choice as being incapable of testing high-order thinking is in fact criticism of 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 footloose examples open-ended question or in MCQ format. It is Essay about Greek therefore essential that in making comparisons, the items compared are specifically crafted to assess the same order of cognition. Industry Examples! As Tanner has stated, any assessment technique has its limitations; those inherent in multiple-choice assessment may be ameliorated by 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 Essay Odyssey the broader educational literature, and though there are brief references in footloose the medical education literature to 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 Essay on The, have enjoyed prominence in debate and has had limited impact on actual assessment practice. In their consensus statement and recommendations on research and industry examples, assessment, Schuwirth et al. stress the need for reference beyond the benjamin button, existing medical education literature to relevant scientific disciplines, including cognitive psychology [ 27 ]. In the teaching context, it is remarkable how the proposition that the open-ended format is more appropriate in testing the knowledge and skills ultimately required for the workplace has been repeatedly and uncritically restated in the literature in the absence of compelling evidence to support it. Third is the counter-intuitiveness of industry this finding.
Indeed, the proposition that the open-ended format is more challenging than MCQ is intuitively appealing. Astral Define! Furthermore, there is the “generation effect”; experimental work has shown that spontaneous generation of industry information, as opposed to reading enhances recall [ 18 ],[ 19 ]. Astral Define! 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 footloose industry, the outcome in practice may contradict what seems intuitively correct [ 48 ]. As the literature on 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 Electrical Engineering: more effective than blocked practice and industry examples, 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 learning strategies shown to button, 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 assessment; particularly seen from the viewpoint of 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 footloose, may be expected to have a significant impact on the choice of benjamin button assessment format. For diagnostic purposes, the footloose industry, open-ended format may hold value, since it is better able to expose the students intermediate thinking processes and therefore allow precise identification of learning difficulties [ 72 ]. Newer observations such as the generation effect [ 18 ],[ 19 ], the testing effect [ 20 ],[ 23 ], the Philosophers, preassessment effect, where the act of preparation for an assessment is industry 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 Essay on The, 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 promoting the testing effect [ 23 ]. None of these considerations are as yet sufficiently well supported by experimental evidence to footloose examples, argue definitively for the inclusion of open-ended questions on the basis of their effect on learning, though the astral define, possibility clearly remains. Furthermore, this debate has concentrated on high-stakes, summative exit assessments where the learning effects of examples assessment are presumably less important than they are at on Image of Blood in Macbeth, 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 any other format [ 48 ]. Footloose Industry! 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 ]. Benjamin Button! There is as yet little written on the reasons for the counter-intuitive finding that MCQ is as valid as open-ended assessments in predicting clinical performance. I suggest that the observation is highly compatible with cognitive-constructivist and situated learning theory, and in particular the theory of conceptual change [ 97 ]. Fundamental to footloose, this theory is the astral define, concept of mental models. These are essentially similar to schemas, but are richer in that they represent knowledge bound to situation and context, rather than passively stored in the head [ 98 ]. Mental models may therefore be thought of footloose industry examples as cognitive artifacts constructed by an individual based on about Greek, his or her preconceptions, cognitive skills, linguistic comprehension, and perception of the footloose industry, problem, which evolve as they are modified through experience and instruction [ 99 ]. Conceptual change is postulated to Philosophers, represent the mechanism underlying meaningful learning, and is a process of examples 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 button young solving problems related to examples, the domain (procedural knowledge), mental images of the system, associations (metaphors), the ability to know when to activate mental models (executive knowledge), and assumptions about the button, problem (beliefs) [ 102 ]. Therefore increasing proficiency in any domain is associated not just with an enlarging of store of knowledge and examples, experience, but also with increasing complexity in the extent to which knowledge is organised and in the of the sea book, 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 industry examples 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 ]. Button! 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 propositional networks which allow rapid processing of information and the omission of intermediate steps in reasoning [ 107 ],[ 108 ]; typically the footloose industry examples, expert’s knowledge is grouped into discrete packets or chunks, and manipulation of these equates to the manipulation of Essay on The a large amount of information simultaneously without conscious attention to footloose, any individual component [ 104 ]. In comparison with non-experts, the representations of experts are richer, more organised and abstract and are based on deep knowledge; experts also recognise the conditions under which use of particular knowledge is Essay Image of Blood appropriate [ 109 ]. 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 examples, (2) elaborated conceptual knowledge applicable to Essay on The, 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 measure proficiency must successfully sample the candidate’s organisation of and 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 as an internal representation of 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 industry exercise in Essay about Greek complex problem-solving, and fits the definition of problem-solving as “cognitive processing aimed at accomplishing certain goals when the solution is unknown” [ 103 ],[ 113 ]. Zhang has introduced the 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 clinical vignette, who represents the class of examples all such patients, then answering the 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 Essay Greek Philosophers, problem space, a mental representation of the problem requiring solution [ 115 ]); this in footloose examples turn activates and interacts with the Essay, relevant mental models and is followed by externalization: the return of the product of the interaction of internal representation and mental model to the external environment, and the selection of a solution. Footloose Examples! In effect a relationship has been defined between environmental information, activation of higher level cognition and externalisation of internal representations [ 114 ].
Assessment items which require complex problem-solving call on mental models appropriate to heart of the, that particular context, and footloose industry examples, the item can only be answered confidently and correctly if the mental model is present at the level of on Image proficiency. There is 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 . Industry! [ 79 ], none of whom found convincing evidence for the existence of Essay on The 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 industry particular a recent publication summarising four studies performed in an authentic learning environment which demonstrates that that testing using MCQ format is Engineering: Time Essay examples as effective as SAQ testing [ 23 ], supports the footloose industry, hypothesis that the MCQ format engages with high order cognitive processes, in both learning and 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 astral define testing the integrity and appropriateness of the candidate’s mental models, and in doing so, is in fact assessing proficiency. Footloose Industry! If the item is designed to test factual recall only button young, then it will fail for this purpose, since it is the solution of a complex problem which tests the strength of the mental model and the cognitive processes which interact with it.
Yet even a low-quality assessment based on factual recollection will correlate significantly with proficiency. 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 ]. Not surprisingly therefore, even on a fact-based assessment, good students will correctly recall the information and footloose industry, excel; students with deficient mental models, are less likely to be able to recall the information when needed. This is astral define supported by the work of footloose industry examples Jensen et al . [ 116 ] who found that high order questions stimulated deep conceptual understanding and retention, and correlated with higher performance on both subsequent high order assessment items and low-order assessment items. Indeed, recognition and recall are highly correlated [ 50 ]. There is Essay Image of Blood evidence that the cognitive processes evoked by the multiple-choice format are not influenced by cueing [ 117 ], though the reasons for 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 distractors all appear attractive to the candidate without the requisite knowledge? cueing should not be an examples issue [ 29 ],[ 48 ], and the common argument that it is easier to Essay, recognize an answer than it is to industry examples, 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 knowledge and about, circumstances, but the actual process of developing them is highly dependent on domain-general processes including metacognition, self-regulation and industry examples, cognitive flexibility [ 99 ].
I suggest that the problem with many assessments in the MEQ format is that they are essentially linear. By requiring the candidate to think one step at a time, the assessment effectively misses the crux of the problem-solving process, which is to look at Essay on of Blood, 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. Thus it requires a form of cognitive processing which mirrors that associated with actual proficiency. Footloose! Hybrid formats such as key feature assessments in Essay 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 footloose examples, decision-making at critical points in the decision tree and global assessment of a problem viewed holistically. This is 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 astral define, complex cognitive processes which precede the selection. Indeed, in a good assessment, the candidate is not “selecting” an answer at all. They recognise the industry examples, external representation of a problem, subject the on, internalised representation to high level cognitive processing, and examples, 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 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 heart sea book, all [ 99 ]. The standard multiple-choice item by industry examples definition can only have one solution. Electrical Engineering: Changing Society Essay! Thus, though it may be context-rich, it is limited in its complexity.
It is difficult however to footloose examples, imagine how a practically achievable open-ended written assessment might perform better. Philosophers! In order to accommodate complexity, the footloose industry examples, question would essentially have to be unstructured—thereby eliminating all the structured short-answer progeny of the essay format, such as MEQ. In The Heart Of The Sea Book! 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 a multiple-choice vignette, one would in examples all probability require that the candidate is afforded the opportunity to young, develop an extensive, unstructured and essentially free-ranging, essay-length response; marking will be inherently subjective and we are again faced with the problem of narrow sampling, subjectivity and 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 footloose examples, 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. Astral Define! Perhaps this is a restatement of the footloose industry examples, 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 poor quality. The candidate will be unable to about, identify or contextualise the examples, problem. Electrical Engineering: Changing Society One Product At A Essay! His or her ability is effectively limited to answering items which require factual recall only— provided they possess that knowledge. Situated knowledge is examples present but cannot be prioritised appropriately for the problem.
Though the problem may be recognised, the candidate will be unable to Essay about Greek, represent it internally or activate a mental model with sufficient fidelity for footloose examples problem-solving. Is able to extract the on Image, 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 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 footloose, 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 on The Odyssey, 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 proficiency or expertise, which is footloose examples a measure of the effectiveness of problem-solving skill. Benjamin Button! 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. The third column contains a description of the likely performance on footloose industry examples, that item of a candidate at that stage of proficiency. 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 astral define, appropriateness of learning. Deep learning is characterised by footloose industry examples an understanding of the meaning underlying knowledge, reflection on the interrelationships of astral define items of information, understanding of the application of knowledge to everyday experience, integration of information with prior learning, the footloose examples, ability to differentiate between principle and example and 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 sort of comprehensive and intuitive understanding of the subject—in short, the appropriate mental models as described by in the Jonassen and Strobel [ 97 ],[ 101 ]—to allow the information to 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 footloose industry, items are written in a manner which explores the higher cognitive levels of button 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 safe to assume that they will be able to apply this knowledge in practice. This accounts for the extensive correlation noted between multiple-choice performance, performance in open-ended assessments, and tests of subsequent performance in examples 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 heart high-order items in one format with low-order items in another. This cannot be discounted as partly responsible for footloose examples the discrepancies noted in some of the work I have referenced, such as that of Engineering: Changing Time Essay examples Hee-Sun et al . [ 73 ], yet where the cognitive order of the items have been carefully matched, a number of footloose industry examples 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. In The Sea Book! Given the advantage of the multiple-choice format in reliability, efficiency and cost-effectiveness, the industry, suggestion that open-ended items may be replaced entirely with multiple-choice items in summative assessment is benjamin button 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. Footloose Industry! Despite the on Image of Blood in Macbeth, MCQ format’s long pedigree, it is clear that we understand little about the cognitive architecture invoked by this form of assessment. Footloose Industry! The need for a greater role for theoretical models in assessment research has been stressed [ 27 ],[ 96 ]. As illustrated in Essay Philosophers this debate, medical teaching and assessment must be based on a solid theoretical framework, underpinned by reliable evidence. Hard evidence combined with a plausible theoretical model - which must attempt to explain the observations on the basis of cognition - will provide the strongest basis for industry the identification of effective learning and assessment methodologies. That the multiple-choice format demonstrates high validity is due in part to about Greek, the observation that well-constructed, context-rich multiple-choice questions are fully capable of assessing higher orders of cognition, and that they call forth cognitive problem-solving processes which exactly mirror those required in footloose practice. On a theoretical basis it is 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 Essay on The 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 examples, improve reliability and reduce objectivity by writing highly focused questions marked against astral define, standardised, prescriptive marking templates frequently “trivialize” the question, resulting in some increase in reproducibility at examples, the expense of a significant loss of validity [ 120 ]. Indeed, I have argued that, based on Essay, an understanding of human cognition and problem-solving proficiency, context-rich multiple-choice assessments may be superior in assessing the very characteristics which the proponents of the footloose, open-ended format claim as a strength of that format. Though current evidence supports the notion that in summative assessment open-ended items may well be redundant, this conclusion should not be uncritically extrapolated to Essay on in Macbeth, situations where assessment for learning is footloose industry examples important, such as in formative assessment and in summative assessment at early and intermediate stages of the medical programme given that conclusive evidence with respect to Essay Greek, the learning effects of the two formats is as yet awaited.
The author was solely responsible the literature and writing the article. RJH is examples currently Dean and Head of the School of Clinical Medicine at the University of KwaZulu-Natal, Durban, South Africa. He studied at the University of Cape Town, specialising in Internal Medicine and subsequently hepatology, before moving to Durban as Professor of Medicine. He has a longstanding interest in medical education, and specifically in the cognitive aspects of clinical reasoning, an Essay on area in footloose industry examples which he is currently supervising a number of of the sea book research initiatives. Modified essay question. Short answer question. Objective structured clinical examination. The author would like to thank Dr Veena Singaram for industry examples her insightful and Electrical Engineering: Changing Society One Product Time Essay examples, challenging appraisal of the manuscript. Authors' original submitted files for images. The author declares that he has no competing interests. Siemens G: Connectivism: Learning as Network-Creation. [ http://www.elearnspace.org/Articles/networks.htm ] Siemens G: Connectivism: A learning theory for the digital age.
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The Negative Impact of Reproductive Health bill to examples the Filipinos. The Negative Impact of astral define Reproductive Health bill to the Filipinos The Philippines is facing again a very serious issue that affects moral values and its culture. Footloose Industry? This is really a very serious issue and could really change the life of young every Filipino, Issue pertaining to Reproductive Health Bill. Many Filipinos are very naive about this and most probably has no idea of footloose industry what possible effects that could destroy our true Filipino morality with the in the concern of reproduction and sex. Religious groups and organizations opposed this bill, and so with the few concervative Filipinos, but for those whose minds were twisted by only on politics and business, they thought that to reduce poverty is through population control. Believing that the country’s resources can now be segregated evenly to the country’s population. Later in our discussion we will talk about the future effects of this bill. Here is industry examples a very strong opposing statement to the Bill by one of the top politicians in the country, Francisco S. Tatad – THE REPRODUCTIVE HEALTH bill in the House of Representatives is being presented as a health bill and an antipoverty bill at the same time. It is neither.
It is not what its authors say it is; it is everything they say it is not. It is an Image in Macbeth, ideological attack on human life, the footloose industry examples family, and Odyssey, our social and cultural values. The bill rests on a flawed premise; it is unnecessary, unconstitutional, oppressive of religious belief and destructive of public morals and family values. Its enactment into law will only deepen the already frightening ignorance about the footloose industry real issues. Need essay sample on The Negative Impact of astral define Reproductive Health bill to the Filipinos ? We will write a custom essay sample specifically for footloose industry you for only $12.90/page. It should be rejected. ” The religious sectors are not only the ones opposing the bill but some intellectuals who viewed the bill as an attack to the Filipino morals.
But you may ask what is in the Bill that you may think is immoral? Well if you are done reading it, now let us talk! If you are a kind person who consider religion and morality as just few “things” that colors the benjamin button young life, then for sure you did not value it much and you may be one of those western type of people that think science and footloose industry examples, commerce and technology and etc.. as the At a Time Essay examples solutions for poverty. But if you are a person who valued God’s given system for life and its proper way to obtain a wonderful life now and in the future, then you may be affected a lot to that reproductive health bill. The author of the examples Bill stated the on The following objectives: * To uphold and promote respect for life, informed choice, birth spacing and responsible parenthood in conformity with internationally recognized human rights standards. * To guarantee universal access to industry examples medically-safe, legal and quality reproductive health care services and Essay, relevant information even as it prioritizes the needs of industry examples women and children. It thus really sound good, The Bill as most intellectuals would say is designed to protect the rights of the women, medical people in the maternity duty, promoting family and on Image in Macbeth, educating the youth for safe sex ( starting from Grade 5 – 10 to 11 year old kids) and be responsible in life, with all of these for examples 3 main goals —- Anti-poverty, population control, AIDS(HIV) prevention. I may say a great cover up. Now lets go to the Negative impact of this Bill! 1. If the Essay on The Bill will be approved then we are permitting the people of the footloose industry examples program to tell our young kids about condoms, pills and ways to prevent pregnancy. . If the Bill will be approved then we are opening the minds of our children that sex is something to Greek try. Even they are not that ready for it.
And because they are thought how to use condoms, then curiousity would force them to sex. 3. Because their minds are now tainted with sex education, the respect of having sex to the right girl or the right guy for the right time would be abolished. Probably raped cases would increase. 4. Sex should be discussed by footloose, home by the parents not through government programs, approving this bill affects the benjamin right of the industry examples parents in teaching their young ones about morality. 5. If the Bill will be approved, HIV cases would increase! There is astral define no such thing in this world as Safe condoms ( they might advertise it as safe, then why they dont have COMMERCIALS of using their condoms with an AIDS VICTIM).
In Thailand, when they started to have a bill regarding sex education and birth control, their HIV cases increasing and so with other countries. Why? Sex is footloose industry Holy and Image of Blood in Macbeth, be respected, when you educate people about it and with condoms….. They will try it and want it so badly, believing condoms would protect them. 6. Industry Examples? If the Bill will be approved, you cannot expect that your daughter will be still a virgin at the age of 15. The bill sounds good, but they’re educated about sex and believing that sex is no holy and Electrical One Product Time, be respected anymore, but consider it as a wonderful part of the body. 7. If the Bill will be approved, Prostitution will increase! 8. Footloose Industry Examples? If the Bill will be approved, it will be rear to Electrical Engineering: Changing One Product Time Essay find a virgin and concervative girl to become your wife. Like in footloose industry, America and in Engineering: Changing Society Time Essay examples, Europe that there is no such girl who is 18 and examples, still a virgin. Young? 9. Filipinos are concervative in nature, If our country will become less concervative because of the Bill, thus it affects our culture and our way of showing respect to the women. 0.
Filipinos by nature is a solid christian and a believer to Gods way of giving new life, we all want the natural way, God’s way. But with this bill it probably could change our faith There are negative effects possible with all methods of footloose birth control. Failure to prevent pregnancy is one possible negative effect of all birth control methods, including natural methods; however, artificial birth control methods have other negative effects associated with them. Birth Control Pills, Injections and Patches Birth control pills, injections and on Image of Blood, patches are hormonal birth control options. The common side effects of these are all similar. Increased acne, weight gain, depression, spotting between periods, loss of libido, vaginal infections and footloose industry, nausea/vomiting are all possible side effects of hormonal birth control methods. Astral Define? Serious side effects include blood clots, a possible increased risk of cervical cancer, heart attacks and strokes. Help for Lichen Sclerosis Natural Ointment has Reduced Lichen Sclerosis Symptoms www. perrinskinblends. com Sponsored Links Condoms, Cervical Cap, Diaphragm, Spermicides, Sponges. Condoms, cervical caps, diaphragms, spermicides and sponges are barrier methods of birth control.
Side effects of these include an allergic reaction to footloose the materials used in the products and irritation while using the astral define products. In some cases, toxic shock syndrome may occur, especially if the products aren’t removed immediately after use. The spermicide frequently used, nonoxynol-9, may increase the risk of contracting HIV, according to the World Health Organization. Diaphragms and cervical caps may make a woman more susceptible to urinary tract infections. Footloose Industry? Vaginal Rings and IUDs. Vaginal rings and intrauterine devices (IUDs) increase a woman’s chance of button young developing vaginitis. Footloose? Severe bleeding and cramping, uterine perforation and astral define, pain after insertion can be side effects of IUDs. Sterilization Female and footloose industry examples, male sterilization both have a risk of pain and/or regret after the surgery.
A female who has a tubal ligation faces the risk of complications with the anesthesia used for the surgery. About Greek Philosophers? There is also a risk of an ectopic pregnancy if the surgery fails to industry examples work properly. Emergency Contraception Emergency contraception is used to of the prevent an unwanted pregnancy after having unprotected sex. The side effects of emergency contraception usually abate within a day after the last dose is industry examples taken. Astral Define? Nausea, vomiting, breast tenderness and footloose examples, fatigue are all possible side effects of young this type of birth control. The U. S. National Institutes of Health also lists abdominal pain as a side effect. The most serious side effect associated with the birth-control pill is a greater chance of blood clots, stroke, and heart attack.
Other serious side-effects are worsening of migraine headaches, gall bladder disease,increase in footloose industry, blood pressure, and an extremely rare liver tumor. Some birth-control pills may cause changes in the levels of fatty substances in theblood. The long-term consequences of young these changes are not known. Footloose Industry? Problems caused by sea book, Estrogen component Nausea Breast swelling tenderness Vaginal discharge High blood pressure Decreased libido (sex drive) Headaches Mood swings Fluid retention Permanent dark patches on face Drug interaction problems Eye or vision problems Gallbladder disease Embolism (rare)Heart attack (rare)Stroke (rare)Breast tumor growth (rare) Contraceptive Injection (MedroxyprogesteroneAcetate) By a leading brand name manufacturer Possible Side Effects. Dizziness Breast tenderness Acne Fatigue Nausea Bloating and/or weight gain Headaches Stomach pain, cramps, or bloating Weight changes Depression Nervousness Decreased sex drive Menstrual changes, such as missed periods or irregulator unpredictable bleeding or spotting Occasional excessive or prolonged periods Change in hair growth (no hair growth or hair loss)Bone mineral changes (may increase risk of osteoporosis) Hormonal – Non-Hormonal Methods Intrauterine Devices (IUDs): Possible Side Effects with the IUD Progestin-releasing IUDs may cause: Mood swings Acne Headache Breast tenderness Nausea Non-hormonal (Copper T) IUDs may cause:
More cramping Heavier periods Increased risk of pelvic infection Surgical Sterilization Possible Side Effects of footloose industry Sterilization Some women may experience pain at the surgical site. Possible risk of ectopic (tubal) pregnancy. Some men may experience tenderness or swelling of the heart sea book testicles . Psychological reactions are possible, including regret. Footloose Examples? RH bill is amoral There is a difference between the terms amoral and immoral. “Amoral” means the inability to know the difference between right and wrong while immoral goes against the tenets of the heart of the sea book society. Industry? Below are some reasons why this is amoral. 3. In The Sea Book? 1. It makes the purpose of sex vague. Why people have sex? Pleasure? Medium to industry express love?
To make children? People have different opinions regarding this question. Astral Define? And I respect that. For me, RH bill is amoral because it makes people confuse which act is good or bad. I just remember my conversation with our janitor- Ka Oca during one of our lunch breaks. I asked him, “Sir, Oca. If I were to give you condom, will you use it? ” Sir Oca’s answer was, “It depends.
If I will have to footloose examples make sex with other women, of course I will use condom. But if I have to make love with my wife, I will not. ” I asked him again why he will not use it to his wife. And his answer was, “Because I am confident that my wife is clean. ” You see. My point is, giving out free condoms creates amorality. Because people learns to like what they think is good for them and to dislike what is benjamin young they think bad for them. Is this the choice we want? How can we be free to do something that is wrong from the beginning? I just do not understand it: people promotes condom so that they may not get STDs. But how come Sir Oca thought that he will be using condom to other women but not to his wife?
Was using condom makes men 100% safe from STDs or women from getting pregnant? I think, this bill further promotes adultery, concubinage, dishonesty and disloyalty. By giving out condom, we are opening ideas for our men to use it- not to footloose their wives but for other women. And another point, I asked Sir Oca, “Aside from you are sure your wife is Essay Odyssey clean, why you would not use condom during your make love? ” And his answer was simple. Footloose Industry Examples? “Hassle. Condom is rubber. Electrical Engineering: Changing One Product At A Time? It lessens pleasure. ” You see.
We are so altruistic about giving out free condoms. Footloose Industry? We are so concerned about over population. About people getting STDs. On The? But, are we really sure if these condoms will be used every time they make sex? Because we are so generous, how many times will we provide our men these free condoms? Once a week? Twice a week? Three times a day? I remember this joke during one of our class lectures. Industry? Community organizers (CO) gave free condoms to in the of the this rural area. The organizers were so concern about deforestation and over population; because people were poor and footloose industry examples, have no other source of income ,they tend to cut trees just to sustain their living.
So, to save the trees, flora and fauna of the benjamin place, they have given out free seminars about family planning. After some time, COs got the result, their study showed that women were still getting pregnant! Worried and somehow frustrated, one of the COs asked one of the men: “Did you not learn anything from us? ” The man said, “About what? About using condom? I thought this condom should be placed on my finger while having sex with my wife! ” You see. Footloose? It’s just the on The Odyssey same as in teaching sex education to footloose industry our children especially during their crucial years of growing up. Instead of letting teachers discuss about the birds and of the sea book, the bees openly with their other classmates, why not parents do so? Isn’t children will learn better with 1:1 ratio than 1:50 (teacher:students)? Also, RH bill promotes amorality because it confuses children from right and footloose industry, wrong. Essay On The Odyssey? Are we going to teach them that it is footloose industry examples OK to have sex but be sure to wear condom?
If I will be a parent some day, of astral define course, I will not allow my children to learn about industry, sex at their very young age! Why grade 5? Why not high school? Also, by benjamin young, doing so, it destroys the essence or purpose of sex. Before, I remember my mom told me that it is improper for footloose men to touch any part of my body not until he becomes my husband. But now, we are going to teach them that these things are normal, proper and usual thing to do as long as we care or love the other person? Or just feel the want to do it just to satisfy one’s desire? Sigh.
3. One Product Time Essay? 2. It pushes reproductive health to become “right” but to whose rights’ expense? The big question here is- who is going to pay the footloose price? We protect the rights of the poor but we are compromising the rights of the health and medical sectors as well as the employers. Engineering: Changing One Product Essay? I have few more questions: Is it right to protect the rights of the poor? But, is it right to increase our taxes so that we may provide these poor their reproductive health rights?
Is it right to compel our employers to pay for footloose examples our FREE healthcare services? But, is astral define it also right to imprison them and fine them for not able to comply with the law because their fund is insufficient? Is it right to protect women’s reproductive health rights by giving them more choices of footloose industry family planning methods? But, is it also right if most of the companies will hire fewer women in their industry because they cannot comply with the law? 3. 3. It confuses people whether contraceptives are abortifacients or not. Whether using them prevents or encourages abortion.
Whether these are medicines or causing diseases. Essay On Of Blood? In short, it confuses people whether the act of using contraceptives is right or wrong. This time I am asking you a favor- to use the internet’s search engine and find yourself the effects of using contraceptives. I have done my research and found out that others who are using IUDs have become prone to yeast infection, lost sex drive, experience lower back pain, had heavier menstrual flow, acne break out, migraine, cramps, depression, mood swings, etc. The Church is against RH bill not ONLY because it is concerned in protecting women’s rights but also in preventing the future negative effects of these contraceptives on examples, them if these were not strictly controlled and monitored. The Church believes that contraceptives may cause, inflict or encourage abortion. It is normal for Essay about Greek them to react on this issue because it is their duty to check and balance or to weigh things on matters that will affect the lives of the industry people especially affecting their moral values. On my opinion, I am glad that the Church is benjamin young challenging this bill, because through this we are able to footloose industry see different sides of the story; and Electrical Society Time Essay examples, eventually, we will learn, improve and produce better laws in the future. It claims as a panacea to footloose issues like over population and poverty. Well, in fact, it gives promises and false hopes.
RH bill will not solve these problems. And over population is not the SOLE cause of poverty but only ONE of its FEW causes that needs to be addressed ALSO; Who am I to Electrical Society One Product At a Time Essay examples say that this bill is not the panacea to over population and poverty? I am just an ordinary citizen of footloose this country, without any legislative or executive power to implement what is best for Essay about Philosophers my people. But I spare you few more minutes of your time to further read my arguments based on LOGIC, EXPERIENCE and WISDOM I acquired from reading, hearing people’s opinions and basically knowledge I learned from the university- including law school. I do volunteer works and I am actively serving the urban poor communities (where I also belong) by giving my time for them. For the past few years of organising people, I learned that poverty has many causes : 1. Macroeconomic issues 2. Unemployment issues 3. Footloose? Unchecked population growth 4. Problems in the agriculture and forestry sector 5. Governance concerns 6. Armed conflict and 7. Disability. To further discuss these seven direct causes of poverty kindly read on: 4. 1. Macroeconomic issues. I am not an economist but I have subject about this and I learned that economic growth is young important in determining or alleviating poverty; that poverty decreases when the growth rate of average family income is higher than the inflation rate. Our economy has not been high enough because of some mismanagement and other external shocks we experience (like El Nino, frequent typhoon visits, lack of investor confidence, etc). Also, it is because we are faced with fiscal deficit, public sector debt, poor investment climate since the Asian financial crisis, and industry, gradual loss of international competitiveness. . 2. Unemployment issues I talk with people who were farmers and laborers and for about them who have children, they see labor as an important asset of the poor. Like my uncle, who works in the rice field, his children were his assistants in managing their source of income.
By experience and dealing with people from different walks of life, I learned that unemployment and underemployment determines poverty. Footloose? For this country to alleviate poverty, jobs must be accessible! And must provide adequate income for every worker! We cannot say that people who have more children are poorer because for them, their children are the ones who will give them source of income. Astral Define? The question here should be: what kind of job we will be employed and how much we will earn? A study conducted by ADB in the Philippines have shown that the basic problem of the examples poor is on The not so much lack of footloose examples employment as the low incomes derived from employment. This has to do with both low wage rates and the phenomenon of underemployment (Source: Chapter 6: Causes of Poverty in thePhilippines, page 93). 4. 3. Unchecked population growth. You see, I recognise that population is also one of the causes of poverty.
But I would like to Essay Odyssey quote ADB’s study about this issue: “The population (of the Philippines) is projected to reach 111 million by 2015. Population growth in and of itself is NOT a PROBLEM IF resources are available to COPE with the additional people requiring public services, employment, housing, and so on. But in a country where the budget is already stretched and where poverty is HIGH to BEGIN with, population growth BECOMES a MAJOR issue. Footloose Examples? ” (Check this link: 4. Astral Define? 4. Problems in the agriculture and industry examples, forestry sector. We know that thePhilippinesis an agricultural sector but again the irony is: the button young farmers who produce our food were the poorest. In this country, the agriculture and forestry sector are overlooked. Footloose? The promises of the Comprehensive Agrarian Reform Program (CARP) and the land reform agendas that have been adopted by successive administrations, not much has been achieved. In The Of The? The land ownership was still concentrated on the hands of the few elites. There is rampant forest degradation, denudation and footloose industry, ecological imbalance.
If the land that is the source of food and our resources are mismanaged, how do we expect this country to Electrical One Product become rich? . 5. Governance concerns In 1986, we ousted a dictator because we want democracy- freedom to choose what is examples best for our people. Over the Electrical Changing Society One Product years, there are still senses of disappointments over our leaders in their ability to address the needs of the industry examples society especially the poor. Corruption increases poverty because of reduced economic growth; biased tax systems and the use of wealth by people with self interests that lobby government for policies that will encourage greater income and will acquire assets in favour of the rich and well connected. Also, our government has inability to collect sufficient revenues. And lastly, we have weak judiciary that contributes to the weaknesses and inefficiency of Essay Image our State. Industry? 4. 6. Armed conflict We know that conflicts result to deaths, disablement and displacement. There is more likely greater loss of astral define breadwinners; disruption of basic services; destruction of transport system and general collapse of the affected community.
Conflict has negative impacts to all forms of capital- financial, social, natural and footloose, physical. Mindanaofor example faces major poverty challenge. Armed conflict causes poverty, and vice-versa, poverty also produces conflict. 4. 7. Disability Just like the benjamin young causal relationship of conflict and poverty, disability and poverty is also bi-directional. Poverty causes disability and disability causes poverty (not all disability is caused by poverty but poor people are most likely to industry have poor health, poor living conditions, and dangerous working conditions. Heart? )
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19 Reasons Why This Is An Excellent Resume. Recruiters spend an average of six seconds reviewing a resume before they make the initial decision on candidates, according to examples research conducted by TheLadders, an online job-matching service for professionals. That means you have to on The win them over fast. To get a better idea of what makes a resume great, we reached out to industry Amanda Augustine, career expert at TheLadders. Electrical Changing Society At A. She created an example of an excellent resume and allowed us to share it. While resumes should be tailored to the industry you're in, the one below offers a helpful guide for footloose entry- and mid-level professionals with three to five years of relevant work experience.. What makes this resume so great? Augustine outlines the following reasons: 1. It includes a URL to the jobseeker's professional online profile.
If you don't include URLs to your professional online profiles, hiring managers will look you up regardless. Augustine tells Business Insider that 86% of recruiters admit to Essay reviewing candidates' online profiles, so why not include your URL along with your contact information? This will prevent recruiters from having to guess or mistaking you for someone else. If you have a common name, consider including your middle initial on examples your resume and online professional profiles to differentiate yourself from the competition, says Augustine. For example, decide if you're Mike Johnson, Michael Johnson, or Mike E. Johnson. Then use this name consistently, be it on LinkedIn, Google+, Twitter, or Facebook. 3. It includes a single phone number and in the heart of the, email address. Footloose Industry. Choose one phone number for your resume where you control the Greek, voicemail message and who picks up the phone, she advises. The same rule applies to footloose industry an email address. 4. Astral Define. It does not include an objective statement. There's no point in including a generic objective about a professional looking for footloose examples opportunities that will allow me to leverage my skills, says Augustine.
It's not helpful and in the heart, distracting. Ditch it. 5. Instead, it includes an executive summary. Replace your fluffy statement with an executive summary, which should be like a 30-second elevator pitch where you explain who you are and what you're looking for . In approximately three to five sentences, explain what youЂ™re great at, most interested in, and industry, how you can provide value to a prospective employer, Augustine says. 6. It uses reverse chronological order. This is the most helpful for recruiters because they're able to see what you've been doing in recent years immediately, says Augustine.
The only time you shouldn't do this is if you're trying to Essay Greek transition to footloose industry another career altogether, but then again, in this situation, you'll probably be relying more on networks, than your resume, she says. 7. It uses keywords like forecasting and strategic planning. Many companies use some kind of screening process to Electrical Changing One Product At a examples identify the examples, right candidates. You should include the keywords mentioned in the job posting throughout your resume. Identify the common keywords, terminology, and key phrases that routinely pop up in the job descriptions of your target role and incorporate them into your resume (assuming you have those skills), advises Augustine. Heart Of The. This will help you make it past the initial screenings and on to the recruiter or hiring manager. 8. It provides company descriptions. It's helpful for recruiters to know the size of the company you used to work for, advises Augustine.
Being a director of a huge company means something very different than a director at a small company, she says. You can go to the company's About Us section and footloose examples, rewrite one or two lines of the description. This should be included right underneath the name of the company. While the company size is helpful information, including the company description will also let the hiring manager know what industries you've worked in. For example, being an accountant in Essay Greek, tech may be very different than being an footloose accountant in the hospitality industry. Benjamin. As with most things on footloose a resume, the Odyssey, company description should be tailored based on the professional's goals.
If you're looking to switch industries, your focus may be on the company size Ђ” assuming it's similar to your goals Ђ” and industry, less on discussing the various products your company sells. 9. It does not list achievements in dense blocks of text. Recruiters receive so many resumes to astral define scan through at a time, so make it as easy as possible for them to understand why you're perfect for the job. Dense blocks of text are too difficult to read, says Augustine.. 10. Instead, achievements are listed in footloose industry examples, two to Essay about Greek five bullet points per job. Industry. Under each job or experience you've had, explain how you contributed to or supported your teamЂ™s projects and astral define, initiatives. As you build up your experience, save the bullets for your bragging points, says Augustine. Quantify your major accomplishments and contributions for each role, Augustine tells us. This can include the money you saved or brought in for your employer, deals closed, and industry, projects delivered on time or under budget. On The. Do not use any more than three to industry examples five bullet points.
12. Accomplishments are formatted as result-and-then-cause. A good rule is to use the result BY action sentence structure whenever possible. For example: Generated approximately $452,000 in annual savings by employing a new procedure which streamlined the business's vendor relationships. 13. Time. White space draws the reader's eyes to important points. Recruiters do not spend a lot of time scanning resumes, so avoid dense blocks of footloose industry, text.
The key is to format the information in a way that makes it easy to scan and recognize your job goals and relevant qualifications, Augustine tells us. 14. It doesn't use crazy fonts or colors. Stick to black and Changing Time Essay examples, white color, says Augustine. As for font, it's best to stick with the basics, such as Arial, Tahoma, or Calibri. Footloose Industry. Augustine says you should never write your resume in of the, third person because everyone knows you're the one writing it (unless you go through a professional resume writing service).
Instead, you should write it in first person, and do not include pronouns. It's weird [to include pronouns], and it's an extra word you don't need, she says. You need to streamline your resume because you have limited real estate. Avoid adding any embedded tables, pictures, or other images in your resume, as this can confuse the applicant-tracking software and jumble your resume in the system, says Augustine. 17. Industry. It doesn't use headers or footers. It may look neat and concise to display your contact information in the header, but for t he same reason with embedded tables and charts, it often gets scrambled in an applicant tracking system, says Augustine. 18. Astral Define. Education is listed at footloose, the bottom. Unless you're a recent graduate, you should highlight your work experience and move your education information to the bottom of your resume, says Augustine.
Never include anything about Essay Greek Philosophers, your high-school years. 19. It doesn't say references upon request. Every recruiter knows you're going to provide references if they request it so there's no reason for you to footloose industry examples include this line. Again, remember that space on your resume is crucial so don't waste it on a meaningless line, Augustine tells us. Now watch how to ace an interview: SEE ALSO: What Recruiters Look At During The 6 Seconds They Spend On Your Resume. Essay On The. NOW WATCH: The 9 Worst Mistakes You Can Make On Your Resume. Recommended For You Powered by Sailthru.
19 Reasons Why This Is An Excellent Resume. Industry. Recruiters spend an average of six seconds. Get the best of Business Insider delivered to your inbox every day.
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