Web Based Technology And Continuing Medical Education - Free Essay Example

Sample details Pages: 24 Words: 7332 Downloads: 8 Date added: 2017/06/26 Category Statistics Essay Did you like this example? This dissertation explores the use of Web based technology to enhance and maintain procedural skills in the context of continuing medical education. The research was initiated by the perceived need for novel and alternative methods of providing procedural skills training to health practitioners. This observation, supported by learning needs analysis, led to the design and implementation of a Web based educational resource aimed at doctors and other healthcare practitioners. The assessment part of the research focused on an empirical evaluation of the effectiveness of this Web based educational resource. This dissertation draws on a number of strands of Health Informatics: Don’t waste time! Our writers will create an original "Web Based Technology And Continuing Medical Education" essay for you Create order Principals of Heath Informatics Research Methods Clinical Information Systems Creating Online Educational Resources Whilst on a small scale, the results are relevant to medical educators involved in developing and evaluating web based educational resources. BACKGROUND Medical practitioners receive comprehensive procedural skills training and it is expected that this is maintained and regularly updated to limit skills decay and ensure clinical competency. Skills decay is defined as the loss of a trained or an acquired skill after a period of nonuse. Skills decay rapidly as the period of nonuse lengthens; and the extent of the decay is influenced by the characteristics of the skill and how and when these skills were learnt. Arthur et al., (1998) Skills are classified either as à ¢Ã¢â€š ¬Ã…“closed loopà ¢Ã¢â€š ¬? or à ¢Ã¢â€š ¬Ã…“open loop tasks.à ¢Ã¢â€š ¬? Arthur et al., (1998). Closed loop tasks are fixed sequence tasks with a defined beginning and end, for example, the preoperative anaesthetic machine check. à ¢Ã¢â€š ¬Ã…“Open loop tasksà ¢Ã¢â€š ¬? are tracking and problem solving tasks, for example, managing patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s hypoxia. Arthur et al., (1998) in their review on the rate of skills decay and its influencing factors concluded that à ¢Ã¢â€š ¬Ã‹Å"closed loop tasksà ¢Ã¢â€š ¬Ã¢â€ž ¢ decay more slowly than à ¢Ã¢â€š ¬Ã‹Å"opened loop tasks.à ¢Ã¢â€š ¬Ã¢â€ž ¢ Arthur et al., (1998) also mentions that mental tasks decay more quickly than physical tasks and after 28 to 90 days of nonuse of the trained skills, task performance declines by 23% and by 40% after a year of nonuse. Clinical practice alone may be insufficient to prevent skills decay as indicated in a simulated airway management training study Kovacs et al., (2000). Skills decay quickly without practice; and procedural skills are only optimally retained when trainees regularly practiced the procedure on their own, in their own time and received periodic feedback. Training on simulation modalities, mannequins, fresh cadavers and live patients have the potential to successfully teach the procedural skill with significantly less skills decay over time as compared to didactic teaching alone. TI L et al., (2006). The traditional à ¢Ã¢â€š ¬Ã‹Å"one to oneà ¢Ã¢â€š ¬Ã¢â€ž ¢ apprenticeship model of medical procedural skills training and the in-hospital continuous medical education and maintenance of a skills base are often inefficient, expensive, and labour intensive. Patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s, who are often used as practice tests subjects during skills training, safety is reliant on the medical practit ioner skills retention and task competency. Maintaining procedural skills competency may prove to be increasingly more challenging as expense, time constraints, available manpower, lack of resources and patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s reluctance to be used as experimental models make this endeavor increasingly impossible to set up. The resultant worldwide move towards competency based training programs and self directed problem oriented based learning has made necessary the search for alternative valid and reliable educational methods for skills training and its maintenance. Fortunately, the last decade has seen an explosion in the use of technology to enhance medical education. Web-based educational programs, computer aided virtual reality situations, and high fidelity simulation has played an increasingly important role in medical education owning to its efficiency, ability to provide flexible learning experiences, multimedia capabilities, and economies of scale and power to distribute instructional content internationally. Vozenilik et al., (2004) In the last 5 to 10 years extensive empirical research has been conducted on the use of computer aided and web-based instruction in medical education where there has been overwhelming support for these mediums of instruction. Unfortunately the literature is strikingly sparse on the use of Web based instruction for procedural skills training and in the few studies where empirical research has been carried out; study designs were not robust enough to withstand interrogation or had inconclusive results. LITERATURE REVIEW A review of the literature was conducted to ascertain what work had been done in the field of Web based learning, medical education and procedural skills training. A CINAHL and Medline search was carried out exploring all citations up to June 2010. The search using Medical Subjects Headings (MeSH) à ¢Ã¢â€š ¬Ã…“Computer Aided Instructionà ¢Ã¢â€š ¬?, à ¢Ã¢â€š ¬Ã…“Internetà ¢Ã¢â€š ¬?, à ¢Ã¢â€š ¬Ã…“CMEà ¢Ã¢â€š ¬? returned 322 publications. Adding the MeSH term à ¢Ã¢â€š ¬Ã…“Reviewà ¢Ã¢â€š ¬? returned 21 reviews of which four were relevant. Replacing à ¢Ã¢â€š ¬Ã…“CMEà ¢Ã¢â€š ¬? with à ¢Ã¢â€š ¬Ã…“Procedural Skills Trainingà ¢Ã¢â€š ¬? produced only one noteworthy empirical research paper and 2 publications worthy of discussion. Relevant systematic reviews of the literature are summarized in the table below: 3 Title Author / Date Findings Review Conclusions Assessment of the Review Internet-Based Learning in Health Professionals: A Meta-analysis Cook et al., 2008 201 eligible studies with qualitative or comparative studies of Internet based learning accounting for 56 publications Internet formats were equivalent to non-Internet formats in terms of learner satisfaction and changes in knowledge, skills and behavior. Internet based learning is educationally beneficial. Comprehensive work with a robust study design. Skills outcomes included communication with patients, critical appraisal, medication dosing, cardiopulmonary resuscitation, and lumbar puncture. Unfortunately the study had many limitations as many publications were poorly designed with low methodological quality, without validity and reliability evidence for assessment scores and with widely varying interventions What the meta analysis did suggest was that no further studies comparing Internet based interventions with traditional methods or no intervention were merited as these types of studies would almost invariably be in favour of Internet Based interventions. The author of the review suggested that the questions that warranted further research would be when and should Internet based learning be used and how could it be effectively implemented giving impetus to the exploration of Internet based skills training and maintenance. Title Author / Date Findings Review Conclusions Assessment of the Review The Effectiveness of Computer-Aided (CAL) Self-Instructional Programs in Dental Education: Rosenberg et al. 2003 1024 articles systematically reviewed. 12 publications included in the final review. Five studies significantly favored CAL. CAL is as effective as other methods of teaching and can be used as an adjunct to traditional education or as a means of self-instruction. This study is a comprehensive review of controlled randomized studies with clear and relevant inclusion criteria assessed with good inter and intra rated reliability. The reviewer limited the study to dental students. Forms of Computer Aided Instruction was not clearly defined or specified in the inclusion criteria. It is unclear whether web based studies were included. The skills referred to in the studies were dental diagnostic not procedural skills. The apparent dearth of studies assessing procedural skills justified the investigation undertaken by this dissertation. Title Author / Date Findings Review Conclusions Assessment of the Review Internet-based medical education: a realist review of what works, for whom and in what circumstances. Wong et al. 2010 249 papers met their inclusion criteria. Learners were more likely to accept a course if it offered a perceived advantage over available internet alternatives, if it was easy to use technically, had elements of à ¢Ã¢â€š ¬Ã‹Å"interactivityà ¢Ã¢â€š ¬Ã¢â€ž ¢ and gave formative feedback. This study is a realist review and the methodology used answered the question of the study which aimed to provide a theory driven criteria to guide development and evaluation of Internet based tools. The findings and guidelines suggested in this review would later be incorporated in the design of the resource to be investigated in this dissertation. Title Author / Date Findings Review Conclusions Assessment of the Review eLearning: a review of Internet-based continuing medical education (CME). Wuton et al. 2004 16 studies met their eligibility criteria Internet based CME programs were as effective as traditional formats of CME A comprehensive and appropriate search of databases. Randomized controlled trials of Internet based education in practicing health care professionals. These results showed that Internet based interventions do have a place in CME and that these effects on skills behavior warrants further investigation. Title Author / Date Review Conclusions Assessment of the publication Procedures can be learned on the Web: a randomized study of ultrasound-guided vascular access training. Chenkin et al. 2008 Web based tutorial may be an useful alternative to didactic teaching for learning of procedural skills A randomized control trial with non inferiority data analysis. The non inferiority margin was specified at a 10% margin however the actual amount of improvement was not specified. Blinding bias was not assured and the trial relied on the reputation of the investigator. No mention of inter rated reliability was made. Despite its inherent weaknesses, the trial suggested that web based intervention is as good as the alternatives; however, the study incorporated the use of simulation and live models to teach the actual procedural skill. David Cook is a prolific writer of many reviews and publications investigating Internet based formats in medical education. His noteworthy publications à ¢Ã¢â€š ¬Ã…“Web based learning: pros, cons and controversiesà ¢Ã¢â€š ¬? Cook, (2007) and à ¢Ã¢â€š ¬Ã…“Where are we with Web based educationà ¢Ã¢â€š ¬? Cook,( 2006) extolled the benefits overcoming barriers of distance and time with novel instructional methods, and extenuated the disadvantages which included social isolation, upfront costs and technical difficulties of Web based education. He concluded that Web based instruction can be a potentially powerful tool and strongly recommended that the focus of future studies should concentrate on the timing and application of Web based learning tools. Summary of literature survey The review of the literature has outlined the use of Web based procedural skills training as an area that requires further research. Empirical research and systematic reviews that has been carried out thus far has been limited. The literature research conducted for this dissertation (though in its self may have been limited) was unable to find publications exploring the whole use of the Internet as a means of procedural skills training and skills maintenance. Justification and Learning needs analysis To assess the effectiveness of an Internet based learning resource in the context of procedural skills training, a skill had to be chosen that was relevant, involved both a physical and mental task, and had the potential of decaying. A procedural skill is defined as à ¢Ã¢â€š ¬Ã…“the mental (knowledge) and motor activities (behaviour) required to execute a manual taskà ¢Ã¢â€š ¬? and usually involves patient contact. Kovacs (1997). Furthermore, a learning needs analysis was undertaken to assess the value of this topic choice. Justification Intubation with a Laryngeal Airway Device (LAD) was chosen as the representative procedural skill. When a patient collapses from a cardiac or respiratory cause, timely control of the patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s breathing and airway with prompt delivery of cardiopulmonary resuscitation (CPR) and defibrillation have resulted in life saving survival and neurological recovery. The LAD is a breathing maintenance device that can, with minimal training, be inserted effortlessly into the mouth of the patient allowing for breathing and oxygenation. It is increasingly being used in the repertoire of techniques available to frontline practitioners (practitioners first on call to resuscitation events) in emergencies where the technique has proven to be easy to use and life saving in the management of an airway crisis. Kette, (2005). In a survey of family medicine practitioners, all practitioners surveyed agreed that insertion of an LAD during a resuscitation procedure was a core procedural skill that most practitioners were required to perform in any setting; 86% admitting that they had been called upon at some point to perform the procedure. Wetmore et al., (2005). Insertion of a LAD with knowledge of the patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s anatomy, indication and contraindication for use and technique of use both under a controlled setting and in an emergency is representative of a procedural skill a frontline practitioners is expected to perform. Learning needs analysis A key step in developing an effective educational website is performing a learning needs analysis to determine what the learning needs the resource hopes to address are and why these needs were not met by existing learning or teaching arrangements. Cook Dupras, ( 2004). A questionnaire not previously validated, making use of closed type questions, were used to assess three broad areas; knowledge and training, skills application and Internet accessibility. Eleven frontline practitioners were asked to provide an indication of how often they were called to attend resuscitation or airway management situations in the last two years. They were surveyed regarding training received in LAD usage and insertion, their desire to obtain more information or skills updating, and whether there was a perceived need for Internet-based continuing medical education courses on LAD usage and intubation. Their attendances at CME workshops in the last year were surveyed and the barriers to CME workshop attendance were assessed. The respondents were surveyed regarding access to the Internet and previous exposure to e-learning modules. This was done to assess whether the uptake of the resource would be biased towards participants with Internet access, frequent Internet uses or previous e-learning experiences. The results of the learning needs analysis showed that most respondents (90%) received exposure to the device. It is a requirement of their post as frontline practitioners, to be Acute Life Support (ALS) trained where usage of the device in resuscitation is taught. Half the respondents indicated that they were not comfortable with their level of knowledge; and 63% felt unconfident about inserting the device as they were on average, only exposed to two resuscitation scenarios per year. All had Internet access at work and at home; and half had previous experience of online learning. Only one percent of the respondents were able to attend a CME session in the last year, citing lack of time and convenience as the main reasons. 80% of respondents were interested in taking courses through the Internet, as continuous education credits are a requirement of a license to practice in medicine. Interest in the topic was high and given the above self-appraisal, it was felt that the course was nee ded and should appeal to this population. METHODS The method section is dealt with in two parts. The first will focus on the development and design of a Web based educational resource and the second on the evaluation of the resource. 1. Development and design The idea was to develop an educational resource that could be used to train, reinforce knowledge and maintain a procedural skill by employing and integrating principles of effective adult learning with the unique features of the web. The development was driven by educational needs and outcomes of learning needs analysis completed by participants in a previous part of this study. 1.1 Development Theories The course design reflected Adult Learning Principles and the aim of the course was to improve knowledge (cognition), integration of attitude changes (confidence) and in so doing result in a change in behaviour (competency). Gale (1986). With accessibility of the Web based educational resource, it was hoped that the resource would be accessed frequently until the task becomes automatic or accessed as a refresher when required or at regular intervals. The resource incorporated principals that were shown to be effective. It was centered on the learners needs, was focused on a specific task and recognised past experiences of the learner (Gale 1986). The theories used in the development of the resource included; Experiential Learning Theory, which concluded that experiential learning should have personal relevance, should be self-initiated and lead to pervasive effects on the learner. Rodgers (1969) Constructivist Theory where learning is an active process with learners constructing new ideas and concepts based upon past and current knowledge. Bruner (1966) Information Processing Theory where knowledge is presentation in sequences or à ¢Ã¢â€š ¬Ã‹Å"chunkingà ¢Ã¢â€š ¬Ã¢â€ž ¢ to accommodate short attention spans (Miller 1956). The educational resource strived to be pedagogically sound uniquely applying these principles online. Information was presented in small chunks in a sequential fashion, was self-contained, had interactive components and contained assessments with instant feedback. Online communication did not occur in real time as which happens with video conferencing and online chat rooms, instead the resource used communication that was asynchronous where participants logged on, viewed and downloaded course material, read postings and submitted interactive tasks. The advantage of using an asynchronous format was that learners and/or the instructor did not need to be online at the same time allowing the participant to work at his or her own pace. The asynchronous nature of this web based learning environment allowed for barriers of time, location and expense to be overcome. Sanoff (2005) 1.2 Moodle Description University College Londonà ¢Ã¢â€š ¬Ã¢â€ž ¢s (UCL) Moodle was the platform used to develop the educational resource. There are many applications offering free alternatives to the commercial software WebCTTM and BlackboardTM, however the UCL Moodle was chosen as a matter of convenience because it was accessible, independent of specific operating systems, fit for purpose and easy to use without much technical computer knowledge thereby potentially removing barriers to any future course design and development.. Moodle (Modular Object Oriented Dynamic Learning Environment) is software freely available to use and was developed by Dougiamas. Moodle. org (1999). The Moodle software was designed on pedagogical principles that encourage learner interaction in a virtual learning environment. Moodle is a course management system used to support Web-based courses and has a number of innovative tools that could be used to create courses that promoted collaborative learning. Moodle is able to run without modification on Unix, Linux, FreeBSD, Windows, Mac OS and Netware. (Moodle. Org). After an initial learning curve, the program was easy to use with simple but comprehensive online instructions. Moodle It did not require pre-existing computer programming knowledge, and in fact the author of this dissertation considered herself a novice computer user. Moodle is written in hypertext pre-processor (PHP) which is HTML embedded scripting language used to create dynamic Web pages.  PHP allows for connecting to remote servers, checking email, URL encoding and setting cookies. It offers good connectivity to many databases including MySQL, and PostgreSQL,  which Moodle uses as a single database. MySQL is a  relational database management system  that runs as a server providing multi-user access to a number of databases. (www.php.net). Moodle had the support for easily displaying multimedia aspects of the educational resource and the interface could be used in over 70 native language translations. The Web based educational resource was easily built up using multimedia activity modules and design elements, which included with easy navigation; Authentication and enrollment, Syndication with a chat forum made available to others as newsfeeds, Current evidence based didactic teaching, Interactive quizzes allowing import/export in a number of methods Hyperlinked resources to provide for branched learning, The use of a Wikipedia, A glossary of commonly used terms, Instructional video presentations. All the attributes of the Moodle made for an international transportable tool ideal for knowledge presentation, learner interaction, comments and reflection, dynamic and interactive assessments, flexibility, extendibility, and most importantly, support for autonomous learning and continued educational development around the world. The only noteworthy disadvantage of using the UCL Moodle was an imposed instructional design. 1.3 Resource Description The educational resource was named; VIRTUAL [emailprotected]/* */: Onà ¢Ã¢â€š ¬Ã¢â‚¬Å"line Laryngeal Airway Device training. à ¢Ã¢â€š ¬Ã¢â‚¬Å" à ¢Ã¢â€š ¬Ã…“Virtualà ¢Ã¢â€š ¬? suggesting both the virtual reality of an Internet based generated environment and the adjective, meaning à ¢Ã¢â€š ¬Ã‹Å"practicallyà ¢Ã¢â€š ¬Ã¢â€ž ¢ or à ¢Ã¢â€š ¬Ã‹Å"almostà ¢Ã¢â€š ¬Ã¢â€ž ¢ Collins English Dictionary ( 2008). The Web based educational resource was developed for distance learning and contained all the elements of a totally Internet delivered educational resource. The content of the course was drawn from the authorà ¢Ã¢â€š ¬Ã¢â€ž ¢s personal experience using the Laryngeal device; peer reviewed journal articles, manufactureà ¢Ã¢â€š ¬Ã¢â€ž ¢s product information and videos downloaded from the Internet. Permission for the use of copywriter-restricted material was sought and obtained where appropriate. 1.3.1 Screen Design The screen design refers to how the information was arranged and presented on the display screen. The guidelines used followed those (amongst others) suggested by DoD HCI Style Guide (1992). The screen was kept simple, orderly, clutter free and consistent with a limited, non-dominating colour palate of four colours à ¢Ã¢â€š ¬Ã¢â‚¬Å" blue, black, white and blue à ¢Ã¢â€š ¬Ã¢â‚¬Å" green, a combination that has been shown to cause little fatigue and distraction. Kelley (1988). The content of each lesson was presented on a plain white background with black text in a non-jarring informal style font that made the lessons easy to read. Clark (1997). One template was used and the navigation bar, top bar and individual lesson heading bars kept the same with only the content of each lesson changing. All the content was displayed statically on one screen with individual lessons accessed by scrolling vertically down to the individual lesson. Unnecessary menus and long selection lists were avoid ed. This allowed for an overall view of the content, minimized pointer and eye movements and caused less distraction with easy navigation. (Gruneberg 1978). A discussion forum, interactive quizzes and an end of resource examination were included to allow engagement and self-assessment. The quizzes and examination included a range of question types à ¢Ã¢â€š ¬Ã¢â‚¬Å" multiple choice questions, true/ false, photo matching and random short answer matching type questions. These varieties of questions were shown to improve the learning experiences of adult learners. (Mackway-Jones, 1998). Information was provided in chunks and the writing style kept informal, with plain, simple language and in conversational tone with some elements of humour. There were fewer than 60 à ¢Ã¢â€š ¬Ã¢â‚¬Å" character positions on a standard 80 à ¢Ã¢â€š ¬Ã¢â‚¬Å" character line, spacing between characters were 25 à ¢Ã¢â€š ¬Ã¢â‚¬Å" 50% of character height and spacing between lines were equal to the character h eight, this to increase reading efficiency. 1.3.2 Course Content The course material was presented as text, graphics, power point presentations, hyperlinks and video demonstrations of the procedural skill presented in animation and on an actual patient. Knowledge was provided in five short lessons that followed the natural sequence of usage and intubation with a Laryngeal device. Aims of the resource and objectives of each lesson were stated at the beginning of the course. Here too a glossary of commonly used terms and a baseline knowledge assessment quiz were included. Each lesson was kept succinct with hyperlinks to websites and folders for those seeking extra information. This was to limit download times. Each lesson was concluded with an interactive quiz used to reinforce and test the knowledge learnt. Instant responses were provided to the quizzes after submission with suggestions to either revisit the lesson or to continue depending on the results obtained in the quizzes. The resource was concluded with an end of course examination and the c ourse was predicted to take 1 to 2 hours to complete. The resource content was accessed with a secured password with all content downloadable by way of an Internet connection. All the participants were supplied with a secure company email address and all the ISTCs had Internet access. Permission was requested for the use of company time and resources e.g. airway device training mannequin and time during the working day for those who chose to access the resource at work. Participants were supplied with instructions on how to use Microsoft Word and how to log on to and navigate the Moodle site. The course material was available online for two weeks with access monitored. 1.4 Pilot Study The aim of the pilot study was to assess the ease of navigation, gauge the time it took to complete the course, the integrity of the hyperlinks and the validity and reliability of the content and examination questions. Font preferences, layout and download speeds were also assessed. A prototype of the resource was tested on a selected sample of five participants of similar profile to the participants used in the study. The participants of the pilot study were excluded from participating in the actual study. An external panel of three Consultant Anaesthetists and two trainee Registrar Anaesthetists where used to provided expert advice. The Consultant Anaesthetists were selected based on their special interest in emergency medicine or difficult intubation scenario teaching. A few typographic errors were corrected, aims and objectives were clarified, difficult navigational issues were corrected and some content deemed repetitive and lengthy by the pilot participants were excluded before rolling out the resource. These changes however, were minor and further usability studies were deemed unnecessary. 1.5 Content Validation The content presented was current, evidence based and peer reviewed for content validity by the panel of experts (made up of three Consultant Anaesthetists and two trainee Registrar Anaesthetists), who deemed the content to be relevant and appropriate. The panel of experts and the pilot participants also judged good face validity. 2. Evaluation of the Resource The study evaluates effectiveness and acceptance of a Web based educational resource used to train and maintain a learnt procedural skill in the context of continuous medical Education (CME). The evaluation of the resource was undertaken in two parts. First the effectiveness of the resource was evaluated and the endpoints measured were changes in knowledge, confidence and technical ability. This evaluation made use of a summative framework redefined by Saettler (1990); which takes place after interaction with the resource. A à ¢Ã¢â€š ¬Ã…“before à ¢Ã¢â€š ¬Ã…“and à ¢Ã¢â€š ¬Ã…“afterà ¢Ã¢â€š ¬? interventional ipsative assessment was undertaken where participantà ¢Ã¢â€š ¬Ã¢â€ž ¢s performance was compared to their own over a period of time. The second part of the evaluation was undertaken to assess the acceptability of the Web based educational resource as a medium for procedural skills training and this was done by way of an evaluation questionnaire completed by the participants after course completion. 2.1 Participants and Setting The participants and settings were specifically targeted, as they would ultimately be interested stakeholders and end users of this type of resource. The research was conducted at five Care UK TM Independent Centers (ISTCs) on practitioners employed at these facilities. The ISTCs are part of the governmentà ¢Ã¢â€š ¬Ã¢â€ž ¢s initiative to reduce long NHS waiting times for elective surgery by adding increased capacity and alternative treatment venues for patients. There are approximately 25 ISTCs in the United Kingdom with Care UK TM represents 20% of this market. The ISTCs were chosen as a setting because: They are not part of the UK NHS medical training scheme and therefore have no formal programs of medical training or teaching that similar grades of staff in the NHS would receive. Contractual obligations of the ISTC contract decreed that the ISTCs could not employ medical practitioners from the NHS; therefore, most of the medical staff employed at the ISTCs have trained abroad and are waiting either to enter a formal career path within the NHS or wanting UK work experience. This situation has resulted in a mixture of nationalities, non-uniform medical training and medical staff with differing levels of post qualification experience and more importantly, a high staff turnover. (ref) These resulting factors were conducive to a system of competency-based appraisals and continuous medical education, which could be addressed with Web, based educational resources. Participants in the study were all frontline practitioners employed at Care UK TM ISTCs, which employs 48 practitioners of this grade. This represents 50% of all frontline practitioners employed in ISTCs throughout the UK. This intended sample size of 48 adequately represented the wider population in this type of analysis. frontline practitioners are the first practitioners on call to the resuscitation of a collapsed patient where they would be called upon to secure the patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s airway and ensure oxygenation until the Anaesthetists or the resuscitation team arrives. It is expected that frontline practitioners are trained and certified with acute cardiac and life support skills and confident in dealing with clinical emergencies. In reality, analysis has shown that frontline practitioners in these ISTCs, though some trained and certified, rarely use these skills due to the infrequent nature of resuscitation clinical emergencies, making these scenarios potentially high -risk events when they do occur. Frontline practitioners are made up of Resident Medical Officers (RMOs), Anaesthetic Assistants (ODAs) and Recovery Room Practitioners (RNs). RMOs are doctors who have completed their medical training and have at least two years post graduate work experience as qualified doctors. They are employed to provide 24 hours on site medical management of patients at the ISTCs and like general practitioners (RACGP 2006) and doctors outside NHS academic hospitals, are usually first on call for emergencies and the sole source of medical advice on the premises on which they work. Anaesthetic assistants and recovery room practitioners are nursing practitioners employed to assist the Anaesthetists in theatre and attend to patients just out of theatre recovering from the effects of the anaesthetic agents. Due to the academic isolation and constraints imposed by a busy and often inflexible rota, frontline practitioners find it difficult to attend CME sessions necessary for skills retention. This, coupled with infrequent use of critical resuscitation equipment like LADs, increases the risk of deskilling with potential harm to a patient in an arrest scenario. There is no formal training pathway or formalised program of Continuing Medical Education (CME) within the ISTCs and most of the frontline practitionerà ¢Ã¢â€š ¬Ã¢â€ž ¢s continued professional development is self-directed. This is likely to make them more receptive to Web based learning. It is important to remember that frontline practitioners employed at the ISTCs are in non-training posts with the ISTCs under no obligation to provide CME or time off for CME, therefore the onus and expense of CME is borne by the staff. It is expected that the convenience of time, place and curriculum will generate an interest in this method of gat hering CME credits and maintaining a procedural skills competency base. 2.2 Sampling There were 48 frontline practitioners of which each grade; RMOs (16), Anaesthetic assistants (16) and Recovery room practitioners (16) make up 33% each and were therefore proportionally represented within the Care UK ISTCs. Sampling was a matter of convenience as all 48 frontline practitioners invited to attend and those who choose to accept were recruited. Participants who choose not to interact with the resource or who choose not to undertake the pre and post written and practical examinations were excluded. It was intended that these be the only exclusion criteria. 2.3 Biases The study may be biased towards candidates interested in self- learning, continuing professional development and those interested or confident with e-learning. Experience suggested that the majority of medical practitioners recognised that continuous professional development is vital for career development and as a requirement of the GMCà ¢Ã¢â€š ¬Ã¢â€ž ¢s revalidation process, would therefore choose to participate. As an added incentive, completion of the learning resource was rewarded with internal CPD points. The research study may also be biased towards participants who were comfortable with negotiating the Internet. To minimise biases, the design of the online resource placed emphasis on simplicity, easy to follow instructions and easy navigation through the course. It was likely that most of the participants would have trained abroad with unknown learning styles and English as a second language introducing potential variation in responses. A telephone helpline, email assistance and Internet based FAQ were made available to assist the participants. It was unlikely that there would be a location bias as these treatment centers were equally spread randomly over 4 counties. 2.4 Ethics Ethical issues were considered broadly within the clinical academic research culture with management of ethics complying with Research Governance Framework standards DH ( 2008); Bowling (2002) Submission for ethics approval was made locally to the Care UK TM Companyà ¢Ã¢â€š ¬Ã¢â€ž ¢s Clinical Governance and Ethic Committee. NHS Ethics Committee approval was not needed, as the research conducted did not involve NHS patients or NHS staff. See appendix X Co-operation of each centreà ¢Ã¢â€š ¬Ã¢â€ž ¢s Medical Director was obtained to contact the frontline practitioners and to dispatch consent letters requesting informed consent to participate in the study. Each participant was provided with a description of the study, its purpose and methods, nature and reason for conducting the research, time scales involved and commitment expected. Participants were encouraged to participate and CPD points were offered on completion of the learning task. Participation however was voluntary with withdrawal from the study possible at any time thereby significantly limiting potential for coercion (see appendix). On acceptance, participants were asked to complete a consent form. Participants were assured that their information would be anonymous and that they would not be individually identified by nationality or age. Each participant was assigned a username and password, which was randomly assigned by way of a sealed unmarked envelope. The username and password was used to access the resource and was used as unique identifiers on the pre and post examination papers. The researcher conducted a blind trial with regards to the allocation of the usernames and passwords. All demographic data was treated confidentially within guidelines laid down by the Data Protection Act and all computer files were stored in a secure server which was password protected (DPA 1988). Findings of the study will be disseminated by way of the dissertation report and possible publication in a peer review journal to a wider audience. Results of the study will be offered to the participants and Care UK TM by way of an online report and formal presentation of the study results. 2.5 Summative Assessment Effectiveness of the resource was objectively measured using à ¢Ã¢â€š ¬Ã…“before à ¢Ã¢â€š ¬Ã…“ and à ¢Ã¢â€š ¬Ã…“afterà ¢Ã¢â€š ¬? written multiple choice type questions and a à ¢Ã¢â€š ¬Ã…“preà ¢Ã¢â€š ¬Ã¢â€ž ¢ and à ¢Ã¢â€š ¬Ã…“postà ¢Ã¢â€š ¬? practical skills test assessing change in knowledge, intubation skill performance and confidence. Procedural skills like behaviour are hard to change and difficult to measure, therefore a proxy measure like change in knowledge, which is easier to measure and quantify was used in the belief that an increase in knowledge is related to an increase in skill. To assess baseline knowledge, participants were randomly assigned to two groups (Group A, Group B), each group receiving a set (MCQ A1 or MCQ B1) of 10 written multiple-choice type questions which they were asked to complete before undertaking the resource. The use of multiple choice type questions has been recommended as a reliable method for use in competency based measures to measure the acquisition of knowledge. Association for Medical Education in Europe (1999) These questions were based on the content described in the lessons of the resource. Participants were requested to complete the questions on the answer sheet under examination conditions and within a time period of 15 minutes. The questions in the two sets were different, of varying degrees of difficulty and were worded in a way to prevent guessing and random answering. All the MCQS were one-best answer type with a few true false type questions included. There were no trick or extended-matching items and there was no negative marking. One point was scored for each correct answer with a maximum score of 10 per examination. An assistant was recruited to invigilate and collect the completed question sheets. Each answer sheet was identifiable only by way of the username randomly assigned to each participant and participants were requested not to discuss the questions. After a two-week period of interacting with the resource, a change in knowledge was assessed using à ¢Ã¢â€š ¬Ã…“afterà ¢Ã¢â€š ¬? written multiple choice type questions. The same format used to assess baseline knowledge was used and the same conditions were applied. Group A received MCQ B1 and Group B received MCQ A1 questions. In the event of participants discussing the questions the à ¢Ã¢â€š ¬Ã…“afterà ¢Ã¢â€š ¬? test questions, though the same were ordered and numbered differently. Psychomotor skills à ¢Ã¢â€š ¬Ã…“preà ¢Ã¢â€š ¬? and à ¢Ã¢â€š ¬Ã…“postà ¢Ã¢â€š ¬? completion of the course were evaluated using a specifically designed airway training mannequin on which the participants used the LAD. An initial à ¢Ã¢â€š ¬Ã…“preà ¢Ã¢â€š ¬? skills test was conducted before undertaking the resource and a à ¢Ã¢â€š ¬Ã…“postà ¢Ã¢â€š ¬? skills test two weeks after completing the resource. A modified, validated three pointà ¢Ã¢â€š ¬Ã¢â€ž ¢s global rating scale and a 22 point checklist was used to assess the procedural skill as suggested by the current gold standard for assessment of procedural skills Bould, (2009). Table 1 Modified 3 point global rating score of Laryngeal airway device insertion ability: Score 1 poor 2 competent 3 clearly superior Maneuvers Repeated, tentative, jerky Competent but occasionally awkward and stiff Fluid with no awkwardness Actual score Participants were presented with a scenario and their appropriate approach and performance were scored using a checklist of predetermined maneuvers with scores assigned to each step correctly performed (see appendix à ¢Ã¢â€š ¬Ã‚ ¦.). Time to ventilate the airway mannequin from initial positioning of the head and mouth opening to successful ventilation was considered a major outcome variable as the outcome was reproducible and easily quantifiable. An additional point was awarded if successful intubation was established within a time interval of 50 seconds. (ref)The researcher and a recruited assistant were used to independently assess the performance of individual participants. Participants were also asked to rate their confidence pre and post resource intervention. 2.6 Evaluation of Usability A previously validated (and modified for purpose) questionnaire evaluating learner satisfaction with the Web based educational resource was undertaken in the final part of the study (ref). Qualitative data by way of structured questions and quantitative data using a Likert Scale were collected after the post resource tests were completed. The participants were given a printed version of the questionnaire to fill in by hand and return anonymously as well as an attached word document for those wishing to return the questionnaire by way of an email. To improve the response rate, a collection box for responses were placed at each centre and a representative recruited to assist with reminders and collection. The questionnaire was made up of two parts (see appendix). The first was a set of structured questions used to collect demographic data about the participants e.g. age, gender, Internet user experience. This part of the survey was undertaken to assess whether there would be a relationship between age, gender, Internet user experience and preferences for Web based learning. Webb (2002). The second set of questions surveyed what the participants thought of the course design, course usability, the use of multimedia and interactive components, and the impact of the resource. The participants were also asked about exposure to similar learning through traditional means. This was to gain an understanding of how participants viewed technology as a means of continuing professional development and how the use of technology influenced their learning. The questionnaire consisted of 22 questions with choices ranked on a 5 point Likert scale where participants had to strongly agree, agree, disagree, strongly disagree or remain neutral. Questionnaire surveys are popular because of their low cost and ease of administration Mann (1998) and a well designed questionnaire can provide useful information in a standardised format and is widely used as a tool in continuing medical education. Pereles (1996), Morris (1997). The benefit of this type of closed-ended questions were that they were easy to standardise and analysis. The downside was that it was more difficult to design. Patton (2001). 2.7 Validity and reliability Validity and reliability describes the quality of a method of assessment and where possible previously validated tools were used. 2.7.1 Multiple Choice Questions The multiple choice type questions were drawn from a pool of unvalidated questions from past examination papers used in the training of Anaesthetic trainees. Examination questions from a pool of validated and reliable test questions would have been ideal to use however, as of this writing, availability of such a databank of questions do not exist. The panel of experts assessed the face and content validity of the questions and concurred that the questions were appropriate and tested knowledge. Concurrent validity was established by comparing the questions to a bank of questions used in the local Trust to examine trainees. The panel of experts independently categorized the test questions as easy or difficult. Where agreement could not be reached, the questions were graded as intermediate. Agreement correlation between the experts were calculated using a raw score formula for Pearsonian à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ To further establish the internal consistency or internal reliability of the questions, a difficulty score (DS) was used to define the degree of difficulty of each question against which the test papers from the pilot study was compared (Crocker 1986). Needs work à ¢Ã¢â€š ¬Ã¢â‚¬Å" speaking to Henry A degree of difficulty for each question was calculated and a Difficulty Score assigned to each grade of question: DS = the number of predicted correct answers that the participants would obtain divided by the number of all answers. Table 2 MCQA MCQB DS Difficult 3 out of 10 2 out of 10 0.25 Intermediate 2 out of 10 3 out of 10 0.125à ¢Ã¢â€š ¬Ã¢â‚¬Å" 0.25 Easy 5 out of 10 4 out of 10 0.55 Participants in the pilot study were given the two test papers (MCQA, MCQ B) to complete and a Difficulty Score was calculated on the actual answers received and compared to the predicted Difficulty Score. Analysis confirmed that different participants tended to do well or badly on the same parts of the tests thereby demonstrating internal consistency (see appendix). To test whether the MCQs were able to distinguish between pilot study participants who knew and understood the material and those who did not (that is to test the reliability of the MCQ), an overall Discriminative Index (DI) was calculated using the following calculation: DI = number of correct answers amongst the highest overall score. A DI score of 0.9 was obtained. Questions with a DI0.30 is considered as adequately discriminative. 2.7.2 Global Rating scale and modified checklist The global rating scale and modified checklist of LMA insertion were tools used in previous studies and were reported as validated, Bello (2005), Naik (2003). However, scanty to no information was provided on the validation process in the two publications and a review of checklists and global rating scales in assessment of procedural skills in anaesthesia did not report the establishment of construct or internal validity specifically for assessing intubation skills. Checklists have been shown to produce excellent reliability in trained observers, are easy to use after some training for optimal reliability, are potentially comprehensive depending on the checklist, Bould ( 2009) and using two experienced Consultant Anaesthetists as examiners of the participants performance resulted in good inter-rater agreement achieved. 2.7.3 Usability Questionnaire The questions used to assess the usability of the resource were a modified version of a validated questionnaire used in a previous study to assess technology (University of Maryland User Interaction Satisfaction 5.0 1995). These questions were specific enough to allow for meaningful, reliable measurement; however its ability to be generalised to wider groups allowed the findings to be reproduced on the participants used in this study (Maxwell 1992). 3 Data Collection and Analysis This study made use of quantitative analysis recorded on standardised data entry forms. Data from open-ended structured questions were categorised and data from closed à ¢Ã¢â€š ¬Ã¢â‚¬Å" ended Likert scale questions required quantitative analysis. 3.1 Power Calculation A power calculation using a web based power calculator for a paired t test was performed to determine the sample and the effect size to make the study significant. www.biomath.info/power/prt.htm). It was estimated that there would be a 30% mean difference of predicted change between pre and post course test scores based on the outcomes of the learning needs analysis. Using approximately one standard deviation in performance, a 5% significance level and a 70% power of the study, a sample size of 8 was suggested by the calculation to show an effect size of 1.1. However, given that it was possible to recruit more than eight participants, it was decided to operate on a smaller effect size and more participants. 3.2 Data presentation Descriptive statistics were used to describe the ordinal data derived from the Likert scale questionnaires. The data was presented as percentages in tables summarised as median or mode with the mode being most suitable for easy interpretation, variability was expressed with a range and the distribution of findings displayed in a dot-plot or bar chart. 3.3 Data Analysis The Wilcoxon signed-rank test, a non-parametric hypothesis test was applied to the ranked data from the à ¢Ã¢â€š ¬Ã…“beforeà ¢Ã¢â€š ¬? and à ¢Ã¢â€š ¬Ã…“afterà ¢Ã¢â€š ¬? MCQs and the à ¢Ã¢â€š ¬Ã…“preà ¢Ã¢â€š ¬? and à ¢Ã¢â€š ¬Ã…“postà ¢Ã¢â€š ¬? practical skills examination. This test was used to compare the two sets of scores from the same participant as an alternative to the paired Students t-test as the population could not be assumed to be normally distributed. The dependent variable was the examination scores and the independent variable the Web based resource. A SPSS data analysing program was used to generate descriptive and quartile statistics for the variables and ranks tables presented data of the comparison of participants à ¢Ã¢â€š ¬Ã…“Beforeà ¢Ã¢â€š ¬? and à ¢Ã¢â€š ¬Ã…“Afterà ¢Ã¢â€š ¬? course completion scores. Examinations of test statistic tables were used to show whether there were changes in examination scores and whether these changes were statis tically significant. Confidence Interval A 95% interval confidence level was chosen to generalise the results to that of the general frontline practitioner population. The selected sample of 48 participants as a proportion of the intended population in all the ISTCs corresponded with a Confidence Interval of ± 19%. That is to say that there was a 95% certainty that the true population proportion would fall into the range from 44% to 82% according to a Web based Confidence Interval for Proportions calculator.

Essay on The Negative Effects of Affirmative Action on...

Imagine going through your school years working hard academically in hopes of going to a respectable college and broadening your horizons. Unfortunately, many students in America strive to reach this goal only to be rejected because the university had to meet a racial quota. Every year in America many students are turned down from colleges because the University was required to select a set amount of minorities before them thanks to something knows as affirmative action. On the other hand, you may be a minority who simply can’t earn the feeling of equality because of educational and employed handicaps. Affirmative action in our education system it an unjust practice that we can do without if we can learn to live in a color-blind society.†¦show more content†¦This is not equal protection for these students. Some of these young adults may decide from their high school freshman years that they have a dream to push themselves and attend the college of their dreams and whe n this is taken away, most people feel cheated that all their hard work has just gone to waste. For some, it might even be enough to shatter their hopes and discourage them from perusing their education further or even just moving on. Having to select a number of minorities in an educational situation is just not fair to everyone. Our country is one that values and rewards hard work whether it be putting on your best to secure a job, or putting many years of work and experience into being accepted to the college you desire. If everyone wants to be treated as equals in this country then we must make these people work as equals. Nothing in this country is free without working for it and your education is not something that should be handed to you without previous dedication. You can not encourage students to go foreword in school and do the best they can only to reject them later because you gave their chance away to someone simply because they are a minority. When you work hard and are rewarded it means so much more that having it handed to you. In addition to looking at the negative outcome of non-minority students, we must also look at the effect affirmative action can have on the minoritiesShow MoreRelatedRace Based Affirmative Action On Higher Education Essay1445 Words   |  6 PagesRace-Based Affirmative Action in Higher Education In 1961, President John F. Kennedy issued Executive Order 10925, which created the Committee on Equal Employment Opportunity, or CEEO. One purpose of the CEEO was to â€Å"recommend additional affirmative steps which should be taken by executive departments and agencies to realize more fully the national policy of nondiscrimination† (Kennedy). This executive order planted the seeds that grew into what is today known as â€Å"race-based affirmative action,† or theRead MoreAffirmative Action And Its Effects On Affirmative1263 Words   |  6 PagesThroughout America there are many different views on the effects of affirmative action. Many see it as a negative policy which gives an unnecessary advantage to minorities in America. In a 2009 Pew Poll, â€Å"58% of African Americans agree† and only â€Å"22% whites agree† that there should be â€Å"preferential treatment to improve the position of blacks and other minorities† (Public Backs Affirmative Acti on†). Today affirmative action and other racial injustices tend to be in the spotlight quite often, suchRead MoreUnderlying Reasons for Affirmative Action1442 Words   |  6 PagesIntroduction The issue of affirmative action has existed for around forty years, but the Wall Street Journal reports that the idea may be coming to an end (Sander Taylor, 2012). The reason for this is that while the idea of affirmative action originated for positive reasons, it has also had some negative side effects. In light of the possibility that affirmative actions are unwound, it is necessary to consider what might happen if that were to occur. This essay will consider precisely that issueRead MoreAdvantages and Disadvantages of Affirmative Action Essay1667 Words   |  7 PagesThe Affirmative Action Debate Affirmative Action Defined Affirmative Action can be defined as â€Å"positive steps taken to increase the representation of women and minorities in areas of employment, education, and business from which they have been historically excluded (Standford Encyclopedia of Philosophy)†. However because those steps involve â€Å"preferential† selection affirmative action generates intense controversy (Standford Encyclopedia of Philosophy). Affirmative Action (Negative) Read MoreThe Ban On Affirmative Action902 Words   |  4 Pagesplan on researching why California and other states should uplift the ban of Affirmative Action is establishments like universities. Removing the ban on Affirmative Action would help encourage and advance that generally don’t gravitate towards higher education thus equalizing the playing field in terms of success in future life. So California should heavily consider lifting the legislative bans on the Affirmative Action Plan because although all Americans should be treated as equals, there are instancesRead MoreAffermative Action1316 Words   |  6 PagesBy: Elissa Thomas E-mail: elissa@usais.net Affirmative Action Affirmative Action efforts were started in 1964 to end the long history of overlooking qualified people of color and women from higher education. Affirmative Action sets standards for a business or office of admissions, so that a white man does not have the upper-hand over an equally or greater educated minority. The initial way the government tried to justify Affirmative Action was to develop a human resource approach: first identifyingRead MoreAffirmative Action For College Admissions990 Words   |  4 Pages Affirmative action in college admissions continues to be heatedly debated. In 2003, the Supreme Court had ruled in Grutter v. Bollinger that diversity was a compelling interest for colleges to use race in admissions. In the amicus brief that the American Sociological Association et al. provided to the Supreme Court, sociological evidence was presented to elucidate the value of affirmative action. Yet in 2006, Proposal 2 was passed in Michigan to ban affirma tive action in public education (Levitsky)Read More Two Views of Affirmative Action Essay1498 Words   |  6 PagesTwo Views of Affirmative Action We hold these truths to be self-evident, that all men are created equal†¦. Even before it became a nation, America was heralded as a land of equality. Thomas Jeffersons statement begs more than a few questions, one of which is: How can we ensure equality to everyone? Beginning in the late 1960s, the federal government provided an answer to this question in the form of affirmative action. In recent years, many people have called this policy into question. InterestinglyRead MoreAfrican Americans And The Civil War1309 Words   |  6 Pagesproven to have negative implications that are difficult to mend. There have been different approaches to rectify the effects of racism dating back even before the Civil War. One of the fruition of these attempts is Affirmative Action, which was initially enforced â€Å"to ensure equality in hiring† among minorities. Later, Affirmative Action was amended to include education under its protection. Throughout its duration, however, it has all eviated the racial tension unsubstantially. Affirmative Action’s attemptRead More Affirmative Action Essay1086 Words   |  5 Pages The roots of Affirmative Action can be traced back to the passage of the Civil Rights Act where legislation redefined public and private behavior. The act states that to discriminate in private is legal, but anything regarding business or public discrimination is illegal. There are two instances when opposing affirmative action might seem the wrong thing to do. The nobility of the cause that help others. Affirmative Action was a great starter for equality in the work place. The most

Skunk Hour by Robert Lowell Essay Example For Students

Skunk Hour by Robert Lowell Essay Poetry analysis: Skunk Hour, by Robert Lowell In beginning of Skunk Hour (the first four stanzas to be more precise), Robert Lowell gives the sense of a Maine sea town that is slowly declining. For example, lines 4 through 6 state the following: Her farmer / is first selectman in our village; / shes in her dotage. With the usage of the word dotage in line 6, it clearly suggests that the condition of Maine is in its declining years. For a better understanding of its poor state, stanza two (7-12) presents itself as follows: Thirsting for the hierarchy privacy f Queen Victorias century, she buys up all the eyesores facing her shore, and lets them fall. This stanza shows how dire need of help the city of Maine is because it craves for the status of Queen Victoria, who was the Queen of Great Britain and Ireland for quite some time. Even though the poem seems to be about a city that is on its last leg, Lowell presents humor to a sad scenery by mentioning, weve lost our summer millionaire, / who seemed to leap from an L. L Bean. In stanzas five and six, he is searching for love, but seems to not find such pleasure. His spirit is very low and sad, supported by line 33: My ill-spirited sob in each blood cell. The world is in essence a place that delivers pains, because he judges himself by saying, I myself is hell; / nobodys here as if there is no God. Symbolically, nobodys here, except the skunks. They are not afraid by the emptiness of the world. They search for food to eat in the darkness; the skunks feast freely without any fright. Maybe if the human race could find its way in a corrupt world as the skunks, he/she too would not be afraid. In some strange way, Lowell is trying to say that the skunks are positive models for a better world. The poem has so many messages. Not only does Robert Lowell describe the Maine sea town that is slowly declining, but he also describes an entire social culture. Basically everything in existence will meet its demise one way or another, meaning living and nonliving things. For instance, Queen Victorias century was once alive but died out at a certain time. In other words, the Victorian age represents the past; its history similar to how today will be history in the future. The summer millionaire mentioned in stanza two has also past his prime, for his possessions have been auctioned off. This is just another example that states this: what is fresh or new will become old as time passes. Nature itself has grown old and creepy which is supported by line 18: A red fox stain covers Blue Hill. This line implies that nature is stained and will continue to be stained in the future. In conclusion, Skunk Hour (1959) is interesting and well put together by Robert Lowell. Basically it states that nothing lives forever. For example, humans live at their prime (at least some do) and pass the time of existence when old age renders them depleted and death arrives. Similar to a nonliving thing like a building, it is built and as time passes, its stature declines with wear and tear until it is knocked down to the ground via implosion or bulldozers. The skunk analogy Robert Lowell uses is very profound, because it gives hope for a dying world in which humankind occupy perhaps hope that could change the way humans view life in general, and better the living conditions. ny Robert

J. O. De La Mettrie

Table of Contents Introduction Intellectual Strengths Intellectual Weakness Conclusion Reference Introduction De La Mettrie was a French philosopher and a physician who argued his philosophical ideologies contrary to other great philosophers like Descartes, Locke, Leibnitz, Wolff and Malebranche. His arguments hinged on the definition of a human nature as he rejected two philosophical systems that define human soul, materialism and spiritualism.Advertising We will write a custom essay sample on J. O. De La Mettrie specifically for you for only $16.05 $11/page Learn More Arguing from his experience as a physician, he questioned the capacity of other philosophers to define and explain the human nature from theoretical perspective only. He believed the proper definition of a human being should entail both theoretical and empirical considerations and with his philosophical knowledge and experience as a physician, he claimed to be better placed to define human nature than any other philosopher does. He argued that a human being is a complicated machine whose definition lies in the philosophical and empirical experiences of the physicians. Nevertheless, De La Mettrie, just like anybody else had his intellectual strengths and weaknesses as explored in this work. Intellectual Strengths De La Mettrie was a great philosopher because he applied his empirical experience as a physician in trying to define human nature, unlike other philosophers who relied only on their theoretical perceptions. He objectively criticized theologians and metaphysicians for trying to define human nature narrow-mindedly. He argued that, it is unwise to study nature and truth without stating their true benefits. For instance, metaphysicians theorized that, matter and thoughts relate to one another without articulating the true meaning of their theory. The proponents of materialism and spiritualism have also erred in defining the human soul from purely theoretical perception without expressing the empirical aspect. Unlike other philosophers, De La Mettrie did not want to be complacent with mere theories that make one become a slave of prejudice. He argued that observation and experience gave credible definition of the human nature and â€Å"they are to be found throughout the records of physicians who were philosophers, and not in the works of philosophers who were not physicians† (De La Mettrie, 1747, p. 92). He insinuates that, physicians alone have the ability to explain the human nature because they understand the mechanism of the body.Advertising Looking for essay on philosophy? Let's see if we can help you! Get your first paper with 15% OFF Learn More With his great intellectual ability, he realized that other philosophers and theologians did not understand the nature of the human body for they based their arguments on their sheer ignorance formulating incredible theories about the human soul. De La Mettrie (1747) wonders, â€Å"what could others, especially the theologians, have to tell us? Is not ridiculous to hear them shamelessly dogmatize on a subject that lies completely out of their province?† (p. 92). He perceived other philosophers and theologians as slaves of prejudice because obscure theories had turned them into philosophical fanatics who tried to explain human nature out of ignorance. Since the nature of a human being is complicated and hard to define, the theoretical explanation is quite incredible as â€Å"all the investigations which the greatest philosophers have conducted a priori, that is to say, by attempting in away to use the wings of the spirit, have been fruitless† (De La Mettrie,1747, p. 92). This observation is quite true because theories without true empirical application in life cannot define the nature of a human being, which is naturally complicated. Despising theologians and philosophical proponents of materialism and spiritualism, De La Mettrie pe rceived the nature of a human being as a very complicated entity that only through anatomy; one could have a glimpse of what constitutes human nature. As a physician and a philosopher, he sees, â€Å"the human body as a machine which winds itself up, the living image of perpetual motion† (De La Mettrie, 1747, p. 94). Food nourishes the body and soul, hence perpetuating the life of a human being since with food, a man becomes strong physically and the soul too gains courage and happiness, while without food, the body become weak and the soul loses courage and happiness. When the body is sick, the soul is also inflamed and both of them die together as â€Å"the soul feels itself gently sinking along with the eyelids and relaxing along with the fibers of the brain; thus little by little it becomes as if paralyzed along with the muscles of the body† (De La Mettrie, 1747, p. 93). When the body cannot withstand the weight of the head, and the soul cannot endure the burden of thoughts, then, death occurs. These observations underline De La Mettrie’s unique philosophy. De La Mettrie reasoned that the human brain is a faculty of imagination where the human soul resides. â€Å"†¦judgment, reason, and memory, are no wise absolute parts of the soul, but real modifications of the kind of medullary screen upon which images of objects painted in the eye are reflected as by a magic lantern† (De La Mettrie, 1747, p. 95).Advertising We will write a custom essay sample on J. O. De La Mettrie specifically for you for only $16.05 $11/page Learn More The human soul is complex and is indivisible into distinct parts as suggested by the theories of spiritualism and materialism. Although other philosophers concurred that the human soul is indivisible, it is ambiguous that the same philosophers coined materialism and spiritualism as the two components of the soul. The philosophers used these terms haphazardly to confuse the minds of the learners and make them slaves of prejudice. In his conclusion, De La Mettrie (1747) offers, â€Å"†¦man is a machine, and that in the whole universe there is but a single substance with various modifications† (p. 96). The physicians are the only ones who can understand this various modifications in the human body but not philosophical and theological fanatics. Intellectual Weakness De La Mettrie in his quest to explain the nature of a human being demonstrated his intellectual weaknesses. He equated the structure of the human brain with that of a monkey and that intellectual gain is similar to that of animals. â€Å"A geometrician has learned to perform the most difficult demonstrations and calculations, as a monkey has learned to take off or put on his little hat to mount his tame dog† (De La Mettrie, 1747, p. 94). He supports his argument that it is only through education that men polished their minds with knowledge to become different from monkeys. In his philosophy, he reduced intellectual capacity of the human beings to the level of animals, which is practically and logically absurd since the intellectual ability of the human being is matchless. Human beings have made many inventions and discoveries during the course of history while animals remain with their natural instincts in surviving and adapting to the changing environment. Doubting the existence of humanity, religion and a Supreme Being, is another intellectual weakness of De La Mettrie. Although he may believe the existence of God, he criticizes forms of worship and religion saying that they are dishonest as atheism. On the existence of the human being, he suggests, â€Å"perhaps he was thrown by chance on some spot of the earth’s surface; nobody knows how or why, but simply that he must live and die like mushrooms that appear from one day to the next† (De La Mettrie, 1747, p. 96). This argument underscores his intellectual weakness in trying to deny t he true existence of humanity, religion and God. The existence of humanity proves the existence of God and the religion is what links humanity to God. De La Mettrie was very biased in his argument as he viewed himself as the most intellectual philosopher and physician who should have right to critique the work of other philosophers as useless. â€Å"We even should admire all these fine geniuses in their most useless works, Descartes, Malebranche, Leibnitz, Wolff, and the rest, but what profit, I ask any one gained from the profound meditations, and from all their works? (De La Mettrie, 1747. P. 93).Advertising Looking for essay on philosophy? Let's see if we can help you! Get your first paper with 15% OFF Learn More He did not want to appreciate the great works of other great philosophers for he believed in exploring new thoughts rather than old thoughts. His intellectual weakness lies in his claims that, his knowledge of anatomy makes him the best philosopher who can explain the human nature. Conclusion De La Mettrie employed great intellectual abilities in his arguments concerning the nature of a human being, but some of his argument revealed his intellectual weakness. In his argument, he criticized other philosophers who defined human nature according to their theoretical perceptions. He argued that proper definition of human nature must entail both theoretical and empirical experience; as in his case, being a philosopher and a physician. His experience as a physician and the philosophical knowledge he had, formed a perfect combination of knowledge, which gave him the ability to explain human nature. The philosophical concepts of materialism and spiritualism are not enough in defining human soul because they have theoretical basis only. However, he demonstrated his intellectual weakness by equating the intellectual ability of human beings to that of animals. He also criticized unfairly the works of other great philosophers and further doubted the existence of God, humanity and religion. Reference De La Mettrie, J.O. (1747). Man a Machine. London: Penguin. This essay on J. O. De La Mettrie was written and submitted by user Melina Delgado to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Word Choice All Together vs. Altogether

Word Choice All Together vs. Altogether Word Choice: All Together vs. Altogether What happens when two words become one? Sometimes, like with â€Å"all right† and â€Å"alright,† both terms mean the same thing. But then we have â€Å"all together† and â€Å"altogether.† These terms have a shared origin, but they have also developed distinct meanings in modern English. How, then, should we use them? And how can you avoid errors in your writing? Let us explain. All Together (All in One Place or All in Unison) Written as two words, â€Å"all together† usually means â€Å"all in one place†: My family and I were all together on vacation last year. A slightly different use is to mean â€Å"all in unison† or â€Å"all at the same time†: Let’s sing a Christmas carol. All together now! We can also separate the â€Å"all† and â€Å"together† in some sentences. For example: All of my family and I were together on vacation last year. Let’s all sing a Christmas carol together! These mean the same as the equivalent sentences above, but they have been restructured. The key factor is that â€Å"all† is a determiner and â€Å"together† is an adverb in all of these sentences. Altogether (Entirely or Taken as a Whole) Written as one word, â€Å"altogether† usually means â€Å"entirely† or â€Å"completely†: I’m not altogether sure you used that word correctly. Another use is to mean â€Å"takes as a whole† or â€Å"all things considered†: Altogether, it was the best Christmas we ever had. Finally, especially in the UK, â€Å"in the altogether† is a slang phrase for being nude. You probably don’t need to know this, as it’s quite rare. But we find the phrase amusing, so we thought we’d share. All Together or Altogether? These terms have developed distinct meanings over time, so make sure not to confuse them. Remember: The two-word phrase all together means â€Å"all in one place† or â€Å"all in unison.† Written as a single word, altogether means â€Å"entirely† or â€Å"taken as a whole.† If you are unsure which to use, try replacing it in the sentence with â€Å"entirely† or â€Å"taken as a whole.† If the replacement fits, â€Å"altogether† will be correct. Otherwise, â€Å"all together† will be correct. And if you’d like any help checking the spelling in your writing, feel free to get in touch.

Evaluating Causal Reasoning Example

Evaluating Causal Reasoning Example Evaluating Causal Reasoning – Coursework Example Task: Evaluating Casual Reasoning Transcendental meditation causes peace as proven when crime rate rose after the Maharishi’s School of Natural Law shifted from Washington to Iowa in 1987. Nevertheless, the proof is weak since there is no alternative causal hypothesis that has been shown. The identified error is the single cause error. What shows that the evidence is weak is the assumption that transcended alone can cause peace. Perhaps there exist other causes of peace (Govier 304). Bisphenol A causes human disease, and reduction of human contact to it can reduce diseases. This was verified by a research that was conducted using the 60-year-old American males who had the highest quantity of bisphenol A in their urine. 45percent of the males had higher possibility of getting cardiovascular illness compared to men of the same age with lesser contact to the plastic compound. The error that has been committed is post hoc. This is because, it was assumed that the cardiovascular di sease was caused after the exposure to the bisphenol A. Exposure to the compound is not the only source of the cardiovascular illness. More experiments were necessary before establishing the cause (Govier 304). Regular hugs, cause improved health as proven by the outcome of the research that was done by comparing the Canadians who got hugs frequently with the ones who did not get hugs. Those who got hugs regularly were twice likely to say their psychological health had upgraded than those who hug irregularly. Nevertheless, the proof of the causal claim is weak because of error committed by the writer. The writer committed a single cause error. There could be more causes for the improved mental health apart from hugs. The writer has neglected the likelihood that other factors can result into the improvement mental health (Govier 304).Work citedGovier, Trudy. A practical Study of Argument. Boston: MA. Cengage Learning. 2009. Print.

Not Specified Yet (ACCORDING TO THE TOPIC CHOSEN BY THE WRITER) Essay

Not Specified Yet (ACCORDING TO THE TOPIC CHOSEN BY THE WRITER) - Essay Example Latin American free trade experience started in Mexico and spread out to Central and South America, and has included multiple negotiations between the United States and several countries. In this paper, I want to draw your attention into the United States-Colombia free trade agreement, its history, nature, and foundation. I will approach important data and the potential impact of this relationship; finally, I will explain different difficulties and areas of conflict that have emerged. An institution could be defined as rules, both formal and informal, that guide human activities within societies (North, Douglass 1990). An important institution is International Trade, which accelerates technological transference, competition, and productivity. The United States has put in place numerous trade agreements: the North American Free Trade Agreement (NAFTA), the Central America-Dominican Republic-United States Free Trade Agreement (CAFTA-DR), and various bilateral agreements (Australia, Chile, Israel, Jordan, Malaysia, etc). For years, Colombia has been an unconditional ally of the United States of America, and has exchanged various resources with its Northern partner. The Andean Trade Preference Act-ATPA was enacted in 1991, during Bush administration, to combat drug production and trafficking in 4 Andean countries: Bolivia, Colombia, Ecuador and Peru. It offered trade benefits to help these countries develop and strengthen legitimate industries (Office of the United States Trade Representative 2008). In 2002, the United States government extended trade preferences by a public law: the Andean Trade Promotion and Drug Eradication Act-ATPDEA, through which Latin American products and goods gained entrance without customs duties. According to the Office of the US Trade Representative, it â€Å"expanded trade benefits for

Australia's national interests would be better served by pursuing a Essay

Australia's national interests would be better served by pursuing a foreign policy that is more independent of the United S - Essay Example For instance, Australia’s primary national interest was to gain strategic dominance in the region to fight against all possible external threats. Initially it was among the colonies of UK in the pre World War II era and therefore it had to face substantial political threats soon after the independence. Hence forming ANZUS alliance with USA was the foremost step in order to safeguard the national interests of the country (McLean, 2006). However, after the US declaration of war on terror the overall nature of ANZUS was dramatically changed and Australia’s national interests began to get negatively affected by the intervention of US. Now researchers are critically analyzing the core objectives of ANZUS alliance and the current political scenario. It would be now significantly better for the Australian government to execute an independent foreign policy so as to protect its national goals and objectives. Moreover such independence will facilitate the Australian government t o save itself from the international wars and politics. But the consequences and reaction of US government in such a situation cannot be underestimated (Umetsu, 2006). This paper aims to critically evaluate the relationship between Australia and USA in terms of Australia’s national interests and foreign policy. Moreover, it will discuss the key interest behind ANZUS alliance since 1950s, the core reasons behind Australia’s participation in wars against Afghanistan and Iraq including its moral and legal justifications. This shall be followed by Australia’s relationships with Asia and Middle East subsequently leading to the end of discussion i.e. either independent foreign policy is suitable for Australia or not. Since the very beginning Australia has depended upon the British and American powers in order to gain strategic benefits and also to fulfill its national interests. When British were ruling the world Australians were under their strong influence. However, when America came into power it also took control over the foreign policies and strategic matters of Australia. This ultimately resulted in ANZUS alliance which was formed in 1950 (McLean, 2006). Historical records reveal that Australia was never able to practice complete authority over its national matters due to the mental dependency and also because of the massive influence of American power. Critics such as Alan Ramsey argue that Australian government officials have proved to be more sincere to US rather than to their own nation. Hence it can be said that Australia actually transformed into an American colony after gaining independence from Britain (McLean, 2006). Australia had some key interests in forming and maintaining ANZUS alliance. For instance, in the post-World War II era Australia needed to have strong foreign relationships in order to meet any threat to its national interests. Furthermore, the significantly strong economic position of USA played a vital role in drivi ng and uplifting the Australian economy, while on the other hand Australia was specifically interested in gaining domestic political benefits from US interventions (Beeson, 2003). If we closely analyze the address of Australian Prime Minister Julia Gillard’s to the Congress representatives in the US then we can easily anticipate that Australia is not only

Marketing Explanation Essay Example for Free

Marketing Explanation Essay Background of marketing: Starting In the 1920’s it was the production era. A product was thought to be good if it was bought by a customer. Producers could only sell what they could produce. From the 1950’s marketing was shown in a sales era. Customers didn’t buy anything unless they needed it. Communication and persuading customers to buy your good was now stronger then it was so some companies goods were better than others. From the 1960s onwards most markets have become saturated (the size of the market remains the same). This means that there is now intense competition for customers. The sophistication of marketing management has therefore developed into what we now see in a modern marketing department. Marketers are involved at a strategic level within the organisation and therefore inform an organisation about what should be produced, where it should be sold, how much should be charged for it and how it should be communicated to consumers. Modern marketers research markets and consumers. They attempt to understand consumer needs (and potential needs) and allocate organisational resources appropriately to meet these needs. Modern marketers are particularly interested in brands. They are also increasingly interested in ensuring that employees understand marketing, i.e. that everyone within the organisation involves themselves with marketing activities. Started from the 1990’s organisation had to start considering what customers actually want and had to form relationships to create ‘loyal customers’. Function of marketing: â€Å"The function of marketing is to encompass the whole process of deciding which product and services the customer will want and how will they be delivered to the customer†. (Travel Tourism book 1, Page 112) What are the aims of marketing? * Meet customers’ needs * Know the competition * Manage any threats * Research customers need * Know the market Marketing Mix: The marketing mix describes the key elements that an organisation uses to inform and persuade and meet the customers’ needs using the 4 P’s. The 4 P’s are: * Product * Price * Place * Promotion Product: â€Å"a product is anything that is offered to the marketplace that can satisfy a customer’s perceived need† (Eric Davies, Successful marketing book, 2012, page 78) Price: How much the product is being sold to the customer for? Place: The place of marketing focus of how the product is contributed to the customers and where it is being stored. Promotion: who the product is being sold to (target audience) Marketing Segmentation: marketing segmentation is the way how the target market is divided into different sectors that are a best fit for them. The 4 groups are: * Demographic * Social-economic * Geographical * Psychograph Demographic segmentation: â€Å"Gender, age, income, housing type, and education level are common demographic variables.† (http://www.decisionanalyst.com) Social-economic segmentation: Mainly split you’re through your personality. The main groups are consumer attitudes, values, behaviours, emotions, perceptions, beliefs, and interests. Geographical segmentation: This is based on where you live e.g. post code Psychographic segmentation: â€Å"This is perhaps the most common form of market segmentation, wherein companies segment the market by attacking a restricted geographic area. For example, corporations may choose to market their brands in certain countries, but not in others.† (http://www.decisionanalyst.com) E-marketing: The process of using digital technology to market products and services. Company ethos: Values and beliefs that define the company, normally expressed in vision mission statements. Virgin Atlantic Mission Statement: â€Å"Safety, security and consistent delivery of the basics are the foundation of everything we do.† â€Å"The success of our three year strategy requires us to build on these foundations by focusing on the business and leisure markets and driving efficiency and effectiveness.† (http://www.virgin-atlantic.com) Ryanair Mission Statement: Ryanair will become Europe’s most profitable lowest cost airline by rolling out our proven ‘low-fare-no-frills’ service in all markets in which we operate, to the benefit of our passengers, people and shareholders. Ryanair’s objective is to firmly establish itself as Europe’s leading low-faresscheduled passenger airline through continued improvements and expandedofferings of its low-fare service.’ Ryanair’s goal is to provide a no frills service with low fares designed to stimulate demand. (http://www.scribd.com) Consumer protection: Rules legislations that protect customers from many bad problems e.g. fraud, flight delay. There are 3 Main act that cover consumers. They are: * The Consumer Act 1987 * Data Protection Act 1998 * The Unfair In Consumer Contract Regulations 1999 The Consumer Act 1987: An Act to make provision with respect to the liability of persons for damage caused by defective products; to consolidate with amendments the Consumer Safety Act 1978 and the Consumer Safety (Amendment) Act 1986; to make provision with respect to the giving of price indications; to amend Part I of the Health and Safety at Work etc. Act 1974 and sections 31 and 80 of the Explosives Act 1875; to repeal the Trade Descriptions Act 1972 and the Fabrics (Misdescription) Act 1913; and for connected purposes. (http://www.legislation.gov.uk, 15th May 1987) So if there was an item on the plane that says its 69p but its scanned as 80p you have a right to purchase it for 69p. Data Protection Act 1998: The Data Protection Act (DPA) gives individuals the right to know what information is held about them, and provides a framework to ensure that personal information is handled properly. (http://www.admin.ox.ac.uk) The Unfair In Consumer Contract Regulations 1999: The Unfair Terms in Consumer Contracts Regulations 1999 (SI 1999 No 2083) (the Regulations) recognize that, in many circumstances, consumers have no power or influence over the details of the terms which they are asked to agree to when entering into consumer contracts. The purpose of the Regulations is to set a framework within which firms must work when drawing up their contact terms and conditions, and appoints certain third parties (known as Qualifying Bodies) who are authorized to challenge firms when they think a particular term is unfair. (http://www.cml.org.uk) Standards of practice: The advertising standards authority is an independent body set up to police the rules for advertising, sales, promotion and direct marketing. The system is aiming to protect consumers and maintain the integrity or marketing communications. P.E.S.T: P.E.S.T stands for: * P- political * E- economic * S- sociocultural * T- technological Travel tourism organisations have to be aware of the external factors that affect or influence their business. Political factors: Some political factors that would affect an organisation are: * Changes of government * Increase in tax * Security law Economical: Some economic factors that would affect an organisation are: * Recession * Exchange rates * Unemployment Socio-cultural: Some socio-cultural factors that would affect an organisation are: * More tourists * Income/trends Technological: Some technological factors that would affect an organisation are: *New technology * Websites * IT References: 1. (www.cim.co.uk) 2. http://www.atkinsmarketingsolutions.com/wp/2011/04/07/dr-philip-kotler-defines-marketing/ Friday, 16 November 2012 3. (Eric Davies, Successful marketing book, 2012, page 8) 4. (Travel Tourism book 1, Page 112) 5. (Eric Davies, Successful marketing book, 2012, page 78) 6. (http://www.decisionanalyst.com/publ_art/marketsegmentation.dai) 7. (http://www.decisionanalyst.com/publ_art/marketsegmentation.dai) 8. (http://www.virgin-atlantic.com/en/gb/allaboutus/missionstatement/index.jsp) 9. (http://www.scribd.com/doc/80225985/Marketing-Plan-for-Ryanair) 10. (http://www.legislation.gov.uk/ukpga/1987/43,15th May 1987) 11. (http://www.admin.ox.ac.uk/dataprotection/)

The Importance of Psychotherapy and Medication in the Treatment of Buli

The Importance of Psychotherapy and Medication in the Treatment of Bulimia Nervosa This researched argument is on the disorder of bulimia nervosa. The reason behind my writing about the topic of bulimia is because my sister suffers from it and I want to know how to help her. I also would like to be able to share the information I obtained while doing my research. I want to argue the importance of having both psychotherapy and medication in the treatment for the people afflicted with this serious health disorder. Society needs to be altered by the media and educated about the disorders of bulimia and other disorders that are associated with eating problems. Hopefully my essay will inform you about the health dangers and complications caused by bulimia. I also want to readers of my essay to be able to gain a deep understanding for how bulimic individuals are victims and how they are suffering with this disorder. Maybe, if more people are informed about bulimia nervosa, then the number of people suffering from this ailment will lessen. In recent years, an awareness of the negative impact of the media icons on society is extremely apparent in today's youth. Countless numbers of individuals, the majority being women, try to obtain the "ideal" body images viewed everywhere. However, this idealized image is not a realistic one. The terms "Barbie doll syndrome", "yo-yo dieting", "bulimia", and "anorexia" are commonly talked about. Unfortunately, the words are the labels for some serious disorders that have dangerous affects and sometimes lead to the death of many individuals. People in today ¹s society have idea that bulimia, or any other eating disorder, will not affect them. These people are totally wrong to think in such a m... ...e body they want, but then after that moment they can not control their weight and keep on losing more weight. Pictures of half-dead, overly skinny people should be shown to society for everyone to be able to view first hand what the end product of bulimia looks like. That the goal of the bulimic is to be thin and attractive, but the reality is that they become ugly and sickly looking. Is this the life anyone really wants to live? Works Cited 1. Fairburn CG, Overcoming binge eating, New York: Guilford, 1995. 2. The International Journal of Eating Disorders, May 1995 v17 n4 p323(7). 3.the international journal of eating disorders, July 1997 v22 n1 p1(13). 4. Behavior Research and Therapy, March 1996 v34 n3 p197(16), Author G. Tarence Wilson. 5. Patient care, November 15, 1995 v29 n18 p101(3). 6. The Addiction Letter, May 1995 v 11 n5 p7(1).

Many Are the Crimes

The period of McCarthyism brought strong anti-communist campaign in the United States which started in the 1940s and ended in the 1950s. This era was also known as the Second Red Scare. There were fears of Communist infiltration on American organizations and â€Å"espionage by Soviet agents† (Fried, 124). It was a troubled time during the McCarthy era where many Americans where charged of being Communists or being Communist sympathizers. Many of them went through a series of investigations and interrogations by government committees and agencies. These investigations were directed at individuals who work for the government, those in the entertainment business, union members and educators. Although evidences were weak and often exaggerated, suspicions were given more weight. As a result, many Americans lost their jobs and some were even incarcerated (Fried, 150). In Ellen Schrecker’s book Many Are the Crimes, the author describes the persecution of the Communist Party in the U.S. from the 1920s until the 1950s. Schrecker believed that McCarthyism contributed to the downfall of Communism in America and thrusted the country into a gulf of right-wing sentiments which plagues the U.S. until now ( Reeves, Are You Now†¦A new study of McCarthyism and the legacy of HUAC, 1998). The first three chapters of Schrecker’s book explain the Communist Party’s emergence in the 1930s in America. She explained why the Communist Party was susceptible to attacks by the U.S. government. The second chapter â€Å"Red Baiters, Inc.† is an extensive analysis of people and institutions which characterized anticommunism in the 1920s and 1930s (Schrecker, 41). The author outlines Franklin D. Roosevelt’s stance on Communism. According to Schrecker, President Roosevelt’s approach to Communism was â€Å"non-ideological† (p. 87), there were occasions that he did not pay attention to the existence of the Communist Party and there were times that he supported political suppression. Roosevelt authorized the FBI under J. Edgar Hoover to look into the Communist Party’s movement because they saw it as â€Å"a threat to national security† (p. 89). In Chapter 4, Schrecker discusses the U.S. government’s propaganda that the Communist Party was being influenced by Moscow. In Chapter 5, the author talks about how Americans saw Communism as a national threat through â€Å"subversion, espionage and sabotage† (p. 181). In the third part of Ellen Schrecker’s book, explains the â€Å"instruments† of anti-communism and how the FBI under J. Edgar Hoover used different tactics to purge communists in America by wiretapping and surveillance (p. 239). Schrecker discussed the role of Senator John McCarthy in the â€Å"anti-communist crusade†, and his â€Å"disregard for civil liberties† (p. 265). The last chapters of the book Many Are the Crimes, Schrecker talks about the experiences of Clinton Jencks and members of the workers union and how they were persecuted and eventually lost their jobs.   Schrecker explains the impact of McCarthyism in the American society, how it â€Å"destroyed the left† and paralyzed the Communist Party (p. 369). In context, Schrecker’s book exposed the effects of the McCarthy era not only in politics but also in the entertainment business wherein the Hollywood blacklist dictated who would produce movies and star in those films. Screenwriters, actors and actresses did not escape interrogation by the anticommunist committees and those found guilty of espionage were sent to jail (Whitfield, p. 194). The unions played an important part in those days because they talked about racial concerns in terms of equality. The union also provided support for women’s issues. It showed the inequality in terms of salaries that female workers get and how they are poorly-paid in comparison with the male workers. The union also encouraged women to be strong leaders. These progressive attempts of bringing change in the role of women in society and the work force were halted during the McCarthy era (Cherny, p.10). For the most part the greatest damage done during the McCarthy era was the destruction of the American left and the decline of the Communist Party in America. In terms of social policy, McCarthyism interrupted the reforms needed for health insurance. The country’s â€Å"cultural and intellectual life† became stagnant because of censorship during the McCarthy era (Schrecker, The Legacy of McCarthyism). The downfall of the McCarthy era was due to the decline of public support and court decisions which upheld individual rights and freedom (Fried, p. 197). With the current situation in the U.S., people are more vigilant and aware of the effects of McCarthyism. This episode will serve as a â€Å"cautionary tale for future generations† (Rosen, Could It Happen Again?). Works Cited Cherny, Robert W., William Issel and Kieran Walsh Taylor. American Labor and the Cold War: Grassroots Politics and Postwar Political Culture. New Brunswick, New Jersey: Rutgers University Press, 2004. Fried, Albert. McCarthyism, The Great American Red Scare: A Documentary History. Oxford: Oxford University Press, 1997. Reeves, Thomas C. â€Å"Are You Now†¦.A New Study of McCarthyism and the Legacy of HUAC†.   14 June 1998. http://www.nytimes.com/books/98/06/14/reviews/980614. 14reevest.html. Retrieved on 7 January 2008. Rosen, Ruth. â€Å"Could It Happen Again?† 12 May 2003. http://www.commondreams.org/ views03/0512-01.htm. Retrieved on 7 January 2008. Schrecker, Ellen. â€Å"The Legacy of McCarthyism†. Retrieved on 7 January 2008. Schrecker, Ellen. Many Are the Crimes: McCarthyism in America. Princeton, New Jersey: Princeton University Press, 1999. Whitfield, Stephen J. The Culture of the Cold War. Baltimore: The Johns Hopkins University Press, 1996.