E.Port Final

audiometry

the use of an audiometer to measure hearing acuity

bronchoscopy

the visual examination of the bronchi using a bronchoscope

Testwiseness

"A subject's capacity to utilize the characteristics and formats of the test and/or the test-taking situation to receive a high score" -->Millman, Bishop, and Ebel (1965) "Analysis of testwiseness" (1965)

When all else fails...GUESS

"Guessing nearly always pays off in a course for which you've studied, because when you have studied, you will rarely encounter a question about which you know absolutely nothing." Guessing always pays off when there's no penalty for it.

NYS Office of the Professions

"The State Education Department, under Regents' direction, administers professional regulation through its Office of the Professions, assisted by the State Boards for the Professions." http://www.op.nysed.gov/

Critical Thinking Defined

"active, persistent, and careful consideration of a belief or a supposed form of knowledge in the light of the grounds which support it and the further conclusions to which it tends" John Dewey - 'Thinking about thinking' (Metacognition) - 'Analyzing and evaluating thinking to improve thinking'

Examples of Critical Thinking (2 of 3)

- Construct cogent arguments rooted in data rather than opinion - Attend to contradictory, inadequate or ambiguous information - Recognize that a problem may have no clear answer or single solution - Consider all stakeholders or parties affected in suggesting a course of action

audiogram

(graphic) record of hearing

Test Taking Skills Three Pass Stategy

*1st Pass:* answers you're sure of and that come easily *2nd Pass:* go back to the ones you've marked to rethink. If still really uncertain, move on *3rd Pass:* the really tough ones. (but now you should have 'money in the bank')

Assumptions & Inferences

*Assumptions:* belief that was previously learned, not questioned - taken for granted (subway is a dangerous place; ulcers caused by stress) *Inferences:* deriving one idea from another - if this, then that (knife left on train used un crime, sedatives will prevent ulcers) *Logical inferences are based on sound assumptions*

Professionalism vs 'Ethical Integrity'

*Autonomy:* acknowledge a person's right to make choices *Beneficence:* (do good) - provide benefits *Nonmaleficience:* do no harm *Justice:* treat other equitably

Causal Explanation (2 of 2)

*Fallacy:* confusing cause with effect: 90% of patients having an MI have chest pain; I have chest pain, I must be having a heart attack; chest pain (symptom) is an effect of the condition (MI) not the cause; it still applies if 100% of patients having an MI have chest pain

Causal Explanation (1 of 2)

*Fallacy:* correlation proves causation *Fallacy:* Post hoc, ergo propter hoc: after that, therefore because of that - thinking that because one event preceded another proves that the earlier event caused the later one - Strongest (but not absolute) confirmation of causal hypotheses is the controlled experiment

Test Taking Skills Time Management

*KNOW ABOUT or LOOK over the test first* - See how many questions there are and how long you have to answer them - Subtract 10-15 minutes for checking your answers depending on your test-taking styles - Divide the rest by 2 --> the half-way point

Problem Solving #1

*Philanthropist* - Promote environmentalism - Reduce dependence on foreign oil *Choice* - SUV 15mpg --> Car 27 mpg (12 mpg difference) - Car 27 mpg --> Hybrid 60 mpg (33 mpg difference)

Medical Literature

*Publication Bias:* selective publication of research findings depending on the nature and direction of results - Inherent limitations of medical research using human subjects - controlled experiments usually just not possible

Problem Solving #1 Answers

*SUV* 10,000 mi/yr / 15 = 667 gallons 10,000 mi/yr / 27 = 370 gallons *Save 297 gallons* *Car* 10,000 mi/yr / 27 = 370 gallons 10,000 mi/yr / 60 = 167 gallons *Save 203 gallons*

Civility and Professionalism

*Structural Attributes* - Specialized Knowledge and Skills - Licensure/Certification - Professional Associations - Social Prestige - Code of Ethics *Attitudinal Attributes* - Belief in service to public - Self-regulation - Professional Organization sets standards

True/False Questions

- *if it is not completely true, it's false* - In a complicated question break it up into phrases and make sure that each one is correct (in other words, make each phrase a T/F statement) - On the other hand, don't over-read the question - remember the 6-chambered heart

Test Taking Skills Multiple Choice Hints

- A 'good test taker' has the calm and focus to stick with a difficult question to figure it out (AFTER you've answered the easier ones) - Use your partial knowledge to figure out the questions for which you don't immediately have an answer.

ABIM Challenges to Professionalism

- Abuse of Power - Arrogance - Greed - Misrepresentation - Impairment - Lack of conscientiousness - Conflict of Interest

Professionalism Framewoks *ABIM*

- Altruism - Accountability - Excellence - Duty - Honor and Integrity - Respect for Others (American Board of Internal Medicine 1995)

Test Taking Skills Multiple Choice - *Pay special attention to qualifying words*

- Always - Never - Except - Only - Necessarily - Must - Completely - Often - Sometimes - Perhaps - May - Generally

Problems

- Bias - Misinformed - Vague - Illogical

Critical Thinking Defined

- Careful application of reasoning to evaluate whether a claim is true - Widely applicable

Intellectual Standards

- Clarity - Accuracy - Precision - Relevance - Depth - Breadth - Logic

Emotional Intelligence

- Clinical interactions can result in happiness, guilt, grief, compassion, pride, anxiety, anger, etc - Professionals exhibit 'Emotional Intelligence:' --> Knowing one's own emotions --> Managing one's emotions --> Motivating oneself --> Recognizing emotions in others --> Handling relationships

Examples of Critical Thinking (3 of 3)

- Correctly and precisely use evidence to defend the argument - Present evidence in an order that contributes to a persuasive argument

Test Taking Skills Multiple Choice - Review

- Depending on the directions, the answer should be either completely correct or completely wrong before you choose it. If it's a mix of both, it's probably not the correct answer - For more difficult questions, *make your best guess, mark or flag the question and move on.*

Test Taking Skills Strategies for Difficult Questions

- Eliminate options that you *know* are incorrect - "All of the above" is probably correct if you can find 2 options you know are correct (UNLESS there is an answer like 'a&b are correct') - "None of the above" *cannot* be the answer if *any* of the other choices are correct - Choices which say exactly the same thing in different ways are probably wrong - Remember to look at other questions which may give a hint for the one you're stuck on - Use your medical terminology to figure things out - Don't get PARALYZED

Clinical Reasoning

- Expert thinking - Evidence-based -> scientific - Also - ethical, psychosocial, economic and legal aspects

When should you change your answer?

- Find out if you're generally a right --> wrong changer or a wrong --> right changer - NEVER change answers unless you have a good reason for doing so (not just second-guessing yourself)

*Rule Two* (via Kaplan PANCE Guide)

- If you truly can't eliminate any of them, have a favorite letter that you choose - Again - does not improve your odds, but it does keep you from getting stuck

Credibility

- Is the source credible enough to warrant belief? - Publisher's clearing house prizewinner call - Are degrees of credibility - "Interested Party" or conflicts of interest = less credible - Applies to literature, patients, co-workers, etc

What comprises a "good" soap note?

- Makes the case for your diagnosis - Omit extraneous or non-contributory information · - Underline abnormal findings - Short, concise without omitting pertinent information - Document only what you did

Test Interpretation Types

- Normal Values - Sensitivity - Specificity - Types --> Screening --> Diagnostic --> Ongoing evaluation - Pre-test probability

AAPA Statement of Values (2 of 3)

- PAs assess their personal capabilities and limitations, striving always to improve their medical practice - PAs actively seek to expand their knowledge & skills, keeping abreast of advances in medicine

AAPA Statement of Values (3 of 3)

- PAs work with other members of the health care team to provide compassionate and effective care of patients - PAs use their knowledge and experience to contribute to an improved community - PAs respect their professional relationship with physicians - PAs share and expand knowledge within the profession

Professionalism Frameworks

- Patient-centered Care - Integrity & Accountability - Pursuit of Excellence - Fair and Ethical Stweardship of Healthcare Resources

AAPA Statement of Values (1 of 3)

- Physician assistants hold as their primary responsibility the health, safety, welfare and dignity of all human beings - Physician assistants uphold the tenets of patient Autonomy, Beneficence, Nonmaleficience and Justice - PA recognize and promote the value of diversity - PAs treat equally all persons who seek their care - PAs hold in confidence the information shared in the course of practicing medicine https://www.aapa.org/wp-content/uploads/2017/02/16-EthicalConduct.pdf

Test Taking Skills Read the Directions & Questions Carefully

- Read the directions and each question more than once - One of the most common reasons for getting questions wrong is misreading the test directions or the question stem

Test Taking Skills Multiple Choice - Approach

- Read the question at least twice and try to answer it BEFORE looking at the answers - *HOWEVER,* continue to look at all of the answers before actually marking your choice (sometimes you're looking for the BEST answer among several with correct parts) *EXCEPTION* On a long case question, the strategy changes: - Read the answers first and then the case

OP - Professional Misconduct Includes: (2 of 2)

- Releasing confidential information without authorization - Being convicted of a crime - Failing to return or provide copies of records on request - Being sexually or physically abusive - Abandoning or neglecting a patient in need of immediate care - Performing unnecessary work or unauthorized services - Practicing under the influence of alcohol or other drugs

Examples of Critical Thinking (1 of 3)

- Separate fact from opinion - Determine what information is or is not pertinent - Recognize the ways in which evidence is limited or compromised - Present his/her own analysis of data - Draw connections between discrete sources of data

Differential Diagnosis

- The determination of which one of two or more diseases or conditions a patient is suffering from, by systematically comparing and contrasting their clinical findings - Usually in order of most likely to least likely - Can also be of a clinical finding i.e. calcification on chest x-ray

Professionalism Issues

- Use of electronics while seeing patients - Appearance and language - Representation - Not enough time - Reaction to hostility - Attendance - Completing assigned tasks

SOAP note mistakes

- having a physical exam template with all the normals already pre-written but you did not do all physical exams this time; This can hurt not just your credibility but may translate into actually harming a patient - omiting important information - not clearly signing as. "physician assistant student" be clear in your credentials -verbose, including extraneous information and/or a lot of medical abbreviations not approved

Evidence-Based Medicine

1. Formulate Question 2. Gather & Assess Information 3. Apply to problem at hand "Integrates individual experience with best available external evidence" -- White B.

Professionalism

A professional is one who willingly 'adopts' and consistently applies the knowledge, skills and values of a chosen profession. (American Academy of Professional Coders) vs. 'Unprofessional Behavior

What is lymphangiography?

A special exam in which an IV dye and radiograph are used to detect lymph node involvement, reveals the degree and extent of blockage in the lymph system.

The Plagiarism Spectrum (1-5)

10 Types of Plagiarism Ordered from *MOST to LEAST severe*: 1. CLONE: An act of submitting another's work, word-for-word, as one's own. 2. CTRL-C: A written piece that contains significant portions of text from a single source without alterations. 3. FIND-REPLACE: The act of changing key words and phrases but retaining the essential content of the source in a paper. 4. REMIX: An act of paraphrasing from other sources and making the content fit together seamlessly. 5. RECYCLE: The act of borrowing generously from one's own previous work without citation; To self plagiarize.

The Plagiarism Spectrum (6-10)

6. HYBRID: The act of combining perfectly cited sources with copied passages—without citation—in one paper. 7. MASHUP: A paper that represents a mix of copied material from several different sources without proper citation. 8. 404 ERROR: A written piece that includes citations to non-existent or inaccurate information about sources 9. AGGREGATOR: The "Aggregator" includes proper citation, but the paper contains almost no original work. 10. RE-TWEET: This paper includes proper citation, but relies too closely on the text's original wording and/or structure http://turnitin.com/assets/en_us/media/plagiarism_spectrum.php

What is the Glasgow Coma Scale?

A neurologic scale used to assess level of consciousness based upon this criteria: eye opening, verbal response, motor response

What is creatine kinase?

Creatine kinase (CK) catalyzes the breakdown of creatine to creatine phosphate testing for the presence of this enzyme in the blood which can indicate condition that can cause muscle weakness

What is a cystoscopy?

Cystoscopy is a procedure used to see inside your urinary bladder and urethra using a hollow scope (cystoscope)

CUNY Policy on Academic Integrity

Academic dishonesty is prohibited in The City University of New York. Penalties for academic dishonesty include academic sanctions, such as failing or otherwise reduced grades, and/or disciplinary sanctions, including suspension or expulsion.

What is UGI series?

An upper gastrointestinal series (UGI) is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract

What part of the soap note is a one to two sentence summary of the patient and a working differential diagnosis?

Assessment

What is the difference between inferences and assumptions?

Assumptions: belief that was previously learned, and taken for granted; not questioned Inferences: deriving one idea from another

What is rheumatoid factor?

Commonly seen in RA; IgM autoantibody against Fc portion of IgG that is a marker of tissue damage and disease activity blood test used to diagnose rheumatoid arthritis

Cognitive Biases

CDR = Cognitive Disposition to Respond - Can be subconscious - Errors can be classified in three ways --> No-fault errors --> System errors --> Cognitive Errors

What is the difference between CT and MRI?

CT: x-ray, computer generated cross-sectional images, used to evaluate musculoskeletal MRI: imaging that used magnetic fields and radiofrequency waves to visuals anatomic structures; often used to diagnose joint problems

Problem #2

Father and son in a terrible car crash - Father dies - Son rushed to OR for Neurosurgery Neurosurgeon enters room and exclaims 'I can't operate! This boy is my son!' *Boy's MOTHER is the surgeon*

Husbands & Wives Examples

Fred, Ed and Ted are married to Joan, Sally and Vicky. Joan, who is Ed's sister, lives in Detroit. Fred dislikes animals. Ed weighs more than the man married to Vicky. The man married to Sally breeds Siamese cats as a hobby. Fred commutes over 200 hours each year from his home in Ann Arbor to his job in Detroit. Match them up!

Diagnostic Errors Cognitive Errors

Gaps in knowledge or experience, faulty test interpretation, cognitive bias

Professionalism vs 'Professional Integrity'

Having moral principals guide behavior

Pre-Test Probability / Predictive Value

Lyme Disease Example - Predictive values vary with prevalence = clinical judgment important

Problem #4

Two elderly patients are seen separately by an expert clinician and diagnosed with moderate osteoarthritis. They are twins and have exactly the same clinical presentation. The clinician aggressively treats one twin with medications while the other is treated conservatively. How come? *Income differences, physical therapy options, housing (walk-up apt vs. home)*

The Up/Down Rule (via Kaplan PANCE Guide)

If down to 2 choices and you're stuck - Up for even numbered questions - Down for odd numbered questions --> this doesn't increase your chances of getting it right, but it does keep you from wasting your time being stuck

What part of the soap note is the HPI and ancillary patient-provided information?

Subjective

SOAP Note

Subjective: patient reported Objective: observed physical examination and diagnostic study results Assessment - includes differential diagnosis Plan - includes any type of intervention, further work-up or treatment

What is a barium enema?

It is a radiographic exam of the large intestine during and after the retrograde administration of barium sulfate and/or air (double contrast).

Clinical Judgment

Judgment A. the process of forming an opinion or evaluation by discerning and comparing B. an opinion or estimate so formed (Webster Online) *Knowledge base + experiences are basis for clinical judgment.*

Clinical Diagnostic Reasoning

Judith Bowen - University of Oregon *Classroom Learning* - parallels syllabus - compartmentalized - contextual clues *Clinical Learning* - patient-centered - complex, multi-system - contextualized in 'Patient Story'

Diagnostic Errors System Errors

Lack of appropriate equipment or testing, error tolerance culture, communication problems

Novice vs. Experienced (example)

My knee hurt so much last night, I woke up from sleep. It was fine when I went to bed. Now it's swollen. I've had problems before in the same knee, once nine months ago and once two years ago. It doesn't bother me between times.

What part of the soap note is the vitals signs and physical exam?

Objective

Obtaining Unfair Advantage

Obtaining Unfair Advantage is any action taken by a student that gives that student an unfair advantage in his/her academic work over another student, or an action taken by a student through which a student attempts to gain an unfair advantage in his or her academic work over another student. Examples of obtaining unfair advantage include: - Stealing, reproducing, circulating or otherwise gaining advance access to examination materials. - Depriving other students of access to library materials by stealing, destroying, defacing, or concealing them. - Retaining, using or circulating examination materials which clearly indicate that they should be returned at the end of the exam. - Intentionally obstructing or interfering with another student's work.

Test Interpretation What is Sensitivity?

Percentage of diseased patients identified as having disease >> both are prevalence-independent

Test Interpretation What is Specificity?

Percentage of well patients identified as not having disease >> both are prevalence-independent

Plagiarism

Plagiarism is the act of presenting another person's ideas, research or writings as your own. Examples of plagiarism include: •Copying another person's actual words or images without the use of quotation marks and footnotes attributing the words to their source. •Presenting another person's ideas or theories in your own words without acknowledging the source. •Failing to acknowledge collaborators on homework and laboratory assignments. •Internet plagiarism, including submitting downloaded term papers or parts of term papers, paraphrasing or copying information from the internet without citing the source, or "cutting & pasting" from various sources without proper attribution.

What part of the soap note is your proposed intervention(s) depending on your assessment?

Plan

OP - Professional Misconduct Includes: (1 of 2)

Professional misconduct includes the following: - Engaging in acts of gross incompetence or gross negligence on a single occasion, or negligence or incompetence on more than one occasion - Permitting or aiding an unlicensed person to perform activities requiring a license - Refusing a client or patient service because of race, creed, color or national origin - Practicing beyond the scope of the profession

Diagnostic Errors No Fault Errors

Rare disease misdiagnosed, atypical presentation, patient non-adherence

Problem #3

Rooster Problem - Rooster is on the peak of a roof - facing Northeast - If the rooster lays an egg, which direction would it roll down the roof? *It wouldn't as Rooster's don't lay eggs*

Testwiseness Example Question

The climate of LaBruk is: A. Damp *B. Warm and Sunny* C. Dark and rainy D. Frequently moist

Defining and Discriminating Features of a Set of Diagnostic Hypotheses for Acute Arthritis

The problem representation is "acute onset of a recurrent, painful, monoarticular process in an otherwise healthy middle-aged man." Defining features are descriptors that are characteristic of the diagnoses (e.g., gout, septic arthritis, osteoarthritis). Discriminating features are descriptors that are useful for distinguishing the diagnoses from one another.

Cheating

The unauthorized use or attempted use of material, information, notes, study aids, devices or communication during an academic exercise. *Examples of cheating include:* •Copying from another student during an examination or allowing another to copy your work. •Unauthorized collaboration on a take home assignment or examination. •Using notes during a closed book examination. •Taking an examination for another student, or asking or allowing another student to take an examination for you. •Changing a graded exam and returning it for more credit.

Paradigm Shift

Thomas Kuhn -- The Structure of Scientific Revolutions 1962 - Concept Continuity vs. Paradigm Shift - Copernican Revolution - Change in the 'rules' possible

What is erythrocyte sedimentation rate (ESR)?

Time measurement of RBC settling in a test tube over an hour products of inflammation like fibrinogen coat RBCs and cause aggregation. ESR simply describes the fact that the more aggregation = faster the RBCs fall to the bottom of a test tube. Increased rates are associated with anemia or inflammation

One Antidote to Test Anxiety

To practice when you DON'T have an exam in the immediate future. Take a few moments away from stress in a quiet place. Imagine a time when you were a "hero" in a situation or when you were faced with a big challenge, and you got through it successfully. It needs to be a situation where you needed to gather your skills and best judgment to solve a problem or correct a bad situation. Once you have selected such a moment in your life, spend at least 10 minutes a day in a quiet place reliving the event, trying to bring back the memory in as much detail as possible. What was the weather like? What was the light like? Were there any characteristic smells? What were you wearing? Were there any particular sounds? Recall as much of the sensory information as you can. As you practice this you will get better at "putting yourself back in the moment". Try to fell how your physiology felt to you - the sense of accomplishment and success. Perhaps there was happiness attached to it or warmth or affection or just feeling like you'd done a good job in a difficult situation. Reliving this experience can help put your mind and body back into that calmer state and help you to focus your best attention on the exam.

Test Interpretation What are Normal Values?

Typically two standard deviations, includes 95% of normal population = 5% of normal will have abnormal results

Hertz (Hz)

Unit of measurement for frequency or pitch of sound

What is an arthrography?

X-ray imaging of a joint using contrast dye

What is bone densitometry?

X-ray technique to measure bone density

What is an electronic portfolio?

a collection of electronic evidence assembled and managed by a user...such electronic evidence may include input text, electronic files, images, multimedia, blog entries, and hyperlinks. E-portfolios are both demonstrations of the user's abilities and platforms for self-expression. If they are online, users can maintain them dynamically over time.

What is test wiseness?

a subject's capacity to utilize the characteristics and formats of the test and/or the test-taking situation to receive a high score

otoscope/otoscopy

an instrument used to visually examine the external ear canal and tympanic membrane

What is a antinuclear antibody (ANA) test?

assessment for autoimmune disorders such as LUPUS and RA

What is an epstein-barr virus (EBV) antibody test?

diagnostic test for MONO

What is a electromyogram (EMG)?

diagnostic test that produces a graphic record of electric currents that are associated with muscle action

What are evoked potential studies?

diagnostic test. that use an EEG to record changes in brain waves during various stimuli

Professionalism Defined

the conduct, aims or qualities that characterize or mark a profession or a professional person Annals of IM 2002: basis of medicine's contract with society -> no specific, common definition

What is an EEG?

electroencephalography - measures electrical impulses in the brain (as waves)

What is a athroscopy?

endoscopic exam for the inferior of a joint

What is a deep tendon reflex (DTR)?

evaluation of the response of a muscle to stimuli to provide information on the integrity of the CNS and PNS exaggerate reflex indicate a problem with CNS decreased reflex indicate a problem with PNS

radiography

examination of any part of the body by x-rays

Test Interpretation *On-going evaluation*

good precision good accuracy lower cost

Test Interpretation *Diagnosis*

good sensitivity and specificity -might be higher risk, higher cost

Test Interpretation *Screening*

high sensitivity low risk low cost

What is the Glasgow Coma Scale (GCS)?

how an extent of trauma is measured 14-15 = minor head trauma 9-13 = moderate <8 = severe worst possible score is 3

audiometer

instrument to measure hearing

What is a sphygmomanometer?

instrument used to measure blood pressure

tympanometry

measurement (of movement) of the tympanic membrane

glucose tolerance test (GTT)

measurement of the body's ability to metabolize carbohydrates by administering a prescribed amount of glucose after a fasting period, then measuring blood and urine for glucose levels every hour thereafter for 4 to 6 hours

What is a bone scan?

nuclear medicine imaging of bone to diagnose bone disorders

What is a reflection?

pivotal to meaningful student ePortfolios, which function as sites for prompting, documenting, and sharing students' reflection on their learning. And reflection helps to move outcomes assessment beyond accountability as individuals and programs reflect on assessment findings and their implications for curricular and pedagogical change.

What is a PET scan?

positron emission tomography a nuclear medicine procedure that shows metabolic activity that can correspond to various type of brain activity

What is a bronchoalveolar lavage (BAL)?

procedure performed during bronchpscopy to collect cells of alveoli; saline solution is instilled into distal bronchi that solution is then withdrawn along with alveolar cells

What is scintigraphy?

procedure using a scintillation (gamma) camera in which lymphatic absorption of a radioactvie substance leads to a computer-gernated image detecting increased metabolic activity as "hot spots".

tympanogram

record of middle ear function (presented in graph form)

electronystagmography (ENG)

recording of eye movements in response to electrical impulses to diagnose balance problems

What is the Babinski sign?

reflex action in which the big toe remains extended when the sole of the foot is stroke neurologic test performed on the sole of the foot to indicate injury to the brain or spinal nerves negative: if there is toe flexion Positive sign after age 2: This suggests that there is been spread of the sensory input beyond the S1 myotome to L4 and L5.

What is Bloom's Taxonomy?

six levels of comprehension: knowledge level (students give back info that is on the page), comprehension level (students show that they can give the meaning of terms, idioms, etc), application level (life applications), analysis level (students examine the parts or components of a passage), synthesis level ( students move from specifics to generalitites, evaluation (students judge if a passage is fact or opinion, true or false, biased or unbiased.

What is polysomnography?

sleep study monitoring and recording normal or abnormal activity during sleep to diagnosis sleep disorders

What is a uric acid test?

test for elevated presence of uric acid in the blood indicating gout

video-assisted thoracic surgery (VATS)

the use of a thoracoscope to view the inside of the pleural cavity through very small incisions

Decibel (dB)

unit of measurement; measures intensity of sound

What is esophagogastroduodenoscopy (EGD)?

visual exam of esophagus, stomach, duodenum with endoscope

What is a laparoscopy?

visual examination of the abdominopelvic cavity with a type of endoscope called a laparoscope

Falsification of Records and Official Documents (examples)

•Forging signatures of authorization; falsifying information on an official academic record; falsifying information on an official document such as a grade report, letter of permission, drop/add form, ID card or other college document.

What does reflective journaling do?

•Reinforces learning •Form of self-directed learning •Encourages critical thinking •Encourages integrative learning •Documents changing skill sets •Encourages reflective professional practice

Academic Dishonesty

•Submitting substantial portions of the same paper to more than one course without consulting with each instructor. Preparing answers or writing notes in a blue book (exam booklet) before an examination. •Allowing others to research and write assigned papers or do assigned projects, including using commercial term paper services. •Giving assistance to acts of academic misconduct/ dishonesty. •Fabricating data (in whole or in part). •Falsifying data (in whole or in part). •Submitting someone else's work as your own. •Unauthorized use during an examination of any electronic devices such as cell phones, computers or other technologies to retrieve or send information.