OSCE For Assessing Nutrition Care Process

2y ago
58 Views
4 Downloads
628.32 KB
17 Pages
Last View : 1d ago
Last Download : 2m ago
Upload by : Camille Dion
Transcription

3/26/2018While you get connected .1 Go to SOCRATIVE.COM on phone orcomputer using your browser: Enter Classroom Myers7751Teaching and Evaluating criticalthinking in dietetics using NCP/T:OSCE’S, KAHOOTS AND SOCRATIVEWinnie Chee,,PhD, FNSM,FMDAProfessor, International Medical University, Kuala Lumpur, MalaysiaEsther Myers, PhD, RDN, FANDAdjunct, North Dakota State University, Fargo, North DakotaEF Myers Consulting, IncOverview of today’s webinarObjective Structured Clinical Examination (OSCE) fordietetics Learn about exciting new ways to make case based approachesto teaching NCP and dietetics come alive for students. Identify benefits and challenges of using an objectivestructured clinical examination (OSCE) for dietetics Hear about the development and use of the ObjectiveStructured Clinical Examination (OSCE) for dietetics. TheOSCE is currently being used in other medical professions butnot yet widely used in dietetics Evaluate whether their educational program can/shouldpursue development of an objective structured clinicalexamination (OSCE) for dietetics Experience two free types of on-line teaching tools (Kahoot andSocrative).Making case based learning realistic (and fun!!) Identify various types of free interactive game/quiz productsthat support using case-based simulations in dietetics education Select or create activities to teach students how to apply theNutrition Care Process in a case based approachOSCE for assessingNutrition Care ProcessWinnie Chee, PhD, FNSM,FMDAProfessor, Nutrition & DieteticsInternational Medical UniversityKuala Lumpur, Malaysia1

3/26/2018Learning Objectives Identify benefits and challenges of using an objective structuredclinical examination (OSCE) for dietetics Evaluate whether their educational program can/should pursuedevelopment of an objective structured clinical examination (OSCE)for dieteticsIdentify the process for developing OSCE at IMUDescribe benefits and challengesDescribe results from OSCE at IMUInternship rotationBackgroundIMU : 1 of 6 top ranking universities inMalaysiaTOTAL 1200 hours4 years Bachelor’s program in DieteticsGraduated 245 alumni with goodemployer feedback in the past 10 yearsPioneers in new employment areas –pharmacies, long term care facilities,international schools, web-based companiesFood Service Placement(160 hours)Curriculum benchmark – ICDANutrition Care Process and Standardised LanguageCommunity DieteticsPlacement ( 160 hours)Clinical Placement(800 hours)Why adopt the NCP in teaching & practice?We were already performing components of the Nutrition Care Process –Assessment ( ABCD), Implementation, Monitoring.It provided an opportunity and framework to standardised practice bylocal dietitiansAll students and faculty have FREEaccess to eNCPT as subscribed byMalaysian Dietitians’ AssociationNutrition Diagnosis helps to focus/prioritise the nutrition problem andinterventionElevate the status of dietetics practice2

3/26/2018How do we teach NCP in IMU’s curriculum?1. TheorySemester 2 : NutritionAssessment MethodsSemester 5:Medical Nutrition Therapy 1Education & counselling indieteticsNutrition Care Process for Dietetics PracticeStudents will learn the framework to provide nutrition carefollowing the steps in nutrition care process (NCP) and its practicalapplication for various clinical conditions in dietetics practice.The use of standardized language or nutrition care processterminologies (NCPT) for each step of the NCP will also beintroduced.Semester 6 :Medical Nutrition Therapy 2Emphasis will be placed on the assessment and monitoring &evaluation domains within the NCP and labelling of the nutritionproblem called nutrition diagnosis.Nutrition Care Process forDietetics PracticeThis module enhances applications of medical nutrition therapy(MNT) 1 and 2 and nutrition counselling and education.Develop Clinical Mind MapsCASE-BASED LearningHow do we teach NCP in IMU’s curriculum?2. Case-based 3. SimulationClinical Practice : NCP worksheets for all cases4. RealsettingGoalsMedical DiagnosisClient HistoryNutrition PrescriptionNutrition PlanRationale & justificationAnthropometry,Biochemistry, NFPE,Comparative StandardsMonitoring & evaluationFinal Year Assessment on Clinical CompetenceObjective Structured Clinical Examination (OSCE) Clinical Competency Case Portfolio Professional conduct IMU is the first in Malaysia toimplement OSCE as an exit examfor clinical dietetics skills OSCEMini-CEX :componentsof NCPADIME Objective Structured ClinicalExamination (OSCE) is wellestablished method of assessingclinical competence in medicine. The aim of the OSCE was to assessclinical skills performance.3

3/26/2018What is an OSCE?What is an OSCE? Objective –all candidates arepresented with the same stimuliWhat is an OSCE? Objective Structured Clinical Examination – Test ofperformance of clinicalcompetencies, with an emphasis onskills and attitudes Objective Structured – Specific foundationaland functional competencies aretested at each station and themarking schema for each station isstructuredWhy Use the OSCE?Problems in use of routine clinical practice as assessments includevariability in difficulty level of cases, patients may be uncooperative or tooill to interact fully with the student – introduce bias and subjectivity tostudents assessment OSCE provides standardised assessment: Use standardised patientsStructured & objective assessment of the process of delivering nutrition careTest not only knowledge and skills, but also attitudesTest how students are able to integrate knowledge, skills and communication withpatientsThe OSCE Design Each station: 1 minute Reading time & 9minutes to complete the activityMulti-station arrangement; every station assess a different competency in Nutrition care ProcessUse standardised patient and watched by an examiner in each stationStudents rotate through a number of stations & allocated equal time in each 10 minute stationEach student performs the same set of tasks and mark according to the same criteria on theexaminer’s mark sheet4

3/26/2018Example of Counselling StationSteps in designing an OSCEStation 7INSTRUCTIONS TO STUDENTSPg 2/2Case scenario (Exam Copy)Ms Tang is a 45 year old Chinese lady with hyperlipidemia on diet control only. She has a 16-year old daughterand works as a bank clerk from 9am to 7pm from Mondays to Saturdays.A complete OSCE stationincludesShe was referred to the dietitian for Therapeutic Lifestyle Changes to lower her blood cholesterol levels.After the first visit to the dietitian, Ms Tang can successfully reduce her fat intake for most meals except lunch.This session is a follow-up visit to the diet clinic. a construct, a mark scheme, candidateinstructions, examiner instructions, instructions forsimulated patient and an equipment listA copy of her diet history is as attached:Patient diet history (follow-up)TimeFoodsPortion SizeFrequency7.30 amBreakfast(Home)Wholemeal bread Olive oil spreadLow fat milkApple or Orange2 pieces1 tsp1 cup1 medium fruit7/77/77/77/72.00 pmLunchFried rice Curry sauce1 Chinese Rice Bo wl5 dessert spoon4/74/7Office cafeteria Fried fish1 medium fish4/71 medium bow l5 fishballs3/73/7Watermelon1 slice7/7Plain water1 glass7/7OrNoodles in curry Fishballs8.00 pmBrown rice3 rice scoops7/7Dinner(Home) Vegetables cooked in soup Grilled or steamed fish wit h ‘cili padi’1 cup vegetables1 medium fish7/77/7Plain water1 cup7/7-End of Case Scenario-Example of counselling stationAdvantages of OSCEsMarking rubricChallenges of OSCEs Challenging to create and administer Labor intensive Costly Only cost-effective when many individuals are examined at one administration Requires high demand of other resources Simulated patients Assessors/Examiners Time commitment Physical resources – clinical skills center Doesn’t adequately assess complex skills requiring integrated professionaljudgmentMeasures clinical competence cross-sectionally using standardized meansFocuses on observable behaviors : measure attitudes, patient-centerednessEnables fairer peer comparisonAllows for assessing complex competencies without endangering patients’well-being Encourages a collaborative assessment approach Has the potential for peer feedback and assessment Has been extensively researched and found to be valuable for summativeassessment. However, not extensively used in dietetics Students’ feedback on OSCE Majority of studentsagreed that 10minutes wereadequate for moststations. Challenging for diethistory anddocumentation5

3/26/2018 Students had high levelsof confidence in theirability to conduct diethistory and nutrientcalculations, subjectiveglobal assessment,counselling anddocumentationAbout 70% of students felt the OSCE was anobjective measure of clinical skills attainment andhad a positive experience in the OSCE.Summary The OSCE exams were found to be a valuable assessment method forcompetency in executing nutrition care process in dietetics It allowed direct observation of skills acquired and also the ability toassess the attitudes towards patient careTHANK YOU The OSCE adds value along with other methods i.e viva portfolio andmini-CEX to assess clinical competencies in dietetics students afterplacementsDisclosure slideMaking case based learningrealistic (and fun!!)Esther F Myers, PhD, RDN, FANDPresident-Elect, IAANDEF Myers Consulting IncNutrition Care Professionals, Pty, Ltd No financial conflict of interest with two free interactiveapplications demonstrated today Co-owner of Nutrition Care Professionals, Pty, Ltd, Australiancompany that provides NCP Workbook for educating dietitians Owner, EF Myers Consulting, Inc which provides research andeducational services, including NCP Lectures Intellectual bias due to 12 years employed at the Academy ofNutrition and Dietetics as Chief Science Officer6

3/26/2018OverviewBackground Adoption of games in classrooms appear to be related to 2 factors Background on use of games in teaching Previous experience of educator Curriculum relatedness1 Description of two free on-line applications Systematic review of 143 articles between 2009 and 2014 2 Demonstration of use in a case-based approach Most frequently outcome was knowledge acquisition Entertainment games addressed a broader range of affective, behavior change,perceptual and cognitive and physiological outcomes. Games for learning were found across varied topics STEM subjects and health the most popular.DeGrove, et al. Digital games in the classroom? A contextual approach to teachers’ adoption intentionof digital games in formal education. Computers in Human Behavior. 2012:28(6): p 2023-2033Boyle et al. An update to the systematic literature review of empirical evidence of the impacts andoutcomes of computer games and serious games. Computers and Education. 2016:94: p 178-192Kahoot SocrativeCompetitive Game (individual or group) TF or Multiple choice Up to 4 Answers options Color and shape coded Must be able to read question on screen inclassroom (not phone) Displays “cumulative score” Based on accuracy and speed Quizzes which can be anonymous or with names Various types of questions T or F, Multiple Choice (one or multiple choices,)Open ended Can view questions on phone AND on screen inclassroom Displays total responses for each option Can provide reports with names Depends on what options you choose Complete with music and sound effectsExamples of use of games todayExamples of use of games todayAssign students to review NCPT terms listed for NutritionAssessment/Monitoring and Evaluation in preparation for game.Have them bring the NA/ME Term list to classAssign students to review Mr Garcia’s case and View videosAssign students to review NCPT terms listed for NutritionAssessment/Monitoring and Evaluation in preparation for game.Have them bring the NA/ME Term list to classAssign students to review Mr Garcia’s case and View videosStudent ObjectivesGame Apply NCPT to describe Nutrition Assessment Data Understand what type of data fits into NutritionAssessment DomainsKAHOOT KRDN 3.1 Use NCP and NCPTStudent ObjectivesGame Evaluate Mr Garcia’s knowledge and attitudes of key information related toT2DMPrinciples of Diabetes, carbohydrate containing foods, readiness to change,perceived susceptibility, benefits outweigh effort, stage of readiness tochange, ability to use social network.SocrativeKDRN 1.3 Apply critical thinking skillsKDRN 3.2 Use of NCP and standardized language7

3/26/2018Examples of use of games todayExamples of use of games todayAssign students to review NCPT terms listed for NutritionDiagnosis in preparation for game. Have them bring the ND Termlist to classAssign students to review NCPT terms listed for NutritionDiagnoses in preparation for game. Have them bring the NDTerm list to class (requires eNCPT subscriptionAssign students to review Mr Garcia’s case and View videosAssign students to review Mr Garcia’s case and View videosStudent ObjectivesGame Identify potential nutrition diagnosesSocrative KDRN 1.3 Apply critical thinking skills KDRN 3.1 Use NCP and standardized languagesStudent ObjectivesGame Identify current status of previous nutrition diagnosisKahoot KDRN 1.3 Apply critical thinking skills KDRN 3.1 Use of NCP and standardized languageOther ExamplesObjectiveExample of Interactive ToolDevelop Nutrition PrescriptionSocrative – Multiple choice andOpen ended quizIdentify nutrition intervention activities based on NutritionPrescription and Nutrition DiagnosesSocrative – Multiple choiceIdentify Nutrition monitoring and evaluation indicators based onnutrition diagnoses and nutrition interventionSocrative – Multiple choiceRe-Assessment in subsequent visit– Determine if M&E were metKAHOOT-GameDetermine status of Nutrition DiagnosisKAHOOT-GameNutrition Care Process: What’s in itfor my patients (and me)Esther F Myers, PhD, RDN,LDN, FANDefmyers@efmyersconsulting.comDialogue on Nutrition Care Process:esthermyers@blogspot.comUse NCP and NCPT In this case the Nutrition Assessment information was subdividedinto 8 different pieces (slides) Each piece has a separate Kahoot, allowing students multipleopportunities to select data categories Can use Kahoot alone and then discuss afterwards OR Use Kahoot, but then discuss each afterwardsInformation in ConsultationRequest Mr Garcia newly diagnosed Type 2 DM, is 5’6” andweighs 179 lbs and has a Hemoglobin A1C of 8.0 %mg/dl (64 mmol/L). The lipid panel shows LDL 77mg/dL (2.0 mmol), HDL 70 mg/dL, and Triglycerides129 mg/dL (1.45 mmol) He is starting oral hypoglycemic agents today(Sulfonylureas) At least for the first one or two to allow for more learning and applicationduring the class period8

3/26/2018Information in Consultation Request Mr Garcia newly diagnosed Type 2 DM, is 5’6” and weighs 179 lbs and has aHemoglobin A1C of 8.0 mg/dl (64 mmol/L). The lipid panel shows LDL 77 mg/dL(2.0 mmol), HDL 70 mg/dL, and Triglycerides 129 mg/dL (1.45 mmol). He isstarting oral hypoglycemic agent today (Sulfonylureas) Anthropometric Measurements: Body Composition/growth/weight history(Measured height, Measured weight) Biochemical Data, Medical Procedures and Tests: Glucose/endocrine profile(Hemoglobin A1C), Lipid Profile (Cholesterol HDL, Cholesterol LDL,Triglycerides, serum) Client History: Pt nutrition-related medical/health history(P:Endocrine/metabolism); Medical Treatment/therapy (oral hypoglycemicagent)Show Video of KahootMr Garcia Mr Garcia is a 71 year oldretiree who has made anappointment to see you in theoutpatient nutrition clinic. Hehas never seen a dietitianbefore. At his last physicianvisit he was diagnosed withType 2 DM and Obesity.Kahoot Which domains of NCPT are reflected in the previous paragraph9

3/26/2018Mr Garcia Mr Garcia is a 71 year old retiree who has made an appointmentto see you in the outpatient nutrition clinic. He has never seen adietitian before. At his last physician visit he was diagnosed withType 2 DM and Obesity. Food and Nutrient Administration, Personal history, patientmedical history, social history, Personal History, Patient Medical History Patient Medical History, Social History Patient Medical History, Personal History, Social History, PhysicalActivity and FunctionMr. GarciaKahoot Mr Garcia has been experiencing tiredness starting about 6 monthsago along with being very thirsty and experiencing frequenturination during the day and also at nighttime. Which domains of NCPT are reflected in the previous paragraph Which of the domains are represented in these two sentences: NFPE: Overall Findings (lethargic), Mouth (Excessive thirst),Genitourinary system (polyuria),Interview- Tell me about your weightKahoot Mr Garcia tells you he used to work in construction, but after heretired 3 years ago, he gained about 30 lbs. He always used toweigh 149 lbs when he was working. Which domains of NCPT are reflected in the previous paragraph Client History: Occupation (retired from construction work) Anthropometric Measurements: Weight (Usual stated weight)Weight change (weight gain)10

3/26/2018Tell me about your social activitiesKahoot He enjoys meeting with his lifelong friends, having several bottlesof beer with some snacks (chips, Kornik (corn nuts), Chicharon(Pork Rinds), Buto ng Kalabasa (Squash Seeds), or Adobong Mani(Adobo Peanuts)) each afternoon. Which domains of NCPT are reflected in the previous paragraph Food and Nutrition History – Alcohol intake, Types of food/meals(take-out, high sodium, high energy snacks) Client History; Social and medical support (life long friends)Tell me about your mealsKahoot He often skips breakfast and gets a sandwich for lunch from cornergrocery. His wife is not yet retired and works in a office job 6days per week. She often picks up food at the market on the wayhome or prepares supper when she gets home. Usually it is stirfried rice and chicken, pork or chicken adobo, or pancit. Which domains of NCPT are reflected in the previous paragraph Food and Nutrition History: Types of foods (often carry out orsandwiches) Meal/snack pattern (2 meals plus snacks per day) Client History: Domestic issues (married) Social and medicalsupport (wife works and provides/cooks evening meals)Desribe what you do to be activeKahoot Mr Garcia has recently been more active than he was after he firstretired about 3 years ago. After increasing his activity his weight hasbeen stable for the past 6 months. He currently includes a 20 minutebicycle ride in the morning and afternoon 3 days per week, goesshopping one day per week, and works in the garden for about 15minutes each day. Which domains of NCPT are reflected in the previous paragraph Food and Nutrition-Related History – Physical Activity and Function(frequency, duration, intensity, or type of physical activity) Anthropometric Measures: Weight (stated peak weight) Client History: Occupation (retired)11

3/26/2018Interview about knowledge of DM When you ask Mr Garcia what he knows about diabetes, he states thatboth his mother and father had diabetes when they were older. Heremembers that they had to cut down on rice and desserts. He alsostates that he really doesn’t eat that much rice and eats hardly anydesserts. He states that he thinks his current diet is pretty healthy,especially since he has stopped gaining weight. Food and Nutrition History- Knowledge, attitudes and beliefs (Area andlevel of knowledge), Food Intake – Types of foods/meals (desserts andrice) Client History: Family nutrition-oriented medical/health history (F:Endocrine/metabolism: T2DM x 2 parents)Instructor View to start quiz Teacher paced Require names Shuffle answers Show final scoreQuestion View (same on student phone)Student log in toSocrative for rest ofcasehttps://socrative.com/Enter ClassroomMYERS7751What is your assessment of Mr Garcia’sknowledge?Diabetes principles rate containingfoods Inadequate Basic Moderate Comprehensive UnsureShow video12

3/26/2018What is your assessment of Mr Garcia’smotivation to changePerceived susceptibility tonutrition-related problemsBelief that benefits of dietchange out weigh barriers Yes Yes No No Maybe Maybe No information available yet No information available yetReadiness and Support AssessmentSelect the Stage of Changebased on Mr Garcia’scommentsIs he able to use socialnetworks to support hisbehaviorsEstimated Dietary Intake in ExchangesMealStarch FruitVegDairyMeat(HF)Fat32Alcohol CHOBreakfastNoon2Afternoon5 NoEvening21142 Preparation MaybeTotal Kcal9*801*601*257*1006*453*100 Action No information available yet6025700270300 Precontemplation Yes Contemplation 2075 kcal 720 Maintenance2 UnsureYour Assessment Estimate his intake to be 2100 kcalper day Carbohydrate distribution of currentintake:3037550 26% of kcal fromcarbohydrateComparative Standards BMI 28 Estimated physical activity levels andEstimated Total Energy Needs Estimated physical activity levels tobe mild Miflin St Jeor estimates his energyneeds to be 2106 kcal (using on-linecalculator) 30 g – noon meal 75 g – afternoon 50 g – evening meal13

3/26/2018What categories of data would your record fromNutrition Assessment?Could also ask more specific from each type of datawithin categories? https://b.socrative.com/login/student/Status of Previous Nutrition Diagnosis(IF not first consultation)Potential Nutrition Diagnoses Excessive energy intake Impaired nutrient utilization Excessive fat intake Altered nutrition-related laboratoryvalues Excessive alcohol intake Inadequate fiber intake Overweight, adult or pediatric Inadequate calcium intake Obese Food and Nutrition Knowledge Deficit Not ready for diet-lifestyle change Undesirable food choicesWhat nutrition diagnoses are selected fortoday’s consultation?Use open ended question for PES StatementsPROBLEMETIOLOGYSIGNS ANDSYMPTOMS14

3/26/2018Switch to Socrativefor rest of caseWhat components would be included inNutrition Prescription?What components should be included in theNutrition PrescriptionNutrition Intervention (Broad categories) Energy Macronutrient distribution Carbohydrate distribution Physical activity Which would you include in the nutritionintervention?Which Nutrition Education would you use?(Specific items)Which Theory and Which Strategies (Specificchoices)Food and/or Nutrient DeliveryNutrition EducationNutrition CounselingCoordination of Nutrition Care by a NutritionProfessional Popuulation Based Nutrition Theory/ApproachContent Purpose of the Ntr EdPriority ModificationsSurvival InformationNutrition Relationship tohealth/diseaseRecommended modificationsOther or related topicsOtherPhysical Activity guidanceStrategiesApplication Results Interpretation Skill Development OtherCognitive behavioral theoryHealth belief modelSocial learning theoryTranstheoretical model/stages ofchange Other Motivational InterviewingGoal settingSelf-monitoringProblem solvingSocial supportStress managementStimulus controlCognitve restructuringRelapse preventionRewards/contingency managementOther15

3/26/2018Coordination of Nutrition Care by a NutritionProfessionalCollaboration and Referral ofNutrition Care Team meeting Referral to RDN with differentexpertise Collab with other nutritionprofessionals Collab with other providersMore complex – “Best” sequence of activitiesDischarge and Transfer ofNutrition Care to new settingor provider Discharge and transfer to otherproviders Discharge and transfer tocommunity agencies/programs Discharge and transfer to anothernutrition professional Referral to communityagencies/programsOpen ended for Monitoring and EvaluationIndicatorsNutrition Monitoring and EvaluationDomainParameter(what)Indicator(how much)Timeframe(when)Food & NutrKnowled/Att/BeliefsBehaviorAnthropometricsNext consultation with dietitianNutrition Re-AssessmentNutrition Intervention Re-assessment starts with M&E Indicators Determine whether intervention is beingsuccessful Determine other changes that need to beassessed Adjust nutrition prescription if needed Provide intervention to sustain positive changesand achieve new changes Used Kahoot to practice taking information from consultation and interview andcapture as data (speed and accuracy Use Socrative (open ended) to identify nutrition diagnoses and write PESstatement Use Socrative (open ended) to develop Nutrition Prescription for Mr GarciaNutrition Monitoring and EvaluationNutrition Diagnoses Determine status of previous nutrition diagnoses Keep or add new nutrition diagnoses to guidecare If problems resolved, then discharge patientsSummaries Determine if changes are needed to indicatorsto reflect new intervention or criteria adjustedfor maintenance Use Socrative (multiple choice) to identify nutrition intervention activities basedon Nutrition Prescription and Nutrition Diagnoses (focused on more detail) Use Socrative (open ended) to identify Nutrition monitoring and evaluationindicators based on nutrition diagnoses and nutrition interventions16

3/26/2018Resources used for this presentationAcknowledgements KAHOOT. Available at www.kahoot.com Dr Winnie Chee and International Medical University (IMU) faculty SOCRATIVE. Available at www.Socrative.com Academy of Nutrition and Dietetics Nutrition CareProcess/Standardized Language Task Forces and Committees (2003to 2012) E Nutrition Care Process Manual. Academy of Nutrition and Dietetics.Available at www.ncpro.org Current Academy of Nutrition and Dietetics RISA Staff Nutrition Care Process and Terminology: A Practical Approach. NutritionCare Professionals, Pty, Ltd. Available at www.nutritioncarepro.com17

Objective Structured Clinical Examination (OSCE) for . OSCE Mini-CEX : components of NCP Objective Structured Clinical Examination (OSCE) IMU is the first in Malaysia to implement OSCE as an exit exam for

Related Documents:

The QLTS School OSCE toolkit: your guide to understanding and preparing for the OSCE This toolkit is designed to assist you both at the outset and during the course of your OSCE preparation with QLTS School. This toolkit will: Provide an overview of the OSCE, both generall

Bruksanvisning för bilstereo . Bruksanvisning for bilstereo . Instrukcja obsługi samochodowego odtwarzacza stereo . Operating Instructions for Car Stereo . 610-104 . SV . Bruksanvisning i original

The OSCE The OSCE is made up of six stations, each lasting between 10 – 20 minutes. The OSCE is a scenario based approach which includes the following A - Patient Centred Assessment P - Planning Care I - Implementation E - Evaluation There

Organization for Security and Co-operation in Europe OSCE Handbook on Data Collection in support of Money Laundering and Terrorism Financing National Risk Assessments OSCE Handbook on Data Collection in support of Money Laundering and Terrorism Financing National Risk Assessments OSCE Handbook on Data Collection in support of Money Laundering and Terrorism Financing

Welcome to the Monash Health OSCE Preparation Course. This course aims to give you guidance and practice in each of the OSCE station types and ultimately help you pass the exam. Your performance in the OSCE should be the culmination of years of work in the ED. Preparation should not invo

1 OSCE Project Manager: Roel Janssens, Economic Adviser, Office of the Co-ordinator of OSCE Economic and Environmental Activities / OSCE Secretariat. OSCE Members of the Project T

10 tips och tricks för att lyckas med ert sap-projekt 20 SAPSANYTT 2/2015 De flesta projektledare känner säkert till Cobb’s paradox. Martin Cobb verkade som CIO för sekretariatet för Treasury Board of Canada 1995 då han ställde frågan

Any dishonesty in our academic transactions violates this trust. The University of Manitoba General Calendar addresses the issue of academic dishonesty under the heading “Plagiarism and Cheating.” Specifically, acts of academic dishonesty include, but are not limited to: