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We thus decided to put the majority of our staff time into achieving the first two objectives cheap arcoxia 120 mg line. The most appropriate teaching method was obviously direct observation with feedback and as this is very time-consuming we opted for a preceptor system where one staff member was respon- sible for only three students throughout the programme. However, opportunity was also provided for students to obtain additional ward practice on their own and with the resident staff. Senior students were also mobilised to provide further help and instruction in this area. One of the implications of this decision on staff allocation was to accept that the sixth objective (improving their knowledge in the subjects Medicine and Surgery) would have to be achieved by other methods. This has involved an expectation that students accept responsibility for doing much of this themselves. We have also designed and prepared a variety of self-instructional materials. RELATING OBJECTIVES TO ASSESSMENT METHODS While it is obviously important to match the teaching and learning activities with the objectives, it is absolutely vital to match the assessment methods to the objectives and to the teaching and learning activities. Failure to do so is the reason why many courses fail to live up to expectations. A mismatch of assessment and objectives may lead to serious distortions of student learning because, whether we like it or not, what is present in the assessments will drive what most students set out to learn. In designing your course, we believe that it is also important to distinguish carefully between two types of assessment. One is primarily designed to give feedback to the students as they go along (formative assessment). The other is to assess their abilities for the purposes of decision making or grading (summative assessment). Formative assessment is a crucial part of the educational process, especially where complex intellectual and practical skills are to be mastered. Such assessment is notoriously deficient in medical schools, particularly in regard to clinical teaching (see Chapter 5). As no formal examination is required at the completion of the course, the major emphasis of the assessment activities is formative.

On the other hand discount 90mg arcoxia with mastercard, an explicit purpose of therapy and of mobility aids is to allow people to leave their homes comfortably and safely. But this goal directly conflicts with policies such as Medicare’s coverage rules for power wheel- chairs (described in chapter 14). In addition, Medicare and most private in- surers view such equipment as grab bars and shower seats as “convenience items,” and therefore not covered benefits. Since the 1970s, Medicare regulations have stipulated that to qualify for home-based services, people must be “homebound,” having “a condition that results in a normal inability to leave home except with considerable and taxing effort, and absences from home are infrequent or of relatively short duration or are attributable to receiving medical treatment” (U. A law enacted 21 December 2000 loos- ened this requirement somewhat: attending religious services was deemed Who Will Pay? Persons must require skilled care, under a physician’s explicit treatment plan. In contrast, Medicaid home health care beneficiaries “need not be homebound nor require skilled care” (Tanenbaum 1989, 296). Medicare beneficiaries who also have Medicaid therefore frequently get their home care financed by Medicaid (Foote and Hogan 2001, 248). Scooter-user Louisa Delarte can’t understand why Medicare stopped her home PT. Going back and forth from her rural residence to office-based PT services requires some effort. Delarte does have a household handy- man who drives her to shop and visits with her son. Delarte’s shopping and social engage- ments suggest she is too robust to merit Medicare home PT. Medicare home-based care epitomizes that “bottomless pit” anticipated by Vladeck and colleagues (1997, 88). Many factors explain this increase, including changes in Medicare coverage policies (e. Policy changes between 1980 and 1989 “essentially transformed the home health benefit from one focused on patients needing short-term posthospital care to one that serves chronic, long-term care patients as well....

In 1975 Ken 137 THE CRISIS OF MODERN MEDICINE Kesey’s novel One Flew Over the Cuckoo’s Nest discount arcoxia 60 mg on-line, which depicted psychiatric illness as a higher form of awareness and exposed the oppressive conditions of the mental hospital, was made into an award-winning film starring Jack Nicholson. One common feature of the questioning of established medicine from different social movements was a challenge to the authority of the medical profession. The tendency for the demand for rights in the USA to lead to legal intervention in relations between patients and doctors had the effect of undermining professional sovereignty. Trust in medical authority was displaced by a conception of the doctor- patient relationship as a partnership in decision-making. Yet even in Britain, where litigation was a marginal influence, there was a shift in the perception from that of the doctor as an essentially benign figure, to one from whom the patient needed a degree of protection. Feminists were scathing: ‘professionalism in medicine is nothing more than the institutionalisation of a male upper class monopoly’ (Ehrenreich and English, 1974:40). Left-wing commentators, particularly in America, exposed the ‘medical-industrial complex’, depicted the medical profession as an instrument of capitalist class rule and denounced ‘medical ideology’ (Navarro 1976; Waitzkin 1978). Commentators on medicine from other academic fields, formerly sympathetic towards doctors, increasingly ‘portrayed the medical profession as a dominating, monopolising, self-interested force’ (Starr, 1982:392). The radical critics of medicine were often fiercely polemical, but like the wider movements of which they were a part, they were optimistic about their capacity to change things and not lacking in alternative programmes. Undoubtedly some of medicine’s critics aspired to overthrow capitalism and patriarchy as well as the power of the medical profession, but many had more specific proposals for reform. Indeed some of these—such as demands for de- institutionalisation of treatment and care for the mentally ill and for the de-medicalisation of many aspects of childbirth—were rapidly assimilated by the mainstream. Pressures for reform of the American health-care system made some headway before becoming stalled in the complexities of the political process and its relations with doctors, insurers and other commercial interests. Parallel pressures for reform of the medical profession itself—notably in the recruitment of women—made steady progress. The proportion of women admitted to medical schools in Britain increased from 22 per cent in 1965–66, to 41 per cent in 1980–81 and reached 52 per cent in 1992–93 (Allen 1994). In the recessionary climate of the mid-1970s the radical upsurge was gradually contained and a conservative backlash gathered momentum. By the end of the decade the new right was in the ascendant with Margaret Thatcher in 10 Downing Street and her ideological ally Ronald Reagan in the White House.