Comprehensive Exam Orientation

Comprehensive Exam Comprehensive Exam OrientationOrientation

Spring 2014Spring 2014

Roxanne Garbez, RN, PhD, ACNP-BC, Roxanne Garbez, RN, PhD, ACNP-BC, CNSCNS

Mark Hawk, RN, MSN, AG ACNP-BCMark Hawk, RN, MSN, AG ACNP-BC

Starting Spring 2015 Starting Spring 2015 Comprehensive exam Comprehensive exam submissions will use submissions will use

the new format.the new format.

Comprehensive exams Comprehensive exams submitted prior to submitted prior to

Spring 2015 will use Spring 2015 will use old format.old format.

Outline of Comp Outline of Comp ProcessProcess Description of the projectDescription of the project The Comprehensive Exam The Comprehensive Exam

HandbookHandbook Qualifying for the examinationQualifying for the examination Important datesImportant dates Technical requirementsTechnical requirements ResourcesResources

Graduate Division Graduate Division LanguageLanguage

““The comprehensive The comprehensive examination should examination should demonstrate the studentdemonstrate the student’’s s mastery of the mastery of the major field major field and ability to think and ability to think criticallycritically. .

The AssignmentThe Assignment

The purpose of this paper is The purpose of this paper is to evaluate your ability to:to evaluate your ability to:– Critique research as it applies to Critique research as it applies to

your area of specializationyour area of specialization– Apply advanced clinical and Apply advanced clinical and

theoretical knowledge to practicetheoretical knowledge to practice– Utilize writing skills to disseminate Utilize writing skills to disseminate

nursing information using a scholarly nursing information using a scholarly paperpaper

– Demonstrate you can be a consumer Demonstrate you can be a consumer of researchof research

Critical PointsCritical Points

Twenty (20) page paper Twenty (20) page paper not including title page, not including title page, references, grid and references, grid and appendicesappendices

Four exam optionsFour exam options– Research ProposalResearch Proposal– Critical Literature Review Critical Literature Review – Problem-solving Problem-solving – White Paper White Paper (still in process)(still in process)

The HandbookThe Handbook

You can download You can download a copy of the a copy of the Comprehensive Comprehensive Examination Examination Handbook from the Handbook from the UCSF School of UCSF School of Nursing websiteNursing website

Handbook will be Handbook will be available starting available starting September 2014.September 2014.

How to Qualify for the How to Qualify for the ExaminationExamination

You are eligible in the last quarter You are eligible in the last quarter you are enrolled in course and you are enrolled in course and clinical work.clinical work.

If you have completed ALL course If you have completed ALL course work with the exception of the work with the exception of the comp exam you may submit the comp exam you may submit the exam while on filing fee status for exam while on filing fee status for a reduced fee. a reduced fee.

Filing Fee StatusFiling Fee Status

Advance to Advance to CandidacyCandidacy

Before you can be issued your Before you can be issued your individualized Comp Number, YOU MUST individualized Comp Number, YOU MUST ADVANCE TO CANDIDACY.ADVANCE TO CANDIDACY.

Advance to Candidacy forms are available Advance to Candidacy forms are available from the Office of Admissions and from the Office of Admissions and Registrar. Forms can also be downloaded Registrar. Forms can also be downloaded online.online.

After you submit your form Graduate After you submit your form Graduate Division notifies Office of Student Affairs. Division notifies Office of Student Affairs. OSA will then generate your Comp Number.OSA will then generate your Comp Number.

The Last Quarter of The Last Quarter of Course and Clinical Course and Clinical

WorkWork Advance to Candidacy Advance to Candidacy

the quarter before you the quarter before you plan to submit your compplan to submit your comp

Your last chance to Your last chance to Advance to Candidacy is Advance to Candidacy is the first week of the the first week of the quarter in which you plan quarter in which you plan to turn in the compto turn in the comp

One incomplete on One incomplete on academic record allowedacademic record allowed

Payment of fees required Payment of fees required for numberfor number

Know the Important Know the Important Dates- Spring 2014Dates- Spring 2014

Number pick up date: Number pick up date: – Between April 8 and April 21Between April 8 and April 21

Submit comp by NoonSubmit comp by Noon– April 22April 22

Notification of resultsNotification of results– May 22May 22

Formatting Formatting ExpectationsExpectations

APA 6APA 6thth Edition format Edition formatMargins 1 inch on all 4 sides of pageMargins 1 inch on all 4 sides of pageCan separate syllables at the end of a Can separate syllables at the end of a

lineline20 pages of text, not counting title page, 20 pages of text, not counting title page,

reference list and appendicesreference list and appendicesTitle should reflect contentTitle should reflect contentNo abstractNo abstractDouble-spaced, 12 point uncompressed Double-spaced, 12 point uncompressed

font (Acceptable font examples: Times font (Acceptable font examples: Times New Roman, Arial)New Roman, Arial)

Submission Submission RequirementsRequirements Completed face sheetCompleted face sheet Separate paper with studentSeparate paper with student’’s name, s name,

address, home and work number, and address, home and work number, and other pertinent information that other pertinent information that facilitates the student being contacted facilitates the student being contacted if necessaryif necessary

It is the studentIt is the student’’s responsibility to s responsibility to ensure that the comprehensive exam is ensure that the comprehensive exam is submitted by 12 noon on the due datesubmitted by 12 noon on the due date

One single-sided original of the One single-sided original of the comprehensive examination in PDF comprehensive examination in PDF formatformat

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Face SheetFace Sheet

In order to pick up your number In order to pick up your number you must complete the face sheet you must complete the face sheet and return itand return it– List your specialtyList your specialty– Topic Topic – Suggested readersSuggested readers

ID number is given to you to be ID number is given to you to be placed on your compplaced on your comp

Reading and ScoringReading and Scoring

Student Student maymay select up to five select up to five preferred readers (not required)preferred readers (not required)

Student is not guaranteed a Student is not guaranteed a preferred readerpreferred reader

Readers use a standard scoring Readers use a standard scoring systemsystem

Student will be given the faculty Student will be given the faculty comment sheets at the end but comment sheets at the end but not the scoring sheetsnot the scoring sheets

PlagiarismPlagiarism

Evidence of Evidence of plagiarism results plagiarism results in a failure of the in a failure of the comprehensive comprehensive exam.exam.

Plagiarism can Plagiarism can become grounds become grounds for dismissal from for dismissal from the School of the School of Nursing.Nursing.

A Comp Does Not PassA Comp Does Not Pass

One pass and One pass and one fail from two one fail from two readers goes to a readers goes to a third reader for third reader for decisiondecision

Exam fails if two Exam fails if two readers fail itreaders fail it

May re-submit May re-submit exam once within exam once within 5 quarters of first 5 quarters of first submissionsubmission

Vital ResourcesVital Resources

Vital resource—Department Vital resource—Department Administrative AssistantsAdministrative Assistants– CHS CHS – PN PN – FHCN FHCN – SBS SBS

Comprehensive Exam CoordinatorsComprehensive Exam Coordinators– CHS Beth Phoenix & Dana Drew-NordCHS Beth Phoenix & Dana Drew-Nord– PN Roxanne GarbezPN Roxanne Garbez– FHCN Karen Duderstadt & Mary LynchFHCN Karen Duderstadt & Mary Lynch– SBS Susan ChapmanSBS Susan Chapman

Additional ResourcesAdditional Resources

Advisors- topic Advisors- topic and formatand format

Specialty facultySpecialty faculty Sample comps on Sample comps on

reserve reserve Office of Student Office of Student

Affairs for tutors Affairs for tutors and editors, and editors, contact Judy contact Judy Martin-HollandMartin-Holland

Consider other Consider other arrangementsarrangements– TypistTypist– Paid tutors and Paid tutors and

editorseditors– Peers as editors Peers as editors

and proofreadersand proofreaders Create a timelineCreate a timeline

– See sample See sample providedprovided

Comprehensive ExamComprehensive Exam2014-20152014-2015

SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG

Identifying the phenomenon of interest

Refine topic outline

Advance toCandidacy

Topic generation

Faculty input re: topic

Literature review

Faculty input re:topic outline

Draft #1

Colleagues read paperfor clarity and organization

Draft #2

Pick upComp #

Edit

SubmitComp

• Advance to Candidacy: Before end of Winter Quarter

• Pick up Comp # from Departments: From 4/08/14 to 4/21/15

• Submit Comp to Departments: 4/22/14

WORK HARD, DO WORK HARD, DO WELL!WELL!

Extensions, Extensions, examination by examination by mail, summer mail, summer comps, oral exam comps, oral exam are available only are available only by special by special arrangement. Read arrangement. Read the corresponding the corresponding section of the comp section of the comp handbook.handbook.

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Sample ExaminationsSample Examinations

On reserve in each of the On reserve in each of the departmentsdepartments

Ask your advisor and/or your Ask your advisor and/or your department's comprehensive department's comprehensive examination coordinatorexamination coordinator

Comprehensive Exam Comprehensive Exam overviewoverview

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Choosing a TheoryChoosing a Theory

Applicable to critical literature Applicable to critical literature review, research proposal and review, research proposal and problem solving compproblem solving comp

A theory should further clarify, A theory should further clarify, support and explain your topicsupport and explain your topic

Nursing theory not requiredNursing theory not required Explain your theory in the text—donExplain your theory in the text—don’’t t

depend on diagrams in the appendixdepend on diagrams in the appendix

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Theory or Conceptual Theory or Conceptual FrameworkFramework

Theory is the format that enables Theory is the format that enables you to explain a phenomenon. you to explain a phenomenon. There is no right or wrong There is no right or wrong theory--it is all in how you want to theory--it is all in how you want to frame the argument you want to frame the argument you want to make. make.

Concept or Concept or PhenomenonPhenomenon

Possible Mechanisms Underlying Possible Mechanisms Underlying the Increased Risk of Type 2 the Increased Risk of Type 2 Diabetes in People on Atypical Diabetes in People on Atypical PsychotrophicsPsychotrophics

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Potential Theoretical Potential Theoretical FrameworksFrameworks

Physiological HPA axis and sympathetic nervous system hyperactivity resulting in overproduction of cortisol.

Genetics Diabetes only occurs in those with a genetic predisposition.

Co-moridity The diabetes is really due to alcoholism or binge eating.

Socio-cultural

Due to socioeconomic, disability, marital status, access to health care

Health care Providers fail to adequately monitor overall health.

Behavioral Inactivity, diet, smoking due to the psychiatric illness

Medication Side effects, appetite stimulation and subsequent weight gain

3131

Research Literature Research Literature Summary Critique Summary Critique

TableTable Organize your literature into a Organize your literature into a

table to compare and contrast table to compare and contrast different components of the different components of the critiquecritique

Briefly describe each study in the Briefly describe each study in the paperpaper

Author(s), Year

Purpose Sample Data Source, Design/Methods

Main Ind. Variable/Dep. Variables

Main Findings

Smith, 2011

Identify states with comparable enrollment for Medicaid-eligible children between immigrant and non-immigrant families

DRAFT – DO NOTUSE AS FINAL COPY

Total 842,196 Medicaid-eligible children (aged 0-17); children of immigrants(321,043); children of non-immigrants (521,153)

2009 US Census Bureau, Cross-sectional survey

Main IVs: immigration status, state of residence Main DV: uninsured families (percent)

Many states had significant enrollment disparities between immigrant vs. non-immigrant families: CA & HI had highest rate of uninsured immigrant families/children

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Research ProposalResearch Proposal

To evaluate a studentTo evaluate a student’’s ability to s ability to identify a significant research identify a significant research question relevant to nursing practice, question relevant to nursing practice, and to design a methodology for and to design a methodology for addressing the question.addressing the question.

Study does not have to be Study does not have to be implementedimplemented

Must have access to UCSF faculty Must have access to UCSF faculty with research experience to mentor with research experience to mentor youyou

Research ProposalResearch Proposal

Good choice if you plan to build Good choice if you plan to build on this topic for future research on this topic for future research or doctoral workor doctoral work

Could be taken back to your Could be taken back to your workplace for implementation if workplace for implementation if approval given by institutionapproval given by institution

Quality of Writing Quality of Writing Area I Area I

Content & FocusContent & Focus Logic & FlowLogic & Flow Structure & organizationStructure & organization Sentence structureSentence structure APA formatAPA format Correct grammar, punctuation, word Correct grammar, punctuation, word

usage, and spellingusage, and spelling

Each category 5 points = Each category 5 points = 30 points30 points

Score of 15 points or less is a technical failScore of 15 points or less is a technical fail

Scoring Areas II - IVScoring Areas II - IV

II: Study & its Context -II: Study & its Context -70 70 pointspoints

III: Conceptual Framework & III: Conceptual Framework & Literature Review -Literature Review -125 points125 points

IV: Methodology -IV: Methodology -105 points105 points

The Comprehensive The Comprehensive Exam Exam

is Pass/Failis Pass/Fail Total points available – Total points available – 330330 Points needed to pass - Points needed to pass -

231231

Proposed White PaperProposed White Paper

Area Content Criteria Possible Score (330)

I: Quality of Writing Content & focus, logic & flow, structure & organization, sentence structure, APA, grammar

30

*must score minimum 15

II: Introduction & Background

Clarity of policy issue, significance of issue/policy, importance to health care/nursing, quality of evidence

80

III: Literature Review, Theoretical Framework, Summary of Research

Quality of theoretical discussion,. Quality of references, addresses elements of critique, quality of critique & interpretation

115

IV: Policy Solutions & Recommendations

Implementation of solutions, feasibility & cost analysis, evaluation framework, summary & conclusion

105

DRAFT COPY

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Critical Literature ReviewCritical Literature ReviewChoosing a TopicChoosing a Topic

Pose a question Pose a question Do initial searchingDo initial searching There is enough research, but no There is enough research, but no

clear synthesis of findings or clear clear synthesis of findings or clear direction direction

You want to argue a point that has You want to argue a point that has some evidence, but is not some evidence, but is not established practiceestablished practice

4141

Critical Literature ReviewCritical Literature ReviewTopic or IssueTopic or Issue

Clarity of topic or purposeClarity of topic or purpose– State in 1 sentence!State in 1 sentence!

The purpose of this paper is to The purpose of this paper is to examine the literature related to examine the literature related to the efficacy of using BNP to the efficacy of using BNP to diagnose patients with heart diagnose patients with heart failurefailure

4242

Topic or IssueTopic or Issue

Significance of topicSignificance of topic– 4.8 million in US have HF, 50% are 4.8 million in US have HF, 50% are

rehospitalized in 6 mos., there is no rehospitalized in 6 mos., there is no lab test for diagnosing HF, BNP lab test for diagnosing HF, BNP might provide better method for might provide better method for effective evaluation of SOB than effective evaluation of SOB than symptomssymptoms

4343

Some evidence exists, but Some evidence exists, but practice is not well practice is not well

delineateddelineated Should diabetics use Should diabetics use

ACE inhibitors to ACE inhibitors to prevent renal prevent renal impairment ?impairment ?

This is well-This is well-established by established by scientific study and scientific study and standard of practice standard of practice in most settings. in most settings.

Is it safe to give Is it safe to give people with stage 4 people with stage 4 kidney disease ACE kidney disease ACE inhibitors to prevent inhibitors to prevent progression?progression?

Practitioners have Practitioners have been hesitant to give been hesitant to give people with stage 4 people with stage 4 CKD ACE inhibitors for CKD ACE inhibitors for fear of increasing fear of increasing creatinine or creatinine or potassium to potassium to dangerous levels.dangerous levels.

4444

Literature ReviewLiterature Review

Theoretical DiscussionTheoretical Discussion Must address the foundation of Must address the foundation of

your question or problemyour question or problem– Example: Sepsis and EGDTExample: Sepsis and EGDT

Use Physiologic theory to explain why Use Physiologic theory to explain why EGDT is appropriate for septic patientsEGDT is appropriate for septic patients

Use Change Theory if you want to Use Change Theory if you want to implement EGDT in a new setting that implement EGDT in a new setting that manages septic patientsmanages septic patients

4545


Quality of ReferencesQuality of References– References significant to the References significant to the

problem area – classic & current problem area – classic & current while noting gaps in research while noting gaps in research literature if anyliterature if any

– Avoid multiple articles from the Avoid multiple articles from the same overall study (different same overall study (different purposes but same sample, purposes but same sample, methodology, statistics, etc.)methodology, statistics, etc.)

4646


Organization of reviewOrganization of review Rationale for selected articles, describe Rationale for selected articles, describe

how you organized your paperhow you organized your paper– The journal articles were chosen because The journal articles were chosen because

they include…….and the oldest is reviewed they include…….and the oldest is reviewed first….first….

How many articles should you critique?How many articles should you critique? Use well written AND perhaps not so Use well written AND perhaps not so

well written research articles – the well written research articles – the heart of the critique process is heart of the critique process is identifying why they may have similar identifying why they may have similar study questions and yet end up with study questions and yet end up with different resultsdifferent results

4747

Literature Review Literature Review CritiqueCritique Synthesis and interpretationSynthesis and interpretation

– YOUR ASSESSMENT OF THE STUDIESYOUR ASSESSMENT OF THE STUDIES– Too small of a sample size to have Too small of a sample size to have

power to find a difference between power to find a difference between those with and without HFthose with and without HF

– Authors were biased b/c they knew Authors were biased b/c they knew the BNP level and may have changed the BNP level and may have changed treatmenttreatment

– Only generalizable to men Only generalizable to men

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Identifies gaps in literature, Identifies gaps in literature, implications for practice, need implications for practice, need

for further researchfor further research

STICK your neck out there! Make STICK your neck out there! Make your opinion known, however you your opinion known, however you must base it on the critique of the must base it on the critique of the literature you presented rather literature you presented rather than your opinion.than your opinion.

4949

Scoring Areas I - IVScoring Areas I - IV

I: Quality of Writing – I: Quality of Writing – 30 points30 points

II: Topic or Issue – II: Topic or Issue – 50 points50 points

III: Literature Review - III: Literature Review - 150 points150 points

IV: Discussion & Application – IV: Discussion & Application –

100 points100 points

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Problem-Solving CompProblem-Solving Comp

PurposePurpose: To evaluate the student: To evaluate the student’’s s ability to effectively communicate ability to effectively communicate the resolution of a problem in an the resolution of a problem in an area of specialization.area of specialization.

Describes an identified need Describes an identified need stemming from a discrepancy stemming from a discrepancy between what is or what between what is or what could/should be.could/should be.

5151

Choosing a Choosing a Problem-Solving TopicProblem-Solving Topic

Can be a problem Can be a problem on an individual or on an individual or a systems level.a systems level.

Must be Must be appropriate to the appropriate to the clinical situation clinical situation – Think of a situation Think of a situation

that is challenging that is challenging to youto you

Must be feasible!Must be feasible! Must be Must be

measurable!measurable!

5252

Problem-Solving Problem-Solving CautionsCautions

Instituting a delirium treatment program Instituting a delirium treatment program in acute care settingin acute care setting– Is delirium identified? Multiple etiologies…Is delirium identified? Multiple etiologies…

what will the intervention be? How will you what will the intervention be? How will you measure this?measure this?

Improving parenting skills by identifying Improving parenting skills by identifying temperament in toddlers in preschoolstemperament in toddlers in preschools– What is meant by What is meant by ““parenting skills?parenting skills?”” How will How will

you get access to preschools? Is there you get access to preschools? Is there literature that indicates that identifying literature that indicates that identifying temperament will change parenting behavior?temperament will change parenting behavior?

5353

The Problem and its The Problem and its Environmental Context Environmental Context

Clarity of the ProblemClarity of the Problem– Who Who is solving the problem is solving the problem

APNAPN

– Where Where the problem occurs the problem occurs ICUICU

– What What is to be accomplished is to be accomplished Improve NursesImprove Nurses’’ Knowledge Knowledge

– Target Target population population ICU NursesICU Nurses

5454

The Problem and its The Problem and its Environmental Context Environmental Context

Significance of the ProblemSignificance of the Problem– Importance of the problem to Importance of the problem to

patients or professionpatients or profession Accurate Hemodynamic Monitoring is Accurate Hemodynamic Monitoring is

essential for ICU patientsessential for ICU patients

5555

The Problem and its The Problem and its Environmental ContextEnvironmental Context

Clarity of the SettingClarity of the Setting– Home, hospital, nursing homeHome, hospital, nursing home– Intensive Care UnitIntensive Care Unit

5656

The Problem and its The Problem and its Environmental ContextEnvironmental Context

Clarity of Roles & Inter-Clarity of Roles & Inter-relationshipsrelationships– Describes functions of individuals sig Describes functions of individuals sig

to problem, their roles and influence to problem, their roles and influence on the settingon the setting

– ICU nurses, Clinical Nurse Specialist, ICU nurses, Clinical Nurse Specialist, Head Nurse Head Nurse


Quality of theoretical discussionQuality of theoretical discussion Quality of referencesQuality of references Addresses elements of critiqueAddresses elements of critique Quality of critique and Quality of critique and

interpretationinterpretation

5858

Intervention, Intervention, Implementation & Implementation &

EvaluationEvaluation Expected OutcomesExpected Outcomes Clarity & Appropriateness of Clarity & Appropriateness of

Intervention ImplementationIntervention Implementation Clarity & Appropriateness of Clarity & Appropriateness of

Evaluation ProcedureEvaluation Procedure DefensibilityDefensibility RealismRealism

5959


EvaluationEvaluation

Clarity of Expected OutcomesClarity of Expected Outcomes– Improvement of Nurses Knowledge Improvement of Nurses Knowledge

evidenced by improvement on post-evidenced by improvement on post-test scorestest scores

6060


EvaluationEvaluation Clarity & Appropriateness of Clarity & Appropriateness of

ImplementationImplementation– Outline procedures for implementing Outline procedures for implementing

the intervention and ensuring they the intervention and ensuring they are appropriateare appropriate Educational intervention was three-foldEducational intervention was three-fold

– Self-study, then 4 hour mandatory class, Self-study, then 4 hour mandatory class, bedside guides developedbedside guides developed

6161


EvaluationEvaluation Clarity & Appropriateness of Clarity & Appropriateness of

Evaluation Evaluation – Delineates specific measurable and Delineates specific measurable and

appropriate evaluation criteriaappropriate evaluation criteria Pretest and post-test measure of ICU Pretest and post-test measure of ICU

nursesnurses’’ knowledge is measured knowledge is measured Number of incident reports are analyzed Number of incident reports are analyzed

regarding monitoring regarding monitoring

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EvaluationEvaluation DefensibilityDefensibility

– Demonstrates intervention has Demonstrates intervention has potential for substantial potential for substantial improvement in the problemimprovement in the problem

RealismRealism– Feasibility of interventionFeasibility of intervention– Will an educational intervention be Will an educational intervention be

possible?possible?

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CaveatsCaveats

Do not wait until the end to Do not wait until the end to decide on method of evaluationdecide on method of evaluation

When writing, do not always start When writing, do not always start with the beginning of the paper with the beginning of the paper and progress to the end or your and progress to the end or your evaluation will suffer.evaluation will suffer.

6464

Scoring Areas I - IVScoring Areas I - IV

I: Quality of Writing – I: Quality of Writing – 30 points30 points II: Problem & environmental II: Problem & environmental

Context – Context – 75 points75 points III: Literature Review: Research, III: Literature Review: Research,

Narrative, & Theory – Narrative, & Theory – 100 points100 points IV: Intervention, IV: Intervention,

Implementation, and Evaluation Implementation, and Evaluation – – 125 points125 points

Most common reasons Most common reasons why comps failwhy comps fail

Started too late to put in necessary time and Started too late to put in necessary time and efforteffort

Did not meet with your advisor to obtain Did not meet with your advisor to obtain feedback and make sure you are on trackfeedback and make sure you are on track

Did not follow the advice of your advisorDid not follow the advice of your advisor Changed your comp topic at the last minuteChanged your comp topic at the last minute Primary editor was someone whose English Primary editor was someone whose English

composition skills were not adequate to give composition skills were not adequate to give you appropriate feedback on your writingyou appropriate feedback on your writing

6666

I PASSED!I PASSED!

Documents

Comprehensive Exam Orientation