Certified Nursing Assistant Program Review - Modesto Junior ...

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Certified Nursing Assistant Program Review - Modesto Junior ...
Certified Nursing Assistant
     Program Review

                              June 2017
Certified Nursing Assistant Program Review - Modesto Junior ...
Modesto Junior College
CTE Program Review
June 2017
Contents
Program Overview ................................................................................................................................................................................................... 2
     Program Overview ............................................................................................................................................................................................. 2
     Response and follow-up to previous program reviews ..................................................................................................................... 3
     The Mission of Modesto Junior College ................................................................................................................................................... 3
Student Achievement and Completion .......................................................................................................................................................... 4
     College Goal for Student Achievement .................................................................................................................................................... 4
     Success ................................................................................................................................................................................................................... 4
     Conferred Award Trends ................................................................................................................................................................................. 8
Student Learning Outcomes ............................................................................................................................................................................... 9
     Student Learning and Outcomes Assessment ....................................................................................................................................... 9
Curriculum and Course Offerings Analysis ................................................................................................................................................ 11
     Curriculum Analysis ........................................................................................................................................................................................ 11
     Course Time, Location and Modality Analysis .................................................................................................................................... 12
Program Analysis .................................................................................................................................................................................................. 14
     Program Personnel ......................................................................................................................................................................................... 14
     Faculty Assignments ...................................................................................................................................................................................... 14
     Departmental Productivity Measurements .......................................................................................................................................... 15
Long Term Planning and Resource Needs ................................................................................................................................................. 17
     Long Term Planning ....................................................................................................................................................................................... 17
     Resource Request and Action Plan .......................................................................................................................................................... 17
     Evaluation of Previous Resource Allocations....................................................................................................................................... 18
Career Technical Education Questions ........................................................................................................................................................ 19
     How many students did you serve in the last two academic years? ......................................................................................... 19
     What kinds of students are you serving? .............................................................................................................................................. 19
     What percentage of your students are persisting? Consider within the program and within the college. ............. 19
     Are students getting and keeping jobs? ............................................................................................................................................... 19
     What percentage of students are attaining a living wage?........................................................................................................... 19
Appendix .................................................................................................................................................................................................................. 20
     Optional Questions ........................................................................................................................................................................................ 20
     Review Process Feedback ............................................................................................................................................................................ 20
Executive Summary ................................................................................................................................................................................................. 2

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Certified Nursing Assistant Program Review - Modesto Junior ...
Executive Summary
Provide an executive summary of the findings of this program review. Your audience will be your Division Program
Review Group, the MJC Program Review Workgroup, and the various councils of MJC.

         The program review showed that the Nurse Assistant Program trend analysis is above that of the college.
         It also showed that the program is productive the program has completed all learning outcomes for the
         course. The Nurse Assistant Program continues to do partnership within the community. But for the
         program to move forward or to plan for long range goals this program needs personnel. Employment for
         nurse assistants is expected to grow by 17 percent between 2014 -2024 according to the United States
         Department of Labor Bureau of Labor Statistics. The growth of the aging baby-boomer population will
         continue to spur demand for trained entry-level care providers. In addition, an increasing number of
         long-term care, rehabilitative, post-acute and long-term acute care facilities need trained staff particularly
         those trained in the care for the older adult. Nurse assistants work mostly in long-term, skilled nursing
         and rehabilitative center, a steadily growing sector of the health care industry. Additional demands are
         expected as nurse assistant begin to retire.

Program Overview
Instructions

Supplemental information, links to previous reviews, and dashboards can be accessed from the review, please
ensure your pop-up blocker is turned off, or use Ctrl-Click to bypass it.

Please review each question below, following the prompts and links given in the help text. Additional help, and a
list of frequently asked questions is available on the Program Review Instructions page.

Programs
Please list program awards that are under this department according to the college catalog. Next to each program
award listed;

  Program Awards                        Include in Review (yes/no)               External Regulations (yes/no)
               No                                        No                                       Yes

         The Nurse Assistant Program is offered in the Fall, Spring and Summer. It is a one semester 16-week
         certification program offering training in theory and clinical (skill) procedures. The students complete fifty
         (50) hours of theory in the classroom developing the necessary skills for practicum. The students enter
         the practicum portion of the program consisting of opportunities for the student to apply the knowledge
         gained in theory and lab by performing clinical procedures in the practicum site. It is also in the
         practicum that students work with patients and other health care team.

         The Nurse Assistant continues to be listed among the fastest growing occupations in the country, listed
         number 1 and 2 on the United States Department of Labor, Bureau of Labor Statistics. Many Long-term
         Care facilities need a higher proportion of health care givers to provide the daily of the older patient
         residing in their facilities. The nurse assistant trains students to become qualified and competent in
         bathing, performing vital signs, feeding and bathing patients. The Nurse Assistant programs serve many
         first generation, single mom and individuals starting a second career. The typical age of a Nurse Assistant
         student is 17 years of age to 60. For some, the initial goal is the Associate Degree Nursing (ADN)
         program, but money, time, and sometimes grades have created a change in direction. Many complete
         the program, secure employment and continue to work on prerequisites for the ADN program.

         The Nurse Assistant Program serves as an entry-level program. It offers the opportunity for student to
         find out if the medical field and patient care is for them. This program helps student realize that yes; they
         can go to college and be successful. For most in this program, this is their first college experience.
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Certified Nursing Assistant Program Review - Modesto Junior ...
The federal and state regulation require all nurse assistants be certified by the state in which they will be
         practicing and we are one of the few colleges in the area offering the nurse assistant program.

         Nurse Assistant can work in long-term care facilities, skilled nursing and rehabilitative facilities, sub-acute
         nursing facilities, long-term acute care facilities and acute care hospitals.

         Students who complete the program receive a certificate of achievement and are eligible to take the
         state certification exam at the end of the semester. The can immediately seek employment.

Response and follow-up to previous program reviews
On the Curricunet website, please locate your department and the previous program review. After reviewing,
please complete the following questions;

Briefly describe the activities and accomplishments of the department since the last program review.

         This is the first program review for the nurse assistant program.

The Mission of Modesto Junior College
MJC is committed to transforming lives through programs and services informed by the latest scholarship of
teaching and learning. We provide a dynamic, innovative, undergraduate educational environment for the ever-
changing populations and workforce needs of our regional community. We facilitate lifelong learning through the
development of intellect, creativity, character, and abilities that shape students into thoughtful, culturally aware,
engaged citizens.

Provide a brief overview of the program and how it contributes to accomplishing the Mission of Modesto Junior
College. (Overview Suggestions: How consistent is the program with the institutional mission, vision, core values
and/or goals? How are aspects of the institutional mission addressed within the program? Is the program critical
to the pursuit of the institutional mission?)

         To prepare competent entry level nurse assistants in the cognitive (knowledge), psychomotor (skills), and
         affective (behavior) learning domains that address needs and/or expectations of communities of interest:
         students, graduates, faculty, employers, state and national standards.

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Certified Nursing Assistant Program Review - Modesto Junior ...
Student Achievement and Completion
College Goal for Student Achievement
Increase Scorecard Completion Rate for Degree and Transfer
The College has a primary aspirational goal of increasing the Completion rate from 43% to 53% on the CCCCO
Scorecard Completion Rate for Degree and Transfer [view] by 2022. The completion rates in the Scorecard
refers to the percentage of degree, certificate and/or transfer-seeking students tracked for six years who
completed a degree, certificate, or transfer-related outcomes (60 transfer units).

As you answer the questions below, please consider how your program is helping the college complete this
aspirational goal of increasing the MJC Degree, Certificate, and Transfer Completion rate by 10% on the CCCCO
Scorecard by 2022.

Success
The following questions refer to data from the Department Success Rates Dashboard. Use the filters to examine
both departmental and course level data. Charts will be included for the record by Research and Planning once the
review is submitted.

Locate your department success rates on the Success Rate Data Dashboard and consider your department
success rates trends over time, especially the last two years. Also, consider the data detailing the variance of
success rate of courses across sections. Are these rates what you expected? Are there any large gaps? Is there
anything surprising about the data? What do you see in the data?

         Students in the Nurse Assistant Program at Modesto Junior College are satisfied with the education that
         they receive as there is an 88 % satisfaction rate over the past two years. Nurse Assistant Program at
         Modesto Junior College has a fill rate of 99% for the past two years, and there are several support
         services available to students so that they can be successful.

What is your set goal for success? Do your department and individual course rates meet this goal?

         The set goal for the nurse assistant program is to have a 100% retention and pass rate. The goal is not
         met.

If your rates for success are lower than your goals, what are your plans to improve them?

         The Nurse Assistant Program will offer skills lab tutoring for students to practice skills and receive
         additional tutoring for course work.

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Locate your department equity rates on the Success Rate Data Dashboard (by pressing on the equity tab).
Examine these rates, disaggregated by ethnicity and gender, over the last two years. If there are differences in
success across groups, how do you plan on addressing issues of student equity? In other words, how do you plan
on closing achievement gaps across student populations?

        Hispanic students are performing slightly higher than White non-Hispanic students. However, all other
        ethnic groups represented in our community rank extremely low in representation in the nurse assistant
        program.

        The goal to increase student attendance in the Nurse Assistant Program at Modesto Junior College is to;
        participate in high school career day, advertise the program here on campus and work with the
        counseling, student success specialties and other services on campus to ensure students are aware of the
        Nurse Assistant Program. In addition contacting the unemployment office to advertise the nurse assistant
        program.

If distance education is offered, consider any gaps between distance education and face-to-face courses. Do these
rates differ? If so, how do you plan on closing the achievement gaps between distance education and face-to-face
courses?

        The California Department of Public Health requires that instruction is completed face-to-face.

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Conferred Award Trends
Review the Program Awards Dashboard, using the drop-down filters to focus the analysis on your department.
Starting with identifying the year, please supply degrees and certificates awarded. These charts will be attached by
Research and Planning before being posted publicly.

What is your set goal for degrees and certificates awarded? Do your rates meet this goal?

         Fall 2016- 80 students completed the Nurse Assistant Program. Spring 2017 -78 students completed the
         Nurse Assistant Program. Upon completion of the program each student received an Certificate of
         Achievement and are eligible to take the state certification exam. Of the students who successful
         completed the Nurse Assistant Program over the last two years 93% passed the state certification exam.
         Most are currently employed working in various jobs (about 60 %), as certified nursing assistants, some
         continue to pursue an associated degree in nursing and others decide the medical field is not the career
         path for them.

         For approximately 8 years a student completing the Modesto Junior College Nurse Assistant Program has
         passed the state certification exam on the first attempt at 90-94% rate.

         The students participate in a pinning ceremony, and job fair which gives them the opportunity to speak
         with local facility seeking to hire them.

         If you have numbers you can get, and if it can be broken down by ethnicity, or if you have W# and
         success on that test, I can find their ethnicities and build out some charts and tables for you.

If your rates for degrees and certificates awarded are lower than your goals, what are your plans to improve them?

         The goal is met.

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Student Learning Outcomes
Instructions

This section of the Program Review measures student learning.

PLO / GELO / ILO Outcomes

To ease in analysis, trending charts have been created by Research and Planning on the Learning Outcomes
Dashboard website. Using these charts, you can identify your current success rates in student achievement
towards the outcomes. Considering your current outcome success rates, and previous semester, set a department
aspirational goal, and examine what your outcome success rates are currently. Later you will be asked to outline a
plan to achieve this threshold, but for now, simply supply the Goal % and Current % for each level.

Note: If the dashboards do not show your Learning Outcomes, please ensure that they have been mapped in
eLumen. Each course will need to be mapped to each applicable PLO, GELO, and ILO. The Outcome Assessment
Workgroup has created a web page detailing the work already done -> PLO, ILO, and GELO Assessment
grids. For additional assistance, review the Course Learning Outcome Assessment web pages, or contact Nita
Gopal at gopaln@mjc.edu.

Student Learning and Outcomes Assessment
Please review your Learning Outcomes data located on the MJC Student Learning Outcomes
Assessment website and below, in regards to any applicable Program, Institutional, and General Education
Learning Outcomes.

For each ILO that your course learning outcomes inform, you will find your overall rate. On the MJC
Student Learning Outcomes Assessment website, you will also see that overall rate disaggregated across student
populations; you can use this information to understand how different student populations are learning in your
courses.

After you have examined your rates and disaggregated data, reflect on the data you encountered. Please address
the program outcomes (PLO), general education outcomes GELO (if any), and institutional outcomes (ILO) in your
analysis.

Course Student Learning Outcomes (CSLO)
What is your set goal for CSLO success? Do your overall rates meet this goal?

         The Nurse Assistant Program PLO data showed that 94% of SLO’s were achieved by 100% of students.
         These findings resulted in the program decision to not make any changes to the instructional process,
         course. An action plan was deemed necessary and will be created.

Continuous Quality Improvement
If your rates for success for any CSLOs are lower than your goals, what are your plans to improve them?

         To provide students with torturing services in the skills lab to help improve proficiency of newly
         developed skills. To assist students with developing study skills to retain newly learned information.

Equity and Success
Do your rates for your CSLOs vary across student populations? How you do you plan on addressing issues of
equity? In other words, how do you plan on closing the learning gaps across student populations?

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To provide students with torturing services in the skills lab to help improve proficiency of newly
       developed skills. To assist students with developing study skills to retain newly learned information.

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Curriculum and Course Offerings Analysis
Curriculum Analysis
Courses that have not been reviewed, or not scheduled to be reviewed, are listed on the Curriculum Committee
web pages. To aid in use, please view this filtered spreadsheet, using the drop down menus along the field
headings, to view just your department. On opening the spreadsheet, click the Enable Editing and Enable content
buttons that should appear across the top menu bar.

Considering those courses that have not been reviewed within the last five years, please address these below.

Provide your plans to bring courses into compliance with the 5-year cycle of review. If your department is
compliant, please state that.

         There are currently no courses in this program out of compliance with the five-year cycle of review.

Provide your plans to either inactivate or teach each course not taught in the last two years.

         All courses are currently being taught.

Does the College Catalog accurately display the descriptions and requirements of all the courses and educational
awards (degrees/certificates) overseen by this program? If not, please describe your plans to correct.

         Yes.

Are there plans for new courses or educational awards (degrees/certificates) in this program? If so, please describe
the new course(s) or award(s) you intend to create.

         The plan is to extend the course to reach students in Columbia and surrounding areas. In addition to
         develop a “Restorative Aide” training program, “Acute Care” nurse assistant training and a certification in
         “Memory Care” assistant.

What needs or rationale support this action, and when do you expect to submit these items to the Curriculum
Committee?

         With close to 50 Long-term Care, Memory Care and Rehabilitation Center with in Stanislaus County and
         the surrounding area the community is in need of entry-level trained individuals who can take care of the
         older population. The aging of America is occurring at rapid speed, the need of trained individuals is
         imperatives if we are going to meet the needs of our community. Currently within the Stanislaus county
         and surrounding area the above courses are not offered at the junior college level. When individuals are
         seeking additional training in the varies areas “Restorative Aide”, “Acute Care” Nurse Assistant training
         and “Memory Care” assistant, they are required to travel outside our community. The Nurse Assistant
         Program at Modesto Junior College receives calls weekly inquiring about when the next course will be
         offered and if we will ever service Tuolumne County.

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Course Time, Location and Modality Analysis
Please follow this link and review the Course Attributes in regards to when, where, and in which method the
courses in this program are taught. Use the filters to focus the report on your department. Then answer the
following questions.

Location/Times/Modality Trend Analysis:
Consider and analyze your location, time, and modality trends. Discuss any program plans that address more
efficient and beneficial location, modality and/or time of day trends.

        This program is a theory portion and a clinical (lab) portion. The 50 hour theory portion is taught within
        the first three weeks of the semester twice per week 8.5 hours per day. The clinical portion is taught the
        last 12 weeks of the semester one day per week for 9.5 hours. The hours for theory and clinical are
        mandated by federal and state regulations. All theory classes are taught on West campus and clinical is
        taught in local long-term care facilities.

        We are utilizing the current trend in nursing assistant program schedules. There are no plans to change
        the current schedule.

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Program Analysis
Program Personnel
Please refer to the Department Faculty and Sections Dashboard to supply the names of faculty and adjuncts for
the periods requested. Use the dashboard filters to focus on your individual department. Due to the complexity of
payroll accounts and assignments, those listed may not match known individuals, please note any discrepancies.

Additional comments or narrative can be added below.

            Faculty Name                       Full-Time or Part-Time (adjunct)

            Robinson, Tonya L                  Full Time
            Clements, Anita L                  Part Time
            Medina Zavala, Micaela             Part Time
            Odishoo, Samera S                  Part Time
            Solano, Jose D                     Part Time
            Stanford, Donna G                  Part Time
            Letitica Havens                    Part-Time

            The Nurse Assistant Program at Modesto Junior College has managed to maintain qualified faculty,
            however it becoming more of a challenge as individuals retire and there are little to no interest for the
            new nurses to train in gerontology.

            Shireen Stinson has been replaced by Letitica Havens this will be her first semester teaching for Modesto
            Junior College Nurse Assistant Program.

Faculty Assignments
Please refer to the Department Faculty and Sections Dashboard to supply the number of faculty and adjuncts
for the past two years of regular terms. Use the dashboard filters to focus on your individual department. Due to
the complexity of payroll accounts and assignments, those listed may not match known individuals, please note
any discrepancies. Please note that summer positions are all shown as adjunct due to payroll categories.

Enter figures for each term, to add additional rows, click in last cell on right and push tab on the keyboard.

Additional comments or narrative can be added below.

Term (Year Term,           # Taught by FT        # Taught by Other       # Sections Offered /    Program Fill Rate %
e.g. 2016)                 Faculty               Faculty                 Term
2015 Fall                  1                     3                       3                       101
2016 Spring                1                     3                       4                       96
2016 Summer                                      1                       2                       117
2016 Fall                  1                     2                       4                       104
2017 Spring                1                     4                       4                       99

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Departmental Productivity Measurements
If not pre-filled, please complete for two years the following table of indicators, as listed on top of
the Productivity Dashboard. A picture of this dashboard will be supplied by Research and Planning. Please enter
one term per line; to add an additional line, click in last cell and use the Tab key.

The space below is available for comments and narratives.

Term (e.g. 2016       FTEF                  FTES                  FTES/FTEF              WSCH/FTEF
Fall)
2015 Fall             2.07                  28.09                 13.57                  407.03
2016 Spring           2.06                  26.85                 13.07                  391.98
2016 Summer           1.05                  14.56                 13.87                  416.00
2016 Fall             2.07                  28.09                 13.57                  407.03
2017 Spring           2.06                  25.46                 12.39                  371.67

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Long Term Planning and Resource Needs
Long Term Planning
Provide any additional information that hasn't been addressed elsewhere in this program review, such as
environmental scans for opportunities or threats to your program, or an analysis of important subgroups of the
college population you serve.

View the Program Review Instructions page for reference and inspiration.

Taking into account the trends within this program and the college, describe what you realistically believe your
program will look like in three to five years, including such things as staffing, facilities, enrollments, breadth and
locations of offerings, etc.

           With close to 50 Long-term Care, Memory Care and Rehabilitation Center with in Stanislaus County and
           the surrounding area the community is in need of entry-level trained individuals who can take care of the
           older population. The aging of America is occurring at rapid speed, the need of trained individuals is
           imperatives if we are going to meet the needs of our community. Currently within the Stanislaus county
           and surrounding area the courses listed below are not offered at the junior college level. When
           individuals are seeking additional training in the varies areas “Restorative Aide”, “Acute Care” Nurse
           Assistant training and “Memory Care” assistant, they are required to travel outside our community. The
           Nurse Assistant Program at Modesto Junior College receives calls weekly inquiring about when the next
           course will be offered and if we will ever service Tuolumne County.

           The long term plan is double (180 to 360 students) the amount of nurse assistant students we service
           over the next 2-3 years. To offer the nurse assistant program in Tuolumne County enrolling
           approximately 30 students per semester. To develop and offer restorative aide training, acute care nurse,
           and memory care training.

           The staff to meet this goal will include at least 2 additional full-time faculties, and administrative aide
           assistant to help with the clerical portions of the program.

Resource Request and Action Plan
Priority    Name                       Resource        Estimated       Objective
                                       Type            Cost
   1        1 Faculty Instructor       Personnel:      $ 80,000         To provide additional sections of the nurse
                                       Instructional                   assistant program. Additional faculty will teach
                                       Faculty                         both theory and clinical components of the
                                                                       Nurse Assistant Program.
   2        Administration             Personnel:      $ 35,000        To help with completing state required
            Support Position           Support                         applications. Complete student files, help with
                                       staff                           scheduling live-scanning for the students.
                                                                       Ensure student health clearances are
                                                                       completed. Maintain, update and destroyed
                                                                       students files as outlined by the California
                                                                       Department of Public Health.
                                                                       Assistant with questions regarding the Nurse
                                                                       Assistant Program.
   3        Skill Lab for Nurse        Facilities:     $404,167.17     To provide an area for the nurse assistant
            Assistant Students         Redesigning                     students to practice newly developed skills,
                                       existing                        before going into the clinical site. The current
                                       facilities                      skills lab for the Associated Degree Program is
                                       (dental                         full and will not be able to accommodate the
                                       assistant                       current or growing Nurse Assistant Program.
                                       program                         This will also provide a place for the nurse
                                       space).                         assistant student to study in a group or as

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Create                        individuals.
                                    Nurse
                                    assistant
                                    skills lab.
   4      (2) Manikins              Equipment       $1800.00      Nurse Assistant can practice newly developed
                                                    each. Total   skills i.e. bathing, dressing and repositioning a
                                                    $3600.00      patient on the manikin before starting clinical.
   5      (90) Blood pressure       Equipment       $ 2700.00     Nurse Assistant can practice newly developed
          cuff and stethoscope                                    skills i.e. measuring blood pressure.
   6      (24)Reusable              Supplies        $ 800.00      Nurse Assistant can practice newly developed
          Hospital Gowns and                                      skills i.e. changing patient night gowns and
          (36) thermometers.                                      measuring body temperature.

Evaluation of Previous Resource Allocations
Below is a list of resource allocations received in previous Program Reviews. Please evaluate the effectiveness of
the resources utilized for your program. How did these resources help student success and completion?
(https://www.mjc.edu/governance/rac/documents/ielmallocationsummary20142015.pdf)

The Evaluation / Measured Effectiveness can be typed in another program and pasted here, or typed directly in to
the box below. The box will expand with additional text, and paragraphs (hard returns) can be added by using
Ctrl+Enter.

          Resource Allocated      PR Year         Evaluation / Measured Effectiveness
          This is my first time
          completing a
          program review.

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Career Technical Education Questions
The following series of question focus on Career and Technical Education, and can be answered using the labor
data from Cal-PASS Plus on Launchboard. You will need to create an account before accessing the Launchboard.

How many students did you serve in the last two academic years?
(See Program Snapshot Reports > Where are students taking courses in the region > student)

        223 students entered the Nurse Assistant Program in the last two academic years.

What kinds of students are you serving?
(See Program Snapshot Reports > Where are students taking courses in the region > Check Categories)

        88% female, 11% male and 1% other.

What percentage of your students are persisting? Consider within the
program and within the college.
(See Program Snapshot Reports > Are students progressing the pathway? > Term-to-Term Retention and
Persistence)

        Due to time lags in collecting the information the data is ot available.

Are students getting and keeping jobs?
(See Program Snapshot Reports > Are students getting jobs?)

        Due to time lags in receiving data employment information is not available.

What percentage of students are attaining a living wage?
(See Program Snapshot Reports > Are Students Making Reasonable Wages? > Living Wages button)

        Due to time lags in receiving data information on wages earned is not available.

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Appendix
Optional Questions
Please consider providing answers to the following questions. While these are optional, they provide crucial
information about your equity efforts, training, classified professional support, and recruitment.

What strategies do you use to recruit, support and retain students from disproportionately impacted groups?

         The goal to increase student attendance in the Nurse Assistant Program at Modesto Junior College is to;
         participate in high school career day, advertise the program here on campus and work with the
         counseling, student success specialties and other services on campus to ensure students are aware of the
         Nurse Assistant Program. In addition contacting the unemployment office to advertise the nurse assistant
         program.

Does your division (or program) provide any training/mentoring for faculty to support the success of students at
risk of academic failure?

         Yes.

Is there a need for more classified professional support in your area, please describe this need. Indicate how it
would support the college mission and college goals for success, and completion.

         Yes. A classified professional can assist with facility contracts (making sure they are current), student
         health clearance process, compiling student records i.e. theory and clinical attendance and health
         clearance and filing them. Sorting and maintaining student files. Scheduling pinning ceremony answer
         questions for students calling or walking in when instructor is not available.

What factors serve as barriers to recruiting active faculty to your program(s)?

         The lack of training as a gerontological nurse working in a long-term care facility.

Review Process Feedback
Please share any recommendations for improvements in the Program Review process, analysis, and questions.
Your comments will become part of the permanent review record.

         This is my first time completed a program review although I attend one day of training I could have used
         additional training.

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