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August 2013 - Volume 88 - Issue 8
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Toward a Common Taxonomy of Competency Domains for the Health Professions and Competencies for Physicians
Englander, Robert, MD, MPH; Cameron, Terri, MA; Ballard, Adrian J.; Dodge, Jessica; Bull, Janet, MA; Aschenbrener, Carol A., MD
Dr. Englander is senior director, Competency-based Learning and Assessment, Association of American Medical Colleges, Washington, DC.
Ms. Cameron is director, Curriculum Management, Association of American Medical Colleges, Washington, DC.
Mr. Ballard is educational content specialist, Association of American Medical Colleges, Washington, DC.
Ms. Dodge is a second-year medical student, University of Connecticut School of Medicine, Farmington, Connecticut.
Ms. Bull is lead specialist, Competency-based Learning and Assessment, Association of American Medical Colleges, Washington, DC.
Dr. Aschenbrener is chief medical education officer, Association of American Medical Colleges, Washington, DC.
Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A138.
Correspondence should be addressed to Dr. Englander, Association of American Medical Colleges, 2450 N St., NW, Washington, DC 20037; telephone: (202) 828-0255; fax: (202) 828-1125; e-mail: renglander@aamc.org.
Academic Medicine: August 2013 - Volume 88 - Issue 8 - p 1088–1094
doi: 10.1097/ACM.0b013e31829a3b2b
Although health professions worldwide are shifting to competency-based education, no common taxonomy for domains of competence and specific competencies currently exists. In this article, the authors describe their work to (1) identify domains of competence that could accommodate any health care profession and (2) extract a common set of competencies for physicians from existing health professions' competency frameworks that would be robust enough to provide a single, relevant infrastructure for curricular resources in the Association of American Medical Colleges' (AAMC's) MedEdPORTAL and Curriculum Inventory and Reports (CIR) sites.
The authors used the Accreditation Council for Graduate Medical Education (ACGME)/American Board of Medical Specialties six domains of competence and 36 competencies delineated by the ACGME as their foundational reference list. They added two domains described by other groups after the original six domains were introduced: Interprofessional Collaboration (4 competencies) and Personal and Professional Development (8 competencies). They compared the expanded reference list (48 competencies within eight domains) with 153 competency lists from across the medical education continuum, physician specialties and subspecialties, countries, and health care professions. Comparison analysis led them to add 13 "new" competencies and to conflate 6 competencies into 3 to eliminate redundancy.
The AAMC will use the resulting "Reference List of General Physician Competencies" (58 competencies in eight domains) to categorize resources for MedEdPORTAL and CIR. The authors hope that researchers and educators within medicine and other health professions will consider using this reference list when applicable to move toward a common taxonomy of competencies.
Public demand for accountability is driving a paradigm shift to competency-based education in the health professions worldwide.1,2 The first step in developing a competency-based system is defining the outcomes desired at the end of the educational pathway. To date, however, competency frameworks implemented in medicine and other health professions have varied in the delineation of and language used to describe specific outcomes. In medicine, for example, different frameworks for physician competencies have been developed in different countries—these include the Outcome Project3 of the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialties (ABMS) in the United States, the CanMEDS Framework4 of the Royal College of Physicians and Surgeons of Canada, the Scottish Doctor Project5 in Scotland, and the Framework for Undergraduate Medical Education in the Netherlands.6 Whereas some health professions, such as nursing, have used competency frameworks for decades,7–11 others, such as dentistry,12 have described the required competencies of their professions more recently. In all cases, delineation of the set of competencies in a given field has resulted from a multistep, multiyear, systematic process that often was not coordinated with the similar efforts of other health professions.3,4,13
At the Association of American Medical Colleges (AAMC), we identified a need for a "master" taxonomy, or classification structure, for use in cataloguing resources in the AAMC's curriculum warehouse, MedEdPORTAL (www.MedEdPORTAL.org), and Curriculum Inventory and Reports (CIR; www.aamc.org/cir). Faced with a wide range of competencies required of physicians and other health care professionals, we undertook a project to compile and compare a representative sample of competency frameworks from medicine (i.e., the continuum of physician education, physician specialties, subspecialties, and other countries) as well as other health professions.
Our goals for this project were twofold: first, to identify domains of competence that could accommodate the competency frameworks used by any health care profession; and second, to extract from existing frameworks a standard set of competencies for physicians across the medical education continuum that would be robust enough to provide a relevant infrastructure for any health professional using the MedEdPORTAL and CIR sites. We sought as our end products (1) a set of domains of competence to which any of the health professions' competencies could be mapped or linked within these two sites, and (2) a reference list of general physician competencies that would both include all of the concepts put forth by the various competency frameworks and eliminate redundancy.
In this article, we describe our cross-classification method and share the resulting set of domains of competence and the reference list of competencies that the AAMC will use to classify curricula and learning resources for physician education and training. We do not intend or suggest that these supplant any current regulatory structures or training requirements. We hope, however, that they can be used across medicine and other health professions as a first step toward a common taxonomy of competencies.
Process for Comparing Competency Frameworks
For the purposes of this project, we defined five key terms—competency, competence, competency list, domains of competence, and competency framework—based on both published definitions14,15 and our experience (List 1).
Using PubMED, Google, and Web sites of selected health care organizations, we searched for published competency frameworks representing
the continuum of physician education, from premed through medical school, residency, fellowship, and practice;
multiple specialties and subspecialties within medicine;
specific content areas in medicine (e.g., cultural competence, geriatrics, women's health);
physicians in nations other than the United States; and
multiple health care professions.
We used the original ACGME/ABMS framework delineated in 199916 and its most recent updates17,18 as the foundational reference list of competencies against which we compared all other competency frameworks and their competency lists. We chose this framework because it currently forms the basis for all accredited residency and fellowship training programs in the United States and has been adopted for the ABMS Maintenance of Certification (MOC) Program. Additionally, as at least one-third of U.S. medical schools use the ACGME/ABMS framework to ground their competency expectations19 for medical students, this framework has by far the broadest reach across the AAMC constituency.
The ACGME/ABMS framework identifies six domains of competence: Patient Care (PC), Medical Knowledge (MK), Interpersonal and Communication Skills (ICS), Professionalism (P), Practice-Based Learning and Improvement (PBLI), and Systems-Based Practice (SBP). Each domain includes a set of competencies. We built our foundational reference list on the original 199916 set of 28 competencies and updated it on the basis of comparisons with the 201017 and 201218 ACGME Common Program Requirements, adding new competencies and eliminating redundancies. This resulted in 36 total competencies for the ACGME's current framework (PC = 10; MK = 2; ICS = 5; P= 5; PBLI = 8; SBP = 6).
Before comparing this foundational competency list with other lists, we sought to identify and fill any gaps in the ACGME/ABMS framework. First, we changed the domain of competence "Medical Knowledge" to "Knowledge for Practice" (KP) to accommodate a broad range of health professions' competency frameworks. Second, we identified two domains of competence that were described after the original ACGME/ABMS domains were delineated. The first domain is "Interprofessional Collaboration" (IPC),20 for which the Interprofessional Education Collaborative defined four competencies. One of the IPC competencies was nearly identical to one of the SBP competencies; we subsumed the competency under IPC. The second domain arose from the work of the Pediatrics Milestone Working Group and the Association of Pediatric Program Directors, who identified a set of 8 competencies which they classified under a domain of "Personal and Professional Development" (PPD).21 Interestingly, we were able to match a number of the PPD competencies to competencies in the CanMEDS4 and Scottish Doctor5 frameworks. Adding IPC and PPD to our foundational reference list resulted in a draft reference list composed of 48 competencies in eight domains against which we compared all other competency frameworks and lists.
Three of us (T.C., A.B., J.D.) used mapping standards based on the World Wide Web Consortium's Simple Knowledge Organization System (SKOS)22 to structure the process of comparing each competency list with our draft reference list. The SKOS mapping schema is used to indicate the nature of relationships between various concepts, or degrees of matching between various ideas. Match types include "exact," "close," "narrow," "broad," and "related." One rater initially matched each comparison list. To ensure the raters were using the same definitions of the match types, they randomly chose lists to review as a team for interrater calibration. Only competencies rated as exact or close matches were ultimately matched to the competencies on the draft reference list. The raters reviewed all of the "unmatched" competencies—those not rated as an exact or close match—for common themes. They grouped the unmatched competencies by theme to inform the articulation of additional competencies that they added to the list. They also reviewed the group of matched competencies and revised the language of some to most closely match the broadest number of competencies in the group. The other authors (R.E., J.B., C.A.) then vetted the final reference list and made only minor modifications to the language.
Outcome of the Comparisons
We identified 153 competency lists and compared them with our draft reference list of 48 competencies in eight domains. Thirty-two lists (comprising 28 frameworks) were outside the ACGME/ABMS framework. Fourteen of these lists were from nine other health professions: nursing,7–10 pharmacy,23 chiropractic,24 optometry,25 public health/global health,26–28 physician assistants,29 dental,30 health professionals–general,31 and veterinary medicine.32 Eighteen lists were from medicine: osteopathic medicine,33 international physicians (CanMEDS,4 Scottish Doctor),5 premedical students,34–36 medical students–general (Medical School Objectives Project),37 medical student clerkships,38–44 and medical students–content-specific45–48 (e.g., cultural competencies, geriatric competencies). We found impressive overlap between and among these lists of competencies. For example, for 17 of the 48 competencies, half of the lists had either an exactly or closely matching competency.
The other 121 competency lists we reviewed were developed by ACGME specialty review committees to fit within the ACGME/ABMS framework: 1 transitional year residency, 26 specialty residency, and 94 subspecialty residency or fellowship lists (see Supplemental Digital Appendix 1, http://links.lww.com/ACADMED/A138). As these lists were essentially modified from the ACGME framework, we expected and were not surprised to find nearly 100% overlap with competencies on our draft reference list.
After completing the matching process for all 153 lists, we determined that only 13 themes representing individual competencies were sufficiently different from the 48 on the draft reference list to merit inclusion in our final reference list. Three of these additions were simply more granular delineations of the KP competency related to application of knowledge. In compiling the final list, we also conflated 6 competencies from the draft list into 3 because of redundancy within or between domains. Our final "Reference List of General Physician Competencies" (List 2) consists of 58 competencies in eight domains (PC = 11; PBLI = 10; ICS = 7; KP, P, and SBP = 6 each; IPC = 4; PPD = 8).
Shared language is important in leading adaptive change. When people begin to use the same words with the same meaning, they communicate more effectively, minimize misunderstandings, and gain the sense of being on the same page, even while grappling with significant differences on the issues.49(p9)
The paradigm shift to competency-based medical education represents an adaptive change driven by public demands for increased accountability for the physicians the medical education system produces.1 One of the barriers to implementation has been the lack of a common language describing domains of competence in the health professions and the specific competencies that are critical to the formation and continuing development of physicians.
As noted above, this lack precluded development of a classification system that would allow MedEdPORTAL and CIR resources to be matched to domains of competence and individual competencies. We therefore began this endeavor with the goal of establishing a robust reference list of competencies that could be mapped to any curriculum within the continuum of medical education.
We learned two lessons from our review of 153 competency lists. First, the ACGME/ABMS framework is quite robust. Our Reference List of General Physician Competencies adds only two domains of competence (IPC20 and PPD,21 encompassing 12 competencies) and 13 "new" competencies that mapped to the six ACGME/ABMS domains16 but had not been captured by the original or updated frameworks.16–18
Second, the resultant eight domains of competence can serve as a template for the health professions in general, as other health professions' competency lists map well to them. Toward that end, our list proposes broadening the title of one domain—changing "Medical Knowledge" to "Knowledge for Practice"—to incorporate other health care professions. We did not set out to establish a master list of competencies for all health care professions, but we hope our reference list will provide a solid foundation for other health care professionals, particularly those that may wish to use MedEdPORTAL or CIR resources.
Our work has limitations. First, the 153 competency lists represent a convenience sample; we did not conduct an exhaustive search in the world literature. There is a clear bias toward competency lists adapted from the ACGME/ABMS framework (121/153; 79%), and we may have missed competencies from frameworks we did not review. Second, the authors who reviewed the lists examined only a sampling of matches between lists as a team for interrater calibration. Thus, a small subset of competencies that were not rated as an exact or close match by one of the raters might have been so categorized by another. However, to avoid omitting any of the concepts addressed in the competency lists, those three authors reviewed all of the unmatched competencies at the end of the process to group them by themes, which led to the addition of 13 competencies (see List 2). The result is that we are likely to have some errors of commission (i.e., 2 competencies that significantly overlap in meaning) rather than of omission (i.e., competencies or concepts that should be present on the list but are not).
Finally, we modified the language of some of the 48 draft reference list competencies and all of the 13 "new" competencies. Our goal was to capture the most common intended meaning for a given competency from among the many lists. The potential unintended consequence is that we may have changed the language of individual competencies in ways that result in a substantively different meaning. We are confident, though, that our process resulted in a final reference list that in the aggregate captures all of the ideas expressed in the many frameworks we examined.
We believe the comprehensive list of competencies presented in this article has multiple uses. First, it can serve as a reference list that describes the current sum total of physician competencies from a wide sample of competency frameworks. Second, it represents a first step toward establishing a common taxonomy of competencies so essential to adaptive change. Third, it enables researchers and educators to begin to track at a detailed level where and how learners are being exposed to content and experiences that help them build these competencies, as well as the ways in which these competencies are being assessed. Ultimately, through the use of shared assessment items and tools that are matched at the competency level, it may be possible to build some general theories of the developmental acquisition of competencies across the educational continuum.
Our Reference List for General Physician Competencies will soon become the organizing framework for MedEdPORTAL and CIR, allowing users to link their submissions or search for resources by specific competencies or domains of competence. Over time, this standardized language will help us gain a better understanding of how medical educators are addressing competencies through curricula and assessment and should allow the identification of curricular gaps and resource needs. We will need to revisit the list frequently as medical educators across the continuum adapt their vision of the 21st-century physician and the competencies he or she requires to meet the ever-changing needs of the health care system and the public.
Funding/Support: None.
Other disclosures: None.
Ethical approval: Not applicable.
Definitions of Key Concepts
Competency framework: "An organized and structured representation of a set of interrelated and purposeful competencies."14
Domains of competence: Broad distinguishable areas of competence that in the aggregate constitute a general descriptive framework for a profession. (Authors' definition)
Competency list: The delineation of the specific competencies within a competency framework. (Authors' definition)
Competence: "The array of abilities [knowledge, skills, and attitudes, or KSA] across multiple domains or aspects of performance in a certain context. Statements about competence require descriptive qualifiers to define the relevant abilities, context, and stage of training. Competence is multi-dimensional and dynamic. It changes with time, experience, and setting."15
Competency: "An observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed to ensure their acquisition."15
Reference List of General Physician Competencies*,†
Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
1.1 Perform all medical, diagnostic, and surgical procedures considered essential for the area of practice
1.2 Gather essential and accurate information about patients and their conditions through history-taking, physical examination, and the use of laboratory data, imaging, and other tests
1.3 ‡Organize and prioritize responsibilities to provide care that is safe, effective, and efficient21
1.4 ‡Interpret laboratory data, imaging studies, and other tests required for the area of practice29,33,37,39,RC
1.5 Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
1.6 Develop and carry out patient management plans
1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making
1.8 ‡Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes9,44,RC
1.9 Provide health care services to patients, families, and communities aimed at preventing health problems or maintaining health
1.10 ‡Provide appropriate role modeling21
1.11 ‡Perform supervisory responsibilities commensurate with one's roles, abilities, and qualifications30,32,RC
Knowledge for Practice§
Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care
2.1 Demonstrate an investigatory and analytic approach to clinical situations
2.2 Apply established and emerging bio-physical scientific principles fundamental to health care for patients and populations
2.3 ‡Apply established and emerging principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based health careRC
2.4 ‡Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations4,5,26,33,34,36,37,44
2.5 ‡Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care9,34,37,44
2.6 ‡Contribute to the creation, dissemination, application, and translation of new health care knowledge and practices4,9,30
Practice-Based Learning and Improvement
Demonstrate the ability to investigate and evaluate one's care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning
3.1 Identify strengths, deficiencies, and limits in one's knowledge and expertise
3.2 Set learning and improvement goals
3.3 Identify and perform learning activities that address one's gaps in knowledge, skills, and/or attitudes
3.4 Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement
3.5 Incorporate feedback into daily practice
3.6 Locate, appraise, and assimilate evidence from scientific studies related to patients' health problems
3.7 Use information technology to optimize learning
3.8 Participate in the education of patients, families, students, trainees, peers, and other health professionals
3.9 Obtain and utilize information about individual patients, populations of patients, or communities from which patients are drawn to improve care
3.10 ‡Continually identify, analyze, and implement new knowledge, guidelines, standards, technologies, products, or services that have been demonstrated to improve outcomes4,9,23,30,35,37
Interpersonal and Communication Skills
Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals
4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds
4.2 Communicate effectively with colleagues within one's profession or specialty, other health professionals, and health related agencies (see also 7.3)
4.3 Work effectively with others as a member or leader of a health care team or other professional group (see also 7.4)
4.4 Act in a consultative role to other health professionals
4.5 Maintain comprehensive, timely, and legible medical records
4.6 ‡Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics9,32,40
4.7 ‡Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions33–35,37,40
Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles
5.1 Demonstrate compassion, integrity, and respect for others
5.2 Demonstrate responsiveness to patient needs that supersedes self-interest
5.3 Demonstrate respect for patient privacy and autonomy
5.4 Demonstrate accountability to patients, society, and the profession
5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
5.6 Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations
6.Systems-Based Practice
Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care
6.1 Work effectively in various health care delivery settings and systems relevant to one's clinical specialty
6.2 Coordinate patient care within the health care system relevant to one's clinical specialty
6.3 Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care
6.4 Advocate for quality patient care and optimal patient care systems
6.5 Participate in identifying system errors and implementing potential systems solutions
6.6 ‡Perform administrative and practice management responsibilities commensurate with one's role, abilities, and qualifications30,32
Interprofessional Collaboration
Demonstrate the ability to engage in an interprofessional team in a manner that optimizes safe, effective patient- and population-centered care
7.1 Work with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust
7.2 Use the knowledge of one's own role and the roles of other health professionals to appropriately assess and address the health care needs of the patients and populations served
7.3 Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the treatment of disease in individual patients and populations
7.4 Participate in different team roles to establish, develop, and continuously enhance interprofessional teams to provide patient- and population-centered care that is safe, timely, efficient, effective, and equitable
Demonstrate the qualities required to sustain lifelong personal and professional growth
8.1 Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors
8.2 Demonstrate healthy coping mechanisms to respond to stress
8.3 Manage conflict between personal and professional responsibilities
8.4 Practice flexibility and maturity in adjusting to change with the capacity to alter one's behavior
8.5 Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients
8.6 Provide leadership skills that enhance team functioning, the learning environment, and/or the health care delivery system
8.7 Demonstrate self-confidence that puts patients, families, and members of the health care team at ease
8.8 Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty
* This list is not intended to supplant any current regulatory requirements. It is solely intended as a robust reference list of physician competencies that captures the essence of competency frameworks published as of June 2012.
† Unless otherwise indicated, the domains of competence are reproduced or adapted from the following sources: Domains 1–6, Accreditation Council for Graduate Medical Education, General Competencies16 and Common Program Requirements17,18; Domain 7, Interprofessional Education Collaborative Expert Panel, Core Competencies for Interprofessional Collaborative Practice20; Domain 8, Pediatrics Milestone Working Group, Pediatrics Milestone Project.21 Some of the competencies in each domain represent modifications or adaptations of original language to accommodate overlapping concepts from a number of competency lists.
‡ These competencies were added on the basis of the authors' review of 153 competency lists. The sources from which the "new" competencies were adapted are cited. RC indicates that at least one was a specialty/subspecialty review committee's list of competencies. See Supplemental Digital Appendix 1 (http://links.lww.com/ACADMED/A138) for the list of RC sources.
§ This domain is titled "Medical Knowledge" in the ACGME framework.16–18 The authors revised the domain name in this reference list to incorporate frameworks from other health professions.
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32. North American Veterinary Medical Education Consortium. . Roadmap for Veterinary Medical Education in the 21st Century: Responsive, Collaborative, Flexible. 2011. http://www.aavmc.org/data/files/navmec/navmec_roadmapreport_web_booklet.pdf. Accessed April 4, 2013
33. National Board of Osteopathic Medical Examiners. . Fundamental Osteopathic Medical Competency Domains: Guidelines for Osteopathic Medical Licensure and the Practice of Osteopathic Medicine. 2011. http://www.nbome.org/docs/NBOME%20Fundamental%20Osteopathic%20Medical%20Competencies.pdf. Accessed December 24, 2012
34. Association of American Medical Colleges. . Behavioral and Social Science Foundations for Future Physicians. 2011. https://www.aamc.org/download/271020/data/behavioralandsocialsciencefoundationsforfuturephysicians.pdf. Accessed April 4, 2013
35. Association of American Medical Colleges. . MCAT2015: A Better Test for Tomorrow's Doctors. Preview Guide for the MCAT2015 Exam. 2012. https://www.aamc.org/students/download/266006/data/2015previewguide.pdf. Accessed April 4, 2013
36. Association of American Medical Colleges and the Howard Hughes Medical Institute. . Scientific Foundations for Future Physicians: Report of the AAMC-HHMI Committee. 2009. http://www.hhmi.org/grants/pdf/08-209_AAMC-HHMI_report.pdf. Accessed April 4, 2013
37. Association of American Medical Colleges. Learning Objectives for Medical Student Education: Guidelines for Medical Schools. 1998 Washington, DC Association of American Medical Colleges
38. Association of Directors of Medical StudentEducation in Psychiatry. . Clinical Learning Objectives Guide for Psychiatry Education of Medical Students. 2007. http://www.admsep.org/Clinical_LO_Guide_Outline_Format_Nov_07.pdf. Accessed April4, 2013
39. Association for Surgical Education. . The Manual of Surgical Objectives: A Symptom and Problem-Based Approach. 20014th ed http://www.surgicaleducation.com/assets/documents/surgicalobjectivesmanual4.pdf. Accessed April 4, 2013
40. Clerkship Directors in Internal Medicine and Society of General Internal Medicine. . Core Medicine Clerkship Curriculum Guide. Version 3.0. 2006. http://www.im.org/toolbox/curriculum/coremedicineclerkshipcurriculum/Documents/OnlineCDIMCurriculum.pdf. Accessed April 4, 2013
41. Academic Pediatric Association and Council on Medical Student Education in Pediatrics. . COMSEP Curriculum Revision. 2005. http://www.comsep.org/curriculum/curriculumcompetencies/pdf/web2005COMSEPCurricul_old.pdf. Accessed April 4, 2013
42. Emergency Medicine Model Review Task Force. . 2009 Model of the Clinical Practice of Emergency Medicine. https://www.abem.org/PUBLIC/_Rainbow/Documents/2009%20EM%20Model%20-%20Website%20Document%20-%20clean.pdf. Accessed April 4, 2013
43. Gelb DJ, Gunderson CH, Henry KA, Kirshner HS, Józefowicz RFConsortium of Neurology Clerkship Directors and the Undergraduate Education Subcommittee of the American Academy of Neurology. . The neurology clerkship core curriculum. 2005. Neurology. 2002;58:849–852
44. Society of Teachers of Family Medicine. . Family Medicine Curriculum Resource (FMCR) Project: FM Clerkship Objectives Indexed by ACGME Competencies and FM Themes. 2003. http://fammed.musc.edu/fmc/data/ACGME_Themes.htm. Accessed 2011. [No longer available.]
45. Association of American Medical Colleges. . Cultural Competence Education for Medical Students (TACCT). 2005. https://www.aamc.org/download/54338/data/culturalcomped.pdf. Accessed April 4, 2013
46. Leipzig RM, Granville L, Simpson D, Anderson MB, Sauvigné K, Soriano RP. Keeping granny safe on July 1: A consensus on minimum geriatrics competencies for graduating medical students. Acad Med. 2009;84:604–610
47. Association of Professors of Human and Medical Genetics and American Society of Human Genetics. . Medical School Core Curriculum in Genetics. 2001. http://www.ashg.org/pdf/Medical%20School%20Core%20Curriculum%20in%20Genetics.pdf. Accessed April 4, 2013
48. Association of Professors of Gynecology and Obstetrics. . Women's Health Care Competencies for Medical Students: Taking Steps to Include Sex and Gender Differences in the Curriculum. 2005. http://www.apgo.org/binary/1959_APGO.pdf. Accessed April 4, 2013
49. Heifetz R, Linsky M, Grashow A The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World. 2009 Boston, Mass Cambridge Leadership Associates
ACADMED_88_8_2013_06_25_ENGLANDER_203421_SDC1.pdf; [PDF] (55 KB)
© 2013 by the Association of American Medical Colleges
Academic Medicine88(8):1088-1094, August 2013.
Articles in PubMed by Robert Englander, MD, MPH
Articles in Google Scholar by Robert Englander, MD, MPH
Other articles in this journal by Robert Englander, MD, MPH
Shifting Paradigms: From Flexner to Competencies
AM Last Page: Self-Regulated Learning—A Dynamic, Cyclical Perspective
Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education
A Lack of Continuity in Education, Training, and Practice Violates the "Do No Harm" Principle
Systematic Review of Depression, Anxiety, and Other Indicators of Psychological Distress Among U.S. and Canadian Medical Students
by the Association of American Medical Colleges


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Lund Studios is a lively independent centre for creativity run by Steve Pomfret and Debbie Loane within the beautiful North Yorkshire Landscape.
Housed in converted barns just outside Easingwold we host an exciting programme of courses run by artists and makers from across the UK – including painting, drawing, textiles, mixed media and printmaking.
We are also home to Lund Gallery, exhibiting original art and ceramics from makers across the UK, and to Debbie Loane's personal studio. Visit our website or get in touch to find out more!


text:
Q: Updating a table by referencing another table I have a table CustPurchase (name, purchase) and another table CustID (id, name).
I altered the CustPurchase table to have an id field. Now, I want to populate this newly created field by referencing the customer ids from the CustID table, using:
UPDATE CustPurchase
   SET CustPurchase.id = CustID.id
 WHERE CustPurchase.name = CustID.name;

I keep getting syntax errors!

A: Joining by name is not an ideal choice, but this should work:
UPDATE custpurchase
   SET id = (SELECT c.id
               FROM CUSTID c
              WHERE c.name = custpurchase.name)

The caveat is that if there's no match, the value attempting to be inserted would be NULL.  Assuming the id column won't allow NULL but will allow duplicate values:
UPDATE custpurchase
   SET id = (SELECT COALESCE(c.id, -99)
               FROM CUSTID c
              WHERE c.name = custpurchase.name)

COALESCE will return the first non-NULL value.  Making this a value outside of what you'd normally expect will make it easier to isolate such records & deal with appropriately.
Otherwise, you'll have to do the updating "by hand", on a name by name basis, to correct instances that SQL could not.

A: I believe you are after the useful UPDATE FROM syntax.
UPDATE CustPurchase SET id = CI.id
FROM
   CustPurchase CP
   inner join CustID CI on (CI.name = CP.name)

This might have to be the following:
UPDATE CustPurchase SET id = CI.id
FROM
   CustID CI
WHERE
   CI.name = CustPurchase.name

Sorry, I'm away from my Postgres machine; however, based upon the reference, it looks like this is allowable. The trouble is whether or not to include the source table in the from_list.

redpajama_set_name: RedPajamaStackExchange


Have questions? Get answers from Popsout or BusinessList.pk users. Visitors haven't asked any questions yet.
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Internal electronic fetal monitoring: An internal monitor can only be used once your "water has broken" and your cervix has dilated enough.
hormones of labor | research studies are being performed to learn about Induction Of Labor .
The Cascade Effect of OB Interventions. Midwife only please!
EKG Simplified. Where was this during the cardiac section of my A&P class!
NCLEX online nursing education for all nurses, all nursing students and healthcare professionals.
Figure 85-4 Patterns of periodic fetal heart rate (FHR) deceleration.


Wroe Alderson and Paul E. Green, 1964.
Planning and Problem Solving in Marketing.
The Dynamics of Brand Loyalty: A Markovian Approach.
Operation Research, Vol. 10 (Jan.-Feb., 1962) pp. 20-21.
Decision Making and the Theory of the Firm.
Holt, Rinehart and Winston, New York.
Jacob Jacoby and Robert W. Chestnut, 1978.
The Use of Mathematical Models in Marketing.
Journal of Marketing, Vol. 27 (October, 1963), p33.
Least Squares Estimation in Finite Markov Processes.
Psychometrika, Vol. 24 (1959), pp 137-144.
Philippe Naert and Peter Leeflang, 1978.
Martinus Nijhoff Social Sciences Division, Boston.
Least-Squares Estimates of Transition Probabilities.
Measurement in Economics, Stanford University.
H. Theil and Guido Rey, 1966.
A Quadratic Programming Approach to the Estimation of Transition Probabilities.
Management Science, Vol. 12, No. 9, May 1966.


The bean is unwashed or natural, meaning the fruit (coffee cherry) is left to dry on the bean before being removed. This process imparts a unique flavour profile. It's our new favourite!
For more information on this coffee, click here.


Paperback, 6.25 x 9 in. / 256 pgs / 9 bw.
Edited by Carolyn Strauss, Ana Paula Pais. Text by Yochai Benkler, Maria Blaisse, Chet Bowers, Olafur Eliasson, et al.
Slow Reader collects theoretical reflections and practical perspectives from writers, designers, architects, artists and environmental activists that aspire toward a holistic vision of human activity. Contributors include Yochai Benkler, Maria Blaisse, Chet Bowers, Olafur Eliasson, Eric Ellingsen, Emilio Fantin, Fernando Garcia-Dory, Lotte van Gelder, Jeanne van Heeswijk, the nanopolitics group, Jogi Panghaal, Eva Pfannes (Ooze Architects), Ann Pendleton-Jullian, Alessandra Pomarico, Marjetica Potr´c, Julian Raxworthy, Uzma Rizvi, Niels Schrader and Christina Werner.
Positioned as a "resource for design thinking and practice," this book challenges the paths through which contemporary designers conventionally operate and the values of speed and efficiency that dominate discourse. Slow Reader is intended to inspire readers well beyond the design field, serving as a vehicle for reflection, imagination and further investigation of "slower" approaches to living.
FORMAT: Pbk, 6.25 x 9 in. / 256 pgs / 9 b&w.


text:
Online only/e-edition -- One Month $6.00 for 30 days
Online only/e-edition One Year $32.00 for 365 days
Print Subscribers - Includes Online access!
Are you an existing print subscriber? Verify your subscription to receive complimentary online access.
Print/online subscription
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Foggy early, then partly cloudy later in the day. High 48F. Winds light and variable..
Mostly cloudy skies. Low 36F. Winds light and variable.
The Perrydale Pirates 8-man lineup gets set to kick off in a game last fall.
Jolene Guzman | Itemizer-Observer
Local 1A schools against OSAA football committee recommendation
By Steve Brandon Itemizer-Observer
WILSONVILLE — The football programs at Perrydale and Falls City want to throw a flag on the Oregon School Activities Association — for too many men on the field.
The OSAA Football Ad Hoc Advisory Committee has recommended the end of 8-man football in Oregon. It would be replaced by 9-man football, starting next season.
Perrydale and Falls City are among those traditional, Class 1A 8-man schools who think nine men on the football field is one too many.
"Makes absolutely no sense," Falls City coach Laric Cook said.
The idea seems to stem mostly from larger schools' interest in a configuration (9-man) that more closely resembles their 11-man game. Schools then more easily could play across classifications at the junior varsity or freshman levels, and Class 2A schools struggling at 11-man could play 9-man varsity.
"Basically, I think it's not a good thing," Perrydale coach Steve Mabry said of the proposed change. "It helps Class 2A schools come down (to 9-man), and gives them a little more advantage size-wise. You're giving an incentive to larger schools having bad years to play down."
"I don't see the point of doing 9-man instead of 8-man," Falls City athletic director Dennis Sickles said. "I don't believe we should do away with 8-man football. What they're proposing is the worst thing for 1A schools."
The OSAA football committee met for the first time on Dec. 20 and will meet three more times, making a final recommendation for the 2022-2026 time block to the Executive Board and Delegate Assembly, most likely in February.
The committee supports putting all the 2A and 1A schools into three groups. Two groups would be in separate 9-man football divisions, based on enrollment and each with its own state championship. The other group would be in a 6-man division, with its own championship.
Division 1 would be for schools with enrollment of 77 to 145 average daily membership.
Division 2 would be for schools with 56 to 77 ADM, including Perrydale and Falls City.
The 6-man division would be for schools with 55 or fewer ADM.
But schools may request to play up or down.
In the initial proposal, Perrydale and Falls City are joined by 24 other schools in Division 2: Adrian, Alsea, Bonanza, Cove, Crosspoint Christian, Dufur, Elgin, Imbler, Ione/Arlington, Lost River, Lowell, Lyle/Wishram/Klickitat, Mohawk, Myrtle Point, North Douglas, Powder Valley, Prospect/Butte Falls, Regis, Riddle, Sherman/Condon, St. Paul, Union and Yoncalla.
Division 1 has 28 schools, and the six-man division has 25 schools, with each division's ultimate size still subject to those play-up or play-down requests.
The committee noted that fewer schools are playing 8-man football since the adoption of six-man football in Oregon four years ago, which only makes sense.
"We had 50 8-man schools in 2010," said Tony Smith, committee chair and the athletic director and football coach at 1A St. Paul, which has played 8-man the past four years.
Last season, 28 schools (eight from 2A, 20 from 1A) played 8-man, and 22 schools (all 1A) played 6-man.
The committee suggested that, under the new set-up, some 11-man and 9-man schools would play each other in nonleague games, largely because it's a fairly seamless change for coaches and players.
For 9-man, offenses basically remove two offensive linemen from their 11-man formations and add a running back or slot receiver from their typical 8-man sets.
Defenses for 9-man add a player in the secondary in going up from 8-man, and can go with various choices on defense, usually with three down linemen.
Four states – Wyoming, Minnesota, North Dakota and South Dakota – have high school state tournaments in 9-man football.
"If 9-man football was so great, why are only a few states doing it?" Cook asked. "Why aren't big football states, like California and Texas and Florida, doing it?"
Some states have used a smaller field for 9-man football, but the 9-man game in Oregon would be on a standard 100-by-53 1/2-yard field, as is used for Oregon 8-man and 11-man.
"When we were 11-man at St. Paul, we played some 9-man games in a 2A JV league for at least 12 years, and we've played 3A and some 4A freshmen or JV2 teams in 9-man games," St. Paul's Smith said.
The committee noted that turnout for high school football has been declining in recent years. Smith didn't say how going from 8-man to 9-man would reverse that trend but said "I wouldn't think it would decrease participation."
At Perrydale, Mabry doesn't see a plus in going to 9-man.
"I don't see how it benefits us," he said, "because we're already chasing numbers, and now we'd have to fill 18 spots on the field (offense, defense), which is a huge difference from 16, in practices and games."
At Falls City, Sickles and Cook also don't see how going to 9-man would help, and they worry about having enough players to compete with larger schools.
"I've got 12 to 15 kids every year, between two schools (Falls City and Kings Valley Charter)," Cook said. "We finished a couple of games this year with only nine kids left."
"Nine-man could adversely affect us," Sickles said. "And it could force some schools to go to 6-man.
"The smaller 2A schools don't want to compete with the larger 2A schools," Sickles added. "A better solution would be to have a smaller 8-man division and a larger 8-man division, and use 6-man only as an emergency measure.
"I'd take the 16 teams that go to state for 8-man and send eight to the smaller playoffs and eight to the larger playoffs. You could end the season in mid-November and get boys off to winter sports on time."
Cook and Sickles are adamantly against playing 6-man football.
"We absolutely will not play 6-man. That's a joke of a game – a P.E., recess type of game," Cook said. "But six-man is going to be the death of 8-man. Everybody wants a trophy."
Perrydale and Falls City football people talk about the tradition of 8-man football, which has been around since the early 1960s.
"It would be a crying shame" to lose 8-man football, Cook said. "Three generations of my family have played it. It's a tradition in a lot of communities. I don't understand why they're taking our game away.
"It's been a sustainable thing, and it's a great game. Nine-man is a watered-down version of 11-man.
"The 11-man community just doesn't want to have to learn a new game (8-man)."
The committee will meet on Jan. 5, Jan. 19 and Feb. 2 at Wilsonville, before making its final recommendation.
Brad Garrett, OSAA assistant executive director, said "it is likely the group will have to schedule some additional meetings, depending on how the 9-player structure works out."
Huskers offer Class of 2023 QB Avery Johnson; WR coach Mickey Joseph recruiting in-state
Daniel Hardy, Taylor Tuiasosopo give thanks as trying Montana State careers end
New Husker OC Whipple becomes highest-paid assistant coach in program history; Busch to make $400,000
Perrydale And Falls City
Osaa Football Ad Hoc Advisory Committee
Dennis Sickles
WOU Guide
Embrace the music: Smith Fine Arts Series auction goes online
Seamus Egan Project to play at Smith Fine Arts
'It's a Wonderful Life' takes stage at Rice
Find the mystery in Monmouth's history
WOU's history
WOU Athletics
Wolf Ride :WOU offers free shuttle service to students
Christmas at WOU
Dallas finds its wings

redpajama_set_name: RedPajamaCommonCrawl


Here at HETTY Preschool, we believe that every child is unique and therefore has his or her own special way of learning.
The EYFS explains that there are different ways in which children learn, and at HETTY we love to provide opportunities for your children to develop their own way of learning.
Your child might learn through being ACTIVE, through THINKING CRITICALLY and being CREATIVE or through PLAYING and EXPLORING. They might also be a combination of some or all of these ways.
However your child learns, we hope they will learn through having fun at HETTY and will be encouraged to be the unique and wonderful child they are!
Please click on the links below to see the 'grown up' and the 'child friendly' ways in which your child will learn.


text:
package org.semanticweb.yars.nx.namespace;

import org.semanticweb.yars.nx.Resource;

public class XHTML {
	public static final String NS = "http://www.w3.org/1999/xhtml#";

	public static final Resource LINK = new Resource(NS+"link");
}

redpajama_set_name: RedPajamaGithub


text:
using System.Text.Json.Serialization;

namespace LinqToTwitter
{
    /// <summary>
    /// Represents an annotation entity
    /// </summary>
    public record TweetEntityAnnotation
    {
        /// <summary>
        /// Start of annotation text
        /// </summary>
        [JsonPropertyName("start")]
        public int Start { get; init; }

        /// <summary>
        /// End of annotation text
        /// </summary>
        [JsonPropertyName("end")]
        public int End { get; init; }

        /// <summary>
        /// Probability that <see cref="NormalizedText"/> belongs to <see cref="Type"/> category
        /// </summary>
        [JsonPropertyName("probability")]
        public float Probability { get; init; }

        /// <summary>
        /// Category that <see cref="NormalizedText"/> belongs to
        /// </summary>
        [JsonPropertyName("type")]
        public string? Type { get; init; }

        /// <summary>
        /// Annotated text
        /// </summary>
        [JsonPropertyName("normalized_text")]
        public string? NormalizedText { get; init; }
    }
}


Selena Gomez has always been one of the topcelebrities on Instagram. Her music, her relationship with Canadian singer Justin Bieber and her pictures have always gotten her aplace amongst the people who must be followed. Now, she's broken her own record – and a record on Instagram as a whole – by reaching an amazing number of followers.
It's been five whole weeks since Gomez uploaded anything to Instagram, but that doesn't seem to have stopped her evergrowing legion of fans. She already held a record for the most liked picture on Instagram. The photograph, uploaded on June 25, got 4.5 million likes in less than a month, a groundbreaking record set in the blink of an eye.
How can Selena Gomez have so many followers?
Back then, Selena was being followed by 90.2 million people – which are indeed a lot – but now she's broken her own record. Selena Gomez has become the first person to be followed by more than 100 million people on Instagram. It's something no one had ever achieved. That's why they call her the Instagram Queen. But how has she managed to reach such an amazing figure? What is her secret?
On her Instagram account, the young singer gives her fans some bits of her life – not only her private life, but also her professional life. Concerts, photo-shootings, collaborations with other artists… What she does very little is something that we've seen other celebrities do a lot, if not too much – Selena almost never shares bits of her private life with her fans. She's always focused and, compared to other Instagram stars, lets people see very little of her privacy. Unlike Taylor Swift, Beyonce or Kim Kardashian, who have tons of followers but haven't reached Selena's level, she is happy to keep some parts of her life a secret.


text:
#ifndef LSL_USER_H
#define LSL_USER_H

#include "common.h"

#include <lslutils/type_forwards.h>
#include <boost/shared_ptr.hpp>

namespace LSL {

//! actual "Online user"
class User : public CommonUser
{
public:
    User( IServerPtr serv,
          const std::string id = GetNewUserId(),
          const std::string nick = "invalid",
          const std::string country = "",
          const int cpu = DEFAULT_CPU_ID );

	virtual ~User();

	// User interface

	ConstIServerPtr GetServer() const { return m_serv; }

	void Said( const std::string& message ) const;
	void Say( const std::string& message ) const;
	void DoAction( const std::string& message ) const;

	void SendMyUserStatus() const;
	void SetStatus( const UserStatus& status );
	void SetCountry( const std::string& country );

	bool ExecuteSayCommand( const std::string& cmd ) const;

	static std::string GetRankName(UserStatus::RankContainer rank);

    UserStatus::RankContainer GetRank() const;
    std::string GetClan() const;

	//bool operator< ( const ConstUserPtr other ) const { return m_nick < other.GetNick() ; }
	//User& operator= ( const ConstUserPtr other );
protected:
	// User variables
	IServerPtr m_serv;
};

} // namespace LSL {

#endif // LSL_USER_H


text:
Rushed budget expected
(CNS): The clock is ticking on government over the 2012/13 budget, which must be presented to the Legislative Assembly, debated and examined in Finance Committee and passed into law, all before the end of this month. However, opposition members of the LA say they are expecting yet another eleventh hour presentation by the premier as there has been no indication of when the country's parliament is going to meet again. Since the UDP administration changed the law which governs how budgets are presented, it has waited until the last minute to present its annual spending plans, forcing the people's representatives to rush through the scrutiny of the critical document.
Opposition Leader Alden McLaughlin said that once again the legislators would be forced to sit through a marathon session, calling civil servant witnesses to account for government's annual spending plans in the early hours of the morning, which was an unacceptable way for government to present the most important bill of the year, he said.
This will be the last budget presented by the current UDP administration before the election. Despite the eleventh hour approaching, there has been very little indication of government's intentions over how it will balance the books in an election year.
McLaughlin said he was aware that government would be facing a significant deficit from the close of this financial year, which it would need to tackle, but he was unaware of what cuts and new fees government would be proposing, if any. Concerned over the last minute meeting, which is unlikely to be called before the 15 June, the opposition leader said that, once again, the country could expect a rushed budget debate.
"This is completely unnecessary but down to government incompetence. Why is it that it has to be so late?" he asked as he pointed to the limited time Finance Committee would now have to closely examine how and why public money was being allocated.
Previously, the Public Management and Finance Law had required governments to deliver their financial plans for the coming year by the end of April. The law was changed by this administration, however, removing that requirement and enabling government to leave the presentation of the budget until the last minute, bound only by its need to have the legal authority to spend money on 1 July.
Ezzard Miller, the independent member for North Side, said he believed that the decision to bring another last minute budget is a deliberate move to curtail the scrutiny. He said that he was concerned that once again members and civil servants called to account would be doing so in the early morning hours, undermining the quality of deliberation.
"I am very concerned," said the North Side member. "Once again there will be no room for discussion about the budget. I believe it is a deliberate move to shorten the public discourse on how government is managing public spending and the collection of revenue."
Miller noted that there was unlikely to be a surplus for this financial year end and that could be one of the reasons why the premier was delaying his final budget, since the administration had promised to have balanced the books by this point. "He clearly is trying to avoid the intense scrutiny which should be made of any budget."
With the UK also needing to sign off on the government's annual spending plan, Miller warned that the budget address was likely to be full of creative language and added that he wasn't expecting the figures presented by the premier to match those in the documents.
There has been no confirmation of dates when legislatures will be meeting for the annual budget meeting but there is speculation that the premier is likely to make his budget address and throne speech on Friday 15 June, with the debate commencing on Wednesday, 19 June, just 11 days ahead of the financial year end.
Caymanian to the bone says:
It makes me shake my head in amazement at the replies posted on CNS. We are living in a society of jealous crabs. It is time to stop sputtering nonsense and speak the truth. Caymanians are the most divided people I have ever seen. They hate to see anyone succeed in anything. For example if the same so called educated persons were elected tomorrow we would find something to complain about them. So please do not act as if that is what you really want. Caymanians just want to blame someone else for their failers, someone else is always the reason why they are jobless, homeless, lazy, complaining bunch or wieners. You could give them the moon and stars and they would still fine something wrong. They are all unsuccessful in their lives, but want to sit everyday and tell others what to do. They hate anyone succeeding if it is not them. They want to live in big homes, drive fancy cars, take vacations, eat out everyday, yet do not want to get off their asses and do anything. It is the government stopping them from buying a home, getting a job, making something of themselves. They know crap about their politicians, yet they spout off their mouths about all others. It is such a me, me society world we live in. They can travel to the US, UK and come back and tell you all the wonderful things they have seen, yet when an attempt is made in their country to try to improve the lives of the Caymanian people, they cry it's wrong, it's bad, it cost too much, boohoo, boohoo, nay, nay, nay. Bunch of cry babies and wieners. Complaining about everything and everyone. We cry about this government and that government. UDP distroying this country, selling out our land to the foreigners, who sold the land, who received the monies, it was surely not the government, if so we might have balanced the books by now. This politician is good, this one is bad. This one is educated, this one is not. Who cares. Who is actually doing something to help the people and the country on a whole? That is what should be the deciding facture. Not who is Mr. Nice guy and who is not. Which politicians is out there fighting for us. Who is helping you to improve your day to day lives. If you spoke the truth you would say for starters Alden, " he is a lawyer, but cannot talk worth sh–, does not have any personality, is clearly not leadership material, any does not belong in politics at all and there is Kurt, have you seen his degrees?where are they, none that i know of, same high school education as the premier, he has been in parliament for twenty plus years, but cannot tell us one thing he has done, what busineses does he own, how much land does he own, Showed he was not leadership material either. The country went belly-up under his watch and yes he is a nice guy. Arden can talk and will speak out, only absolute garble comes out, not leadership material, but is probably the best that the PPM has except for Moses K. No degrees, built resonable roads, of the PPM tried the most except for the CUC deals. He allowed them to increase our lightbills based on cost of living, so obviously he is a failed negotiator and there is Mr. Anthony, who is diffently as wonderful person, but where is his degrees, what has he done for the people. Then we have Ezzard who is a pharmisist and sure can talk, talk, talk, likes to run around and gather gossip on people, will attack anyone who is objective to his views and do not agree with him, tells 10% of the truth, loves to hear himself speak and see himself on TV, unsuccessfull at everything, comeback politician, but is he really for The Caymanian people, does he really have our best interest at heart. His actions speaks louder than words. Then their is John Seymour, cannot act on his own without Mark, speaks without any comprehension or knowledge of the issues, seems to care for his BT people. There is Mac, does not have a degree, tries hard to turn the economy around, tries to help the people, cannot hold his tong, get angry too quickly, will stand up for the Caymanuan people and the country. Rolston tries with education, but only follows Alden in finishing the schools, loves to hear himself talk, educated, but shares a lot of Alden's traites, I.e. drinking, think they are the smartest thing since slice bread, I could go on, but I will not hold delve into their personal lives, both accountable for there personal failings. They are too much alike in that aspect as well. Ellio Solomon, works hard for his people, tries to solve many of the daily woos that pleg our people, speaks well, has a degree, (I know that for a fact, we went off island to attend school at the same time), is very smart, sharp and intelligent, loves his people. Does not hesitate to address the issues, will speak out for the Caymanian people. Capt. Eugene, does not have an education to my knowledge, has lots of heart and really helps his WB people. Hard worker on the ground. Mike Adams, nice guy, no degrees, same as the premier, cannot speak, appears to be totally lost in the world of politics. Cayman when we look at the political field, please be fair on both sides, not just for what color you represent be it party or color of skin.
Caymanian To the bone 2 says:
Caymanianian to the bone, I have read your comments, and I wish all Caymanians read it to, which include foreign Caymanians. Every word you say hit nails on the head. I would love to comment on every passage, but it is there for every one to read so I say read, and of course you will find the society of jealous crabs respond in the negative. Thats the illiterate Caymanians, they named them good when they called them a barrel of jealous crabs, because dont ever let a Caymanian know that you have bought a car, get a new job or a promotion. They will hate you for it. Now you want to have some fun. Sit back and watch the thumbs down to our comments. You are right got to shake our heads in amazament.
Don't worry, you two Caymanian boneheads. Soon those three criminal investigations will come to a head, or the UK will step in and get us out of this mess and all of us intelligent Caymanians won't have reason to be 'jealous' anymore. There is none so blind as he who will not see. McKeeva is taking this country straight through the gates of hell and there are STILL idiots out there worshipping him to the bone. I have to shake my head in "amazament".
Why don't you write using paragraphs? Its much easier on the eye and more people will actually read your post. Once I see a piece written like this I just scroll down.
dartanian says:
Seems such a shame you don't have the confidence in your words and deeds to sign your name.
I like how you call yourself Caymanian to the bone but keep referring to Caymanians as "they".
You obviously really think highly of Ellio which does not say much for you. If you and he went to the same school and got degrees I can see you would think he is educated but your post does not really reflect an education. XXXX
While some of the criticisms are fair some just reflect your emotions and lack of understanding. In no way is it balanced. Very soft on the criticisms of the UDP while giving them a lot of praise but very harsh on Ezzard and the PPM. Definitely not "fair on both sides". Apparently the most you can muster against McKeeva is the he cannot hold his tongue and gets angry too quickly. Really? What about substantial reasons to suspect corruption? What about dictatorial tendencies that override good governance, freedom of speech, freedom of information? What about wasting public funds on the Cohen deal GLF etc through hs own arrogance? What about the failure to actually accomplish anything?
It is ridiculous to suggest that Ezzard is a total failure and does not work hard for the benefit of the people. He is a thornin the side of the UDP because he isholding them to account. You don't like that so you start to question his motives.
Arden is not well spoken but works hard for his MLA salary. You obviously do not understand that CUC does not automatically get a cost of living increase each year. In 2010 and 2011 there was no increase at all and this year the increase worked out at less than a dollar for most people.
Capt. Eugene has not achieved anything at all as an MLA. He is just a yes vote for the govt. Collecting a pay cheque is the biggest part of his job. No doubt what color you represent.
lol… a typical PPM response!
Yes, intelligent.
I wonder says:
I wonder how Ellio is going to convince his comrades to support his motion to set aside a percentage of Immigration revenues for education? I am sure they had other plans for that money and if I have read between the lines based on what Ellio said on Friday, he does not even know if they will support his motion.
p.s. What ever happened to the "jobs to be reserved for Caymanians" ?
Keep up the good fight for the Caymanian people Mr. Solomon.
The Spin Cycle says:
There is a new political party! And it's being formed right now. The PP… the PARTY PARTY.
The platform is as follows:
Sell the Cayman Islands.
For 30 Billion dollars.
This makes every resident a millionaire.
Then everyone heads for the beach in some other place with a million bucks to spend. They can buy villas and speedboats and just relax.
Unlike the present government we have done the numbers.
AND….there will be enough left over for a big party!!!!!
VOTE for THE PARTY PARTY.
BORN FREE says:
What's new????????????????????
Surprise! And we are going to have a surplus yeah!!!
Beelever says:
It's very simple how the budget will be balanced. The churches he gave the money to will ask God to intervene. After that the Chinese will decide to build the cruise facility for free and hand it over to the Caymanian people as a gesture of good will. And then Premier Bush will go to Vegas and win huge and donate it help with the deficit. Following that Mr. Dart will give the rest of his fortune to the needy and Stan Thomas will turn his property into a skateboard park.
You have to believe.
Mac's only chance is to give civil servants a 25% raise, double the poor person's relief, release all prisoners from jail, and make the July referendum on independence.
Make sure you hit the plus and not multiply key!
It doesnt matter how late it is people……..its a sham budget anyway. The budget is currently at $80M but they will say it is at $7M.
Awaiting UK approval to procced.
An Insider !
Morse says:
Give the guy a break. He is never on island so how can he do a budget. It cannot be his fault.
Mac and Budget in the same sentence only means one thing, he's travelling again and wants a mini van this time.
Ted L. Nancy says:
I assume you mean that the delicate is 80 million.
I assume you meant "the deficit".
Trying to hide the deficit eh? Remember the big exclamation, "We will turn this economy around in 90 days!" "We will have a surplus!" It has been a LONG 90 days and still no surplus. Not even a pleasant surprize. But don't worry, May 2013 right around the corner. We're gonna retire you all for good. Goodbye UDP.
Stiffed-Necked Fool says:
You have to forgive Mac as he is not really too good with figures, I think he forgot a "0" off 90 when he said 90 days!
But then again, he wont get the Economy turned around in 900 days either – it best he step aside!
Theft?? CI Govt- Both parties says:
Trips for MLAs to retail cell phone shows in Spain? Goodwill trips to explore Hong Kong? Buddt trips to Vegas? Pave roads for churches in the Brac? Free half-a-million bucks in gas to civil servants and cronies? millions given to churches to buy votes? and all this is just what was reported in the news!!! I shudder to think of the daily inefficient waste that actually goes on behind the scenes. Don't get me wrong…PPM and UDP are the same to me. Wasteful and ineffective.
I'm sorry folks, but with this kind of WASTE and in turn I see a dying downtown, no cruise ship dock (not shopping mall, a simple pier please) failing literacy rates and poor education….I AM Caymanian and have absolutley no problem with the UK taking over to balance the books and just run the place like a decent county. Let private industry practice and dictate our laws, but get rid of ALL the MLA bums.
Failing literacy rate worked just fine for the very successful people the got the jobs running this country!
Kadafe says:
Ha whats new ?? This is how we dew!!! 🙂 jus laid back right till the last minute then run around like chickens with our heads cut off looking like lil island fools in front of the world!! Im so proud to be caymanian!!! …….. NOT.!!!! 🙂
Very handsome picture
LOOKING GOOD says:
I am happy to see how the Premier looks in this picture. ABSOLUTELY NO STRESS. Nice Mohawk hair cut, No fat hanging around his face and neck, Nice glasses, pretty white teeth, staying in shape. That's our Cayman Premier, and we love him, no matter what anyone says.
Stand Tall Mr Premier.
"Mohawk haircut"? – have you checked Wayne Rooney lately? Same Thing Star!
On my way to work, I listen to the radio and the talk is consistently about how many educated Caymanians "can't get jobs." Then comes the glass ceiling because of expats and on and on it goes.
Why don't these unemployed educated Caymanians go into politics? They are educated, so at least they should be able to read a balance sheet, unlike the yahoos currently in power. There are no expats in politics to create glass ceilings. They will get paid handsomely. They will be putting their education to good use by serving their country and securing a better future for the next generation.
Yes politics can be dirty. But only because its currently filled with uneducated, unsucessful, greedy persons. Put in the right people and its about country, not self. I'm certain we have a great deal of educated / committed / hard working people who can put us back on the right path.
Libertarian says:
We already have so many educated fools! What we need is intelligent people with common-sense! I am sure a high school graduate with a bit of intelligence and knowledge would do a way better job at representing our country than most of the clowns I see thirsting for power.
So what are these people with common sense waiting for? The country to collapse? Libertarian, talk is CHEAP!
All those who wish to do something about the way this government is being run, should formulate another party with libertarian principles; principles that involves implementation of direct democracy provisions, reducing the size of government, creating public-private partnerships, strengthening our ties with those who love Cayman in the UK and the UN, lowering fees, duties, and all indirect taxes on the island, and allowing the business market to grow in order to create jobs. People who are educated and have common-sense, and who are unwilling to show favoritism to a few big names and dealers on the island over small businesses. People who are seriously not for government, for themselves, for the UK, for the money, or personal gain – but whose interest is solely the people's interest.
So Libertarian, where do we sign up?
To organize it, a website would have to be created with its own domain. I would ensure its libertarian principles conducive to these islands and our limited resources. Of course, you will need the support and support from individuals who are poltically talented in economic policies, good writer, speaking and researching. We should have a logo, and the party should have a platform or charter on what it believes and holds to be true – nothing complex, but pure libertarian principles that can be embraced by all. Include in the charter, privisions against movements to divide the party. Unlike the UDP / PPM parties, this one will proclaim what it stand for and the party members would be able to hold its leaders accountable for deviating from its principles. And of course, the party will have to be legally registered, and fundraising efforts will have to be made. Also have periodic meetings with refreshments to continue the sameness of party spirit. At least, muster support from at least 5% of the electorate to begin with and chose permanent official members who you know will not backdown on the party and its principles. PPM started off that way, but they failed to openly declare and educate the public as to what they stood for. Instead you had Alden supporting rollover policy, then last year flip-flop opposing rollover policy. These issues should have been outline in a party charter. Instead UDP / PPM left people to vote for personality instead of issues. How I see – if you start a party, you start it right and you lay out to everyone what you stand for. There is no prime leader except who the party votes for and acknowledges is their prime leader. You run the party in a democratic fashion.
anonymousd says:
To begin with, we may need to organize another party. But where is the support?
Firedup says:
Yes Libertarian, another party will be formed, but we do not want anyone who is not a born Caymanian. You may vote, but please do not run.
FYI, I am a born and raised Caymanian with no education! So that already eliminates me from pretty much of societal acceptance. As for running, I don't believe one should run alone. Government is a complex matter. That is the problem with this country, we believe in too much saviors. If you want to change the country, you have to run with a united force behind you, comprising of experts, people of the same goal in mind, well-educated people who will support you every step of the way, and of course – have commonsense!
LOL. Presently we have an uneducated premier who believes himself to be an intelligent persons with common sense and knowledge and we see the mess that has got us in. Why aren't your comments directed at him rather than those who are educated and supposedly "thirsting for power".? I for one have had enough of the ignorance that spews from his mouth. A little education would be a good thing.
I am against the way this current government is doing business! But bear in mind I don't like attacking people… stick to the Issues.
When it suits you. Don't you think "clowns thirsting for power" is attacking people?
Your post only attacked people and did not deal with any issues.
don't believe the old caymanian fariytale about 'qualified caymanians who can't get jobs'…..
True, but it was a brilliantly accurate post anyway, no true??
Evidently you are not Caymanian. They certainly do exist.
Expats get the jobs and make sure the vacancies are filled by their friends and compatriots. What do you have to say about that. FACTS, FACTS.
what facts? give me evidence of discrimination against caymanians….
.all the labour laws are stacked in your favour…..if discrimination did exist it would be very easy to prove….
You are either disingenuous or incredibly naive. There is no question that it exists in both blatant and subtle forms. There are no effective laws for protecting Caymanians from discrimination. It is not easy to prove for a number of reasons: (1) the labour dept. does not have any effective mechanism to deal with this; (2) those making the decisions have the power to effectively blacklist you from employment elsewhere. They can just call up their pals and say don't hire X. In one case the applicant was told that no job was available so long as there was an existing complaint against the former employer. People are mostly not willing to take the risk; (3) complaints to Immigration may get you fired; (4) Caymanians have succumbed to divide and conquer strategy and do not stand together; (5) they have the financial ability to carry out a protracted legal battle whereas you are unemployed; (6) the guilty will be backed up by the expat employees because they feel they are enhancing their own position and will be rewarded.
If you don't know please be quiet.
Is that your excuse this week?
Did bush tell you that?
Mind you I told McKeeva to be careful of those wolves in sheep clothing, in here and get work permit, and do not want to get rolled over and making trouble along with those who have status. I know they would turn round and want to run this country. Keep dreaming, I wish you all would declare. Try do that.
Well, that's right, Fri 11:01 but if you check out the members of the LA now and in the past, you will find they were NOT – I'll repeat that NOT- successful at "real" jobs. There are exceptions – Truman is obvious. But check the following: Ezzard-disgruntled civil servant/failed private pharmacist/failed consultant for Deloitte. Elio disgruntled "can't get ahead in government" Computer Services ex employee. Mac /failed lots of things. Julianna-does anyone use her law firm – does she even have one? Rolston – apparently he was an ok accountant but………… Mark…..good on road stuff nice guy but fish out of water but lucky to have a wife on a HUGE government salary with HUGE benefits. Mike Adam -probably a nice ok guy who is wondering what this politics nonsense is about, like Anthony Eden before him. And blasts from the past": Roy Bodden: Our expert on Education – how many years did he actually spend in the classroom? And his boyhood pal, Gilbert McLean, appointed by him to come up with a report on why young Caymanians don't go in for teaching? How long did Gilbert spend in the classroom? Did he really spend time earning his money selling coconuts at the Blowholes before he became an MLA? And how about some of the last election hopefuls -Theresa. Sandra, Walling.. The common denominator in politics in recent years is if you can't make it in a real job with real accountabilities you can become a politician and gain prestige ("Honourable Minister" ) and money.
Anonymous – I would bet you did not spend any time in the classroom or you would have checked your facts. Gilbert – attained the level of a Master's degree in education and wan placed as the principal of the Cayman Brac School system. That was because another Caymanian wanted to retire. Ezzard is not a "failed pharmacist". He cxlosed his pharmacy by his own choice and should not have to justify his decision to anyone. Mark is not dependent on his wife's huge salary. He owns his own paving company which is operating daily and seems to be doing fine, because he had the foresight to employ reliable people. Do not pick on Mike Adam. It is obvious from your post, you know nothing about him and because he is on McKeeva's party, does not mean he is like McKeeva. Cayman Airways has not been run like it was under Mike Adam, so make sure your ducks are all in a row, before trying to knock them down. The only MLA you named is Elio (Foolio) Solomon and anything anyone says about him is true. He is nothing but McKeeva's little lap dog and does not deserve the title of MLA. XXXX He is a disgrace to our Legislative Assembly and the only time during the week that I turn off Rooster is when he is on the air spouting what he has done and what He is going to do. So 1 out of 5 is not bad, but it should not have been any. You should put your mouth where your pen is and ensure that you do not vote for any of these. It is time to get rid of the party system and support the OMOV.
So they only jobs Caymanians should have are govt. jobs? Politics is only suited to certain personalities. No, why we should actually deal with the problem.
BTW there are a number of elected members who are educated, who have had success in the private sector and who have not shown any signs of greed.
Tired of Complaints says:
Nor have they shown signs of success or carefor the Caymanian people.
Knot S Smart says:
Just watch them push this through in less time than those robbers take to rob a bank…
anonymously says:
its a kodak moment – less than a flash of light
Disheartened says:
For real, but these people sick yow! They gotta go long time now!
The President of the United States serves a term of 4 years. That is understandable seeing the size and scope of the President's work in a very large and powerful economy. But in contrast, what bugs me about this Constitution, is that we allow Satan to find works for idle hands! We are a very small island with no more than 73 square miles of space, and yet we would give a potential monster, certain perks and privileges, and to sit idly in the seat of Premier for the same length of time like Barak Obama! What a stupid and immaterial document that is at odds with our democracy!
In my humble opinion, an MLA should serve a term of no more than 2 years. Every 24 months it wouldn't hurt for a Caymanian to have General Elections. It wouldn't hurt at all! But then again, I am talking nonsense. The PPM Constitution will not be amended because the Constitution was written for only one class of individuals:
Politicians and Religious leaders that support them.
That is why UDP gave millions of dollars to the churches for Votes. It is a disgrace
Now you are just talking nonsense. A govt. can never hope to accomplish anything substantial in two years and we know the penchant for new govts to dismantle rather than build on what the previous govt. did. Think of the cost of a general election every two years. What are you smoking?
What I am really getting at is for an MLA to be held more "accountable" to the electorate. I think if we shorten the time they stay in power or put a check in place like provisions to recall them, they will make sure not to deviate, but accomplish their responsibilities. You and I know that a project started (or much good) could have occurred in less than two years. UDP/PPM don't four long years to start one.
So the number of years in a term should depend on the size of the country/territory? Maybe TCI should only have 1 year terms then. And what is Britain doing with up to 5 years if the U.S. only has 4?. There is absolutely no relationship between the two things.
And the new Constitution did not suddenly introduce 4 year terms. They were there all along in the 1972 Constitution and I heard no one complaining.
They forgot their notes in
(pick one) so gotta go back and get those.
These budgets and financial figures are pure fantasy… our politicians just love to throw the people's money down the drain.
I can present it now: Income= as much as they can collect. Expenditure= as much as they can pay themselves, plus what they can misappropriate and a few million more for their friends.
McKeeva is going to simplify the budget process. All expenditure this year will come under the single line item of Nation Building. All of the government revenue will be allocated to him and he will dole it out to the various departments as he sees fit. All hail McChavez.
HAhahahaha says:
0854 I dont blame him. Do just that. if you all want it take it back just the way you handed it over. Broke. Then see if six months time the people are not saying we want una out.
Exhalted Leader is gunna fix everyting jus watch. He gunna sell dat innalectwal property in dem kerruption inwestigations so we gunna haw a surplus ta spen on free gas fo us an free trabel for dem.
Until there are meaningful financial controls in place to hold our representatives accountable, any kind of budgetary forecast is a joke. Might as well rush through it, or cancel it altogether.
In related news a one-page budget master document has been leaked. It is from the office of El Supremo and say;
"I will spend what I wan an how I wan. Hawe de technocrats make up sum nummers an words to splain dat. See if dey can work in a nation building priwat jet. I always wan one uh dem"
He already has a fleet of private jets…. Called Cayman Air
If nothing else the budget is likely to show once again that the folks in the Ministry of Finance are preparing for a move out of government and into full time fiction writing – if there is a distinction between the two.
shambolic!….. and has been for the last 3 years…..
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text:
Sherry Sylvester is a political worker and journalist. She was the communications director for Doug Forrester's 2005 campaign for Governor of New Jersey.

She served briefly as the communications director for the Republican Party of Texas after heading Texas Media Watch, a project of the Lone Star Foundation, that reported on bias in the Texas press.

She graduated from Oklahoma State University.
In 2005, Sylvester was named Alumna of the Year by the Graduate School of Political Management, now at George Washington University.

Sylvester is the Senior Advisor to Texas Lt. Gov. Dan Patrick. Sylvester formerly was a San Antonio-based political consultant, whose clients include Texans for Lawsuit Reform .

As a journalist, Sylvester won awards in both New Jersey and Texas.  She was the political writer at the San Antonio Express-News, stepping down in early 2003.
Sylvester was the Chief Political Writer for the Trentonian in Trenton, New Jersey for almost a decade.  Her political commentary appeared there and in several Gannett-owned state newspapers.

References

External links
Journalist's website
Texas State Directory

Living people
American women writers
Year of birth missing (living people)
Oklahoma State University alumni
The Graduate School of Political Management alumni
American women journalists

redpajama_set_name: RedPajamaWikipedia


text:
Ellsworth Man Charged With Sexually Assaulting Relative
Townsquare News Staff
Townsquare News Staff Published: June 16, 2020
Chris Popper, Townsquare Media
An Ellsworth man faces felony charges after allegedly sexually assaulting a female relative.
Wayne Rameau, 37, was arrested June 11 on Class A charges of gross sexual assault in connection with the abuse, which allegedly happened many times over the course of about five years and in two different states.
More charges are pending.
The victim is 14 years old, police said.
There were four other children living in the home but there is no information so far that Rameau victimized any of the other children, police said.
The charges came after detectives received a referral from the Hancock County District Attorney's Office in regards to a sexual assault involving the 14-year-old female victim.
His bail is set at $100,000 cash.
Source: Ellsworth Man Charged With Sexually Assaulting Relative
Categories: Articles, Crime, Local News, Police