Nurses retrospective view on nursing education: A repeated cross-sectional study over three decades.

Background: As the healthcare landscape undergoes transformative shifts due to factors like ageing demographics, technological innovations, rapid global dissemination of infectious diseases, and imperatives for accessible, cost-effective care, a pressing need emerges for the contemporisation of nursing education. Notably, there is a paucity of research delving into nurses' introspective evaluations of their educational experiences after their immersion in professional settings. Objective: This study aimed to examine nurses' evaluations of their educational background over 30 years and identify relationships between their assessments and their demographic. Design: The study embraced a recurrent cross-sectional survey methodology, encompassing three distinct quantitative cross-sectional evaluations conducted in the years 1999, 2009, and 2021. Context/participants: The cohort for this inquiry consisted of nurses stationed in Estonian general hospitals and inpatient departments of developmental plan institutions, each with at least one year of professional experience. Cumulatively, 832 nurses were engaged across three sequential evaluations: Study I (n = 463), Study II (n = 198), and Study III (n = 171). Methods: Data procurement was executed via a structured survey, with subsequent analytical procedures encompassing descriptive and correlational methodologies. Results: A discernible augmentation in the educational calibre of nurses was observed with each successive evaluation. This escalation concomitated enhanced positive assessments in areas like evidence-informed education, skill development, and autonomous operational capabilities. Yet, a critical appraisal persisted concerning their competencies in navigating complex patient interactions and addressing socio-religious dilemmas. Conclusions: The merit of this investigation lies in its illumination of nursing education's evolution, as perceived retrospectively by nurses who have operationalized their academic learnings in real-world scenarios. Their vantage point, inherently informed by practice, uniquely positions them to earmark avenues of refinement. This exploration paves the way for enrichments in nursing education, spotlighting the imperative of equipping nurses to adeptly manage intricate situations.

Challenge, integration, and change: ChatGPT and future anatomical education.

With the vigorous development of ChatGPT and its application in the field of education, a new era of the collaborative development of human and artificial intelligence and the symbiosis of education has come. Integrating artificial intelligence (AI) into medical education has the potential to revolutionize it. Large language models, such as ChatGPT, can be used as virtual teaching aids to provide students with individualized and immediate medical knowledge, and conduct interactive simulation learning and detection. In this paper, we discuss the application of ChatGPT in anatomy teaching and its various application levels based on our own teaching experiences, and discuss the advantages and disadvantages of ChatGPT in anatomy teaching. ChatGPT increases student engagement and strengthens students' ability to learn independently. At the same time, ChatGPT faces many challenges and limitations in medical education. Medical educators must keep pace with the rapid changes in technology, taking into account ChatGPT's impact on curriculum design, assessment strategies and teaching methods. Discussing the application of ChatGPT in medical education, especially anatomy teaching, is helpful to the effective integration and application of artificial intelligence tools in medical education.

[The Human Resource Development Policy of the Faculty of Pharmaceutical Sciences at Kanazawa University and Our Initiatives toward Its Realization].

The environment surrounding pharmaceutical education in Japan has changed significantly with the establishment of many new pharmacy schools and the transition to six-year pharmacist education. Under these circumstances, various issues have been revealed in recent years. In particular, the decrease in the number of doctoral students responsible for future pharmaceutical education and research in drug discovery and life science is a concern. To address this issue, we at Kanazawa University have revised the human resource development policy of the Faculty of Pharmaceutical Sciences to "fostering leaders who are active in a variety of professions in pharmaceutical sciences" and have made various efforts toward the realization of this policy. Among the topics introduced at the symposium, this paper focuses on reforming the educational system and reorganizing the School of Pharmacy and Pharmaceutical Sciences at Kanazawa University.

Effects of a Modified Six-Sigma-Methodology-Based Training Program on Core Competencies in Rehabilitation Nurse Specialists.

PURPOSE: Nurses play an important role in ensuring patient rehabilitation and are involved in all aspects of multidimensional rehabilitation. Therefore, strengthening rehabilitation nursing education is vital to ascertain high-quality rehabilitation and optimum outcomes. This study examined the effectiveness of a new teaching reform-a modified Six-Sigma-based training program-against a conventional educational program on rehabilitation specialist nurses' core competencies, post-training performance, and satisfaction. METHODS: A quasi-randomized controlled trial was conducted to assess the effectiveness of the modified training program. We recruited 56 learners from the 2020 training course at the Hunan Rehabilitation Specialist Nurse Training Base as the control group. Sixty learners from the base's 2021 training course were recruited as the intervention group. Data were collected in a consistent manner from both groups after the training program was implemented. RESULTS: Those who underwent the modified training program showed better improvement in all core competencies than those who underwent the conventional training program (p < .05); the scores for theoretical knowledge, clinical nursing lectures, reviews, and nursing case management improved significantly following the teaching reform (p < 0.05). Further, overall satisfaction as well as base management and theoretical teaching satisfaction improved significantly (p < .05). CONCLUSION: The modified training program strengthens rehabilitation nurses' base management abilities; enhances their core competencies; expands their interest in and breadth, depth, and practicability of theoretical courses; and updates the teaching methods.

Epigenetics in Neurological and Psychiatric Disorders: A Comprehensive Review of Current Understanding and Future Perspectives.

The burgeoning field of epigenetics offers transformative insights into the complex landscape of neurological and psychiatric disorders. By unraveling the intricate interplay between genetic, epigenetic, environmental, and lifestyle factors, this comprehensive review highlights the multifaceted nature of mental health. The exploration reveals the potential of epigenetic modifications to revolutionize our understanding, diagnosis, treatment, and prevention of these disorders. Emphasizing the importance of multidisciplinary collaborations, large-scale studies, technological advancements, and ethical considerations, the review asserts the promise of epigenetics as a vital tool for personalized medicine, early intervention, and public health strategies. While acknowledging the challenges in a still-emerging field, the review paints an optimistic picture of epigenetics as a groundbreaking approach that can reshape mental healthcare, offering hope for those affected by neurological and psychiatric conditions. The future trajectory of the field relies on interdisciplinary efforts, ethical diligence, innovative technologies, and translating scientific insights into real-world applications, thereby unlocking the vast potential of epigenetics in mental health.

O estudo das diferenças individuais por alfred binet e sua circulação em minas gerais (1925-1940)1 / The study of individual differences by alfred binet and its circulation in minas gerais (1925-1940)

RESUMO Este estudo analisa os pressupostos do pesquisador francês Alfred Binet (1857-1911) sobre as diferenças individuais a partir de livros e artigos que produziu a respeito do assunto entre 1895 e 1909 e que fundamentaram a elaboração da primeira escala métrica Binet-Simon em 1905. Em seguida, identifica quais elementos de suas elaborações circularam e como foram apropriados, no contexto das reformas educacionais em Minas Gerais nas décadas de 1920 a 1940. A pesquisa se desenvolveu no diálogo entre a História da Psicologia e a História da Educação, mobilizando conceitos da historiografia, como o de intelectuais, redes de sociabilidade e apropriação. A pesquisa documental envolveu a análise dos primeiros livros publicados por Binet e as matérias publicadas na Revista do Ensino, órgão oficial do governo de Minais Gerais, nas quais se tratava sobre as diferenças individuais e sobre o uso dos testes nas escolas. Foi observada a tensão envolvendo a desconfiança e o entusiasmo em relação aos novos métodos para aferir as diferenças individuais; a apropriação da escala métrica adaptada nos Estado Unidos, cujos princípios eram criticados por Binet; a pouca ênfase nas dimensões sociais e culturais dos diferentes grupos sociais, que estava entre as preocupações centrais do autor.

ABSTRACT This study analyzes the assumptions of the French researcher Alfred Binet (1857-1911) about individual differences from his books and articles about the topic between 1895 and 1909, which grounded the elaboration of the first Binet-Simon metric scale in 1905. Next, it identifies which elements of their elaborations circulated and how they were appropriated, in the context of educational reforms in Minas Gerais, Brazil, in the decades from 1920 to 1940. The research was developed in the dialog between the History of Psychology and the History of Education, mobilizing concepts from the historiography, such as intellectuals, sociability networks and appropriation. The documental research involved the analysis of the first books published by Binet and the articles published at Revista do Ensino, an official body of the Minas Gerais government, which dealt with the individual differences and the use of tests in schools. It was observed the tension involving distrust and enthusiasm regarding the new methods to measure individual differences; the appropriation of the metric scale adapted in the United States, whose principles were criticized by Binet; and the little emphasis given to social and cultural dimensions of different social groups, which was among the author's main concerns.

Toward agenda 2030 in education: policies and practices for effective school leadership.

School leadership has been described as a key target for leveraging the quality of education in relation to sustainable development goal (SDG4) that seeks to 'ensure inclusive and quality education for all and promote lifelong learning' as per UNESCO 2030 agenda. This study provides a policy review of school leadership in the State of Qatar, as a case study, but carries out discussions within the global thrive for meeting the demands of Agenda 2030 to achieve quality for public education. It utilized a research instrument developed by UNESCO's Division for Policies and Lifelong Learning Systems in Paris. The study used personal interview surveying, also called face-to-face surveying, and was completed with high-level policymakers at the Ministry of Education and Higher Education (MOEHE). It consisted of four sections that addressed: (1) the regulatory frameworks governing school leadership; (2) the professional development opportunities offered to school leaders; (3) the degree the school leadership profession was attractive; and (4) the procedures followed to appraise school leaders. Findings underscore the critical role played by school autonomy, instructional leadership, and governance in responding to Agenda 2030. The discussion contributes to the global discourse in meeting the requirements of Agenda 2030.

Hong Kong high school students' perceptions of the new secondary school curriculum.

Background: The New Senior Secondary (NSS) curriculum in Hong Kong aims to change the exam-oriented culture and promote students' all-around development. This reform emphasizes student-centered learning and promotes a shift from a top-down approach to school-based management, with the ultimate goal to help students become lifelong learners. This study examined students' perceptions of the NSS curriculum with a focus on their noncognitive development (e.g., self-understanding, positive values, purpose in life, and resilience). Methods: The data were collected from 3,498 Secondary 6 students in Hong Kong (Girls: 47.7%; Mean age: 17.33 years) using a self-reported questionnaire in 2015. We examined the psychometric properties of the instrument, "Perceptions of the New Secondary School Curriculum" (PNSC), and conducted multigroup CFA to evaluate the measurement invariance of PNSC across genders. Paired t-test analysis was used to examine whether students perceived the junior and senior secondary curricula differently. A series of multivariate analysis of variance (MANOVA) were conducted to examine students' perceptions of the curriculum by gender and by academic performance level. Results: Results based on percentage responses showed that most students liked the curriculum and acknowledged its benefits in promoting their noncognitive development. However, substantial proportions of the students also reported relatively negative responses to some items, particularly their fondness for senior secondary education. Students generally reported higher fondness for the junior secondary curriculum than for the senior secondary curriculum. Girls had more positive perceptions of the NSS curriculum than did boys. High-performing students liked the NSS curriculum the most and perceived the most benefits of the curriculum in promoting their noncognitive skills, whereas low-performing students showed the lowest levels of fondness for/interest in the curriculum and perceived benefits. Conclusions: Our findings support previous evidence showing initial success in promoting students' noncognitive skills but also alert educators and policymakers that the curriculum should not leave the low-performing students behind. Collective efforts from schools, educational bureaus, researchers, and policymakers are needed to take appropriate measures to cater to students' balanced development.

[Reform and reflection of teaching microbiology in English].

Microbiology is a key basic professional course for all the students specializing in biology, biotechnology and related majors. To date, microbiology is mainly taught in Chinese within colleges and universities in China. Development of a microbiology course that is taught in English may satisfy the diversified learning needs of the students and promote the "Double First-Class" initiative. We started to teach the microbiology course in English at the East China University of Science and Technology since 2016. This practice was associated with reform and innovation in the teaching methods and contents. The microbiology course taught in English greatly attracted the interest of the attending students and helped improve their professional English learning as well as scientific research. This course provided important support for fostering innovative professional first-class undergraduates under the context of the "Double First-Class" initiative.

Comparison of two teaching methods for stopping the bleed: a randomized controlled trial.

BACKGROUND: The "Stop the Bleed" (STB) campaign has achieved remarkable results since it was launched in 2016, but there is no report on the teaching of an STB course combined with a trauma patient simulator. This study proposes the "problem-, team-, and evidence-based learning" (PTEBL) teaching method combined with Caesar (a trauma patient simulator) based on the STB course and compares its effect to that of the traditional teaching method among outstanding doctoral candidates training in haemostasis skills. METHOD: Seventy-eight outstanding doctoral candidate program students in five and eight-year programs were selected as the research subjects and were randomly divided into a control group (traditional teaching method, n = 34) and an experimental group (PTEBL teaching method combined with Caesar, n = 44). Their confidence in their haemostasis skills and willingness to rescue injured victims were investigated before and after the course in both groups. RESULT: Students' self-confidence in their STB skills and the willingness to rescue improved after the class in both groups. Compared with the control group, students in the experimental group were more confident in compressing with bandages and compressing with a tourniquet after a class (compressing with bandages: control group 3.9 ± 0.8 vs. experimental group 4.3 ± 0.7, P = 0.014; compressing with a tourniquet: control group 3.9 ± 0.4 vs. experimental group 4.5 ± 0.8, P = 0.001) More students in the experimental group than the control group thought that the use of Caesar for scenario simulation could improve learning (control group 55.9% vs. experimental group 81.8%, P = 0.024), and using this mannequin led to higher teacher-student interaction (control group 85.3% vs. experimental group 97.7%, P = 0.042). The overall effectiveness of the teaching was better in the experimental group than in the control group (control group 85.3% vs. experimental group 97.7%, P = 0.042). There was a significant positive correlation between teacher-student interactions and the overall effectiveness of teaching (R = 1.000; 95% CI, 1.000-1.000; P < 0.001). CONCLUSION: The PTEBL teaching method combined with Caesar can effectively improve student mastery of STB skills and overcome the shortcomings of traditional teaching methods, which has some promotional value in the training of outstanding doctoral candidates in STB skills.

Economic Imperialism in Education Research: A Conceptual Review.

In this review, we explore economic imperialism, a concept that captures the phenomenon of a single discipline's power over so many facets of social life and policy-including education. Through a systematic search, we examine how economic imperialism has been conceptualized and applied across fields. We uncovered three key, interconnected elements of economic imperialism that hold relevance for education research. First, economics has colonized other disciplines, narrowing the lens through which policymakers have designed education reforms. Second, an overreliance on economic rationales for human behavior neglects other explanations. Third, a focus on economic outcomes of education has subjugated other important aims of education. We share implications for researchers to use economic theory in ways that are interdisciplinary but not imperialist.

On the present situation of the combination of clinical endoscopy teaching and E-learning / 中华医学教育探索杂志

This paper analyzes the shortcomings of the current clinical endoscopy teaching and the effective combination of endoscopy teaching and E-learning. Moreover, in the case of gastrointestinal endoscopy, we intend to build an E-learning gastroscope roaming system based on Maya and Unity3D software, to solve the existing endoscopy teaching problems, thus promoting the digital reform of endoscopy teaching and the further implementation of E-learning.

On the reform of the personnel training mode of forensic medical undergraduates / 中华医学教育探索杂志

There are many problems in the training mode of traditional forensic undergraduates, such as the lag of curriculum setting, the lack of interdisciplinary and the lack of practical training. Based on the teaching practice of forensic undergraduates in Central South University, this study puts forward the following four reform schemes: ①advancing the setting of forensic medicine curriculum to strengthen the integration of specialized courses with basic medicine and clinical medicine courses; ②increasing related courses to intensify interdisciplinary teaching; ③introducing online teaching mode of virtual simulation to enrich the content of undergraduate forensic medical education; ④expanding the scope of joint classroom teaching inside and outside the school to realize the two-way rapid update of practical and theoretical resources. The purpose of this paper is to provide new ideas and directions for training forensic talents who are more suitable for the development of the times.

[Innovative Instructional Reform and Practice of Oral Microbiology-A Course in Undergraduate Stomatology Curriculum].

Oral Microbiology is a vital component of the basic science of stomatology and an important compulsory course for undergraduate students of stomatology, focusing on the oral microbiology and microecology, the pathogenesis of oral infectious diseases, and the relationship between oral microbes and human health. Our faculty team have made reforms of the theory and laboratory teaching of the course Oral Microbiology. We have introduced in the classroom the concept of Three Comprehensive Approaches to Education-the full involvement of everyone, the through-course approach and all-round education-and offered inquiry-based instruction through a combination of extracting the core information from every chapter, using the core information as the foundation, integrating the core information with clinical problems, and using experiment operation to foster in the students an attitude of solving clinical problems through research. These teaching innovations improved the undergraduate students'motivation to learn. We evaluated the teaching effect with questionnaire surveys. The results suggested that the students showed high interest in learning and were satisfied with our teaching innovations. In addition, student performance evaluation for the course showed significant improvement, indicating that the instructional reform program of Oral Microbiology was conducive to students'understanding and mastery of the course content, improved student motivation to learn and their grades, and received positive reviews from the students. We report herein, from three aspects, the course innovations and the experiences gained. We discussed the significance of integrating ideological and political theories teaching in all courses and using innovative teaching materials and teaching models and, highlighted their importance in the education of stomatology students, and proposed suggestions to further improve the course design of Oral Microbiology.

Aversion to Hospital Admission Due to Fear of COVID Infection Leading to Fatality From Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) is a potentially life-threatening condition that occurs in patients with diabetes mellitus (DM) where the decrease in the insulin level leads to a state of metabolic acidosis and hyperglycemia. Based on the literature review, the risk of severity of DKA in children was significantly associated with coronavirus disease-2019 (COVID-19) cases during the first wave of the pandemic. This could be attributed to social distancing restrictions which delayed hospital presentation and timely treatment and interventions. We present the case of a 15-year-old female, with non-insulin-dependent diabetes (type 2), who presented during the COVID-19 pandemic with severe DKA from another hospital. She had elevated glucose level at home for three days that was worsening but her parents continue to manage the patient at home out of fear of the patient contracting COVID-19 if she was brought to the hospital. After she deteriorated, the parents took her to the nearest hospital which did not have a pediatric intensive care unit (PICU). She was immediately transferred to our facility. The patient was intubated immediately on arrival because of altered mental status possibly due to cerebral edema from severe metabolic acidosis and elevated glucose level. The patient rapidly progressed into shock, acute respiratory distress syndrome (ARDS), and multiple organ dysfunction syndrome (MODS). She was managed aggressively with vasopressors, fluid resuscitation, and insulin drip. She had four cardiac arrests for which she was resuscitated. Despite all efforts, she subsequently expired less than 24 hours after admission. We intend on shedding light on an emerging phenomenon due to the ongoing COVID-19 pandemic, wherein due to the fear of contracting COVID-19, many parents opt to keep and manage sick children at home. This report highlights the important role that the aversion of presenting to medical establishments out of fear of contracting COVID-19 may have led to the untimely and preventable death of our patient. It also outlines the importance of future educational reforms toward changing the patient and family's perception of hospitals and medical institutions, especially in children with pre-existing chronic medical conditions.

Practice research on the construction of health education ability of higher vocational nursing students by a "trinity" system / 中华医学教育探索杂志

Objective:To explore the effect of the "trinity" training mode with curriculum training as the core, lecture training as supplement and community training as reinforcement, and to improve the health education ability of higher vocational nursing students.Methods:A total of 209 nursing students were selected as the research objects by random cluster sampling, and they were randomly divided into experimental group and control group. The experimental group adopted the "trinity" system to improve the health education ability of higher vocational nursing students, while the control group carried out the routine teaching. The health education ability of nursing students was evaluated by using the health education ability scale of nursing staff, and the nursing students of the experimental group were investigated by questionnaire. Statistics analysis was made by SPSS 15.0 software, the t test was conducted for analysis of measurement data, and Z test was used for counting data. Results:The health education ability of the nursing students in the experimental group was significantly higher than that of the control group ( P < 0.001). Nursing students in the experimental group generally had high recognition of the training mode of "trinity" system. The pass rate was 98.13%. Among them, 68.87% of the nursing students thought it would be a big gain to attend the special lectures; 69.81% of the nursing students thought it would be a big gain to participate in the community activities. Conclusion:The "trinity" health education ability training model can significantly improve the health education ability of higher vocational nursing students.

Large-scale assessments and their effects: The case of mid-stakes tests in Ontario.

This paper analyzes the nature and perceived effects of mid-stakes testing (known as the EQAO) in Ontario, Canada. Ontario's mid-stakes tests were meant to ensure accountability and transparency, and assure system-wide improvement, while avoiding the negative effects and perverse incentives of their high-stakes counterparts. The paper provides new evidence from two projects covering almost a 10-year time-span in 10 of Ontario's 72 school districts. It shows that even though mid-stakes testing is milder in its manifestations and effects than high-stakes testing, concerns remain about the need for and side effects of such testing. The findings concern two periods of Ontario educational reform. In the first period, with a specific focus on improving performance in literacy and mathematics, administrators and special education support staff felt that the assessments raised teachers' expectations and sense of urgency leading to steady improvements in measured achievement, but that there was also evidence of negative effects, especially on paying undue attention to "bubble" students just below the threshold for minimum proficiency. In the second reform period focused on broad excellence, well-being and equity as inclusion, mid-stakes tests were perceived as having more widespread negative effects. These included teaching to the test, cultural bias, avoidance of innovation, dilemmas of whether to include highly vulnerable students in the testing process or not, and emotional ill-being among students and teachers. The paper concludes that Ontario's twentieth century system of large scale, mid-stakes assessment has not kept pace with its twenty first century commitments to deeper learning and stronger well-being.

Fill the gap between traditional and new era: The medical educational reform in Taiwan.

The 7-year medical education program in Taiwan has been established since 1949. More than 60 years later, many medical professionals have observed and voiced its deficiencies following the outbreak of severe acute respiratory syndrome. The deficiencies are three-fold: (1) specialties are excessively institutionalized, (2) students engage in passive learning and memorization, and (3) passing one written national examination serves as the means of granting permanent physician qualification. The situation has aroused concerns and discussions among medical professionals and educators for a new medical education program. Authorized by the Conference of Deans of Medical Schools in Taiwan, Prof. Chyi-Her Lin assembled a team for planning medical curricular reform. Subsequently, Prof. Shan-Chwen Chang organized a task force team which has been monitoring the new 6-year program since 2013. The aims of medical reform by Prof. Lin are (1) to eliminate the specialty training part, (2) to use innovative teaching methods to motivate students to learn proactively, and (3) to implement competency-based medical education. Now, the first class of physicians will enter the workplace in 2019, subject to various clinical challenges.

To Switch or Not to Switch? The Influence of School Choice and Labor Market Segmentation on Teachers' Job Searches.

Informal and institutional barriers may limit teacher movement between charter schools and traditional public schools (TPSs). However, we know little about how teachers choose schools in areas with a robust charter school sector. This study uses qualitative data from 123 teachers to examine teachers' job decisions in three cities with varying charter densities: San Antonio, Detroit, and New Orleans. Our findings illuminate different types of segmentation and factors that facilitate and limit mobility between sectors. We find that structural policies within each sector can create barriers to mobility across charter schools and TPSs and that teachers' ideological beliefs and values serve as informal, personal barriers that reinforce divides between sectors. This study offers implications for policy in districts with school choice.

Análisis de la reforma educativa en México, desde la perspectiva de educación física / Analysis of the educational reform in México, from the perspective of the physical education subject

El propósito de este trabajo es analizar el Nuevo Modelo propuesto recientemente en México desde la perspectiva de la Educación Física, dada la importancia de la asignatura en proceso formativo de los alumnos de la educación básica. El análisis de la documentación se realizó utilizando la técnica V de Gowin, que como estrategia permitió analizar críticamente el nuevo modelo educativo. El currículo plantea el enfoque competencial desarrollando el pensamiento complejo de los educandos, que es la base para que gestionen sus conocimientos. Este cambio de programa pudiera ser una gran oportunidad para que los educadores físicos cambiaran a estilos de enseñanza que permita la participación activa y reflexiva de los alumnos. Las prácticas educativas de los docentes tienen una gran relación con su formación inicial y la actualización en activo, por lo que es importante atender el proceso formativo y de actualización, ya que son las mismas autoridades las que permiten que se sigan utilizando enfoques tradicionales en lugar de los propuestos en la actualidad.

The purpose of this work is to analyze the New Educational Model proposed recently in Mexico f rom the physical education perspective, given the importance of the subject in the formative process of elementary education students. The analysis of the documentation was carried out using Gowin's V technique, which, as a strategy, allowed for a critical analysis of the new educational model. The curriculum raises the competence approach by developing the learner's complex thinking, which is the basis for managing their knowledge. This change in the program could be a great opportunity for physical educators to change teaching styles that allow the active and reflexive participation of students. The teachers' educational practices have a great relationship with the initial training and active updating, so it is important to attend newtraining and updating process since they are the same authorities that continuously use traditional approaches instead of currently proposed ones. The teacher is the one who organizes the learning and interacts directly with learners.