Comprehensive Exam Comprehensive Exam OrientationOrientation

Spring 2013Spring 2013

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

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

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

The AssignmentThe Assignment

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

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

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

nursing information using a scholarly nursing information using a scholarly paperpaper

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

Critical PointsCritical Points

Thirty (30) page paper Thirty (30) page paper (maximum)(maximum)

Three exam optionsThree exam options– Research ProposalResearch Proposal– Critical Literature Critical Literature

Review Review – Problem-solving Problem-solving

The HandbookThe Handbook

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

How to Qualify for the How to Qualify for the ExaminationExamination

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

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

Filing Fee StatusFiling Fee Status

Talk with your advisorTalk with your advisor You may not take courses of any type You may not take courses of any type

if you are on Filing Fee status if you are on Filing Fee status Apply and pay filing fee to OARApply and pay filing fee to OAR Most frequently used for second time Most frequently used for second time

comp exam submission comp exam submission Filing fee status can be used only Filing fee status can be used only

once. If you pay filing fee then do not once. If you pay filing fee then do not submit your comp you must pay full submit your comp you must pay full tuition for the subsequent quarter you tuition for the subsequent quarter you submit your compsubmit your comp

Advance to Advance to CandidacyCandidacy

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

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

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

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

WorkWork Advance to Advance to

Candidacy any time Candidacy any time before the first before the first week of the quarter week of the quarter in which you plan to in which you plan to turn in the compturn in the comp

One incomplete on One incomplete on record allowedrecord allowed

Payment of fees Payment of fees required for numberrequired for number

Know the Important Know the Important Dates- Spring 2013Dates- Spring 2013

Number pick up date: Number pick up date: – Between April 9 and April 22Between April 9 and April 22

Submit comp by NoonSubmit comp by Noon– April 23April 23

Notification of resultsNotification of results– May 23May 23

Technical and Technical and Procedural PointsProcedural Points

FormatFormat

Submission Submission

ScoringScoring

Formatting Formatting ExpectationsExpectations

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

lineline30 pages of text, not counting title page, 30 pages of text, not counting title page,

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

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

Submission Submission RequirementsRequirements One single-sided original of the One single-sided original of the

comprehensive examination plus three comprehensive examination plus three double sided copies double sided copies – Next fall submission likely PDF, no hard Next fall submission likely PDF, no hard

copiescopies Completed face sheetCompleted face sheet Separate paper with student’s name, Separate paper with student’s name,

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

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

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Face SheetFace Sheet

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

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

Reading and ScoringReading and Scoring

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

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

Readers use a standard scoring Readers use a standard scoring systemsystem

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

PlagiarismPlagiarism

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

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

A Comp Does Not PassA Comp Does Not Pass

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

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

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

Vital ResourcesVital Resources

Vital resource—Department Vital resource—Department Administrative AssistantsAdministrative Assistants– CHS Kathryn Young CHS Kathryn Young – PN James NegriPN James Negri– FHCN Kathryn KeihlFHCN Kathryn Keihl– SBS Brandee Woleslagle SBS Brandee Woleslagle

Comprehensive Exam CoordinatorsComprehensive Exam Coordinators– CHS Beth Phoenix & Dana Drew-NordCHS Beth Phoenix & Dana Drew-Nord– PN Roxanne GarbezPN Roxanne Garbez– FHCN Karen Duderstadt & Barbara FHCN Karen Duderstadt & Barbara

HollingerHollinger– SBS Susan ChapmanSBS Susan Chapman

Additional ResourcesAdditional Resources

Advisors- topic Advisors- topic and formatand format

Specialty facultySpecialty faculty Sample comps on Sample comps on

reserve reserve Office of Student Office of Student

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

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

editorseditors– Peers as editors Peers as editors

and proofreadersand proofreaders Create a timelineCreate a timeline

– See sample See sample providedprovided

Comprehensive ExamComprehensive Exam2012-20132012-2013

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

Identifying the phenomenon of interest

Refine topic outline

Advance toCandidacy

Topic generation

Faculty input re: topic

Literature review

Faculty input re:topic outline

Draft #1

Colleagues read paperfor clarity and organization

Draft #2

Pick upComp #

Edit

SubmitComp

• Advance to Candidacy: Before end of Winter Quarter

• Pick up Comp # from Departments: From 4/09/13 to 4/22/13

• Submit Comp to Departments: 4/23/13

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

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

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Sample ExaminationsSample Examinations

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

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

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Other ResourcesOther Resources

UCSF SON UCSF SON websitewebsite

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Choosing a TheoryChoosing a Theory

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

Nursing theory not requiredNursing theory not required

Explain your theory in the text—Explain your theory in the text—don’t depend on diagrams in the don’t depend on diagrams in the appendixappendix

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Theory or Conceptual Theory or Conceptual FrameworkFramework

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

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

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

Genetics Diabetes only occurs in those with a genetic predisposition.

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

Socio-cultural

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

Health care Providers fail to adequately monitor overall health.

Behavioral Inactivity, diet, smoking due to the psychiatric illness

Medication Side effects, appetite stimulation and subsequent weight gain

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Possible Titles Possible Titles

The Relationship Between The Relationship Between Atypical Psychotropic Use and Atypical Psychotropic Use and Diabetes Mellitus: The role of Diabetes Mellitus: The role of GeneticsGenetics

Sociocultural Factors in the Sociocultural Factors in the Development of Diabetes Mellitus Development of Diabetes Mellitus in Patients with Severe Mental in Patients with Severe Mental IllnessIllness

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Types of ExaminationsTypes of Examinations

Research Proposal (check with Research Proposal (check with your advisor as early as possible)your advisor as early as possible)

Critical Literature ReviewCritical Literature Review

Problem-solvingProblem-solving

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Research ProposalResearch Proposal

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

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

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

Research ProposalResearch Proposal

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

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

Research Proposal Research Proposal ScoringScoring Total Points – Total Points – 330 330

– Area 1 – Study and Context – Area 1 – Study and Context – 6363 – Conceptual Framework and Conceptual Framework and

Literature Review - Literature Review - 126126 – Methodology – Methodology – 126126 – Technical (grammar, organization, Technical (grammar, organization,

use of APA format) – use of APA format) – 1515

The Comprehensive The Comprehensive Exam is Pass/FailExam is Pass/Fail

Points needed to pass - Points needed to pass - 231231

3333

Critical Literature ReviewCritical Literature ReviewChoosing a TopicChoosing a Topic

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

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

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

3434

Critical Literature Critical Literature ReviewReviewTopic or IssueTopic or Issue Clarity of topic or purposeClarity of topic or purpose

– State in 1 sentence!State in 1 sentence! The purpose of this paper is to The purpose of this paper is to

examine the literature related to examine the literature related to the efficacy of using BNP to the efficacy of using BNP to diagnose patients with heart diagnose patients with heart failurefailure

3535

Topic or IssueTopic or Issue

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

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

3636

Some evidence exists, but Some evidence exists, but practice is not well practice is not well delineateddelineated Should diabetics use Should diabetics use

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

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

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

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

3737

Literature Review Literature Review

Theoretical DiscussionTheoretical Discussion Quality of ReferencesQuality of References Elements of CritiqueElements of Critique Quality of Critique Quality of Critique

3838

Literature ReviewLiterature Review

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

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

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

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

3939

Literature ReviewLiterature Review

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

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

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

4040

Literature ReviewLiterature Review

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

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

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

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

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

4141

Literature ReviewLiterature Review

Elements & Quality of Critique – Elements & Quality of Critique – Articulate Main PointsArticulate Main Points– SampleSample– DesignDesign– ProcedureProcedure– MeasuresMeasures– ResultsResults– ConclusionsConclusions

4242

Literature ReviewLiterature ReviewDiscussion and Discussion and ApplicationApplication Critical and original analysisCritical and original analysis Integration and synthesis of Integration and synthesis of

research articlesresearch articles Implications for practiceImplications for practice Future researchFuture research

4343

Literature Review Literature Review CritiqueCritique Synthesis and interpretationSynthesis and interpretation

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

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

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

– Only generalizable to men Only generalizable to men

4444

Make a Table!Make a Table!

Organize your literature into a Organize your literature into a table to compare and contrasttable to compare and contrast

Describe each studyDescribe each study

4545

Identifies gaps in literature, Identifies gaps in literature, implications for practice, need implications for practice, need for further researchfor further research

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

4646

Technical CriteriaTechnical Criteria

Grammar and spellingGrammar and spelling Organization of paperOrganization of paper APA formatAPA format

4747

Literature Review Literature Review ScoringScoring Total Points - Total Points - 330330

– Area 1 – Topic or Issue - Area 1 – Topic or Issue - 7070– Area 2 – Literature Review - Area 2 – Literature Review - 165165– Area 3 – Discussion & Application - Area 3 – Discussion & Application - 8080– Area 4 – Technical (grammar, Area 4 – Technical (grammar,

organization, APA) organization, APA) 1515

LITERATURE REVIEW ISLITERATURE REVIEW IS

50% OF THE PAPER50% OF THE PAPER

4848

Problem-solving CompProblem-solving Comp

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

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

4949

Choosing a Problem-Choosing a Problem-solving Topicsolving Topic

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

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

that is challenging that is challenging to youto you

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

measurable!measurable!

5050

Examples of Problem-Examples of Problem-Solving TopicsSolving Topics

Initiating an Oral Care Program in a Initiating an Oral Care Program in a Nursing HomeNursing Home

Post-Partum Depression: Transition Post-Partum Depression: Transition to Motherhoodto Motherhood

ICU Nurses’ Knowledge Deficit ICU Nurses’ Knowledge Deficit Regarding Hemodynamic MonitoringRegarding Hemodynamic Monitoring

Loss of Venous Access and Dialysis Loss of Venous Access and Dialysis Delay in End Stage Renal Disease Delay in End Stage Renal Disease PatientsPatients

5151

Problem-solving Problem-solving CautionsCautions

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

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

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

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

5252

Criteria for Scoring Criteria for Scoring CompComp Clarity of the ProblemClarity of the Problem

Significance of the ProblemSignificance of the Problem

Clarity of Setting Clarity of Setting

Clarity of Roles and inter-Clarity of Roles and inter-

relationshipsrelationships

5353

The Problem and its The Problem and its Environmental Context Environmental Context Clarity of the ProblemClarity of the Problem

– Who Who is solving the problem is solving the problem APNAPN

– Where Where the problem occurs the problem occurs ICUICU

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

– Target Target population population ICU NursesICU Nurses

5454

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

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

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

essential for ICU patientsessential for ICU patients

5555

The Problem and its The Problem and its Environmental ContextEnvironmental Context Clarity of the SettingClarity of the Setting

– Home, hospital, nursing homeHome, hospital, nursing home– Intensive Care UnitIntensive Care Unit

5656

The Problem and its The Problem and its Environmental ContextEnvironmental Context

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

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

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

Literature ReviewLiterature Review

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

interpretationinterpretation

5858

Intervention, Intervention, Implementation & Implementation & EvaluationEvaluation Expected OutcomesExpected Outcomes Clarity & Appropriateness of Clarity & Appropriateness of

Intervention ImplementationIntervention Implementation Clarity & Appropriateness of Clarity & Appropriateness of

Evaluation ProcedureEvaluation Procedure DefensibilityDefensibility RealismRealism

5959

Intervention, Intervention, Implementation & Implementation & EvaluationEvaluation

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

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

6060

Intervention, Intervention, Implementation & Implementation & EvaluationEvaluation Clarity & Appropriateness of Clarity & Appropriateness of

ImplementationImplementation– Outline procedures for implementing Outline procedures for implementing

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

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

6161

Intervention, Intervention, Implementation & Implementation & EvaluationEvaluation Clarity & Appropriateness of Clarity & Appropriateness of

Evaluation Evaluation – Delineates specific measurable and Delineates specific measurable and

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

nurses’ knowledge is measurednurses’ knowledge is measured Number of incident reports are analyzed Number of incident reports are analyzed

regarding monitoring regarding monitoring

6262

Intervention, Intervention, Implementation & Implementation & EvaluationEvaluation DefensibilityDefensibility

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

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

possible?possible?

6363

CaveatsCaveats

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

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

6464

Problem-solving Problem-solving ScoringScoring Total Points - Total Points - 330330

– Area 1 – The Problem - Area 1 – The Problem - 105105– Area 2 – Literature Review - Area 2 – Literature Review - 105105– Area 3 – Intervention, Area 3 – Intervention,

Implementation, Evaluation - Implementation, Evaluation - 105105– Area 4 – Technical (grammar, Area 4 – Technical (grammar,

organization, APA) -organization, APA) -1515

EACH SECTION IS EQUALLY WEIGHTED EACH SECTION IS EQUALLY WEIGHTED SO PLAN FOR 10 PAGES PER SECTION!SO PLAN FOR 10 PAGES PER SECTION!

Most common reasons why Most common reasons why comps failcomps fail

Started too late to put in necessary time Started too late to put in necessary time and effortand effort

Did not meet with advisor to make sure Did not meet with advisor to make sure you are on trackyou are on track

Did not follow the advice of your advisorDid not follow the advice of your advisor Primary editor was someone whose Primary editor was someone whose

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

6666

I PASSED!I PASSED!