February 2013ISIS CAREER PATHWAYSPROGRAM PROFILE:Madison Area Technical CollegePatient Care Pathway ProgramMay 20131

This report is in the public domain. Permission to reproduce is not necessary. Suggested citation: Cook, Rachel,Gardiner, Karen and Karin Martinson. (2013). Innovative Strategies for Increasing Self-Sufficiency CareerPathways Profile: Madison Area Technical College Patient Care Pathway Program. OPRE Report # 2013-20,Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S.Department of Health and Human Services.Submitted to:Brendan Kelly, Project OfficerOffice of Planning, Research and EvaluationAdministration for Children and FamiliesU.S. Department of Health and Human ServicesContract Number: HHSP23320072913YCProject Director:Karen GardinerAbt Associates, Inc.4550 Montgomery Ave.Bethesda, MD 20814Disclaimer: The views expressed in this publication do not necessarily reflect the views or policies of the Officeof Planning, Research and Evaluation, the Administration for Children and Families, or the U.S. Departmentof Health and Human Services.This report and other reports sponsored by the Office of Planning, Research and Evaluation are available at

F e b r uMaar y 2 0 1 3IntroductionThere is a substantial skills gap betweenthe education and training of the laborforce and the needs of employers inmany high growth industries, includinghealthcare and manufacturing. This gapresults in unemployment while goodpaying jobs go unfilled. At the same time,many low-skilled adults persist in lowwage work with little opportunity foradvancement.1 Career pathways programsare an approach to fill a vital need forskilled workers in the economy and offerlow-wage workers the opportunity toobtain occupational and other skills andadvance into the middle class.The goal of career pathways programs is toimprove the education and earnings of lowskilled adults by providing well-articulatedtraining and employment steps, combinedwith promising instructional approachesand supportive services, which are targetedto jobs that are in demand locally. There isgreat interest in career pathways programsamong policy makers and practitionersin part because such programs provide aframework for guiding the developmentof improved education and trainingapproaches for low-skilled individuals.Along these lines, the Innovative Strategiesfor Increasing Self-Sufficiency (ISIS) studyis using an experimental design to assessthe effectiveness of nine career pathwayprograms across the country.An experimental evaluation design assigns individuals eligible for a program via lottery to a treatmentgroup that can receive the program or a control group that cannot -- but can access other services in thecommunity. Because the assignment process is random, there are no systematic differences between thetreatment and control groups at the time they enter the study. Thus, any differences detected during thefollow-up period can be attributed to the program. Random assignment is considered the gold standard ofprogram evaluation.31

24Career Pathways Program Profile:Madison Area Technical College Patient Care Pathway ProgramThis profile is an overview of the Madison AreaTechnical College (MATC) Patient Care PathwayProgram (PCPP).2 Designed and operated by MATCin Madison, Wisconsin, PCPP targets students whootherwise would not be able to pursue a post-secondarydegree in the health field because of their low skilllevels. It is designed to accelerate entry into college-levelhealthcare programs by allowing students to pursuebasic skills and occupational training simultaneously.The program also provides supports and advising.This profile first describes the career pathwayframework used in the ISIS evaluation, a frameworkthat provides a common approach for describingand assessing career pathways programs, and thendiscusses MATC’s PCPP model and how it fitswithin the career pathway framework.3The Career PathwaysFrameworkThe career pathways thesis is that post-secondaryeducation and training should be organized as a seriesof manageable steps leading to successively highercredentials and employment opportunities in growingoccupations. Each step is designed to prepare studentsfor the next level of employment and education andalso provide a credential with labor market value.To effectively engage, retain, and facilitate learning,programs integrate four core elements: (1) assessment,(2) promising instructional strategies, (3) supports, and(4) employer connections. Individual programs varyin terms of emphasis placed on each core component,although all are comprehensive in nature in order toaddress the learning and life challenges facing adultstudents. Mobilizing these components typicallyrequires a partnership between multiple providers,including community-based organizations, communityand technical colleges, human services and workforceagencies, and employers and their representatives.Although steps in career pathways programs varywith their target populations, focal occupations,and service strategies, the broad training andemployment levels shown in Figure 1 provide a basisfor classifying programs.Prospects for good-paying, stable employmentFigure 1: The Career Pathways StepsV. BA Programs Upper-Skilled JobsIV. 1-2 year Certificate to AA Programs Mid-Level Skilled JobsIII. Short-Term Certificate Programs Entry Level Skilled JobsII. Sectoral Bridge Programs Semi-Skilled JobsI. Basic Bridge ProgramsOccupational, academic, and life skills

F e b r uMaar y 2 0 1 3The first two steps (I and II) represent “onramp” programs designed to prepare lowskilled participants for college-level trainingand lower-skilled jobs with a career focus.The next two steps (III and IV) providecollege-level training for “middle skills”employment—jobs requiring some collegebut less than a bachelor’s degree (e.g., anassociate’s degree or shorter certificate).The final step (V) includes interventionspromoting completion of a bachelor’s degreeand more advanced credentials. Careerpathways are designed to allow entries, exits,and re-entries at each stage—depending onskill levels and prior training, employmentprospects, and changing personal situations.Programs vary in terms of entry and exitpoints as well as steps incorporated.MATC’s Patient CarePathway ProgramPCPP targets low-skilled adult learnersand includes key components of thecareer pathways model. It featuresaccelerated entry into college-leveldegree or diploma programs in healthfor those with skill levels too low to meetentry requirements. The instruction iscontextualized, allowing students tobuild knowledge about the healthcare fieldwhile simultaneously increasing their basicskills. Additionally, the program providesa range of support services to encouragestudents to complete classes, addressissues they may face, and plan for futureacademic, occupational, and employmentopportunities.Program Goals, Target Populationand StructurePCPP is operated by the MATC School ofOnline and Accelerated Learning, whichis responsible for a range of occupationaltrainings for returning adults. MATCdeveloped PCPP to promote enrollmentin and accelerate completion of collegelevel healthcare programs for lower-skilledstudents. Many students cannot entertheir chosen one- or two-year healthcareprogram each year due to low basic skills.Of those students, 75 percent nevercomplete the necessary remediation toraise their skills and thus do not enroll ina health program. This is likely becauseremediation can add up to three semestersof school work. PCPP was designed toimprove persistence and completionamong low-skilled students.PCPP targets students who are interestedin a healthcare career but score too lowon the COMPASS test to enroll inMATC’s six one-year health diplomaprograms (Medical Coding, AdvancedMedical Coding, Massage Therapy, MedicalAssistant, Optometric Technician, andLicensed Practical Nurse) or eight twoyear health degree programs (AssociateDegree Nursing, Dental Hygiene, MedicalLab Technician, Occupational TherapyAssistant, Physical Therapy Assistant,Radiography, Respiratory Therapy, and theone-year Surgical Technician Diploma).4 Inthe absence of the program, students wouldfirst have to raise their skill levels, potentiallythrough basic education courses. They thenwould move to the course prerequisites35

4Career Pathways Program Profile:Madison Area Technical College Patient Care Pathway Programneeded for enrollment, a sequence that may takeseveral semesters. In comparison, PCPP provides basiceducation in parallel with field-specific courseworkwithin one semester.PCPP students generally are at an 8th-10th gradelevel equivalent in their reading or math skills.Although a high school diploma or GED is notrequired for program entry, most students have asecondary credential since one is required for entryinto college programs. The program does not havean income eligibility requirement, but staff reportthat the majority of students are low income.Within the ISIS career pathways model, PCPP isdesigned so that individuals enter a sectoral bridgeprogram (step II in Figure 1) and then move to oneor two-year diploma or degree programs (step IV).PCPP provides two tracks: Patient Care Academies 1and 2. Where a student starts depends on his or herinterests (diploma or degree) and skill level (as assessedby the COMPASS ). Figure 2 depicts the PCPPacademies and associated pathways, including the sixdiploma and eight degree programs available. TheFigure 2. PCPP Course Content and Career PathwayTarget Population: Individuals interested in health careers who have placement test scores too low to begin in theprograms in the traditional manner. Students interested in a one-year Health Diploma program would take PCA 1. Studentsinterested in a Health Associates Degree program (or the one-year Surgical Technician diploma) can start with either PCA 1 orPCA-2 depending on their placement test scores.EducationPatient Care 2 (1 semester)ChemistryApplied Math forChemistryPatient Care 1 (1 semester)Written Communicationsfor HealthcareBody Structure & FunctionMedical TerminologySupport Classes: Math,Reading, and Student SuccessEmployment1-Year Health DiplomaPrograms Medical CodingAdvanced medical CodingMassage TherapyMedical AssistantOptometric TechnicianLicensed Practical NurseMid-Level EmploymentGraduates report wages rangingfrom 12.72 to 16.85 per hour,depending on job and programchoice. Titles vary based onprogram choice.1-Year Health DiplomaPrograms Associate Degree NursingDental HygieneMedical Lab TechnicianOccupational TherapyAssistantPhysical Therapy AssistantRadiographyRespiratory TherapySurgical Technician (1-yearDiploma)Upper-Mid-Level EmploymentGraduates report wages rangingfrom 17.82 to 24.17 per hour,depending on job and programchoice. Titles vary based onprogram choice.

May 2013specific program components are describedin the next section. Briefly: Patient Care Academy 1 (PCA 1)is designed for students interestedin a one-year health diploma whoseCOMPASS scores are too low toenter directly into the program ofchoice. As well, students interestedin a two-year degree program butwho do not have the requisite skillsto enter PCA 2 start at PCA 1. Duringthe one-semester academy, studentscomplete a series of non-credit adultbasic skills classes and two for-credithealth courses needed for the diplomaprograms. After completing PCA 1,students can move into a one-yearhealth diploma program, if they meetthe program admission-requiredCOMPASS test scores, or they canmove into PCA 2 which will preparethem to pursue a two-year degreeprogram.5Patient Care Academy 2 (PCA 2)is designed for students interestedin pursuing a two-year health As sociate’s Degree or the one-yearSurgical Technician program6 andwhose COMPASS scores are toolow to enter these programs but highenough to test out of PCA 1. Over thecourse of the semester, students enrollconcurrently in Math and Chemistry(rather than taking them sequentiallyas is typically required) and alsotake Written Communications forHealthcare, a course requirementfor all of MATC’s two-year healthprograms. Students receive credits forthe Chemistry and Written Commu nications courses. After completingPCA 2, students have fulfilled neededprerequisites for the two-year diplo ma programs in one semester. PCA 2completers do not need to retake theCOMPASS ; they are directly eli gible for their degree programs.Although students do not receive acertificate or credential at the conclusionof the academies, they are able to movemore quickly into the health diplomaand degree programs. Each PCA course isstaffed by its respective department—theDepartment of Arts and Sciences operatesWritten Communications and Chemistry,the Adult Basic Education departmentoperates the basic skills courses, and theHealth Department provides occupationalskills courses. Staff at the School of Onlineand Accelerated Learning coordinatethe program and provide the advisingcomponent. The Admissions departmentis a key partner for assisting studentsin enrolling in college programs aftercompleting PCA 1 or PCA 2. Programrecruitment is supported by MATC’s testingdepartment as well as the local WorkforceInvestment Board and other local partners.PCPP builds on existing MATC programsin the manufacturing, informationtechnology, business technology andhealthcare fields. It aims to improvestudents’ academic and occupational skillsand prepare them to transition to collegeand earn a post-secondary credential.Ultimately, PCPP strives to help studentsobtain diplomas and degrees so they cansecure a good job or advance to a higher5

6Career Pathways Program Profile:Madison Area Technical College Patient Care Pathway Programlevel in the healthcare field and improve their overalleconomic, personal and family well-being.reported barriers and potential solutions, includingreferrals to other service providers as needed.Career Pathway ComponentsCurriculumCareer pathways programs draw from a widerepertoire of services strategies to address theacademic and non-academic needs of participants.PCPP incorporates promising approaches toacademic and non-academic assessment, basic skillsinstruction and occupational training, and studentsupports. PCPP also involves employers in programdesign. Each approach is described below.Both Patient Care Academies include credit-basedhealthcare-related courses and non-credit basic skillscourses. PCA 1 and PCA 2 classes are scheduledconsecutively on two (PCA 1) or three (PCA 2) dayseach week to accommodate working students.7The curriculum of PCA 1 includes: AssessmentPCPP uses the COMPASS test to assess students’academic skills and determine program placement.COMPASS is an untimed, computer-basedassessment used to gauge academic skill level inmath, reading, writing, and English as a SecondLanguage (ESL). Some instructors also use the testscores to help gauge initial student skill level andadjust lessons accordingly.PCPP also administers a non-academic barriersassessment at the beginning of each academy. Staffcreated the barriers assessment, which asks studentsto report: Long-term academic and career goals;Current employment status and schedule;Financial aid status and needs;Other coursework being taken;Non-academic barriers such as lack ofchildcare, difficulty paying bills, lack ofhousing, etc.; andCriminal background.PCPP advisors use the non-academic assessmentresults in their discussions with students. Starting inthe first advising session, staff and students discuss the Two health diploma prerequisite courses –Medical Terminology and Body Structure andFunction – which provide students with anintroduction to fundamentals in health;One Lab course that provides unstructuredtime for the health instructor to answer ques tions or review material;Two classes focused on contextualized basicskills in reading and math – Academic ReadingSurvey and Math Survey; andOne course – Student Success Survey – thatprovides structured instruction in a range ofnon-academic topics including study skills,time management, computer skills, financialadvising, and strategies for navigating college.All courses are delivered over a 16-week period. Theprogram is designed so that basic skills courses arecontextualized for the health field and emphasize “collegesuccess” strategies, such as helping students work on timemanagement, goal setting, study skills, and computerskills. While the basic skills and content courses areseparate classes, students take all of the courses together asa cohort and instructors work collaboratively to developthe curriculum and communicate about student progressthroughout the semester.As shown in Figure 3, the PCA 1 courses are staggeredthroughout the semester so that at any time students are

F e b r uMaar y 2 0 1 3Figure 3: Schedule of PCA 1 CoursesStudent Success SurveyAcademic Reading SurveyMath SurveyBody Structure and FunctionStudent Success LabMedical Terminology12345678910111213141516Weeks in PCA 1 Semesterenrolled in no more than four courses. Forthe first two weeks of the academy, studentstake only the Reading, Student Success, andMath basic skills classes. In the third week of the semester, the Body Structure andFunction course begins. After five weeks,the Reading and Student Success classes endand the Medical Terminology course and Student Success Lab begin. Students spendabout 12.5 hours in class each week, with theexception of the first two weeks when theyare in class approximately 6.5 hours per week.Over the course of the semester, studentscomplete a total of 64 hours in MathSurvey, 12 hours in Academic Reading,24 hours in Student Success Survey, 56hours in Body Structure and Function,55 hours in Medical Terminology, and 22hours in the Student Success Lab. Uponcompletion, PCA 1 students will haveearned 6 credits towards a health diploma,which require between 19 and 33 credits.PCA 2 includes three courses completedover a 16-week period: Chemistry – a prerequisite for alltwo-year health degree programs –provides college-level Chemistryinstruction utilizing, when possible,examples and activities from thehealth field;Applied Math for Chemistry supportsthe PCA 2 Chemistry course and wasdeveloped jointly by the adult basicskills and chemistry faculty; andWritten Communication forHealthcare is a degree requirementfor all health programs and iscontextualized for the health field.Unlike the traditional course route,which requires students to take Math andChemistry sequentially, PCA 2 studentstake Applied Math and Chemistryconcurrently, thus accelerating theircompletion of prerequisites and entryinto degree programs. The instructorscollaborate so that the courses are alignedand, like PCA 1, students take all of theclasses together as a group. While thePCA 1 classes are staggered throughoutthe semester, each of the PCA 2 coursesruns for the full semester, as shown inFigure 4. PCA 2 students are in classesfor 12 hours each week for the 16 week97

8Career Pathways Program Profile:Madison Area Technical College Patient Care Pathway ProgramFigure 4: Schedule of PCA 2 CoursesGeneral ChemistryApplied Math for ChemistryWritten Communication for Healthcare1234567891011Weeks in PCA 2 Semestersemester. Over the course of the semester, studentsspend 80 hours in Chemistry, 72 hours in AppliedMath for Chemistry, and 40 hours in WrittenCommunication for Healthcare. Upon completion,students earn 7 credits: 4 for Chemistry and 3 forWritten Communications. PCA 2 completion meetsthe admissions requirements for most College healthprograms, which require between 60 and 70 credits. SupportsPCPP provides a number of supports to students inPCA 1 and PCA 2, including advising, financial andsocial supports.Advising. A PCPP advisor works with each student toidentify potential barriers to success, map career goals,identify course requirements, coordinate instructionalsupport, and make referrals to supportive servicesas needed. It is expected that each student will meetwith the advisor a minimum of three times during thesemester, and more frequently as needed. Throughoutthe semester, the advisor also works with the instructorsto monitor students’ class performance and coordinateinstructional supports, such as tutoring, as needed. Advising session 1 occurs by the third week inthe semester. The student and advisor discusscareer and academic goals, early experienceswith academy courses, potential barriers tocompletion, and resource gaps. 1213141516Advising session 2 occurs between weeksthree and nine. The advisor and student revisitcareer and academic goals based on students’exposure to course content and difficultylevel; map a plan for completing the requiredprogram coursework; set realistic goals basedon an understanding of the wage range,work schedule, and tasks associated with thehealth occupation pursued; and assess studentperformance and determine any instructionalor personal support needs.Advising session 3 occurs between weekten and the end of the semester. The advisorreviews the career and educational goals ofthe student and assists in identifying andcompleting next steps, including helping thestudent register for classes for the followingsemester.Investing in Advising“Case management-style intensive advising has the potentialto make a huge difference in student outcomes, especiallyour academically disadvantaged or lower-skilled students.Because so many of them are inexperienced navigatingthe college system, they can easily become discouraged,confused or caught up in college processes that they don’tunderstand. Our students need someone to be their ‘pointperson’, someone who ties all of the pieces of the college,work and life puzzle together and helps them navigate anyhurdles”-- PCPP Advisor

May 2013Financial Assistance. Students are required topay for both Patient Care Academies. The costis based on credit hour. Because non-creditcourses are free, PCA 1 is less expensive thanPCA 2 ( 800 versus 980). PCPP does notprovide direct financial assistance; however,advisors work with students to help navigatethe college’s financial aid system and fill outthe Free Application for Federal StudentAid (FAFSA). PCPP students rely heavilyon Federal aid, particularly Pell grants andsubsidized and unsubsidized loans. About fivepercent also receive Workforce Investment Act(WIA) Individual Training Account (ITA)funds or veterans benefits. The state DivisionWhy PCPP uses the Cohort ModelPCPP advisors describe several benefits of thecohort-based structure of the PCPP, including: Students are able to meet people who are oftenat the same life stage and experience similarchallenges inside and outside the classroom. Bonds are formed among cohort students. Theywork together to solve problems, study, andkeep one another engaged and motivated. Forexample, one PCPP student had to miss a fewdays of class for a medical issue, and the classworked together to figure out who would bringher the notes before she returned so she couldcome back to class prepared. The relationships formed during the PCAsare often long-lasting. Students tend tomaintain these relationships after the programhas ended. For example, two recent PCA 2graduates still take all of their classes together,study together, and share a tutor. This is thecase even though they live more than 50 milesapart. One of the students drives several milesto take classes with the other student whohas to juggle school, work, and childcare. Inmany cases, the benefits of the cohort supportscontinue beyond the one-semester program.of Vocational Rehabilitation is also a potentialfunding source for program participants.Advisors may refer students to these programsif they are eligible and will also help studentscomplete any necessary paperwork. PCPPstaff can also access the School of Online andAccelerated Learning’s emergency fund toassist students with short-term financial needs,such as removing a financial hold on a MATCaccount or covering a car repair.Social Supports. PCPP’s cohort-based structureis designed to facilitate social support andcamaraderie among students. Entering studentstake all of the courses as a group, with the goalof being able to support one another bothacademically and socially by forming studygroups, working together outside of class, andproviding encouragement (e.g., if a studentmisses class, others will follow up to learn why).Employment ConnectionPCPP is designed to be the first step onthe academic ladder. As such, academycompleters are encouraged to continueto the next step, be it PCA 2, a diplomaprogram or a two-year degree. Althoughthe program does not directly provideemployment connections such as jobsearch assistance, resume building support,job shadowing, or internships, the localWorkforce Investment Board and itshealthcare alliance were involved in thedevelopment of the PCA 1 curriculum.Additionally, the health degree anddiploma programs into which PCA 1and PCA 2 ladder each has an employerbased advisory committee that monitorsthe job market, industry changes, and theappropriateness of the course curricula.9

1012Career Pathways Program Profile:Madison Area Technical College Patient Care Pathway ProgramComparison of PCPP to other MATCOfferingsMATC’s PCPP incorporates the core career pathwayscomponents. The package of services available toparticipating students is more robust than thoseavailable to low-skilled students enrolled in otherMATC classes. As noted above, PCPP is beingevaluated as part of ISIS. Students assigned atrandom to receive the program will have access toadditional barriers assessment; curriculum that iscontextualized and collaboratively taught; the abilityto enroll immediately in college-level coursework; aspecified minimum number of advising sessions; andan emergency fund for short-term financial needs.Those not assigned to the program group will haveaccess to other MATC offerings. The general pathwayfor low-skilled students who cannot enter directlyinto a health diploma or degree program is remedialeducation courses. Figure 5 below illustrates thedifferent career pathway services available to PCPPstudents and to those who enroll in regular MATCbasic skills courses.SummaryMATC developed the Patient Care Pathway Programin an effort to improve low-skilled students’ academicand occupational skills, prepare them for transition tocollege degree and diploma programs and ultimatelysecure employment in the healthcare field. PCPPcombines accelerated entry into college-level degreeor diploma programs in healthcare with instructionthat is contextualized, and a range of support servicesto encourage students to complete classes, addressissues they may face, and plan for future academic,occupational, and employment opportunities. In theabsence of PCPP, low-skilled students interested inenrolling in healthcare diploma and degree programswould first have to raise their skill levels, potentiallythrough basic education programs, and then move tothe course prerequisites needed for enrollment. Thissequence may take several semesters, compared to theone-semester Patient Care Academies.For more information about PCPP, go to gure 5: Comparison Career Pathway Components Available to PCPP and Other MATC StudentsCareer PathwayComponentPatient CarePathway ProgramMATC BasicSkills PreparationAssessment COMPASS test Barriers Assessment COMPASS testCurriculum Basic skills plus college-level coursework Contextualized basic skills Collaborative instruction Basic skills completion prior tocollege-level coursework Non-contextualized basic skillsSupports Access to MATC support servicessuch as tutoring, disability resources, and the career and employment centerEmploymentConnections Curriculum input from local WIB (for PCA 1) Employer-based advisory committees for MATC’s degreeand diploma programsAdvising with a minimum of three sessions per semesterGuidance on available financial resourcesEmergency fund for short-term financial needsAccess to MATC support services such as tutoring,disability resources, and the career and employment center Employer-based advisorycommittees for MATC’s degreeand diploma programs

F e b r uMaar y 2 0 1 3Endnotes1.Carnevale, A., Smith, N., & Strohl,J. (2010). Help Wanted: Projectionsof jobs and education requirementsthrough 2018. GeorgetownPublic Policy Institute, Retrievedfrom one-year technical diplomaprograms, individuals must scorea minimum of 80 in reading, 70in writing, and 55 in pre-Algebra.For two-year degree programs,individuals must score 85 in reading,78 in writing, and 30 in Algebra.2.PCPP receives support from theOpen Society Foundations and theJoyce Foundation. The evaluationof PCPP through ISIS is funded bythe Office of Planning, Research andEvaluation in the U.S. Departmentof Health and Human Services’Administration for Children andFamilies (ACF).5.Completers of PCA 1 must retakethe COMPASS test to becomeeligible for their programs.6.While the Surgical Technicianprogram is a one-year diploma, itis most appropriate for those whocomplete PCA 2 because Chemistryis a prerequisite for the program.For more information on the ISISframework, see Fein, DavidJ. (2012). Career Pathways as aFramework for Program Design andEvaluation: A Working Paper fromthe Innovative Strategies for IncreasingSelf-Sufficiency (ISIS) Project. OPREReport # 2012-30, Washington,DC: Office of Planning, Researchand Evaluation, Administrationfor Children and Families, U.S.Department of Health and HumanServices.7.About two-thirds of PCPP studentsare employed while enrolled in theprogram.3.1113

12Career Pathways Program Profile:Madison Area Technical College Patient Care Pathway ProgramBox 1: Overview of the ISIS EvaluationThe Innovative Strateg

MATC’s six one-year health diploma programs (Medical Coding, Advanced Medical Coding, Massage Therapy, Medical Assistant, Optometric Technician, and Licensed Practical Nurse) or eight two-year health degree programs (Associate Degree Nursing, Dental Hygiene, Medical Lab Technician, Oc