Hi Melissa,
If you don't know where to start something like this, it is important to do some soul searching. You want to do med. transcription, but you don't know any short and long term goals. But doing transcription should be a way of achieving some kind of goal. Why do you want to do that instead of being a P.A. or a nurse or an admin person?
Search your feelings, Luke! You have to be able to envision the future, and it has to have details. If you read enough articles about med. transcription, that is the place to start. Read several articles, and you will think of goals while you read. If you are not interested in the articles, you might not be interested in this field.
As for the essay, I think you should start with the body paragraphs and write the conclusion last. Begin with a body paragraph about a short term goal. Once you have written a paragraph, it will get easier! :-)
And also, I really mean it about reading some articles. Read articles, and you will think of LOTS of short and long term goals.