L’identification et la remédiation des difficultés de raisonnement clinique en médecine (État des pratiques, recherche d’outils et processus pour soutenir les cliniciens enseignants)

INTRODUCTION : Le raisonnement clinique est au coeur de l’exercice professionnel. Cependant, nous manquons d'instruments pour identifier et objectiver les difficultés de raisonnement clinique, et il existe relativement peu de descriptions de méthodes de remédiation définies. Un important travail reste donc à faire, pour mieux comprendre comment les difficultés se manifestent dans le raisonnement clinique des étudiants en formation, mais également pour rendre ces concepts plus accessibles aux enseignants; ceci permettra alors d’améliorer la qualité de la démarche d’identification des difficultés, et d’envisager des remédiations ciblées et efficaces. OBJECTIFS : Cette recherche s’articule d’une part, autour de l’objectivation et la compréhension des pratiques actuelles des cliniciens enseignants en médecine, d’autre part, autour de la construction et l’implantation d’outils et de processus susceptibles de faciliter la démarche de diagnostic et de remédiation des difficultés de raisonnement clinique. MÉTHODOLOGIE : Une recherche de type qualitative, utilisant les méthodes de la recherche action participative s’est révélée pertinente pour atteindre nos objectifs. La recherche est composée de quatre étapes : 1. Une étude exploratoire. 2. La construction et de l’implantation d’un premier outil dans trois milieux cliniques en médecine familiale. 3. L’élaboration d’une taxonomie des difficultés de raisonnement clinique ainsi que la construction d’un nouvel outil. 4. Le développement d’une approche globale pour soutenir et former les cliniciens enseignants. RÉSULTATS : Les enseignants ont une perception rapide, mais qui demeure globale et intuitive, des potentielles difficultés de raisonnement clinique des résidents. Cette perception ne se traduit pas forcément en termes pédagogiques. Nous avons pu observer l’absence de processus pédagogiques organisés et structurés pour la gestion de ces difficultés. Ceci semble projeter les cliniciens enseignants dans une zone d’inconfort, en les confrontant à un manque de maîtrise et à l’incertitude au sujet de leurs actions pédagogiques. La catégorisation des difficultés de raisonnement clinique que nous avons construite permet d’identifier les difficultés telles qu’elles se manifestent dans le quotidien des supervisions cliniques. Cet outil a cependant besoin d’être intégré dans un processus plus global. CONCLUSION : Une approche globale qui comprenne le développement de processus implantés par le Département, l’implantation d’outils, la vulgarisation de la théorie, et la formation des enseignants est déterminante.

Processus de facilitation d'une pratique réflexive, de type codéveloppement, auprès d'infirmières pivots en oncologie et son influence sur leur pratique professionnelle

Deux catégories de compétences influenceraient toute pratique professionnelle, les compétences disciplinaires et relationnelles. Selon le cadre théorique de ce projet, la pratique réflexive (PR) aiderait le professionnel à développer les compétences relationnelles, grâce à l’approfondissement de sa conscience et de son autocritique des composantes tacites de sa pratique, telles que ses valeurs et principes, ses perceptions et ses stratégies d’action, afin de les rendre plus efficaces et satisfaisantes lors de la résolution de problèmes. Dans cette étude, la PR souhaitait aider un groupe d’infirmières pivots en oncologie (IPO) à réfléchir et agir sur les composantes de leur pratique qui contribuaient à certaines difficultés relationnelles persistantes vécues auprès de gestionnaires, collègues et familles et qui, selon les IPO, avaient un impact sur l’expérience de santé de familles touchées par le cancer. Toutefois, la recension des écrits effectuée dans cette recherche soutient qu’il y a un nombre insuffisant d’études qui a trait à l’influence d’une PR sur la pratique infirmière et, plus encore, sur le développement des compétences relationnelles des infirmières. Les écueils théoriques et méthodologiques suivants ont entre autres été rapportés: la PR étudiée ne reposait pas toujours sur un modèle théorique clair et le but poursuivi par la PR n’était pas toujours énoncé; aucune recherche n’a documenté de quelle manière la PR s’était développée et, une fois acquise, de quelle façon elle avait contribué aux résultats; et, enfin, aucune étude recensée n’a exploré l’influence d’une PR intégrée par l’infirmière, en tenant compte de la perspective de familles qui bénéficiaient de leurs soins. Considérant ces principaux écueils, cette étude a privilégié la recherche-action participative afin de documenter la facilitation d’une PR et son influence sur les compétences relationnelles d’IPO et sur d’autres dimensions à la fois personnelles, organisationnelles et cliniques. Six IPO ont pris part à l’intervention de l’étude d’une durée d’un an. Cinq collègues des équipes de soins et douze membres de familles touchées par le cancer ont participé à l’évaluation de son influence. Les résultats de cette recherche portent à croire que les IPO qui développent une PR plus profonde, c’est-à-dire jusqu’à leurs sentiments et besoins internes, parviennent à établir des relations plus mutuelles auprès de collègues et de familles, grâce à des changements importants réalisés sur le plan de leurs valeurs et principes, de leurs perceptions et de leurs stratégies d’action. Les résultats de l’étude soutiennent aussi que ces changements au sein de la pratique infirmière génèrent des effets positifs. Les IPO ont parlé d’une plus grande satisfaction liée à leur travail et de bienfaits sur leur santé. La majorité des IPO et des participantes-collègues de l’étude ont rapporté un climat de travail plus calme et des processus d’équipe plus satisfaisants lors, par exemple, de la résolution de problèmes. Enfin, lorsque les IPO intégraient une approche plus mutuelle, des familles rapportaient une atténuation de leur inquiétude ou de leur détresse psychologique, une plus grande capacité de donner du sens à leur expérience de cancer, une qualité accrue de leur communication intrafamiliale ou avec l’équipe soignante.

Endeuillés, mais non isolés : création et mise en place d’une intervention de groupe axée sur le modèle de l’aide mutuelle auprès d’enfants endeuillés

Cette recherche témoigne d'une démarche de recherche-action-participative réalisée auprès d'enfants ayant vécu la perte d'un parent. Elle vise à comprendre l'expérience vécue par les enfants endeuillés d'un parent qui participent à un groupe d'intervention axé sur le modèle de l'aide mutuelle. La réalisation d'une entrevue pré-intervention et une autre post-intervention donnent accès aux perceptions des enfants concernant leur expérience d'endeuillé quant à leurs besoins, mais aussi à leur interprétation de leur réalité. Aussi, l'intervention de groupe utilisée comme méthode d’intervention, et comme méthode de collecte de données reflète la dynamique d'aide mutuelle et son influence sur le vécu des membres autant sur le plan émotif que sur le plan des stratégies adaptatives. Bref, cette recherche en service social, alliant les savoirs pratiques et ceux théoriques, permet de reconnaître que l’aide mutuelle soutient les enfants dans leur réalité d’endeuillés et met aussi l’accent sur le caractère unique de leur deuil respectif.

Finding Spaces for Urban Food Production – Matching Spatial and Stakeholder Analysis with Urban Agriculture Approaches in the Urban Renewal Area of Dortmund-Hörde, Germany

Using the case of an economically declined neighbourhood in the post-industrial German Ruhr Area (sometimes characterized as Germany’s “Rust Belt”), we analyse, describe and conclude how urban agriculture can be used as a catalyst to stimulate and support urban renewal and regeneration, especially from a socio-cultural perspective. Using the methodological framework of participatory action research, and linking bottom-up and top-down planning approaches, a project path was developed to include the population affected and foster individual responsibility for their district, as well as to strengthen inhabitants and stakeholder groups in a permanent collective stewardship for the individual forms of urban agriculture developed and implemented. On a more abstract level, the research carried out can be characterized as a form of action research with an intended transgression of the boundaries between research, planning, design, and implementation. We conclude that by synchronously combining those four domains with intense feedback loops, synergies for the academic knowledge on the potential performance of urban agriculture in terms of sustainable development, as well as the benefits for the case-study area and the interests of individual urban gardeners can be achieved.

The playful as a psycho-pedagogic method: one experience in preventing youth drug dependence

This participatory action research was based on a experience of educational intervention on La Cruz and Bello Oriente (Manrique-Medellin), a marginal zone in the northeastern part of the Commune 3 in Medellin,. Colombia. In this marginal sector, psychosocial problems seem to be associated to limited educational and employment opportunities, domestic violence, illegal armed forces, sexual abuse, social discrimination, and lack of adequate public services, among others.  All these are also considered as risk factors for drug dependency.  We used a structured interview designed to identify leisure tendencies, use of free time, and tendencies in recreational activities. Data from the interview were triangulated with information collected by observation and in field work and used to build a psycho-pedagogic method based on play and leisure activities. The effects of the use of this educational intervention on the satisfaction of human needs were analyzed in light of the theory of Manfred Max-Neef. Results point out the need for new educational strategies aimed to promote creativity, solidarity, mental, physical and social health, more enthusiasm and motivation and in general, positive attitudes that help prevent drug dependence.

Establishing a community of practice of researchers, practitioners, policy-makers and communities to sustainably manage environmental health risks in Ecuador

The Sustainably Managing Environmental Health Risk in Ecuador project was launched in 2004 as a partnership linking a large Canadian university with leading Cuban and Mexican institutes to strengthen the capacities of four Ecuadorian universities for leading community-based learning and research in areas as diverse as pesticide poisoning, dengue control, water and sanitation, and disaster preparedness. By 2009, train-the-trainer project initiation involved 27 participatory action research Master’s theses in 15 communities where 1200 community learners participated in the implementation of associated interventions. This led to establishment of innovative Ecuadorian-led master’s and doctoral programs, and a Population Health Observatory on Collective Health, Environment and Society for the Andean region based at the Universidad Andina Simon Bolivar. Building on this network, numerous initiatives were begun, such as an internationally funded research project to strengthen dengue control in the coastal community of Machala, and establishment of a local community eco-health centre focusing on determinants of health near Cuenca. Alliances of academic and non-academic partners from the South and North provide a promising orientation for learning together about ways of addressing negative trends of development. Assessing the impacts and sustainability of such processes, however, requires longer term monitoring of results and related challenges.

Teachers as researchers and teachers as software developers: how use-case analysis helps build better educational software

A series of government initiatives has raised both the profile of ICT in the curriculum and the expectation that high quality teaching and learning resources will be accessible across electronic networks. In order for e-learning resources such as websites to have the maximum educational impact, teachers need to be involved in their design and development. Use-case analysis provides a means of defining user requirements and other constraints in such a way that software developers can produce e-learning resources which reflect teachers' professional knowledge and support their classroom practice. It has some features in common with the participatory action research used to develop other aspects of classroom practice. Two case-studies are presented: one involves the development of an on-line resource centred on transcripts of original historical documents; the other describes how 'Learning how to Learn', a major, distributed research project funded under the ESRC Teaching and Learning Research Programme is using use-case analysis to develop web resources and services.

Adequação de cadeia de suprimentos : um estudo na indústria automotiva brasileira

O conceito de cadeias de suprimentos (supp/y chains) é um dos mais avançados, no contexto da gestão contemporânea de empreendimentos, sendo fundamental para a compreensão da ação dos integrantes dos ramos e canais de fornecimento de recursos para a produção de produtos e serviços. Na indústria da mobilidade, que compreende os esforços voltados para a produção de meios de transporte de tangíveis em geral (incluindo veículos automotores, navios, locomotivas, aviões, dentre outros), a cadeia de suprimentos é complexa e envolve múltiplos canais. Dentre os vários canais, há o que se ocupa de fornecer componentes essenciais para a fabricação de veículos automotores, destacando-se, neste, o de fornecimento de DET (dispositivo eletrônico por toque). Numa economia globalizada, como ocorre no Brasil, neste princípio do século XXI , DET e outros componentes podem ser adquiridos no país ou em qualquer outro lugar do planeta, onde preço, qualidade e condições de fornecimento se mostrarem competitivos. Há, entretanto, fatores perturbadores que prevalecem, mesmo em situação de comércio praticamente livre e com o predomínio de acordos comerciais bilaterais ou multilaterais. Um desses fatores é o risco cambial, aliás, um fenômeno típico da realidade atual, onde instabilidades monetárias podem fazer oscilar a cotação das moedas, alterando inteiramente os padrões de custos vigentes na cadeia de suprimentos, afetando o processo de tomada de decisões e o preço final do produto para o cliente. Visando a reduzir este problema, uma montadora de veículos instalada no Brasil (aqui denominada MAGfl manifestou-se interessada em que os fornecedores de DET com gabarito para integrar sua supp/y chain pudessem fornecer produtos em moeda nacional, significando, na prática, a busca de soluções para melhorar sua competitividade (em qualidade e preço, a primeira com um leque maior de fornecedores e o segundo através da redução do espectro de variações de custo, eliminadas as oscilações cambiais). Deste modo, a empresa pretendeu agregar valor aos seus produtos. A presente dissertação de mestrado, utilizando o método combinado de estudo de caso com PAR (Participatory Action Research ou pesquisaação), retrata a experiência vivida por uma organização transnacional, com negócios no país (a ETE), em sua busca de solução para adequar-se aos objetivos do cliente MAG, adaptando o canal de fornecimento para que maior valor agregado possa ser percebido. A dissertação procura, neste sentido, acompanhar o processo de análise e estudos de viabilidade de um empreendimento denominado "Projeto High Sound", realizado pelas organizações envolvidas, incluindo a pesquisa e a constituição de uma joint venture com parceiro nacional (PAN), contemplando, por fim, a análise de oportunidade sobre a possível operação direta futura da ETE no país confrontada com a análise de manutenção de operação com gestão compartilhada, em sistema de off-set, com empresa gerenciadora de canais de comercialização

Tecnologias de Informação e Comunicação em Bibliotecas Escolares: em busca de um espaço dinâmico

The Information and Communication Technologies (ICT) can be combined with the acquisition of academic knowledge and cultural development of students, as they improve their information literacy, and why not say, also digital. Weaim in this research seek references and present experiences that encourage a new concept of school library with the use of ICT in teaching and learning in individual and collective development of the student community. To complement this study we prioritized the following objectives: to insert the technology into the routine of a school library; identify the informational and technological profile of adolescents; understand the needs and technological resources they use to obtain information in daily life and also analyze the importance the effective participation of the school library in the educational context of the school, through greater interaction between the librarian, teacher and pedagogical coordination seeking a cooperative and informal ICT teaching and learning for along with the students, sharing the search for information and knowledge, in a conscious and responsible way. Chosen as theoretical foundation the cognitive studies of Jean Piaget, witch explains how the stages of assimilation and accommodation of knowledge in cooperative practices work. As a methodology was developed a participatory-action research, to learn the behavioral state of young people and adolescents, based on the model of information search for the everyday life (Everyday Life Information Seeking) – ELIS, developed by Finnish researcher Savoleinen (2006), as well as identify the informational and technological profile of adolescents from two selected approaches in the scientific literature (HUGUES-HASSEL; AGOSTO, 2007; UCL, 2008). Thus, came up the initiative to create a Confraternity of the Library in a collaborative digital environment, providing the participants discussion and learning technologies as well as digital information literacy enhancement.

O uso social da leitura e as práticas pedagógicas em sala de aula: construção de conhecimentos e formação de leitores

This research aimed at studying the social role of reading, its importance in building knowledge and training of readers, as well as reflect on the teaching of reading in schools, with children in the literacy process. For their achievement, were used as theoretical support authors who are dedicated to the study of language, thematic reading, and phenomena that occur through it in the school environment, especially those of Bakhtin, Kleiman, Chartier, Foucambert, among others . The research was carried out using the approach of qualitative research, using participatory action research, through which the researcher could have direct contact with the observed phenomena, to participate and collect the participants' actions in its natural context, the from their perspective and their views. As for collecting and analyzing data, we used the tools of questionnaire, interview and participant observation. Its subjects a literacy class and their respective teacher, in 2009. By analyzing this information, one can draw a picture of reading in the school environment and teaching practices that surround this object. The results of the literature survey and data analysis suggest that reading is a social practice, and as such has indispensable social function in society today. And the school, one of the greatest instruments of contact with the world of letters, therefore, of reading for children means not literate, have key role in developing and training of readers who are aware of the importance of reading and perpetuate this practice in their daily lives. Similarly, subjects of research, have achieved an advanced level of literacy and understand the social role of reading and its importance to live in society, in which they belong

Transformation of local medicinal knowledge in the Andean Highlands: Case studies from Peru and Bolivia

In the Andean highlands, indigenous environmental knowledge is currently undergoing major changes as a result of various external and internal factors. As in other parts of the world, an overall process of erosion of local knowledge can be observed. In response to this trend, some initiatives that adopt a biocultural approach aim at actively strengthening local identities and revalorizing indigenous environmental knowledge and practices, assuming that such practices can contribute to more sustainable management of biodiversity. However, these initiatives usually lack a sound research basis, as few studies have focused on the dynamics of indigenous environmental knowledge in the Andes and on its links with biodiversity management. Against this background, the general objective of this research project was to contribute to the understanding of the dynamics of indigenous environmental knowledge in the Andean highlands of Peru and Bolivia by investigating how local medicinal knowledge is socially differentiated within rural communities, how it is transformed, and which external and internal factors influence these transformation processes. The project adopted an actor-oriented perspective and emphasized the concept of knowledge dialogue by analyzing the integration of traditional and formal medicinal systems within family therapeutic strategies. It also aimed at grasping some of the links between the dynamics of medicinal knowledge and the types of land use systems and biodiversity management. Research was conducted in two case study areas of the Andes, both Quechua-speaking and situated in comparable agro-ecological production belts - Pitumarca District, Department of Cusco (Southern Peruvian Highlands) and the Tunari National Park, Department of Cochabamba (Bolivian inner-Andean valleys). In each case study area, the land use systems and strategies of 18 families from two rural communities, their environmental knowledge related to medicine and to the local therapeutic flora, and an appreciation of the dynamics of this knowledge were assessed. Data were collected through a combination of disciplinary and participatory action-research methods. It was mostly analyzed using qualitative methods, though some quantitative ethnobotanical methods were also used. In both case studies, traditional medicine still constitutes the preferred option for the families interviewed, independently of their age, education level, economic status, religion, or migration status. Surprisingly and contrary to general assertions among local NGOs and researchers, results show that there is a revival of Andean medicine within the younger generation, who have greater knowledge of medicinal plants than the previous one, value this knowledge as an important element of their way of life and relationship with “Mother Earth” (Pachamama), and, at least in the Bolivian case, prefer to consult the traditional healer rather than go to the health post. Migration to the urban centres and the Amazon lowlands, commonly thought to be an important factor of local medicinal knowledge loss, only affects people’s knowledge in the case of families who migrate over half of the year or permanently. Migration does not influence the knowledge of medicinal plants or the therapeutic strategies of families who migrate temporarily for shorter periods of time. Finally, economic status influences neither the status of people’s medicinal knowledge, nor families’ therapeutic strategies, even though the financial factor is often mentioned by practitioners and local people as the main reason for not using the formal health system. The influence of the formal health system on traditional medicinal knowledge varies in each case study area. In the Bolivian case, where it was only introduced in the 1990s and access to it is still very limited, the main impact was to give local communities access to contraceptive methods and to vaccination. In the Peruvian case, the formal system had a much greater impact on families’ health practices, due to local and national policies that, for instance, practically prohibit some traditional practices such as home birth. But in both cases, biomedicine is not considered capable of responding to cultural illnesses such as “fear” (susto), “bad air” (malviento), or “anger” (colerina). As a consequence, Andean farmers integrate the traditional medicinal system and the formal one within their multiple therapeutic strategies, reflecting an inter-ontological dialogue between different conceptions of health and illness. These findings reflect a more general trend in the Andes, where indigenous communities are currently actively revalorizing their knowledge and taking up traditional practices, thus strengthening their indigenous collective identities in a process of cultural resistance.

An International Professional Development Collaboration in Literacy Education

An International Professional Development Collaboration in Literacy Education is a report of an international professional development project in Guatemala designed to improve literacy instructional practices and thereby raise student achievement in reading and writing. The opportunity for coaching Guatemalan teachers in teaching literacy strategies and skills provides data for this participatory action research study. This research is intended to contribute to cross-cultural understanding by graduate and undergraduate students in literacy, improved pedagogical techniques, international outreach in developing countries, and student academic success worldwide.

Factors Related to Mental Health of Native Americans in Eastern Tribes

This paper is part of a five-year research project funded by the National Institute on Disability and Rehabilitation Research (NIDRR) that addresses the health, disability and service needs of Native Americans in eastern tribes. The Participatory Action Research model with a community-based approach was used to facilitate collaboration among the participating tribes. Native American research technicians conducted individual interviews with members of their tribes. Demographics, prevalence of disabilities, and various factors associated with health and mental health are presented. Of the 858 tribal members who responded to survey questions, the third most prominent health problem reported was mental illness.

Sacred vocation program follow up evaluation at the Baylor healthcare system

Background: The Sacred Vocation Program (SVP) (Amick B, Karff S., 2003) helps workers find meaning, spirituality, and see their job as a sacred vocation. The SVP is based on Participatory Action Research (PAR) (Minkler & Wallerstein, 1997; Parker & Wall, 1998). This study aims to evaluate the SVP implemented at the Baylor Healthcare System, Dallas-Fort Worth. ^ Methods: The study design is a qualitative design. We used data from study participants who have participated in focus groups. During these focus groups specific questions and probes regarding the effectiveness of the SVP have been asked. We analyzed the focus groups and derived themes. ^ Results: Results of this study demonstrate SVP helps graduates feel valued and important. The SVP has improved meaningful work for employees and improved a sense of belonging for participants. The program has also increased participant spirituality. The coping techniques developed during a SVP class helps participants deal with stressful situations. The SVP faces challenges of implementation fidelity, poor communication, program viability in tough economic times and implementation of phase II. Another sustainability challenge for SVP is the perception of the program being a religious one versus a spiritual program. ^ Conclusion: Several aspects of the SVP work. The phase I of SVP is successful in improving meaningful work and a sense of belonging for participants. The coping techniques help participants deal with difficult work situations. The SVP can increase effectiveness through improvements in implementation fidelity, communication and leadership commitment. ^

Análisis de las prácticas de promoción social del Mayor de Bolívar : hacia la construcción de saberes desde la investigación activa participativa

A partir de la siguiente pregunta: ¿cómo retroalimentar las prácticas del programa de tecnología en promoción social del colegio mayor de bolívar, para la construcción de saberes desde el conocimiento de lo cotidiano?, Surge el objetivo central del presente artículo que consiste en: analizar las prácticas profesionales del programa de promoción social del colegio mayor de bolívar, para la consolidación de la investigación acción participativa, en aras de enriquecer el currículo y las prácticas pedagógicas, permitiendo recrear y fortalecer procesos instituidos, y detectar vacíos o limitaciones. Ello indica que se fundamentará con postulados teóricos de autores como orlando fals borda, para la comprensión de la iap y ezequiel ander egg para la interpretación del concepto de asistencialismo entre otros. El itinerario metodológico, se acoge al paradigma interpretativo-fenomenológico, en torno a la estrategia cualitativa: inductiva-deductiva. Tendrá inicialmente actividades de análisis de documentación, específicamente referente a los documentos institucionales, además de la implementación de entrevistas y la revisión de la bibliografía con la cual se fundamentará teóricamente la investigación. Se trata de generar dudas y reflexiones acerca la importancia del fortalecimiento de la actividad investigativa en programas tecnológicos, en contra de lo que podría convertirse en procesos asistencialistas.