Ethical reasoning through simulation: a phenomenological analysis of student experience

Background
Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students’ lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment.

Methods
This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data.

Results
Four main themes emerged from the analysis: (1) ‘Authentic on all levels?’, (2)‘Letting the emotions flow’, (3) ‘Ethical alarm bells’ and (4) ‘Voices of children and ghosts’. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences.

Conclusions
This study provided deep insights into medical students’ immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.

L'intégration des principes de la procédure applicables aux modes de prévention et de règlement des différends dans le nouveau "Code de procédure civile"- les effets envisagés sur l'accès à la justice civile au Québec

La problématique liée au manque d’accès à la justice se pose dans toutes les régions du monde. Afin de résoudre celle-ci, l’Assemblée nationale du Québec a adopté, le 20 février 2014, le projet de loi 28, Loi instituant le nouveau Code de procédure civile, 1e sess, 40e lég. À cet égard, la disposition préliminaire indique que le nouveau Code de procédure civile (ci-après : « NCPC »), qui régit dorénavant la procédure applicable aux modes de prévention et de règlement des différends (ci-après : « modes de PRD »), vise à « assurer l’accessibilité, la qualité et la célérité de la justice civile […] ». Au-delà de ces mots, qui ont une grande valeur interprétative, ce mémoire analyse dans quelle mesure l’intégration des principes de la procédure applicables aux modes de PRD dans le NCPC est réellement susceptible d’améliorer l’accessibilité de la justice civile au Québec.

A review of the S.C. Department of Transportation

Members of the General Assembly asked the Legislative Audit Council to conduct an audit of the S.C. Department of Transportation. The objectives were to:Identify funding levels since FY 05-06 ; Review expenditures since FY 05-06 ; Determine if the department has followed the provisions of Act 114 regarding prioritization ; Review contracting activities for fairness, percentage of out-of-state entity awards, and identify the amount awarded to contractors employing former SCDOT employees ; Report the status of problems identified in the annual audits performed as a result of S.C. Code of Laws §57-1-490 ; Perform a follow-up review of the contracted 2010 MGT, Inc. audit recommendations ; Review pavement resurfacing issues ; Conduct a limited review of certain management-related topics.

Corporate governance and cost of capital: evidence from Pakistani listed firms

This thesis investigates the effectiveness of Corporate Governance (CG) reforms in Pakistan. Using a sample of 160 Pakistani firms from 2003 to 2013 and governance data collected manually from the annual reports, this thesis investigates seven closely related and important corporate issues that are related to the compliance of governance rules. Specifically, it aims to : (i) investigate the degree of CG compliance with 2002 Pakistani Code of CG (PCCG); (ii) determine whether the introduction of 2002 PCCG has improved Pakistani CG practices; (iii) investigate the determinants of CG compliance and disclosure for Pakistani listed firms; (iv) test the nexus between CG compliance with the 2002 PCCG and firms’ cost of capital (COC); (v) investigate the impact of different individual CG mechanisms on listed firms COC; (vi) examine how different ownership structures impact on firms’ COC; and (vii) analyse relationship between CG structures and Cost of Equity (COE) as well as Cost of Debt (COD) for Pakistani listed firms. These empirical investigations report some important results. First, the reported findings suggest that Pakistani firms have responded positively to governance disclosure requirements over the eleven year period from 2003 to 2013. The results also show that the introduction of the PCCG in 2002 has improved CG standards by Pakistani listed firms. Second, the reported results related to the determinants of CG compliance demonstrate that significant and positive association between institutional, government and foreign ownership with CG compliance. However, findings relating to the determinants of CG compliance show a negative and significant association between board size and block ownership with CG compliance and disclosure. The study finds no significant relationship between director ownership, audit firm size and the presence of female board members with the constructed Pakistan Corporate Governance Index (PCGI). Third, the investigation on the relationship between CG and COC report a significantly negative nexus between PCGI and firms’ COC. The investigation on the association between ownership structures and COC report a negative and significant nexus between block ownership with firms’ COC. Further, a number of robustness analyses performed in this study suggest that the empirical results reported in this study are generally robust to the alternative CG variables, alternative COC variables and potential endogeneity problems.

Espionage against Poland in the Documents and Analyses of the Polish Special Services (1944 - 1989) - as Illustrated by the Intelligence Activities of the USA

The text analyses the intelligence activity against Poland in the period 1944-1989. The paper also contains a case study, i.e. an analysis of the American intelligence service activity held against Poland. While examining the research thesis, the author used the documents and analyses prepared by the Ministry of Internal Affairs. In order to best illustrate the point, the author presented a number of cases of persons who spied for the USA, which was possible thanks to the analysis of the training materials of the Ministry of Internal Affairs directed to the officers of the Security Service and the Citizens’ Militia. The text tackles the following issues: (1) to what extent did the character of the socio-political system influence the number of persons convicted for espionage against Poland in the period under examination?, (2) what was the level of interest of the foreign intelligence services in Poland before the year 1990?, (3) is it possible to indicate the specificity of the U.S. intelligence activity against Poland? 1) The analysis of data indicates that the period 1946-1956 witnessed a great number of convictions for espionage, which is often associated with the peculiar political situation in Poland of that time. Up to 1953, the countries of the Eastern bloc had reproduced the Stalin’s system, which only ceased due to the death of Stalin himself. Since then, the communist systems gradually transformed into the system of nomenklatura. Irrespective of these changes, Poland still witnessed a wave of repressions, which resulted from the threats continuously looming over the communist authorities – combating the anti-communist underground movement, fighting with the Ukrainian Insurgent Army, the Polish government-in-exile, possible revisionism of borders, social discontent related to the socio-political reforms. Hence, a great number of convictions for espionage at that time could be ascribed to purely political sentences. Moreover, equally significant was the fact that the then judicial practice was preoccupied assessing negatively any contacts and relations with foreigners. This excessive number of convictions could ensue from other criminal-law provisions, which applied with respect to the crimes against the State, including espionage. What is also important is the fact that in the Stalin’s period the judiciary personnel acquired their skills and qualifications through intensive courses in law with the predominant spirit of the theory of evidence and law by Andrey Vyshinsky. Additionally, by the decree of 1944 the Penal Code of the Polish Armed Forces was introduced; the code envisaged the increase in the number of offences classified as penalised with death penalty, whereas the high treason was subject to the military jurisdiction (the civilians were prosecuted in military courts till 1955; the espionage, however, still stood under the military jurisdiction). In 1946, there was introduced the Decree on particularly dangerous crimes in the period of the State’s recovery, which was later called a Small Penal Code. 2) The interest that foreign intelligence services expressed in relation to Poland was similar to the one they had in all countries of Eastern and Central Europe. In the case of Poland, it should be noted that foreign intelligence services recruited Polish citizens who had previously stayed abroad and after WWII returned to their home country. The services also gathered information from Poles staying in immigrant camps (e.g. in FRG). The activity of the American intelligence service on the territory of FRG and West Berlin played a key role. The documents of the Ministry of Internal Affairs pointed to the global range of this activity, e.g. through the recruitment of Polish sailors in the ports of the Netherlands, Japan, etc. In line with the development in the 1970s, espionage, which had so far concentrated on the defence and strategic sectors, became focused on science and technology of the People’s Republic of Poland. The acquisition of collaborators in academic circles was much easier, as PRL opened to academic exchange. Due to the system of visas, the process of candidate selection for intelligence services (e.g. the American) began in embassies. In the 1980s, the activity of the foreign intelligence services concentrated on the specific political situation in Poland, i.e. the growing significance of the “Solidarity” social movement. 3) The specificity of the American intelligence activity against Poland was related to the composition of the residency staff, which was the largest in comparison to other Western countries. The wide range of these activities can be proved by the quantitative data of convictions for espionage in the years 1944-1984 (however, one has to bear in mind the factors mentioned earlier in the text, which led to the misinterpretation of these data). Analysing the data and the documents prepared by the Ministry of Internal Affairs, one should treat them with caution, as, frequently, the Polish counter-intelligence service used to classify the ordinary diplomatic practice and any contacts with foreigners as espionage threats. It is clearly visible in the language of the training materials concerned with “secret service methods of the intelligence activity” as well as in the documents on operational activities of the Security Service in relation to foreigners. The level of interest the USA had in Poland was mirrored in the classification of diplomatic posts, according to which Warsaw occupied the second place (the so-called Group “B”) on the three-point scale. The CIA experienced spectacular defeats during their activity in Poland: supporting the Polish underground anti-communist organisation Freedom and Independence and the so-called Munich-Berg episode (both cases took place in the 1950s). The text focuses only on selected issues related to the espionage activities against Poland. Similarly, the analysis of the problem has been based on selected sources, which has limited the research scope - however, it was not the aim of the author to present the espionage activity against Poland in a comprehensive way. In order to assess the real threat posed by the espionage activity, one should analyse the case of persons convicted for espionage in the period 1944-1989, as the available quantitative data, mentioned in the text, cannot constitute an explicit benchmark for the scale of espionage activity. The inaccuracies in the interpretation of data and variables, which can affect the evaluation of this phenomenon, have been pointed out in the text.

La subrogation légale de l’assureur en vertu du Code civil : historique, développements et aspects procéduraux

En assurance de dommages, l’article 2474 C.c.Q. prévoit la possibilité pour l’assureur d’être légalement subrogé dans les droits de l’assuré contre l’auteur du préjudice, à concurrence des indemnités qu’il a payées. L’assureur ne pourra jamais être subrogé contre les personnes faisant partie de la maison de l’assuré. Dans un premier temps, le présent mémoire fait un survol historique du droit à la subrogation de l’assureur en vertu du Code civil. Depuis la codification de 1865, les principes relatifs à la subrogation de l’assureur ne sont pas demeurés statiques. Ils firent l’objet de plusieurs modifications législatives et de nombreuses controverses et développements jurisprudentiels. Dans un deuxième temps, un portrait global de l’état actuel du droit est dressé en ce qui concerne l’article 2474 C.c.Q., tant sur le plan des composantes du droit à la subrogation que de ses aspects procéduraux.

CLASHES IN CONFINEMENT: MEN’S GENDERED EXPERIENCES WITH CONFLICT IN CANADIAN PRISONS

This dissertation presents the results of in-depth qualitative interviews with twenty-three formerly imprisoned men regarding their lived experience with prison conflict and the pain of incarceration. The results suggest that prison is a gendered ‘total institution’ (Goffman 1961). The pains that men experience in prison are uniquely gendered in that the deprivations imposed by incarceration– deprivation of autonomy, liberty, goods and services, heterosexual sex, and security (Sykes 1958) – in the reverse, define idealized masculinity as it is currently socially constructed: self-reliance, independence, toughness or invulnerability, material and economic success, and heterosexual prowess. From these shared deprivations emerges a gendered code of conduct that perpetuates a hierarchy among incarcerated men by constructing violent masculinity as a subcultural norm. The results suggest that the gender code in prison represents a set of rules that create opportunities for men to police each other’s gender performance and make claims to masculine statuses. Because status is inextricably tied to survival in this context, many men feel pressured to perform violent masculinities in prison despite privately subscribing to a non-violent sense of self-concept. The results suggest that violence is an expressive and instrumental resource for men in prison. A gender theory of prison violence, methodological findings, theoretical implications, ethical considerations and the short and long term aftermath of violent prison conflict are discussed.

Relevance of anatomy to medical education and clinical practice: perspectives of medical students, clinicians, and educators

Introduction: Against a backdrop of ever-changing diagnostic and treatment modalities, stakeholder perceptions (medical students, clinicians, anatomy educators) are crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. This study compared perceptions of students, practising clinicians, and anatomy educators with respect to the relevance of anatomy education to medicine. Methods: A quantitative survey was administered to undergraduate entry (n = 352) and graduate entry students (n = 219) at two Irish medical schools, recently graduated Irish clinicians (n = 146), and anatomy educators based in Irish and British medical schools (n = 30). Areas addressed included the association of anatomy with medical education and clinical practice, mode of instruction, and curriculum duration. Results: Graduate-entry students were less likely to associate anatomy with the development of professionalism, teamwork skills, or improved awareness of ethics in medicine. Clinicians highlighted the challenge of tailoring anatomy education to increase student readiness to function effectively in a clinical role. Anatomy educators indicated dissatisfaction with the time available for anatomy within medical curricula, and were equivocal about whether curriculum content should be responsive to societal feedback. Conclusions: The group differences identified in the current study highlight areas and requirements which medical education curriculum developers should be sensitive to when designing anatomy courses.

La subrogation légale de l’assureur en vertu du Code civil : historique, développements et aspects procéduraux

En assurance de dommages, l’article 2474 C.c.Q. prévoit la possibilité pour l’assureur d’être légalement subrogé dans les droits de l’assuré contre l’auteur du préjudice, à concurrence des indemnités qu’il a payées. L’assureur ne pourra jamais être subrogé contre les personnes faisant partie de la maison de l’assuré. Dans un premier temps, le présent mémoire fait un survol historique du droit à la subrogation de l’assureur en vertu du Code civil. Depuis la codification de 1865, les principes relatifs à la subrogation de l’assureur ne sont pas demeurés statiques. Ils firent l’objet de plusieurs modifications législatives et de nombreuses controverses et développements jurisprudentiels. Dans un deuxième temps, un portrait global de l’état actuel du droit est dressé en ce qui concerne l’article 2474 C.c.Q., tant sur le plan des composantes du droit à la subrogation que de ses aspects procéduraux.

1979 Annual Report of the Iowa Board of Medical Examiners, January 16, 1980

This report is submitted in compliance with 258A.4(2)of the Code of Iowa.

1980 Annual Report of the Iowa Board of Medical Examiners, January 1, 1981

This report is submitted in compliance with 258A.4(2)of the Code of Iowa.

1981 Annual Report of the Iowa Board of Medical Examiners, January 29, 1982

This report is submitted in compliance with 258A.4(2)of the Code of Iowa.

1982 Annual Report of the Iowa Board of Medical Examiners, January 10, 1983

This report is submitted in compliance with 258A.4(2)of the Code of Iowa.

1983 Annual Report of the Iowa Board of Medical Examiners, January 6, 1984

This report is submitted in compliance with 258A.4(2)of the Code of Iowa.

1984 Annual Report of the Iowa Board of Medical Examiners, January 30, 1985

This report is submitted in compliance with 258A.4(2)of the Code of Iowa.