Helping medical students to acquire a deeper understanding of truth-telling.

PROBLEM: Truth-telling is an important component of respect for patients' self-determination, but in the context of breaking bad news, it is also a distressing and difficult task. INTERVENTION: We investigated the long-term influence of a simulated patient-based teaching intervention, integrating learning objectives in communication skills and ethics into students' attitudes and concerns regarding truth-telling. We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). Open-ended responses were analysed to explore medical students' reported difficulties in breaking bad news. CONTEXT: This intervention was implemented during the last preclinical year of a problem-based medical curriculum, in collaboration between the doctor-patient communication and ethics programs. OUTCOME: Over time, concerns such as empathy and truthfulness shifted from a personal to a relational focus. Whereas 'truthfulness' was a concern for the content of the message, 'truth-telling' included concerns on how information was communicated and how realistically it was received. Truth-telling required empathy, adaptation to the patient, and appropriate management of emotions, both for the patient's welfare and for a realistic understanding of the situation. LESSONS LEARNED: Our study confirms that an intervention confronting students with a realistic situation succeeds in making them more aware of the real issues of truth-telling. Medical students deepened their reflection over time, acquiring a deeper understanding of the relational dimension of values such as truth-telling, and honing their view of empathy.

The analysis of knowledge retention mechanisms for leaving experts

The goal of this thesis is studying knowledge retention mechanisms used in cases of single experts’ leaving in the case company, analyzing the reason for the mechanisms choice and successfulness of knowledge retention process depending of that choice. The theoretical part discusses the origins of knowledge retention processes in the theoretical studies, the existing knowledge retention mechanisms and practical issues of their implementation. The empirical part of the study is designed as employees’ interview with later discussion of the findings. The empirical findings indicate the following reasons for knowledge retention mechanisms choice: type of knowledge retained, specialty of leaving experts and time and distance issues of a particular case. The following factors influenced the success of a retention process: choice of knowledge retention mechanisms, usage of combination of mechanisms and creation of knowledge retention plans. The results might be useful for those interested in factors influencing knowledge retention processes in cases of experts’ departure.

The neo-liberal state and the crisis of public service broadcasting in the Anglo-American democracies /

The NeO'liberal State and the Crisis ofPublic Service Broadcasting in the Anglo-American Democracies The purpose ofthis analysis ofthe present condition ofpublic service broadcasting in the Anglo- American democracies was to investigate whether such media can still be regarded as the primarypublic spherefor a dialogue between each nation 's civil society and the State. The motivationfor this thesis was based on a presumption that such fora for public discussion on the central issues of each society have become viewed as less relevant bypoliticians andpolicy-makers and thepublics they were intended to serve in the Anglo-American democracies over thepast two decades. It is speculated that this is the case because ofa beliefthat the post-war consensus between the respective States andpublics that led to the construction of the Keynesian Welfare State and the notion ofpublic service broadcasting has been displaced by an individualistic, neo-liberal, laissez-faire ideology. In other words, broadcasting as a consumer-oriented, commercial commodity has superseded concerns pertaining to the importance ofthe public interest. The methodology employed in this thesis is a comparative analysisfrom a criticalpolitical economy perspective. It was considered appropriate to focus on the United Kingdom, Australia, Canada and the\ United States because they comprise the four largest Anglo-American nations with democratic political systems andprimarily market economies. Justificationfor this particular sample is reinforced by thefact that case study countries also share a common socio-political and economic tradition. The evidence assembledfor this thesis consisted almost exclusively ofexisting literature on the subjects ofpublic service broadcasting, global economic andpolitical integration, and the ascendance ofthe 'free-market ' ethos in Western democracies since the late mid- to late-1970s. In essence, this thesis could be considered as a reinterpretation ofthe existing literature relevant to these issues. Several important common features werefound among the political, economic and broadcasting systems of the four case study nations. It is proposed that the prevalence of the neo-liberal world view throughout the political and policy environments of the four countries has undermined the stability and credibility of each nation 's national public service broadcasting organization, although with varying intensity and effect,. Deregulation ofeach nation 's broadcasting system and the supremacy ofthe notion of 'consumer sovereignty' have marginalized the view of broadcasting on any basis other than strictly economic criteria in thefour case study countries. This thesis concludes that,for a reconstruction ofa trulyparticipatory anddemocraticpublicsphere to be realized in the present as well as thefuture, a reassessment ofthe conventional concept ofthe 'public sphere ' is necessary. Therefore, it is recommended that thefocus ofpolicy-makers in each Anglo-American democracy be redirectedfrom that which conceived ofan all-encompassing, large, state-ownedand operated public broadcasting service toward a view which considers alternativeforms ofpublic communication, such as local community and ethnic broadcasting operations, that are likely to be more responsive to the needs of the increasingly diverse and heterogeneous populations that comprise the modem Anglo-American democracies. The traditional conception of public broadcasters must change in accordance with its contemporary environment if the fundamental principles of the public sphere and public service broadcasting are to be realized.

Openness and privacy in Ontario: an evaluation of the implementation of FIPPA : (The Freedom of Information and Protection of Privacy Act, 1987, Chapter 25 and Ontario Regulation 532/87) /

Since the early 1970's, Canadians have expressed many concerns about the growth of government and its impact on their daily lives. The public has requested increased access to government documents and improved protection of the personal information which is held in government files and data banks. At the same time, both academics and practitioners in the field of public administration have become more interested in the values that public servants bring to their decisions and recommendations. Certain administrative values, such as accountability and integrity, have taken on greater relative importance. The purpose of this thesis is to examine the implementation of Ontario's access and privacy law. It centres on the question of whether or not the Freedom of Information and Protection of Privacy Act, 1987, (FIPPA) has answered the demand for open access to government while at the same time protecting the personal privacy of individual citizens. It also assesses the extent to which this relatively new piece of legislation has made a difference to the people of Ontario. The thesis presents an overview of the issues of freedom of information and protection of privacy in Ontario. It begins with the evolution of the legislation and a description of the law itself. It focuses on the structures and processes which have been established to meet the procedural and administrative demands of the Act. These structures and processes are evaluated in two ways. First, the thesis evaluates how open the Ontario government has become and, second, it determines how Ill carefully the privacy rights of individuals are safeguarded. An analytical framework of administrative values is used to evaluate the overall performance of the government in these two areas. The conclusion is drawn that, overall, the Ontario government has effectively implemented the Freedom of Information and Protection of Privacy Act, particularly by providing access to most government-held documents. The protection of individual privacy has proved to be not only more difficult to achieve, but more difficult to evaluate. However, the administrative culture of the Ontario bureaucracy is shown to be committed to ensuring that the access and privacy rights of citizens are respected.

An exploration of gifted and highly able adolescents' experiences with stress and coping /

This narrative case study explored gifted and highly able adolescents' experiences with stress and coping. Nine students, ages 13-18, at 2 independent schools in southern Ontario, participated. They completed the Adolescent Coping Scale (Frydenberg & Lewis, 1993), and I generated individualized graphs of coping strategies. Participants talked about experiences they perceived as stressful in their academic, personal, social, and familial settings during a 60-90 minute one-on-one audiotaped interview. During the interview, each participant made observations about their own coping strategies profile. The interview was analyzed to identify stressor and coping themes. Participants completed a writing or art task to record perceptions of stress and coping. The 3 data sources were used to craft 9 individual story portraits, from which 5 main stressor themes emerged: issues of time; relationships, emotions, and communication; ethical, moral, and spiritual issues; global issues; and silences, or stressors not talked about in depth. Coping themes were: seeking relaxing activities; having positive attitudes and making wise choices; maintaining relationships with peers and family; understanding the role of faith and moral beliefs; having a supportive environment; knowing your own personality type; being aware of negative coping strategies; and keeping busy and avoiding stressfiil issues. The narratives are important because they present teenagers talking about their socioemotional worlds. The present findings provide empirical groundwork for curriculum development in affective education and highlight the importance of socioemotional development for future research in the area of giftedness and adolescence.

The interpretation of music videos : an interactive relationship between medium and viewer

There is a great deal of evidence to support the examination of an interactive relationship between the medium and the viewer in the interpretation of mainstream media. The exact nature of this relationship, however, is not well understood. The current study was carried out to assess the variables that may help explain why certain people interpret media, such as music videos, differently than others. Jensen's concept of reception analysis describes the relationship between the medium and the audience, and thus remains a strong focus within this study. Differences in the interpretation of music videos were investigated as a function of Absorption, gender role, screen size, age and viewing experience. Multiple regression analyses uncovered independent predictions of sexuality and violence scores by absorption and experience, as well as an interaction between absorption and screen size in the sexuality rating of the music videos.

Advocating recognition and redistribution in poverty alleviation programs in Ghana : an examination of state and NGO programs and policies

Abstract This thesis argues that poverty alleviation strategies and programs carried out by the government and Non Governmental Organizations in Ghana provide affirmative solutions to poverty. This is because, these intervention strategies have been influenced by conventional discourses on poverty that fail to adequately address non-economic issues of poverty such as powerlessness, marginalization and tmder-representation. The study is carried out in a two-pronged manner; first, it analyses state policies and strategies, particularly the Ghana Poverty Reduction Strategy (GPRS), on poverty alleviation and compares these to NGO programs, implemented with funds and support from external donor organizations. Specifically, I focus on how NGOs and the governnlent of Ghana negotiate autonomy and financial dependency with their funding donor-partners and how these affect their policies and programs. Findings from this study reveal that while external influences dominate poverty alleviation policies and strategies, NGOs and the government of Ghana exercise varying degrees of agency in navigating these issues. In particular, NGOs have been able to adapt their programs to the changing needs of donor markets, and are also actively engaged in re-orienting poverty back to the political domain through advocacy campaigns. Overall, rural communities in Ghana depend on charitable NGOs for the provision of essential social services, while the Ghanaian government depends on international donor assistance for its development projects.

The Mirror Room Project: A Critical Ethnographic Program Evaluation of a Teaching Personal and Social Responsibility Based Youth Development Program

Amongst a host of other benefits, proper physical education has the possibility to create a safe place where responsibility can be transferred from the teacher/facilitator, to the student. This is especially true with an underserved population. This critical program evaluation of the program CHARM was done for the purpose of program improvement. This research was a place for participants to share their experiences of the program. The participants were 5 underserved youth, 5 undergraduate students, 3 teachers and 1 graduate student. Observations, interviews, and document analysis were used to gather data. Data was analyzed using a first level read-through, and two second-level analyses. Summaries were written, and cross-case analyses were completed. The main finding of the research was the development of a Handbook, which is a guide to running the program. Secondary findings include issues of program structure, goal setting, meaningful relationships, roles, SNAP, and an outlier in the data.

Identity Formation and Negotiation of Afghan Female Youth in Ontario

The following thesis provides an empirical case study in which a group of 6 first generation female Afghan Canadian youth is studied to determine their identity negotiation and development processes in everyday experiences. This process is investigated across different contexts of home, school, and the community. In terms of schooling experiences, 2 participants each are selected representing public, Islamic, and Catholic schools in Southern Ontario. This study employs feminist research methods and is analyzed through a convergence of critical race theory (critical race feminism), youth development theory, and feminist theory. Participant experiences reveal issues of racism, discrimination, and bias within schooling (public, Catholic) systems. Within these contexts, participants suppress their identities or are exposed to negative experiences based on their ethnic or religious identification. Students in Islamic schools experience support for a more positive ethnic and religious identity. Home and community provided nurturing contexts where participants are able to reaffirm and develop a positive overall identity.

Provocative Innocence: Deconstructing Youth Sexuality through a Patriarchal & Immanent Framework

The purpose of this exploratory study is to deconstruct dominant discourses of youth’s sexuality through the exploration of a cultural text. Patriarchal and immanent frameworks form the theoretical basis for a deconstructive textual analysis and systematic mise en scène analysis of the chosen text, the film, Thirteen (Hardwicke, 2003). I intend to explore the portrayal of youth sexuality by deconstructing discourses of sexuality that are simultaneously reflected and interrogated in the above mentioned media text. I have chosen this approach in order to deconstruct socially constructed ways of knowing and experiencing sexuality in order to uncover a multitude of possibilities for sexuality. In other words, this project will use deconstruction in order to reconceptualize sexuality.

Queer Encounters: exploring experiences of (gender)queers in women's public washroom spaces

This thesis is based on 13 qualitative interviews conducted with 12 individuals whom I refer to as (gender)queers in Winnipeg, Manitoba, and St. Catharines, Ontario. Drawing on queer theory and the literature of sexuality and space, I explore how (gender)queers experience women's public washrooms as gendered and heterosexualized spaces. I examine the degree to which a simultaneous heterosexing and female gendering of women's public washrooms is linked to the marginalization and sometimes violent exclusion of (gender)queers within these particular spaces. I also discuss the ways in which (gender)queers may use a variety of strategies aimed at navigating heterosexualized and gendered public washrooms. Finally, I explore alternatives to conventional washrooms spaces, including the gender-neutral washrooms, multi-stall non-gendered public washrooms, and public washrooms in queer spaces.

An Exploration of Male Adolescents' Body Image Perceptions

There has been an increasing concern among researchers and the general population of our culture's increasing emphasis on "ideal" physical attractiveness-for both females and males. Despite this growing concern, research on body image has focused primarily on women and girls, with little research aimed specifically for males. Prior research (Grogan & Richards, 2002; Hargreaves & Tiggemann, 2006) stated that body image was a "feminine" or a "gay" issue, according to men and boys. The present study investigates this issue, particularly within the theoretical framework of multiple selves and gender theories. This exploratory case study involved semi-structured interviews with six male adolescents between the ages of 13 and 18 years. Researcher's fieldnotes were taken after the interviews. Content analysis of the interviews and fieldnotes revealed that for these six male adolescents, body image is not relevant to them, as they think about and discuss their issues of physical appearance with family and close peers. Traditional stereotypic notions of masculinity and what it means to be an adolescent male for the participants are discussed within the context of developmentally appropriate and gender-inclusive curriculum.

Rethinking Fiscal Decentralization Policies in Developing Economies: A Case Study of Ghana

This thesis invites geographers to pay more attention to public policy research by addressing the need to rethink fiscal decentralization policies in Ghana. By applying “Simandan’s wise stance in human geography” and “Grix’s building blocks of social research design”, I developed a conceptual framework that unites two incommensurable ontological and epistemological research positions in geography—the positive and normative positions. I used the framework to investigate two key research questions. First, does fiscal decentralization actually work in Ghana? Through quantitative analysis of empirical revenue and expenditure data (1994-2011) of local governments in Ghana, this study reveals significant issues of inefficiency, inequity, and unaccountability. Local governments generate less revenue, and therefore depend largely on central government transfers for developing their jurisdictions. Worse yet, these transfers are highly unpredictable in terms of amount and timing. Even though a multivariate regression analysis revealed that these transfers are apolitical, the actual disbursement formula tends to focus on equality instead of equity. Additionally, the unclear expenditure assignments in each locality make accountability difficult. In view of these problems, I addressed the question: why is fiscal decentralization held out as a good thing in Ghana? By drawing lessons from Foucault’s and Escobar’s critical discourse analysis, I traced a genealogy of Ghana’s fiscal decentralization. I found that the policy is held out as a good thing in Ghana because of the triangular operation of multiplicities of power, knowledge, and truth regimes at the local, national and international scale. I concluded that although nation-states remains a necessary causal link in fiscal decentralization policy process in Ghana, direct and indirect international involvement have profound effect on these policies. Therefore, rethinking fiscal decentralization involves acknowledging the complex intermingling effects that global, national, and local territories produce.

Major Sport Event Operational Planning Issues and Strategies: A Multi-Case Delphi Study

This study examined the operational planning, implementation and execution issues of major sport events, as well as the mitigation and management strategies used to address these issues, with the aim of determining best practices in sport event operational planning. The three Research Questions were: 1) What can previous major sport events provide to guide the operational management of future events? 2) What are the operational issues that arise in the planning and execution of a major sport event, how are they mitigated and what are the strategies used to deal with these issues? 3) What are the best practices for sport event operational planning and how can these practices aid future events? Data collection involved a modified Delphi technique that consisted of one round of in-depth interviews followed by two rounds of questionnaires. Both data collection and analysis were guided by an adaptation of the work of Parent, Rouillard & Leopkey (2011) with a focus on previously established issue and strategy categories. The results provided a list of Top 26 Prominent Issues and Top 17 Prominent Strategies with additional issue-strategy links that can be used to aid event managers producing future major sport events. The following issue categories emerged as having had the highest impact on previous major sport events that participants had managed: timing, funding and knowledge management. In addition, participants used strategies from the following categories most frequently: other, formalized agreements and communication.

Psychiatric services utilization in completed suicides of a youth centres population

Affiliation: Johanne Renaud & Claude Marquette : CHU Ste-Justine, Université de Montréal