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.

Verbal emotional memory in a case with left amygdala damage.

The amygdala nuclei appear to be critically implicated in emotional memory. However, in most studies, encoding and consolidation processes cannot be analyzed separately. We thus studied the verbal emotional memory in a young woman with a ganglioglioma of the left amygdala and analyzed its impact (1) on each step of the memory process (encoding, retrieval, and recognition) (2) on short- and long-term consolidation (1-hour and 1-week delay) and (3) on processing of valence (positive and negative items compared to neutral words). Results showed emotional encoding impairments and, after encoding was controlled for, emotional long-term consolidation. Finally, although the negative words were not acknowledged as emotionally arousing by the patient, these words were specifically poorly encoded, recalled, and consolidated. Our data suggest that separate cerebral networks support the processing of emotional versus neutral stimuli.

Recueil de documents concernant la Bourgogne et la rivalité de François Ier et de Charles-Quint. Copies.

Contient : 1 Mémoires d'OLIVIER DE LA MARCHE, sans commencement ni fin. Premiers mots : «... et vengance de leurs haultaines et grandes entreprinses... ». Derniers mots : « ... que on nommoit messire Jaques de Lalaing, natif du pays... » ; 2 « C'est le triste revel de messire OLIVIER DE LA MARCHE, en son temps chevallier d'honneur de madame Marie, duchesse de Bourgoingne, dit le chevalier deliberé ». Premier vers : « Au sorty de mon reveil de somme... ». Derniers mots : «... Par celluy qui a tant souffert. La Marche ». Tout ce poème est écrit au vermillon ; 3 « S'ensuit la Relacion de BOURGOINGNE, roy d'armes de l'empereur, contenant son besoigner, quant il pourta au roy de France la responce de son cartel et la seurté du camp ». Premiers mots : « Jehan Bourgoingne, roy d'armes... de l'empereur... Charles cinquiesme... » ; 4 « S'ensuit le double de la teneur du cartel du roy de France » FRANÇOIS Ier « envers l'empereur » ; Premiers mots : « Nous Françoys, par la grace de Dieu roy de France... ». 1528 ; 5 Chronique de Bourgogne. Premiers mots : « En l'an XIIIIe apres la Resurrection N.-S., la tres glorieuse Magdeleine,... convertix le roy et la royne de Bourgoigne... ». Derniers mots : «... Dudit monseigneur le duc Philippe descendit tres victorieulx, tres chrestien prince Charles, à present duc et conte de Bourgoingne, que Dieu veuille garder, donner victoyre contre ses ennemis ». Après ces mots vient la mention en latin du décès du duc Charles le Téméraire devant Nancy ; 6 « La dispute du droict de la duché de Bourgoingne ». Premiers mots : « Le roy estant en Espaingne furent commis et depputez certains notables personnaiges tant de France que d'Espaigne... » ; 7 « L'espitaphe du duc Philippe de Bourgoingne ». Premier vers : « Jehan fut nay de Philippe, qui du roy Jehan fust filz... » ; 8 « Election imperialle ». Premiers mots : « Comme vasquoit nagueres la saincte empire... » ; 9 « Anno Domini 1519 fuit electus rex Hyspanorum imperator Romanorum, vacante nuper sacro Romano imperio... » ; 10 Vers en latin sur le même sujet : « Postulat imperium Gallus, Germanus, Iberus,... » ; 11 Vers en français sur le même sujet : « Lyon rempant en tout honneur prospere... » ; 12 « A quodam etiam interpretatio nominis Karoli, secundum litteras ». Premier vers : « Cueur coraigeux, carboucle reluisant... » ; 13 « Questio theologa. Utrum voluntas status triplicis varietate insignis multiplici fuerit libertate decorata ». Premiers mots : « Voluntas divina prima... » ; 14 Autres questions théologiques, en latin ; 15 Prophétie. Premiers mots : « Une prophétie trouvée à Veronne... » ; 16 Autre prophétie : « Item au pays du Lyon se fera une grande et merveilleuse bataille... » ; 17 Vers moraux tirés d'une édition de la Danse macabre : « Qui à bien vivre veult entendre... » ; 18 Autres vers : « Depuis Adam, le premier homme... » ; 19 « 1536. Nota que en l'an 1536 furent mutacions et grandes emotions entre les souverains... » ; 20 « Du lundi XVe de janvier 1536. Le roy a assisté à l'audition du Palais, au siege real de la salle dorée ». C'est le procès-verbal du lit de justice tenu pour déclarer Charles d'Autriche félon et la réversion des comtés de Flandre, Artois, Charolais, etc. à la couronne, fiefs tenus par ledit Charles ; 21 « Charolus sic interpretatur : Cueur coraigeux, carboucle reluisant... » ; 22 « Nota. Triplici enim coronatur illustrissimus imperator, videlicet ferrea, argentea, aurea... » ; 23 « Versus. Postulat imperium Gallus, Germanus, Iberus... » ; 24 Vers. « Lyon rampant en tout honneur prospère... » ; 25 « Vacante nuper sacro romano imperio, per obitum quondam serenissimi principis domini domini nostri Maximiliani,... ego Laurentius Triesis, decanus Maguntinis (sic), mere prefatorum dominorum dominorum graciosissimorum principum electorum... quo universi cognoscant prefatum dominum Karolum electum in... futurum imperatorem... ». Proclamation de l'élection de Charles-Quint à l'empire ; 26 « Condempnatio domini nostri Jhesu Christi. Nos Pontius Pilatus,... Ite, tenete eum »

Factors affecting a woman's decision to leave an abusive relationship : the theory of planned behaviour /

The present study tested the appHcabiUty of Ajzen's (1985) theory of planned behaviour (TPB), an extension of Fishbein and Ajzen's (1975) theory of reasoned action (TRA), for the first time, in the context of abused women's decision to leave their abusive relationships. The TPB, as a means of predicting women's decision to leave their abusive partners' was drawn from Strube's (1988, 1991) proposed decision-making model based on the principle that the decision-making process is a rational, deliberative process, and regardless of outcome, was a result of a logical assessment of the available data. As a means of predicting those behaviours not under volitional control, Ajzen's (1985) TPB incorporated a measure of perceived behavioural control. Data were collected in two phases, ranging from 6 months to 1 year apart. It was hypothesized that, to the extent that an abused woman held positive attitudes, subjective norms conducive to leaving, and perceived control over leaving, she would form an intention to leave and thus, increase the likelihood of actually leaving her partner. Furthermore, it was expected that perceptions of control would predict leaving behaviour over and above attitude and subjective norm. In addition, severity and frequency of abuse were assessed, as were demographic variables. The TPB failed to account significantly for variability in either intentions or leaving behaviour. All of the variance was attributed to those variables associated with the theory of reasoned action, with social influence emerging as the strongest predictor of a woman's intentions. The poor performance of this model is attributed to measurement problems with aspects of attitude and perceived control, as well as a lack of power due to the small sample size. The insufficiency of perceived control to predict behaviour also suggests that, on the surface at least, other factors may be at work in this context. Implications of these results, and recommendations such as, the importance of obtaining representative samples, the inclusion of self-esteem and emotions as predictor variables in this model, a reevaluation of the target behaviovu" as nonvolitional, and longitudinal studies spanning a longer time period for future research within the context of decision-making are discussed.

Physiological reactivity and the perception of emotional stimuli as they relate to social adaptive functioning after traumatic brain injury / y Melonie Jane Hopkins.

Traumatic brain injury (TBI) often affects social adaptive functioning and these changes in social adaptability are usually associated with general damage to the frontal cortex. Recent evidence suggests that certain neurons within the orbitofrontal cortex appear to be specialized for the processing of faces and facial expressions. The orbitofrontal cortex also appears to be involved in self-initiated somatic activation to emotionally-charged stimuli. According to Somatic Marker Theory (Damasio, 1994), the reduced physiological activation fails to provide an individual with appropriate somatic cues to personally-relevant stimuli and this, in turn, may result in maladaptive behaviour. Given the susceptibility of the orbitofrontal cortex in TBI, it was hypothesized that impaired perception and reactivity to socially-relevant information might be responsible for some of the social difficulties encountered after TBL Fifteen persons who sustained a moderate to severe brain injury were compared to age and education matched Control participants. In the first study, both groups were presented with photographs of models displaying the major emotions and either asked to identify the emotions or simply view the faces passively. In a second study, participants were asked to select cards from decks that varied in terms of how much money could be won or lost. Those decks with higher losses were considered to be high-risk decks. Electrodermal activity was measured concurrently in both situations. Relative to Controls, TBI participants were found to have difficulty identifying expressions of surprise, sadness, anger, and fear. TBI persons were also found to be under-reactive, as measured by electrodermal activity, while passively viewing slides of negative expressions. No group difference,in reactivity to high-risk card decks was observed. The ability to identify emotions in the face and electrodermal reactivity to faces and to high-risk decks in the card game were examined in relationship to social monitoring and empathy as described by family members or friends on the Brock Adaptive Functioning Questionnaire (BAFQ). Difficulties identifying negative expressions (i.e., sadness, anger, fear, and disgust) predicted problems in monitoring social situations. As well, a modest relationship was observed between hypo-arousal to negative faces and problems with social monitoring. Finally, hypo-arousal in the anticipation of risk during the card game related to problems in empathy. In summary, these data are consistent with the view that alterations in the ability to perceive emotional expressions in the face and the disruption in arousal to personally-relevant information may be accounting for some of the difficulties in social adaptation often observed in persons who have sustained a TBI. Furthermore, these data provide modest support for Damasio's Somatic Marker Theory in that physiological reactivity to socially-relevant information has some value in predicting social function. Therefore, the assessment of TBI persons, particularly those with adaptive behavioural problems, should be expanded to determine whether alterations in perception and reactivity to socially-relevant stimuli have occurred. When this is the case, rehabilitative strategies aimed more specifically at these difficulties should be considered.

Young children's behavioral responses to the distress of others /

The relationship between child temperament and parenting factors in the development of prosocial behavior during the toddler years was investigated by examining children's helping behaviors and responses to the distress of others as observed and as reported by mothers and teachers. These behaviors were linked to the sociability, emotionality, and attention shifting of toddlers. Children who are relatively high in characteristics such as language skills and sociability appear more likely to exhibit competent prosocial behaviors than children who are relatively low in these skills. Prosocial competence was also linked to maternal comfort, maternal control over children's emotions, and family expressiveness, although the latter two variables related to children's behaviors differently, depending on whether children were low or high in emotional intensity.

The nature experiences of wilderness recreation leaders : throwing a stone

Through this descriptive exploratory study, the ways that wilderness recreation leaders experience nature are illuminated, deconstructing the assumed environmental benefits of and practices used in outdoor recreation (Haluza-Delay, 2001). This study also offers a foundation for advancing an environmental ethic among wilderness recreation leaders, participants, and organizations. With the continued degradation of and threats to natural environments, and the rising popularity of outdoor recreation participation, the outdoor recreation professional can be a leader in promoting human reconnections to the Earth (Henderson, 1999). Leaders of outdoor recreation experiences play an important role in encouraging these revived relationships to natural settings and can contribute to the necessary environmental consciousness shift needed within Western society (Hanna, 1995; Jordan, 1996). The purpose of this research was to describe the lived-experience in nature of wilderness recreation leaders. Specifically, a phenomenological method of inquiry was used to describe the meaning of nature, the connections and relationships to nature, and the behaviours and emotions experienced in nature by a group of wilderness canoe trip leaders employed by a residential summer camp. In addition to the implications of this research, achieving this outcome provides a rich descriptive understanding of wilderness leaders' experiences—a basis from which to extend future research endeavours and programmatic practices that promote effective environmental outcomes of outdoor recreation participation. Each of the five study participants was employed in the summer of 2003 by an Ontario residential summer camp organization that sponsors extended wilderness river canoe trips for youth. Two in-depth and semi-structured interviews were performed with each participant, asking them to reflect on the canoe trip that they led for the summer camp organization during 2003. Phenomenological data was analyzed according to Colaizzi's (1978) thematic analysis process. Consistent with van Manen's (1997) emphasis on phenomenological writing, the final result presents the essence of the nature experiences of wilderness recreation leaders in the format of a narrative description. This narrative piece is the culmination of this research effort. Throughout the journey, however, various foundations within the outdoor recreation field, such as minimum impact principles, environmentally responsible behaviours, anthropocentric and ecocentric worldviews, and effective leadership are deconstructed and discussed.

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.

Forsaking all others: towards a new model of nationalism utilizing the case study of former Yugoslavia

Many people would like to believe that nationalism is a thing of the past, a dinosaur belonging to some bygone, uncivilized era. Such a belief is not borne out by recent history, however. Nationalism occupies the political forum with as much force as ever. Yet, in many ways, it remains a mystery to us. The purpose of this study is to explore individual motivations involved in the rise of nationalism, in addition to the role of structural factors. The linkage employed in this exploration is the psychosocial phenomenon of self-identity, including emotions and self-esteem. We demonstrate how individual, socially-constructed self-identity accounts for why some people embrace nationalism while others eschew it. The methodology employed was theoretical and historical analyses of secondary sources and indepth interviews with subjects who had some connection with former Yugoslavia, the country utilized to test the new model. Our analyses yielded the result that current conceptualizations of nationalism from an exclusively macro or micro perspective are unsatisfactory; we require a more comprehensive approach wherein the two perspectives are integrated. Such an integration necessitates a bridge: hence, our new model, which rests on the psychosocial premise, offers a more useful conceptual tool for the understanding of nationalism. We conclude that nationalism is first and foremost a matter relating to individual social self-identity which takes place within a particular context where oppositional forces emerge from structural factors and our membership in a particular group becomes paramount.

Women over thirty choosing education as a solution to a problem

This study explored motivations of mid-life women over 30 years old who had returned to school. It sought to fmd whether these women returned to solve a problem arising from life events, whether viewing a problem was related to internal or external motivation, whether this perception was related to having greater coping skills, and whether having greater coping was related to seeking support from internal or external sources. This study examined which emotions were most related to viewing a life event as a problem. Finally, it explored the results of previous research of mid-life women in their role as a student. Women (N==83) from three types of institutions volunteered for this study: a university (N==34), a college (N==28), and an adult education centre (N==21). Participants took home a questionnaire package - a I3-page questionnaire and consent form - that were completed and mailed back to the researcher in pre-paid envelopes. Results showed that women over 30 seek education as a solution to a life event problem. External motivation was related to a life event being a problem (p<.005). There was a significant difference in coping scores between institutions. Moods that were related to viewing a life event as problematic were: anger and depressive moods (p<. 001), fatigue and vigor (p<.O 1), and tension/anxiety (p<.05). Mid-life women students' satisfaction in this role was related to being externally motivated. These women sought support from both internal and external sources, rarely had social interactions with peers, and viewed this role as important, yet, temporary in that it will help them change their lives. Implications ofthe results suggest further exploration ofthe roles of anger and depression in motivating women over 30 to learn and finding ways of directing women to use their emotional intelligence to seek out learning.

Exploring an emotion intervention for preschoolers with autism spectrum disorder /

The purpose of this multiple case study was 1) to explore the effectiveness of an emotions recognition program for preschoolers with Autism Spectrum Disorders (ASD), and 2) to investigate one parent's perception of the emotions program. To address these objectives, the emotion unit scores of 7 preschoolers with ASD aged 3 to 5 years old (1 female, 6 males) were graphed and analyzed using visual inspection. In addition, the mother of 1 participant was interviewed to explore her perceptions of the emotions program and emotional learning. Overall, results revealed that participants' emotion recognition scores increased over the course of the emotions unit. The parent reported improvements in her son's expression and understanding of emotion, but noted that he continued to have difficulty with regulation of emotion. Implications for theory, education, and future research are discussed.

A five factor model of grief : a q-methodological study /

Q-methodology permitted 41 people to communicate their perspective of grief. In an attempt to clarify the research to date and to allow those who have experienced this human journey to direct the scientists, 80 statements were chosen to present to the participants based on the research from academic and counselling sources. Five different perspectives emerged from the Q-sorts and factor analysis. Each perspective was valuable for the understanding of different groups of mourners. They were interpreted using questionnaire data and interview information. They are as follows: Factor 1- Growth Optimism; Factor 2 - Schema Destruction and Negative Affect; Factor 3- Identification with the Deceased Person; Factor 4- Intact World view with High Clarity and High Social Support; Factor 5- Schema Destruction with High Preoccupation and Attention to Emotion. Some people grow in the face of grief, others hold on to essentially the same schemas and others are devastated by their loss. The different perspectives reported herein supply clues to the sources of these differing outcomes. From examination of Factor 1, it appears that a healthy living relationship helps substantially in the event of loss. An orientation toward emotions that encourages clarity, exemplified by Factor 4, without hyper-vigilance to emotion may be helpful as well. Strategies for maintaining schematic representations of the world with little alteration include: identification with the values of the deceased person, as in Factor 3 and reliance on social support and/or God as demonstrated by Factor 4. When the relationship had painful periods, social support may be accessed to benefit some mourners. When the person's frame of reference or higher order schemas are assaulted by the events of loss, the people most at risk for traumatic grief seem to be those with difficult relationships as indicated by Factor 5 individuals. When low social support, high attention to emotion with low clarity and little belief that feelings can be altered for the better are also attributes of the mourner devastating grief can result. In the end, there are groups of people who are forced to endure the entire process of schema destruction and devastation. Some appear to recover in part and others appear to stay in a form of purgatory for many years. The results of this study suggest that, those who experience devastating grief may be in the minority. In the future interventions could be more specifically addressed if these perspectives are replicated in a larger, more detailed study.

Electrophysiological and behavioural correlates of facial identity and expression perception deficits following a closed head injury /

A large variety of social signals, such as facial expression and body language, are conveyed in everyday interactions and an accurate perception and interpretation of these social cues is necessary in order for reciprocal social interactions to take place successfully and efficiently. The present study was conducted to determine whether impairments in social functioning that are commonly observed following a closed head injury, could at least be partially attributable to disruption in the ability to appreciate social cues. More specifically, an attempt was made to determine whether face processing deficits following a closed head injury (CHI) coincide with changes in electrophysiological responsivity to the presentation of facial stimuli. A number of event-related potentials (ERPs) that have been linked specifically to various aspects of visual processing were examined. These included the N170, an index of structural encoding ability, the N400, an index of the ability to detect differences in serially presented stimuli, and the Late Positivity (LP), an index of the sensitivity to affective content in visually-presented stimuli. Electrophysiological responses were recorded while participants with and without a closed head injury were presented with pairs of faces delivered in a rapid sequence and asked to compare them on the basis of whether they matched with respect to identity or emotion. Other behavioural measures of identity and emotion recognition were also employed, along with a small battery of standard neuropsychological tests used to determine general levels of cognitive impairment. Participants in the CHI group were impaired in a number of cognitive domains that are commonly affected following a brain injury. These impairments included reduced efficiency in various aspects of encoding verbal information into memory, general slower rate of information processing, decreased sensitivity to smell, and greater difficulty in the regulation of emotion and a limited awareness of this impairment. Impairments in face and emotion processing were clearly evident in the CHI group. However, despite these impairments in face processing, there were no significant differences between groups in the electrophysiological components examined. The only exception was a trend indicating delayed N170 peak latencies in the CHI group (p = .09), which may reflect inefficient structural encoding processes. In addition, group differences were noted in the region of the N100, thought to reflect very early selective attention. It is possible, then, that facial expression and identity processing deficits following CHI are secondary to (or exacerbated by) an underlying disruption of very early attentional processes. Alternately the difficulty may arise in the later cognitive stages involved in the interpretation of the relevant visual information. However, the present data do not allow these alternatives to be distinguished. Nonetheless, it was clearly evident that individuals with CHI are more likely than controls to make face processing errors, particularly for the more difficult to discriminate negative emotions. Those working with individuals who have sustained a head injury should be alerted to this potential source of social monitoring difficulties which is often observed as part of the sequelae following a CHI.

A multidimensional measurement approach and analysis of children's motivation for reading, attributional style, and reading achievement

The present study investigates the usefulness of a multi-method approach to the measurement of reading motivation and achievement. A sample of 127 elementary and middle-school children aged 10 to 14 responded to measures of motivation, attributions, and achievement both longitudinally and in a challenging reading context. Novel measures of motivation and attributions were constructed, validated, and utilized to examine the relationship between ~ motivation, attributions, and achievement over a one-year period (Study I). The impact of classroom contexts and instructional practices was also explored through a study of the influence of topic interest and challenge on motivation, attributions, and persistence (Study II), as well as through interviews with children regarding motivation and reading in the classroom (Study III). Creation and validation of novel measures of motivation and attributions supported the use of a self-report measure of motivation in situation-specific contexts, and confirmed a three-factor structure of attributions for reading performance in both hypothetical and situation-specific contexts. A one-year follow up study of children's motivation and reading achievement demonstrated declines in all components of motivation beginning at age 10 through 12, and particularly strong decreases in motivation with the transition to middle school. Past perceived competence for reading predicted current achievement after controlling for past achievement, and showed the strongest relationships with reading-related skills in both elementary and middle school. Motivation and attributions were strongly related, and children with higher motivation Fulmer III displayed more adaptive attributions for reading success and failure. In the context of a developmentally inappropriate challenging reading task, children's motivation for reading, especially in terms of perceived competence, was threatened. However, interest in the story buffered some ofthe negative impacts of challenge, sustaining children's motivation, adaptive attributions, and reading persistence. Finally, children's responses during interviews outlined several emotions, perceptions, and aspects of reading tasks and contexts that influence reading motivation and achievement. Findings revealed that children with comparable motivation and achievement profiles respond in a similar way to particular reading situations, such as excessive challenge, but also that motivation is dynamic and individualistic and can change over time and across contexts. Overall, the present study outlines the importance of motivation and adaptive attributions for reading success, and the necessity of integrating various methodologies to study the dynamic construct of achievement motivation.

The formation of conscience : pedagogy of the sacred

This qualitative study explores Thomas Green's (1999) treatise, Voices: The Educational Formation of Conscience; for the purpose of reconstruing the transformative usefulness of conscience in moral education. Conscience is "reflexive judgment about things that matter" (Green, 1999, p. 21). Paul Lehmann (1963) suggested that we must "do the conscience over or do the conscience in" (p. 327). Thomas Green "does the conscience over", arguing that a philosophy of moral education, and not a moral philosophy, provides the only framework from which governance of moral behaviour can be understood. Narratives from four one-to-one interviews and a focus group are analysed and interpreted in search of: (a) awareness and understanding of conscience, (b) voices of conscience, (c) normation, (d) reflexive emotions, and (e) the idea of the sacred. Participants in this study (ages 16-21) demonstrated an active awareness of their conscience and a willingness to engage in a reflective process of their moral behaviour. They understood their conscience to be a process of self-judgment about what is right and wrong, and that its authority comes from within themselves. Narrative accounts from childhood indicated that conscience is there "from the beginning" with evidence of selfcorrecting behaviour. A maturing conscience is accompanied by an increased cognitive capacity, more complicated life experiences, and individualization. Moral motivation was grounded in " a desire to connect with things that are most important." A model for conscience formation is proposed, which visualizes a critical path of reflexive emotions. It is argued that schools, striving to shape good citizens, can promote conscience formation through a "curriculum of moral skills"; a curriculum that embraces complexity, diversity, social criticism, and selfhood.