This thesis investigates the potential for Knowledge Building in large size Pharmacy classrooms. Knowledge Building is the social creation and continual improvement of ideas (Scardamalia & Bereiter, 2003). The pedagogy and technology that underlie it are based on a complex system involving 12 interdependent principles. This research examines principle-based classroom designs, targeting two Knowledge Building principles--epistemic agency and collective responsibility for community knowledge. Successive design changes were implemented to a self-care course for undergraduate Pharmacy students (n = 182), using case study methodology. The goal underlying design changes was to develop a more dynamic classroom environment involving all students and empowering them to take charge of knowledge advancement at high cognitive levels, through assuming greater agency and collective responsibility for their knowledge advances. Design features that were incorporated into class procedures included class panels to discuss cases, student-generated self-assessment examination questions, and online discussion views in a virtual learning community, Knowledge Forum. Surveys, student comments, self-assessments, field notes, online discourse and course exam scores were used to determine effects of principle-based design changes. Results, taken as a whole, indicate that each new design feature contributed to advances with no negative effects uncovered. Raters blind to authorship of student- versus instructor-generated exam questions could not distinguish between them. Analysis of student commentary indicated advances in line with the broad network of Knowledge Building principles, as well as those specifically targeted in design improvements. Advances in performance on exams, surveys, and in student discourse further contributed to the overall picture of positive effects. Design strategies appropriate for large classroom implementation are shown to facilitate a shift from learning as an exclusively individual enterprise, to the creation of a Knowledge Building Community with students assuming levels of responsibility and agency normally assumed by the teacher.

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. / CONTEXT: Clinical reasoning is central to medical practice. However, we lack tools to identify and objectify the difficulties of clinical reasoning, and there are relatively few descriptions of remediation methods defined. Much work remains to be done to better understand how the problems manifest themselves in the clinical reasoning of students in training, but also to make these concepts more accessible to teachers.Then this will improve the quality of the identification process difficulties, and allow considering targeted and effective remediations.PURPOSE: This research is based on the one hand, around the objectification and understanding of current practices of clinical teachers, on the other hand, around the construction and implementation of tools and processes to facilitate the process of diagnosis and remediation of difficulties in clinical reasoning. METHODOLOGY: A qualitative research, mainly using the methods of participatory action research has been relevant to achieving our goals. The research consists of four steps: 1. An exploratory study 2. The construction and implementation of a first tool in three clinical settings 3. The development of a taxonomy of difficulties in clinical reasoning and the construction of a new tool. 4. The development of a comprehensive approach to support and train clinical teachers RESULTS: Teachers have a quick perception, but still global and intuitive, of the potential difficulties of clinical reasoning residents. This perception does not necessarily move into pedagogical terms. We observed the absence of organized and structured pedagogical processes to manage these difficulties. This seems to project the clinical teachers in a zone of discomfort, by confronting them with a lack of control and uncertainty about their educational activities. The categorization of clinical reasoning difficulties that we have built allows identifying the problems as they occur in everyday clinical supervision. This tool, however, needs to be integrated into a larger process. CONCLUSION: It is necessary to develop a comprehensive approach that includes faculty development process, implementation tools, vulgarization of the theory, and teacher training.

Abstract Type 2 diabetes mellitus is a disease that has trebled in incidence over the last 25 years, affecting both adults and increasingly children. The rapid increase of the disease mirrors the gradients of social position and income distribution, and parallels the accelerated environmental changes witnessed with the rise of neoliberal capitalism. This research situates neoliberal capitalism as a collection of political and economic policies that form an ideology suited to protect discrete elite interests. The current ideology has permeated all social aspects of society, including education and healthcare. Therefore, it is argued that the practice of healthcare and the education of healthcare students are shaped by the sociopolitical environment in which they exist. Ten best-selling postsecondary textbooks in pathology, pathophysiology, and disease processes were selected for content analysis to determine if the interpretation of type 2 diabetes in pathophysiology textbooks reflects neoliberal thinking. The data were interpreted within the tradition of critical discourse analysis and theoretically enriched using Foucault’s descriptions of governmentality, biopolitics, and discursive formations. The results indicate that notions consistent with neoliberal capitalism permeate pathology textbooks in the understandings of type 2 diabetes. Consistent with how neoliberal thought embodies and explicates social conditions, type 2 diabetes is described in a way that stresses iii self-responsibility and culpability for falling ill. The texts also impart the importance of biomedical industry interventions for the treatment of the sick and the surveillance of the healthy. Finally, in a way that substantiates the degradation of the environment and retrenchment of social welfare policies, the textbooks fail to make any reference to the ecological factors that contribute to type 2 diabetes, including urbanisation and the propagation of food deserts, environmental toxins, income inequality, the steepening of the social gradient, and the deleterious effects of globalisation on human nutrition.

Abstract Type 2 diabetes mellitus is a disease that has trebled in incidence over the last 25 years, affecting both adults and increasingly children. The rapid increase of the disease mirrors the gradients of social position and income distribution, and parallels the accelerated environmental changes witnessed with the rise of neoliberal capitalism. This research situates neoliberal capitalism as a collection of political and economic policies that form an ideology suited to protect discrete elite interests. The current ideology has permeated all social aspects of society, including education and healthcare. Therefore, it is argued that the practice of healthcare and the education of healthcare students are shaped by the sociopolitical environment in which they exist. Ten best-selling postsecondary textbooks in pathology, pathophysiology, and disease processes were selected for content analysis to determine if the interpretation of type 2 diabetes in pathophysiology textbooks reflects neoliberal thinking. The data were interpreted within the tradition of critical discourse analysis and theoretically enriched using Foucault’s descriptions of governmentality, biopolitics, and discursive formations. The results indicate that notions consistent with neoliberal capitalism permeate pathology textbooks in the understandings of type 2 diabetes. Consistent with how neoliberal thought embodies and explicates social conditions, type 2 diabetes is described in a way that stresses iii self-responsibility and culpability for falling ill. The texts also impart the importance of biomedical industry interventions for the treatment of the sick and the surveillance of the healthy. Finally, in a way that substantiates the degradation of the environment and retrenchment of social welfare policies, the textbooks fail to make any reference to the ecological factors that contribute to type 2 diabetes, including urbanisation and the propagation of food deserts, environmental toxins, income inequality, the steepening of the social gradient, and the deleterious effects of globalisation on human nutrition.

Current understandings of aging and the life course are largely based on taken-for-granted hetero-normative assumptions. Gay men lack aging road maps that are unique to their life course experiences and which consider the changing contextual and social conditions that shape their participation choices in family and community roles. This is particularly so for gay men aging in rural environments as most studies of aging gay men focus on the urban experience. This study adds to understandings of aging and the life course by examining the lives of three gay men aging in rural environments. I use a life history approach to shed light on how sexual identity development and marginalization within rural environments intersect with shifting social contexts to shape the aging process in terms of engagement in social role opportunities, namely, community and family participation. As a life course researcher, I pay particular attention to the tensions between individual agency and structural constraints and how they are revealed through the life histories. Epistemological and methodological assumptions based on social constructivism, critical and queer theory inform the study while my own lived experiences as a gay man and an occupational therapist practitioner and educator ground the study. Cross-cutting themes identified in the life narratives reveal connections between sexual identity development and the coming out processes with patterns of social relationships and the gay aging process. These themes are then discussed in terms of their relevance to broader aging and life course constructs including generativity, social capital and gay aging; agency and structure in identity development; and expanded notions of family and social support for gay men. Findings from this study have implications for current explanations of ageing and life course processes; challenge limiting stereotypes of older gay men; inform health and social service professionals who work with older gay people; and provide examples of alternative queer life pathways for gay people of all ages.

No description available.

Doctor of Philosophy / Department of Human Nutrition / Valentina M. Remig / Preventing foodborne illness and promoting safe food practices among all age groups is a high priority, particularly for college students because little about their food safety awareness and food handling practices has been reported. The research aim was to evaluate food safety attitudes, beliefs, knowledge, and self-reported practices of current upper-division college students, and to determine whether a three-module interactive educational intervention, developed for this study, positively influenced these variables. Comparisons between health and non-health majors were made. Two methods of data collection were used with volunteer health and non-health majors: focused food safety discussion groups during academic year 2004-05, and a pre-experimental design. Prior to engaging in either method, students completed an on-line food safety questionnaire (FSQ), adapted from a telephone survey used at K-State with older adults. The FSQ was administered again to those in the pre-experimental design group one week after exposure to the food safety educational intervention. Five weeks later, the FSQ was administered to determine whether changes in attitudes, beliefs, knowledge, and self-reported practices persisted over time. Focused food safety discussion group responses were qualitatively evaluated. Pre-experimental statistical analyses included Wilcoxin Signed Rank, Friedman, Mann-Whitney U, Chi Square tests, and Spearman rho. Focused discussion group findings indicated that students perceived themselves at low risk for foodborne illness; few used food thermometers; students without health backgrounds mimicked undesirable home practices; and students stated being open to changing non-recommended behaviors. Pre-experimental findings showed the effects of intervention were improved food safety attitudes, beliefs, and knowledge, with the strongest effects seen in health majors. Students' FSQ attitude scores increased from 114 to 122 (P<0.001), FSQ belief scores increased from 86 to 98 (P<0.001), and FSQ knowledge scores increased from 11 to 13 (P<0.001). Intervention resulted in some improved food safety self-reported practices for health majors but not non-health majors. Intervention module post-test scores improved significantly for all students; health majors had greater increases. Conclusions. Focused food safety discussion groups were useful for obtaining food safety information from college students; educational intervention improved college students’ food safety attitudes, beliefs, and knowledge and for health majors, some self-reported practices improved.

Objectif : Comprendre les tensions identitaires vécus par les professionnels de la santé, lorsque ceux-ci travaillent en partenariat avec des patients sur un comité d’amélioration continue. Devis : Étude qualitative ethnographique participative. Terrain de recherche : Une clinique de médecine de famille qui a décidé de former un nouveau comité d’amélioration de la qualité (CAQ) interdisciplinaire et d’y inclure des patients partenaires. Participants : Le CAQ était composé de deux patients partenaires, deux médecins de famille, deux résidents de médecine de famille, une pharmacienne, une infirmière clinicienne, un infirmier praticien spécialisé, une secrétaire, une réceptionniste, une agente de communication et une gestionnaire. Tous les participants ont été invités à participer à l’étude. Collecte des données : La collecte des données a commencé à l’automne 2017 et s’est terminé à l’été 2018. Elle comprenait des observations participatives, la tenue d’un journal de bord et des entrevues semi-dirigées. Résultats: À partir du cadre conceptuel développé par Ghadiri sur les menaces identitaires, notre étude met en lumière que le passage de la relation “soignant-soigné” à une relation “collègue-collègue” génère différentes tensions identitaires chez les professionnels, tant au plan de l’idéal du “bon” professionnel, de l’étanchéité des catégories patient-professionnel, du métissage des symboles associés à l’une ou l’autre de ces identités, et de l’équilibre intérieur entre les rôles de soignant et de collègue. Conclusion : Nos résultats offrent une grille de lecture originale et différente par rapport à la littérature scientifique existante, permettant de comprendre certains enjeux fréquemment rencontrés sur le terrain. Travailler en partenariat avec des patients n’implique pas, pour le professionnel, une relation de simple « collègue de travail », mais plutôt la construction d’un nouveau cadre relationnel, flexible et dynamique, prenant en compte une coexistence identitaire de plusieurs identités. / Objectives: To understand the identity tensions experienced by health professionals during a partnership relationship with patients on a quality improvement committee. Design: Qualitative ethnographic study based on participatory observation. Setting: Family medicine clinic in Montreal who decided to create a new interdisciplinary quality improvement committee (QIC) and to include PP for the first time. Participants: The QIC consisted of two patient partners, two family physicians, two family medicine residents, one pharmacist, one nurse clinician, one specialized nurse practitioner, one secretary, one receptionist, and one manager. All members of the QIC were invited to participate in the study. Data collection: Data collection began in the winter of 2017, when the committee was created, and ended in summer 2018. It consisted of participatory observations, logbook notes, and semistructured interviews. Results: Through Ghadiri's theoretical framework on identity threats, health professionals experienced significant identity tensions. Transforming the “caregiver–patient” relationship into a “colleague-colleague” relationship generated identity upheavals among the professionals, relating to the “good professional” ideal, the impermeability of the patient and professional categories, the interweaving of the symbols associated with one or the other of these identities, and the inner balance between the roles of carer and colleague. Conclusion: our results provide an interpretive reading that is original and different from the current literature, shedding light on certain issues frequently encountered in the field. Working with patients does not, for the professional, imply a purely “collegial” relationship, but rather the construction of a new relational framework, flexible and dynamic, that takes into account the coexistence of multiple identities.

L’enseignement de la chirurgie nasale est difficile, car l’opération est pratiquée dans le nez en regardant par les narines. Cela signifie que le résident (étudiant en chirurgie) et le patron (chirurgien-enseignant) ne voient pas ce que l’autre fait dans le nez (Ahmidi et al., 2015). Une solution semble être la septoplastie vidéo-assistée (SVA) où une caméra est ajoutée à un instrument chirurgical et projette le champ opératoire sur un écran (Rahal & Charron, 2017). Le but de cette étude est de mesurer l’impact de la SVA sur le processus d’apprentissage des résidents en comparaison à la chirurgie conventionnelle. Projet en 2 étapes : 1. Création d’un outil de mesure a. Création du modèle du processus d’apprentissage au bloc opératoire selon les écrits de Piaget (Piaget, 1975) et Collins (Collins, Brown, & Newman, 1987) b. Création et Validation d’un questionnaire (Quivy & Van Campenhoudt, 2011) 2. Comparaison a. Recrutement de 5 patrons et 4 résidents pour effectuer 38 septoplasties b. Assignation aléatoire du spéculum vidéo vs conventionnel c. Réponse au questionnaire après chaque chirurgie Résultats : Pour chaque élément du modèle d’apprentissage mesuré à l’aide du questionnaire, la SVA s’est avérée supérieure de manière statistiquement et cliniquement significative. Discussion et Conclusion : La SVA améliore la vue du champ opératoire, la communication et le raisonnement clinique tout en permettant d’enseigner la chirurgie nasale à plusieurs étudiants à la fois. En conclusion, la SVA a un impact positif significatif sur le processus d’apprentissage des résidents en comparaison à la chirurgie conventionnelle. / Teaching nasal surgery is challenging since the operative field is within the nose and the surgeon perform the surgery by looking through the nostrils. This means the resident and the attending surgeon cannot see what each other are doing in the nose. A solution could be the Video-Assisted Speculum of Rosemont where a high definition flexible endoscope is mounted on a modified nasal speculum. While the surgery is performed in the usual fashion by looking in the nose, the surgery is displayed in the operative room. Methodology The aim of this study was to measure the impact of adding a camera to the nasal speculum on the learning process of residents compared to the conventional speculum. A questionnaire was developed and validated with the help of three experts in education. Then five surgeons and four residents were recruited to perform 32 consecutive septoplasties. Either the Rosemont or the conventional speculum was randomly assigned, and the questionnaire was filled by the participants after each surgery. The scores for the specula were compared with Mann-Whitney U Test. Results For all the 7 elements underlying the learning process of residents in the operative room, the video-assisted Rosemont speculum performed significantly better than the conventional speculum. Discussion and conclusion The Rosemont speculum contribute to offer a better view of the operative field to bystanders, it also helps with verbal communication and clinical reasoning while giving the opportunity to teach several residents at the same time. In conclusion, the Rosemont speculum has a positive impact on the learning process of nasal surgery.

Objectif : Notre objectif était d’évaluer la qualité des données de la base de données haute résolution (BDHR) implantée dans l’unité de soins intensifs pédiatriques (USIP) de l’Hôpital Sainte-Justine (HSJ). Type d’étude : Un rapport descriptif et une analyse d’une étude prospective de validation d’une BDHR. Environnement : Une USIP de 32 lits, adaptée aux soins médicaux, chirurgicaux et cardiaques dans un centre tertiaire mère-enfant du Canada. Population : Tous les patients admis à l’USIP et ayant un monitorage d’au moins 1 signe vital par un moniteur cardio-respiratoire. Mesures et résultats principaux : Entre juin 2017 et août 2018, les données de 295 jours de patients ont été enregistrées à partir des appareils médicaux et 4465 données ont été filmées et comparées aux données correspondantes dans la BDHR de l’USIP de l’HSJ. Les analyses statistiques ont démontré en général une bonne corrélation, une excellente fiabilité et un bon agrément. Les graphiques de Bland-Altman ont aussi démontré l’exactitude et la précision entre les données récoltées et les données filmées selon les limites d’agrément cliniquement significatives préalablement définies. Conclusions : Cette étude de validation exécutée sur un échantillon représentatif a démontré que la qualité des données était globalement excellente. / Objective: Our objective was to evaluate the data quality of our high-resolution electronic database (HRDB) implemented in the pediatric intensive care unit (PICU) of HSJ. Design: A descriptive report and analysis of a prospective validation of a HRDB. Setting: A 32 beds pediatric medical, surgical and cardiac PICU in a tertiary care free-standing maternal-child health center in Canada. Population: All patients admitted to the PICU with at least one vital sign recorded using a cardiorespiratory monitor connected to the central monitoring station. Measurements and Main Results: Between June 2017 and August 2018, data from 295 patient days were recorded from medical devices and 4,645 data points were video recorded and compared to the corresponding data collected in the HSJ-PICU HRDB. Statistical analysis showed excellent overall correlation, agreement and reliability. Bland-Altman analysis showed excellent accuracy and precision between recorded and collected data within clinically significant pre-defined limits of agreement. Conclusions: This prospective validation study performed on a representative sample showed excellent overall data quality.