Plusieurs recherches traitent de l’importance de la promotion de la diversité et l’équité pour les cohortes de médecine. D’autres recherches font état de la diversité des étudiants de médecine par rapport à la diversité de la population desservie. À cet intérêt, la plupart de ces études témoignent que « la profession médicale présente un problème d’iniquité » (Tricco et al., 2021, p. 664). Dans le cadre de la reddition de compte, le secteur médical, avec ses différents détenteurs d’enjeux, doit diriger ses services afin de répondre aux différents besoins locaux et régionaux de la société (Boelen et Heck, 1995). Cependant, en absence d’une diversité suffisante, le secteur médical ne peut vraisemblablement pas remplir son devoir de donner des soins optimaux à tout le monde (Cohen et al., 2002). Il faut noter qu’assurer une diversité optimale des cohortes de médecine implique de promouvoir la diversité des professionnels de santé. À cet intérêt, les facultés de médecine doivent être socialement responsables et doivent attacher une grande importance à la sélection des candidats afin de former de futurs médecins compétents, représentatifs de la société qu’ils desservent et en mesure de répondre aux besoins de celle-ci (Gough, 2004). Ainsi, les facultés de médecine sont engagées à promouvoir la diversité et l’équité parmi leurs cohortes de médecine. À cet intérêt, plusieurs recherches canadiennes ont trouvé que les caractéristiques sociodémographiques des étudiants de médecine diffèrent de celles de la population (Khan et al., 2020; Pitre et al., 2020). Au Québec, peu d’études ont exploré cette problématique. Dans ce contexte, nous avons mené notre recherche afin de comprendre le processus d’admission aux facultés de médecine franco-québécoises tout en tenant compte des caractéristiques sociodémographiques et de la performance des candidats et des étudiants admis en 2019. En premier lieu, nous avons brossé le profil sociodémographique des candidats et des étudiants de médecine par rapport au profil sociodémographique de la population québécoise. En second lieu, nous avons exploré le lien entre la performance des candidats et des candidats admis (pour la cote R, le Casper et les MEMFI) avec leurs caractéristiques sociodémographiques. Enfin, nous avons mené des études de simulation afin d’explorer l’effet potentiel de la variation des pondérations des résultats de la cote R, du Casper et des MEMFI sur la composition démographique des cohortes de médecine. Cette recherche utilise une base de données des candidats qui sont passés par la deuxième phase d’admission de 2019 et qui ont répondu au questionnaire sur les caractéristiques sociodémographiques. À l’aide d’analyses descriptives, d’analyses de variance univariées, des tests T et de la simulation, nous avons essayé de répondre à nos intérêts de recherches déjà mentionnées. Les résultats de cette étude montrent que les caractéristiques sociodémographiques des candidats et des candidats admis des facultés de médecine franco-québécoises, en général, diffèrent des caractéristiques sociodémographiques de la population québécoise. En effet, la majorité des étudiants sont des femmes et la grande majorité des étudiants sont favorisés ou ont tendance à la favorisation matérielle et sociale ; ayant des parents qui ont fréquenté l’université et qui ont un revenu annuel supérieur à 100 000 $. En ce qui concerne la diversité ethnoculturelle, les candidats noirs, latino-américains et autochtones sont sous-représentés dans notre bassin d’étudiants admis en 2019. D’autre part, nos analyses de simulation ont permis de reconnaitre le potentiel de chaque outil d’évaluation à promouvoir ou à limiter la diversité des cohortes simulées. En effet, dans le sous-groupe étudié, la cote R favorisera les chances d’admission des hommes et des candidats matériellement et socialement défavorisés. En contrepartie, les MEMFI favoriseront les chances des candidats matériellement et socialement favorisés et pourraient défavoriser les chances des candidats asiatiques par rapport aux autres. D’autre part, nous avons montré que la procédure d’admission de 2019 n’a pas favorisé des candidats sur la base de leurs caractéristiques sociodémographiques. À travers ces résultats, nous avons constaté que notre recherche confirme les résultats d’études antérieures rapportés dans la littérature médicale. / Many research works seek to highlight the importance of promoting diversity and equity for medicine cohorts. Other works promote the diversity of medical students in relation to the diversity of the population. In this regard, most of these studies claimed that " the medical profession suffers from an inequity problem " (Tricco et al., 2021, p. 664). In terms of accountability, the medical sector, including its various stakeholders, must direct its services to meet the local and regional needs of society (Boelen et Heck, 1995). However, with lack of diversity, the medical sector is unlikely to fulfill its duty to provide optimal care for everyone (Cohen et al., 2002). Indeed, ensuring optimal diversity of medical cohorts enforces promoting the diversity of health professionals. Given the importance of health professionals, medical schools must be socially accountable and must give significant importance to the process of student selection in order to ensure diversity within doctors and health professionals (Gough, 2004). Thus, medical schools are committed to promoting diversity and equity among their medical cohorts. In this regard, several Canadian studies have found that socio-demographic characteristics of medical students differ from those of the general population (Khan et al., 2020; Pitre et al., 2020). In Quebec, few studies have explored this subject. In this context, we conducted our study to understand the process of admission to French medical schools in Quebec while considering the socio-demographic characteristics and performance of applicants and admitted students in 2019. First, we outlined the socio-demographic profile of applicants and medical students in relation to the socio-demographic profile of Quebec’s population. Second, we explored the link between the performance of candidates and admitted candidates (for the R score, the Casper and the MEMFI) and their socio-demographic characteristics. Finally, we performed various simulation scenarios to explore the potential effect of varying the weights of the R-score, Casper, and MEMFI scores on the demographic composition of medical cohorts. This study is based on a database of applicants who went through the second phase of admission in 2019 and answered the socio-demographic characteristics survey. Furthermore, the research interest is demonstrated using descriptive statistics, univariate analysis, Student’s T-tests and simulation. The results of this study demonstrate that, in general, the socio-demographic characteristics of candidates and students from French medical schools in Quebec differ from the socio-demographic characteristics of the Quebec population. Indeed, we found out that most of the students are women, have high socioeconomic status; have parents who attended university and have an annual parental income of more than $100,000. In terms of ethnocultural diversity, Black, Latino, and Indigenous candidates are underrepresented in our pool of admitted students in 2019. On the other hand, our simulation analyses revealed the potential for each assessment tool to promote or limit the diversity of the simulated cohorts. Indeed, the R-score would favour the chances of admission of men and materially and socially disadvantaged candidates in the studied subgroup. On the other hand, the MEMFI would favour the chances of materially and socially advantaged candidates and could disadvantage the chances of Asian candidates compared to others. Furthermore, we have demonstrated that admission procedure in 2019 did not favour candidates based on their socio-demographic characteristics. Through these results, we found that our research affirms the results of previous studies reported in the medical literature.

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INTRODUCTION: Students from low-income backgrounds (LIB) have been underrepresented in Canadian medical schools for over fifty years. Despite our awareness of this problem, little is known about the experiences of aspiring physicians from LIB in Canada who are working towards medical school admission. As a result, we do not have insight into the barriers and facilitators that may be used to increase the representation of students from LIB in Canadian medical schools. METHODS: This thesis describes a qualitative description interview study aimed at understanding the experiences of aspiring physicians from LIB as they attempt to gain entry to medical school. We conducted semi-structured interviews with 15 participants at different stages of their undergraduate, master’s, and non-medical professional education. RESULTS: We used the theories of intersectionality and identity capital as a theoretical framework for identifying barriers and facilitators to a career in medicine. Participants experienced social, identity-related, economic, structural, and informational barriers to a career in medicine. Intrinsic facilitators included motivation, self-confidence, attitude, strategy, information seeking and sorting, and financial literacy and increasing income. Extrinsic facilitators were social, informational, financial, and institutional in nature. CONCLUSION: This study fills existing gaps in the literature by identifying the pre-admissions barriers and facilitators encountered by aspiring physicians from LIB. This information will be useful to medical schools, organizations, and researchers interested in supporting underrepresented groups. Given that medical students from LIB are more likely to serve underserved populations, this is relevant to Canadian medical schools’ social accountability commitment to producing physicians that meet the health needs of marginalized and vulnerable patients. / Thesis / Master of Science (MSc) / GOALS: This thesis describes an interview study aimed at understanding the experiences of aspiring physicians from low-income backgrounds (LIB) as they attempt to gain entry to medical school. Interviews were conducted with 15 participants at different stages of their undergraduate, master’s, and non-medical professional education. CONTRIBUTIONS: This study fills existing gaps in the literature by identifying the pre-admissions barriers and facilitators encountered by aspiring physicians from LIB. Participants experienced social, identity-related, economic, structural, and informational barriers to a career in medicine. Intrinsic facilitators included motivation, self-confidence, attitude, strategy, information seeking and sorting, and financial literacy and increasing income. Extrinsic facilitators were social, informational, financial, and institutional. This information will be useful to medical schools, supportive organizations and researchers interested in supporting underrepresented groups.

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The problem with which this study is concerned is to determine the perceived attitudes of medical and health school deans toward selected factors that are related to employee assistance programs (EPAs). These factors, which are variables in this study, include perceptions toward EPAs of necessity and desirability, purposes and goals, services offered, policies and procedures, sources of referrals, and barriers to successful implementation.

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本論文緣起於本研究者積三十年於醫學教育之教學、研究、服務及醫院臨床經驗之心得，透過近年於國立政治大學商學院EMBA策略管理課程之學習，乃試以北醫大為個案實例，探討大學教學醫院與醫學院資源互惠之最適經營策略，並嘗試提出可能之最適經營模式。 基於管理哲學之建立，首在掌握探討經營目標之界定，運用可能之資源，判別環境之變化，而採取最適經營策略，進而提出最適經營模式。而本研究者，以商學院之理論基礎，檢測台北醫學大學附屬教學醫院之教育目標及使命，深受近年台灣醫學、醫藥之嚴峻挑戰與變遷，以及政府健保政策等之鉅變下，所擁有之有限醫學教育教學資源，必須與現有醫學院系之資源，有所調整與互惠運用之經營策略，故本研究者以近距離觀察，與獨有之醫學教學及臨床實務任務，作此研究，貢獻予台灣各大學教學醫院與醫學院資源互惠之經營策略參考。 關鍵詞：大學教學醫院、醫學院、醫學教育目標及使命、資源互惠、最適經營模式、調整與互惠運用、經營策略 / A study to develop effective cooperation and beneficial collaboration in resources between teaching hospitals and medical schools- a case study of Taipei Medical University Hospital This paper seeks to explore ways through which medical schools and teaching hospitals can better share their medical educational resources. With his thirty odd years of teaching and clinical experience in both Taipei Medical University and the university hospital, coupled with his EMBA structural and management learning, the author plans to develop an effective model drawing on both business management theories and his personal familiarity with the hospital management climate. With a current scarcity in medical education resources, caused by reasons ranging from the government’s recent instatement of the medical care program to the newest wave of changes in medical ethics in Taiwan, the author proposes that Taipei Medical University and its teaching hospital must re-distribute and re-organize the current model with which teaching resources is deployed if it wishes to uphold its vision of educating well-rounded young doctor. To successfully re-invent an effective model, the author proposes to employ a business management approach. According to the basic philosophy of management, a successful model must be established with a firm objective for the institution, an honest evaluation of the institution’s available resources, and careful observation of the current climate of the market. These principles would be the building blocks in the current paper for the development of an efficient model for medical education resource allocation. The following research spans a period of six years, from 2001 to 2007. Done with strict scientific methods, the research aims to provide solutions for medical school and teaching hospitals in Taiwan a better way to allocate medical education resources, and ultimately contribute to the future advancement of medical education and management in Taiwan. Key word：medical school 、teaching hospitals、medical educational resources、effective cooperation and beneficial collaboration in resources、medical education and management、efficient model

O objetivo deste trabalho foi avaliar a evolução clínica, sorológica e terapêutica dos doentes de pênfigo foliáceo, acompanhados no ambulatório de doenças bolhosas auto-Imunes do Departamento de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 1991 a 2002. Foram avaliados todos os 104 doentes com diagnóstico de pênfigo foliáceo acompanhados dentro do período citado. Os dados foram obtidos através das análises dos prontuários dos doentes. Do ponto de vista clínico, os doentes foram divididos de acordo com a forma clínica da doença: 15 doentes apresentaram a forma localizada da doença e 89, a forma generalizada de pênfigo foliáceo, sendo 12 eritrodérmicos. Com relação à terapêutica, a droga de escolha para tratamento do pênfigo foliáceo foi a prednisona oral usada como primeira opção em 99 doentes. A triancinolona foi opção terapêutica para 39 casos prednisona resistentes, sendo usada, ainda, em cinco casos como primeira opção. Os imunossupressores, em especial a ciclofosfamida, foram utilizados, com relativo sucesso, em casos de difícil controle. Houve queda dos títulos de auto-anticorpos circulantes da classe IgG após a instituição da terapêutica específica. As complicações mais freqüentes foram: parasitoses intestinais, infecções bacterianas e virais, diabetes e hipertensão. O índice de mortalidade foi de 5,7%, e esteve associado à septicemia e/ou à broncopneumonia. Cinco entre os seis doentes que evoluíram para óbito encontravam-se nos dois primeiros anos da doença. Seis mulheres engravidaram durante o seguimento e, dentre as oito gestações acompanhadas, três foram espontaneamente interrompidas e cinco culminaram com o nascimento de cinco crianças sadias. / The present study evaluated the clinical, serological and therapeutic profile of 104 patients with pemphigus foliaceus followed at Hospital das Clínicas, Department of Dermatology, University of São Paulo from 1991 to 2002. Data were obtained by retrospective analysis of patients´records . From the clinical point of view, 15 out of 104 pemphigus foliaceus patients presented the localized form, and 89 the generalized form; erythroderma was seen in 12 patients with the generalized form. The drug of choice for the treatment of pemphigus foliaceus was systemic prednisone, which was administered in 99 patients. Triamcinolone was utilized in 39 cases as an option for prednisone-resistant cases, and was utilized as a first option only in 5 patients. Immunossupressants, in special cyclophosphamide, were used as adjuvant therapy in refractory cases, and showed to be a good option. As for the patients´ serological profile, circulating IgG autoantibodies titers decreased after the introduction of specific therapy. Most frequent complications included: intestinal parasitosis, bacterial and viral infections, diabetes and hypertension. Mortality rate was 5.7%, occurred during the first two years of the disease, and was associated to sepsis or pneumonia. Six patients were pregnant during the follow-up: 5 out of 8 pregnancies were well-succeeded, resulting in five healthy newborns, and three were spontaneously interrupted.

O objetivo deste trabalho foi avaliar a evolução clínica, sorológica e terapêutica dos doentes de pênfigo foliáceo, acompanhados no ambulatório de doenças bolhosas auto-Imunes do Departamento de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 1991 a 2002. Foram avaliados todos os 104 doentes com diagnóstico de pênfigo foliáceo acompanhados dentro do período citado. Os dados foram obtidos através das análises dos prontuários dos doentes. Do ponto de vista clínico, os doentes foram divididos de acordo com a forma clínica da doença: 15 doentes apresentaram a forma localizada da doença e 89, a forma generalizada de pênfigo foliáceo, sendo 12 eritrodérmicos. Com relação à terapêutica, a droga de escolha para tratamento do pênfigo foliáceo foi a prednisona oral usada como primeira opção em 99 doentes. A triancinolona foi opção terapêutica para 39 casos prednisona resistentes, sendo usada, ainda, em cinco casos como primeira opção. Os imunossupressores, em especial a ciclofosfamida, foram utilizados, com relativo sucesso, em casos de difícil controle. Houve queda dos títulos de auto-anticorpos circulantes da classe IgG após a instituição da terapêutica específica. As complicações mais freqüentes foram: parasitoses intestinais, infecções bacterianas e virais, diabetes e hipertensão. O índice de mortalidade foi de 5,7%, e esteve associado à septicemia e/ou à broncopneumonia. Cinco entre os seis doentes que evoluíram para óbito encontravam-se nos dois primeiros anos da doença. Seis mulheres engravidaram durante o seguimento e, dentre as oito gestações acompanhadas, três foram espontaneamente interrompidas e cinco culminaram com o nascimento de cinco crianças sadias. / The present study evaluated the clinical, serological and therapeutic profile of 104 patients with pemphigus foliaceus followed at Hospital das Clínicas, Department of Dermatology, University of São Paulo from 1991 to 2002. Data were obtained by retrospective analysis of patients´records . From the clinical point of view, 15 out of 104 pemphigus foliaceus patients presented the localized form, and 89 the generalized form; erythroderma was seen in 12 patients with the generalized form. The drug of choice for the treatment of pemphigus foliaceus was systemic prednisone, which was administered in 99 patients. Triamcinolone was utilized in 39 cases as an option for prednisone-resistant cases, and was utilized as a first option only in 5 patients. Immunossupressants, in special cyclophosphamide, were used as adjuvant therapy in refractory cases, and showed to be a good option. As for the patients´ serological profile, circulating IgG autoantibodies titers decreased after the introduction of specific therapy. Most frequent complications included: intestinal parasitosis, bacterial and viral infections, diabetes and hypertension. Mortality rate was 5.7%, occurred during the first two years of the disease, and was associated to sepsis or pneumonia. Six patients were pregnant during the follow-up: 5 out of 8 pregnancies were well-succeeded, resulting in five healthy newborns, and three were spontaneously interrupted.