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.

Submitted by Ana Paula Jelihovschi (anapgj@gmail.com) on 2017-04-06T23:50:28Z No. of bitstreams: 1 Dissertação Ana Paula Jelihovschi.pdf: 735331 bytes, checksum: d5037818c52a08c937e7a7b8c3199e0c (MD5) / Approved for entry into archive by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br) on 2017-05-08T14:08:01Z (GMT) No. of bitstreams: 1 Dissertação Ana Paula Jelihovschi.pdf: 735331 bytes, checksum: d5037818c52a08c937e7a7b8c3199e0c (MD5) / Made available in DSpace on 2017-05-16T12:32:31Z (GMT). No. of bitstreams: 1 Dissertação Ana Paula Jelihovschi.pdf: 735331 bytes, checksum: d5037818c52a08c937e7a7b8c3199e0c (MD5) Previous issue date: 2016-10-19 / Impulsivity may lead to several unfortunate consequences and maladaptive behaviors for clinical and non-clinical people. Although many studies discuss the negative impact of it, few of them emphasize the relationship between cognitive impulsiveness and decision making in non-clinical subjects. The aim of this study is to investigate the effects of cognitive impulsiveness on decision making and explore the strategies used by participants to solve problems. For this purpose, we apply two measures of impulsivity: the self-report Barratt Impulsiveness Scale (BIS-11) and the performance based Cognitive Reflection Test (CRT).This is the first study that compares self-report impulsiveness based on BIS-11 and performance-based reflectivity measured by CRT. Moreover, due to the fact that we apply the instruments on pen and paper, it is possible to evaluate participants’ reasoning processes employed to answer CRT questions. These reasoning processes are related to the role of Executive Functions for decision making and its relationship with impulsiveness. In practical terms, we observed participants’ strategies by analyzing their calculation expressions and data organization to answer CRT questions in the paper sheet. The sample consists of 191 non-clinical adults, professionals, and undergraduate students from the fields of business, management, and accounting. Results show that cognitive impulsiveness may negatively affect performance. Moreover, there is no difference in strategies used by impulsive and non-impulsive people during a decision making, and who calculate in the paper sheet perform better. Finally, people who inhibit their immediate answers also perform better during a decision making.

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