The science and technology of medicine is evolving and changing at a fast pace. With these rapid advances, it is paramount that physicians maintain a level of medical knowledge that is current and relevant to their practice in order to address the challenges of patient care and safety. One way physicians can maintain a level of medical knowledge that is current and relevant to their practice is through self-directed, lifelong learning, however little is known about how to develop these traits during clinical training. Schön (1983, 1987) theorized that one way learners can become self-directed, lifelong learners is through reflective practice. This study utilized an experimental design and employed quantitative methods to investigate the effects of a reflective practice exercise, based on Gibbs' (1988) model of reflection, on readiness for self-directed learning as measured by Guglielmino's (1977) Self-Directed Learning Readiness Scale/Learning Preference Assessment (SDLRS/LPA). A total of 51 anesthesiology residents training in three residency programs in the United States participated in this study. A follow-up survey was administered to all study participants to determine if participation in the reflective exercises affected future engagement in or attitudes about reflective practice. While the data analysis showed that participation in reflective practice did not affect readiness for self-directed learning in these study participants, this study has implications for medical education. Responses to the follow-up survey indicated that participants plan to engage in reflective practice in the future and that participating in reflective practice would have an impact on patient care. Chapter 5 includes ways to integrate the findings of this study into medical education and outlines next steps for future research utilizing both evidence from the literature and the qualitative responses from this study.

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Le recours aux contentions physiques auprès des personnes âgées hospitalisées demeure une problématique malgré l'abondance d'écrits scientifiques sur la nécessité d'en réduire l'usage pour la sécurité et le maintien de la dignité des patients, notamment par l’utilisation des mesures alternatives. Les infirmières, qui sont parmi les professionnels de la santé qui ont la responsabilité d'en déterminer l'utilisation et la surveillance auprès d'aînés, se perçoivent comme étant peu formées sur le sujet. Bien que diverses interventions éducatives aient été mises en place pour tenter d'en réduire l'utilisation, leur efficacité sur les changements de pratique des infirmières demeure limitée. Par ailleurs, des interventions éducatives actives et engageantes, telle qu'une intervention de pratique réflexive, seraient pertinentes à explorer puisqu'elles semblent soutenir le développement professionnel des infirmières et l'amélioration des pratiques cliniques. Une étude pilote à devis mixte a permis de mettre à l'essai une intervention de pratique réflexive portant sur l’utilisation des contentions physiques auprès de huit infirmières d'un centre hospitalier universitaire et d'en évaluer l'acceptabilité, la faisabilité ainsi que les retombées. Les données collectées au moyen de questionnaires, de journaux réflexifs (infirmières participantes), d’un journal de bord (étudiante-chercheuse) et de groupes de discussion focalisée ont été analysées selon la méthode d’analyse thématique de Paillé et Mucchielli ainsi que de tests de Student. Les résultats de cette étude suggèrent qu’une intervention de pratique réflexive est acceptable et faisable auprès des infirmières, en plus d’améliorer leurs connaissances et favoriser leur réflexion quant à leurs attitudes et leur pratique en lien avec l’utilisation des contentions physiques auprès des personnes âgées hospitalisées. Cette étude a permis de relever les forces et les pistes d’amélioration de l’intervention. De nouvelles études portant sur l’évaluation des effets d’une intervention de pratique réflexive sur l’amélioration des pratiques cliniques des infirmières au regard de l’utilisation de la contention seraient pertinentes à mener. / The use of physical restraints on hospitalized elderly persons remains a concern despite the abundance of scientific literature emphasizing the need to reduce their use for the safety and dignity of patients through the implementation of alternative measures. Nurses, who are among the healthcare professionals responsible for determining the use and monitoring of restraints, perceive themselves as poorly trained on the subject. Although various educational interventions have been implemented to try to reduce their use, their effectiveness in changing nurses' practices remains limited. Moreover, active and engaging educational interventions, such as a reflective practice intervention, would be relevant to explore, as they appear to support nurses' professional development and the improvement of their clinical practices. A mixed-design pilot study was conducted to test a reflective practice intervention on the use of physical restraints with eight nurses from a university hospital and to assess its acceptability, feasibility, and outcomes. Data were collected through questionnaires, reflective journals (from participating nurses), field notes (from the student-researcher) and focused groups, and were analyzed using Paillé and Mucchielli's thematic analysis method as well as Student's t-tests. The results of this study suggest that a reflective practice intervention is acceptable and feasible among nurses, in addition to enhancing their knowledge and encouraging reflection on their attitudes and practices related to the use of physical restraints among hospitalized elderly. This study identified strengths and avenues for improvement in the intervention. Further studies evaluating the effects of a reflective practice intervention would be relevant.

Alors que les gouvernements cherchent à améliorer le rendement des systèmes scolaires qu’ils financent, l’intérêt des dirigeants porte sur les résultats des élèves mais aussi sur le rendement des professionnels de l’éducation, dont les directions d’école. Cette étude a pour but de contribuer au développement de la connaissance sur l’évaluation du rendement de ces dernières en répondant à la question : Comment les directions d’école perçoivent-elles la pratique réflexive dans leur processus d’évaluation? La recension des écrits montre que les directions qui ont le plus de succès jouent un rôle actif dans leur amélioration et que la pratique réflexive accroît la pertinence du perfectionnement professionnel et par conséquent le rendement de la direction. L’étude propose un cadre conceptuel qui tient compte du perfectionnement professionnel, de l’évaluation axée sur l’apprentissage et de la pratique réflexive. Cette recherche suit une méthodologie mixte afin de déceler les tendances et les perceptions quant aux pratiques à l’étude. D’abord, un questionnaire à choix de réponses a été administré sur Internet et les réponses de 65 directions d’écoles de langue française de l’Ontario ont été traitées de façon quantitative. Ensuite, des entrevues semi-structurées avec dix des répondants ont permis d’approfondir le sujet par une méthode qualitative en offrant l’occasion aux participants de partager leur vécu. Les résultats dévoilent que le perfectionnement professionnel occupe peu de place dans l’évaluation du rendement bien que les participants se servent d’objectifs de croissance professionnelle. La pratique réflexive est souvent déclenchée par un inconfort, par un succès ou par une occasion de perfectionnement ou est provoquée par des situations extérieures transposées à la situation de l’école du participant. Les échanges structurés et les discussions franches entre collègues et avec le superviseur favorisent la pratique réflexive. La rétroaction spécifique du superviseur donne des pistes d’amélioration appuyées d’un soutien. Les participants reconnaissent qu’ils jouent un rôle actif dans leur évaluation et recherchent un encadrement orienté vers l’amélioration. Les participants perçoivent que la pratique réflexive occupe une grande place dans leur processus d’évaluation, qu’ils soient encadrés par le superviseur dans un processus axé sur leur amélioration ou qu’ils s’auto-évaluent quand le processus est flou.

Depuis les années 1990, les formations à visée professionnelle, comme l’enseignement, adoptent le paradigme du praticien réflexif. Au Québec, le référentiel de compétences proposé par le ministère de l’Éducation introduit l’idée que tout futur enseignant doit apprendre à « réfléchir sur sa pratique » (MEQ, 2001). Malgré de nombreuses études sur la réflexion, le concept reste flou et polysémique. Comment, dans ces conditions, « faire réfléchir » ? Des chercheurs contemporains, dans la mouvance éducative, humaniste et pragmatique de Dewey (1933), aboutissent à des conceptions convergentes de l’apprentissage par réflexion sur l’expérience (Osterman et Kottkamp, 2004; Brouwer et Korthagen, 2005; Loughran, 2006; Brockbank et McGill, 2007; Donnay et Charlier, 2008, entre autres). De leurs points communs est synthétisée une définition de la réflexion qui peut aider à clarifier son rôle en formation. La recherche se donne comme objectif de « saisir » des événements réflexifs pour élucider comment des formations universitaires contribuent à développer des mécanismes de réflexion favorables à un autorenouvellement professionnel à long terme. La démarche est qualitative, l’approche interprétative-compréhensive. Des entrevues semi-structurées ont permis de recueillir des données auprès de finissants en enseignement du français langue seconde (FLS), en coopération internationale, à l’Université de Montréal, ainsi que d’enseignants de FLS expérimentés d’une université québécoise. Du corpus d’« occurrences de réflexion » ont émergé les significations que les acteurs donnaient à leur expérience d’apprentissage ou de travail. Les résultats sont présentés en trois articles. Le premier décrit la méthodologie construite pour repérer des occurrences de réflexion. Le second révèle deux grandes caractéristiques de dispositifs qui la stimulent particulièrement: 1) l’agir en situation de travail authentique ou vraisemblable; 2) la confrontation interactive à l’altérité (pairs, clientèle). Le troisième article aborde les représentations plus riches, nuancées et critiques de la profession, l’Autre et soi-même sur lesquelles débouche la réflexion. L’étude documente aussi les effets de ces reconceptualisations sur l’acteur et l’action, et produit des typologies des préoccupations des (futurs) professionnels et des objets réfléchis Des pistes de recherche et d’application sont dégagées pour les formations professionnalisantes et le développement professionnel en milieu de travail. / Since the 1990’s, the paradigm of the reflective practitioner entered higher education curricula. In Quebec, the Ministry of Education introduced in its list of skills required to become a teacher the idea that one should learn ‘to reflect on one’s practice’ (MEQ, 2001). Despite many studies about reflection, the concept of ‘reflection’ itself remains vague. So the effectiveness of the pedagogical and organizational tools used to “make people reflect” is highly questionable. Nevertheless, some researchers, following the seminal educative humanistic and pragmatic ideas of Dewey (1933) come to similar conceptualizations of what learning is through the reflection on practice (Osterman & Kottkamp, 2004; Brouwer & Korthagen, 2005; Loughran, 2006; Brockbank & McGill, 2007; Donnay & Charlier, 2008, among others). An operational definition of reflection is synthetized. It can help clarify the role of reflection in professional curricula. Going beyond the challenge of ‘capturing’ reflection events, this research aims at understanding how higher education programs contribute to develop long term professional self-renewal mecanisms. This study is based on qualitative interviews, within an interpretive approach. Data came from prospective teachers in French as a second language (FSL) and in international co-operation at Université de Montréal, as well as experienced FSL teachers working in a Quebec university. The method first isolated ‘occurrences of reflection’, then extracted the meanings emerging from what the interviewees had said about their experience of learning or working. Results provide insights into the process and outcomes of reflection. Two characteristics of the higher education programs appear to stimulate it the most : 1) ‘doing’ things in an authentic workplace or in simulated situations in the classroom; 2) interactive confrontation to others (peers and clients). Different types of ‘triggers’, conditions, concerns and objects of reflection are also brought to light. It appears that reflection stimulates changes in perspective in the mind of learners or workers, which makes them see things ‘differently’, that is, in a richer, more precise, more critical way, about their work, their colleagues or clients, and themselves as professionals. The study proposes some ways of improving teacher education programs and professional development in the workplace.

Deux catégories de compétences influenceraient toute pratique professionnelle, les compétences disciplinaires et relationnelles. Selon le cadre théorique de ce projet, la pratique réflexive (PR) aiderait le professionnel à développer les compétences relationnelles, grâce à l’approfondissement de sa conscience et de son autocritique des composantes tacites de sa pratique, telles que ses valeurs et principes, ses perceptions et ses stratégies d’action, afin de les rendre plus efficaces et satisfaisantes lors de la résolution de problèmes. Dans cette étude, la PR souhaitait aider un groupe d’infirmières pivots en oncologie (IPO) à réfléchir et agir sur les composantes de leur pratique qui contribuaient à certaines difficultés relationnelles persistantes vécues auprès de gestionnaires, collègues et familles et qui, selon les IPO, avaient un impact sur l’expérience de santé de familles touchées par le cancer. Toutefois, la recension des écrits effectuée dans cette recherche soutient qu’il y a un nombre insuffisant d’études qui a trait à l’influence d’une PR sur la pratique infirmière et, plus encore, sur le développement des compétences relationnelles des infirmières. Les écueils théoriques et méthodologiques suivants ont entre autres été rapportés: la PR étudiée ne reposait pas toujours sur un modèle théorique clair et le but poursuivi par la PR n’était pas toujours énoncé; aucune recherche n’a documenté de quelle manière la PR s’était développée et, une fois acquise, de quelle façon elle avait contribué aux résultats; et, enfin, aucune étude recensée n’a exploré l’influence d’une PR intégrée par l’infirmière, en tenant compte de la perspective de familles qui bénéficiaient de leurs soins. Considérant ces principaux écueils, cette étude a privilégié la recherche-action participative afin de documenter la facilitation d’une PR et son influence sur les compétences relationnelles d’IPO et sur d’autres dimensions à la fois personnelles, organisationnelles et cliniques. Six IPO ont pris part à l’intervention de l’étude d’une durée d’un an. Cinq collègues des équipes de soins et douze membres de familles touchées par le cancer ont participé à l’évaluation de son influence. Les résultats de cette recherche portent à croire que les IPO qui développent une PR plus profonde, c’est-à-dire jusqu’à leurs sentiments et besoins internes, parviennent à établir des relations plus mutuelles auprès de collègues et de familles, grâce à des changements importants réalisés sur le plan de leurs valeurs et principes, de leurs perceptions et de leurs stratégies d’action. Les résultats de l’étude soutiennent aussi que ces changements au sein de la pratique infirmière génèrent des effets positifs. Les IPO ont parlé d’une plus grande satisfaction liée à leur travail et de bienfaits sur leur santé. La majorité des IPO et des participantes-collègues de l’étude ont rapporté un climat de travail plus calme et des processus d’équipe plus satisfaisants lors, par exemple, de la résolution de problèmes. Enfin, lorsque les IPO intégraient une approche plus mutuelle, des familles rapportaient une atténuation de leur inquiétude ou de leur détresse psychologique, une plus grande capacité de donner du sens à leur expérience de cancer, une qualité accrue de leur communication intrafamiliale ou avec l’équipe soignante. / Two categories of competencies influence all professional practice: disciplinary skills and relational skills. According to the conceptual model of this study, reflective practice (RP) helps the professional develop the latter, by way of a deepening of consciousness and a self-critique of the tacit components of one’s practice, such as one’s values and beliefs, perceptions and action strategies, in order to render them more effective and satisfying when problem solving. In this study, RP sought to help a group of oncology pivot nurses (OPNs) reflect and act on the components of their practice that contributed to certain persistent relational difficulties experienced with nursing leaders, colleagues and families, which in turn, they felt had an impact on the health experience of families affected by cancer. The literature review conducted in this study however, supports that there are an insufficient number of studies regarding the influence of RP on nursing practice and on the development of relational competencies by nurses. The following theoretical and methodological gaps have, amongst others, been reported: the RP studied was not always based on a clear conceptual model and the aim sought by RP wasn`t always stated; no study has documented in what way RP had been developed and, once acquired, in what manner it had contributed to the results; and finally, none of the identified studies explored the influence of the integration of RP by the nurse, and took into account the perspectives of the families that benefited from their care. Taking these gaps into consideration, this study used a participatory action research approach in order to document the facilitation of RP and its influence on the relational competencies of OPNs’ as well as on other areas like personal, organizational and clinical ones. Six OPNs took part in the intervention of the study for a one year period. Five colleagues from care teams and a dozen family members affected by cancer participated in the evaluation of its influence. The study results suggest that the OPNs who develop a deeper RP, that is one that involves their feelings and internal needs, are able to establish more mutual relationships with colleagues and families because of important changes made with regards to their values and principles, perceptions and action strategies. The results of the study also support that these changes in nursing practice yielded positive effects. The OPNs spoke about improved work related satisfaction and of benefits on their health. The majority of OPNs and participant colleagues in the study reported a calmer work climate and more satisfactory team processes, for example, when problem-solving. Finally, when OPNs integrate a more mutual approach, families reported a reduction of their concerns and of their psychological distress, a greater capacity to make sense of their cancer experience, a higher quality of communication within their family or with the health care team.

Made available in DSpace on 2016-04-28T18:23:26Z (GMT). No. of bitstreams: 1 Paula Tatianne Carrera Azundy.pdf: 2893511 bytes, checksum: b6d13ec4ff4ea1c5f75946396220e77e (MD5) Previous issue date: 2005-05-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Having as its main purpose to carry out an in depth discussion about the use of games as teaching-learning tools in the EFL classroom, this research is oriented by two mains goals: investigate the development of language games and the role played by them in construction of the oral skill in three different learning stages of the foreign language. promote teacher reflection about the role played by games in their practices in the EFL classroom. The set of data for this research was collected in a language school in a city in the state of São Paulo. Two teachers, about twenty eight students and the researcher took part in the data collection. The corpus for analysis consists of seven videotaped games, written questionnaires answered by students after the videotaping of each game and four dialogical reflective sessions recorded in audio from which the two teachers and the researcher participated. The theoretical framework that gives support to the discussion concerning the use of games in the EFL classroom is based on the studies of Vygotsky (1930), Leontiev (1934), Elkonin (1978), Huizinga (1944), Caillois (1955) , Wittgenstein (1953), Bruner (1975), Rojo (1999, 2001), Dolz and Schneuwly (1996), among others. In what concerns the reflective process triggered in the dialogue between the teachers and the researcher, we sought theoretical support mainly in the conceptions of Bakhtin (1929, 1953, 1975), Coulter (1999), Fullan (1996), Freire (1970, 1992), Brookfield (1987, 1995) and Brookfield e Preskill (1999). In relation to the first goal, the analysis of the knowledge construction process in the games indicates that the less formatted the game is, the greater the complexity of discourse genres circulating in the interaction and of the language skills constructed. As to the second focus of this research, there are indications that the dialogue between the teachers and the researcher is characterized by the conflict between ideologies constituted along the teachers everyday experiences and those historically crystallized ideologies present in the texts suggested for reading and revoiced by the researcher in her constant attempts to relate theory and practice. The present research aims at contributing to the studies in EFL teaching-learning processes and teacher development / Com o intuito de realizar uma discussão profunda sobre o uso de jogos como instrumento de ensino-aprendizagem na sala de aula de LE, a presente pesquisa é orientada por dois objetivos centrais: investigar o desenvolvimento dos jogos de linguagem e o papel por eles exercido no processo de construção do conhecimento da habilidade oral em três estágios da aprendizagem de uma LE; promover a reflexão dos professores-participantes sobre o papel desempenhado pelo jogo nas suas práticas em sala de aula. Os dados foram coletados em uma escola de línguas em uma cidade do interior do estado de São Paulo. Participaram da coleta dois professores, cerca de vinte e oito alunos e a pesquisadora. O corpus de análise é composto por sete jogos gravados em vídeo, questionários escritos respondidos pelos alunos após a filmagem de cada jogo e quatro sessões reflexivas dialogais gravadas em áudio entre os professores-participantes e a pesquisadora. A discussão sobre o uso de jogos na sala de aula de LE é fundamentada pelos pressupostos de Vygotsky (1930), Leontiev (1934), Elkonin (1978), Huizinga (1944), Caillois (1955), Wittgenstein (1953), Bruner (1975), Rojo (1999, 2001), Dolz e Schneuwly (1996), entre outros. No que se refere ao processo reflexivo desencadeado no diálogo entre os professores e a pesquisadora, buscamos fundamentos principalmente nas concepções de Bakhtin (1929, 1953, 1975), Coulter (1999), Fullan (1996), Freire (1970, 1992), Brookfield (1987, 1995) e Brookfield e Preskill (1999). Em relação ao primeiro objetivo da pesquisa, a análise do processo de construção do conhecimento nos jogos revela que, quanto menor o grau de formatação do jogo de linguagem, maior a complexidade dos gêneros do discurso que circulam na interação e, em conseqüência, das capacidades de linguagem socioconstruídas. Quanto ao segundo foco de interesse da pesquisa, observamos que o diálogo entre professores-participantes e pesquisadora é marcado pelo embate entre as ideologias constuituídas ao longo da experiência cotidiana dos professores e as ideologias cristalizadas presentes nos textos sugeridos para leitura e revozeadas pela pesquisadora nas suas tentativas de relacionar teoria e prática. Pretendemos, com a presente pesquisa, contribuir para as áreas de ensino-aprendizagem de LE e de formação de educadores

The study examined three Japanese junior high-school English teachers’ initial years of full-time employment. It investigated the type of pedagogical puzzles these teachers experienced, how their practice developed over 18 months, and my role as a Teacher of Teachers (TOT). Drawing on linguistic ethnography, this study took an ethnographic approach to understanding the teachers’ social context and used techniques from discourse analysis to consider how they interpreted their puzzles and constructed their practice. These techniques were also used to analyze my working relationship with the teachers. The purpose of this endeavor was to contribute to the understanding of novice teacher development in an ‘expanding circle’ country. Over the course of the study, I observed the teachers’ classes and interviewed them once or twice a month. Using the coding of interview transcripts and class fieldnotes, I identified Critical Incidents that represented the teachers’ pedagogical puzzles and typical practice, as well as my role as a TOT. Using Cultural Historical Activity Theory(CHAT), I analyzed how elements of the social context brought about the teachers’ pedagogical puzzles and affected their capacity to address them. Coding of the interviews and a microanalysis of the interactions showed my role as a TOT. Overall, the CIs gave an emic portrait of each teacher’s experience and my efforts to support them. The pedagogical puzzles the teachers faced were a result of their personal histories and school conditions. These puzzles did not change, which indicates that teachers will face complex issues that cannot be resolved. Understanding them, however, can promote teacher development. Applying CHAT, I could identify the conditions that helped determine the types of pedagogy in which teachers engaged. I tried to fulfill my role as a TOT by conducting a form of reflective practice (RP). An examination of the RP I conducted with the teachers challenged the notion that it involves the sequential steps of identifying issues, attempting to resolve them, and reflecting on one’s efforts. This dissertation concludes with a discussion about the contributions it has made toward the field of English teacher development: using CHAT to understand the English teaching experiences, the development of an understanding of RP as it can be carried out in the field, an understanding of novice teachers in expanding circle countries, and the value of linguistic ethnography for researching novice teachers.