The aim of this study was to determine the impact of appreciative inquiry (AI) on the development of organisational culture after a merger. The empirical study was con-ducted among the employees of a telecommunications company in South Africa. AI was conducted after a merger of teams within a department of the organisation to assist in the development of a new and combined team culture. Interactive qualitative analysis (IQA) was used to determine the impact of AI on the new culture. The sample size for the study was 35 for the AI session and 20 for the IQA. A qualitative approach was adopted in this study in order to understand and explore the experiences of individuals who had recently been a part of the change process. The research design was based on IQA, a structured approach which constructs a systematic representation of the experience. It was found that AI allowed the teams to gain a new understanding of and insight into what it meant to work together as a unit. A significant difference was noted in the IQA facilitation that was performed six months after the AI session. This re-search therefore confirmed that the AI had a significant positive impact on the culture of the organisation under investigation. / Industrial and Organisational Psychology / M. Com. (Industrial and Organisational Psychology)

INTRODUÇÃO: Distúrbios mentais, neurológicos e de uso de substâncias estão dentre os principais contribuintes para a morbidade e mortalidade prematura no mundo. Mesmo onde existem cuidados de saúde mental e tratamentos eficazes, muitas vezes eles não são acessíveis para aqueles que mais precisam, principalmente por causa da desigualdade na distribuição de serviços e recursos humanos dentro de um país. Devido aos avanços contínuos nas tecnologias de informação e comunicação e a disseminação crescente da internet na sociedade, o cuidado de saúde mental à distância via webconferência, denominado telepsiquiatria, tornou-se uma ferramenta promissora para o atendimento psiquiátrico. OBJETIVOS: O presente projeto visou avaliar a eficácia e a aplicabilidade do acompanhamento psiquiátrico ambulatorial por webconferência em ambientes clinicamente não supervisionados, comparando esta nova forma de acompanhamento com o cuidado padrão (presencial) em relação à evolução clínica (gravidade da depressão, estado de saúde mental, medicação, e recaídas), à satisfação com o tratamento, à relação terapêutica, à adesão ao tratamento (faltas e taxas de abandonos), e à adesão à medicação. MÉTODOS: Trata-se de um estudo clínico randomizado e controlado. Pacientes entre 18 e 55 anos, com depressão leve ou com quadro estabilizado, internet banda larga em casa, e em tratamento no Instituto de Psiquiatria do Hospital das Clínicas das Faculdade de Medicina da Universidade de São Paulo (IPq- HCFMUSP) foram alocados aleatoriamente em um grupo experimental ou controle. Enquanto o grupo controle recebeu consultas psiquiátricas mensais de forma presencial no IPq, o grupo experimental realizou consultas mensais com o psiquiatra por webconferência. Uma amostra de 107 pacientes foi recrutada. De forma aleatória, 54 pacientes foram colocados no grupo controle e 53 no grupo de webconferência. Não houve diferenças significantes entre os grupos com respeito aos dados sociodemográficos na avaliação inicial. Durante o acompanhamento, 950 consultas foram concluídas, 489 (51,5%) delas por webconferência. Além disso, 277 consultas de avaliação foram realizadas. No início, depois de 6 e 12 meses, a gravidade da depressão, o estado de saúde mental, a satisfação com o tratamento, a relação terapêutica, e a adesão ao tratamento e à medicação foram avaliados. RESULTADOS: A gravidade da depressão diminuiu significativamente ao longo do acompanhamento de 12 meses em ambos os grupos. Os grupos diferiram significativamente em relação ao desenvolvimento da gravidade da depressão ao longo do período de seguimento, com melhores resultados para o acompanhamento por webconferência. Além disso, houve 4 recaídas no grupo controle e apenas uma no grupo de webconferência. Quanto a estado de saúde mental, a satisfação com o tratamento, a relação terapêutica, a adesão ao tratamento, e a adesão à medicação não foram encontradas diferenças significantes entre os grupos. Contudo, depois de 6 meses, o número de abandonos foi significativamente maior no grupo controle (18,5 vs. 5,7%, p < 0,05). A satisfação com o acompanhamento por webconferência foi alta tanto para os pacientes como para os psiquiatras. CONCLUSÕES: O acompanhamento psiquiátrico por webconferência foi tão eficaz e viável quanto o acompanhamento presencial com respeito à evolução clínica, a satisfação dos pacientes, a relação terapêutica, adesão ao tratamento e à medicação. Esses achados apontam o potencial da telepsiquiatria estender a assistência psiquiátrica à população de lugares remotos e até então sem acesso ao atendimento especializado / INTRODUCTION: Mental, neurological and substance-use disorders are major contributors to morbidity and premature mortality worldwide. Even where mental health care and effective treatment exist, they are frequently not available to those in greatest need, mainly because of the unequal distribution of services and human resources within a country. Due to continuous advances in information and communication technologies and the growing spread of the Internet in society, remote mental health care via videoconferencing, called telepsychiatry, has become a promising tool for psychiatric attendance. OBJECTIVES: The present project aimed to evaluate the efficacy and feasibility of psychiatric outpatient care via videoconferencing in clinically unsupervised settings, comparing this new form of attendance with in-person standard care regarding to clinical outcomes (severity of depression, mental health status, medication course, and relapses), satisfaction with treatment, therapeutic relationship, treatment adherence (appointment compliance and dropouts), and medication adherence. METHODS: This randomized controlled clinical trial allocated adult patients between 18 and 55 years old with mild depression or in remission state, treated at the Institute of Psychiatry of the University of São Paulo Medical School (IPq-HCFMUSP), and with broadband Internet access at home into a intervention and control group. Whereas the control group received monthly psychiatric consultations in person at the IPq, the intervention group realized monthly consultations with the psychiatrist via videoconferencing. At baseline and after 6 and 12 months, the severity of depression, mental health status, satisfaction with treatment, therapeutic relationship, treatment adherence and medication compliance were assessed. RESULTS: A sample of 107 patients was recruited; 54 patients were randomly allocated to the control group, and 53 to the intervention group. Patients in both groups did not differ with respect to demographic data. During follow-up, 950 consultations were completed; 489 (51,5%) via videoconferencing. In addition, there were 277 assessment consultations. The severity of depression decreased significantly over the 12-month follow-up in both groups. There was a significant difference between groups regarding to the development of the severity of depression throughout the follow-up period, with better results for the attendance via videoconferencing. Further, there were 4 relapses in the control group and only one in the videoconferencing group. There were no significant differences between groups regarding to mental health status, satisfaction with treatment, therapeutic relationship, treatment adherence, and medication compliance. Though, after 6 months, the number of dropouts was significantly higher in the control group (18,5 vs. 5,7%, p < 0,05). Satisfaction with attendance via videoconferencing was high among patients as well as among psychiatrists. CONCLUSIONS: Psychiatric attendance via videoconferencing can be considered applicable for the outpatient care at the IPq-HCFMUSP and as effective and viable as standard care (in person treatment) with respect to clinical outcomes, patient satisfaction, therapeutic relationship, treatment adherence and medication compliance. These results indicate the potential of telepsychiatry to extend the access to psychiatric care for remote and underserved populations

Esta dissertação teve como objetivo “pensar” a proposta e ação dos Consultórios na Rua, diferentes do consultório biomédico, um consultório a céu aberto. Admite que este dispositivo visa a ampliar o acesso da população de rua ao cuidado de saúde, ouvindo essa população e contribuindo com suas instâncias organizativas nascentes. Foi trazida a prática de trabalho no consultório Pintando Saúde, do Grupo Hospitalar Conceição, localizado na zona norte da cidade de Porto Alegre/RS. A metodologia do “pensar” envolveu deixar aparecer o debate sobre atenção e promoção de saúde, redução de danos em álcool e outras drogas, respeito às pessoas em seus modos de ser/existir/constituir vida e a inscrição desse grupo social em modos de atenção à saúde que lhe sejam próprios. O trabalho de dissertação perpassou a descrição do trabalho no Consultório na Rua, questionando a produção em saúde que envolve a população de rua, a experiência da pesquisadora como trabalhadora dentro desse tipo serviço, assim como as vivências de equipe e a presença do orientador e seus estudantes em meio ao trabalho do Consultório. Foram usadas anotações destacadas de gravações em áudio, as atas do consultório e as redes de conversa sobre moradores de rua no próprio consultório, incluindo a presença de um psiquiatra matriciador. A cartografia, nos termos de Gilles Deleuze e Félix Guattari, fundamentou a metodologia, conforme já vem sendo utilizada em pesquisas com o estudo da micropolítica em saúde coletiva. Quatro âmbitos foram colhidos como representativos da prática de atenção “a céu aberto”: a experiência do morar, a experiência do atuar com saúde na rua, a experiência do aprender em ato de equipe multiprofissional e interdisciplinar de um consultório na rua e a intercessão sociocultural proveniente do “encontro” com a população atendida. / This dissertation aimed to "think" the proposal and action of the “On Street Clinics”, different from the biomedical clinic, an “open sky clinic". It admits that this device seek to expand the street population access to health care, listening to this population and contributing to their nascent organizational instances. The work practices of "Pintando Saúde On Street Clinic", of Conceição Hospitalar Group, located in the northern part of the city of Porto Alegre/RS, were evidenced. The methodology of "thinking" involved revealing the debate about health care and health promotion, harm reduction in alcohol and other drugs, respect for people in their ways of being / existing / constituting life and the inclusion of this social group health models that be their own. The dissertation work deal with the description of the work at the On Street Clinic, questioning the health production involving the street population, the researcher's experience as a worker within this sort of service, as well as the team experiences and the presence of the master’s advisor and his students in the work of the clinic. Significant notes of audio recordings, clinic minutes, and street-talk networks that happened in the clinic, including the ones with the presence of a psychiatrist matrix support, were used. The cartography, according to Gilles Deleuze and Félix Guattari, founded the methodology, as it has been used in researches with studies on micropolitics in collective health. Four scopes were collected as representative of the practice of “open sky clinic" care: the experience of indwelling, the experience of working with health on street, the experience of learning in act of a multiprofessional and interdisciplinary team of an "on street clinic" and the sociocultural intercession provided when "meeting" the attended population.

INTRODUÇÃO: Distúrbios mentais, neurológicos e de uso de substâncias estão dentre os principais contribuintes para a morbidade e mortalidade prematura no mundo. Mesmo onde existem cuidados de saúde mental e tratamentos eficazes, muitas vezes eles não são acessíveis para aqueles que mais precisam, principalmente por causa da desigualdade na distribuição de serviços e recursos humanos dentro de um país. Devido aos avanços contínuos nas tecnologias de informação e comunicação e a disseminação crescente da internet na sociedade, o cuidado de saúde mental à distância via webconferência, denominado telepsiquiatria, tornou-se uma ferramenta promissora para o atendimento psiquiátrico. OBJETIVOS: O presente projeto visou avaliar a eficácia e a aplicabilidade do acompanhamento psiquiátrico ambulatorial por webconferência em ambientes clinicamente não supervisionados, comparando esta nova forma de acompanhamento com o cuidado padrão (presencial) em relação à evolução clínica (gravidade da depressão, estado de saúde mental, medicação, e recaídas), à satisfação com o tratamento, à relação terapêutica, à adesão ao tratamento (faltas e taxas de abandonos), e à adesão à medicação. MÉTODOS: Trata-se de um estudo clínico randomizado e controlado. Pacientes entre 18 e 55 anos, com depressão leve ou com quadro estabilizado, internet banda larga em casa, e em tratamento no Instituto de Psiquiatria do Hospital das Clínicas das Faculdade de Medicina da Universidade de São Paulo (IPq- HCFMUSP) foram alocados aleatoriamente em um grupo experimental ou controle. Enquanto o grupo controle recebeu consultas psiquiátricas mensais de forma presencial no IPq, o grupo experimental realizou consultas mensais com o psiquiatra por webconferência. Uma amostra de 107 pacientes foi recrutada. De forma aleatória, 54 pacientes foram colocados no grupo controle e 53 no grupo de webconferência. Não houve diferenças significantes entre os grupos com respeito aos dados sociodemográficos na avaliação inicial. Durante o acompanhamento, 950 consultas foram concluídas, 489 (51,5%) delas por webconferência. Além disso, 277 consultas de avaliação foram realizadas. No início, depois de 6 e 12 meses, a gravidade da depressão, o estado de saúde mental, a satisfação com o tratamento, a relação terapêutica, e a adesão ao tratamento e à medicação foram avaliados. RESULTADOS: A gravidade da depressão diminuiu significativamente ao longo do acompanhamento de 12 meses em ambos os grupos. Os grupos diferiram significativamente em relação ao desenvolvimento da gravidade da depressão ao longo do período de seguimento, com melhores resultados para o acompanhamento por webconferência. Além disso, houve 4 recaídas no grupo controle e apenas uma no grupo de webconferência. Quanto a estado de saúde mental, a satisfação com o tratamento, a relação terapêutica, a adesão ao tratamento, e a adesão à medicação não foram encontradas diferenças significantes entre os grupos. Contudo, depois de 6 meses, o número de abandonos foi significativamente maior no grupo controle (18,5 vs. 5,7%, p < 0,05). A satisfação com o acompanhamento por webconferência foi alta tanto para os pacientes como para os psiquiatras. CONCLUSÕES: O acompanhamento psiquiátrico por webconferência foi tão eficaz e viável quanto o acompanhamento presencial com respeito à evolução clínica, a satisfação dos pacientes, a relação terapêutica, adesão ao tratamento e à medicação. Esses achados apontam o potencial da telepsiquiatria estender a assistência psiquiátrica à população de lugares remotos e até então sem acesso ao atendimento especializado / INTRODUCTION: Mental, neurological and substance-use disorders are major contributors to morbidity and premature mortality worldwide. Even where mental health care and effective treatment exist, they are frequently not available to those in greatest need, mainly because of the unequal distribution of services and human resources within a country. Due to continuous advances in information and communication technologies and the growing spread of the Internet in society, remote mental health care via videoconferencing, called telepsychiatry, has become a promising tool for psychiatric attendance. OBJECTIVES: The present project aimed to evaluate the efficacy and feasibility of psychiatric outpatient care via videoconferencing in clinically unsupervised settings, comparing this new form of attendance with in-person standard care regarding to clinical outcomes (severity of depression, mental health status, medication course, and relapses), satisfaction with treatment, therapeutic relationship, treatment adherence (appointment compliance and dropouts), and medication adherence. METHODS: This randomized controlled clinical trial allocated adult patients between 18 and 55 years old with mild depression or in remission state, treated at the Institute of Psychiatry of the University of São Paulo Medical School (IPq-HCFMUSP), and with broadband Internet access at home into a intervention and control group. Whereas the control group received monthly psychiatric consultations in person at the IPq, the intervention group realized monthly consultations with the psychiatrist via videoconferencing. At baseline and after 6 and 12 months, the severity of depression, mental health status, satisfaction with treatment, therapeutic relationship, treatment adherence and medication compliance were assessed. RESULTS: A sample of 107 patients was recruited; 54 patients were randomly allocated to the control group, and 53 to the intervention group. Patients in both groups did not differ with respect to demographic data. During follow-up, 950 consultations were completed; 489 (51,5%) via videoconferencing. In addition, there were 277 assessment consultations. The severity of depression decreased significantly over the 12-month follow-up in both groups. There was a significant difference between groups regarding to the development of the severity of depression throughout the follow-up period, with better results for the attendance via videoconferencing. Further, there were 4 relapses in the control group and only one in the videoconferencing group. There were no significant differences between groups regarding to mental health status, satisfaction with treatment, therapeutic relationship, treatment adherence, and medication compliance. Though, after 6 months, the number of dropouts was significantly higher in the control group (18,5 vs. 5,7%, p < 0,05). Satisfaction with attendance via videoconferencing was high among patients as well as among psychiatrists. CONCLUSIONS: Psychiatric attendance via videoconferencing can be considered applicable for the outpatient care at the IPq-HCFMUSP and as effective and viable as standard care (in person treatment) with respect to clinical outcomes, patient satisfaction, therapeutic relationship, treatment adherence and medication compliance. These results indicate the potential of telepsychiatry to extend the access to psychiatric care for remote and underserved populations

Made available in DSpace on 2016-04-04T18:29:43Z (GMT). No. of bitstreams: 1 Camila Ferreira de Avila.pdf: 3850297 bytes, checksum: 0bff87b5bc56e4ac73916f502ac94d65 (MD5) Previous issue date: 2008-05-15 / The present work aimed at the psychoanalytic investigation of Higher Education Professors on school inclusion. It has been methodologically organized for the accomplishment of a collective therapeutic consultation, during which the Procedure of Drawing-Stories with Theme was used as a dialogical mediator in the approach of twelve professors, from Language and Pedagogy degrees, who were in charge of the formation of teachers from primary and secondary courses. The clinical happening allowed the elaboration of a narrative and the production of twelve drawing-stories, originating clinical material which has been analyzed by the psychoanalytic method. Four fields have been collected: his mother's boy , "(un) capacities , "where s Wally? and "the pain and the delicacy". In its set, such fields indicate that teachers suffer when facing the problem of deficiency and the task of including. / O presente trabalho teve como objetivo a investiga??o psicanal?tica de professores do ensino superior sobre inclus?o escolar. Foi organizado metodologicamente pela realiza??o de uma consulta terap?utica coletiva, durante a qual o Procedimento de Desenhos-Est?rias com Tema ? usado como mediador dial?gico na abordagem de doze docentes, dos cursos de Letras e Pedagogia, que se encarregam da forma??o de professores de n?vel fundamental e m?dio. O acontecer cl?nico permitiu a elabora??o de uma narrativa e a produ??o de doze desenhos-est?rias, originando material cl?nico que foi analisado ? luz do m?todo psicanal?tico. Foram captados quatro campos: o menino de sua m?e , (in) capacidades , onde est? Wally? e a dor e a del?cia . Em seu conjunto, tais campos indicaram que o professor sofre quando se defronta com a problem?tica da defici?ncia e com a tarefa de incluir.

This diploma thesis deals with the issue of parental evenings and their associated preparation, realization, process and communication of beginning teachers of primary school with pupils' parents. The aim of the diploma thesis is to create a set of procedures and recommendations based on the data obtained from starting teachers and parents, which have been successfully implemented in practice and can be inspired not only by other novice teachers. In the theoretical part, the diploma thesis identifies competencies that enable the teacher to effectively manage this professional situation and, on the basis of professional literature, it provides examples of conduct that contribute to better preparation and process of parental evenings. Research in the empirical part follows the cases of four beginning teachers. Methods which were used are observation, semi-structured interview and questionnaire. The research of this diploma thesis lasted for six months, during which were observed parental evenings, followed by interviews with beginning teachers. The whole research was completed with a questionnaire created for parents. The obtained data was then evaluated and compared with the theoretical part. After six months of co-operation with participating teachers, data collection and evaluation, it was...

Em meio às manifestações sociais crescentes, as insuficiências das democracias representativas em recepcionar e fluir as expectativas sociais, e estados nacionais fracos e subordinados aos mercados financeiros globais, novas institucionalidades democráticas interrogam as democracias existentes. Coerente com estas questões, a tese desenvolvida neste estudo propõe que o tamanho do desafio exige mais democracia, não menos. A ampliação dos modelos de democracia participativa, combinados em um sistema que integre participação cidadã, democratização da gestão e interação em redes, alargam o modelo representativo e garantem novos canais de comunicação entre sociedade e Estado. São alternativas disponíveis às democracias. Dentre elas, interessa verificar as condições para a validade de processos de concertação social em arranjos de ampla representação societal. O modelo referenciado na teoria habermasiana transporta a esfera pública e a estrutura comunicacional original adequando-as conceitualmente ao espaço público institucional e à concertação social, respectivamente. Durante os quatro anos de existência do Conselho de Desenvolvimento Econômico e Social do Rio Grande do Sul (CDES RS) quase duzentas propostas elaboradas por noventa conselheiros e conselheiras da sociedade civil e dez do governo, a partir de um processo dialógico e colaborativo, foram tratadas e encaminhadas pelo executivo estadual. O resultado foi possível, conforme o estudo, por uma série não exaustiva de condicionantes para a validade da concertação social, um conjunto reconhecível e executável de políticas e práticas democráticas. Todavia, defende, ainda, a diversificação dos arranjos institucionais participativos como formas complementares de democracia, multifacetada e transversalizada, para sociedades complexas fruto das novas formas de acumulação capitalista e da transformação dos sujeitos no mundo do trabalho. / In the midst of growing social manifestations, the inadequacies of representative democracies in welcoming and flowing social expectations, and weak national states subordinated to global financial markets, new democratic institutions question the existing democracies. Coherent with these questions, the thesis developed in this study proposes that the size of the challenge requires more democracy, not less. The expansion of participative democracy models, combined in a system that integrates citizen participation, democratization of management and interaction in networks, broadens the representative model and guarantees new channels of communication between society and State. They are alternatives available to democracies. Among them, it is important to verify the conditions for validity of social concertation processes in arrangements of broad societal representation. The model referenced in the Habermasian theory transports the public sphere and the original communicational structure, adapting them conceptually to the public institutional space and the social conciliation, respectively. During the four years of existence of the Social and Economic Development Council of Rio Grande do Sul (CDES RS), almost two hundred proposals prepared by ninety councilors and councilors of civil society and ten of the government, from a dialogical and collaborative process, were treated And forwarded by the state executive. The result was, according to the study, a nonexhaustive set of constraints to the validity of social concertation, a recognizable and enforceable set of democratic policies and practices. However, it also defends the diversification of participatory institutional arrangements as complementary forms of democracy, multifaceted and cross-cutting, for complex societies resulting from new forms of capitalist accumulation and the transformation of subjects into the world of work.

The thesis named Consultation teacher - student - parent at primary school with focus to providing feedback deals with specific role of consultations in the process of education as a form of cooperation between family and school. The aim of this thesis is to closer describe consultations teacher - student - parent in the extensive context and point out their potential in particular from the point of view of the formative assessment. It is a special educational opportunity that facilitates students' personal development and improvement in the process of learning via providing feedback which comes simultaneously from three sides. The theoretical part deals with defining term consultation teacher - student - parent, describing their functions and development as a communication platform. Part of the text offers an inspiring application of this untraditional appointment in Sweden. Attention is also focused to implementing students'sources that work as essential support for work with the formative feedback. The second, empirical part deals with reconstruction of three consultation meetings at primary school and reflects development of this event from the side of teacher, student as well as parent in the form of a case study. This research confirms the value of all three approaches and formation of...

This research project addresses the following: how topical talk operates in the organisation and management of MSE interactions; and how topical talk operates in the co-ordination of specific service requests and service provisions. It draws on a corpus of audio-recorded and transcribed interactions between general practitioners and persons seeking general medical services in suburban clinics in Brisbane, Australia. The corpus comprised a total of 67 medical service events (henceforth MSEs), audio-taped with the full informed consent of the participants. Many contemporary medical sociological accounts of the operation of topical talk in MSEs, typified by the work of Mishler (1981, 1984) and Waitzkin (1991), remain anchored to the 'professional dominance' thesis (Freidson 1970a; 1970b), arguing for the fundamental conflict between two perspectives - lay and professional. Topical talk has been formulated as one expression of this conflict in 'doctor-centred' communicative 'styles' (Byrne and Long 1976; Silverman 1987). Within such accounts, familiar interactional patterns in MSEs, including the content and structure of topics, have been theorised as instruments of power and control whereby the dominance of specialised medical knowledge and expertise are established and maintained. Mishler's (1984) characterisation of the conflict between a biomedically oriented 'voice of medicine' used by professional physicians (henceforth GPs) and a 'voice of the lifeworld' used by persons seeking medical services (henceforth Ps) is an expression of the 'professional dominance' thesis. The voices are characterised as attesting to a fundamental, theoretically problematic, asymmetry of power relations between GPs and Ps, thereby reinforcing the ideological status of professionals in general and the medical profession in particular. Further, recommendations regarding correctives to 'professional dominance' centre on advice GPs to attend to the primacy of Ps' talk on their experiences of illnesses rather than apparently 'ignoring' or transforming these topics into biomedical accounts of disease. This research project critiques this formulation of topical talk and the traditional theoretical and empirical bases on which it has drawn. This critique arises from the application of ethnomethodological approaches to the study of MSEs. Such approaches, as outlined in Chapters 2 and 3, are characterised by a number of conceptual and analytic premises: First, particular social structural features of social activities and the institutional contexts within which activities occur should not be assumed to be the primary criteria for judging the import and adequacy of situated action. Second, the parties to situated social events mutually constitute those events in the real world. Third, issues of agency are collaborative situated accomplishments such that the management of everyday social activities is accomplished by the people involved who show one another the rationalities of their actions as they assemble the familiar scenic features of those same institutional events (Garfinkel 1967; Sacks 1992a, 1992b). These assumptions have been applied in ethnomethodological analyses of social action, including the analysis of professional service encounters that have critiqued the 'professional dominance' thesis (Eglin and Wideman 1986; Sharrock 1979). The novelty of this study is the analysis of the operation of topic organisation as a phenomenon of order. This study also draws on recommendations within Ethnomethodology (Hester & Eglin 1997b; Watson 1997) that sequential and categorial organisations are mutually informative in the analysis of the rationality of situated social action. One of the particular contributions of this thesis is that it not only jointly applies both conversation analysis and membership categorisation analysis but also extends this recommendation to the inclusion of topic analysis as was originally provided for by Sacks (1992a , 1992b) and Garfinkel and Sacks (1970). Within this study a model of analysis has been constructed that has enabled the analytical consideration of four dimensions of social organisation: local sequential, extended sequential, topical and categorial organisations. The theoretical and empirical concepts of ethnomethodogical analysis have thus been developed and extended within this project. The central findings of this study are that in institutional service events, the 'service topic' is both significant and consequential, and that persons constitute themselves as bona fide incumbents of the categories GP or P by attending to their actions as topically organised. The local adequacy of any particular interactional move (such as questioning-answering, greetings, the design of a topic proposal, etc) is shown to be referenced to the service topic. This study found no evidence of potential or actual "struggles" between the 'voice of the life-world and the voice of medicine'. Rather, this study finds routine recognition on the part of both Ps and GPs of the centrality of the service topic and, thereby, the service task, and no evidence of orientation to distinctive biographical contributions staged in competition with biomedically relevant service topics. It is found that Ps' biographical references were made in the context of an assembled service topic such that particular service tasks, however conventional, were constituted as both relevant and reasonable as medical goods and service for the specific service recipient and provider. At the most general level, it is concluded that the service topic operates as a phenomenon of order in MSEs where order, as defined by Garfinkel and Weider (1992: 202), refers to all of the rationalities evident in the generic features of institutional events and settings, that is, the situated logic and intelligibility as well as the procedures whereby they are constituted as recognisable social events. The thesis concludes with a discussion of the implications of the findings for the theorisation, policy-making, medical education, and practices of GPs and Ps within MSEs. Overall, the significance of this work for researchers into medical interactions is that the relevance of the service topic and its pervasive organisational consequences need to be considered analytically. A major outcome of this thesis is the establishment of a new order of interest within the study of institutional interactions. The project demonstrates the pervasive consequences of service topics and thus provides a step forward in the study of institutional service interactions and ways of theorising their rationality, a step that extends beyond social structural pre-theorisations of power and domination and also beyond interactional accounts of the primary relevance of turn taking structures.

L'école se préoccupe de la transmission de savoirs qui ne se réfèrent pas tous à des corps de savoirs savants constitués, comme ceux des mathématiques, par exemple. Il en est ainsi de la recherche d'information via Internet qui prend une place grandissante dans de nombreuses pratiques sociales. Dans cette perspective, un enseignement de la consultation d'information a été introduit dans les programmes de technologie de la classe de 4e. La thèse a pour objet d'examiner la question des savoirs à transmettre et de l'organisation des modes de transmission-appropriation de ce nouvel objet d'enseignement. La consultation d'information relève d'une activité humaine qui s'organise autour de l'usage, et donc de l'instrumentalisation d'un outil. Nous connaissons la faiblesse des apprentissages fondés sur la seule maîtrise opératoire. Examiner les enjeux de la transposition didactique à partir de pratiques, suppose donc de s'extraire d'une approche exclusivement procédurale, pour, dans un premier temps, examiner la question de l'élaboration de savoirs experts en nous appuyant sur la genèse instrumentale et à partir d'analyse de pratiques. Dans un second temps, nous nous sommes intéressés au processus d'enseignement apprentissage. L'observation d'élèves nous a permis, au travers de leurs conceptions, de mesurer la distance qui sépare leurs pratiques de consultation d'information de celles d'experts et ainsi de qualifier les enjeux de l'apprentissage. L'analyse du travail des enseignants permet d'identifier les modes de transmission qu'ils utilisent pour cet enseignement et donc d'anticiper sur les probables difficultés des élèves. Ainsi, le croisement de ces analyses nous permet de qualifier le processus de transmission-appropriation d'un corpus de savoirs particuliers liés à la consultation d'information via Internet et, au final, de penser des aides au travail des enseignants dans une perspective d'ingénierie didactique.