The Internet offers potential for reducing professional isolation of Appalachian health care providers by enhancing access to medical information and facilitating contact with colleagues. However, there is a gap in the knowledge of current computer and Internet access in Appalachia, and in the technology-related behaviors and attitudes of health care professionals there. This study examined Internet-related access and behaviors of Appalachian family physicians and advanced practice nurses. A survey was mailed to 429 graduates of East Tennessee State University's family medicine residency and advanced practice nursing programs currently in practice in southern and central Appalachia. Demographic information was collected from ETSU graduate records. The Dillman survey method included a pre-notice letter, two survey mailings, and post card and telephone follow-ups. Two hundred sixty-four providers (61.5%) returned surveys. Data were analyzed using SPSS. Respondents were similar to the total population in gender, provider discipline, age, and percentage in rural practice. Workplace computer access was common; 59.6% had sole access and 40.2% shared access. Internet access was: 82.7% broadband, 13.5% dial-up, and 2.4% no access. Although rural providers were more likely than urban to have slower dial-up access, they regularly used the Internet. Over 75% of providers accessed the Internet at home for work; 34% reported dial-up and 66% broadband home connection. Although 50% used the Internet for continuing education in 2004, most preferred in-person workshops or print-based modes of continuing education; 58.9% e-mailed daily and 80% accessed medical information via the Internet regularly. Other Internet uses included accessing online journals and patient information, receiving professional association updates, filing insurance, and writing prescriptions. The Internet is ubiquitous in Appalachia; health care providers access it for a variety of professional activities daily. Telemedicine was not a popular technological innovation. Of those 20.8% reporting telemedicine availability in the practice, few used it. When presented with a list of possible benefits of telemedicine, 41.1% selected "none of the above". Although many technological innovations are used regularly by Appalachian health care providers, barriers to the use of new technologies lie more in attitudes than in technology access.

The study investigated the self-reported information needs and information-seeking behaviour of 143 general practitioners in their delivery of patient care to the elderly on the Gold Coast. The study sought to obtain an information profile in order to begin discussion on the need for possible infrastructures that may need to be considered in any planning strategies concerned with access to and provision of relevant, accurate and timely information to general practitioners which affects their delivery of patient care to the growing number of elderly patients. A ten-page questionnaire utilising both structured and unstructured questions was returned by 61.9 percent of the survey population. Demographic characteristics indicated that respondents were representative of general practitioners in Australia. Respondents frequently needed information with 40 percent requiring it '1 - 4 times a week' and 78 percent 'once a month or more often'. Information on medical fact was required most frequently, 29 percent, medical opinion 27 percent, and non-medical information 23 percent. The study found support for the proposition that computerised information systems need to be enhanced and made widely known and available to general practitioners to assist them in obtaining information that they need in delivery of patient care to the elderly. There is a great need by these general practitioners for non-medical information as well as medical information. Therefore, the development of a database of non-medical information containing information on local agencies and services is of high priority. Library information delivery services should also be de-institutionalised in terms of lifting restrictions to services provided to enable general practitioners greater access to information. Library services should aim to provide remote access to information via telephone, fax and modem with emphasis on value added services aimed at solving a particular specific information need as well as straight-out bibliographic search services and document delivery services. Continuing medical education in the form of CME courses, conferences and meetings should focus on specific information needs of general practitioners in this area of patient care to the elderly. The need for information on cardiology, orthopaedics, dermatology, physiotherapy, podiatry, pharmaceutical benefits, home help, Meals-on-Wheels and nursing home placement were areas of particular interest identified by respondents in this study.

Made available in DSpace on 2015-07-22T20:49:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-11-28 / Leite, Maria Teresa Meirelles. Cursos em educação médica continuada on-line na América Latina: um olhar pedagógico. [Online Continuing Medical Education Courses in Latina America: a pedagogical approach]. Orientador: Daniel Sigulem. São Paulo: s.n., 2008. [146]. Dissertação(Mestrado em Ciências)-Universidade Federal de São Paulo. Escola Paulista de Medicina. Resumo: Introdução: A educação médica continuada on-line oferecida por universidades parece priorizar os conteúdos transmitidos, a qualidade estética e a sofisticação tecnológica, dedicando pouca atenção aos aspectos pedagógicos. Os objetivos desta pesquisa são: sistematizar aspectos teóricos de educação, de educação a distância e de educação médica continuada (EMC) e identificar as abordagens pedagógicas prevalentes nos cursos em EMC on-line no Brasil e América Latina, por meio de artigos publicados. Metodologia: Após a elaboração do quadro teórico e do estabelecimento do escopo da pesquisa foram conduzidas buscas bibliográficas em bases de dados eletrônicas internacionais em saúde, medicina e humanidades. A seguir, foram realizadas pesquisas complementares, em websites de universidades da América do Sul. Resultados: Apenas quatro relatos obedeciam plenamente aos critérios estabelecidos para a investigação, sendo que três (3) parecem obedecer à abordagem cognitivista e um (1) à abordagem tradicional. Após a busca complementar, constatou-se que de um total de duzentas e vinte e seis (226) escolas médicas presentes em treze (13) países da América do Sul, estão disponíveis para consulta na Internet treze (13) experiências de EMC on-line. Entre elas, houve referência a concepções de educação em apenas oito (8). Discussão: Foram discriminados os limites impostos a esta pesquisa, observaram-se as características de uma busca bibliográfica envolvendo a área de humanas, estabeleceu-se que os resultados não constituem um referencial para avaliar os cursos quanto à concepção de educação, considerou-se a legitimidade dos resultados como amostragem significativa para ilustrar o volume de artigos disponíveis sobre o tema. Foram analisados os artigos incluídos, assim como diversos achados relevantes. Foram discutidos outros aspectos relacionados ao quadro teórico inicial, como perfil do docente e pós-modernidade. Conclusões: 1. Praticamente inexiste, na comunidade acadêmica latino-americana que desenvolve estudos pedagógicos nesta área, um envolvimento com a publicação científica nas bases de dados pesquisadas. 2. A falta de informações sobre aspectos pedagógicos pode revelar a ausência de um especialista em educação no planejamento dos cursos e pode apontar para a necessidade dos cursos de Pedagogia brasileiros investirem na formação do profissional capaz de atender essa demanda. 3. Há grande tendência das instituições privadas oferecerem educação continuada a distância, o que ficou evidente a partir da pesquisa complementar nos sites das universidades. 4. A partir dos resultados, foi possível constatar também que vários autores concordam que, com as recentes mudanças sociais, muitas transformações são esperadas da Educação. 5. O quadro teórico desenvolvido pode auxiliar a estabelecer fundamentos para reconhecer onde o conhecimento pedagógico se insere no contexto da EaD. 6. Além da pesquisa sobre o número de cursos oferecidos na América Latina e suas características, pode ser relevante utilizar o mesmo referencial teórico para estabelecer critérios de análise qualitativa dos cursos oferecidos por uma instituição específica, indicando possibilidade de novas pesquisas.. / Introduction: Continuing medical education online offered by universities in Brazil seems to prioritize aesthetic quality and technological sophistication, paying little attention to pedagogical aspects. The objectives of this research are: to systematize theoretical aspects to the concepts of education, distance learning and continuing medical education (CME) and to identify the pedagogical approaches adopted in CME online courses in Brazil and Latin America by means of published articles. Method: After the construction of the theoretical basis and the establishment of the research limits, bibliographical queries in international electronic databases in health, medicine and humanities were carried through. Following, complementary research was performed in South American universities websites. Results: Only four articles obeyed the established criteria, from which three (3) seem to hold a cognitivist pedagogical approach and one (1) held a traditional approach of education. After the complementary search, it was found that, from a total of two hundred and twenty and six (226) medical schools in thirteen (13) South American countries, there were thirteen (13) online CME courses available for consultation in the Internet. Among them, only eight (8) referred to the education conceptions. Discussion: The limits for the query were discriminated, the characteristics of a bibliographical query involving the humanities was observed, it was established that the present results cannot constitute a referential tool to evaluate the courses, the legitimacy of the results as a significant sampling to illustrate the volume of available articles on the subject was discussed, the four articles were deeply analyzed, as well as diverse other findings that were not included. Besides, other aspects were discussed, as teacher profile and post modernity. Conclusions: 1. There is practically no involvement with scientific publication in the searched databases by the Latin American researchers in educational approaches for online continuing medical education. 2. The lack of information on pedagogical aspects may reveal the absence of an education specialist in the courses design and may suggest for the necessity for Brazilian Pedagogy courses to form a professional who is capable of answering this demand. 3. The trend of private institutions to offer online CME was evidenced from the complementary research. 4. From the results, it was possible to see that some authors agree that with the recent social changes, many transformations are expected from Education. 5. The developed theoretical basis may be able to contribute to establish connections to understand how the pedagogical knowledge inserts in the context of distance learning. 6. Beyond the research on the number of courses offered in Latin America and its characteristics, it is desirable to use the same theoretical referential to establish criteria for qualitative analysis for the courses offered by a specific institution, indicating a possibility of continuing this research. / TEDE / BV UNIFESP: Teses e dissertações

En 2007, le Collège des médecins du Québec a résolu d’adopter le plan d’autogestion du développement professionnel continu (DPC) comme outil de maintien de la compétence professionnelle. Bien que la plupart des médecins reconnaissent la nécessité de demeurer à la fine pointe des connaissances et des découvertes médicales, certains considèrent le plan d’autogestion comme une corvée administrative. Afin de mieux comprendre leurs perceptions à l’égard du plan de DPC, une recherche qualitative a été menée à l’été 2010, par le biais d’entretiens individuels semi-structurés, auprès d’un échantillon de vingt-sept médecins québécois. Un échantillonnage mixte, utilisant la technique « boule de neige » et faisant appel à des informateurs clés et à des cas dits « négatifs », a permis d’atteindre un bon niveau de diversification de l’échantillon et la saturation empirique des données. Bien que les médecins interrogés soient généralement favorables au principe d’un plan d’autogestion de DPC, les commentaires et suggestions formulés par certains d’entre eux devraient inciter le Collège à apporter certaines améliorations à ce plan. Certains irritants tels que la nécessité de tenir à jour un registre des activités de DPC et d’en rendre compte au Collège ont été soulevés. Par contre, la majorité des médecins interrogés considèrent que le plan de DPC d’un médecin témoigne des efforts qu’ils déploient pour rester à la fine pointe des progrès scientifiques et technologiques dans le domaine de la santé. Finalement, tous les médecins interrogés considèrent que le maintien de leur compétence professionnelle est une obligation morale et déontologique. / In 2007, the Collège des médecins du Québec adopted the Continuing professional development plan (CPD) as a tool to maintain professional competency. Despite the fact that most physicians agree on the obligation to keep their knowledge up to date and to apply state-of-the-art medical techniques, treatments and procedures, some of them have a negative opinion about the CPD plan. To better understand the perceptions of Quebec physicians, a qualitative research was carried out in the summer of 2010, through a series of semi-structured interviews conducted with 27 physicians. Purposeful sampling was used to select key informants and physicians with a potentially negative opinion towards the CPD plan (“negative” cases). The remaining participants were identified through snowball and opportunistic sampling. Combining these recruitment methods allowed us to get a wide diversity of opinions and to achieve a high level of empirical data saturation. Although a majority of the physicians interviewed agree with the idea of having a CPD plan, comments and suggestions mentioned by some participants should help the Collège des médecins du Québec improve its plan. Some irritants were mentioned, like having to maintain a CPD portfolio of activities, a task considered tedious and cumbersome by some participants. In contrast, the majority of participants are of the opinion that the CPD plan reflects the efforts made by a physician to keep up to date with medical advances. Finally, they all agree with the fact that maintaining their professional competency is a moral as well as deontological obligation for all physicians.

Background: Accrual of continuing medical education credits is part of licensure in family medicine but opinions are mixed as to whether the training has an impact on clinical practice. Literature does suggest that practice change is most likely when training involves multiple interactive exposures, and when the benefit to patients is apparent. Aim: To determine whether an interactive peer-lead educational intervention for General Practitioners in British Columbia, the Practice Support Program Mental Health Module, resulted in measureable change in clinical practice of the Vancouver Island participants. Method: Administrative information from British Columbia Ministry of Health databases was obtained for analysis regarding physician billing and prescribing, and hospitalizations on Vancouver Island. Paired t-tests were used to compare physician-patient interactions among module participants before and after the training regarding a) initiation of antidepressants and anti-anxiety medication, and b) use of the mental health plan billing code, used to support patients who struggle with activities of daily living. In addition, mental health hospitalizations among participants' patients before and after training were used to measure its impact on patient outcomes. Results: One-hundred and ninety-seven General Practitioners on Vancouver Island completed the mental health module between 2008 and 2011. While no significant difference was found in the numbers of mental health patients seen during the pre- and post- periods (M=142.06, SD=97.45) and (M=144.44, SD=103.00); t(196)=-0.679, p=0.498, α=.05, the change in the proportion of new prescriptions between pre-period mean (M=0.0796, SD=.06527) and post-period means (M=.0530, SD=.03877); t(195)=6.668, p<0.001 was found to be significant and indicative of a relative decrease between 31.2 and 33.4%. The change in the proportion of mental health plans was also found to be significant between pre-period (M=0.1142, SD=.018598) and post-period means (M=.1674, SD=.23973); t(180)=-3.586, p<0.001. This indicated a relative increase between 42.0 and 46.6%. No significant change in patient hospitalizations was found between the pre- and post-period means: (M=0.039, SD=.0612) and (M=.0392, SD=.0978); t(192)=-0.055, p=0.956. Conclusion: This educational intervention appears to have resulted in significant changes in the practice patterns of the physician participants. Future research using better indicators may reveal more about the impact of physician training on patient outcomes. / Graduate

En 2007, le Collège des médecins du Québec a résolu d’adopter le plan d’autogestion du développement professionnel continu (DPC) comme outil de maintien de la compétence professionnelle. Bien que la plupart des médecins reconnaissent la nécessité de demeurer à la fine pointe des connaissances et des découvertes médicales, certains considèrent le plan d’autogestion comme une corvée administrative. Afin de mieux comprendre leurs perceptions à l’égard du plan de DPC, une recherche qualitative a été menée à l’été 2010, par le biais d’entretiens individuels semi-structurés, auprès d’un échantillon de vingt-sept médecins québécois. Un échantillonnage mixte, utilisant la technique « boule de neige » et faisant appel à des informateurs clés et à des cas dits « négatifs », a permis d’atteindre un bon niveau de diversification de l’échantillon et la saturation empirique des données. Bien que les médecins interrogés soient généralement favorables au principe d’un plan d’autogestion de DPC, les commentaires et suggestions formulés par certains d’entre eux devraient inciter le Collège à apporter certaines améliorations à ce plan. Certains irritants tels que la nécessité de tenir à jour un registre des activités de DPC et d’en rendre compte au Collège ont été soulevés. Par contre, la majorité des médecins interrogés considèrent que le plan de DPC d’un médecin témoigne des efforts qu’ils déploient pour rester à la fine pointe des progrès scientifiques et technologiques dans le domaine de la santé. Finalement, tous les médecins interrogés considèrent que le maintien de leur compétence professionnelle est une obligation morale et déontologique. / In 2007, the Collège des médecins du Québec adopted the Continuing professional development plan (CPD) as a tool to maintain professional competency. Despite the fact that most physicians agree on the obligation to keep their knowledge up to date and to apply state-of-the-art medical techniques, treatments and procedures, some of them have a negative opinion about the CPD plan. To better understand the perceptions of Quebec physicians, a qualitative research was carried out in the summer of 2010, through a series of semi-structured interviews conducted with 27 physicians. Purposeful sampling was used to select key informants and physicians with a potentially negative opinion towards the CPD plan (“negative” cases). The remaining participants were identified through snowball and opportunistic sampling. Combining these recruitment methods allowed us to get a wide diversity of opinions and to achieve a high level of empirical data saturation. Although a majority of the physicians interviewed agree with the idea of having a CPD plan, comments and suggestions mentioned by some participants should help the Collège des médecins du Québec improve its plan. Some irritants were mentioned, like having to maintain a CPD portfolio of activities, a task considered tedious and cumbersome by some participants. In contrast, the majority of participants are of the opinion that the CPD plan reflects the efforts made by a physician to keep up to date with medical advances. Finally, they all agree with the fact that maintaining their professional competency is a moral as well as deontological obligation for all physicians.

L’objectif de la thèse est de parvenir à élaborer un modèle d’acquisition de la compétence du médecin. La question de recherche a été libellée ainsi : quelles implications peuvent avoir les expériences professionnelles, la vie quotidienne, les échanges entre pairs, enfin, tout ce qui peut correspondre à des ressources pédagogiques dites « informelles» dans l’amélioration des compétences professionnelles des étudiants en médecine et des médecins. J’ai fait l’hypothèse suivante : dans tout apprentissage, il y a du formel et de l’informel. Et cet informel pourrait être repéré dans un dispositif pédagogique de type coopératif, expérientiel et réflexif ; le contexte d’apprentissage « informel» et « non formel » a certainement un rôle dans l’acquisition des connaissances et des compétences des professionnels de santé.Trois dispositifs pédagogiques fréquemment utilisés au cours du 3e cycle de la formation initiale des médecins et en formation médicale continue ont été proposés à des étudiants en médecine et des médecins installés en milieu ambulatoire. De tels dispositifs basés sur la mobilisation de l’expérience, la réflexion et la coopération entre les participants seraient susceptibles de contribuer à l’amélioration de la compétence des étudiants en médecine et des médecins.Il existe, dans chacun des dispositifs d’apprentissages éprouvés, et en tenant compte des cadres de références et des connaissances propres à chaque participant, des savoirs formels et informels. Ces savoirs ont contribué dans leur globalité à la transformation des apprenants. Cependant, la distinction entre ces deux modes d’apprentissages formels,informels est surtout théorique. Elle est notamment fonction des lieux et des moments où ces apprentissages ont été dispensés. Il existe en réalité un véritable continuum entre ces différents apprentissages. / This thesis attempts to offer a model for the acquisition of knowledge and skills amongphysicians. The research undertook to explore the role of professional experiences, dailylife, exchanges between peers, and all other forms of so-called « informal » learning inenhancing the professional skills of medical students and physicians. The author laboredunder the following hypothesis: all learning involves both formal and informal aspects,and the informal aspects can be found in cooperative, experiential and reflexive typepedagogical constructs. Finally, « informal » and « non-formal » learning opportunitiescertainly play a role in the acquisition of knowledge and skills among health care professionals.Three teaching mechanisms frequently used during the 3rd cycle of initial medical trainingas well as in medical continuing education programs were made available to medicalstudents and physicians working in ambulatory setting. These tools, which encourageparticipants to marshal their own experiences, to reflect thoughtfully and to cooperatewith each other, can improve the skills of medical students and physicians.Each of the three teaching mechanisms studied herein, factoring in individual backgroundsand proficiencies, contain both formal and informal knowledge and skills which,as a whole, contributed to the transformation of the participants. However, it is importantto note that the distinction between formal and informal learning is primarily theoretical,and may simply depend on context or location. Therefore, rather than opposethem, it may be more appropriate to consider that these types of learning lie on a continuum.

Laboratory analyses, essential in screening, diagnosis, treatment, and monitoring of disease, are indispensable in health care, but appropriate utilization is intricate. The overall aim of this thesis was to study the use of laboratory tests in Sweden with the objective to evaluate and optimize test utilization. Considerable inter-county variations in test utilization in primary health care in Sweden were found; variations likely influenced by local traditions and habits of test ordering leading to over- as well as underutilization. Optimized test utilization was demonstrated to convey improved quality and substantial cost savings. It was further established that continuing medical education is a suitable means of optimizing test utilization, and consequently enhancing quality and cost-efficiency, as such education was demonstrated to achieve long-lasting improvements in the test ordering habits of primary health care physicians. Laboratory tests are closely associated with other, greater, health care costs, but their indirect effects on other areas of medicine are rarely evaluated or measured in monetary terms. In an illustrative example of the effects that optimal test utilization may have on associated health care costs it was demonstrated that F-calprotectin, a fecal marker of intestinal inflammation, has the potential to substantially reduce the number of invasive investigations necessary in, and the costs associated with, the diagnosis of Inflammatory Bowel Disease. Information on trends in test utilization is essential to optimal financial management of laboratories. A longitudinal evaluation revealed that test utilization had increased by 70% in 6 years, and even though the selection of tests more than doubled, a very small number of tests represented a stable, and disproportionally large, share of the total number of tests ordered. The study defines trends and thus has potential predictive values. In summary, appropriate utilization of laboratory analyses has both clinical and economical benefits on all levels of health care.

Thesis (MPhil)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The practice of medicine has always been a big area of interest as a profession. The focus ranges depending on issues at hand - it may be on the educational, training, humanistic, economic, professional ethics and legal aspects. One area of medicine that is under the spotlight around the world is that of the maintenance of clinical competency, followed very closely and almost linked to professional ethics. This study follows the introduction of a system of Continuing Professional Development (hereinafter also referred to as CPD), in South Africa and an overview of how it has been introduced in a few other countries. The main areas of focus being the extrication of inherent values of CPD, relating this aspect to quality improvement in medical health care. The medical profession as well as most of the interested parties, has different perspectives regarding the fact that the system is regulated through legislation. There is also the doubt whether the CPD system will be effective in achieving the goals that it has been set to achieve. Although a system of Continuing Medical Education has been a tradition in all countries, which implies that the CPD system is not totally new as far as the educational principles are concerned, the values accruable need to be exploited. It is the possible success of this kind of evaluations that may foster more understanding of the inherent values in this CPD system. / AFRIKAANSE OPSOMMING: Beroepsgewys het die praktyk van geneeskunde nog altyd groot belangstelling gelok. Die fokus verskuif na gelang van die onderwerpe ter sprake. Dit wissel van opvoedkunde, opleiding, humanisme, ekonomie, en professionele etiek tot regsaspekte. Dwarsoor die wêreld word daar gefokus op die handhawing van kliniese vaardighede, gevolg deur professionele etiek wat ook daarin verweef is. Hierdie studie bespreek die instelling van 'n stelsel van Voortgesette Professionele Ontwikkeling (hierna verwys na as VPO) in Suid-Afrika asook oorsig oor die wyse waarop dit in 'n paar ander lande ingestel is. Die klem lê op die inherente waardes met betrekking tot die verbetering gehalte in mediese gesondheidsorg. Die mediese beroep, asook meeste van die belangegroepe het verskillende opvattings oor die feit dat die stelsel deur wetgewing gereguleer word. Daar is ook twyfel of die VPO-stelsel in sy vooropgestelde doelwitte sal slaag. Wat die opvoedkundige beginsels betref, is die VPO-stelsel nie totaal en al nuut nie. Alhoewel VPO in ander lande tradisie is, is dit nodig om die totstandkoming van waardes te ontgin. Die moontlike sukses van hierdie tipe van evaluasies mag dalk beter begrip ten opsigte van die inherente waardes in die VPO-stelsel bevorder.

L’objectif de la présente thèse est de générer des connaissances sur les contributions possibles d’une formation continue à l’évolution des perspectives et pratiques des professionnels de la santé buccodentaire. Prônant une approche centrée sur le patient, la formation vise à sensibiliser les professionnels à la pauvreté et à encourager des pratiques qui se veulent inclusives et qui tiennent compte du contexte social des patients. L’évaluation de la formation s’inscrit dans le contexte d’une recherche-action participative de développement d’outils éducatifs et de transfert des connaissances sur la pauvreté. Cette recherche-action aspire à contribuer à la lutte contre les iniquités sociales de santé et d’accès aux soins au Québec; elle reflète une préoccupation pour une plus grande justice sociale ainsi qu’une prise de position pour une santé publique critique fondée sur une « science des solutions » (Potvin, 2013). Quatre articles scientifiques, ancrés dans une philosophie constructiviste et dans les concepts et principes de l’apprentissage transformationnel (Mezirow, 1991), constituent le cœur de cette thèse. Le premier article présente une revue critique de la littérature portant sur l’enseignement de l’approche de soins centrés sur le patient. Prenant appui sur le concept d’une « épistémologie partagée », des principes éducatifs porteurs d’une transformation de perspective à l’égard de la relation professionnel-patient ont été identifiés et analysés. Le deuxième article de thèse s’inscrit dans le cadre du développement participatif d’outils de formation sur la pauvreté et illustre le processus de co-construction d’un scénario de court-métrage social réaliste portant sur la pauvreté et l’accès aux soins. L’article décrit et apporte une réflexion, notamment sur la dimension de co-formation entre les différents acteurs des milieux académique, professionnel et citoyen qui ont constitué le collectif À l’écoute les uns des autres. Nous y découvrons la force du croisement des savoirs pour générer des prises de conscience sur soi et sur ses préjugés. Les outils développés par le collectif ont été intégrés à une formation continue axée sur la réflexion critique et l’apprentissage transformationnel, et conçue pour être livrée en cabinet dentaire privé. Les deux derniers articles de thèse présentent les résultats d’une étude de cas instrumentale évaluative centrée sur cette formation continue et visant donc à répondre à l’objectif premier de cette thèse. Le premier consiste en une analyse des transformations de perspectives et d’action au sein d’une équipe de 15 professionnels dentaires ayant participé à la formation continue sur une période de trois mois. L’article décrit, entre autres, une plus grande ouverture, chez certains participants, sur les causes structurelles de la pauvreté et une plus grande sensibilité au vécu au quotidien des personnes prestataires de l’aide sociale. L’article comprend également une exploration des effets paradoxaux dans l’apprentissage, notamment le renforcement, chez certains, de perceptions négatives à l’égard des personnes prestataires de l’aide sociale. Le quatrième article fait état de barrières idéologiques contraignant la transformation des pratiques professionnelles : 1) l’identification à l’idéologie du marché privé comme véhicule d’organisation des soins; 2) l’attachement au concept d’égalité dans les pratiques, au détriment de l’équité; 3) la prédominance du modèle biomédical, contraignant l’adoption de pratiques centrées sur la personne et 4) la catégorisation sociale des personnes prestataires de l’aide sociale. L’analyse des perceptions, mais aussi de l’expérience vécue de ces barrières démontre comment des facteurs systémiques et sociaux influent sur le rapport entre professionnel dentaire et personne prestataire de l’aide sociale. Les conséquences pour la recherche, l’éducation dentaire, le transfert des connaissances, ainsi que pour la régulation professionnelle et les politiques de santé buccodentaire, sont examinées à partir de cette perspective. / This thesis aims to generate knowledge on how a continuing education course might contribute to the evolution of oral health professionals’ perspectives and practices. Promoting patient centered care, the course aims to sensitize professionals to poverty issues and to encourage socially inclusive practices that take into account the social context of patients. The course evaluation is nested within a participatory action research project aimed at developing educational and knowledge transfer tools to sensitize oral health professionals to poverty issues and Our research strives to contribute to the fight against social inequities in health and in access to care in Québec; it is grounded in our intent for greater social justice and reflects our belief in the importance of a critical public health founded on a « science of solutions » (Potvin, 2013). Four scientific articles, grounded in constructivism and in the concepts and principles of transformative learning theory (Mezirow, 1991), constitute the heart of this thesis. The first presents a critical review of the literature on health professional education for patient-centered care. We focus on the concept of shared epistemology as a foundation for patient-centered care and determine and analyse the educational principles allowing for its development in students and practitioners. Our second article, located within the participatory developmental process, delves into the co-construction of a social realist screenplay portraying poverty and issues of access to dental care. The article examines and reflects on the participatory processes, in particular the co-learning that took place among the partners involved in writing the screenplay and in producing the educational tools on poverty. We discover the potency of shared knowledge among professionals, citizens, educators and academics for enhancing reflection on bias and perspective taking. The educational tools developed have been integrated into an onsite credited continuing education course on poverty and oral health, privileging critical reflection, founded on transformative learning theory, and integrating dimensions of person-centered care. The results of an instrumental case study among the 15 members of a dental team having participated in the course constitute the last two articles of the thesis. The first describes and analyzes the new meanings and actions among course participants, emphasizing shifts in thinking about the causes of poverty, about life on welfare, about certain patient behaviors and about the participants themselves. New actions refer to changes made in verbal and non-verbal communication and appointment giving policy. The article also examines unanticipated and paradoxical effects of learning, such as the reinforcement of certain beliefs. The final thesis article presents the case study results in terms of the participants’ experience of their workplace ideologies and how these constitute obstacles or objections to learning or to making practice or policy changes. These ideologies include 1) identification with a for-profit and private market oral health care system; 2) “equal treatment”, a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into « deserving » vs. « non-deserving » poor. This knowledge contributes to our understanding of systemic influences on professionals’ practices and interactions with patients living on welfare. We discuss implications for research, dental education and knowledge translation, as well as in terms of oral health policy and oral health professional regulation.