Made available in DSpace on 2016-03-15T19:31:18Z (GMT). No. of bitstreams: 1 Denise Maria Candiotto Caselani.pdf: 910353 bytes, checksum: da553c51d138e2dfdf723e2e42f319c3 (MD5) Previous issue date: 2009-03-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Based on the relational perspective reasoning this doctoral dissertation proposed a model that theorizes on the relationship between organizational and individual trust, cooperative behaviors and organizational performance in the sector of entertainment, specifically children parties businesses segment. An extensive literature review was conducted to better understand the definition of those variables and their theoretical relationship. The review also helped to identify scales used in previous research to measure the research variables. The identified scales were then back translated and adapted to be used in this research. The cooperative behavior scale was translated and tested in other studies conducted in Brazil and as the procedures used in those studies were reliable we used the scale from Hashiba (2008). The research instrument was pre-tested during the first part of the research in which deep interviews were conducted with manufacturers of equipment for entertaining children, like professionals toys used in parks and their customers. This phase of the study also helped to better understand the business segment and the relationship between the players in the business. In the next phase of the research the boundary spanner of each company in the business segment was contact and those that accepted to take part in the study was personally helped to fill the research questionnaire. Some 158 good responses were available in the end of data collection. The data was then analyzed using the statistical packages Stata and Amos. The last one allowed to test validation of the research constructs through SEM. Validation of the research constructs were reached and the basic model had a good fit. The results from both phases of the research show that organizational and individual trust are highly correlated but they are different constructs. Cooperative behaviors were explained by organizational trust and that only joint problem solve is the only cooperative behavior tested which explain organizational performance. The data also indicated that flexibility in the negotiation is negative related to performance. These findings corroborate previous researches in the field and also helped to further the knowledge on the subject. / Este estudo analisou as relações entre confiança, cooperação e desempenho organizacional. O tema cresceu em importância na área de administração nos últimos anos e várias são as perspectivas que o abordam e aqui optou-se pela perspectiva de governança relacional. O estudo teve como objetivo analisar relação entre confiança e desempenho em relacionamentos interorganizacionais e a interveniência da variável cooperação. Para tal, foi conduzida uma pesquisa em duas fases no setor de buffets, mais especificamente no segmento de festas infantis. A primeira fase da pesquisa foi importante para melhor entender a estrutura e a dinâmica do setor, o relacionamento entre fornecedores de brinquedos e os buffets e testar qualitativamente as escalas construídas para mensurar os construtos a partir da teoria. Foram feitas 10 entrevistas em profundidade, sendo três com fornecedores. Na fase seguinte foram coletados dados junto aos buffets. Os respondentes foram os agentes de contato das empresas para a compra de brinquedos, em geral, este papel é do proprietário do negócio, em função da relevância do investimento e a especificidade do ativo. Responderam o questionário 158 empresas. A coleta de dados foi feita usando um questionário e este foi aplicado pessoalmente. Os dados coletados relevam que a confiança interpessoal apresentou grande influência na confiança interorganizacional. Esta relação é tão intensa que houve um questionamento se os dois são comporiam um único construto. No entanto, a AFC mostrou são dois construtos. A mensuração da cooperação por meio dos comportamentos cooperativos também teve ajuste adequado e estes mostraram ter influências distintas sobre o desempenho. As duas fases da pesquisa de campo apontaram para uma relação positiva e significativa entre resolução conjunta de problemas e desempenho organizacional. Fica evidente pelas falas dos entrevistados que diferentemente da disponibilidade de se contornar o problema de fornecimento de itens como decoração e alimentos , os brinquedos com funcionamento ruim ou a falta deles faz com que os clientes não retornem e ainda façam uma campanha negativa contra o buffet. Esse resultado mostra que, quando as partes estão engajadas na solução conjunta de problemas é mais fácil encontrar soluções mutuamente satisfatórias, aumentando o sucesso da relação cliente-fornecedor, conforme argumentado por Deutsch (1969). Por outro lado, a relação negativa entre restrição ao uso de poder e desempenho ilustra bem o sentimento capturado pelas entrevistas. Os gestores dos buffets apontam como se sentem pressionados pela demanda induzida de novos brinquedos, quando têm que seguir a concorrência. A flexibilidade na negociação também não apresentou explicação significativa para o desempenho, pelo contrário, pois há indicação nas duas fases da pesquisa que a relação entre estas variáveis é negativa. Os resultados indicam que a confiança interorganizacional e indiretamente a confiança interpessoal explicam os comportamentos cooperativos entre as empresas da cadeia de fornecimento estudada pela visão dos donos do buffets. Por outro lado, apenas um os comportamentos cooperativos explica parte da variação do desempenho organizacional. O estudo corrobora estudos anteriores usados como base para este e representa um avanço nos estudos da área, em especial, pela discussão e operacionalização dos construtos que foram testados e validados com bom nível de ajuste.

Våren 2020 nådde Coronapandemin Östergötland. Tillgången till skyddsutrustning och provtagning var begränsad samtidigt som pandemin utgjorde ett allvarligt hot mot liv och hälsa. För att försöka hindra smittspridningen startade ett länsgemensamt förbättringsarbete. Syftet var att hitta och testa åtgärder som kunde vidtas på meso-/ledningsnivå för att hindra covid-19 från att nå riskgrupper inom kommunal vård och omsorg. Förbättringsarbetets mål var att innan midsommarafton 2020 skulle Ledningsgrupp vård och omsorg (LGVO) ha startat test av minst tio åtgärder för att hindra smittspridningen. Åtgärder testades kopplat till tre områden: samordna ledning och styrning i kris (t.ex. täta krisledningsmöten tillsammans med Länsstyrelsen och smittskyddsläkare), undanröja hinder för smittskydd (t.ex. tillgång till skyddsutrustning) samt verktyg för överblick (mall med gemensamma kvalitetsparametrar togs fram och följdes varje vecka). Studien genomfördes som en fallstudie där data utgjordes av en fokusgruppsintervju som analyserades med kvalitativ innehållsanalys. Syftet var att undersöka 1) hur medlemmar i en krisledningsgrupp gemensamt hanterar en kris och 2) hur de uppfattar att strategier och arbetssätt i den gemensamma krisledningen har påverkat förutsättningarna att hantera krisen. Förbättringsarbetet och studien visade att i krissituation kan förbättringskunskapens verktyg och metoder tillämpas på mesonivå. Det framkom också att dessa verktyg behövde anpassas till situationen, exempelvis på grund av avsaknaden av relevant baslinje och svårigheter att låta planeringsfasen ta den tid som egentligen skulle behövas samt behovet av att genomföra flera samtidiga förändringar. Studien visade att respondenterna uppfattade att ett gemensamt mål gynnar arbetet att hitta och testa åtgärdsförslag i krisläge. Systemtänkande, systematisk mätning och visualisering underlättade förbättringsarbete. Att balansera eftertanke och snabbt agerande ställde särskilda krav på ledarskapsstrategier. Det framkom också att tillit mellan aktörerna i systemledningen underlättade vägval i svårbedömda situationer. / In the spring of 2020, the Corona pandemic reached Region Östergötland. Access to protective equipment and virus sampling was limited, with the pandemic posing a serious threat to life and health. To prevent covid-19 from spreading, a county-wide improvement work began. The purpose was to find and test measures on a meso- /management level to prevent covid-19 from reaching risk groups located within municipal health and care. The goal was that before midsummer commence testing at least ten measures to prevent the spread of the infection. The tested measures were linked to three areas: coordination of management and control, removing infection control obstacles, and developing tools for overview. A case study was conducted with data collected through a focus group interview which was analyzed using qualitative content analysis. The purpose was to investigate 1) how members of a crisis management group jointly handled a crisis and 2) how they perceived that strategies and working methods in the joint crisis management affected the conditions for handling the crisis. The improvement work and the study showed that in a crisis, tools and methods of improvement knowledge can be applied on meso-levels. It was also shown that such tools needs to be adapted to the situation due to a lack of a relevant baseline, difficulties in allowing the planning phase to take the time needed, and a need to implement several simultaneous changes. The study showed that respondents perceive that a shared goal benefitted the discovery and testing of measures in a crisis. Systems thinking, systematic measurement and visualization also facilitated improvement work. Balancing reflection and rapid action placed special demands on leadership strategies. Also, trust between actors in the system management facilitated the choice of path in difficult-to-assess situations.

Diese Dissertation untersucht das Ausmaß der Spendenbereitschaft für Flüchtlinge und dessen individuelle sowie kontextuelle Korrelate unter einheimischen Deutschen zwischen Jahren 2015 und 2018. Die Dissertation enthält drei originäre empirische Beiträge. Im ersten empirischen Beitrag wird das Ausmaß des Spendenverhaltens für Flüchtlinge, seine regionale Variation und Veränderung im Zeitverlauf beschrieben. Das Kapitel beschreibt, wie Einstellungen und soziodemografische Merkmale mit Spenden für Flüchtlinge zusammenhängen. Ich stelle fest, dass die Spenden für Flüchtlinge besonders hoch waren bei Frauen, Menschen mit einer höheren sozioökonomischen Position und Personen mit einer positiven Einstellung zur Einwanderung. Im zweiten und dritten empirischen Beitrag werden mögliche kontextuelle korrelate für solche Spenden betrachtet. Dies wird erreicht durch die Kombination von individuellen Panelerhebungsdaten mit Sozialindikatoren auf Stadtteilebene. Die zweite empirische Studie prüft, ob das Geben an mit der Anwesenheit von Ausländern im Wohnumfeld korreliert ist. Umgebung korreliert. Es gibt keine robusten Beweise dafür, dass die Anwesenheit von verschiedenen Gruppen von Ausländern negativ mit Spenden für Flüchtlinge verbunden ist. Im letzten empirischen Kapitel wird untersucht, ob die ethnische Segregation auf Stadtebene und der Wohnsitz in den Clustern der Einheimischen negativ mit Spenden für Flüchtlinge verbunden ist. Einerseits wird manchmal eine negative Korrelation zwischen der Segregation auf Stadtebene und Spenden für Flüchtlinge festgestellt. Es gibt jedoch keine Hinweise darauf, dass Einheimische die in den Clustern der Einheimischen leben, weniger wahrscheinlich Flüchtlinge unterstützen. / This doctoral thesis analyzes extent of charitable giving to refugees and its individual as well as contextual correlates among native Germans between years 2015 and 2018. Dissertation contains three original empirical contributions. In the first empirical contribution the extent of charitable giving to refugees, its regional variation and change over time is described. Chapter describes how attitudes and socio-demographic characteristics are correlated with giving to refugees. I find that giving to refugees was especially high among females, people of higher socio-economic position and those holding positive attitude towards immigration. In the second and third empirical contributions possible environmental correlates of such giving are considered. This is achieved by combining panel survey data with fine-grained neighborhood level social indicators. Second empirical study tests if giving to refugees is correlated with presence of foreigners in the residential environment. There is lack of robust evidence that presence of various foreigner groups is negatively associated with giving to refugees. Final empirical chapter investigates if city-level ethnic segregation and residing in the clusters of natives is negatively associated with donating to refugees. On the one hand, negative correlation between city-level segregation and giving to refugees is sometimes found. There is, however, no evidence that natives living in the clusters of natives are less likely to support refugees with their donations.

Epiteloidcellig granulomatos (ECG) är en patologanatomisk diagnos (PAD) av en inflammationstyp som kan ses i orala vävnadsbiopsier. Inflammationsbilden visar infiltrat av inflammationsceller och epiteloidcelliga granulom med eller utan jätteceller, därtill kan ödematös vävnad och fibros presenteras. Makroskopiskt ses en symtombild med t ex läpp- och ansiktssvullnad, munvinkelragader och gingivala hyperplasier. Klinisk ställs exklusionsdiagnosen orofacial granulomatos (OFG). Etiologin är multifaktoriell och kan ses vid exempelvis Crohns sjukdom (CS) och sarkoidos. På Avdelning för Oral Patologi, Malmö Tandvårdshögskola, sker PAD av biopsier som vid ECG diagnoskodas med 995, vilket tilldelats 152 remissfall. Metoden utgörs av en retrospektiv uppföljning av dessa remisser med syfte att undersöka etiologin, utfört remitteringshandhavande, samt för att få en uppfattning om den orala biopsin bidragit till eventuell systemisk sjukdomsdiagnos och huruvida återkoppling mellan remissinstanserna förekommit. Vidare undersöktes om ett eventuellt samarbete mellan tandläkare och läkare praktiserats.Antalet deltagande vårdgivare i studien visar på ett intresse för ECG och dess etiologi. Misstänkt etiologi var i de flesta fall CS vilket stämde överens med ställd diagnos. Remitteringshandhavandet visade i vissa fall på bristande återkoppling mellan inkluderade vårdinstanser och vårdgivare samt avsaknad av förutbestämda remitteringsvägar. Andra remissfall visade väl fungerande samarbete mellan vårdyrken och instanser samt att den orala biopsin i vissa fall bidragit till ställd systemisk sjukdomsdiagnos. Författarna önskar att studien i förlängningen ska kunna bidra till väl fungerande kommunikation mellan berörda vårdgivare med förhoppning om snabbare handhavande, säkrare patienthantering med tidigare ställd diagnos och minskat lidande för patienterna. / Epithelioid cell granulomatosis (ECG) is a diagnosis of anatomical pathology (PAD) and a type of inflammation seen in oral biopsies. ECG presents with histological features such as epithelioid cell granuloma with or without presence of multinucleated giant cells, inflammatory cells and occasionally oedematous fibrotic changes. Clinical symptoms presents as e.g. enlargement of lips, facial swelling, angular cheilitis and gingival hyperplasia. Orofacial granulomatosis (OFG) is the clinical diagnosis given PAD ECG with a multifactorial aetiology e.g. Crohn’s disease (CS) and sarcoidosis. The Department of Oral Pathology, Faculty of Odontology, Malmö University, determine PAD of oral biopsies that when given ECG are marked with the code of diagnosis 995, given 152 referrals. This retrospective follow-up of referrals with PAD ECG aims to investigate represented aetiology, management of referrals and to get a notion of whether the oral biopsy has contributed to systemic diagnosis, if there has been any feedback between included instances and collaboration between dentists and physicians. Number of included participants could be interpreted as an interest in ECG, which most frequently showed to be CS, agreeing with later confirmed diagnosis. The management in some cases of referral lacked feedback between health professionals as well as absence of predetermined ways of referral. Others showed cooperation and that the oral biopsy had contributed to diagnosis of systemic disease. The authors wish that this study will contribute to a well functional communication between health professionals, anticipating a more efficient and secure management of patients, improvement of early diagnosis and decreased patient discomfort.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction.The study of quality of health services constitutes a major change tool and incentive for health care services, such as pharmaceutical services, meet minimum quality standards and promote a renewal of its work culture. In Brazil, however the development and evaluation of the quality of services such as Medication Review is still in its infancy and needs to be implemented aiming to improve the practices of patient care. Aim. Evaluate structure and process indicators in the implementation of Medication Review services of the ambulatory of a university hospital. Methods. The study was structured in three stages from February 2012 to March 2015. The first stage corresponded to a methodological development research, in which structure and process indicators were collected from national and international literature for use in evaluating the Medication Review services.The second stage corresponded to translation to Portuguese and the transcultural adaptation to Brazil of Scale of Attitudes Toward Physician-Pharmacist Collaboration . The third stage corresponded to a longitudinal study evaluating the process of a collaborative practice model of Medication Review service in the ambulatory of a University Hospital of Sergipe. Results. From the literature (stage 1) were surveyed in the study, 28 indicators divided into structure criteria: physical installations, human resources, material resources, documentation and financing. The evaluation of the structural indicators of Medication Review service showed that the ambulatory has met most of the criteria submitted. About the process was able to gather 54 indicators divided into two categories: 21 technical-managerial indicators and 33 technicalassistance indicators. The second stage resulted in a translated and adapted scale for the Portuguese of Brazil used to evaluate the collaborative attitudes of pharmacists and physicians. In the third stage, the analysis of Medication Review service found that 146 patients were treated on average 2.1 ± 1.1 times during the study.The prescriptions of these patients contained3,3±1,9 drugs and24,5% of them had five or more drugs. The study identified 366 drug therapy problems (DTPs) and most frequent was a indication category (67,5%) and it was observed that patients who have had four to five pharmaceutical consultations has 1.14 times more likely to have identified their DTPs (χ2= 33,83; p<0,0001). Moreover, the analysis showed that patients who had between 1-2 pharmaceutical consultations had 1.22 times more likely to have not resolved their DTPs when compared to the group with more than 3 pharmaceutical consultations (χ2= 3,44; p<0,05). This study also reported 173 pharmaceutical interventions, of which 52,6% were intended for physicians, 46,2% for students of medicine and the most of them were accepted (98,7%). Conclusion. The structure and process indicators may be used to evaluate the implementation of Medication Review service. The pharmacist can collaborate with physicians identifying and solving DTPs, as well as assisting in the monitoring and decision making on pharmacotherapy, benefiting the patient. / Introdução. O estudo da qualidade e da implementação de serviços de saúde configura um importante instrumento de mudança e incentivo para que os serviços de atenção à saúde, como os serviços farmacêuticos, cumpram padrões mínimos e promovam uma renovação da sua cultura de trabalho. No Brasil, entretanto o desenvolvimento e a avaliação da qualidade de serviços como a Revisão da Farmacoterapia ainda é incipiente e precisa ser implementada visando aprimorar as práticas de cuidado ao paciente. Objetivo. Avaliar indicadores de estrutura e processo na implementação de um serviço de Revisão da Farmacoterapia no ambulatório de um Hospital Universitário. Metodologia. O estudo foi estruturado em três etapas, de fevereiro de 2012 a março de 2015. A primeira correspondeu a uma pesquisa de desenvolvimento metodológico, na qual indicadores de estrutura e processo foram reunidos da literatura nacional e internacional para serem utilizados na avaliação do Serviço de Revisão da Farmacoterapia. A segunda etapa correspondeu tradução para o português e adaptação transcultural para o Brasil da Scale of Attitudes Toward Physician-Pharmacist Collaboration . A terceira etapa correspondeu a um estudo longitudinal que avaliou o processo de um modelo colaborativo de serviço de Revisão da Farmacoterapia no ambulatório de um Hospital Universitário de Sergipe. Resultados. A partir da literatura (etapa 1) foram levantados, no estudo, 28 indicadores de estrutura divididos nos critérios: instalações físicas, recursos humanos, recursos materiais, documentação e financiamento. A avaliação dos indicadores de estrutura do serviço de Revisão da Farmacoterapia do ambulatório estudado revelou que o mesmo atendeu a maioria dos critérios apresentados. Quanto ao processo foi possível reunir 54 indicadores divididos em duas categorias: 21 indicadores técnico-gerencias e 33 técnico-assistenciais. Da segunda etapa resultou uma escala traduzida e adaptada para o português do Brasil usada para avaliar as atitudes colaborativas de farmacêuticos e médicos. Na terceira etapa, a análise do serviço de Revisão da Farmacoterapia verificou que 146 pacientes foram atendidos em média 2,1±1,1 vezes durante o estudo. As prescrições médicas desses pacientes continham 3,3±1,9 medicamentos e 24,5% das mesmas tinham cinco ou mais medicamentos. No estudo foram identificados 366 problemas relacionados ao uso de medicamentos (PRMs) sendo a maioria de necessidade (67,5%) e foi observado que os pacientes que tiveram 4 a 5 atendimentos farmacêuticos tem 1,14 vezes mais probabilidade de terem seus PRMs identificados (χ2= 33,83; p<0,0001). Ademais, a análise demonstrou que os pacientes que tiveram entre 1 a 2 atendimentos farmacêuticos apresentaram 1,22 vezes mais probabilidade de não terem seus PRMs resolvidos quando comparado ao grupo com mais de 3 atendimentos farmacêuticos (χ2= 3,44; p<0,05). Neste estudo ainda foram notificadas 173 intervenções farmacêuticas, das quais 52,6% foram destinadas aos médicos, 46,2% aos estudantes de Medicina e a maioria delas (98,7%) foi aceita. Conclusão. Os indicadores de estrutura e processo reunidos podem ser utilizados para avaliar a implementação do Serviço de Revisão da Farmacoterapia. O farmacêutico pode colaborar com os médicos identificando e resolvendo PRMs, bem como auxiliando no monitoramento e na tomada de decisão sobre a farmacoterapia, beneficiando o paciente.

The comprehensive cancer control approach is used by state, tribes, tribal organizations, territorial and Pacific Island Jurisdiction cancer coalitions to spur local implementation of cancer plans to reduce the burden of cancer in jurisdictions across the country. There is a rich diversity of models and approaches to the development of relationships and scope of planning for cancer control activities between coalitions and advocates in local communities. The national comprehensive cancer control philosophy provides an operational framework while support from the Centers for Disease Control and Prevention enables coalitions to act as catalysts to bring local partners together to combat cancer in communities. This manuscript describes multiple characteristics of cancer coalitions and how they are organized. Two models of how coalitions and local partners collaborate are described. A case study method was used to identify how five different state and tribal coalitions use the two models to organize their collaborations with local communities that result in local implementation of cancer plan priorities. Conclusions support the use of multiple organizing models to ensure involvement of diverse interests and sensitivity to local cancer issues that encourages implementation of cancer control activities.

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences. / Being able to collaborate is a key competence that physicians need to learn. Determining competence levels is crucial to planning the learning process. By defining performance levels in qualitative terms, descriptive scales are a promising avenue. We developed a five-stage competence-level scale based on Blais, Laurier & Rousseau (2009) mixed methodology: 1) having researchers (n= 3) and a group of educators (n= 7), pedagogical leaders with expertise in the field of collaboration, list indicators that apply to the four training levels (preclinical, clerkship, junior and senior residencies); 2) conducting with clinician teachers, representative of various specialties (n= 277), an online survey that includes four questionnaires on the 118 indicator levels; 3) performing an analysis using the Rasch partial credit model on responses to questionnaires linked through concurrent calibration; 4) having educators and researchers determine the indicator levels; 5) creating a scale based on indicators at each level. The iterative analysis of the responses shows that it fits the Rasch model and distributes indicators on the linear scale on the four levels. The educators were responsible for determining the level of 111 selected indicators by taking into account the results of the survey and coherence with the curriculum. The scale includes a descriptive paragraph for each level as it applies to the 3 abilities : 1) taking part in running the team; 2) preventing and managing conflicts; 3) planning, coordinating and providing care as a team. The scale explains the collaborative behaviors expected at the end of each level and can be used to plan learning and evaluate competence. The source of disagreement between the levels set by the educators and those resulting from the analysis of clinician teacher responses are mostly explained by the low response by teachers at the preclinical level and misfit issues for the indicators describing conflict management. The research provided a broader understanding of collaboration competency and demonstrated the effectiveness of the Blais et al.1 methodology within the context of cross-curricular competency in health sciences. The methodology could be useful to go deaper into other competencies development path.

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences. / Being able to collaborate is a key competence that physicians need to learn. Determining competence levels is crucial to planning the learning process. By defining performance levels in qualitative terms, descriptive scales are a promising avenue. We developed a five-stage competence-level scale based on Blais, Laurier & Rousseau (2009) mixed methodology: 1) having researchers (n= 3) and a group of educators (n= 7), pedagogical leaders with expertise in the field of collaboration, list indicators that apply to the four training levels (preclinical, clerkship, junior and senior residencies); 2) conducting with clinician teachers, representative of various specialties (n= 277), an online survey that includes four questionnaires on the 118 indicator levels; 3) performing an analysis using the Rasch partial credit model on responses to questionnaires linked through concurrent calibration; 4) having educators and researchers determine the indicator levels; 5) creating a scale based on indicators at each level. The iterative analysis of the responses shows that it fits the Rasch model and distributes indicators on the linear scale on the four levels. The educators were responsible for determining the level of 111 selected indicators by taking into account the results of the survey and coherence with the curriculum. The scale includes a descriptive paragraph for each level as it applies to the 3 abilities : 1) taking part in running the team; 2) preventing and managing conflicts; 3) planning, coordinating and providing care as a team. The scale explains the collaborative behaviors expected at the end of each level and can be used to plan learning and evaluate competence. The source of disagreement between the levels set by the educators and those resulting from the analysis of clinician teacher responses are mostly explained by the low response by teachers at the preclinical level and misfit issues for the indicators describing conflict management. The research provided a broader understanding of collaboration competency and demonstrated the effectiveness of the Blais et al.1 methodology within the context of cross-curricular competency in health sciences. The methodology could be useful to go deaper into other competencies development path.