La simulation est largement utilisée et étudiée dans plusieurs disciplines en santé, mais son intégration dans la formation professionnelle en nutrition demeure une pratique émergente. Cette étude mixte visait à évaluer le développement des compétences professionnelles des étudiant.e.s débutant.e.s en nutrition en contexte de simulation et à connaître leur perception. Trois simulations de cinq stations chacune (dont une avec patients simulés acteurs et deux avec patients simulés étudiants) suivies d’un débreffage ont eu lieu. Les compétences des participant.e.s (n = 35) ont été évaluées par vidéo pour la première et la dernière simulation grâce à un outil inspiré des compétences intégrées pour l'enseignement et la pratique de la diététique et des groupes de discussion virtuels ont permis de nuancer les résultats et d’approfondir les perceptions des participant.e.s (n = 13). Toutes les compétences liées au professionnalisme, à la communication et aux soins nutritionnels se sont améliorées de façon statistiquement significative entre les deux temps de mesure. En plus de la démonstration des compétences, l’analyse qualitative a montré que la simulation a permis aux participant.e.s de mieux comprendre et d’appliquer les notions apprises en cours, de réaliser que le patient doit être au cœur des interventions, de se mettre dans la peau d’un.e professionnel.le et d’être bien préparé.e pour les stages cliniques en milieu externe. Ces résultats montrent que la simulation en nutrition améliore les compétences des débutant.e.s et semble consolider leurs apprentissages antérieurs, améliorer leur compréhension de l’approche centrée sur le patient et initier la formation de leur identité professionnelle. / Simulation is widely used and studied in several healthcare disciplines, but its integration into dietetics training remains an emerging practice. This mixed-methods study aimed to assess the development of professional competencies of beginner dietetics students during simulations and to understand their perceptions. Three simulations of five stations each (including one with actor-simulated patients and two with student-simulated patients) followed by a group debriefing took place. The competencies of the participants (n = 35) were assessed by video for the first and the last simulation using an evaluation tool inspired by the national Integrated Competencies for Dietetic Education and Practice, whereas virtual focus groups helped to nuance the results and deepen participants’ perceptions (n = 13). Student t tests showed that all competencies related to professionalism, communication and nutritional care improved statistically significantly between the two measurement times. In addition to the improvement of skills, the qualitative analysis showed that simulation enabled participants to better understand and apply the concepts previously learned in class, to realize that all interventions should be patient-centered, to enact a professional dietitian role and to feel prepared for their clinical placement in an external environment. These results show that simulation as a pedagogy approach improves beginners’ competencies and seems to consolidate their previous learnings, improve their understanding of the patient-centered approach and initiate the formation of their professional identity.

La Brigade militaire de Rio Grande do Sul a été créé comme un Etat militaire, de sorte que ses officiers ont formé une classe de militaires professionnels et qualifiés dans l'art de la guerre. Ainsi, les officiers de la brigade militaire est devenu une élite militaire repose sur trois éléments: la mission de l'instructeur que l'armée a commencé à former la brigade depuis 1909, le cours de préparation militaire et la vaste expérience acquise dans les guerres de guerre insurrectionnelle. L'Union, à partir de 1934, supprime le caractère belliqueux des Armée d'État en les transformant en de la police militaire. L'armée reste exclusivement militaire jusqu'en 1950 quand l'Brigade militaire commence son long processus de policialização, déclenchant l'affrontement entre les valeurs culturelles et la militaire. Le fonctionnaire professionnalisé que militaires et entraînés à la guerre ont été d'immenses difficultés à s'adapter aux modèles et aux vicissitudes des services de police où il n'y avait pas de médailles, la gloire ou glamour qui étaient habitués. Les officiers formés par l'éthos militaire, pour la plupart, à peu près résisté policialização imposées par l'Union n'a pas été facile pour les fonctionnaires, les militaires professionnels et qualifiés dans l'art de la guerre, la famine de l'adaptation des services de police. Le militaire en dépit de tout, a cimenté son policialização par le biais manifestes de police préventive, tout en gardant une grande partie de valeurs militaires. La brigade militaire policialização caractérisé comme trois types de police: ordre, la sécurité et pénales. Ainsi, la police militaire l'Armée de terre a été transformée en police d'Etat militaire et que la Constitution de 1988, sa recherche officiers du cycle complet de la police. La sédimentation de la brigade militaire et de police - qui, dans cette thèse est appelé policialização - il a été l'une des marques les plus importantes et significatives de la sécurité publique l'état. Ainsi, l'insertion de la police militaire en tant qu'organe de la sécurité publique, a redéfini le sens du rythme de police à Rio Grande do Sul. / A Brigada Militar do Estado do Rio Grande do Sul foi criada como exército estadual, de modo que seus oficiais formaram uma classe de militares profissionais e especializados na arte da guerra. Assim, os oficiais da Brigada Militar tornaram-se uma elite militar com base em três elementos: a Missão Instrutora do Exército que a passou a treinar a Brigada Militar desde 1909; o Curso de Preparação Militar e a grande experiência bélica adquirida nas guerras insurrecionais. A União, a partir de 1934, retira o caráter bélico das milícias estaduais transformando-as em polícias militares. A Brigada Militar permanece exclusivamente exército estadual até 1950 quando tem início o seu longo processo de policialização, desencadeando o choque cultural entre os valores bélico-militares e os de polícia. Os oficias profissionalizados como militares e treinados para a guerra tiveram imensas dificuldades em se adaptar aos desígnios e agruras dos serviços policias onde não havia medalhas, glória ou glamour a que estavam acostumados. Os oficiais formados pelo ethos militar, na sua maior parte, resistiram a policialização, grosso modo imposta pela União. Não foi fácil para os oficiais, militares profissionais e especializados na arte da guerra, adaptar-se aos serviços do policiamento. A Brigada Militar a despeito de tudo, sedimentou a sua policialização, através da polícia ostensiva preventiva, mantendo ainda muito dos valores bélico-militares. A Brigada Militar, no processo de policialização, avançou em três dimensões de polícia: de ordem, durante o regime militar; de segurança antes e depois do regime militar e comunitária dentro de uma perspectiva democrática. Dessa forma, a Brigada Militar foi transformada de exército estadual em força policial-militar e desde a Constituição de 1988, o sua oficialidade busca, mais abertamente, o ciclo completo de polícia. A sedimentação da Brigada Militar como polícia militar – que nesta tese é denominada de policialização - se constituiu uma das marcas mais importantes e significativas na segurança pública estadual. Assim, a inserção da Brigada Militar como órgão de segurança pública, redefiniu os rumos do policiamento ostensivo no Estado do Rio Grande do Sul. / The Military Brigade of Rio Grande do Sul was created as a military state, so that his officers have formed a class of military professionals and skilled in the art of war. Thus, the officers of the Military Brigade became a military elite based on three elements: the mission of the instructor that the Army began to train the Brigade since 1909, the Course for Military Readiness and the extensive experience gained in the wars insurrectionary war. The Union, from 1934, removes the warlike character of the state militias turning them into military police. The State Army remains exclusively until 1950 when the state begins its long process of policialização, triggering the clash between cultural values and the military and military police. The official professionalized as military and trained for war were immense difficulties in adapting to the designs and travails of police departments where there were no medals, glory or glamor that were accustomed. The officers trained by the military ethos, mostly endured policialização roughly imposed by the Union was not easy for officials, military professionals and skilled in the art of war, starvation of adapting services to policing. The Military in spite of everything, cemented his policialização through overt preventive police, still keeping much of military values and military. The Military Brigade policialização characterized as three types of police equipment order, security and criminal. Thus, the State Army was transformed into military police force and since the Constitution of 1988, its officers search the complete cycle of police. The sedimentation of the Military Brigade and police force - which in this thesis is called policialização - it was one of the most important brands and significant public safety statewide. Thus, the insertion of the Military Police as an organ of public security, has redefined the direction of beat policing in Rio Grande do Sul.

La Brigade militaire de Rio Grande do Sul a été créé comme un Etat militaire, de sorte que ses officiers ont formé une classe de militaires professionnels et qualifiés dans l'art de la guerre. Ainsi, les officiers de la brigade militaire est devenu une élite militaire repose sur trois éléments: la mission de l'instructeur que l'armée a commencé à former la brigade depuis 1909, le cours de préparation militaire et la vaste expérience acquise dans les guerres de guerre insurrectionnelle. L'Union, à partir de 1934, supprime le caractère belliqueux des Armée d'État en les transformant en de la police militaire. L'armée reste exclusivement militaire jusqu'en 1950 quand l'Brigade militaire commence son long processus de policialização, déclenchant l'affrontement entre les valeurs culturelles et la militaire. Le fonctionnaire professionnalisé que militaires et entraînés à la guerre ont été d'immenses difficultés à s'adapter aux modèles et aux vicissitudes des services de police où il n'y avait pas de médailles, la gloire ou glamour qui étaient habitués. Les officiers formés par l'éthos militaire, pour la plupart, à peu près résisté policialização imposées par l'Union n'a pas été facile pour les fonctionnaires, les militaires professionnels et qualifiés dans l'art de la guerre, la famine de l'adaptation des services de police. Le militaire en dépit de tout, a cimenté son policialização par le biais manifestes de police préventive, tout en gardant une grande partie de valeurs militaires. La brigade militaire policialização caractérisé comme trois types de police: ordre, la sécurité et pénales. Ainsi, la police militaire l'Armée de terre a été transformée en police d'Etat militaire et que la Constitution de 1988, sa recherche officiers du cycle complet de la police. La sédimentation de la brigade militaire et de police - qui, dans cette thèse est appelé policialização - il a été l'une des marques les plus importantes et significatives de la sécurité publique l'état. Ainsi, l'insertion de la police militaire en tant qu'organe de la sécurité publique, a redéfini le sens du rythme de police à Rio Grande do Sul. / A Brigada Militar do Estado do Rio Grande do Sul foi criada como exército estadual, de modo que seus oficiais formaram uma classe de militares profissionais e especializados na arte da guerra. Assim, os oficiais da Brigada Militar tornaram-se uma elite militar com base em três elementos: a Missão Instrutora do Exército que a passou a treinar a Brigada Militar desde 1909; o Curso de Preparação Militar e a grande experiência bélica adquirida nas guerras insurrecionais. A União, a partir de 1934, retira o caráter bélico das milícias estaduais transformando-as em polícias militares. A Brigada Militar permanece exclusivamente exército estadual até 1950 quando tem início o seu longo processo de policialização, desencadeando o choque cultural entre os valores bélico-militares e os de polícia. Os oficias profissionalizados como militares e treinados para a guerra tiveram imensas dificuldades em se adaptar aos desígnios e agruras dos serviços policias onde não havia medalhas, glória ou glamour a que estavam acostumados. Os oficiais formados pelo ethos militar, na sua maior parte, resistiram a policialização, grosso modo imposta pela União. Não foi fácil para os oficiais, militares profissionais e especializados na arte da guerra, adaptar-se aos serviços do policiamento. A Brigada Militar a despeito de tudo, sedimentou a sua policialização, através da polícia ostensiva preventiva, mantendo ainda muito dos valores bélico-militares. A Brigada Militar, no processo de policialização, avançou em três dimensões de polícia: de ordem, durante o regime militar; de segurança antes e depois do regime militar e comunitária dentro de uma perspectiva democrática. Dessa forma, a Brigada Militar foi transformada de exército estadual em força policial-militar e desde a Constituição de 1988, o sua oficialidade busca, mais abertamente, o ciclo completo de polícia. A sedimentação da Brigada Militar como polícia militar – que nesta tese é denominada de policialização - se constituiu uma das marcas mais importantes e significativas na segurança pública estadual. Assim, a inserção da Brigada Militar como órgão de segurança pública, redefiniu os rumos do policiamento ostensivo no Estado do Rio Grande do Sul. / The Military Brigade of Rio Grande do Sul was created as a military state, so that his officers have formed a class of military professionals and skilled in the art of war. Thus, the officers of the Military Brigade became a military elite based on three elements: the mission of the instructor that the Army began to train the Brigade since 1909, the Course for Military Readiness and the extensive experience gained in the wars insurrectionary war. The Union, from 1934, removes the warlike character of the state militias turning them into military police. The State Army remains exclusively until 1950 when the state begins its long process of policialização, triggering the clash between cultural values and the military and military police. The official professionalized as military and trained for war were immense difficulties in adapting to the designs and travails of police departments where there were no medals, glory or glamor that were accustomed. The officers trained by the military ethos, mostly endured policialização roughly imposed by the Union was not easy for officials, military professionals and skilled in the art of war, starvation of adapting services to policing. The Military in spite of everything, cemented his policialização through overt preventive police, still keeping much of military values and military. The Military Brigade policialização characterized as three types of police equipment order, security and criminal. Thus, the State Army was transformed into military police force and since the Constitution of 1988, its officers search the complete cycle of police. The sedimentation of the Military Brigade and police force - which in this thesis is called policialização - it was one of the most important brands and significant public safety statewide. Thus, the insertion of the Military Police as an organ of public security, has redefined the direction of beat policing in Rio Grande do Sul.

La Brigade militaire de Rio Grande do Sul a été créé comme un Etat militaire, de sorte que ses officiers ont formé une classe de militaires professionnels et qualifiés dans l'art de la guerre. Ainsi, les officiers de la brigade militaire est devenu une élite militaire repose sur trois éléments: la mission de l'instructeur que l'armée a commencé à former la brigade depuis 1909, le cours de préparation militaire et la vaste expérience acquise dans les guerres de guerre insurrectionnelle. L'Union, à partir de 1934, supprime le caractère belliqueux des Armée d'État en les transformant en de la police militaire. L'armée reste exclusivement militaire jusqu'en 1950 quand l'Brigade militaire commence son long processus de policialização, déclenchant l'affrontement entre les valeurs culturelles et la militaire. Le fonctionnaire professionnalisé que militaires et entraînés à la guerre ont été d'immenses difficultés à s'adapter aux modèles et aux vicissitudes des services de police où il n'y avait pas de médailles, la gloire ou glamour qui étaient habitués. Les officiers formés par l'éthos militaire, pour la plupart, à peu près résisté policialização imposées par l'Union n'a pas été facile pour les fonctionnaires, les militaires professionnels et qualifiés dans l'art de la guerre, la famine de l'adaptation des services de police. Le militaire en dépit de tout, a cimenté son policialização par le biais manifestes de police préventive, tout en gardant une grande partie de valeurs militaires. La brigade militaire policialização caractérisé comme trois types de police: ordre, la sécurité et pénales. Ainsi, la police militaire l'Armée de terre a été transformée en police d'Etat militaire et que la Constitution de 1988, sa recherche officiers du cycle complet de la police. La sédimentation de la brigade militaire et de police - qui, dans cette thèse est appelé policialização - il a été l'une des marques les plus importantes et significatives de la sécurité publique l'état. Ainsi, l'insertion de la police militaire en tant qu'organe de la sécurité publique, a redéfini le sens du rythme de police à Rio Grande do Sul. / A Brigada Militar do Estado do Rio Grande do Sul foi criada como exército estadual, de modo que seus oficiais formaram uma classe de militares profissionais e especializados na arte da guerra. Assim, os oficiais da Brigada Militar tornaram-se uma elite militar com base em três elementos: a Missão Instrutora do Exército que a passou a treinar a Brigada Militar desde 1909; o Curso de Preparação Militar e a grande experiência bélica adquirida nas guerras insurrecionais. A União, a partir de 1934, retira o caráter bélico das milícias estaduais transformando-as em polícias militares. A Brigada Militar permanece exclusivamente exército estadual até 1950 quando tem início o seu longo processo de policialização, desencadeando o choque cultural entre os valores bélico-militares e os de polícia. Os oficias profissionalizados como militares e treinados para a guerra tiveram imensas dificuldades em se adaptar aos desígnios e agruras dos serviços policias onde não havia medalhas, glória ou glamour a que estavam acostumados. Os oficiais formados pelo ethos militar, na sua maior parte, resistiram a policialização, grosso modo imposta pela União. Não foi fácil para os oficiais, militares profissionais e especializados na arte da guerra, adaptar-se aos serviços do policiamento. A Brigada Militar a despeito de tudo, sedimentou a sua policialização, através da polícia ostensiva preventiva, mantendo ainda muito dos valores bélico-militares. A Brigada Militar, no processo de policialização, avançou em três dimensões de polícia: de ordem, durante o regime militar; de segurança antes e depois do regime militar e comunitária dentro de uma perspectiva democrática. Dessa forma, a Brigada Militar foi transformada de exército estadual em força policial-militar e desde a Constituição de 1988, o sua oficialidade busca, mais abertamente, o ciclo completo de polícia. A sedimentação da Brigada Militar como polícia militar – que nesta tese é denominada de policialização - se constituiu uma das marcas mais importantes e significativas na segurança pública estadual. Assim, a inserção da Brigada Militar como órgão de segurança pública, redefiniu os rumos do policiamento ostensivo no Estado do Rio Grande do Sul. / The Military Brigade of Rio Grande do Sul was created as a military state, so that his officers have formed a class of military professionals and skilled in the art of war. Thus, the officers of the Military Brigade became a military elite based on three elements: the mission of the instructor that the Army began to train the Brigade since 1909, the Course for Military Readiness and the extensive experience gained in the wars insurrectionary war. The Union, from 1934, removes the warlike character of the state militias turning them into military police. The State Army remains exclusively until 1950 when the state begins its long process of policialização, triggering the clash between cultural values and the military and military police. The official professionalized as military and trained for war were immense difficulties in adapting to the designs and travails of police departments where there were no medals, glory or glamor that were accustomed. The officers trained by the military ethos, mostly endured policialização roughly imposed by the Union was not easy for officials, military professionals and skilled in the art of war, starvation of adapting services to policing. The Military in spite of everything, cemented his policialização through overt preventive police, still keeping much of military values and military. The Military Brigade policialização characterized as three types of police equipment order, security and criminal. Thus, the State Army was transformed into military police force and since the Constitution of 1988, its officers search the complete cycle of police. The sedimentation of the Military Brigade and police force - which in this thesis is called policialização - it was one of the most important brands and significant public safety statewide. Thus, the insertion of the Military Police as an organ of public security, has redefined the direction of beat policing in Rio Grande do Sul.

Nous rapportons une analyse des 1045 écrits narratifs produits sur une période de 16 ans par des étudiants de troisième année de médecine, dans le cadre d’un atelier sur l’éthique et le professionnalisme. À l’occasion de chaque stage de chirurgie effectué dans un des centres hospitaliers affiliés au département de chirurgie de l’Université de Montréal, les étudiants devaient identifier les enjeux éthiques ou de professionnalisme, rencontrés durant le stage. Par la suite, ils devaient dans un essai en raconter la nature et aussi discuter de leur accord avec les décisions prises par les supérieurs dans le cas de l’éthique clinique ou dans le cas de professionnalisme émettre une opinion sur les attitudes et comportements observés chez les cliniciens ou des résidents. Nous avons constaté que le questionnement des étudiants était majoritairement dirigé sur les problèmes de professionnalisme. La communication avec les patients et leurs familles, l’annonce de mauvaises nouvelles, l’obtention d’un consentement, la révélation de la vérité ou d’une erreur médicale et les relations avec les collègues représentaient la majorité des dilemmes rapportés par les étudiants dans leurs narratifs. Nous avons pu comprendre, à la lecture des écrits, les préoccupations éthiques de nos étudiants et les bases de leur raisonnement moral. Nous avons découvert la nature du curriculum caché dans notre milieu hospitalier et les rôles modèles que jouaient auprès des étudiants nos cliniciens et des résidents. Nous avons fait la comparaison avec la littérature existante sur le sujet. Ce travail a permis de valider l’efficacité de la stratégie pédagogique adoptée pour initier les étudiants à l’approche narrative en éthique et pour produire des narratifs signifiants et de qualité. Notre étude se distingue par la longueur de l’observation et le nombre élevé de narratifs analysés. Nous pouvons donc à partir de notre expérience suggérer des recommandations pour la formation et la recherche. Développer une compétence narrative chez les étudiants dès le début de la formation en médecine serait un avantage pour une pratique humaniste et participerait à la construction de l’identité professionnelle. / This is an analysis of 1045 narrative writings produced by third-year medical students over a 16- year period as part of a workshop on ethics and professionalism held during each surgical internship completed in a hospital affiliated with the Department of Surgery at the Université de Montréal. The students were asked to identify an ethical or professionalism issue they encountered during their rotation in surgery, and then to recount this, followed by comments on the ethical rationale for the decisions taken in the actual case. They were also asked to discuss their agreement with decisions made by superiors in the case of clinical ethics or professionalism dilemmas, and the attitudes and behavior observed among clinicians or residents. The analysis indicates that most of the students’ questioning focused on issues of professionalism. Communication with patients and their families, giving bad news, obtaining consent, revealing the truth or a medical error, and relationship with colleagues represented most dilemmas reported by students in their narratives. In reading the narratives, I was able to identify our students’ ethical concerns and the basis of their moral reasoning. I discovered the nature of the hidden curriculum in our institution and the role models our clinicians and residents played for the students. I further reviewed the literature for a comparison with my own observations. This work validated the effectiveness of the pedagogical strategy adopted to introduce students to the narrative approach to ethics and to produce meaningful, high-quality narratives. This study stands out for the length of the observation and the high number of narratives analyzed. Based on this experience, I can therefore suggest recommendations for training and research. Developing narrative skills in students right from the start of their medical training would be an advantage for humanist practice and would help build their professional identity.