Still a 'boys' club': a qualitative analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand.

Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under-represented in all areas of anaesthetic research, academia and leadership. The Gender Equity Subcommittee of the Australian and New Zealand College of Anaesthetists recently conducted a survey asking "Does gender still matter in the pursuit of a career in anaesthesia in 2022?". The survey was distributed to a randomly selected sample of 1225 anaesthetic consultants and completed by 470 respondents (38% response rate) with 793 free-text comments provided. Three overarching themes were identified: gender effects on the career and family interface; women do not fit the mould; and gender equity changes the status quo. Women respondents described a need to make a choice between career and family, which was not described by men, as well as stigmatisation of part-time work, a lack of access to challenging work and negative impacts of parental leave. Women respondents also described a sense of marginalisation within anaesthesia due to a 'boys' club' mentality, a lack of professional respect and insufficient structural supports for women in leadership. This was compounded for women from ethnically and culturally diverse backgrounds. A need for specific strategies to support anaesthetic careers for women was described as well as normalisation of flexibility in workplaces, combined with a broadening of our definition of success to allow people of all genders to experience fulfilment both at home and at work. This study is the first published qualitative data on factors affecting gender equity for anaesthetists in Australia and Aotearoa New Zealand. It highlights the need for further exploration, as well providing a foundation for changes in attitude and structural changes towards advancing gender equity.

Partner Exclusion from Childbirth During COVID-19 in Canada: Implications for Theory and Policy.

We explore partner exclusion from perinatal care in Canada during the COVID-19 pandemic. Participants' narratives show that pregnant couples frame partner presence as a [human] right that was denied, and articulated this as denial of the "right to experience" and the "right to care." These restrictions deprived birth partners and families of an experience that is important to them, and represent a repudiation of the resurgence of birth as a social event which entails valued forms of care. We show that the medical establishment's commitment to partner presence during perinatal care is weak, although caring masculinity is normative.

"Learning by osmosis": the transformative social identity journey of physiotherapists developing psychologically-informed practice, a reflexive thematic analysis.

BACKGROUND: Despite efforts to support physiotherapists in integrating psychosocial aspects of care to biological ones, clinical practice remains dominated by biomechanistic priorities. To facilitate change, attention and actions need to consider not only the individual level of the therapists but also the cultural and structural levels of the profession. How these multi-layered social dynamics shape practice have not previously been investigated. The Social Identity Approach (SIA) provides a relevant framework to this exploration. AIM: This study aimed to identify the social identity processes involved in the development of psychologically-informed physiotherapy (PIP) to understand how they may influence practice change. METHODS: Nine semi-structured interviews were conducted with self-identified psychologically-informed physiotherapists. A Reflexive Thematic Analysis informed by SIA principles enabled to consider meaning as the product of social processes. FINDINGS: The analysis of participants' experiences in moving from a primarily biomechanistic practice toward the integration of psychosocial aspects of health demonstrated: 1) a transformative "mind-blowing" identity journey; 2) a journey that is not made in isolation; and 3) where leadership matters. CONCLUSION: Changes in clinical practice involve dynamics at the collective level of the practice environment and of the physiotherapy profession itself, rather than solely at the individual level of clinicians. An understanding of these complex social processes at a managerial level could be important to better support leaders and clinicians in implementing PIP in clinical practice.

Cultura de la profesión: su operacionalización en la universidad médica cubana

RESUMEN Introducción: la cultura de la profesión resulta un concepto complejo e imprescindible en el contexto actual, debido a la prioridad que le concede el Estado y el Gobierno cubanos a la formación integral como elemento esencial de la calidad académica que exige la educación superior. Objetivo: conceptualizar la cultura de la profesión y su operacionalización en la educación médica superior cubana contemporánea. Materiales y métodos: se realizó el análisis de contenido de un conjunto de documentos programáticos y normativos esenciales a diferentes niveles; se hizo una revisión bibliográfica de los principales autores que han abordado el tema, y se contrastaron los principales presupuestos teórico-conceptuales y prácticos, a través de la triangulación. Resultados: se evidenció la carencia de un cuerpo teórico-conceptual de la cultura de la profesión, y la necesidad e importancia de este en la formación integral, valores profesionales e identitarios que prioriza la educación superior cubana, en particular en la educación médica superior. Conclusiones: la cultura de la profesión es parte esencial del modelo de formación del profesional cubano, y constituye un elemento de su memoria histórica. Por ello adquiere relevancia en la formación de valores profesionales identitarios, especialmente en el profesional de la salud, y debe consolidarse en los documentos normativos desde lo teórico-conceptual y operacional, a partir de proyectos integradores.

ABSTRACT Introduction: professional culture is a complex and essential concept in the current context, due to the priority granted by Cuban state and government to the comprehensive training as essential element of the academic quality higher education exacts. Objective: to conceptualize professional culture and its operationalization in present-day Cuban higher medical education. Materials and methods: the authors performed the content analysis of a group of essential programmatic and normative documents at different levels, carried out a bibliographic review of the main authors that approached the theme, and contrasted the main theoretic-conceptual and practical presuppositions by triangulation. Results: it was evidenced the lack of a theoretic-conceptual body on professional culture, and its necessity and importance in the comprehensive training and formation of professional and identity values prioritized by Cuban higher education, mainly by higher medical education. Conclusions: professional culture is an essential part of the training of the Cuban professional, and is an element of its historic memory. Because of that it is relevant in the training of identity professional values, especially in health professionals, and it should be consolidated in the normative documents from the theoretic-conceptual and operational point of view, through comprehensive projects.

Owning educational change in Korean schools: three driving forces behind sustainable change.

In this essay, we discuss how the COVID-19 pandemic drove key changes in schooling and what forces can sustain these changes. Responding to the argument that COVID-19-driven changes may not be sustainable, this essay offers a counter narrative from the Korean context, in which educators re-visited existing school systems and re-constructed policies and teaching practices to fill the educational vacuum caused by the pandemic. This essay specifically builds on interviews conducted with Korean educators throughout the 2020 school year during COVID-19. First, we discuss ownership of educational change as reflected in educators' narratives. We then explore three driving forces behind the transformation of the "grammar of Korean schooling": policy discourse about "future education," professional teaching culture, and administration for creativity. Based on our analysis, we offer several suggestions for policymakers, district leaders, and educators around the world for how to leverage and sustain the educational changes catalyzed by COVID-19. We conclude by arguing that educators' desires to achieve change must be actualized in schools and policies through collaborative foresight and system-level support.

Networks as culture: understanding and accounting for risks within networks of medico-social actors.

The anthropological part of the present research project addresses the issue of risk and uncertainties relating to perinatality and disability, and draws from the discourses of professionals in a perinatal network in the French Lorraine region. From an anthropological point of view, it is necessary to determine how and to what extent the views of professionals determine the network's management policies. The place conferred to 'the user' in these representations is one of several important issues to be analysed in order to gain better understanding of the management of relationships that result from it. What is the position of professionals who 'negotiate' and 'organise' the cost of the risk of disability when grasped in connection with their images of the 'users' (children and parents)? This qualitative study consisted of 40 semi-structured interviews conducted with 20 medical, social, and community professionals, all involved directly or indirectly with the network. The results demonstrate the importance of a network assessment as a 'culture' from the social and cultural relations of network professionals. These relations form the cement of a structure made of interpersonal ties and rooted in particular histories around a 'user' that are conveyed through individual narratives.

Professional Culture in Medical Schools: A Medical Educator Interpretation.

Besides sharing knowledge, values, and attitudes, the members of a profession share a way of understanding how to perceive life, also known as professional identity. The formation of this identity is related to the acquisition of multiple roles, responsibilities, and collaboration, defining their professional culture. The medical educator is a professional who is committed to student development, who is a leader in his field, and who is active in academic or clinical activities, demonstrating the commitment to the community. The objective of this study was to explore the professional culture through the perception of the medical educator identity. A qualitative method was implemented by applying a content analysis strategy. A sample of 39 medical educators participated in structured interviews. Answers transcription was analyzed unitizing assumptions, effects, enablers, and barriers through the professional culture model: individualism, balkanized, collegiality per project, and extended collaboration. The definition of the medical educator was associated with 44% to individualism, 31% balkanized, 13% collegiality per project, and 13% extended collaboration. Generally, contributions from Basic Science educators are more individual, and the projects in the university are part of the operation planned for the short and medium term. Clinical Science educators are used to working in medical specialty groups, and some of them are involved in strategical social projects that provide care for the community. A cultural change transitioning from a highly autonomous strategy toward meaningful collaborative projects can help physicians and health professionals to develop a shared vision of what it means to be a medical educator. The medical school should provide a sense of collegial community environment to set common goals and expectations with adequate resources, and leadership is the standard.

Nephrology in the Academic Intensive Care Unit: A Qualitative Study of Interdisciplinary Collaboration.

RATIONALE & OBJECTIVE: Collaboration between nephrology consultants and intensive care unit (ICU) teams is important in light of the high incidence of acute kidney injury in today's ICUs. Although there is considerable debate about how nephrology consultants and ICU teams should collaborate, communicative dynamics between the 2 parties remain poorly understood. This article describes interactions between nephrology consultants and ICU teams in the academic medical setting. STUDY DESIGN: Focused ethnography using semi-structured interviews and participant observation. SETTING & PARTICIPANTS: Purposive sampling was used to enroll nephrologists, nephrology fellows, and ICU practitioners across several roles collaborating in 3 ICUs (a medical ICU, a surgical ICU, and a cardiothoracic surgical ICU) of a large urban US academic medical center. Participant observation (150 hours) and semi-structured interviews (35) continued until theoretical saturation. ANALYTICAL APPROACH: Interview and fieldnote transcripts were coded in an iterative team-based process. Explanation was developed using an abductive approach. RESULTS: Nephrology consultants and surgical ICU teams exhibited discordant preferences about the aggressiveness of renal replacement therapy based on different understandings of physiology, goals of care, and acuity. Collaborative difficulties resulting from this discordance led to nephrology consultants often serving as dialysis proceduralists rather than diagnosticians in surgical ICUs and to consultants sometimes choosing not to express disagreements about clinical care because of the belief that doing so would not lead to changes in the course of care. LIMITATIONS: Aspects of this single-site study of an academic medical center may not be generalizable to other clinical settings and samples. Surgical team perspectives would provide further detail about nephrology consultation in surgical ICUs. The effects of findings on patient care were not examined. CONCLUSIONS: Differences in approach between internal medicine-trained nephrologists and anesthesia- and surgery-trained intensivists and surgeons led to collaborative difficulties in surgical ICUs. These findings stress the need for medical teamwork research and intervention to address issues stemming from disciplinary siloing rooted in long-term socialization to different disciplinary practices.

Acceptability, attitudes and knowledge towards Transcranial Magnetic Stimulation (TMS) among psychiatrists in France.

BACKGROUND: Non-invasive brain stimulation techniques are becoming a part of psychiatrists' therapeutic arsenal. Proof of TMS effectiveness and its indications are becoming clearer. While international recommendations exist, and many countries have already recognized the use of these techniques, the French situation is peculiar since no recommendation has been published by the High Authority of Health. Consequently, those techniques are not reimbursed by the healthcare service, few practitioners are trained, some are criticized for using it, and practices remain very heterogeneous. It is therefore important to investigate what slows down the development of these techniques. The objective of this study was to determine the acceptability of TMS by psychiatrists and to analyze the factors influencing it. METHOD: A sample of psychiatrists was recruited in order to complete an online quantitative acceptability study using a four variable domain model (utility, intention of use, facility, risk) allowing an acceptability score calculation. RESULT: Four hundreds and seventy-six observations were included in the analysis. Regarding the main objective, the overall TMS acceptability score was high for 47.2% of psychiatrists, average for 40.6% and low for 12.1% of them. The main factors influencing it were theoretical orientation (psychoanalytic vs neurobiological) and training level (only one in three psychiatrists acknowledge having been trained in this technique). DISCUSSION: The majority of practitioners consider TMS to be a credible alternative to current therapies, especially for depressive disorders. Yet psychiatrists are uninformed and poorly trained in these techniques and report very clearly a desire for more training and information. Our study highlights a significant lack of training that negatively impacts the accessibility of these techniques.

Are student nurses ready for new technologies in mental health? Mixed-methods study.

BACKGROUND: Technical innovations such as ecological momentary assessment (EMA), machine learning (ML), computerized adaptive testing (CAT), Digital Phenotyping, Clinical Decision Support Systems (CDSS), Algorithms, and Biomarkers have caused a paradigm shift in psychiatric care. The aim of the present study was to explore how student nurses view this paradigm shift, by assessing the acceptability of smartphone-based EMA, CAT, and biosensor-based Digital Phenotyping. We also investigated the factors affecting this acceptability. METHOD: Student nurses recruited via nursing schools participated in a quantitative study involving the screenplay method, in which they were exposed to two scenarios about depression care, one featuring EMA and CAT, the other featuring a connected wristband (CW) for Digital Phenotyping. Four acceptability domains (usefulness, usability, reliability, risk) were investigated. RESULTS: We recorded 1216 observations for the first scenario and 1106 for the second. Regarding overall acceptability, the CW was viewed less positively than CAT and EMA. Regarding reliability, whereas respondents believed that the CW could correctly detect depressive relapse, they did not think that EMA and CAT were sufficiently reliable for the accurate diagnosis of depressive disorder. More than 70% of respondents stated that they would nevertheless be interested in offering EMA, CAT or CW to their patients, but more than 60% feared that these devices might hinder the therapeutic relationship. CONCLUSION: This was the first study assessing student nurses' views of EMA, CAT and CW-based digital phenotyping. Respondents were interested in these new technologies and keen to offer them to their patients. However, our study highlighted several issues, as respondents doubted the reliability of these devices and feared that they would hinder the therapeutic relationship. Subgroup analysis revealed correspondences between acceptability profiles and demographic profiles. It is therefore essential for nurses and student nurses to receive training and become involved in the development of this new technologies.

The role of organizational and professional cultures in medication safety: a scoping review of the literature.

PURPOSE: This scoping review explores what is known about the role of organizational and professional cultures in medication safety. The aim is to increase our understanding of 'cultures' within medication safety and provide an evidence base to shape governance arrangements. DATA SOURCES: Databases searched are ASSIA, CINAHL, EMBASE, HMIC, IPA, MEDLINE, PsycINFO and SCOPUS. STUDY SELECTION: Inclusion criteria were original research and grey literature articles written in English and reporting the role of culture in medication safety on either organizational or professional levels, with a focus on nursing, medical and pharmacy professions. Articles were excluded if they did not conceptualize what was meant by 'culture' or its impact was not discussed. DATA EXTRACTION: Data were extracted for the following characteristics: author(s), title, location, methods, medication safety focus, professional group and role of culture in medication safety. RESULTS OF DATA SYNTHESIS: A total of 1272 citations were reviewed, of which, 42 full-text articles were included in the synthesis. Four key themes were identified which influenced medication safety: professional identity, fear of litigation and punishment, hierarchy and pressure to conform to established culture. At times, the term 'culture' was used in a non-specific and arbitrary way, for example, as a metaphor for improving medication safety, but with little focus on what this meant in practice. CONCLUSIONS: Organizational and professional cultures influence aspects of medication safety. Understanding the role these cultures play can help shape both local governance arrangements and the development of interventions which take into account the impact of these aspects of culture.

Psychiatrists' Attitudes Toward Disruptive New Technologies: Mixed-Methods Study.

BACKGROUND: Recent discoveries in the fields of machine learning (ML), Ecological Momentary Assessment (EMA), computerized adaptive testing (CAT), digital phenotype, imaging, and biomarkers have brought about a new paradigm shift in medicine. OBJECTIVE: The aim of this study was to explore psychiatrists' perspectives on this paradigm through the prism of new clinical decision support systems (CDSSs). Our primary objective was to assess the acceptability of these new technologies. Our secondary objective was to characterize the factors affecting their acceptability. METHODS: A sample of psychiatrists was recruited through a mailing list. Respondents completed a Web-based survey. A quantitative study with an original form of assessment involving the screenplay method was implemented involving 3 scenarios, each featuring 1 of the 3 support systems, namely, EMA and CAT, biosensors comprising a connected wristband-based digital phenotype, and an ML-based blood test or magnetic resonance imaging (MRI). We investigated 4 acceptability domains based on International Organization for Standardization and Nielsen models (usefulness, usability, reliability, and risk). RESULTS: We recorded 515 observations. Regarding our primary objective, overall acceptability was moderate. MRI coupled with ML was considered to be the most useful system, and the connected wristband was considered the least. All the systems were described as risky (410/515, 79.6%). Regarding our secondary objective, acceptability was strongly influenced by socioepidemiological variables (professional culture), such as gender, age, and theoretical approach. CONCLUSIONS: This is the first study to assess psychiatrists' views on new CDSSs. Data revealed moderate acceptability, but our analysis shows that this is more the result of the lack of knowledge about these new technologies rather than a strong rejection. Furthermore, we found strong correspondences between acceptability profiles and professional culture profiles. Many medical, forensics, and ethical issues were raised, including therapeutic relationship, data security, data storage, and privacy risk. It is essential for psychiatrists to receive training and become involved in the development of new technologies.

The Professional Culture of Community Pharmacy and the Provision of MTM Services.

The integration of advanced pharmacy services into community pharmacy practice is not complete. According to implementation research understanding professional culture, as a part of context, may provide insights for accelerating this process. There are three objectives in this study. The first objective of this study was to validate an adapted version of an organizational culture measure in a sample of United States' (US) community pharmacists. The second objective was to examine potential relationships between the cultural factors identified using the validated instrument and a number of socialization and education variables. The third objective was to examine any relationships between the scores on the identified cultural factors and the provision of MTM services. This study was a cross-sectional online survey for community pharmacists in the southeastern US. The survey contained questions on socialization/education, respondents' self-reported provision of medication therapy management (MTM) services, and the organizational culture profile (OCP). Analyses included descriptive statistics, a principle components analysis (PCA), independent samples t-test, and multivariate ordinal regression. A total of 303 surveys were completed. The PCA revealed a six-factor structure: social responsibility, innovation, people orientation, competitiveness, attention to detail, and reward orientation. Further analysis revealed significant relationships between social responsibility and years in practice, and people orientation and attention to detail and pharmacists' training and practice setting. Significant positive relationships were observed between social responsibility, innovation, and competitiveness and the increased provision of MTM services. The significant relationships identified between the OCP factors and community pharmacist respondents' provision of MTM services provides an important starting point for developing interventions to improve the uptake of practice change opportunities.

[Assessment of mood disorders by passive data gathering: The concept of digital phenotype versus psychiatrist's professional culture]. / Évaluation des troubles thymiques par l'étude des données passives : le concept de phénotype digital à l'épreuve de la culture de métier de psychiatre.

OBJECTIVES: The search for objective clinical signs is a constant practitioners' and researchers' concern in psychiatry. New technologies (embedded sensors, artificial intelligence) give an easier access to untapped information such as passive data (i.e. that do not require patient intervention). The concept of "digital phenotype" is emerging in psychiatry: a psychomotor alteration translated by accelerometer's modifications contrasting with the usual functioning of the subject, or the graphorrhea of patients presenting a manic episode which is replaced by an increase of SMS sent. Our main objective is to highlight the digital phenotype of mood disorders by means of a selective review of the literature. METHOD: We conducted a selective review of the literature by querying the PubMed database until February 2017 with the terms [Computer] [Computerized] [Machine] [Automatic] [Automated] [Heart rate variability] [HRV] [actigraphy] [actimetry] [digital] [motion] [temperature] [Mood] [Bipolar] [Depression] [Depressive]. Eight hundred and forty-nine articles were submitted for evaluation, 37 articles were included. RESULTS: For unipolar disorders, smartphones can diagnose depression with excellent accuracy by combining GPS and call log data. Actigraphic measurements showing daytime alteration in basal function while ECG sensors assessing variation in heart rate variability (HRV) and body temperature appear to be useful tools to diagnose a depressive episode. For bipolar disorders, systems which combine several sensors are described: MONARCA, PRIORI, SIMBA and PSYCHE. All these systems combine passive and active data on smartphones. From a synthesis of these data, a digital phenotype of the disorders is proposed based on the accelerometer and the GPS, the ECG, the body temperature, the use of the smartphone and the voice. This digital phenotype thus brings into question certain clinical paradigms in which psychiatrists evolve. CONCLUSION: All these systems can be used to computerize the clinical characteristics of the various mental states studied, sometimes with greater precision than a clinician could do. Most authors recommend the use of passive data rather than active data in the context of bipolar disorders because automatically generated data reduce biases and limit the feeling of intrusion that self-questionnaires may cause. The impact of these technologies questions the psychiatrist's professional culture, defined as a specific language and a set of common values. We address issues related to these changes. Impact on psychiatrists could be important because their unity seems to be questioned due to technologies that profoundly modify the collect and process of clinical data.

80 anos do Serviço Social brasileiro: conquistas históricas e desafios na atual conjuntura / 80 years of the Brazilian Social Work: historical achievements and challenges in the current situation

Resumo: Expõe as conquistas históricas do Serviço Social brasileiro nos seus 80 anos de existência. Aponta os desafios da profissão na atual conjuntura e ressalta o significado do Projeto Ético-Político do Serviço Social. Conclui que nas três últimas décadas o Serviço Social ampliou sua função intelectual, contribuindo para a formação da cultura profissional, que se contrapõe à hegemonia das classes dominantes, em orgânica articulação com a esquerda marxista no Brasil.

Abstract: The article presents the historical achievements of the Brazilian Social Work in its 80 years´ existence. It shows its professional challenges in the current situation, and it stresses the meaning of its ethical and political project. The article finishes by concluding that, in the last three decades, Social Work has widened its intellectual function, which has contributed to the formation of the professional culture, counteracting the hegemony of the ruling classes, in organic articulation with the Brazilian Marxist left.

Examining the Influence of Context and Professional Culture on Clinical Reasoning Through Rhetorical-Narrative Analysis.

According to the dual process model of reasoning, physicians make diagnostic decisions using two mental systems: System 1, which is rapid, unconscious, and intuitive, and System 2, which is slow, rational, and analytical. Currently, little is known about physicians' use of System 1 or intuitive reasoning in practice. In a qualitative study of clinical reasoning, physicians were asked to tell stories about times when they used intuitive reasoning while working up an acutely unwell patient, and we combine socio-narratology and rhetorical theory to analyze physicians' stories. Our analysis reveals that in describing their work, physicians draw on two competing narrative structures: one that is aligned with an evidence-based medicine approach valuing System 2 and one that is aligned with cooperative decision making involving others in the clinical environment valuing System 1. Our findings support an understanding of clinical reasoning as distributed, contextual, and influenced by professional culture.

Culture and cognition in health systems change.

PURPOSE: Large-scale change involves modifying not only the structures and functions of multiple organizations, but also the mindsets and behaviours of diverse stakeholders. This paper focuses on the latter: the informal, less visible, and often neglected psychological and social factors implicated in change efforts. The purpose of this paper is to differentiate between the concepts of organizational culture and mental models, to argue for the value of applying a shared mental models (SMM) framework to large-scale change, and to suggest directions for future research. DESIGN/METHODOLOGY/APPROACH: The authors provide an overview of SMM theory and use it to explore the dynamic relationship between culture and cognition. The contributions and limitations of the theory to change efforts are also discussed. FINDINGS: Culture and cognition are complementary perspectives, providing insight into two different levels of the change process. SMM theory draws attention to important questions that add value to existing perspectives on large-scale change. The authors outline these questions for future research and argue that research and practice in this domain may be best served by focusing less on the potentially narrow goal of "achieving consensus" and more on identifying, understanding, and managing cognitive convergences and divergences as part of broader research and change management programmes. ORIGINALITY/VALUE: Drawing from both cultural and cognitive paradigms can provide researchers with a more complete picture of the processes by which coordinated action are achieved in complex change initiatives in the healthcare domain.

Professional Culture and Personality Traits of Hospital Pharmacists across Canada: A Fundamental First Step in Developing Effective Knowledge Translation Strategies.

BACKGROUND: Evidence for the value of pharmacists' interventions in the care of patients is strong and continues to grow, but the rate at which these new practice opportunities are being integrated into daily practice has not kept pace. The knowledge translation literature suggests that before effective change strategies can be implemented, a better understanding of the current environment must be obtained. Two important factors within the practice environment are the professional culture and personality traits of group members. OBJECTIVE: To gain insight, at a national level, into the culture of hospital pharmacy, using the Organizational Culture Profile, and into hospital pharmacists' personality traits, using the Big Five Inventory. METHODS: A cross-sectional survey of hospital pharmacists from across Canada was conducted intermittently over the period August 2012 to September 2013. The online survey contained questions about demographic characteristics and practice setting, as well as questions from the Organizational Culture Profile and Big Five Inventory. The survey link was distributed directly to hospital pharmacists or made available through provincial monthly newsletters. All data were analyzed descriptively and inferentially. RESULTS: In total, 401 surveys were returned. Descriptive analyses from the Organizational Culture Profile revealed that most respondents perceived value in the factors of supportiveness, competitiveness, and stability. Descriptive analyses from the Big Five Inventory revealed that respondents may have been more likely to exhibit behaviours in line with the trait of conscientiousness. Several significant subgroup differences were noted in relation to levels of education, regions of practice within Canada, years in practice, and proportion of time spent conducting clinical duties. CONCLUSIONS: The results from this survey provide preliminary insight into the professional culture and personality traits of Canadian hospital pharmacists. It will be important to explore these findings in more depth to maximize the success of any future practice change initiatives.

CONTEXTE: Le nombre de données solides montrant que les interventions des pharmaciens dans les soins des patients sont bénéfiques ne cesse de croître. Pourtant, l'intégration dans le quotidien de ces nouvelles occasions de pratique ne se fait pas au même rythme. D'après la littérature portant sur l'application des connaissances, il est nécessaire d'améliorer la compréhension du milieu d'aujourd'hui avant de pouvoir mettre en œuvre des stratégies de changement efficaces. Deux facteurs importants dont il faut tenir compte quant au milieu de pratique sont la culture professionnelle et les traits de personnalité des membres du groupe. OBJECTIF: Apprendre à mieux connaître, au niveau national, la culture de la pharmacie hospitalière à l'aide de l'outil de mesure de la culture organisationnelle, « Organizational Culture Profile ¼, et apprendre à connaître les traits de personnalité des pharmaciens hospitaliers à l'aide de l'outil sur les cinq traits centraux de la personnalité, « Big Five Inventory ¼. MÉTHODES: Une enquête transversale auprès des pharmaciens hospitaliers du Canada a été réalisée de façon intermittente sur une période s'échelonnant d'août 2012 à septembre 2013. Le sondage en ligne contenait des questions sur les caractéristiques démographiques et le milieu d'exercice ainsi que des questions issues des outils « Organizational Culture Profile ¼ et « Big Five Inventory ¼. Le lien vers le sondage a été donné directement aux pharmaciens hospitaliers ou il a été intégré à des bulletins d'information mensuels provinciaux. Toutes les données ont été analysées de façon descriptive et inférentielle. RÉSULTATS: Au total, 401 sondages ont été retournés. Des analyses descriptives obtenues par l'intermédiaire de l'outil « Organizational Culture Profile ¼ ont démontré que la plupart des répondants accordaient de la valeur aux facteurs de soutien, de compétitivité et de stabilité. Des analyses descriptives obtenues par l'intermédiaire de l'outil « Big Five Inventory ¼ ont démontré que les répondants avaient plus de chances de présenter des comportements en lien avec le trait de la conscience professionnelle. Plusieurs importantes différences de sous-catégories ont été relevées en lien avec le niveau de scolarité, la région de la pratique au Canada, le nombre d'années de pratique et le temps passé à effectuer des activités cliniques. CONCLUSIONS: Les résultats de ce sondage offrent un aperçu de la culture professionnelle et des traits de personnalité des pharmaciens hospitaliers du Canada. Il est important d'étudier plus en profondeur ces résultats afin de maximiser les chances de réussite des futures initiatives de changement de la pratique.

El trabajo colaborativo y su influencia en el desarrollo de la cultura profesional docente / Collaborative work and its influence on the development of teaching professional culture

Fundamentación: La necesidad de colaborar entre los docentes conduce al desarrollo de iniciativas, proyectos y planificación donde todos los miembros del grupo trabajan para fines comunes. Objetivo: Sistematizar los referentes teórico-metodológicos que sustentan el trabajo colaborativo para el desarrollo de la cultura profesional docente en el proceso de formación del profesional de la educación superior. Resultados: Los fundamentos que sustentan el trabajo colaborativo son consecuentes con los postulados vigotskianos, donde se conciben al profesor como un sujeto comprometido con las demandas y exigencias de la sociedad, a partir de dotarlo de mayores conocimientos y habilidades que tributen al desarrollo de una cultura profesional docente colaborativa. Conclusiones: El desarrollo de la cultura profesional docente se sustenta en su estructura de contenido y forma. El contenido abarca el conocimiento, las actitudes, las habilidades los hábitos y los valores que el profesor tiene sobre la actividad docente. Las formas de relación y asociación que se desarrollan entre los profesores determinan el tipo de cultura profesional docente predominante en un colectivo pedagógico.

Background: The need for collaboration among teachers leads to the development of initiatives, projects and planning where all members work for common goals. Objective: To systemize the theoretical and methodological references that support collaborative work for the development of teaching professional culture in the formation of professional in higher education. Results: The rationale supporting collaborative work are consistent with the Vygotskian principles, where the teacher is seen as an individual committed to the needs and demands of society, providing him with greater knowledge and skills that ascribe to the development of a teaching professionalcollaborative culture. Conclusions: The development of teaching professional culture is based on its content and form. The content covers the knowledge, attitudes, skills, habits and values that the teacher has on teaching. The forms of relationship and association that develop among teachers determine the type of teaching professional culture prevailing in an educational group.

Lowbury Lecture 2013. Cultural determinants of infection control behaviour: understanding drivers and implementing effective change.

Despite dealing with biomedical practices, infection prevention and control (IPC) is essentially a behavioural science. Human behaviour is influenced by various factors, including culture. Hofstede's model of cultural dimensions proposes that national cultures vary along consistent dimensions which can be grouped and scored as specific constructs. Studies have reported that three Hofstede constructs--power distance, uncertainty avoidance, and masculinity--show significant association with several key performance indicators relevant to IPC and antibiotic stewardship. In addition, national meticillin-resistant Staphylococcus aureus (MRSA) levels within Europe correlate well with general quality-of-care indices, including preventive strategies and patient rights. This suggests that IPC may be simply a microcosm of overall quality and safety standards within hospitals and countries. Effective improvement would therefore need to address underlying and embedded core cultural values relevant to patient safety and quality of care. Successful IPC strategies are likely to be those that are compatible with the cultural background where they are implemented. To this end, content analysis of many current IPC improvement tools identifies elements of strong compatibility with cultures that are low in uncertainty avoidance and power distance, and high in individualism and masculinity. However, this cultural combination is largely restricted to Anglo-Saxon countries, where most of the recent improvements in healthcare-associated infection (HCAI) incidence have taken place. There is a paucity of research on IPC behaviour change in different cultural backgrounds, especially countries that score high for power distance and/or uncertainty avoidance. This information is vital to inform IPC campaigns in these countries, which often show high HCAI prevalence.