Repenser l’accompagnement des enseignants novices pour accroitre leur satisfaction professionnelle

L’augmentation de la charge de travail des enseignants novices (EN) et les problèmes de santé au travail qu’elle engendre sont significatifs des difficultés de l’entrée dans le métier des EN. Pour y répondre, des aménagements de la formation sont proposés sans que pour autant leurs retombées soient réellement évaluées. L’objet de cette étude, menée à partir d’une théorie de l’action collective (Wittgenstein, 1996), se situe à ce niveau. En prenant comme dispositif support un aménagement de formation, cette étude montre principalement que sa mise en œuvre n’a que peu d’impact sur la santé au travail des EN. Deux résultats majeurs étayent cette conclusion. Tout d’abord, les formateurs procèdent rarement à un enseignement ostensif de nouvelles règles relatives à ce qui pourrait être réalisé en classe ainsi qu’aux résultats qui pourraient en être attendus. Autrement dit, les EN ne sont pas placés en situation de « mieux faire » (Clot, 2010) leur travail et par-là même d’en être satisfaits. Sans ces règles, les EN ne peuvent en effet interpréter, juger et in fine s’adapter aux diverses expériences vécues en s’engageant dans des actions singulières et attendues au sein de la communauté professionnelle. D’autre part, les formateurs ne considèrent jamais la situation de classe comme une situation de formation potentielle. Non aménagée, cette dernière place régulièrement les EN en situation d’insatisfaction professionnelle aboutissant à du stress au travail.The increased workload of preservice teachers (PTs) and the work-related health problems this has often caused point to the substantial difficulties in becoming a teacher. One response has been to reorganize the teacher education program, although the consequences have not yet been closely evaluated. We do so in this study, from the perspective of collective action theory (Wittgenstein, 1996). In this examination of the recent modifications in teacher education programs, we conclude that the modifications have had little impact on PT workplace health, which is supported by the two major results. First, we found that teacher educators rarely provide ostensive teaching of new rules about what can be done in the classroom and what might then be expected. In other words, PTs are not placed in a situation of “doing [their work] better” (Clot, 2010) and subsequently feeling greater job satisfaction. Yet without these rules, PTs cannot effectively interpret, judge and make fine adjustments to their many lived classroom experiences by undertaking the highly individualized actions expected by the teaching community. Second, teacher educators never consider the classroom situation as having the potential to train PTs. Because this aspect of teacher education remains undeveloped, PTs often feel job dissatisfaction, which eventually is expressed as workplace stress

Le travail des chefs d’établissement avec les parents d’élèves : des activités complexes à l’interface entre leur hiérarchie et les enseignants

Si la formation des chefs d’établissement en France est fortement balisée, référencée et définie par un corpus de savoirs théoriques et pratiques, leurs activités professionnelles quotidiennes n’y sont pas spécifiquement abordées. L’objet de l’étude est donc de recenser, formaliser et analyser certaines de ces activités, en particulier celles réalisées auprès des parents d’élèves qui sont peu examinées dans la littérature. Inscrite dans un programme de recherche sur la formation professionnelle, l’étude a consisté à analyser les rencontres entre deux chefs d’établissement et des parents d’élèves. Chaque rencontre a été enregistrée et des entretiens d’autoconfrontation ont été menés avec un principal et une principale de collège. Les résultats montrent la complexité de leur travail d’une part, en raison de la diversité des activités qu’ils mènent avec les parents d’élèves (les convaincre, leur donner des exemples, leur donner des explications, leur affirmer l’identité du collège, répondre à leurs questions et les associer) et, d’autre part, du fait que ces activités sont mêlées à d’autres activités qu’ils conduisent avec les enseignants et/ou leur hiérarchie. La complexité de ces activités des chefs d’établissement à l’interface entre leur hiérarchie et les enseignants est amplifiée par le contexte spécifique d’une réforme importante des enseignements. Sur la base d’une discussion de ces résultats, des pistes en matière de recherches complémentaires à mener et d’aménagement des dispositifs de formation des chefs d’établissement sont finalement proposées.Although the training of principals in France is strongly established, referenced and defined by a body of theoretical and practical knowledge, their daily professional activities are not specifically addressed. The purpose of this study is therefore to identify, formalize, and analyze some of these activities, particularly those involving contact with students’ parents, as they are underrepresented in current scholarship. As part of a research program dedicated to professional training, this study consists of analyzing the meetings between two principals and parents of students. Each meeting was recorded, and self-analysis interviews were carried out with these high school principals. The results demonstrate the complexity of their work: on the one hand, the intricacy is due to the diversity of the activities they undertake with students’ parents (convincing them, giving them examples, offering explanations, reaffirming their idea of the high school’s identity, responding to their questions, and bringing them together), and then on the other hand, it is because these activities are combined with others that they carry out with teachers and/or their supervisors. The complexity of the principals’ activities as they work to interface between their supervisors and teachers is amplified by the specific context of a major teaching reform. Based on a discussion of these results, leads for future research and potential training tools for principals will be suggested

Pathogenesis, diagnosis and management of pneumorrhachis

Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis and treatment modalities of patients with PR and associated pathologies to highlight this uncommon phenomenon and outline aetiology-based guidelines for the practical management of PR. Air within the spinal canal can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and nontraumatic PR. Intraspinal air is usually found isolated not only in the cervical, thoracic and, less frequently, the lumbosacral regions but can also be located in the entire spinal canal. PR is almost exceptional associated with further air distributions in the body. The pathogenesis and aetiologies of PR are multifold and can be a diagnostic challenge. The diagnostic procedure should include spinal CT, the imaging tool of choice. PR has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. PR usually represents an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime

The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

Background & Aims: Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF. Methods: A total of 1,071 patients with AD were enrolled. We collected detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed up for 3 months. Outcomes (liver transplantation and death) at 1 year were also recorded. Results: Three groups of patients were identified. Pre-ACLF patients (n = 218) developed ACLF and had 3-month and 1-year mortality rates of 53.7% and 67.4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required ≥1 readmission but did not develop ACLF and had mortality rates of 21.0% and 35.6%, respectively. Stable decompensated cirrhosis (SDC) patients (n = 620) were not readmitted, did not develop ACLF and had a 1-year mortality rate of only 9.5%. The 3 groups differed significantly regarding the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in SDC) and the prevalence of surrogates of severe portal hypertension throughout the study (high in UDC vs. low in pre-ACLF and SDC). Conclusions: Acute decompensation without ACLF is a heterogeneous condition with 3 different clinical courses and 2 major pathophysiological mechanisms: systemic inflammation and portal hypertension. Predicting the development of ACLF remains a major future challenge. ClinicalTrials.gov number: NCT03056612. Lay summary: Herein, we describe, for the first time, 3 different clinical courses of acute decompensation (AD) of cirrhosis after hospital admission. The first clinical course includes patients who develop acute-on-chronic liver failure (ACLF) and have a high short-term risk of death – termed pre-ACLF. The second clinical course (unstable decompensated cirrhosis) includes patients requiring frequent hospitalizations unrelated to ACLF and is associated with a lower mortality risk than pre-ACLF. Finally, the third clinical course (stable decompensated cirrhosis), includes two-thirds of all patients admitted to hospital with AD – patients in this group rarely require hospital admission and have a much lower 1-year mortality risk

The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF. A total of 1,071 patients with AD were enrolled. We collected detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed up for 3 months. Outcomes (liver transplantation and death) at 1 year were also recorded. Three groups of patients were identified. Pre-ACLF patients (n = 218) developed ACLF and had 3-month and 1-year mortality rates of 53.7% and 67.4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required ≥1 readmission but did not develop ACLF and had mortality rates of 21.0% and 35.6%, respectively. Stable decompensated cirrhosis (SDC) patients (n = 620) were not readmitted, did not develop ACLF and had a 1-year mortality rate of only 9.5%. The 3 groups differed significantly regarding the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in SDC) and the prevalence of surrogates of severe portal hypertension throughout the study (high in UDC vs. low in pre-ACLF and SDC). Acute decompensation without ACLF is a heterogeneous condition with 3 different clinical courses and 2 major pathophysiological mechanisms: systemic inflammation and portal hypertension. Predicting the development of ACLF remains a major future challenge. ClinicalTrials.gov number: NCT03056612. Lay summary: Herein, we describe, for the first time, 3 different clinical courses of acute decompensation (AD) of cirrhosis after hospital admission. The first clinical course includes patients who develop acute-on-chronic liver failure (ACLF) and have a high short-term risk of death - termed pre-ACLF. The second clinical course (unstable decompensated cirrhosis) includes patients requiring frequent hospitalizations unrelated to ACLF and is associated with a lower mortality risk than pre-ACLF. Finally, the third clinical course (stable decompensated cirrhosis), includes two-thirds of all patients admitted to hospital with AD - patients in this group rarely require hospital admission and have a much lower 1-year mortality risk

PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis

Background & Aims: Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (ADNo ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. Methods: The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome. Results: Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality. Conclusions: This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis. Lay summary: Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes. (c) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Circumstances in teacher education that allow preservice teachers to experience job satisfaction in the classroom : case study in physical education and sport

Alors que de nombreuses directives institutionnelles invitent à considérer la formation des enseignants novices (EN) comme un moyen d’accroitre leur satisfaction professionnelle et in fine leur santé, peu de travaux scientifiques ont réellement étudié le caractère effectif de ce type de considération. Cette étude a donc pour objet premier d’analyser, dans le cadre de situations de formation de type tutorat mixte impliquant tuteurs de terrain et formateurs universitaires, les circonstances de formation permettant d’aboutir à la satisfaction professionnelles des enseignants novices en situation de travail en classe. Cette étude s’inscrit dans un programme de recherche sur la formation professionnelle dont les soubassements épistémologiques sont issus d’une anthropologie culturaliste principalement inspirée de la philosophie analytique de Wittgenstein (2004). Elle a été menée dans le cadre d’un dispositif innovant de formation en alternance articulant de façon itérative des séquences de formation menées sous la forme d’entretiens de conseil pédagogique et des séquences de travail en classe. Les résultats de cette étude permettent de situer trois principales circonstances de formation ayant permis d’aboutir à l’apprentissage de règles par les EN, voire à leur développement professionnel et, par-là même, à leur satisfaction : (i) l’intérêt pour les formateurs de « dé-satisfaire » les EN avant de s’engager dans une activité d’enseignement de nouvelles règles, (ii) la nécessité pour les EN d’avoir une « exemplarisation » des règles enseignées qui s’ancre dans leurs circonstances d’enseignement et, (iii) la nécessité pour les formateurs d’engager un véritable travail d’accompagnement des EN lors de leurs premiers suivis des règles préalablement enseignées. Sur la base d’une discussion de ces résultats des pistes, en matière de recherches complémentaires à mener et de dispositifs innovants à mettre en œuvre, sont finalement proposées.Many institutional guidelines point out that teacher education programs can be a means to enhance the job satisfaction, and thereby the health, of preservice teachers (PTs). However, few studies have actually examined this proposition. This study therefore sought to determine the training circumstances that contribute to PTs’ satisfaction with their classroom work in the context of teacher education with teams composed of cooperating teachers and university supervisors. This study is part of a research program based on epistemological principles derived from cultural anthropology, which has been much inspired by the analytical philosophy of Wittgenstein (2004). The study was conducted within the framework of an innovative teacher education program that alternates sequences of PTs’ classroom work with sequences of supervisory meetings. The results indicate three main training circumstances that facilitated the PTs’ learning of the work rules, which in turn contributed to their professional development and thereby to their satisfaction: (i) the teacher educator team needs to “de-satisfy” the PTs before engaging in the activity of teaching new work rules, (ii) the PTs need an “exemplification” of the new work rules that is rooted in their actual teaching circumstances, and (iii) the teacher education team needs to engage in a veritable work of supporting the PTs as they begin to follow the work rules that they have learned. The discussion of the results focuses on proposals for new directions in complementary research and innovative training methods