What can designing learning-by-concordance clinical reasoning cases teach us about instruction in the health sciences?

Introduction: Learning-by-concordance (LbC) is an online learning strategy to practice reasoning skills in clinical situations. Writing LbC clinical cases, comprising an initial hypothesis and supplementary data, differs from typical instructional design. We sought to gain a deeper understanding from experienced LbC designers to better support clinician educators’ broader uptake of LbC. Methods: A dialogic action research approach was selected because it yields triangulated data from a heterogeneous group. We conducted three 90-minute dialogue-group sessions with eight clinical educators. Discussions focused on the challenges and pitfalls of each LbC design stage described in the literature. Recordings were transcribed and analyzed thematically. Results: We identified three themes by thematic analysis about the challenges inherent in designing LbC that are unique for this type of learning strategy: 1) the distinction between pedagogical intent and learning outcome; 2) the contextual cues used to challenge students and advance their learning and 3) the integration of experiential with formalized knowledge for cognitive apprenticeship. Discussion: A clinical situation can be experienced and conceptualized in many ways, and multiple responses are appropriate. LbC designers use contextual cues from their experience and combine them with formalized knowledge and protocols to write effective LbC clinical reasoning cases. LbC focuses learners’ attention on decision-making in grey areas that characterize the nature of professional clinical work. This in-depth study on LbC design, indicating the integration of experiential knowledge, might call for new thinking about instructional design

L’EROP : 10 ans pour le rétablissement des oiseaux de proie au Québec

L’Équipe de rétablissement des oiseaux de proie du Québec (EROP) a été fondée en 2004, à la suite de la fusion des équipes de rétablissement du faucon pèlerin (Falco peregrinus), du pygargue à tête blanche (Haliaeetus leucocephalus) et de l’aigle royal (Aquila chrysaetos). À ces espèces d’intérêt pour l’EROP s’est ajouté récemment le hibou des marais (Asio flammeus). À l’aide des plans de rétablissement de chacune des espèces, l’EROP veille à la mise en oeuvre de mesures de conservation (p. ex. acquisition de connaissances, sensibilisation, protection) visant à redresser la situation des populations d’oiseaux de proie en situation précaire au Québec. Cet article présente le mandat, le mode de fonctionnement et les principales réalisations de l’EROP au cours de la dernière décennie. The Québec raptor recovery team (EROP) was established in 2004 following the merger of the peregrine falcon (Falcoperegrinus), bald eagle (Haliaeetus leucocephalus) and golden eagle (Aquilachrysaetos) recovery teams. Recently, the short-eared owl (Asioflammeus) has also been added to the list of species covered by EROP. The team aims to foster conservation measures (e.g., data collection, public awareness and protection) to improve the population status of endangered birds of prey, and achieves this through the publication of species recovery plans. This article outlines the mission, and the working and main achievements of EROP over the past decade

Guide d'une démarche pratique de concertation à l'usage de partenaires engagés dans un projet partagé de développement local et régional

Le concept d’enjeux représente les défis que comporte un projet partagé. La notion de problèmes concerne les diffi cultés, les conflits à surmonter lors de la démarche de résolution de chacun de ces enjeux. Finalement, le terme de partenaires, identifie tous les acteurs (ex. les maires, les échevins, les agents de développement, les secrétaires/ trésoriers, les divers comités de développement, les citoyens) impliqués dans la réussite d’un projet partagé. De 1999 à 2002, les ingrédients d’une démarche de concertation ont été appliqués pour aider cinq (5) municipalités rurales du Bas-Saguenay à élaborer des enjeux de développement local et territorial ainsi que pour favoriser le cheminement d’un projet de concertation entre les régions des Cévennes-Alès (France) et du Bas-Saguenay (Canada) portant sur la revitalisation territoriale et l’économie sociale. Ce guide s’inscrit dans cette continuité. Il a pris forme grâce à une participation financière de Partenariat Rural du Canada qui a permis l’élargissement de cette démarche de concertation à l’ensemble des partenaires de la MRC du Fjord-du-Saguenay. Nous remercions de leur coopération les maires et les agents de développement des 13 municipalités rurales de cette MRC qui ont rendu possible la parution de ce guide. Pierre Deschênes (Ph.D.), professeur de psychologie organisationnelle à l’Université du Québec à Chicoutimi, a rédigé ce guide avec la collaboration de Jean Bergeron et Anne-Lise Minier du CLD du Fjord

Beliefs and experiences of educators when involved in the design of a Learning-by-concordance tool : a qualitative interpretative study

Background Based on the involvement of qualified educators in its design, the Learning-by-Concordance tool aims to promote the learning of reasoning in contexts of uncertainty. However, data are still scarce on the experience of educators in terms of sharing and exposing their reasoning processes using this tool. Purpose This study sought to explore the beliefs and experiences of educators when involved in the design of a Learning-by-Concordance tool. Method This research used a descriptive qualitative design. Four dialogue groups were conducted with educators with different roles and responsibilities while designing a Learning-by-Concordance tool. A descriptive interpretative analysis of educators' verbatim quotes was done. Findings A total of 14 participants took part in the study. The results show the discomfort of educators despite their recognized expertise. Three themes emerged: 1- the need to be reassured by the opinions of colleagues; 2-feeling like impostors; and 3- concerns for the quality of instructional supports. Conclusions The role taken by educators for teaching reasoning in contexts of uncertainty is to draw on practical experience where different types of knowledge intersect and are mobilized, to overcome feelings of insecurity, and to engage in close and authentic conversation with learners

A Metabolic Signature of Mitochondrial Dysfunction Revealed through a Monogenic Form of Leigh Syndrome

A decline in mitochondrial respiration represents the root cause of a large number of inborn errors of metabolism. It is also associated with common age-associated diseases and the aging process. To gain insight into the systemic, biochemical consequences of respiratory chain dysfunction, we performed a case-control, prospective metabolic profiling study in a genetically homogenous cohort of patients with Leigh syndrome French Canadian variant, a mitochondrial respiratory chain disease due to loss-of-function mutations in LRPPRC. We discovered 45 plasma and urinary analytes discriminating patients from controls, including classic markers of mitochondrial metabolic dysfunction (lactate and acylcarnitines), as well as unexpected markers of cardiometabolic risk (insulin and adiponectin), amino acid catabolism linked to NADH status (α-hydroxybutyrate), and NAD+ biosynthesis (kynurenine and 3-hydroxyanthranilic acid). Our study identifies systemic, metabolic pathway derangements that can lie downstream of primary mitochondrial lesions, with implications for understanding how the organelle contributes to rare and common diseases