Perceptions des étudiants en médecine quant à leur degré de préparation et à la prestation de soins aux patients autistes ou présentant un handicap intellectuel

Introduction: To provide competent care to patients with autism spectrum disorder (ASD) or intellectual developmental disorder (IDD), healthcare professionals must recognize the needs of neurodivergent populations and adapt their clinical approach. We assessed the perceived preparedness of medical students to adapt care delivery for patients with ASD/IDD, as well as their perceptions on neurodiversity education. Methods: We conducted a sequential explanatory mixed-methods study on undergraduate medical students at McGill University during the academic year 2020-2021. We administered an online survey, followed by semi-structured interviews. We analyzed data using descriptive statistics and thematic analysis. We integrated findings at the interpretation level. Results: We included two-hundred-ten survey responses (~29% of class), and 12 interviews. Few students felt prepared to adjust care for patients with ASD/IDD despite most indicating doing so was important. Ninety-seven percent desired more training regarding care accommodation for neurodivergent patients. Thematic analysis unveiled the perception of current insufficient education, and the value of experiential learning. Discussion/Conclusions: This study highlights low perceived preparedness of medical students to accommodate care for neurodivergent patients, and a desire for more instruction. Incorporating interactive training in medical school curricula regarding modifying care delivery for neurodivergent individuals may improve the perceived preparedness of medical trainees to work with these patients and care quality.Introduction : Pour fournir des soins compétents aux patients atteints d’un trouble du spectre de l’autisme (TSA) ou d’un trouble du développement intellectuel (TDI), les professionnels de la santé doivent reconnaître les besoins des populations neurodivergentes et adapter leur approche clinique. Nous avons évalué le degré perçu de préparation des étudiants en médecine à adapter la prestation de soins aux patients atteints de TSA/TDI, ainsi que leurs perceptions de la formation relative à la neurodiversité. Méthodes : Nous avons mené une étude séquentielle explicative à méthodes mixtes auprès d'étudiants en médecine de premier cycle de l'Université McGill au cours de l'année universitaire 2020-2021. Nous avons administré un sondage en ligne, suivi d'entretiens semi-structurés. Nous avons analysé les données en faisant appel à la statistique descriptive et à une analyse thématique. Nous avons intégré les résultats sur le plan interprétatif. Résultats : Nous avons inclus deux cent dix réponses à l'enquête (~29% de la classe), et 12 entretiens. Peu d'étudiants se sentaient préparés à adapter les soins aux patients atteints de TSA/TDI, bien que la plupart d'entre eux aient indiqué qu'il était important de le faire. Quatre-vingt-dix-sept pour cent d'entre eux souhaitaient davantage de formation sur l'adaptation des soins aux patients neurodivergents. L'analyse thématique a révélé que les participants considéraient la formation actuelle insuffisante et jugeaient utile l'apprentissage par l'expérience. Discussion/Conclusions : Cette étude met en évidence le faible niveau de préparation perçu par les étudiants en médecine en ce qui concerne l'adaptation des soins aux patients neurodivergents, ainsi que le désir d'une formation plus poussée. L'intégration dans les programmes des facultés de médecine d'une formation interactive portant sur la modification de la prestation des soins pour les personnes neurodivergentes pourrait améliorer la perception des étudiants en médecine de leur degré de préparation à travailler avec ce type de patients et de la qualité des soins

Consumers as legitimating agents : How consumer-citizens challenge marketer legitimacy on social media

Previous research has shown that consumers increasingly challenge the legitimacy of marketers and unsolicited marketing communication in online contexts. Based on a qualitative study, this article examines how and for what reasons consumers challenge marketer legitimacy—the perceived appropriateness of marketers and their activities—in the empirical context of Reddit, a popular social news and community website. The study suggests that consumers challenge or accept marketer legitimacy in online communities based on particular, community and situation specific, legitimacy criteria that reflect and reproduce the values and norms of the community. In doing so, it is argued, consumers play a role as legitimating agents—consumer-citizens that have the power to confer or deny legitimacy in the context of business-society relations. Overall, the study advances knowledge in the field of consumer studies in two ways. First, it builds a symbolic interactionist perspective on consumer-citizens as legitimating agents who enact their active citizenship role in the marketplace by assessing and constructing marketer legitimacy in online communities. Second, it offers an empirically grounded account of how and for what reasons consumer-citizens challenge or accept the legitimacy of marketers and unsolicited marketing communication in online communities.Peer reviewe

Balancing “what matters to me” with “what matters to them”: exploring the legitimation process of environmental entrepreneurs

We extend current knowledge on new venture legitimation by focusing on how environmental entrepreneurs enact their values and beliefs during the legitimation process and on the resultant business and personal consequences. On the basis of our longitudinal analysis of six cases studies we develop a staged process model of legitimation. Our findings suggest three novel insights. First, the entrepreneur’s (i.e. the legitimacy seeker’s) own values and beliefs are found to anchor initial decisions about how to gain legitimacy (the “what matters to me” stage) but are then toned down as attention shifts to gain legitimacy from diverse audiences (the “what matters to them” stage). Eventually, the entrepreneurs arrive at an approach that balances “what matters to me and them”. Second, we are able to explain how and why these changes in legitimation take place. The entrepreneurs learned to adapt their legitimation work by engaging in reflection and reflexivity about both the business and personal consequences of their work in each stage. Finally, we detail the significance of dissonance to this process as a trigger for changes in behavior. Overall, our three insights allow us to extend the notion of what a skillful legitimacy seeker might be

To Frack or Not to Frack? The Interaction of Justification and Power in a Sustainability Controversy

How could a de facto moratorium on shale gas exploration emerge in Québec despite the broad adoption of fracking in North American jurisdictions, support from the provincial government and a favourable power position initially enjoyed by the oil and gas industry? This paper analyses this turn of events by studying how stakeholders from government, civil society, and industry mobilized modes of justification and forms of power with the aim to influence the moral legitimacy of the fracking technology during a controversy surrounding shale gas exploration. Combining Boltanski and Thévenot's economies of worth theory with Lukes’ concept of power, we analytically induced the justification of power mechanisms whereby uses of power become justified or ‘escape’ justification, and the power of justification mechanisms by which justifications alter subsequent power dynamics. We finally explain how these mechanisms contribute to explaining the controversy's ultimate outcome, and advance current debates on political corporate social responsibility

Attributes of legitimate venture failure impressions

The current research investigates the effectiveness of impression management strategies available to entrepreneurs to foster social legitimacy with stakeholders following venture failure. We use a conjoint experiment to examine how different attributions of causes of failure influence the general public's legitimacy judgments. The most effective strategy proves to be the entrepreneurs distancing themselves from the failure, in that they attribute the failure to external factors that are not under the entrepreneurs' volitional control, and brought about by circumstances that are unlikely to reoccur. Our analysis also considers how the audience members' dispositional agreeableness and general self-efficacy influence judgment formation

Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care

Elevating design in the organization

Following evidence of its positive contribution to innovation and company performance, many firms are seeking to elevate design to a strategic level. However, little is known as to how this can be achieved. This study draws on the literatures concerned with elevating organizational functions and with organizational legitimacy, and aims to unravel and detail critical practices and potential tensions influencing the elevation of design’s status in firms. To do so, 53 in-depth interviews were undertaken with key informants, representing a range of functional specialisms, in 12 companies, including large multinational companies as well as SMEs. Findings show how six practices – top management support, leadership of the design function, generating awareness of design’s role and contribution, inter-functional coordination, evaluation of design, and formalization of product and service development processes – affect the design elevation process. In contrast with previous studies on raising the status of organizational functions, this research reveals that the same practive can play both positive and negative roles, and that there are fundamental tensions, which should be reconciled if design’s status is to be elevated. Drawing on the concept of organizational legitimacy, we also examine how design moves beyond being seen as pragmatically useful, to being identified as a relevant, alternative way of operating, to being regarded as essential for success. The article concludes by articulating contributions to design and innovation management theory and practice, and to the body of scholarly work seeking to understand how to elevate the status of a function

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How can corporations develop legitimacy when coping with stakeholders who have multiple, often conflicting sustainable development (SD) agendas? We address this question by conducting an in‐depth longitudinal case study of a corporation's stakeholder engagement in social media and propose the concept of a networked legitimacy strategy. With this strategy, legitimacy is gained through participation in non‐hierarchical open platforms and the co‐construction of agendas. We explore the organizational transition needed to yield this new legitimacy approach. We argue that, in this context, legitimacy gains may increase when firms are able to reduce the control over the engagements and relate non‐hierarchically with their publics. We contribute to the extant literature on political corporate social responsibility and legitimacy by providing an understanding of a new context for engagement that reconfigures cultural, network, and power relations between the firm and their stakeholders in ways that challenge previous forms of legitimation

Entrepreneurial Orientation, Legitimation, and New Venture Performance

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140021/1/sej1246_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/140021/2/sej1246.pd

Selling issues with solutions: Igniting social intrapreneurship in for-profit organizations

We offer an explanation of the issue selling process when issues deviate from the dominant logic of organizations. Our main objective is to articulate the multiple ways in which socially oriented innovations can be legitimated in for-profit organizations through the work of bottom-up change agents, also known as social intrapreneurs. To unpack this multiplicity, we draw on both institutional theory and the framing perspective in social movements. Specifically, we propose how sellers may advance social issues with solutions by drawing on the logic composite of both organizations and selling targets. By providing an account of the social issue selling process in for-profit organizations, we consider how the nature of an issue shapes selling efforts when it diverges from the dominant logic, and we shed light on how the content choices of sellers relate to the meaning systems of organizations and targets