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Background Since they are key witnesses to the systemic difficulties and social inequities experienced by vulnerable patients, health and social service (HSS) professionals and clinical managers must act as change agents. Using their expertise to achieve greater social justice, change agents employ a wide range of actions that span a continuum from the clinical (microsystem) to the societal (macrosystem) sphere and involve actors inside and outside the HSS system. Typically, however, clinical professionals and managers act in a circumscribed manner, that is, within the clinical sphere and with patients and colleagues. Among the hypotheses explaining this reduced scope of action is the fear of reprisal. Little is known about the prevalence of this fear and its complex dynamics. Objective The overall aim is to gain a better understanding of the complex dynamic process leading to clinical professionals’ and managers’ fear of reprisal in their change agent actions and senior administrators’ and managers’ determination of wrongdoing. The objectives are (1) to estimate the prevalence of fear of reprisal among clinical professionals and managers; (2) to identify the factors involved in (a) the emergence of this fear among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; (3) to describe the process of emergence of (a) the fear of reprisal among clinical professionals and managers, and (b) the determination of wrongdoing by senior administrators and managers; and (4) to document the legal and ethical issues associated with the factors identified (objective 2) and the processes described (objective 3). Methods Based on the Exit, Voice, Loyalty, Neglect model, a 3-part sequential mixed methods design will include (1) a web-based survey (objective 1), (2) a qualitative grounded theory design (objectives 2 and 3), and (3) legal and ethical analysis (objective 4). Survey: 77,794 clinical professionals or clinical managers working in the Québec public HSS system will be contacted via email. Data will be analyzed using descriptive statistics. Grounded theory design: for each of the 3 types of participants (clinical professionals, clinical managers, and senior administrators and managers), a theoretical sample of 15 to 30 people will be selected via various strategies. Data will be independently analyzed using constant comparison process. Legal and ethical analysis: situations described by participants will be analyzed using, respectively, applicable legislation and jurisprudence and 2 ethical models. Results This ongoing study began in June 2022 and is scheduled for completion by March 2027. Conclusions Instead of acting, fear of reprisal could induce clinical professionals to tolerate situations that run counter to their social justice values. To ensure they use their capacities for serving a population that is or could become vulnerable, it is important to know the prevalence of the fear of reprisal and gain a better understanding of its complex dynamics. International Registered Report Identifier (IRRID)PRR1-10.2196/48400

BackgroundThere are still unanswered questions regarding effective educational strategies to promote the transformation and articulation of clinical data while teaching and learning clinical reasoning. Additionally, understanding how this process can be analyzed and assessed is crucial, particularly considering the rapid growth of natural language processing in artificial intelligence. ObjectiveThe aim of this study is to map educational strategies to promote the transformation and articulation of clinical data among students and health care professionals and to explore the methods used to assess these individuals’ transformation and articulation of clinical data. MethodsThis scoping review follows the Joanna Briggs Institute framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for the analysis. A literature search was performed in November 2022 using 5 databases: CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science (Clarivate). The protocol was registered on the Open Science Framework in November 2023. The scoping review will follow the 9-step framework proposed by Peters and colleagues of the Joanna Briggs Institute. A data extraction form has been developed using key themes from the research questions. ResultsAfter removing duplicates, the initial search yielded 6656 results, and study selection is underway. The extracted data will be qualitatively analyzed and presented in a diagrammatic or tabular form alongside a narrative summary. The review will be completed by February 2024. ConclusionsBy synthesizing the evidence on semantic transformation and articulation of clinical data during clinical reasoning education, this review aims to contribute to the refinement of educational strategies and assessment methods used in academic and continuing education programs. The insights gained from this review will help educators develop more effective semantic approaches for teaching or learning clinical reasoning, as opposed to fragmented, purely symptom-based or probabilistic approaches. Besides, the results may suggest some ways to address challenges related to the assessment of clinical reasoning and ensure that the assessment tasks accurately reflect learners’ developing competencies and educational progress. International Registered Report Identifier (IRRID)DERR1-10.2196/50797

This article discusses the rhetoric deployed by two professional orders, the Ordre des ergothérapeutes du Québec and the Ordre des orthophonistes et des audiologistes du Québec, when they are called upon to contribute to public debates on various social issues. What rationalities do they promote and how are these rationalities are in tension with those articulated by the government? To answer this question, we analyzed 10 recent briefs tabled at the National Assembly of Quebec. Our analyses reveal four rationalities: political, economic, scientific and ethical. By revealing these rationalities, we highlight the tensions between bureaucratic and professional logic. This article thus helps to demystify a little-known political communication exercise.

Après avoir introduit et décrit les modes managériaux en santé, les auteures articulent une réflexion critique sur quatre enjeux éthiques qui découlent de ces modes.

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L’éthique professionnelle est une compétence importante pour les professionnels qui œuvrent dans le domaine de la santé. Chez les orthophonistes, plus spécifiquement, l’élargissement constant du champ de pratique et la complexification des besoins de la population vieillissante font en sorte que ces professionnels sont confrontés à davantage de questionnements de nature éthique. Pourtant, la littérature scientifique démontre que les orthophonistes ne se sentent pas adéquatement préparés à résoudre des enjeux de nature éthique. L’objectif général de cette étude était d’examiner l’état de la formation en éthique professionnelle dans tous les programmes canadiens qui offrent une formation en orthophonie. Afin de répondre à cet objectif, un sondage a été envoyé aux directeurs des onze programmes universitaires canadiens en orthophonie. Trois programmes ont répondu au sondage. Les principaux résultats obtenus suggèrent que l’éthique professionnelle est un sujet enseigné à l’intérieur de différents cours des cursus universitaires canadiens en orthophonie. Malgré tout, le pourcentage consacré à celui-ci à l’intérieur des cours s’avère faible et difficile à bien estimer. Ces résultats offrent un premier éclairage sur la quantité et la qualité des cours portant sur l’éthique professionnelle offerts dans les différents programmes canadiens d’orthophonie, de même que sur les méthodes pédagogiques utilisées.