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Université de Montréal

Construction d'une échelle décrivant les

niveaux de compétence de collaboration,

à partir d'indicateurs validés par

des enseignants cliniciens en médecine par

Monique Saint-Martin

Centre de pédagogie appliquée aux sciences de la santé

Faculté de médecine

Mémoire présenté à la Faculté des études supérieure s et post doctorales en vue de l'obtention du grade de maîtrise es arts en Sciences de l'éducation option pédagogie universitaire des sciences médicales

Mars 2012

© Monique Saint-Martin, 2012

Université de Montréal

Faculté des études supérieures et postdoctorales

Ce mémoire intitulé :

Construction d'une échelle décrivant les niveaux de compéten ce de collaboration, à partir d'indicateurs validés par des enseignan ts cliniciens en médecine

Présenté par :

Monique Saint-Martin

a été évalué par un jury composé des personnes suivantes

François Bowen, président-rapporteur

Paule Lebel, directeur de recherche

Jean-Guy Blais, co-directeur

Roch Chouinard, membre du jury

Centre de pédagogie appliquée aux sciences de la santé Faculté de médecine Mémoire présenté à la Faculté des études supérieures et post doctorales en vue de l'obtention du grade de maîtrise es arts en Sciences de l'éducation option pédagogie universitaire des sciences médicales

Mars 2012

© Monique Saint-Martin, 2012

Université de Montréal

i fiflfl La collaboration est une compétence essentielle que les futurs médecins doivent dé- velopper. La détermination des niveaux de compétence est cruciale dans la planifica- tion de cet apprentissage. Les échelles descriptives suscitent un int

érêt croissant, car

elles décrivent en termes qualitatifs les performances attendues. Nou s inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration : 1) formulation d'une liste d'indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d'éducateurs (n=7), leaders pédagogiques possédant une expertise pour la comp

étence de collabora-

tion; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de

118 indicateurs, auprès d'enseignants cliniciens représentant les différentes spécialités

(n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux question- naires appariés par calibration concurrente; 4) détermination des niveaux des indica-

teurs par les éducateurs et les chercheurs; et 5) rédaction de l'échelle à partir des indi-

cateurs de chaque niveau. L'analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l'échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L'échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d'une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendu s à la fin de chaque niveau et est utile à la planification de l'apprentissage et de l'évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l'analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d'adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l'efficacité de la méthodologie de Blais (2009) dans un contexte de compétenc e transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d'autres compétences. ii

Abstract

Being able to collaborate is a key competence that physicians need to le arn. Determining competence levels is crucial to planning the learning process. By defi ning performance levels in qualitative terms, descriptive scales are a promising avenue.

We developed

a five-stage competence-level scale based on Blais, Laurier & Rousseau (2009) mixed methodology: 1) having researchers (n= 3) and a group of educators ( n= 7), pedagogical leaders with expertise in the field of collaboration, list indicators that apply to the four training levels (preclinical, clerkship, junior and senior residencies); 2) conducting with clinician teachers, representative of various specialties (n= 277 ), an online survey that includes four questionnaires on the 118 indicator levels; 3) perfo rming an analysis using the Rasch partial credit model on responses to questionnaires link ed through concurrent calibration; 4) having educators and researchers determine t he indicator levels; 5) creating a scale based on indicators at each level. The iterative analysis of the responses shows that it fits the Rasch m odel and distributes indicators on the linear scale on the four levels. The educators were re sponsible for determining the level of 111 selected indicators by taking into account the results of the survey and coherence with the curriculum. The scale includes a descriptive paragraph for each level as it applies to the 3 abilities : 1) taking p art in running the team; 2) preventing and managing conflicts; 3) planning, coordinatin g and providing care as a team. The scale explains the collaborative behaviors expected at the end of ea ch level and can be used to plan learning and evaluate competence. The source of disa greement between the levels set by the educators and those resulting from the ana lysis of clinician teacher responses are mostly explained by the low response by teachers a t the preclinical level and misfit issues for the indicators describing conflict manag ement. The research provided a broader understanding of collaboration competency and demonst rated the effectiveness of the Blais et al.1 methodology within the context of cro ss-curricular competency in health sciences. The methodology could be useful to go dea per into other competencies development path. iii Mots-clés: compétence clinique, curriculum axé sur les compétences, enseignement médical premier cycle, enseignement spécialisé en médecine, collaboration, compor- tement coopératif, relations interprofessionnelles, conflit, mod̀èles statistiques, Rasch. 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Tableau 1 Exemple d"échelle de Guttman ...............................................................21

Tableau 2. Tableau de spécication des indicateurs selon les niveaux et les capacités ..41

Tableau 3. Répartition par spécialités, des enseignants sollicités par courriel et des répondants.

Tableau 4. Caractéristiques des participants pour l"ensemble des répondants et par questionnaire

Tableau 5. Proportion d"indicateurs dont un niveau est choisi par plus de 50 % des répondants ...................................................46 Tableau 6. Facteurs personnels des répondants analysés par le modèle de Rasch ........47 Tableau 7. Paires d"indicateurs démontrant une corrélation des résidus de plus de 0,5 58
Tableau 8. Sommaire comparatif du sondage et des quatre questionnaires ................60 Tableau 9. Répartition des indicateurs dont le niveau est concordant entre la s ituation retenue par le groupe d"éducateurs et celle issue de l"analyse des données du sondage......73 Tableau 10. Répartition des indicateurs par capacités, selon les étapes de la recherche .79 Tableau 11 Échelle de niveau de compétence de collaboration ................................82 Tableau 12. Comparaison des statistiques de l"analyse avant et après la combinaison des deux premières catégories de la capacité 3 ...................................A-13 Tableau 13 Comparaison de deux répartitions des indicateurs en quatre niveaux de formation ixquotesdbs_dbs33.pdfusesText_39

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