Clinical ethics committees (CECs) have been developing in many countries since the 1980s, more recently in the transitional countries in Eastern Europe. With their increasing profile they are now faced with a range of questions and challenges regarding their position within the health care organizations in which they are situated: Should CECs be independent bodies with a critical role towards institutional management, or should they be an integral part of the hospital organization? In this paper, we discuss the organizational context in which CECs function in Europe focusing on five aspects. We conclude that in Europe clinical ethics committees need to maintain a critical independence while generating acceptance of the CEC and its potential benefit to both individuals and the organization. CECs, perhaps particularly in transitional countries, must counter the charge of "alibi ethics". CECs must define their contribution to in-house quality management in their respective health care organization, clarifying how ethical reflection on various levels serves the hospital and patient care in general. This last challenge is made more difficult by lack of consensus about appropriate quality outcomes for CECs internationally. These are daunting challenges, but the fact that CECs continue to develop suggests that we should make the effort to overcome them. We believe there is a need for further research that specifically addresses some of the institutional challenges facing CECs.

The contemporary evolution of the request and the recourse for ethics in the health field questions the models of ethics training. Indeed the stake is no more to train actors able of producing a moral speech on the practices but, in a destabilized context, to accompany them in the development of new practices in professional situation. This pragmatic turn in health ethics requires more active, reflective and contextual models of training, needing new links between training places and care practices. This paper is about theoretical foundations of such an ethics pedagogy, and about its stakes in terms of re-institutionalization. Pragmatism, and more particularly the approach of John Dewey, will be mobilized here to found educational practices needed by such an ethics pedagogy (an experiential, reflective and collective learning), but also to consider issues concerning training device linked to such a learning. On this point, the philosophy of integrative block-release training is investigated as a way to develop future professional competences, even if the last part of this text will insist on the reflective governance such an alternation requires and on the "re-institutionalization of the ethics pedagogy" that the latter generates.

Introduction: A three-year European project focused on ethical practice in health and social care. Its key objective was to enhance dignity in care through transformational learning as a result of the sTimul-experience. In the sTimul-experience, health and social care professionals adopted a patients' role for 24 hours, while nursing students provided them care. Aim:The aim of this evaluation study was to examine and evaluate the sTimul-experience.Method: A tailored evaluation based on the first and third level of Kirkpatrick's Four Levels of Evaluation of educational programs was defined. Specifically designed questionnaires were completed by participants of the sTimul-experience.Results: Evaluation-scores varied between a modest satisfaction on the appropriateness of materials provided during the preparation process, to a high satisfaction on coaching during the reflection sessions. The degree the global sTimul experience impacted professional practice scored 7.6. Participants from the UK and France reported highest satisfactory scores. For the majority of the time student-trainers and facilitators worked within the formulated guidelines.Discussion: After the sTimul-experience, participants reported changes in their personal view on patients situations, underlining the transformative learning in the sTimul-experience. The sTimul-experience broke existing orientations participants had on what it is to be dependent. Participants changed their mental models towards dignity and what is good care. Conclusion:The sTimul-experience had a serious impact on participants practices. A synthesis of the findings of all the evaluation data clearly demonstrated the relevance of 'a structured and comprehensive preparation', 'the importance of being a simulant by remaining in profile/role', and 'the importance of having different stages of reflection throughout the sTimulexperience'. This paper presents both qualitative as well as quantitative descriptive insights in the evaluation of transformative learning in the sTimul process, whereas until now no publications with a mixed evaluation design exist. Future studies can use our insights in the development of instruments to evaluate transformational learning by simulation in ethics.

La complexification des pratiques en santé fait naître un nouveau besoin d’éthique. Celle-ci n’est en effet plus mobilisée pour produire un discours moral sur les pratiques, mais comme une ressource d’action, une compétence, visant le développement, par les acteurs, d’un agir autonome, responsable et critique. Cette approche pragmatique de l’éthique requiert une évolution des pratiques pédagogiques, appelées à se développer dans une perspective plus expérientielle, réflexive et situationnelle. Cependant, une relecture épistémologique de la notion de compétence nous amènera à en questionner le recours en éthique. En se centrant sur la capacité des acteurs à remobiliser des ressources de l’action référentialisées, elle ne garantit pas la capacité effective des acteurs d’initier un nouvel agir en situation en fonction de la singularité du contexte. Ce texte proposera ainsi de dépasser l’approche de l’éthique par les compétences pour la revisiter au prisme de la capacitation. Il ne s’agit plus dans ce cadre d’apprendre à remobiliser des ressources prédéterminées de l’action, mais de se centrer sur l’opération d’apprentissage permettant d’apprendre à construire des compétences en action et en situation. Dans ce cadre de la capacitation, la visée pédagogique de l’éthique n’est plus de « savoir-agir », mais de développer un « pouvoir d’agir ».

Integration of interprofessional collaboration into healthcare education and training programmes has become a fundamental issue. Its objective is to learn how to collectively build collaborative care practice that addresses the uniqueness of each context and the specific situation of the patient. It is also about understanding the process of collectively building collaborative care practice in order to be able to apply it in different contexts. This article describes a study that aimed to examine the value of relying on activity confrontation methods to develop training. These methods consist of filming practitioners during an activity and encouraging them to analyse it. It was found that these methods encourage reflexive analysis of the motives for pursuing interprofessional action (identifying constitutive factors) but also a metacognitive approach on the conditions of learning (p < 0.01). In addition to the educational dimensions (methods and leadership positions) and organisational dimensions (frameworks), it was found that the patient's role is essential in developing interprofessional care practice and training (p < 0.01). Given the nature of these findings, this article goes on to suggest that the patient must be considered a "partner" in development and delivery of interprofessional learning and care.