Gotowa bibliografia na temat „Centre culturel des prés du Roy”

La vie et l’oeuvre de Gabrielle Roy sont marquées par les rapports complexes entre un centre (soit-il métropolitain, urbain, anglophone, linguistique, culturel ou économique) et ses marges. Manitobaine de naissance, Roy quitta la province en 1937 pour s’établir finalement au Québec. Pourtant l’espace manitobain, ainsi que les groupes minoritaires qui l’habitent, jouent un rôle très important dans son oeuvre. Cet article propose une analyse de quatre des textes de Roy (Rue Deschambault, La route d’Altamont, Ces enfants de ma vie et De quoi t’ennuies-tu, Éveline?). Jusqu’à quel point l’espace manitobain représenté dans ces textes reflète-t-il les oppositions entre une communauté minoritaire et une communauté majoritaire? Dans quel sens l’expérience de la migration a-t-elle marqué la conceptualisation de l’espace qui ressort de l’oeuvre manitobaine de Roy? Ce seront là les questions que nous explorerons.

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Introduction For some time now there has been a strong critical framework that identifies a significant shift in the politics of homosexuality in the Anglo-oriented West over the last fifteen to twenty years. In this article I draw on this framework to describe the current moment in the Australian cultural politics of homosexuality. I focus on the issue of same-sex marriage as a key indicator of the currently emerging era. I then turn to two Australian texts about marriage that were produced in “the period before” this time, with the aim of recovering what has been partially lost from current formations of GLBT politics and from available memories of the past. Critical Histories Lisa Duggan’s term “the new homonormativity” is the frame that has gained widest currency among writers who point to the incorporation of certain versions of homosexuality into the neo-liberal (U.S.) mainstream. She identifies a sexual politics that “does not contest dominant heteronormative assumptions and institutions, but upholds and sustains them, while promising the possibility of a demobilized gay constituency and a privatized, depoliticized gay culture anchored in domesticity and consumption” (50). More recently, writing of the period inaugurated by the so-called “war on terror” and following Duggan, Jasbir Puar has introduced the term “homonationalism” to refer to “a collusion between homosexuality and American nationalism that is generated both by national rhetorics of patriotic inclusion and by gay and queer subjects themselves” (39). Damien Riggs adds the claims of Indigenous peoples in ongoing colonial contexts to the ground from which contemporary GLBT political claims can be critiqued. He concludes that while “queer people” will need to continue to struggle for rights, it is likely that cultural intelligibility “as a subject of the nation” will be extended only to those “who are established through the language of the nation (i.e., one that is founded upon the denial of colonial violence)” (97). Most writers who follow these kinds of critical analyses refer to the discursive place of homosexual couples and families, specifically marriage. For Duggan it was the increasing focus on “full gay access to marriage and military service” that defined homonormativity (50). Puar allows for a diversity of meanings of same-sex marriage, but claims that for many it is “a demand for reinstatement of white privileges and rights—rights of property and inheritance in particular” (29; see also Riggs 66–70). Of course not all authors locate the political focus on same-sex marriage and its effects as a conservative affair. British scholar Jeffrey Weeks stresses what “we” have gained and celebrates the rise of the discourse of human rights in relation to sexuality. “The very ordinariness of recognized same-sex unions in a culture which until recently cast homosexuality into secret corners and dark whispers is surely the most extraordinary achievement of all” (198), he writes. Australian historian Graham Willett takes a similar approach in his assessment of recent Australian history. Noting the near achievement of “the legal equality agenda for gay people” (“Homos” 187), he notes that “the gay and lesbian movement went on reshaping Australian values and culture and society through the Howard years” (193). In his account it did this in spite of, and untainted by, the dominance of Howard's values and programs. The Howard period was “littered with episodes of insult and discrimination … [as the] government tried to stem the tide of gay, lesbian and transgender rights that had been flowing so strongly since 1969”, Willett writes (188). My own analysis of the Howard years acknowledges the significant progress made in law reform relating to same-sex couples and lesbian and gay parents but draws attention to its mutual constitution with the dominance of the white, patriarchal, neo-liberal and neo-conservative ideologies which dominated social and political life (2013 forthcoming). I argue that the costs of reform, fought for predominantly by white and middle class lesbians and gay men deploying homonormative discourses, included the creation of new identities—single lesbians and gays whose identity did not fit mainstream notions, non-monogamous couples and bad mothers—which were positioned on the illegitimate side of the newly enfranchised. Further the success of the reforms marginalised critical perspectives that are, for many, necessary tools for survival in socially conservative neoliberal times. Same-Sex Marriage in Australia The focus on same-sex marriage in the Australian context was initiated in April 2004 by then Prime Minister Howard. An election was looming and two same-sex couples were seeking recognition of their Canadian marriages through the courts. With little warning, Howard announced that he would amend the Federal Marriage Act to specify that marriage could only take place between a man and a woman. His amendment also prevented the recognition of same-sex marriages undertaken overseas. Legislation was rushed through the parliament in August of that year. In response, Australian Marriage Equality was formed in 2004 and remains at the centre of the GLBT movement. Since that time political rallies in support of marriage equality have been held regularly and the issue has become the key vehicle through which gay politics is understood. Australians across the board increasingly support same-sex marriage (over 60% in 2012) and a growing majority of gay and lesbian people would marry if they could (54% in 2010) (AME). Carol Johnson et al. note that while there are some critiques, most GLBT people see marriage “as a major equality issue” (Johnson, Maddison and Partridge 37). The degree to which Howard’s move changed the terrain of GLBT politics cannot be underestimated. The idea and practice of (non-legal) homosexual marriage in Australia is not new. And some individuals, publicly and privately, were calling for legal marriage for same-sex couples before 2004 (e.g. Baird, “Kerryn and Jackie”). But before 2004 legal marriage did not inspire great interest among GLBT people nor have great support among them. Only weeks before Howard’s announcement, Victorian legal academic and co-convenor of the Victorian Gay & Lesbian Rights Lobby Miranda Stewart concluded an article about same-sex relationship law reform in Victoria with a call to “begin the debate about gay marriage” (80, emphasis added). She noted that the growing number of Australian couples married overseas would influence thinking about marriage in Australia. She also asked “do we really want to be part of that ‘old edifice’ of marriage?” (80). Late in 2003 the co-convenors of the NSW Gay and Lesbian Rights Lobby declared that “many members of our community are not interested in marriage” and argued that there were more pressing, and more practical, issues for the Lobby to be focused on (Cerise and McGrory 5). In 2001 Jenni Millbank and Wayne Morgan, two leading legal academics and activists in the arena of same-sex relationship politics in Australia, wrote that “The notion of ‘same-sex marriage’ is quite alien to Australia” (Millbank and Morgan, 295). They pointed to the then legal recognition of heterosexual de facto relationships as the specific context in Australia, which meant that marriage was not viewed as "paradigmatic" (296). In 1998 a community consultation conducted by the Equal Opportunity Commission in Victoria found that “legalising marriage for same-sex couples did not enjoy broad based support from either the community at large or the gay and lesbian community” (Stewart 76). Alongside this general lack of interest in marriage, from the early-mid 1990s gay and lesbian rights groups in each state and territory began to think about, if not campaign for, law reform to give same-sex couples the same entitlements as heterosexual de facto couples. The eventual campaigns differed from state to state, and included moments of high profile public activity, but were in the main low key affairs that met with broadly sympathetic responses from state and territory ALP governments (Millbank). The previous reforms in every state that accorded heterosexual de facto couples near equality with married couples meant that gay and lesbian couples in Australia could gain most of the privileges available to heterosexual couples without having to encroach on the sacred territory (and federal domain) of marriage. In 2004 when Howard announced his marriage bill only South Australia had not reformed its law. Notwithstanding these reforms, there were matters relating to lesbian and gay parenting that remained in need of reform in nearly every jurisdiction. Further, Howard’s aggressive move in 2004 had been preceded by his dogged refusal to consider any federal legislation to remove discrimination. But in 2008 the new Rudd government enacted legislation to remove all discrimination against same-sex couples in federal law, with marriage and (ironically) the lack of anti-discrimination legislation on the grounds of sexuality the exceptions, and at the time of writing most states have made or will soon implement the reforms that give full lesbian and gay parenting rights. In his comprehensive account of gay politics from the 1950s onwards, published in 2000, Graham Willett does not mention marriage at all, and deals with the moves to recognise same-sex relationships in one sixteen line paragraph (Living 249). Willett’s book concludes with the decriminalisation of sex between men across every state of Australia. It was written just as the demand for relationship reform was becoming the central issue of GLBT politics. In this sense, the book marks the end of one era of homosexual politics and the beginning of the next which, after 2004, became organised around the desire for marriage. This understanding of the recent gay past has become common sense. In a recent article in the Adelaide gay paper blaze a young male journalist wrote of the time since the early 1970s that “the gay rights movement has shifted from the issue of decriminalising homosexuality nationwide to now lobbying for full equal rights for gay people” (Dunkin 3). While this (reductive and male-focused) characterisation is not the only one possible, I simply note that this view of past and future progress has wide currency. The shift of attention in this period to the demand for marriage is an intensification and narrowing of political focus in a period of almost universal turn by state and federal governments to neoliberalism and an uneven turn to neo-conservatism, directions which have detrimental effects on the lives of many people already marginalised by discourses of sexuality, race, class, gender, migration status, (dis)ability and so on. While the shift to the focus on marriage from 2004 might be understood as the logical final step in gaining equal status for gay and lesbian relationships (albeit one with little enthusiasm from the GLBT political communities before 2004), the initiation of this shift by Prime Minister Howard, with little preparatory debate in the LGBT political communities, meant that the issue emerged onto the Australian political agenda in terms defined by the (neo)conservative side of politics. Further, it is an example of identity politics which, as Lisa Duggan has observed in the US case, is “increasingly divorced from any critique of global capitalism” and settles for “a stripped-down equality, paradoxically imagined as compatible with persistent overall inequality” (xx). Brides before Marriage In the last part of this article I turn to two texts produced early in 1994—an activist document and an ephemeral performance during the Sydney Gay and Lesbian Mardi Gras parade. If we point only to the end of the era of (de)criminalisation, then the year 1997, when the last state, Tasmania, decriminalised male homosex, marks the shift from one era of the regulation of homosexuality to another. But 1994 bore the seeds of the new era too. Of course attempts to identify a single year as the border between one era and the next are rhetorical devices. But some significant events in 1994 make it a year of note. The Australian films Priscilla: Queen of the Desert and The Sum of Us were both released in 1994, marking particular Australian contributions to the growing presence of gay and lesbian characters in Western popular culture (e.g. Hamer and Budge). 1994 was the UN International Year of the Family (IYF) and the Sydney Gay and Lesbian Mardi Gras chose the theme “We are Family” and published endorsement from both Prime Minister Keating and the federal opposition leader John Hewson in their program. In 1994 the ACT became the first Australian jurisdiction to pass legislation that recognised the rights and entitlements of same-sex couples, albeit in a very limited and preliminary form (Millbank 29). The NSW Gay and Lesbian Rights Lobby's (GLRL) 1994 discussion paper, The Bride Wore Pink, can be pinpointed as the formal start to community-based activism for the legal recognition of same-sex relationships. It was a revision of an earlier version that had been the basis for discussion among (largely inner Sydney) gay and lesbian communities where there had been lively debate and dissent (Zetlein, Lesbian Bodies 48–57). The 1994 version recommended that the NSW government amend the existing definition of de facto in various pieces of legislation to include lesbian and gay relationships and close non-cohabiting interdependent relationships as well. This was judged to be politically feasible. In 1999 NSW became the first state to implement wide ranging reforms of this nature although these were narrower than called for by the GLRL, “including lesser number of Acts amended and narrower application and definition of the non-couple category” (Millbank 10). My concern here is not with the politics that preceded or followed the 1994 version of The Bride, but with the document itself. Notwithstanding its status for some as a document of limited political vision, The Bride bore clear traces of the feminist and liberationist thinking, the experiences of the AIDS crisis in Sydney, and the disagreements about relationships within lesbian and gay communities that characterised the milieu from which it emerged. Marriage was clearly rejected, for reasons of political impossibility but also in light of a list of criticisms of its implication in patriarchal hierarchies of relationship value (31–2). Feminist analysis of relationships was apparent throughout the consideration of pros and cons of different legislative options. Conflict and differences of opinion were evident. So was humour. The proliferation of lesbian and gay commitment ceremonies was listed as both a pro and a con of marriage. On the one hand "just think about the prezzies” (31); on the other, “what will you wear” (32). As well as recommending change to the definition of de facto, The Bride recommended the allocation of state funds to consider “the appropriateness or otherwise of bestowing entitlements on the basis of relationships,” “the focusing on monogamy, exclusivity and blood relations” and the need for broader definitions of “relationships” in state legislation (3). In a gesture towards a political agenda beyond narrowly defined lesbian and gay interests, The Bride also recommended that “the lesbian and gay community join together with other groups to lobby for the removal of the cohabitation rule in the Social Security Act 1991” (federal legislation) (34). This measure would mean that the payment of benefits and pensions would not be judged in the basis of a person’s relationship status. While these radical recommendations may not have been energetically pursued by the GLRL, their presence in The Bride records their currency at the time. The other text I wish to excavate from 1994 is the “flotilla of lesbian brides” in the 1994 Sydney Gay and Lesbian Mardi Gras. These lesbians later appeared in the April 1994 issue of Sydney lesbian magazine Lesbians on the Loose, and they have a public afterlife in a photo by Sydney photographer C Moore Hardy held in the City of Sydney archives (City of Sydney). The group of between a dozen and twenty lesbians (it is hard to tell from the photos) was dressed in waist-to-ankle tulle skirts, white bras and white top hats. Many wore black boots. Unshaven underarm hair is clearly visible. Many wore long necklaces around their necks and the magazine photo makes clear that one bride has a black whip tucked into the band of her skirt. In an article about lesbians and legal recognition of their relationships published in 1995, Sarah Zetlein referred to the brides as “chicks in white satin” (“Chicks”). This chick was a figure that refused the binary distinction between being inside and outside the law, which Zetlein argued characterised thinking about the then emerging possibilities of the legal recognition of lesbian (and gay) relationships. Zetlein wrote that “the chick in white satin”: Represents a politics which moves beyond the concerns of one’s own identity and demands for inclusion to exclusion to a radical reconceptualisation of social relations. She de(con)structs and (re) constructs. … The chick in white satin’s resistance often lies in her exposure and manipulation of her regulation. It is not so much a matter of saying ‘no’ to marriage outright, or arguing only for a ‘piecemeal’ approach to legal relationship regulation, or lobbying for de facto inclusion as was recommended by The Bride Wore Pink, but perverting the understanding of what these legally-sanctioned sexual, social and economic relationships mean, hence undermining their shaky straight foundations.(“Chicks” 56–57) Looking back to 1994 from a time nearly twenty years later when (straight) lesbian brides are celebrated by GLBT culture, incorporated into the mainstream and constitute a market al.ready anticipated by “the wedding industrial complex” (Ingraham), the “flotilla of lesbian brides” can be read as a prescient queer negotiation of their time. It would be a mistake to read the brides only in terms of a nascent interest in legally endorsed same-sex marriage. In my own limited experience, some lesbians have always had a thing for dressing up in wedding garb—as brides or bridesmaids. The lesbian brides marching group gave expression to this desire in queer ways. The brides were not paired into couples. Zetlein writes that “the chick in white satin … [has] a veritable posse of her girlfriends with her (and they are all the brides)” (“Chicks” 63, original emphasis). Their costumes were recognisably bridal but also recognisably parodic and subverting; white but hardly innocent; the tulle and bras were feminine but the top hats were accessories conventionally worn by the groom and his men; the underarm hair a sign of feminist body politics. The whip signalled the lesbian underground sexual culture that flourished in Sydney in the early 1990s (O’Sullivan). The black boots were both lesbian street fashion and sensible shoes for marching! Conclusion It would be incorrect to say that GLBT politics and lesbian and gay couples who desire legal marriage in post-2004 Australia bear no trace of the history of ambivalence, critique and parody of marriage and weddings that have come before. The multiple voices in the 2011 collection of “Australian perspectives on same-sex marriage” (Marsh) put the lie to this claim. But in a climate where our radical pasts are repeatedly forgotten and lesbian and gay couples increasingly desire legal marriage, the political argument is hell-bent on inclusion in the mainstream. There seems to be little interest in a dance around the margins of inclusion/exclusion. I add my voice to the concern with the near exclusive focus on marriage and the terms on which it is sought. It is not a liberationist politics to which I have returned in recalling The Bride Wore Pink and the lesbian brides of the 1994 Gay and Lesbian Mardi Gras, but rather an attention to the differences in the diverse collective histories of non-heterosexual politics. The examples I elaborate are hardly cases of radical difference. But even these instances might remind us that “we” have never been on a single road to equality: there may be incommensurable differences between “us” as much as commonalities. They also remind that desires for inclusion and recognition by the state should be leavened with a strong dose of laughter as well as with critical political analysis. References Australian Marriage Equality (AME). “Public Opinion Nationally.” 22 Oct. 2012. ‹http://www.australianmarriageequality.com/wp/who-supports-equality/a-majority-of-australians-support-marriage-equality/›. Baird, Barbara. “The Politics of Homosexuality in Howard's Australia.” Acts of Love and Lust: Sexuality in Australia from 1945-2010. Eds. Lisa Featherstone, Rebecca Jennings and Robert Reynolds. Newcastle: Cambridge Scholars Press, 2013 (forthcoming). —. “‘Kerryn and Jackie’: Thinking Historically about Lesbian Marriages.” Australian Historical Studies 126 (2005): 253–271. Butler, Judith. “Is Kinship Always Already Heterosexual?” Differences 13.1 (2002): 14–44. Cerise, Somali, and Rob McGrory. “Why Marriage Is Not a Priority.” Sydney Star Observer 28 Aug. 2003: 5. City of Sydney Archives [061\061352] (C. Moore Hardy Collection). ‹http://www.dictionaryofsydney.org//image/40440?zoom_highlight=c+moore+hardy›. Duggan Lisa. The Twilight of Equality?: Neoliberalism, Cultural politics, and the Attack on Democracy. Boston: Beacon Press, 2003. Dunkin, Alex. “Hunter to Speak at Dr Duncan Memorial.” blaze 290 (August 2012): 3. Hamer, Diane, and Belinda Budege, Eds. The Good Bad And The Gorgeous: Popular Culture's Romance With Lesbianism. London: Pandora, 1994. Ingraham, Chrys. White Weddings: Romancing Heterosexuality in Popular Culture, 2nd ed. New York: Routledge, 2008. Johnson, Carol, and Sarah Maddison, and Emma Partridge. “Australia: Parties, Federalism and Rights Agendas.” The Lesbian and Gay Movement and the State. Ed. Manon Tremblay, David Paternotte and Carol Johnson. Surrey: Ashgate, 2011. 27–42. Lesbian and Gay Legal Rights Service. The Bride Wore Pink, 2nd ed. Sydney: GLRL, 1994. Marsh, Victor, ed. Speak Now: Australian Perspectives on Same-Sex Marriage. Melbourne: Clouds of Mgaellan, 2011. Millbank Jenni, “Recognition of Lesbian and Gay Families in Australian Law—Part one: Couples.” Federal Law Review 34 (2006): 1–44Millbank, Jenni, and Wayne Morgan. “Let Them Eat Cake and Ice Cream: Wanting Something ‘More’ from the Relationship Recognition Menu.” Legal Recognition of Same-Sex Partnerships: A Study of National, European and International Law. Ed. Robert Wintermute and Mads Andenaes. Portland: Hart Publishing, 2001. 295–316. O'Sullivan Kimberley. “Dangerous Desire: Lesbianism as Sex or Politics.” Ed. Jill Julius Matthews. Sex in Public: Australian Sexual Cultures Sydney: Allen and Unwin, 1997. 120–23. Puar, Jasbir K. Terrorist Assemblages: Homonationalism in Queer Times. Durham: Duke UP, 2007 Stewart, Miranda, “It’s a Queer Thing: Campaigning for Equality and Social Justice for Lesbians and Gay Men”. Alternative Law Journal 29.2 (April 2004): 75–80. Walker, Kristen. “The Same-Sex Marriage Debate in Australia.” The International Journal of Human Rights 11.1–2 (2007): 109–130. Weeks, Jeffrey. The World We Have Won: The Remaking of Erotic and Intimate Life. Abindgdon: Routledge, 2007. Willett, Graham. Living Out Loud: A History of Gay and Lesbian Activism in Australia. Sydney: Allen & Unwin, 2000. Willett, Graham. “Howard and the Homos.” Social Movement Studies 9.2 (2010): 187–199. Zetlein, Sarah. Lesbian Bodies Before the Law: Intimate Relations and Regulatory Fictions. Honours Thesis, University of Adelaide, 1994. —. “Lesbian Bodies before the Law: Chicks in White Satin.” Australian Feminist Law Journal 5 (1995): 48–63.

Morning report (MR) is a valued educational experience in internal medicine training programs. Many senior residents and faculty have not received formal training in how to effectively facilitate MR. Faculty at the University of Toronto were surveyed to provide insights into what they felt were key elements for the successful facilitation of MR. These insights fell within 5 major categories: planning and preparation, the case, running the show, wrapping up and closing the loop.Résumé Le rapport du matin (RM) est un outil pédagogique précieux dans les programmes de formation en médecine interne. Nombre de résidents séniors et de membres du corps enseignant n’ont toutefois jamais reçu de formation officielle sur la façon de faciliter l’élaboration du RM. Nous avons sondé les membres du corps enseignant de l’université de Toronto pour avoir un aperçu de ce qu’ils percevaient comme étant des éléments-clés susceptibles d’améliorer grandement l’élaboration du RM. Les réponses reçues se répartissent en cinq principales catégories: la planification et la préparation du RM, les caractéristiques du cas évalué, l’importance et la façon de prendre en main le processus, le résumé des informations et l’art de « boucler la boucle». Morning report (MR) has long been an integral and valued part of Internal Medicine training programs in North America.1,2 Some residents recognize MR as the most important educational activity during their training.3 Medical students, residents and faculty typically attend MR. Although the structure and function of MR can vary across institutions, it usually involves a case-based discussion facilitated by a faculty member, chief medical resident (CMR), or other senior resident. The facilitator discusses pertinent aspects of one or more clinical cases to teach medical knowledge, clinical reasoning and other important aspects of physician competencies, such as communication and collaboration skills. 4 Residents have expressed a preference for an interactive teaching session led by an individual with extensive medical knowledge and excellent clinical acumen.5Despite trainees’ perceptions about the core educational function of MR and their preference for skilled facilitators, most residents and many faculty have never received any formal training on how to conduct an effective MR. This, coupled with a lack of resources in the literature, may contribute to feelings of trepidation about assuming the role of facilitator.6 Based on this need, we were invited by the organizing group of residents at the 2015 Canadian CMR Conference, held in Toronto, Canada, to lead a seminar to introduce CMRs to the principles of effective MR facilitation. The conference was attended by over 70 current and future CMRs. In preparation for this seminar, we reviewed available literature and found that practical guidelines on how to facilitate a successful MR were generally lacking. To help us to provide guidance and to capture broad opinions and experiences, we recruited a sample of 24 faculty at the University of Toronto, including many award-winning teachers whose experience in leading MR ranges from 3 to over 30 years. We asked them to provide insights into what they felt were key elements of facilitating a successful MR. While not a systematic collection of data, their insights taken together represent a broad experience base. Given the relative lack of evidence-based literature describing how to facilitate MR, we decided to disseminate a refined summary of the shared wisdom we uncovered in hopes that it would benefit other CMRs and junior faculty as they take on this challenging role.The insights provided fall within 5 main themes (Table 1) which are discussed below, followed by a brief discussion about future directions for MR:1) Planning and preparation2) The case3) Running the show4) Wrapping up5) Closing the LoopTable 1. Experience-Based Tips to Running an Effective Morning ReportPLANNING AND PREPARATION:1) Ensure audiovisual aids are present and working before starting. 2) Start and end on time. 3) Encourage all faculty to attend and participate. 4) Know the audience (including names).THE CASE:5) The case can be undifferentiated or one for which the diagnosis and even response to treatment is known. 6) There are pros and cons to the facilitator knowing details of the case in advance. 7) If details of the case are not known to the facilitator, determine with the person presenting if the discussion should be focused on diagnosis, management or other pertinent issues. 8) Cases need not be limited to inpatients and can include ambulatory cases and case simulations.RUNNING THE SHOW:9) Establish a respectful learning climate. 10) Personal anecdotes and reflections on past cases can engage the audience. 11) Ensure time is spent discuss learning issues valuable to all present. 12) Facilitate and engage in discussion rather than deliver a lecture. 13) Use a mix of pattern recognition (heuristics) and analytical reasoning strategies. 14) Start with a question that has an obvious answer if dealing with a quiet audience. 15) Promote volunteerism for answers as much as possible, but direct a question to a specific person if no one volunteers. 16) Begin by engaging the most junior learners and advance to involve senior learners. 17) Encourage resource stewardship and evidence-based medicine. 18) Acknowledge areas of uncertainty and don’t be afraid to say “I don’t know”. 19) Teaching “scripts” or the use of a systematic approach to developing a differential diagnosis can be used when discussing less familiar topics. 20) Highlight the variability in clinical approach amongst "the experts" in the room.WRAPPING-UP:21) Ensure there is time to summarize “take home points”. 22) Provide learners with the opportunity to summarize what they have learned.CLOSING THE LOOP23) Reinforcement of learning can include a distribution of a relevant paper or providing a summary of learning points via email or blog. 24) Maintain a case log to ensure a balanced curriculum. 25) Provide feedback to the case presenter and facilitator.Planning and Preparation It is important for the organizer and facilitator (these may or may not be the same person) to be diligent when preparing for MR. The person in charge of organizing MR should ensure that all necessary audiovisual equipment is in working order, which may be as simple as ensuring there is a whiteboard and working marker. To optimize housestaff attendance, the sessions and facilitators should be scheduled in a regular and predictable way. The lure of a light breakfast should not be underestimated and may add to the social aspect of this event. Sessions should begin and finish on time (or even slightly early). Ideally, deferring pages for all but critical clinical issues should occur. Having faculty regularly attend MR as audience participants, and not just as facilitators, improves the attendance of learners who see through role-modelling the importance of continuing medical education and lifelong learning. Faculty presence also raises the level of discussion around grey areas of diagnosis and management, providing trainees with a spectrum of opinions and approaches to clinical medicine, specifically role-modelling how faculty approach clinical uncertainty. The organizer must also ensure that someone, usually a trainee, is responsible for bringing the details of one or more clinical cases to be discussed.The facilitator should ensure they know the names and year of training of the housestaff in attendance. It is helpful if the organizer can provide a list (ideally with pictures) of those who will be in attendance for the facilitator to reference. Over time, this helps to develop a sense of community within the group. It also allows the facilitator to engage all participants and with the goals of first posing level-specific questions to the more junior learners and ending with the most senior learners.The Case The selected clinical case can be either a new patient seen in consultation in the past 24 hours or a patient that has been in hospital for some time and for whom results of investigations and response to treatment are known. Ideally, the majority of the cases selected should not involve particularly rare medical issues and should mirror the clinical case mix of patients being cared for by the trainees. Trainees will benefit more from discussions about common clinical problems rather. However, to highlight issues of diagnostic reasoning, it can be beneficial to occasionally discussing uncommon case including typical presentations of rare diseases or unusual presentations of common problems.The faculty surveyed expressed differing opinions when asked if they thought the details of the case should be known to the facilitator in advance. Knowing the details of the case in advance can ensure the facilitator is comfortable with the content area and allows them to focus on aspects of the case that they think will have the highest learning impact for trainees. However, when the case is not known to the facilitator, the audience will be more likely to garner insight into the clinical reasoning process of the facilitator. The opportunity to learn about the cognitive process that an “expert” uses when generating a differential diagnosis and formulating plans for investigation and management is potentially much more valuable than the discussion of content that could be read in a textbook or electronically. When the details of a case are not known, the discussion is more spontaneous and the lines of discussion are more reflective of the thoughts of the trainees, rather than the facilitator. The discussion can be guided by the case itself and the trainees’ questions and answers. A mixed approach to case discussion will provide the variety that the participants value.Although traditionally MR has focused on the diagnosis or management of one or more clinical cases from the inpatient service, its format is flexible enough to provide opportunity for discussion or for other important aspects of patient care. MR can also address ambulatory cases,7 include the presence of a real patient for the purposes of highlighting history-taking and clinical findings and also incorporate discussion of simulated cases, such as code blue scenarios. The discussion can also be enriched by the health professionals from other disciplines including, pharmacists, physical therapists, occupational therapists, nurses, and social workers. The case can also be selected to allow the discussion to be focused on other specific elements of management, such as resource utilization and “choosing wisely,”8 quality and safety, bioethics, and evidence-based medicine.9Running the Show In developing their skills in facilitation, many of the faculty surveyed discussed that they continuously build on the facilitation skills that they have learned over time, the basic principles of which are described elsewhere.10,11 Through feedback and reflection, they adapt to a style that reflects how they believe the MR should be conducted.The facilitator must establish a respectful climate at MR that is conducive to learning. He or she must ensure that the session is collegial and enforce that the goal of the session is learning, rather than showmanship. The environment should encourage interaction and permit people to ask questions. Trainees should feel comfortable enough to answer questions and test hypotheses, even if answers are incorrect. However, the facilitator must ensure that the correct information is conveyed to the group and that incorrect answers are explored as key teaching points. Humour can put people at ease. Self-deprecating humour can be non-threatening and freely employed if it is within the facilitator’s comfort zone. However, humour should never come at the expense of a trainee. Personal anecdotes and reflections on past cases can engage the audience, relax the atmosphere and vividly impart key facts and clinical wisdom.It is important for the facilitator to be respectful of time. Trainees often report that too much time is spent on reviewing the history and physical examination and on the development of an exhaustive differential diagnosis while less time is spent on investigation and management issues, which senior trainees find most valuable. There need not be a fixed formula related to how much time to spend on specific components of the case. A skilled facilitator will expand and abbreviate aspects of the case discussion based on the specific case presented. Some cases represent excellent opportunities to review evidence-based physical examination, some may highlight issues of resource stewardship related to investigation and some are particularly well-suited to discussion of evidence-based management.The facilitator should facilitate a clinical discussion, rather than deliver a didactic talk. He or she should coach the audience to identify key historical facts or findings on physical examination to allow everyone to fully participate in the case formulation and clinical reasoning that will follow. Demonstrating a mix of pattern recognition and heuristics (e.g., “Quick – what do you think the diagnosis is?”) and analytical reasoning strategies will help trainees learn to employ and recognize the strengths and limitations of each.In the face of a quiet audience, questions that have obvious answers should be posed first. The facilitator should promote volunteerism as much as possible; however, addressing specific members of the audience prevents silence and can help ensure everyone is engaged in the discussion. Sensitivity to the level of trainee is important. A facilitator should avoid potential embarrassment of a trainee by allowing a more junior learner to come up with the answer to a question that the more senior trainee could not answer. In other words, there should be an inviolate sequence wherein, for any given topic, the facilitator starts with trainees at an appropriate level for the questions and moves upward sequentially by level of training. This allows participants to relax and set their focus on learning, rather than avoiding eye contact and fearing embarrassment.A skilled facilitator should not allow any one person to dominate the discussion and should also refrain from asking multiple questions to the same participant. However, it can be valuable to challenge a respondent or the group to elaborate on their answers, as this can uncover gaps in knowledge and understanding and provide additional opportunities for learning.It is important to ensure that the discussion is of interest to trainees at all levels. If faculty are present, their opinions should be sought throughout the case. It is helpful to highlight the variability in approach amongst “the experts” in the room. Judicious use and justification of investigations should be encouraged to promote learning about resource stewardship and evidence-based medicine principles should be incorporated, when relevant.Many facilitators are anxious about how to handle situations where they don’t know the answer to a particular clinical problem. In these cases, a demonstration of the clinical reasoning process and a focus on an approach to clinical problems can be helpful. Some of the most useful discussions centre on how to deal with uncertainty and on how to find answers to clinical questions in real-time using available resources. The facilitator should not hesitate to say “I don’t know,” as this demonstrates that nobody has infinite knowledge and role-models the necessity of recognizing one’s limitations. Teaching scripts relating to specific topics or the use of an etiologic or body systems-based approach to developing a differential diagnosis are helpful teaching approaches6.Wrapping Up Sufficient time should be dedicated to recapitulation and repetition of one to 3 key take home messages. This serves to reinforce the important points that were discussed and to ensure that participants walk away with key messages to facilitate learning. Having a few members of the audience identify what they have learned is often beneficial as the facilitator may not identify the same issues as the trainees.Closing the Loop Further reinforcement can occur if a summary of the take home points, or a relevant paper, is circulated by email or posted to a blog.12 This must be done in a manner that protects patient confidentiality. Updates on previously presented diagnostic dilemmas will enhance learning. Finally, the organizer of MR can keep a log of cases that have been presented to avoid excessive repetition of topics and ensure a balanced curriculum.A process for the person presenting the case to be provided with feedback about their presentation skills by the facilitator or peers should be implemented. It is also important for the facilitator to receive feedback about their teaching and the session overall. Feedback will help faculty refine their facilitation skills, especially if coupled with faculty development initiatives to improve teaching skills.13 It may also be important for novice clinician teachers who need to build a teaching portfolio as part of their academic review and promotion process. 14 If it is clear the faculty utilize the feedback, it serves to role-model self-reflection and promote a culture of frequent formative feedback.The Future of MR MR has a long tradition and can be an evolving teaching format capable of meeting current educational needs. For example, with the implementation of competency-based medical education (CBME) into residency training programs, the competencies being developed for Internal Medicine trainees can provide a framework to organize aspects of learning experiences, including MR. 15 Issues of advocacy and stewardship may be highlighted as explicit learning points of cases, as MR allows for discussion of authentic core clinical tasks and problems, avoiding the reduction of competencies to endless lists taught without the necessary context needed for deeper learning.16 There are also challenges to implementing and sustaining a successful MR in today's current training climate. Issues such as duty-hour restrictions, increased volume and acuity of patients, and pressure to discharge patients early in the day17–19 have prompted some to modify the traditional MR. An “afternoon report” allows for attention to clinical duties early in the day and preserves teaching for later in the day. MR should continue to evolve to meet current education and healthcare delivery needs, and these innovations should be described in the literature and studied.Although these tips have been generated from shared experiences at a single centre, we believe they will be useful to facilitators in many other settings, as they represent the experiences of many facilitators with many cumulative years of experience. This article is intended to stimulate others to reflect upon and discuss what they have found to be the key elements to facilitating a successful MR.Acknowledgements We would like to thank our colleagues who contributed tips and whose teaching has influenced the careers of countless trainees: Dr. Ahmed Bayoumi, Dr. Isaac Bogoch, Dr. Mark Cheung, Dr. Allan Detsky, Dr. Irfan Dhalla, Dr. Vera Dounaevskaia, Dr. Trevor Jamieson, Dr. Lauren Lapointe Shaw, Dr. Jerome A. 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