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The growth of the “patient‐centred” approach to health care has highlighted the importance of quality communication practices. One area that remains problematic, however, is the process of breaking bad news to patients and/or relatives. Hence, there have been calls for more research and training in this domain. Reports the findings of a study that used the critical incident technique to explore the breaking bad news encounter from the perspective of the health care practitioner. In total 33 senior medical and nursing staff reported on situations in which they described specific, vividly recalled, experiences of both “effective” and “ineffective” bad news delivery. These reported incidents were content analysed and a range of key dimensions was identified for both effective and ineffective experiences. Interpersonal communication skills emerged as particularly salient factors and these are discussed in detail, together with implications for future research and training.

For many Indigenous nations globally, ethics is a conversation. The purpose of this paper is to share and mobilize knowledge to build relationships and capacities regarding the ethics review and approval of research with Indigenous peoples throughout Atlantic Canada. The authors share key principles that emerged for shifting practices that recognize Indigenous rights holders through ethical research review practice.

The NunatuKavut Inuit hosted and led a two-day gathering on March 2019 in Happy Valley-Goose Bay, Newfoundland and Labrador, to promote a regional dialogue on Indigenous Research Governance. It brought together Indigenous Nations within the Atlantic Region and invited guests from institutional ethics review boards and researchers in the region to address the principles-to-policy-to-practice gap as it relates to the research ethics review process. Called “Naalak”, an Inuktitut word that means “to listen and to pay close attention”, the gathering created a dynamic moment of respect and understanding of how to work better together and support one another in research with Indigenous peoples on Indigenous lands.

Through this process of dialogue and reflection, emergent principles and practices for “good” research ethics were collectively identified. Open dialogue between institutional ethics boards and Indigenous research review committees acknowledged past and current research practices from Indigenous peoples’ perspectives; supported and encouraged community-led research; articulated and exemplified Indigenous ownership and control of data; promoted and practiced ethical and responsible research with Indigenous peoples; and supported and emphasized rights based approaches within the current research regulatory system. Key principles emerged for shifting paradigms to honour Indigenous rights holders through ethical research practice, including: recognizing Indigenous peoples as rights holders with sovereignty over research; accepting collective responsibility for research in a “good” way; enlarging the sphere of ethical consideration to include the land; acknowledging that “The stories are ours” through Indigenous-led (or co-led) research; articulating relationships between Indigenous and Research Ethics Board (REB) approvals; addressing justice and proportionate review of Indigenous research; and, means of identifying the Indigenous governing authority for approving research.

Future steps (including further research) include pursuing collective responsibilities towards empowering Indigenous communities to build their own consensus around research with/in their people and their lands. This entails pursuing further understanding of how to move forward in recognition and respect for Indigenous peoples as rights holders, and disrupting mainstream dialogue around Indigenous peoples as “stakeholders” in research.

The first step in moving forward in a way that embraces Indigenous principles is to deeply embed the respect of Indigenous peoples as rights holders across and within REBs. This shift in perspective changes our collective responsibilities in equitable ways, reflecting and respecting differing impetus and resources between the two parties: “equity” does imply “equality”. Several examples of practical changes to REB procedures and considerations are detailed.

What the authors have discovered is that it is not just about academic or institutional REB decolonization: there are broad systematic issues at play. However, pursuing the collective responsibilities outlined in our paper should work towards empowering communities to build their own consensus around research with/in their people and their lands. Indigenous peoples are rights holders, and have governance over research, including the autonomy to make decisions about themselves, their future, and their past.

The value is in its guidance around how authentic partnerships can develop that promote equity with regard to community and researcher and community/researcher voice and power throughout the research lifecycle, including through research ethics reviews that respect Indigenous rights, world views and ways of knowing. It helps to show how both Indigenous and non-Indigenous institutions can collectively honour Indigenous rights holders through ethical research practice.

For strategic and competitive insights, this paper aims to measure and benchmark comparative operating efficiencies of major airlines in Asia, Europe, and North America.

The authors employ data envelopment analysis for measuring the relative efficiency of 90 airlines in Asia, Europe, and North America. In addition, the authors use Tobit regression analysis for finding determinants of the efficiency.

Results indicate that the efficiency of the airlines in Europe is the lowest among the airlines in these three regions. Efficiency differences between the airlines in Europe and the airlines in the two other regions (Asia and North America) are statistically significant in terms of technical efficiency and pure technical efficiency, but not significant between the airlines in Asia and North America. For the determinants of efficiency, the authors identified that revenues and expenses were significant for explaining efficiency scores of airlines.

Further research is needed to explain the findings that airlines in Europe were less efficient than airlines in Asia and North America. In addition, including variables on customer satisfaction in a future study is desirable.

Major contributions of this study include measuring the comparative efficiency of major airlines in Asia, Europe, and North America and finding determinants of the efficiency for strategic insights.

Migration is increasing worldwide. health care practitioners must provide care to migrants in a culturally competent manner that is sensitive to cultural, political and economic contexts shaping health and illness. Many studies have provided strong evidence that health providers benefit from training in cross-cultural care. Cultural competence education of medical students during their early learning can begin to address attitudes and responsiveness toward refugees. At Memorial University in Canada, the authors designed “Morning in Refugee Health”, an innovative program in cultural competency training for first year medical students in the Clinical Skills and Ethics course. The purpose of this paper is to discuss these issues.

Here the authors introduce the curriculum and provide the rationale for the specific pedagogical techniques employed, emphasizing the consideration of culture in its relation to political and economic contexts. The authors describe the innovation of training standardized patients (SPs) who are themselves immigrants or refugees. The authors explain how and why the collaboration of community agencies and medical school administration is key to the successful implementation of such a curriculum.

Medical students benefit from early pre-clinical education in refugee health. Specific attention to community context, SP training, small group format, linkages between clinical skills and medical ethics, medical school administrative and community agency support are essential to development and delivery of this curriculum. As a result of the Morning in Refugee Health, students initiated a community medical outreach project for newly arriving refugees.

The approach is unique in three ways: integration of training in clinical skills and ethics; training of SPs who are themselves immigrants or refugees; and reflection on the political, economic and cultural contexts shaping health and health care.