[Teaching and learning during attending rounds in internal medicine: an anthropological study]. / Enseigner et apprendre lors des grandes visites en médecine interne hospitalière : Une étude anthropologique.

This anthropological research aims to highlight the educational approaches in action during attending rounds. The goal is to understand how specific learning domains, professional socialization and learning environments are influenced by the different ways of conducting attending rounds. Two formats of rounds were noted: the IN format, when the patient case is presented in the patient room, and the OUT format. Six educational approaches were identified. The attending round format has an impact on the approaches used. The latter contribute to the development, to varying degrees, of knowledge, skills and attitudes. Attending rounds remain a space for "top-down" transmission and supervision, even though some approaches involve learner initiatives and peer group logic.

Notre recherche anthropologique vise à mettre en lumière les approches pédagogiques à l'œuvre durant les grandes visites. Comment les domaines d'apprentissages visés, la socialisation professionnelle et l'environnement d'apprentissage sont-ils influencés par les différentes manières de les conduire ? Deux formes de visites sont retrouvées : la forme IN (le cas est présenté au lit du patient) et la forme OUT. Six approches pédagogiques ont été identifiées. La forme de grande visite influence les approches pédagogiques mobilisées. Celles-ci contribuent à développer, à des degrés variables, des savoirs, savoir-faire et savoir-être. Les grandes visites restent un espace de transmission « top-down ¼ et de surveillance, même si certaines approches encouragent les initiatives des apprenants ainsi que les logiques de groupes de pairs.

Representations of personalised medicine in family medicine: a qualitative analysis.

BACKGROUND: The promise of personalised medicine (PM) to transform healthcare has sparked great enthusiasm in the last years. Yet, its lack of consensus around the nature and scope of the concept has ended in terminological confusion amongst the users in primary care. We aimed to investigate the perceptions of doctors and their patients in response to this evolving concept. This present article focuses on the general understanding of personalised medicine, underlining the confusion over the concept. METHODS: Semi-structured comprehensive interviews were conducted with 10 general practitioners (GPs) and 10 of their patients. The purposive sampling took into account the doctor's age, sex, and place of practice (rural/urban); each doctor recruited one patient of the same age and sex. Each interview began with the same open-ended question about the participant's knowledge of the topic, after which a working definition was provided to continue the discussion. Using the grounded theory method, the analysis consisted of open coding, axial coding and selective coding. RESULTS: From our present analysis focusing on the general understanding of PM, three main themes representing the concept emerged. The first two representations being "centred on the person as a whole" and "focused on alternative and complementary methods", in which the therapeutic relationship was stated as key. The third theme "medicine open to innovation" involved the few participants who had a good understanding of the concept and could associate personalised medicine with genomics. For those who value therapeutic relationship, the risks of accepting innovation could result in "fast-food" medicine and interpersonal barriers. DISCUSSION: PM is predominantly unfamiliar in family medicine. It is misinterpreted as a holistic or integrative type of medicine. This semantic confusion probably lies in the choice of the label "personalised" or from the lack of a uniform definition for the term.

[Personalized medicine and chronic disease prevention: Needs, attitudes and expectations regarding in general practice]. / Médecine personnalisée et prévention des maladies chroniques - Besoins, perceptions et attentes des patients et des médecins généralistes.

The ambition of personalized medicine now also concerns the prevention of chronic diseases, based on genetic risk profiles. The objective of this project was to describe the perception and attitudes of patients and general practitioners (GP) on this issue, in order to consider the consequences on the health system. The study included two axes, patients (questionnaire survey) and GPs (consensus study using the Delphi method), preceded by a qualitative exploratory phase. The study showed that genetic screening for disease risk factors was not a priority, either for patients or for GPs. On the other hand, the role of the GP in the use of these tests will probably be predominant. This implies the need for training and availability of up-to-date information.

L'ambition de la médecine personnalisée (MP) concerne désormais aussi la prévention des maladies chroniques en se basant sur les profils génétiques de risque. L'objectif de ce projet était de connaître la perception et les attentes des patients et des médecins généralistes (MG) sur cette question, pour envisager les conséquences sur le système de santé. L'étude comprenait deux axes, patients (enquête par questionnaire) et MG (étude de consensus par méthode Delphi), précédés d'une phase exploratoire qualitative. Elle a montré que le dépistage génétique des facteurs de risque aux maladies ne constituait pas une priorité, ni pour les patients, ni pour les MG. En revanche, la place du MG autour de l'utilisation de ces tests sera probablement prépondérante. Cela implique la nécessité de formations et la disponibilité d'informations à jour.

Médecine personnalisée et prévention des maladies chroniques : l'attitude des médecins généralistes.

OBJECTIVES: In a context of future generalization of access to genetic risk profiles, general practitioners (GP) will have a major role to play. The objective of this study was to understand their attitude towards this approach and the potential consequences on their practice. METHODS: In 2018, the University Center of General Medicine and Public Health of Lausanne, the Department of Primary Care Medicine of the University Hospitals of Geneva, and the Institute of Social Sciences of the University of Lausanne set up a study with patients and general practitioners concerning the access to genetic risk profiles. The GPs attitude, the subject of this study, was explored using the two-round Delphi consensus method. 120 interns and senior clinicians responded to 24 statements. RESULTS: A consensus was reached for 80% of the statements. The GP’s significant role in terms of access to genetic profiles became evident, even if their position seems conditioned by their position as front-line health workers, and doubts remain as to the impact of this process in guiding their practice. The need for training was widely emphasized as well as the possibility multidisciplinary support and management. There was also a consensus for the need of a legislative framework for these practices. CONCLUSION: This study has underlined the importance of anticipating the needs in developing an advanced and evolving training and information program for GPs in the domain of genomic medicine in light of the prevention activities that could result.

May direct-to-consumer genetic testing have an impact on general practitioners' daily practice? a cross-sectional study of patients' intentions towards this approach.

BACKGROUND: Direct-to-consumer genetic testing (DTCGT) offers individuals access to information on their probable risks of suffering from a wide range of chronic diseases. General practitioners (GPs) will probably play a major role in supporting its use, but patients' perception of DTCGT remain unclear. This study aimed to describe those attitudes and expectations and how they might affect GPs' daily practices. METHODS: In 2018-2019, a study related to the use of DTCGT for preventive care in general medicine was conducted among patients in Switzerland's French-speaking areas. Data were collected in the waiting room using a self-administrated questionnaire about patients' interest in DTCGT and what their attitudes might be if testing revealed an elevated risk of diabetes, colorectal cancer, or Alzheimer's disease. RESULTS: About 40% of the 929 participating (participation rate about 80%) patients had heard about DTCGT and, once the test had been explained, 43% reported that they would be interested in being tested. If that testing suggested an elevated risk of disease, the majority of patients reported that they would change their lifestyle (65%-81%, depending on the disease), request more examinations (63%-77%), and expect changes in their GP's follow-up (48%-59%). Personal characteristics such as sex, age, urbanity, marital status, and perceived health were factors predictive of patients' attitudes. CONCLUSION: Findings indicated that the generalization of DTCGT might affect GPs' daily practices in terms of workload and knowledge about this approach. However, this result must be qualified by the fact that it is based on hypothetical situations.