Psychological first aid in operation for military healthcare providers : a study on pre-deployment training.

INTRODUCTION: During operational missions, while the management of physical injuries in the field remains the priority, the identification of operational incapacity of psychological origin is necessary as it is equally crucial for the safety of the individual, the group and the mission. The French Military Health Service has developed a Psychological First Aid Training in Operation (PFATO) course based on relational simulations, for military service members. The aim is to identify the early signs of psychological distress in a comrade and to adopt an adapted and protective attitude. PFATO training is also offered to healthcare providers. METHODS: We conducted a descriptive cross-sectional study using a self-administered online questionnaire which was sent after deployment to all physicians or nurses trained in PFATO between July 2019 and July 2021 (n=80). The main objective of our work was to evaluate the relevance of this awareness training among physicians and nurses and to identify specific complementary expectations in operational psychiatry for this population. RESULTS: We obtained a response rate of 55%. Significantly, 21.62% of participants used PFATO during their last deployment and another 20% observed a team member using PFATO. The circumstances of use as reported by participants included acute stress related to combat, conflict with hierarchy or comrades, and suicidal crisis. Among those who used PFATO, the training helped 87.5% of them to identify signs of psychological distress and 100% of them to assist combatants . All respondents stressed the added value of practical simulations during PFATO education. Moreover, this study also makes it possible to identify adaptations needed to optimize this module for healthcare providers. CONCLUSION: The results suggest the value for healthcare provider of training in first-response psychological care using relational simulation based on the model of raising awareness about PFATO.

[Systematic analysis of evaluations of Objective Structured Clinical Exam (OSCE) multiple circuits: Explanatory variables and inter-rater correlations]. / Analyse systématique des évaluations de circuits multiples d'examen clinique objectif structuré (ECOS) : variables explicatives et corrélations inter-évaluateurs.

INTRODUCTION: Objective Structured Clinical Examinations (OSCEs) assess professional performance in a simulated environment. Following their integration into the reform of the 2nd cycle of medical studies (R2C), this pedagogical modality was implemented in France. This study investigates the variability of students' OSCE scores, as well as their inter-rater reproducibility. METHODS: This single-center retrospective study covered several sessions of evaluative OSCE circuits conducted between January 2022 and June 2023. Variables collected were: baseline situation family, competency domain, presence of a standardized participant for stations; gender and professional status for evaluators; scores (global, clinical and communication skills), number of previously completed OSCE circuits and faculty scores for students. RESULTS: The variability of the overall score was explained mainly (79.7%, CI95% [77.4; 82.0]) by the station factor. The student factor and the circuit factor explained 7.5% [12.9; 20.2] and<0.01% [2.10-13; 2.10-9] respectively. The inter-rater intra-class correlation coefficient was 87.2% [86.4; 87.9] for the global score. Station characteristics (starting situation, domain) and evaluator characteristics (gender, status) were significantly associated with score variations. CONCLUSION: This first study on the variability of OSCE circuit scores in France shows good reproducibility with influence of station characteristics. In order to standardize circuits, variability linked to the domain competency should be considered as well.

[Design of an escape game by nursing students, a key to developing skills in educational care]. / Conception d'un escape game par des étudiants infirmiers, une clé du développement de compétences en soins éducatifs.

This article is the shared experience of six student nurses. They look back on their health service experience and explain how their decision to create an escape game for 5th graders was a unique and enriching experience for both the students and themselves. In particular, it enabled them to develop a number of skills that were extremely useful in building their professional identity.

[Current state of knowledge of urology residents and fellows on the neuro-urological management of spina bifida patients in France]. / État des lieux des connaissances des internes et chefs de clinique d'urologie sur la prise en charge neuro-urologique des patients spina bifida en France.

OBJECTIVE: To assess the current knowledge of French urology residents and fellows about neurogenic lower urinary tract dysfunction and their management in patients with spina bifida. MATERIAL AND METHOD: A 7-question questionnaire, covering the responder's experience and the various stages in the neuro-urological management of spina bifida, was drafted by an expert urologist. Responses were collected within 5days of being e-mailed to members of the Association française des urologues en formation (AFUF), and a descriptive analysis was carried out. RESULTS: Of the 448 members, 155 completed the questionnaire. Of the participants, 83.8% said they knew the definition of spina bifida, and 76.8% had already had to care for a spina bifida patient. Of the participants, 48.4% correctly estimated the number of spina bifida patients in France. Neurogenic lower urinary tract dysfunction to look for and the specificities of management seemed to have been acquired by a majority of respondents (correct response rates of 70.7% and 75.4%, respectively), unlike the extra-urological aspects (53.9%), and the choice of examinations useful for the initial work-up and follow-up (55.8%). CONCLUSION: While the expected neurogenic lower urinary tract dysfunction and the specificities of therapeutic management of spina bifida patients appear to be well known to urologists in training, knowledge of extra-urological symptoms and the choice of examinations could be improved. These results could be used to adjust the teaching given to French urologists in training on the urological management of spina bifida patients. LEVEL OF EVIDENCE: Grade 4.

[ACACIAS 3: Learning about announcement consultations in the second cycle of medical studies]. / ACACIAS 3 : Apprentissage des consultations d'annonce dans le deuxième cycle d'études médicales.

INTRODUCTION: The second cycle of medical studies is a key time for developing interpersonal skills and the doctor-patient relationship. High-fidelity simulation is an initial learning option that enables learners to confront situations involving empathy. METHODS: This is a feedback report from May 2023 on the implementation of simulation as a training tool for 2nd cycle medical students in the announcement consultation. The training consists of two parts: theoretical teaching via a digital platform with an assessment of theoretical knowledge and a practical part with a simulation session with an actress playing a standardized patient. The acquisition of skills and the reflexivity of learners are assessed by means of a pre- and post-test. RESULTS: Twenty-nine externs took part in this project. Student satisfaction was 96 %. The feedback was very positive, both in terms of the quality of the sessions and the briefings/debriefings. Almost all the students wanted to repeat the experience. The simulation exercise was beneficial for the students in terms of the development (before vs. after) of their skills (verbal, emotional and relational) (1.05±0.25 vs. 1.22±0.19, P=0.047) and appeared to be relevant to the development of reflexivity (3.29±0.72 vs. 3.48±0.9, P=0.134). CONCLUSION: This first published French study demonstrates the feasibility and value of training in announcing a diagnosis, combining teaching via a digital platform and high-fidelity simulation for second cycle medical students.

Teaching and Evaluating an Occupational Perspective in Canada: A Descriptive Qualitative Study.

Background. Occupation is the core domain of occupational therapy, and an occupational perspective is foundational for practice. Research has explored how an occupational perspective is taught. Yet, little has explored the Canadian occupational therapy educational context. There are national differences in core competencies and accreditation standards and nuances in how occupation is defined and what conceptual models are used. As such, a Canadian perspective may offer new understandings of value both within and outside of Canada. Purpose. To understand how, in Canada, educators teach and evaluate student occupational perspectives in entry-level master of occupational therapy programs. Method. This study used a descriptive qualitative design with an interpretive approach. Semi-structured interviews were used to gather data from 12 educators from Canadian entry-level occupational therapy programs. Reflexive thematic analysis was used for data analysis. Findings. Five themes were identified: (1) occupational perspectives as pedagogy (2) it's a process, not an end state; (3) "everybody is involved": a community of educators; (4) thinking critically; and (5) "hard to evaluate." Conclusion. The complex, dynamic, and contextualized nature of an occupational perspective calls for critical, reflexive, communal, and innovative pedagogical and assessment approaches.

[Developing ISP skills: the challenge facing the Sdis medical training department]. / Développer les compétences de l'ISP : l'enjeu du service formation médicale du Sdis.

Teaching can be taught! In order to develop and maintain the skills of its caregivers, the Departemental Fire and Rescue Service 77 Health Sub-Directorate is engaged in an innovative pedagogical dynamic, combining a real engineering of its training programs in compliance with the principles of active pedagogy, full and regular training of its teaching teams.

Gross and Applied Anatomy Pedagogical Approaches in Occupational Therapy Education: A Scoping Review.

Introduction. With technological advancements, anatomy teaching approaches in occupational therapy education have expanded. However, uncertainty remains regarding the approaches that best optimize academic and practice outcomes in student occupational therapists (OTs). Purpose. This scoping review mapped the pedagogical approaches used to teach musculoskeletal anatomy to student OTs. Methods. A scoping review was conducted, with a consultation exercise involving Canadian occupational therapy educators. Six databases were searched, with terms related to student OTs, anatomy, and education. Included articles were available in English, full text; featured empirical research of any study design and/or gray literature; featured a pedagogical approach used to teach anatomy; and targeted student OTs with the pedagogies. Results. Twenty-eight reports between 1978 and 2021 were included. Although technology-based pedagogies became more common with time, historically used pedagogies (e.g., lectures and labs) remained prominent and most common. Narrative synthesis regarding the effectiveness of anatomy pedagogical approaches identified five main factors: (a) anatomy competency; (b) teaching method diversity; (c) learner psychological considerations; (d) interprofessional education; and (e) optimal academic outcomes. Implications. This review demonstrates the importance of anatomy knowledge to occupational therapy education and practice. A diversity of pedagogical approaches, with and without technology, may foster better outcomes by addressing diverse learning needs.

[Health simulation in initial training, a reality to be increased]. / La simulation en santé en formation initiale, une réalité à augmenter.

Simulated practice is a pedagogical tool that invites students to immerse themselves in scenarios close to reality. It confronts them with experiential learning while giving them the opportunity to explore and deconstruct what they have experienced in a distanced and group-based manner during debriefings. Simulation is a recognized tool for continuing professional development, but it is difficult for it to become established in the context of initial training. Its implementation requires certain human and financial resources.

[UTEP/IFSI partnership for therapeutic patient education]. / Partenariat Utep/Ifsi au service de l'éducation thérapeutique du patient.

As part of the week of awareness of therapeutic patient education (TPE) organized at the Blois hospital, nursing students were asked to create videos of non-educational situations in order to raise awareness of TPE among health professionals and their educational posture towards patients. The pedagogical approach used was aimed at distancing themselves from and reflecting on good practices in educational care.

[Healthcare simulation: a powerful method]. / La simulation en santé : une méthode puissante.

Simulation in healthcare has been particularly developed since the report commissioned by the French National Authority for Health (Haute Autorité de Santé), which adopted the motto: "Never the first time on the patient". Ten years later, where are we with simulation-based learning? Is the term still being used appropriately? For whom is it intended and how does simulation-based learning allow for a multidisciplinary approach?

[Procedural simulation for nursing education]. / La simulation procédurale pour la formation des infirmiers.

Simulation is an educational tool that allows, in initial and continuing education, the acquisition of gestures and procedures. The management of the vascular approach concerning the arteriovenous fistula is not yet standardized. Thus, the standardization of the fistula puncture technique, approached through simulation, could be part of an approach to optimizing practices and continuous improvement of care.

COVID-19, Virtual Engagement and the Psychoid Imagination.

The impact of the COVID-19 pandemic on analytic training and the delivery of educational content is explored here. The proliferation of Zoom therapy and teaching is creating a post-human platform to which nearly everyone in contemporary society has had to adapt. Looking at the possible meanings of the pandemic, a psychoid factor (the virus) engaging the imagination has come to the fore as a response to climate change. The striking similarity to the H1N1 viral pandemic ("Spanish flu") is noted, especially in the context of C. G. Jung having had a case in 1919 during which he experienced a number of visions and dreams. The imagery produced can be seen as an implicit attempt at "re-enchanting the world" found in The red book. Finally, a reconsideration of pedagogy in response to the pandemic is discussed with an eye to the archetypal aspects of internet communications.

Cet article étudie l'impact de la pandémie de COVID-19 sur la formation des analystes et sur la manière dont le contenu éducatif est dispensé. La prolifération de thérapie et de formation par Zoom crée une plateforme post-humaine à laquelle quasiment toute personne dans la société contemporaine a eu à s'adapter. En regardant les sens possibles que l'on peut donner à la pandémie, un facteur psychoïde (le virus) qui mobilise l'imagination a pris le devant de la scène en tant que réponse au changement climatique. L'article souligne la similarité frappante avec la pandémie virale H1N1 (la grippe espagnole), particulièrement dans le contexte où C.G. Jung l'a attrapée en 1919 et a fait l'expérience d'un certain nombre de visions et de rêves. L'imagerie produite peut être vue comme une tentative implicite de « ré-enchanter le monde ¼ telle qu'on la trouve dans le Livre Rouge. En conclusion, une reconsidération de la pédagogie issue de la pandémie est discutée en tenant compte des aspects archétypaux des communications par internet.

Se exploran aquí las repercusiones de la pandemia de COVID-19 en la formación analítica y en la transmisión de contenidos educativos. La proliferación de la terapia y la enseñanza vía Zoom está creando una plataforma posthumana a la que casi todo el mundo en la sociedad contemporánea ha tenido que adaptarse. En cuanto a los posibles significados de la pandemia, un factor psicoide (el virus) que atrae la imaginación ha pasado a primer plano como respuesta al cambio climático. Se observa la sorprendente similitud con la pandemia viral H1N1 ("gripe española"), especialmente en el contexto de un caso que C.G. Jung tuvo en 1919 durante el cual experimentó una serie de visiones y sueños. La imaginería producida puede verse como un intento implícito de "reencantar el mundo" que se encuentra en El Libro Rojo. Por último, se plantea una reconsideración de la pedagogía en respuesta a la pandemia, teniendo en cuenta los aspectos arquetípicos de las comunicaciones por Internet.

[Digital adaptation of a therapeutic education program in the context of Covid-19]. / Adaptation numérique d'un programme d'éducation thérapeutique dans le contexte de la Covid-19.

The context of containment due to the Covid-19 epidemic forced professionals to suspend their face-to-face therapeutic education programs. For young patients with asthma, the situation was made even more complex by anxiety-provoking communications (which turned out to be inaccurate) about the possible aggravating role of corticosteroids in the event of Covid-19, which led to untimely discontinuations and sometimes to a decrease in their therapeutic adherence, exposing them to an increased risk of poor control of their disease. Faced with the feeling of abandonment felt by some families in this singular context, a team at Trousseau Hospital in Paris decided to rethink and adapt its distance therapeutic education workshops.

["Junior Doctor" in Plastic Surgery, a new status. Evaluation of the practices after one semester of application of the reform]. / Docteur Junior en chirurgie plastique, un nouveau statut. Évaluation des pratiques après un semestre d'application de la réforme.

INTRODUCTION: The reform of the third cycle of medical studies in 2017 led to the creation of the status of "Junior Doctor", corresponding to the consolidation phase and allowing increasing autonomy and supervision from the intern. In plastic surgery, this status appeared for the first time in November 2021 in French hospitals; it lasts two years and succeeds the first four years of internship. MATERIAL AND METHODS: We sent a self-questionnaire by email in May 2022 to the 21 French Junior Doctors. This was interested in their training ground, formation program, consultation activity, operating program, integration into the on-call list, the existence of half-days of availability, and their general opinion on this reform and its implementation. RESULTS: We collected 20 questionnaires with a sex ratio of twelve men for eight women. The majority of respondents worked in a university hospital (85 %). 45 % had their consultations, 60 % had their own operating sessions under general anesthesia, and 35 % under local anesthesia. Only 25 % of them considered this reform to be a step forward in terms of training. CONCLUSION: The introduction of the status of Junior Doctor is contrasted within the various hospitals. Despite the progressive and supervised autonomy provided by this reform, it is generally perceived neutrally or negatively by Junior Doctors. The establishment of own consultations and operating sessions stands out as a key positive element allowing better application of the reform.

[Tolerating uncertainty: Towards a competence-based approach]. / Faire de la tolérance à l'incertitude une compétence médicale.

Uncertainty in inherent to every aspects of medical practice. As the concept of uncertainty in healthcare is still to explore, deciphering the determinants and the roots of this uncertainty would benefit from the insights of various disciplines, such as epistemology, sociology, mathematics, or philosophy. The urgent need to improve physician's ability to cope with uncertainty, has been recently highlighted by the COVID-19 pandemic. Besides, the concept of uncertainty tolerance has been proposed, and could serve as a relevant basis for approaching uncertainty, in medical education. Thus, we propose at first to discuss the uncertainty tolerance framework from Hillen et al. Then, from an educational perspective, we outline some avenues regarding how uncertainty tolerance could be thought, in a competence-based approach, and discuss several educational activities, which have proven efficient in promoting uncertainty tolerance among medical practitioners abroad.

[Assessment of ophthalmological surgical training in Île-de-France: Results of a survey on 89 residents]. / Formation chirurgicale en ophtalmologie en Île-de-France : résultats d'une enquête sur 89 internes.

OBJECTIVE: This study aims to evaluate surgical training in ophthalmology through feedback from residents. MATERIALS AND METHODS: An anonymous questionnaire was created, including 20 items which assessed the number of complete or partial surgical procedures performed during a semester, self-assessment of surgical skills, use of surgical simulators, an overall rating of the surgical training received and some suggestions to improve surgical training. It was sent by email to all residents in training in Île-de-France (DES Île-de-France and Inter-CHU), France. RESULTS: From October 23 to November 7, 2021, 89/137 residents responded to the questionnaire (65%). Since the beginning of their residency, ninety percent of the residents received training using simulators. Over 90% performed all of the technical steps of a "standard" cataract surgery at least once during the semester, and 60% 10 times or more. The least performed technical steps or procedures also received the lowest self-assessment: management of expulsive hemorrhage, open-globe or lacrimal laceration wound suturing, capsular tension ring injection, and intraocular lens explantation. Residents gave an overall average rating of 6.6/10 to their training and suggested some feedback on videos of resident surgeries (67%) and theoretical courses dealing with surgical techniques (61%). DISCUSSION: The increasing use of simulators should improve surgical training. Residents express the need for training regarding surgical complications and emergencies as well as improvement of their technical skills via improved feedback. CONCLUSION: Surgical teaching appears suitable for learning cataract surgery but seems less effective for the management of emergencies and intraoperative complications.

[Setting up Objective Structured Clinical Examination (OSCE) in ophthalmology]. / Mise en place des examens cliniques objectifs structurés (ECOS) facultaires en ophtalmologie.

Obective Structured Clinical Examinations (OSCE) are a reproducible and objective way to evaluate medical students and have been used for many years in English-speaking countries, Canada and Switzerland. They evaluate candidates more on the basis of their practical skills, know-how and interpersonal skills than on their theoretical knowledge. From a nationally validated, limited list of typical clinical situations, stations are set up by the teaching team with standardized patients played by actors, designed to test a variety of problem solving, technical, diagnostic, therapeutic, communication, examination, and history taking skills, possibly with simulation tools. Setting up a station, as well as creating an OSCE cycle with several stations through which the candidates rotate, requires significant preparation prior to the examination: creating the station scenario with precise instruction sheets for the candidates, simulated patients and evaluators, multiple stages of proofreading, verifying the required equipment and adapting rating scales. OSCEs seek to evaluate students "objectively," as they are the only variable in this type of examination, in which the scripts, materials and rating scales have been standardized to limit subjectivity. This examination method is a flagship measure of the reform of the second cycle of French medical studies. OSCEs are now part of the testing modalities for the 2021-2022 academic year and will be integrated into the National Dematerialized Examination (NDE) starting in May 2023. They may also be useful in validating the achievements of students and residents in various stages of training, as well as in continuing medical education (CME). We present herein the key elements of these new evaluation tools and their practical applications in the evaluation of students in ophthalmology.

Facilitating Age-Conscious Student Development through Lecture-Based Courses on Aging.

Ageism is pervasive and socially normalized, and population aging has created a need to understand how views of aging and of older people, typically considered to be people over the age of 65, can be improved. This study sought to understand how undergraduate students' attitudes towards older adults and the aging process may be influenced after completing a typical, lecture-based undergraduate course on aging that lacked service-learning components. Two undergraduate student cohorts (n = 40) at two Canadian universities participated in semi-structured focus groups/interviews, describing how the course may have impacted their perceptions of the aging process and of older adults. An iterative collaborative qualitative analysis demonstrated that course content stimulated a deeper understanding of the aging process, prompting a reduction in and increased awareness of ageism, and enhanced personal connection with aging, ultimately facilitating the development of an age-conscious student. Lecture-based courses focused on aging may be sufficient to facilitate positive attitude change among undergraduate students towards older adults and the aging process.

[Promotion of Covid-19 vaccination by nursing students]. / Promotion de la vaccination contre la Covid-19 par des étudiants en soins infirmiers.

In the midst of Covid-19 pandemic, on the cusp of a fourth wave, second-year nursing students conducted a campaign to promote vaccination. This educational activity is part of the evaluation of teaching unit 4.6 of semester 3 "educational and preventive care". It is conducted in the form of a project and is based on the principle of so-called active teaching methods.