Ecouter et dire en médecine, une approche psycho-sociale : utiliser la simulation pour former les futurs médecins à la relation thérapeutique

Les « simulations relationnelles » sont assurées par un docteur en psychologie sociale et un médecin ; menées dans un cabinet de médecine générale spécialement recréé pour les étudiants médecins. Les séquences avec patients simulés sont regardées en direct, débriefées et ré visionnées. La formation est réalisée sur quatre promotions de 180 futurs médecins répartis en groupes (9 à 14 étudiants) de 4e ou 5e année. L’objectif est de produire une analyse réflexive et rétrospective sur l’activité du médecin généraliste tout en protégeant les apprenants. La formation exposée ici est réalisée pour quatre promotions de 180 futurs médecins répartis en groupes (9 à 14 étudiants) de 4ème ou 5ème année. L’objectif est, tout en protégeant les apprenants, de susciter une analyse réflexive et rétrospective de l’activité du médecin (avec la production d’une synthèse collective écrite sur les situations abordées).In Switzerland, men predominate in higher education science courses. However, biology courses are attended primarily by women. The little success of affirmative actions targeting girls and women in science invites us to re-examine the way these subjects are taught in Geneva primary school. We will show that only biology seems to occupy a proper place in the real curriculum. Put science back in the general knowledge could be a way to attract women in science

Semantic Similarity To Improve Question Understanding in a Virtual Patient

In medicine, a communicating virtual patient or doctor allows students to train in medical diagnosis and develop skills to conduct a medical consultation. In this paper, we describe a conversational virtual standardized patient system to allow medical students to simulate a diagnosis strategy of an abdominal surgical emergency. We exploited the semantic properties captured by distributed word representations to search for similar questions in the virtual patient dialogue system. We created two dialogue systems that were evaluated on datasets collected during tests with students. The first system based on hand-crafted rules obtains $92.29\%$ as $F1$-score on the studied clinical case while the second system that combines rules and semantic similarity achieves $94.88\%$. It represents an error reduction of $9.70\%$ as compared to the rules-only-based system

Change in Sleep Quality of Residents the Night Before High-Fidelity Simulation: Results From a Prospective 1-Year National Survey.

peer reviewed[en] OBJECTIVE: The stress level of participants in high-fidelity simulation stems from various factors but may result in anticipatory anxiety causing sleep disturbances during the night prior to simulation. The objective of this survey was to determine the change in sleep quality of residents during the night prior to the simulation. METHODS: The survey was proposed for 1 year to all residents at the beginning of the simulation, in 10 simulation centres. The questionnaire combined demographics and the Leeds Sleep Evaluation Questionnaire using visual analogue scales divided into 4 sleep qualitative domains. The primary outcome was the prevalence of sleep disturbance (>10 mm on 1 domain). Secondary outcomes were the prevalence of severe sleep disturbance (>25 mm), as well as qualitatively and quantitatively reported explanatory sleep parameters. RESULTS: Among respondents, 66% [95% CI: 63 to 69] of residents had more than 10 mm and 27% [95% CI: 24 to 30] had more than 25 mm of sleep disturbance. Residents with a sleep disturbance of more than 10 mm had fewer hours of sleep (6.4 [standard deviation=1.8] vs 7.3 [standard deviation=1.3], difference: -0.9 [95% CI: -1.1 to -0.7]; P < .0001), with a higher number of night-time awakenings (1.3 [standard deviation=1.5] vs 0.7 [standard deviation=0.9], difference: 0.6 [95% CI: 0.4 to 0.8]; P < .0001). CONCLUSION: Among residents participating in the simulation, a high prevalence of change in sleep quality during the night before the simulation was noted. Strategies to help residents achieve better sleep prior to simulation should be explored

Intérêt des jeux sérieux pour la formation des professionnels de santé au raisonnement clinique et à la prise de décision

Contexte et problématique : En plein essor, le jeu sérieux est un jeu vidéo à visée pédagogique, c’est à dire un dispositif de simulation virtuelle sur un matériel numérique associant des éléments de jeu et un objectif pédagogique. Cet outil pédagogique permet un apprentissage expérientiel; de ce fait, il peut être exploité pour la formation des professionnels de santé au raisonnement clinique et à la prise de décision. Objectif : En s’appuyant sur des arguments de nature théorique et sur une revue narrative ciblée de la littérature, la présente contribution dresse un inventaire des impacts documentés de l’efficacité des jeux sérieux pour la formation des professionnels de la santé et formule quelques perspectives pédagogiques. Exégèse : Les jeux sérieux permettent d’opérationnaliser quatre conditions favorisant l’apprentissage: l’attention, l’engagement cognitif actif, la rétroaction et la consolidation. Bien qu’hétérogènes, les données de la littérature montrent que, sous certaines conditions, les jeux sérieux permettent de soutenir des apprentissages qui améliorent la prise de décision, d’une manière comparable aux dispositifs traditionnels. Certaines incertitudes demeurent quant à leur place exacte par rapport à d’autres dispositifs utilisant des ressources numériques ou à d’autres méthodes pédagogiques. Des travaux de recherche pédagogique sont à poursuivre dans certains domaines tels que la motivation et les modalités pédagogiques. Conclusion : Les jeux sérieux font partie des outils pédagogiques à disposition des enseignants lorsqu’ils souhaitent proposer à leurs étudiants des opportunités d’apprentissage actif et expérientiel, par exemple dans le cadre de formations centrées sur la prise de décision

Hybridation d'un agent conversationnel avec des plongements lexicaux pour la formation au diagnostic médical

International audienceDans le contexte médical, un patient ou médecin virtuel dialoguant permet de former les apprenants au diagnostic médical via la simulation de manière autonome. Dans ce travail, nous avons exploité les propriétés sémantiques capturées par les représentations distribuées de mots pour la recherche de questions similaires dans le système de dialogues d'un agent conversationnel médical. Deux systèmes de dialogues ont été créés et évalués sur des jeux de données collectées lors des tests avec les apprenants. Le premier système fondé sur la correspondance de règles de dialogue créées à la main présente une performance globale de 92\% comme taux de réponses cohérentes sur le cas clinique étudié tandis que le second système qui combine les règles de dialogue et la similarité sémantique réalise une performance de 97\% de réponses cohérentes en réduisant de 7\% les erreurs de compréhension par rapport au système de correspondance de règles

A French medical conversations corpus annotated for a virtual patient dialogue system

Conférence annuléeInternational audienceData-driven approaches for creating virtual patient dialogue systems require the availability of large data specific to the language,domain and clinical cases studied. Based on the lack of dialogue corpora in French for medical education, we propose an annotatedcorpus of dialogues including medical consultation interactions between doctor and patient. In this work, we detail the building processof the proposed dialogue corpus, describe the annotation guidelines and also present the statistics of its contents. We then conducted aquestion categorization task to evaluate the benefits of the proposed corpus that is made publicly available

Use of Cognitive Aids: Results from a National Survey among Anaesthesia Providers in France and Canada

Introduction. The use of cognitive aids (CAs) during critical events is thought to be useful. However, whether CAs are known and used by French and Canadian anaesthesia providers is not clear. Methods. A survey was emailed to French and Canadian anaesthesia providers in 2017 through their respective national societies. It consisted of 23 questions about the participants’ demographics and their knowledge, use, and impact of CAs. A second survey was sent to French simulation centres. Results. 912 responses were recorded in France and 278 in Canada (overall response rate: 7% and 11%, respectively). Among the respondents, 700/899 in France (78%) versus 249/273 (91%) in Canada were familiar with the concept of cognitive dysfunction during a crisis and 501/893 (56%) in France versus 250/271 (92%) in Canada knew the concept of CAs. Amongst those respondents who knew about CAs, 189/492 (38%) in France versus 108/244 (44%) in Canada stated that they had already used a CA in real life and 225/493 (45%) in France versus 126/245 (51%) in Canada had received training in their use. Simulation was the principal modality for training in 150/225 (67%) of cases in France versus 47/126 (37%) in Canada. Among the 28/50 French simulation centres which responded (2018 January), 27 organised sessions in anaesthesia and 22 used CAs. Conclusion. CAs were better known in Canada than in France, but their actual use in real life was low in both countries. Simulation appears to play a potentially important role training anaesthesia providers in the use of CAs

Hybridation d’un agent conversationnel avec des plongements lexicaux pour la formation au diagnostic médical

Dans le contexte médical, un patient ou médecin virtuel dialoguant permet de former les apprenants au diagnostic médical via la simulation de manière autonome. Dans ce travail, nous avons exploité les propriétés sémantiques capturées par les représentations distribuées de mots pour la recherche de questions similaires dans le système de dialogues d’un agent conversationnel médical. Deux systèmes de dialogues ont été créés et évalués sur des jeux de données collectées lors des tests avec les apprenants. Le premier système fondé sur la correspondance de règles de dialogue créées à la main présente une performance globale de 92% comme taux de réponses cohérentes sur le cas clinique étudié tandis que le second système qui combine les règles de dialogue et la similarité sémantique réalise une performance de 97% de réponses cohérentes en réduisant de 7% les erreurs de compréhension par rapport au système de correspondance de règles

Strategy to Develop a Common Simulation Training Program: Illustration with Anesthesia and Intensive Care Residency in France.

peer reviewedPhenomenon: The urgency of having fair and trustworthy competency-based assessment in medical training is growing. Simulation is increasingly recognized as a potent method for building and assessing applied competencies. The growing use of simulation and its application in summative assessment calls for comprehensive and rigorously designed programs. Defining the current baseline of what is available and feasible is a crucial first step. This paper uses anesthesia and intensive care (AIC) in France as a case study in how to document this baseline. Approach: An IRB-approved, online anonymous closed survey was submitted to AIC residency program directors and AIC simulation program directors in France from January to February 2021. The researcher-developed survey consisted of 65 questions across five sections: centers' characteristics, curricular characteristics, courses' characteristics, instructors' characteristics, and simulation perceptions and perspectives. Findings: The participation rate was 31/31 (100%) with 29 centers affiliated with a university hospital. All centers had AIC simulation activities. Resident training was structured in 94% of centers. Simulation uses were training (100%), research and development (61%), procedural or organizational testing (42%), and summative assessment (13%). Interprofessional full-scale simulation training existed in 90% of centers. Procedural training on simulators prior to clinical patients' care was performed "always" in 16%, "most often" in 45%, "sometimes" in 29% and "rarely" or "not" in 10% of centers. Simulated patients were used in 61% of centers. Main themes were identified for procedural skills, full-scale and simulated patient simulation training. Simulation activity was perceived as increasing in 68% of centers. Centers expressed a desire to participate in developing and using a national common AIC simulation program. Insights: Based on our findings in AIC, we demonstrated a baseline description of nationwide simulation activities. We now have a clearer perspective on a decentralized approach in which individual institutions or regional consortia conduct simulation for a discipline in a relatively homogeneous way, suggesting the feasibility for national guidelines. This approach provides useful clues for AIC and other disciplines to develop a comprehensive and meaningful program matching existing expectations and closing the identified gaps