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International audience; AIM: The placebo effect and the specific effect are often thought to add up (additive model). Whether additivity holds can dramatically influence the external validity of a trial. This assumption of additivity was tested by Kleijnen et al. in 1994 but the data produced since then has not been synthetized. In this review, we aimed to systematically review the literature to determine whether additivity held. METHODS: We searched Medline and PsychInfo up to 10/01/2019. Studies using the balanced placebo design (BPD), testing two different strengths of placebos, were included. The presence of interaction was evaluated by comparing each group in BPD with analysis of variance or covariance. RESULTS: 30 studies were included and the overall risk of bias was high: four found evidence of additivity and 16 studies found evidence of interaction (seven had evidence of positive additivity). CONCLUSION: Evidence of additivity between placebo and specific features of treatments was rare in included studies. We suggest interventions for placebo-sensitive ailments should be tested in trials designed to take interactions seriously once an exploratory RCTs has proven their efficacy with sufficient internal validity.

International audience; Symbolic interactionism (SI) calls to mind reflexivity and self-consciousness favouring an encounter between patient and doctors’ perspectives. Working on self-consciousness facilitates working on countertransference and processes of change. It enables to establish a patient-doctor metacommunication based on their common ground. SI supports the sense of this common ground integrated in the competence patient centered care and professionalism.; L’interactionnisme symbolique (IS) interpelle la réflexivité et la prise de conscience de Soi qui favorisent la rencontre des perspectives du patient avec celles du médecin. Le travail sur la « conscience de Soi » facilite la maitrise du contre transfert et les processus de changement. Il permet une métacommunication entre patients et médecins dans le cadre du « terrain commun ». L’IS donne du sens à ce « terrain commun » dans le cadre des compétences approche centrée patient (ACP) et professionnalisme.

International audience; OBJECTIVE: The objective of this study was to evaluate the proportion of therapeutics that have proven their efficacy on patient-important outcomes with a high quality of evidence among Cochrane systematic reviews (SRs). METHODS: We surveyed a random sample of 400 SRs’ abstracts published between September 2012 and December 2015, which compared therapeutic interventions with at least a placebo or no intervention control. The primary endpoint was the proportion of SRs with a statistically significant efficacy on a patient-important outcome and with a high quality of evidence. RESULTS: Among the 400 abstracts surveyed, 32 (8%) found efficacy on a patient-important outcome with a high quality of evidence. Half of the 400 SRs (50.2%) evaluated a pharmacological intervention and 12% of these found efficacy of the intervention on a patient-important outcome with a reported high quality of evidence. CONCLUSION: Based on an analysis of 400 abstracts of SRs from the Cochrane Collaboration, we found that there is a low number of therapeutic interventions which have proven their efficacy on patient-important outcomes with a high quality of evidence.

Background: Learning the clinical patient centered care (PCC) includes several pedagogical teaching methods. What are the training courses to effectively acquire skills for this PCC clinical approach? To answer this question, we conducted a systematic review of the literature.Summary of work: Method: 2 medical students worked in pairs as part of their thesis according to the good practice protocol of the Cochrane Handbook and the PRISMA statement. From the research question, an analysis of each randomized controlled trial (RCT) and meta-analysis (MA) according to the PICO criteria associated with a risk of bias assessment (ROB 1) was carried out. The review was registered in PROSPERO. We only included a context of medical and/or paramedical populations, in initial or continuing education (IE, CE).Summary of results: From the electronic databases PubMed, Cochrane, Web of Science, LISSA (2812 articles), OpenGrey (4 articles) and the manual database (28 articles), 56 RCT + 1MA have been selected. 21 RCT studied IE, 33 RCT + 1 MA studied CE. 2 RCT were mixed. Five main pedagogical methods were found: theoretical didactic presentations, video vignettes, role plays with real or simulated patients, tutoring-feedback, discussion groups.The main PCC skills to be acquired were communication and the patient-care provider relationship. We found 40 RCTs reporting a significant improvement in their primary outcome, either totally (15 RCTs) or partially (26 RCTs). The MA was moderately effective: ES=0.54(0.27-0.81) for intervention vs passive comparator; ES=0.37 (0.10-0.64) for intervention vs active comparator. 15 RCTs were inconclusive. We selected 18 RCTs that had only 4/8 low or moderate ROB (5 for IE, 12 for CE and 1 mixed). The plurality of pedagogical methods used and the duration of the training seemed to play an important role in the significant positive results of the studies.Discussion and Conclusions: The risk of bias (especially performance bias, attrition bias and risk of contamination), the weak power of many of these RCTs and the variability of the assessment scales with multiple outcomes led to limitations to this review.Take-home messages: The combination of several pedagogical modalities of learning at PCC seemed necessary over time to acquire the PCC competence.

International audience; Context : The patient-centered approach applied to type 2 diabetes patients requires building up a “common ground” favoring a therapeutic relationship. This relationship can express itself through a symbolic interaction, during which each of the protagonists offers to the other one a symbolic “front” in order to elaborate his own “character” on the social stage. How can this interactionism be expressed during a “medical dramaturgy” between type 2 diabetes patients and their general practitioner? Which impact does it have on common ground and the therapeutic relationship? Method : Analysis and comparison of ten diabetic patients’ and their five physicians’ “cross-talks” on their interaction, in order to bring forward “drama-characters”, the “common ground” and its impact on the relationship. A transversal thematic phenomenological analysis has been undertaken. We have made a theorical triangulation with the symbolic interactionism. Results : Three interactions were marked by a concordant “common ground” in a relational climate of confidence and open-mindedness, with a good therapeutic alliance and shared expectations between the various “characters”. Four interactions showed a discordant “common ground”, a nearly closed relationship and a problematic therapeutic alliance. Two interactions seemed less concordant on the “common-ground”, whereas a trusting relationship and open-minded climate remained. The last interaction showed a concordant common ground contrasting with a distant relationship. Conclusion :The interest in the “character’s symbolic face” which both patient and physician play in their interaction enables to better understand the issues influencing the “common ground” and the therapeutic relationship, specifically from a transferantial perspective; Contexte : L’approche centrée patient (ACP) nécessite de créer un « terrain commun » favorable à une relation thérapeutique. Cette relation peut s’exprimer sur la forme d’un interactionnisme symbolique (IS), dans lequel chacun propose à l’autre une « façade » symbolique pour élaborer son « personnage » sur la scène d’une « dramaturgie sociale ». Comment peut s’exprimer cet interactionnisme lors d’une « dramaturgie médicale » entre des patients vivant avec un diabète de type 2 et leur médecin traitant ? Quel est son impact sur le « terrain commun » et la relation thérapeutique ? Méthodes : Enquête par entretiens semi-dirigés auprès de patients vivant avec un diabète de type 2 et auprès de leurs médecins traitants. Une analyse comparée et croisée des discours a été conduite. La méthodologie de l’analyse était phénoménologique avec analyse thématique, validation des répondants et triangulation des données. L’analyse s’intéressait aux interactions médecin-patient pour en dégager les « représentations - personnages », le « terrain commun » et son impact sur la relation. Résultats : dix patients présentant un diabète de type 2 et leurs cinq médecins traitants ont été interviewés. Dans trois interactions, le « terrain commun » semblait concordant entre médecin et patient dans un contexte relationnel de confiance et une bonne alliance thérapeutique entre les « personnages ». Dans quatre interactions, le « terrain commun » n’était pas concordant avec une relation thérapeutique problématique. Dans deux autres interactions, le « terrain commun » semblait moins concordant mais avec une relation thérapeutique satisfaisante. La dernière interaction mettait en évidence un terrain commun concordant mais une relation thérapeutique très distanciée. Conclusion : S’intéresser aux « personnages- façade symboliques », que médecins et patients « jouent» dans leur interaction, interpelle le « terrain commun » et la relation thérapeutique, composantes essentielles de l’approche centrée patient

International audience; Introduction: We aimed at identifying the associations of health issues managed in general practice encounters with patients aged 65 years or over, according to their sex. Methods: Ancillary study of the ECOGEN study on the consultation practice of French general practitioners. We have studied the 15 most frequent health issues managed in patients aged 65 years or over and identified the pairs most frequently and strongly associated. Results: The sample included 5,782 encounters corresponding to 17,182 health issues managed. Each encounter involved an average of 3.0 [2.9-3.0] health issues. The strongest associations mainly included cardio-metabolic conditions. The most frequent and strong pair (OR: 3.8 [3.3-4.4]) associated non-complicated arterial hypertension with lipid disorder. Some associations were specific to patient sex. Conclusion: The remarkable associations identified may enable to improve the management of elderly patients with multimorbidity by favouring synergic treatments.

Background About 25% of patients experience adverse drug events (ADE) in primary care, but few events are reported by the patients themselves. One solution to improve the detection and management of ADEs in primary care is for patients to report them to their general practitioner. The study aimed to assess the effect of a booklet designed to improve communication and interaction between patients treated with anti-hypertensive drugs and general practitioners on the reporting of ADEs. Methods A cluster randomized controlled cross-sectional stepped wedge open trial (five periods of 3 months) was conducted. A cluster was a group of general practitioners working in ambulatory offices in France. Adults consulting their general practitioner to initiate, modify, or renew an antihypertensive prescription were included. A booklet including information on cardiovascular risks, antihypertensive treatments, and ADE report forms was delivered by the general practitioner to the patient in the intervention group. The primary outcome was the reporting of at least one ADE by the patient to his general practitioner during the three-month period after enrolment. Two clusters were randomised by sequence for a total of 8 to receive the intervention. An intention-to-treat analysis was conducted. A logistic mixed model with random intercept was used. Results Sixty general practitioners included 1095 patients (median: 14 per general practitioner; range: 1–103). More patients reported at least one ADE to their general practitioner in the intervention condition compared to the control condition (aOR = 3.5, IC95 [1.2–10.1], p = 0.02). The modification and initiation of an antihypertensive treatment were also significantly associated with the reporting of ADEs (aOR = 4.4, CI95 [1.9–10.0], p 95 [4.6–26.4], p Conclusion A booklet can improve patient self-reporting of ADEs to their general practitioners. Future research should assess whether it can improve general practitioner management of ADEs and patient’s health status. Trial registration Trial registry identifier NCT01610817 (2012/05/30).

This narrative review describes the history of the construction of a concept: the patient-centered approach. It starts with the conceptualization of four authors (M Balint, C Rogers, G Engel and A Kleinman), representing currents of thought which reintroduced the essential place of the patient's experiential subjectivity in objectifying scientific medical practice. It is reinforced by the conceptualization of Anglo-Saxons authors, mainly M Stewart. This approach centered on the human person is positioned in a manner complementary to the scientific approach. It has an obvious ethical dimension and has been enriched with inter-professional organizational arrangements in terms of providing patient centered care; Cette revue narrative décrit l’histoire de la construction d’un concept : l’approche centrée patient (ACP). Elle débute par la conceptualisation de quatre auteurs (M Balint, C Rogers, G Engel et A Kleinman), représentant des courants de pensée qui ont réintroduit la place incontournable de la subjectivité expérientielle du patient dans la pratique médicale scientifique objectivante. Elle se renforce par la conceptualisation d’auteurs anglo-saxons, principalement M Stewart. Cette démarche clinique centrée sur la personne humaine se positionne de manière complémentaire à la démarche scientifique. Elle a une dimension éthique évidente et s’est enrichie de modalités organisationnelles et interprofessionnelles de délivrance de soins centrés patient.

Background Many studies examined gender inequalities in research, but only a few data are available for general biomedical journals. We assessed the prevalence of female first authorship in general biomedical journals and examined its variations across a number of author, article and journal characteristics. Methods This study was nested within a larger project designed to analyze the bibliometric characteristics of scientific articles. We retrieved 767 randomly selected articles published in 2016 in high impact factor journals of primary healthcare (n = 9) and general internal medicine (n = 9). We extracted the following data: author (gender, number of publications and affiliation of the first author), paper (number of authors, number of participants and study design) and journal characteristics (journal discipline and 2015 impact factor). We compared the proportion of articles authored by women and men using univariate and multivariate logistic regressions adjusted for intra-cluster correlations. Results The female authorship proportion was 48% (63% for primary healthcare and 33% for general internal medicine, P-value < 0.001). In multivariate analysis, women published fewer articles (15 publications: OR 1.6 [95% CI 1.1–2.4]), were more often affiliated with institutions in the Western world (OR 2.2 [95% CI 1.2–3.9]), were more likely to publish qualitative studies (versus systematic reviews or experiments: OR 2.7 [95% CI 1.5–4.8]) and to publish in primary healthcare journals (OR 1.7 [95% CI 1.1–2.7]). Conclusions The underrepresentation of women in articles published by general internal medicine journals, in articles from the non-Western world and in systematic reviews and trials should be addressed.

International audience

International audience; L’une des caractéristiques de la pédagogie médicale à Lyon 1 est la place laissée aux initiatives étudiantes et la volonté de prendre au sérieux non seulement les retours des étudiants lors des évaluations, mais également leurs propositions. Ces étudiants bénéficient depuis déjà plusieurs années de l’engagement d’un grand nombre de patients qui prennent part aux enseignements. Certains d’entre eux viennent en amphithéâtres ou lors de Travaux Dirigés facultaires pour partager leur expertise et/ou leurs expériences (Enseignements de Sciences Humaines et Sociales tout au long du 1er cycle, enseignements de Diabétologie, Pédiatrie au 2e cycle, Spécialité de Médecine Générale au 3e cycle, etc.). D’autres personnes concernées par des maladies chroniques rencontrent les étudiants par petits groupes à un moment-clé de leur construction professionnelle, et notamment au tout début des stages pratiques hospitaliers en 3e année. Quelles représentations ont les étudiants de ces interventions de patients dans leurs formations ? Qu’en attendent-ils ? Des données collectées au cours du projet PACTEM (http://pactem.hypotheses.org) ainsi que d’enquêtes conduites très récemment auprès du public étudiant (Saintigny et Wahl) témoignent du fait que les étudiants accueillent avec beaucoup d’enthousiasme et d’intérêt les patients dans leur faculté. Ce que l’institution considère parfois encore comme une révolution pour la formation médicale semble d’ailleurs apparaître comme une évidence pour les étudiants. On notera quand même que ces étudiants ont tendance à cantonner les apports des patients à un travail sur le « savoir-être » plutôt que sur les « savoirs », le médecin restant souvent le principal détenteur des connaissances. Nous proposons d’interroger l’accueil fait par les étudiants aux patients formateurs à partir de ces enquêtes menées à Lyon mais aussi à l’aune des données plus générales sur les attitudes, attentes et représentations générées par le dispositif de formation médicale (Richard et Saint André 2012). Celui-ci comprend aussi un curriculum caché à travers lequel des étudiants en médecine apprennent une certaine culture médicale, qui en retour modèle leurs représentations et attentes (Hafferty et Franck 1994). Accueillir des patients formateurs, c’est réfléchir à la place et aux apports des patients. N’est-ce pas aussi pour les étudiants eux-mêmes l’occasion de jeter un regard critique sur les manques et les travers de leur propre formation et les besoins de la transformer ? Références : • Davin L, Thistlethwaite J, Bartle E, 2018, ''Compassion, the first emotion ditched when I’m busy’. The struggle to maintain our common humanity', MedEdPublish, 7, [3], 29 • Hafferty F et Franck R 1994, « The hidden curriculum, ethics teaching, and the structure of medical education ». Academic Medicine 69, 861–871 • Hardy-Dubernet et Gaddéa, De « faire médecine » à « faire de la médecine », DREES, Série Etudes, 2005, n°16 • Richard, I Saint André, J. 2012 Comment nos médecins sont-ils formés ?, Paris, Les Belles Lettres.

BackgroundOsteoporosis prevention, diagnosis and treatment remain suboptimal.ObjectivesWe conducted a qualitative study to understand barriers towards care initiation and levers to improve awareness and management of osteoporosis among general practitioners (GPs).MethodsSemi-structured face-to face interviews were conducted with 16 GPs in the Rhône area of France to explore their knowledge and representations regarding osteoporosis. A thematic analysis of transcripts was performed to identify GPs' perceptions on osteoporosis diagnosis, prevention, treatment and patients' expectations.ResultsInterviewed GPs considered osteoporosis far less important than other chronic diseases. They questioned whether osteoporosis was a disease or normal aspect of ageing. They associated osteoporosis with fragility fractures, female sex, menopause, and old age but rarely with male sex. They regarded bone mineral density as the reference diagnostic test, but certain GPs indicated that they had difficulties to interpret the results and to know when to prescribe. Biphosphonates were mentioned as the reference treatment but some GPs expressed distrust about osteoporosis medications. Most of them did not think to screen for osteoporosis risk factors in their patients in a preventive medical approach. They mentioned the lack of time to implement prevention and were expecting clear and pragmatic guidelines, as well as information campaigns in general population to increase awareness on osteoporosis.ConclusionGPs tended to underestimate the salience of osteoporosis. Clear recommendations, better awareness of GPs and the general population could improve osteoporosis prevention and treatment.

International audience

International audience; BackgroundUrate Lowering Therapies (ULTs), mainly Xanthine Oxydase Inhibitors, are widely used by general practitioners (GPs) in asymptomatic hyperuricemia, although no guideline currently recommends to do so. The use of ULTs in asymptomatic hyperuricemia has been associated with an increased risk of ULTs-related adverse drug reactions.AimOur study aimed at exploring GPs’ views and practices in relation to the prescription or non-prescription of ULT in asymptomatic hyperuricemia.MethodsWe conducted a qualitative study using individual semi-structured interviews with 14 French GPs. We built a purposeful sample searching for maximum variation on 8 GPs' personal and professional criteria such as age, years of installation, location of their practice. We conducted a thematic analysis of the transcripts, following Miles and Huberman three steps model: data reduction, data presentation, conclusion drawing and verifications.ResultsWe identified two behaviors leading to inappropriate prescription of ULTs among interviewed GPs. Primary prescribers frequently used uric acid serum levels and had a positive representation of ULTs. Other GPs behaved in an ambivalent way: they did not initiate ULTs, but systematically renewed preexisting prescriptions. They had a negative perception of ULTs but considered them unimportant during drug reassessment. De-prescribing occurred mainly because of external input such as the need to lighten the prescription or the participation in an audit in general practice.ConclusionsOur results support several strategies of ULTs de-prescribing in asymptomatic hyperuricemia: the promotion of de-prescribing of serum acid uric lab test in daily practice (a), supporting the clinical reasoning in the case of asymptomatic hyperuricemia detection (b) but also during ULTs renewals (c) leading to a prioritization of the safest prescriptions (d) through shared medical decision (e). Additional studies are necessary to further develop and evaluate these de-prescribing strategies.

International audience; PurposeThe prescription in International Nonproprietary Names (INN) is a legal obligation for all physicians in France since January 2015. The objective of this study was to analyze the frequency and main factors of INN drug prescribing in general practice.MethodsMulticenter cross-sectional study conducted with 11 interns acting as observers of 23 GP trainers between November 2015 and January 2016. Two evaluators analyzed all GPs’ drug prescriptions to identify INN or brand name prescriptions.ResultsThe database included 4957 drugs prescribed during 1647 visits. Of these, 1462 (29.5% [95% CI 28.2–30.8%]) were prescribed only in INN. According to the multivariate analyses, the factors favoring INN prescribing were as follows: at the drug level, its initial prescribing (OR = 1.4), a nonspecific prescribing objective (OR = 1.6), its listing in the generic drug index with (OR = 7.7) or without (OR = 2.9) efficiency objective included in the payment for public health objectives (PPHO) program, and the oral route of administration (OR from 0.4 for the percutaneous route to 0.2 for the pulmonary route); at the patient level, the male gender (OR = 1.3), the age of 15 years or more (OR = 1.9), and the absence of a long-term condition (OR = 1.3); at the physician level, the reception of a public healthcare insurance representative (OR = 4.1), the nonreception of pharmaceutical sales representatives (OR = 3.0), and the urban practice environment (OR = 2.8).ConclusionsIn 2015, less than one third of drugs were prescribed in INN only in general practice. The use of various incentives and regulatory measures is likely to favor the prescription of INNs by practitioners.

International audience

International audience; Les « interactions symboliques » dans la relation entre le médecin généraliste et ses patients-étude qualitative de dyades médecin-patient. Congrès du collège de la médecine générale Paris 30-31 mars 2017 Résumé : Notre travail de thèse aborde la relation médecin-patient à partir du concept sociologique de l'interactionnisme symbolique. Ce concept a été utilisé pour l'élaboration de notre méthodologie ainsi que pour répondre à l'objectif de notre étude. Notre objectif était, dans un premier temps, d'analyser les échanges réciproques entre médecin et patient, afin de comprendre comment le médecin perçoit son rôle dans la relation. Dans un second temps, cette analyse nous a permis de connaitre et faire apparaître les outils relationnels que le médecin utilise dans l'exercice de sa fonction. Une étude qualitative a été réalisée, grâce à dix médecins et en deux phases : un entretien de type semi-directif avec les médecins, puis un second de type focus group avec les dyades médecins-patients ainsi constituées. A partir des dix dyades médecins-patients, nous avons fait émerger les enjeux problématiques de leur relation. Les entretiens ont aussi permis de révéler cinq moyens utilisés par les médecins pour aboutir à la résolution de leurs conflits : la continuité des soins, la relation d'aide, les techniques de communication, la négociation, et le réalisme sur soi. La majeure partie des moyens mis en évidence lors des entretiens se retrouvent dans les dimensions de l' « approche centrée patient ». L'une des observations secondaire de cette étude a été celle d'une dérive de « l'approche centrée patient ». En souhaitant établir une prise en charge globale du patient, les médecins peuvent devenir « englobalisant ». Ils ne prennent alors plus en compte la perspective du patient valorisée par cette approche. Enfin, certains patients de notre étude se sont montrés facilitateurs dans la relation, faisant ainsi écho à la notion de patient expert qui se développe actuellement. L'espace de parole mis en place lors de cette étude, s'apparentant à un espace de métacommunication, pourrait être reproduit lors d'une consultation dédiée. Elle permettrait d'aborder les situations conflictuelles entre médecin et patient et de dégager des pistes de coopération.

International audience

International audience; BACKGROUND: A vaccine against serogroup B Neisseria meningitidis, major cause of bacterial meningitis in children and adults, has recently been developed. In a context of an increasing parental mistrust against vaccinations, understanding the reason for their choices is crucial in order to improve immunization coverage. Our study aimed at evaluating parental attitudes and perceptions towards serogroup B meningococcal invasive disease vaccination. METHODS: A prospective observational study was conducted in different French independent-practice medical offices (general practitioners and paediatricians) and nurseries between May 1 and December 31, 2013, using a questionnaire distributed in electronic and paper forms to parents having at least one child between the ages of 2 months and 16 years old. RESULTS: 1270 parents were included, of whom 671 (52.8%) spontaneously stated to be in favour of this vaccination. Their choice was mainly justified by the severity of the disease (63.8%) and the desire to protect their child (51.7%). In multivariate analysis, the young age of parents (OR 0.949 per additional year; p\textless10(-3)), the history of vaccination against serogroup C meningococcal invasive diseases (OR 6.755; p\textless10(-3)), and the prior knowledge of the vaccine (OR 2.081; p=0.001) were associated with vaccination acceptance. The main reasons for refusal were the lack of hindsight on this new vaccine (50.6%) and the fear of side effects (45.5%). After objective information on the disease and the vaccine, only 6.3% of the entire responding population would refuse to consider vaccination. CONCLUSIONS: The spontaneous acceptance rate of vaccination against serogroup B meningococcal invasive disease is insufficient. However, after objective information by their physician or public health authorities, only a few parents would in the end be completely resistant.

International audience; Dans une approche centrée patient, le patient est reconnu comme le meilleur connaisseur de lui-même qu'il exprime par sa perspective (son expérience vécue, ses représentations, ses attentes, ses préférences …) dans sa relation avec le médecin. Il peut acquérir une expertise sur soi qui le rend partenaire du professionnel qui l'accompagne. Cette réalité de la pratique soignante doit émerger au cours des études médicales dés le 2 ème cycle pour sortir d'un savoir purement académique sur la maladie. Pour remplir cet objectif pédagogique, nous avons fait intervenir l'expertise d'un patient diabétique de type 2 dans le cadre des cours de sciences humaines et sociales (SHS) L'objectif du cours était de reproduire une première séance de consultation d'éducation thérapeutique explorant par écoute active la perspective d'un patient diabétique de type 2 pendant 20 min environ. 1 er temps: les étudiants avaient des consignes précises d'observation (contenu, communication verbale-non verbale, attitudes). 2 ème temps: les étudiants étaient encouragés à poser des questions pour compléter ce qui n'avait pas été abordé. 3 ème temps: les étudiants pouvaient restituer leurs observations et réflexions. La séance devait durer 2 h. Cette expérience pédagogique a permis de mettre en lumière l'approche centrée patient en mobilisant l'expertise du patient qui est là en personne pour la porter. Une telle implication du patient dans la formation mérite discussion : quelle place pour des savoirs expérientiels/savoirs académiques dans le cursus des étudiants ? Quel type de formation pour ces patients experts ? Humaniser la médecine scientifique • « Voir la maladie du point de vue du patient, sa manière d'en parler, ses représentations » qui contraste avec le cours académique. Comprendre l'approche centrée patient • « Apprendre à écouter…partage d'expériences » « ce qui est important dans la prise en charge du patient : quelles sont ses attentes ? comment vit-il au quotidien ?» • « les patients formateurs experts permettent de voir au-delà de la maladie…le patient dans sa globalité, l'impact sur sa vie » • « j'ai aimé voir comment le patient réagit à sa pathologie en transformant une annonce négative en des actions positives, en une force » • « savoir ce que la maladie peut avoir comme impact sur sa vie, ses motivations pour reprendre le contrôle » • « Se rendre compte que les patients ont un rôle actif dans leur maladie et leur prise en charge » • « Comprendre que les leviers et les freins sont propres à chaque patient » Développer la réflexivité • « Réfléchir sur notre pratique futur…ça motive pour aller en cours …à adapter à d'autres cours » Illustrer l'interaction relationnelle médecin patient • « Se recentrer sur l'essentiel : la relation médecin malade » • « Partage… relation de confiance… se mettre à la place » • « dialogue pour donner envie au patient d'être plus précis sur son ressenti, ses émotions, motivations (non prise en compte dans les cours magistraux) » Observer un modèle de rôle médecin • « diagnostiquer, annoncer, accompagner le patient dans sa vie avec la maladie » • « le coté jeu de rôle » « techniques d'entretien, positions, les mots utilisés » • « personnage clé qui rassure, relais d'information, acteur de prévention » Mobiliser les émotions • Cours « innovant », « émouvant », « témoignage touchant » par l'authenticité de l'expérience vécue, la vie au quotidien « voir la réalité en face », « Mettre un visage, un nom et une histoire sur la maladie » • « ça fait beaucoup de bien… on se sent moins désemparé par rapport à la pression de la théorie » Trois séances ont eu lieu regroupant à chaque fois une centaine d'étudiants de FGSM3. Pour évaluer l'impact de la 3 ème séance, les étudiants ont été invités à écrire 2 à 3 idées sur les apports de ce cours. (1) DMG Lyon (2) enseignant SHS Lyon Est (3) EA 4148 15 ème congrès du CNGE Dijon 26-27 novembre 2015 Critiques et propositions « un peu long et beaucoup de redites » ; « Voir différents témoignages moins conciliants »

International audience

International audience

International audience; • Educative counselling have to favour processes of change needed for the improvement of clinical criteria in type 2 diabetes patients. Their efficacy is identical to those of oral antidiabetics on intermediate criteria (1% decrease in HBA1c) but not on morbi-mortality. • Research question: Which processes of change are built during an educational approach based on a patient centred approach in type 2 diabetes patients in General Practice? • Qualitative phenomenological research with transtheorical model of change (Prochaska) triangulation • Educational patient centred approach including, after a purposive sampling, ten type 2 diabetic patients • Intervention : active listening and understanding of patients' perspectives (lived experience, beliefs, expectation, preference) + explanation on diabetes + adapted hygieno-dietetic counselling with an objective of common ground. • Main outcome measures assessed at 3 months : quantitative (weight and HBA1c) and qualitative (satisfaction, achievement of objectives) • Analysis of processes of change from patients' verbatims (NVivo 9) • To stimulate patients' reflexivity , self-evaluation and decisional balance • To highlight and support experiential cognitivo-emotional (Consciousness raising, dramatic relief, environmental reevaluation, self reevaluation, self liberation) and behavioural (Helping relationships, stimulus control, counter-conditioning, reinforcement management) processes of change • To promote strategies reinforcing the feeling of self-efficacy by lived-experiences

International audience

International audience

International audience