Simulation-based summative assessment in healthcare: an overview of key principles for practice.

BACKGROUND: Healthcare curricula need summative assessments relevant to and representative of clinical situations to best select and train learners. Simulation provides multiple benefits with a growing literature base proving its utility for training in a formative context. Advancing to the next step, "the use of simulation for summative assessment" requires rigorous and evidence-based development because any summative assessment is high stakes for participants, trainers, and programs. The first step of this process is to identify the baseline from which we can start. METHODS: First, using a modified nominal group technique, a task force of 34 panelists defined topics to clarify the why, how, what, when, and who for using simulation-based summative assessment (SBSA). Second, each topic was explored by a group of panelists based on state-of-the-art literature reviews technique with a snowball method to identify further references. Our goal was to identify current knowledge and potential recommendations for future directions. Results were cross-checked among groups and reviewed by an independent expert committee. RESULTS: Seven topics were selected by the task force: "What can be assessed in simulation?", "Assessment tools for SBSA", "Consequences of undergoing the SBSA process", "Scenarios for SBSA", "Debriefing, video, and research for SBSA", "Trainers for SBSA", and "Implementation of SBSA in healthcare". Together, these seven explorations provide an overview of what is known and can be done with relative certainty, and what is unknown and probably needs further investigation. Based on this work, we highlighted the trustworthiness of different summative assessment-related conclusions, the remaining important problems and questions, and their consequences for participants and institutions of how SBSA is conducted. CONCLUSION: Our results identified among the seven topics one area with robust evidence in the literature ("What can be assessed in simulation?"), three areas with evidence that require guidance by expert opinion ("Assessment tools for SBSA", "Scenarios for SBSA", "Implementation of SBSA in healthcare"), and three areas with weak or emerging evidence ("Consequences of undergoing the SBSA process", "Debriefing for SBSA", "Trainers for SBSA"). Using SBSA holds much promise, with increasing demand for this application. Due to the important stakes involved, it must be rigorously conducted and supervised. Guidelines for good practice should be formalized to help with conduct and implementation. We believe this baseline can direct future investigation and the development of guidelines.

[Reforms of medical / health studies: in the middle of the ford]. / Réformes des études de médecine/santé : au milieu du gué.

REFORMS OF MEDICAL / HEALTH STUDIES: IN THE MIDDLE OF THE FORD Medical Education Reform: The main aim is learning of skills, attitudes and behavior of students and graduates which was very often neglected until then. Two problems remains ; first, what are the disponibility and motivation of medical faculties and teachers and second how the students will accept the new form of evaluation to access at post graduate level (specialization cycle).

RÉFORMES DES ÉTUDES DE MÉDECINE/SANTÉ : AU MILIEU DU GUÉ Réforme des études médicales : c'est de l'introduction d'un apprentissage et d'une évaluation des attitudes et des comportements des étudiants qu'il s'agit (alors que ces aspects étaient plutôt négligés jusqu'alors). Reste à savoir si ces nouvelles dispositions dont la bonne mise en oeuvre nécessite un engagement militant des enseignants, démontreront une faisabilité suffisante et bénéficieront de l'acceptabilité des étudiants, toujours suspicieux quand leurs modalités d'évaluation changent.

A novel personalized approach to cardiovascular prevention: The VIVOPTIM programme.

BACKGROUND: Cardiovascular diseases are a leading cause of mortality, but a substantial proportion are preventable. AIMS: The Mutuelle générale de l'éducation nationale (MGEN), a provider of private health insurance in France, has developed the VIVOPTIM programme, a novel digital approach to healthcare based on individualized, multiprofessional, ranked management of cardiovascular risk factors. METHODS: Between November 2015 and June 2016, eligible individuals (age 30-70 years) from two regions of France were invited to participate. Volunteers completed a questionnaire based on the Framingham Heart Study Risk Score and were assigned to one of three cardiovascular risk levels. VIVOPTIM comprises four components: cardiovascular risk assessment, instruction on cardiovascular diseases and associated risk factors, personalized coaching (telephone sessions with a specially trained healthcare professional to provide information on risk factors and disease management, set individual health targets, monitor progress and motivate participants), and e-Health monitoring. RESULTS: Data from 2240 participants were analysed. Significant benefits were observed on mean systolic blood pressure (-3.4mmHg), weight (-1.5kg), smoking (-2.2 cigarettes/day) and daily steps (+1726 steps/day (all P<0.0001)), though not on weekly duration of exercise (-0.2hours/week, P=0.619). CONCLUSION: As a result of the positive mid-to-long-term results of the pilot programme on weight, smoking, blood pressure, and uptake of physical activity, the VIVOPTIM programme was extend to the whole of France in 2018 and has the potential to have a genuine impact on patient care and organization of the healthcare system in France.

[Access to graduate medical education and other reforms]. / De l'internat des hôpitaux aux ECN et autres réformes .

Access to graduate medical education and other reforms. In France, the access to Graduate Medical Education is the key component of medical education. The actual process is not usefull ; specially for the quality of the practical/ theorical education (pregraduate students and residents too). The actual process based on clinical-problem solving with MCQ is not so valid quite insecure and too costly. It is time to redifining the process. Looking to the north america and the « National resident matching Program ¼ could be the solution.

oeuvre sont lourdes, dispendieuses et le cas échéant, insécures et génératrices de contestation. Dans ces conditions, il apparaît opportun d'engager.