Subtypes of major depressive disorders and objectively measured physical activity and sedentary behaviors in the community.

BACKGROUND: Lack of physical activity (PA) and high sedentary behavior (SB) may enhance mental health problems, including depression, and are associated with increased mortality. Aside from a large body of research on major depressive disorder (MDD) assessed as an entity and either PA or SB, few studies have examined associations among subtypes of MDD and both PA and SB simultaneously derived from wrist-worn accelerometers. Accordingly, our aim was to explore the associations among MDD subtypes (atypical, melancholic, combined atypical-melancholic and unspecified) and four actigraphy-derived behaviors combining the levels of PA and SB. METHODS: The sample stemmed from CoLaus|PsyCoLaus, a population-based cohort study, consisting of 2375 participants (55.1% women; mean age: 62.4 years) who wore an accelorometer for 14 days after a physical exam and subsequently completed a semi-structured psychiatric interview. Activity behaviors were defined according to the combination of the levels of moderate-to-vigorous intensity PA and SB. Associations of remitted MDD subtypes, current MDD and physical inactivity behaviors were assessed using multinomial logistic regression, adjusted for socio-demographic characteristics, a history of anxiety, alcohol and drug use disorders and cardiovascular risk factors. RESULTS: In the fully adjusted model, participants with the remitted combined atypical-melancholic subtype had a higher risk of being more physically inactive. CONCLUSIONS: Our findings suggest that low PA and high SB are not restricted to the duration of depressive episodes in people with atypical and melancholic episodes. The lack of PA and high SB in this group of depressive patients exposes them to an additional long-term cardiovascular risk and measures to increase PA may be particularly fruitful in this MDD subgroup.

One for all, all for one: neuro-HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV.

BACKGROUND: With ageing, comorbidities such as neurocognitive impairment increase among people living with HIV (PLWH). However, addressing its multifactorial nature is time-consuming and logistically demanding. We developed a neuro-HIV clinic able to assess these complaints in 8 h using a multidisciplinary approach. METHODS: People living with HIV with neurocognitive complaints were referred from outpatient clinics to Lausanne University Hospital. Over 8 h participants underwent formal infectious disease, neurological, neuropsychological and psychiatric evaluations, with opt-out magnetic resonance imaging (MRI) and lumbar puncture. A multidisciplinary panel discussion was performed afterwards, with a final report weighing all findings being produced. RESULTS: Between 2011 and 2019, a total of 185 PLWH (median age 54 years) were evaluated. Of these, 37 (27%) had HIV-associated neurocognitive impairment, but they were mainly asymptomatic (24/37, 64.9%). Most participants had non-HIV-associated neurocognitive impairment (NHNCI), and depression was prevalent across all participants (102/185, 79.5%). Executive function was the principal neurocognitive domain affected among both groups (75.5% and 83.8% of participants impaired, respectively). Polyneuropathy was found in 29 (15.7%) participants. Abnormalities in MRI were found in 45/167 participants (26.9%), being more common among NHNCI (35, 77.8%), and HIV-1 RNA viral escape was detected in 16/142 participants (11.2%). Plasma HIV-RNA was detectable in 18.4% out of 185 participants. CONCLUSIONS: Cognitive complaints remain an important problem among PLWH. Individual assessment from a general practitioner or HIV specialist is not enough. Our observations show the many layers of HIV management and suggest that a multidisciplinary approach could be helpful in determining non-HIV causes of NCI. A 1-day evaluation system is beneficial for both participants and referring physicians.

[Psychiatric dimensions of post-COVID-19 condition : an overview]. / Dimensions psychiatriques de l'affection post-Covid-19 : état des lieux.

In the aftermath of the SARS-CoV-2 pandemic, many patients developed a set of persistent and disabling symptoms, commonly referred to as "long COVID" and defined as "post-COVID-19 condition" by the World Health Organization. The multi-systemic impairments caused by this condition include neuropsychiatric symptoms characterized by the presence of fatigue, cognitive and sleep disturbances, and increased rates of mood and anxiety disorders. Despite their high incidence and a significant risk of chronicity, they remain poorly understood. This article provides an overview of the psychiatric aspects of post-COVID-19 condition and their treatment.

Au décours de la pandémie de SARS-CoV-2 sont apparus chez de nombreux patients un ensemble de symptômes persistants et invalidants, communément appelé « Covid long ¼ et défini comme « affection post-Covid-19 ¼ par l'OMS. Les atteintes multisystémiques provoquées par cette affection comprennent des symptômes neuropsychiatriques caractérisés, notamment une fatigue, des troubles cognitifs et des taux élevés de troubles de l'humeur et anxieux. Malgré leur incidence élevée et un risque important de chronicité, ils restent mal connus. Cet article propose une synthèse et une mise à jour des connaissances au sujet des dimensions psychiatriques de l'affection post-Covid-19 et de leurs prises en charge.

[Multidisciplinary assessment and management of neurocognitive complaints in people living with HIV]. / Troubles cognitifs chez les personnes vivant avec le VIH. L'importance d'une prise en charge multidisciplinaire.

Current recommendations for the management of neurocognitive complaints in people living with HIV (PLWH) include a series of evaluations that may start with the exclusion of depression followed by a stepwise approach comprised by neurological, neuropsychological and psychiatric assessment, alongside the performance of an MRI and a lumbar puncture. This extensive evaluation is time demanding, and face PLHW with multiple medical consultations and waiting lists. As a response to these challenges, we have developed a one-day Neuro-HIV platform where PLWH undergo a state of the art multidisciplinary assessment in order to provide the necessary diagnoses and interventions to improve their quality of life.

Les recommandations actuelles pour la prise en charge des troubles neurocognitifs chez les personnes vivant avec le VIH (PVVIH) comprennent une série d'évaluations pouvant commencer par l'exclusion d'une dépression suivie d'une approche progressive comprenant une évaluation neurologique, neuropsychologique et psychiatrique, ainsi que la réalisation d'une IRM et d'une ponction lombaire. Cette évaluation approfondie est chronophage et confronte les PVVIH à de multiples consultations médicales et à des listes d'attente. En réponse à ces défis, nous avons développé une plateforme Neuro-VIH où les PVVIH bénéficient d'une évaluation multidisciplinaire sur une journée dans le but de faire un diagnostic précis et définir les interventions nécessaires pour améliorer leur qualité de vie.

The relationship between medical students' empathy, mental health, and burnout: A cross-sectional study.

OBJECTIVE: To investigate how medical students' empathy is related to their mental health and burnout. METHODS: This cross-sectional study included 886 medical students from curriculum years 1-6. The cognitive, affective, and behavioural dimensions of empathy were measured with self-report questionnaires and an emotion recognition test. Regressions were used to test the relationship between the empathy dimensions, depressive symptoms, anxiety, and burnout as well as the influence of curriculum year and gender. RESULTS: Cognitive and behavioural empathy were significantly related to less mental health issues and burnout, whereas affective empathy was related to more mental health issues and burnout. Students in later curriculum years reported less mental health issues and burnout than students in earlier years, whereas no systematic difference could be observed for empathy. Female students reported more mental health issues and burnout as well as higher empathy, except for behavioural empathy for which male students scored higher. CONCLUSIONS: The cognitive, affective, and behavioural dimensions of empathy were differently related to the mental health and burnout of medical students. Students presenting mental health issues or burnout might have more difficulty to adapt their behaviour in social situations and keep a certain distance when taking others' perspective.

[Psychiatric liaison III: Research]. / La liaison psychiatrique III : recherche.

Liaison psychiatry consists of an activity of consultation for patients affected by somatic diseases and of an activity of liaison for clinicians. The liaison work can take different forms, such as teaching of patient-physician relationship, supervision or support. To illustrate psychiatric liaison research, we present four studies conducted in our service, which explore (a) the relations between medical students' mental health and their interpersonal competence, (b) the dreams of medical students and what they reveal of their subjectivities, (c) the stakes for primary care practitioners when asking for a specialist's consult, and (d) the situated clinical practice. These studies contribute to nourish psychiatric liaison, which can use their results for training or support of clinicians.

La psychiatrie de liaison comprend une activité de consultation auprès des patient·es en soins somatiques et une activité de liaison auprès des clinicien·nes. La liaison psychiatrique peut prendre des formes diverses, tels l'enseignement de la relation soignant·e-soigné·e, des supervisions ou le soutien d'équipe. Dans cet article, nous présentons 4 études menées dans notre service qui s'intéressent : a) aux liens entre la santé mentale des étudiant·es en médecine et leurs compétences interpersonnelles ; b) à leurs rêves et à ce qu'ils révèlent de leur subjectivité ; c) aux enjeux de l'appel aux spécialistes pour les médecins de premier recours et d) à la pratique clinique en situation. Ces études contribuent à nourrir le travail de liaison qui peut s'appuyer sur leurs résultats dans la formation et le soutien des soignant·es.

[The burned patient: intervention by the liaison psychiatrist]. / Le patient brûlé: accompagnement par le psychiatre de liaison.

Patients suffering from burns, especially when they are extensive, benefit from specialized multidisciplinary care at the Lausanne University Hospital. In recent decades, major advances in medical research have made possible a significant reduction in morbidity and mortality. At the same time, the psychological needs of those patients have continued to increase, with the need for professional and individualized care. Intervention by the liaison psychiatrist face the challenge of integration within the complex somatic care.

Au CHUV, le patient victime de brûlures, notamment lorsque celles-ci sont étendues, bénéficie d'une prise en charge pluridisciplinaire spécialisée. Ces dernières décennies, des avancées majeures au niveau de la recherche médicale ont rendu possible une réduction conséquente de la morbidité et de la mortalité. En parallèle, les besoins psychologiques de cette patientèle n'ont eu de cesse d'augmenter, avec par conséquent la nécessité d'un accompagnement professionnel et individualisé, dont l'articulation reste parfois complexe avec l'ensemble de la prise en charge somatique.

[Assessing occipital nerve stimulation efficacy for chronic refractory headaches]. / Efficacité de la stimulation du nerf occipital pour les céphalées chroniques réfractaires - Une étude prospective lausannoise.

We prospectively followed a cohort of 26 subjects for an average period of 41 months who benefited from occipital nerve stimulation (ONS) in the context of chronic refractory headaches. In 17 patients treated, the frequency of headache decreased, and quality of life scores improved significantly. Among these patients, the "very good" response rate was 34 %. In this cohort, treatment-related adverse events are relatively common (42 %) but not severe. While it is difficult to anticipate the risk factors for non-response to treatment, we estimate that the risk of failure may not be related to the duration of the disease, but rather to the number of different preventives attempted prior to ONS.

Nous avons suivi prospectivement durant une période d'en moyenne 41 mois une cohorte de 26 patients romands qui ont bénéficié d'une stimulation du nerf occipital (ONS) dans le cadre de céphalées chroniques réfractaires. Chez 17 patients non explantés, la fréquence des céphalées a diminué et les scores de qualité de vie se sont améliorés de façon significative. Parmi ces patients, le taux de « très bonne ¼ réponse est de 34 %. On constate dans cette cohorte que les effets indésirables liés au traitement sont relativement courants (42 %) mais non sévères. Même s'il est difficile d'anticiper les facteurs de risque de non-réponse au traitement, nous estimons que la probabilité d'échec ne serait pas corrélée à la durée de la maladie mais plutôt au nombre de traitements préventifs tentés avant l'ONS.

Undergraduate training in breaking bad news: A continuation study exploring the patient perspective.

OBJECTIVE: This paper reports on the continuation of an initial study that demonstrated the effectiveness, as rated by experts, of an undergraduate training in breaking bad news (BBN) using simulated patient (SP) and individual feedback. The current study aimed to further explore whether such an individualized training approach also has positive effects from the perspective of the patient, using the analogue patient (AP) methodology. METHODS: A subsample of 180 videotaped interviews with SPs were selected from the existing data set (N = 332), consisting of 60 pre- and post-training interviews of students benefiting from the individualized approach (intervention group) and 60 post-training interviews of students having small-group SP training and collective supervision (comparison group). Sixty-eight APs-healthy untrained observers-were asked to view the videotaped interviews while "putting themselves in the patient's shoes" and evaluate satisfaction, trust, liking, and the competence of medical students. RESULTS: The intervention group students improved significantly from pre- to post-training on several dimensions evaluated by the APs: patient satisfaction, trust in the student, liking of the student, and perceived medical competence. Increased AP satisfaction was related to different changes in students' communication behavior between pre- and post-training: increase in positive talk, emotional responsiveness, biomedical and psychosocial information, and biomedical counseling. There was no significant between-group difference at post-training. CONCLUSIONS: AP evaluation showed significant improvement between pre- and post-training. This result provides additional and complementary evidence of the positive effects of individualized training in BBN from the AP perspective, a proxy of (real) patients.

[Psychogenic polydipsia†: a (still) unknown psychosomatic entity]. / Polydipsie psychogène†: une entité somato-psychiatrique (encore) méconnue.

Psychogenic polydipsia, as well referred to as «â€…potomania ¼, is a clinical entity that can be found in psychiatric as well as in physical care settings. Its diagnosis is based on the detection of an excessive fluid intake along with a polyuria, after excluding any potential somatic cause of this clinical presentation. Given the different somatic complications and care complexity, early detection and multidisciplinary interventions are necessary. This article offers a literature review on this topic.

La polydipsie psychogène, également dénommée «â€…potomanie ¼, est une entité clinique que l'on rencontre en milieu psychiatrique, ainsi qu'en milieu somatique. Son diagnostic se base sur la détection d'une consommation excessive d'eau et d'une polyurie, après exclusion de toute cause somatique pouvant être à l'origine du tableau clinique. Vu les diverses complications somatiques et la complexité de la prise en charge, la nécessité de la détection précoce et d'une approche pluridisciplinaire est primordiale. Cet article propose une revue de la littérature scientifique sur ce sujet.

Individual Supervision to Enhance Reflexivity and the Practice of Patient-Centered Care: Experience at the Undergraduate Level.

This article reports on what is at work during individual supervision of medical students in the context of teaching breaking bad news (BBN). Surprisingly, there is a relative lack of research and report on the topic of supervision, even though it is regularly used in medical training. Building on our research and teaching experience on BBN at the undergraduate level, as well as interviews of supervisors, the following key elements have been identified: learning objectives (e.g., raising student awareness of structural elements of the interview, emotion (patients and students) handling), pedagogical approach (being centered on student's needs and supportive to promote already existing competences), essentials (e.g., discussing skills and examples from the clinical practice), and enhancing reflexivity while discussing specific issues (e.g., confusion between the needs of the patient and those of the student). Individual supervision has been identified as crucial and most satisfactory by students to provide guidance and to foster a reflexive stance enabling them to critically apprehend their communication style. Ultimately, the challenge is to teach medical students to not only connect with the patient but also with themselves.

[Team supervision in Consultation Liaison psychiatry : thoughts and landmarks]. / Supervision des équipes de soinsen psychiatrie de liaison : quelques points de repère.

Team supervision is an important task in consultation liaison psychiatry. Supervision allows to exchange on a clinical situation with many different objectives that we describe here. The integration of a plurality of views on a situation, as well as the support of caregivers interpersonal skills are among the goals of utmost importance. Based on our experiences in different care settings of a university hospital, we propose some landmarks to guide the caregivers involved in this task renewed with each team encountered.

La supervision d'équipes de soins par les intervenants de psychiatrie de liaison est une tâche importante au sein de l'activité de Consultation et Liaison. La supervision, dans ce qu'elle a d'essentiel, ouvre un espace de parole dont nous allons décrire les objectifs principaux. La mise en commun d'une pluralité de regards sur une situation, ainsi que le soutien des compétences interpersonnelles des soignants, constituent à nos yeux les objectifs prioritaires. Sur la base de nos expériences dans différents lieux de soins d'un hôpital universitaire, nous proposons quelques points de repère pour guider les intervenants qui se mobilisent dans cette tâche dont les contours sont renouvelés avec chaque équipe rencontrée.

Individual training at the undergraduate level to promote competence in breaking bad news in oncology.

OBJECTIVE: Training medical students in breaking bad news (BBN) in oncology may be key to improve patient care in an area where many physicians tend to be uncomfortable. Given the lack of evidence in the literature, this study aimed to assess empirically the impact of 2 teaching strategies to prepare students for the task of BBN in oncology: one-to-one simulated patient (SP) training with individual feedback (intervention group) vs small-group SP training with collective feedback (comparison group). METHODS: Fourth-year students (N = 236) were randomly assigned to the intervention or comparison group. The SP videotaped interviews were analyzed with respect to BBN communication performance, rated using the Calgary-Cambridge checklist of teaching objectives for BBN; verbal interaction behaviors, coded with the Roter interaction analysis system; and 7 nonverbal behaviors. RESULTS: Students in the intervention group scored significantly higher after than before the training on the overall evaluation of the interview (P < .001) as well as on process skills (P < .001); they also obtained significantly higher scores compared to students in the comparison group on the overall evaluation of the interview (P < .001) and on process skills (P < .001). CONCLUSIONS: This study supports an individualized BBN teaching strategy and contributes to efforts to find the best way to train and reach the largest number of future physicians to improve communication competences in oncology.

[Undergraduate training in physician-patient communication]. / Enseignement prégradué à la communication et à la relation médecin-patient.

In addition to providing psychiatric care to patients with somatic diseases, liaison psychiatry plays an important role in the teaching of the relational aspects of the clinical encounter between patients and clinicians. This series of three articles proposes a critical reflection on this topic, and presents examples of undergraduate and postgraduate teaching programs developed by the psychiatric liaison service at Lausanne University Hospital. This article describes the general context of undergraduate teaching, and focuses on our training with simulated patient of a breaking bad news situation, taking place during the fourth year of medical studies. Individual supervision, provided for each student, is discussed as a relatively unique opportunity within the curriculum of medical school.

En plus des soins psychiatriques qu'elle propose aux patients pris en charge pour des problèmes de santé physique, la psychiatrie de liaison joue un rôle important dans la formation des médecins aux aspects relationnels de la pratique clinique. Dans cette série de trois articles, nous proposons d'une part une réflexion critique sur ces enjeux, et nous présentons, d'autre part, certaines des formations mises en place par le Service de psychiatrie de liaison du CHUV.Cet article évoque le contexte de l'enseignement prégradué et décrit l'exemple d'un enseignement pratique, centré sur la situation d'annonce de mauvaise nouvelle, destiné aux étudiants en médecine en 4e année. Cet enseignement inclut en particulier une séance de supervision individuelle, un apport relativement unique et original dans le cursus des études de médecine.

Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study.

BACKGROUND: Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability. OBJECTIVE: The aim was to examine the clinical value of bedside positive signs in the diagnosis of CD presenting with weakness, gait or sensory symptoms by assessing their specificity, sensitivity and their inter-rater reliability. PATIENTS AND METHODS: Standardised video recorded neurological examinations were performed in 20 consecutive patients with CD and 20 'organic' controls. Ten previously validated sensory and motor signs were grouped in a scale. Thirteen additional motor/sensory 'positive signs', 14 gait patterns and 1 general sign were assessed in a pilot validation study. In addition, two blinded independent neurologists rated the video recordings to assess the inter-rater reliability (Cohen's κ) of each sign. RESULTS: A score of ≥ 4/14 on the sensory motor scale showed a 100% specificity (CI 85 to 100) and a 95% sensitivity (CI 85 to 100). Among the additional tested signs, 10 were significantly more frequent in CD than controls. The interobserver agreement was acceptable for 23/38 signs (2 excellent, 10 good, 11 moderate). CONCLUSIONS: Our study confirms that six bedside 'positive signs' are highly specific for CD with good-excellent inter-rater reliability; we propose to consider them as 'highly reliable signs'. In addition 13 signs could be considered as 'reliable signs' and six further signs as 'suggestive signs' while all others should be used with caution until further validation is available.

[Deep brain stimulation: new targets and new indications]. / Stimulation cérébrale profonde: nouvelles cibles et nouvelles indications.

It is thanks to great advances in the field of neuroscience, which allowed identifying dysfunctions in neural networks as the cause of many psychiatric and neurological diseases, that the number of indications for deep brain stimulation (DBS) has quickly expanded. Although the precise mechanism of action of DBS is unknown, this method probably works by influencing the neural pathways through stimulation of deep targeted brain nuclei which behave as "hubs" in these complex networks. Currently, there is growing interest on DBS' potential benefit, especially in the psychiatric field. This review intends to tackle the current and future psychiatric and neurological indications of DBS.

[Patient-caregiver relationship: when illness blogs step in]. / Relation soignant-soigné quand les blogs s'en mêlent.

The use of social media as a communication tool is rapidly growing in the community, and more specifically in patients, through illness blogs. This has been true for several years in North America, but is becoming a reality in Europe as well. We report here the first results of studies on the putative psychological benefits and risks of illness blogs for their authors. We also explore the possible impact of blogging on the patient-caregiver relationship. Social media are expected to have a growing influence in certain areas of health care. Physicians should therefore stay informed about them, take advantage of their benefits, and anticipate their risks.

Substance use and its association with mental health among Swiss medical students: A cross-sectional study.

BACKGROUND: Studies on mental health and substance use among medical students indicated worrying prevalence but have been mainly descriptive. AIM: To evaluate the prevalence of substance use in a sample of medical students and investigate whether mental health variables have an influence on substance use. METHODS: The data were collected as part of the first wave of the ETMED-L, an ongoing longitudinal open cohort study surveying medical students at the University of Lausanne (Switzerland). N = 886 students were included and completed an online survey including measures of mental health (depression, suicidal ideation, anxiety, stress, and burnout) and use of and risk related with several substances (tobacco, alcohol, cannabis, cocaine, stimulants, sedatives, hallucinogens, opioids, nonmedical prescription drugs, and neuroenhancement drugs). We evaluated the prevalence of use of each substance and then tested the association between mental health and substance use in an Exploratory Structural Equation Modeling framework. RESULTS: Statistical indices indicated a four-factor solution for mental health and a three-factor solution for substance use. A factor comprising risk level for alcohol, tobacco, and cannabis use - which were the most prevalent substances - was significantly associated with a burnout factor and a factor related to financial situation and side job stress. There was a significant association between a factor comprising depression, anxiety, and suicidal ideation and a factor related to the use of sedatives, nonmedical prescription drugs and neuroenhancement drugs. Although their use was less prevalent, a factor comprising the risk level of stimulants and cocaine use was significantly but more mildly related to the burnout factor. A factor comprising stress related to studies and work/life balance as well as emotional exhaustion was not related to substance use factors. CONCLUSION: In this sample of medical students, the prevalence of substance use was substantial and poorer mental health status was related with higher substance use risk levels.

Mental health and burnout during medical school: Longitudinal evolution and covariates.

BACKGROUND: Medical students' rate of depression, suicidal ideation, anxiety, and burnout have been shown to be higher than those of the same-age general population. However, longitudinal studies spanning the whole course of medical school are scarce and present contradictory findings. This study aims to analyze the longitudinal evolution of mental health and burnout from the first to the last year of medical school using a wide range of indicators. Moreover, biopsychosocial covariates that can influence this evolution are explored. METHOD: In an open cohort study design, 3066 annual questionnaires were filled in by 1595 different students from the first to the sixth year of the Lausanne Medical School (Switzerland). Depression symptoms, suicidal ideation, anxiety symptoms, stress, and burnout were measured along with biopsychosocial covariates. The longitudinal evolution of mental health and burnout and the impact of covariates were modelled with linear mixed models. RESULTS: Comparison to a same-aged general population sample shows that medical students reported significantly more depression symptoms and anxiety symptoms. Medical students' mental health improved during the course of the studies in terms of depression symptoms, suicidal ideation, and stress, although suicidal ideation increased again in the last year and anxiety symptoms remained stable. Conversely, the results regarding burnout globally showed a significant worsening from beginning to end of medical school. The covariates most strongly related to better mental health and less burnout were less emotion-focused coping, more social support, and more satisfaction with health. CONCLUSION: Both improvement of mental health and worsening of burnout were observed during the course of medical school. This underlines that the beginning and the end of medical school bring specific challenges with the first years' stressors negatively impacting mental health and the last year's difficulties negatively impacting burnout.

Medical students' skills and needs for training in breaking bad news.

This study assessed medical students' perception of individual vs. group training in breaking bad news (BBN) and explored training needs in BBN. Master-level students (N = 124) were randomised to group training (GT)-where only one or two students per group conducted a simulated patient (SP) interview, which was discussed collectively with the faculty-or individual training (IT)-where each student conducted an SP interview, which was discussed during individual supervision. Training evaluation was based on questionnaires, and the videotaped interviews were rated using the Roter Interaction Analysis System. Students were globally satisfied with the training. Still, there were noticeable differences between students performing an interview (GT/IT) and students observing interviews (GT). The analysis of the interviews showed significant differences according to scenarios and to gender. Active involvement through SP interviews seems required for students to feel able to reach training objectives. The evaluation of communication skills, revealing a baseline heterogeneity, supports individualised training.