A multi-method approach to drafting candidate entrustable professional activities for a general internal medicine residency programme.

INTRODUCTION: Entrustable professional activities (EPAs) are units of concrete daily clinical tasks that trainee physicians should be able to handle with increasing autonomy during their postgraduate training. EPAs are gaining international recognition as an essential component of competency-based medical training programmes. The process of developing EPAs for a nationwide training programme is complex and requires an in-depth understanding of EPAs as a concept and good knowledge of appropriate development processes. This article provides a detailed description of the methodology and results of a multi-step approach for developing a list of candidate EPAs for Switzerland's postgraduate training programme in general internal medicine (GIM). METHODS: We took a multi-step approach including a systematic review of international literature, four national focus groups, a national consensus process using a RAND appropriateness method, and a quality check of the selected candidate EPAs using EQual criteria. RESULTS: These steps generated a final list of 247 candidate EPAs in general internal medicine that were submitted for the national consensus process. After two rounds of rating, experts agreed on the appropriateness for general internal medicine postgraduate training of 225 candidate EPAs. Twenty-two were deemed inappropriate, and disagreement persisted only for two EPAs. DISCUSSION: This multi-step programme is one of the few describing in detail the process of developing a list of EPAs and providing evidence of validity at each step. The clinical breadth of our candidate EPAs, together with the detailed description of our methodology, could serve as a useful starting point from which medical education specialists or clinicians could develop or revise applicable lists of EPAs, particularly for postgraduate training programmes in either general internal medicine or family medicine.

Exploring clinical teachers' beliefs about teaching in a newly established medical school in Southern Switzerland.

Academic social contexts and educational beliefs may influence teaching practices and teaching intentions. Insight into such beliefs represents an important source of information for medical schools to improve the quality of teaching and to guide content of faculty development programs. The aim of this study was to explore beliefs about teaching among prospective clinical teachers at a newly established medical school in Southern Switzerland and to estimate the relationship between these beliefs and intention to commit to teaching in the newly established medical curriculum using Fishbein's integrative model of behaviour prediction. We targeted a purposive sample of physicians working in hospital departments potentially involved in the clinical immersion of medical students enrolled in the program. We designed a cross-sectional quantitative study using an online questionnaire. The questionnaire included both items developed by the authors and items belonging to a previously validated questionnaire. Participants showed a high intention to commit to teaching in the newly established curriculum. We found that self-efficacy beliefs and two sets of behavioural beliefs, namely perceived importance and expectations, had a positive correlation with the intention to commit. On the other hand, we pointed out a number of normative beliefs that in the long run could hinder the maintenance of this commitment, which should be addressed both at the levels of both faculty development and institutional policy rules. Our study also highlights the importance of reinforcing teachers' perceived self-efficacy in providing clinical supervision, strengthening their perceived importance of the clinical supervision, and incentivising the commitment of teachers by ensuring they have protected time to devote to this activity.

Eosinophilic Granulomatosis with Polyangiitis after mRNA-1273 SARS-CoV-2 Vaccine.

During one of the worst global health crises, millions of people were vaccinated against SARS-CoV-2. In rare cases, new onset systemic inflammatory diseases were reported with temporal coincidence to the vaccination. We describe a case of severe Eosinophilic Granulomatosis with Polyangiitis (EGPA) in a young asthmatic woman, occurring after a second dose of the mRNA-1273 vaccine. She presented with multisystem EGPA with cardiac and central nervous system involvement, complicated by secondary immune thrombocytopenia (ITP). We review the reported cases of EGPA coinciding with SARS-CoV-2 mRNA vaccination. All potentially vaccine-related EGPA cases reported so far occurred within 14 days from immunization. EGPA is very rare with an incidence of 1:1,000,000 inhabitants, and the number of reported post-vaccination EGPA cases lies within the expected incidence rate for the period. While we cannot prove a causal relationship between the vaccine and EGPA onset, the temporal relationship with the vaccine immune stimulation is intriguing, in a disease occurring almost always in adults with asthma and/or chronic rhinosinusitis and driven by an aberrant Th2 lymphocyte activation with hypereosinophilia; nevertheless, cases of inflammatory diseases (IMIDs) emerging in the context of vaccination remain rare and the benefits of preventing severe COVID presentations with SARS-CoV-2 mRNA vaccines remain unquestionable.

The influence of patient gender on medical students' care: Evaluation during an objective structured clinical examination.

OBJECTIVES: To assess whether men and women are evaluated and treated differently by medical students. METHODS: We evaluated patient care provided by 110 fifth-year medical students during an objective structured clinical examination (OSCE), using two clinical cases with standardized patients (SPs): generalized anxiety disorder (GAD) and ascending aortic dissection (AAD). Half of the students encountered male and half female SPs. Except for gender, the cases were identical. We compared diagnosis and treatment of male vs female SPs. RESULTS: Students diagnosed GAD more often in female SPs than in male SPs (diagnosis completed, partially completed, and not completed in 47%, 16% and 36% respectively vs. 22%, 20%, and 58% for male SPs, p = 0.02). The nature of symptoms was better described for male SPs. For AAD, the emergency was more frequently identified and the examination of femoral pulses better performed in female SPs. CONCLUSION: Medical students have a gender bias when evaluating patients with GAD and AAD. PRACTICE IMPLICATION: The observed gender bias in the evaluation of patients, likely leads to differences in treatment between male and female patients (i.e. under-recognition of anxiety in men). Medical schools should implement gender-sensitive medical education initiatives to improve inclusive patient care.

Entrustable professional activities for residency in general internal medicine: a systematic review.

CONTEXT: Entrustable Professional Activities (EPAs) are observable tasks that are regular parts of a physician's daily clinical work. Before being permitted to accomplish these tasks independently, trainees must gain their supervisors' trust. Defining the list of EPAs that should be mastered by the end of a residency is critical to setting clear expectations about autonomous practice. OBJECTIVE: To collect all the lists of EPAs defined for residencies in general internal medicine and synthesise them into a reference work useful for developing new lists of EPAs or improving existing ones. METHOD: This systematic review searched five databases and relevant grey literature using keywords related to EPAs and postgraduate education, from 2005, when the first article on EPAs was published, to April 2022. Inclusion criteria were the availability of an EPAs list and a focus on general internal medicine. Two reviewers independently selected the studies, extracted data and performed a quality assessment using QATSDD and AACODS tools. Mean values and inter-rater reliability were calculated. RESULTS: The review yielded 3292 records, with 16 articles meeting the inclusion criteria, mostly from North America. Synthesising their 16 lists generated 395 EPAs. The reviewers then inductively categoried those EPAs, 308 of which fell into 6 domains, 14 themes and 24 subthemes. The domains were: (1) care and management of the general adult population (n = 103 EPAs); (2) care and management of patients with specific needs (n = 67); (3) care coordination and communication (n = 52); (4) management and leadership (N = 21); (5) healthcare quality, education, and research (n = 41); and (6) miscellaneous (n = 24). The remaining 87 EPAs were disease-specific and did not fit into this categorisation. CONCLUSIONS: Categorising EPAs created a unique synthesis of the existing lists of EPAs for educating residents in general internal medicine. This synthesis could be used as a reference for anyone tasked with developing new lists of EPAs or improving existing ones.

[Teaching and learning during attending rounds in internal medicine: an anthropological study]. / Enseigner et apprendre lors des grandes visites en médecine interne hospitalière : Une étude anthropologique.

This anthropological research aims to highlight the educational approaches in action during attending rounds. The goal is to understand how specific learning domains, professional socialization and learning environments are influenced by the different ways of conducting attending rounds. Two formats of rounds were noted: the IN format, when the patient case is presented in the patient room, and the OUT format. Six educational approaches were identified. The attending round format has an impact on the approaches used. The latter contribute to the development, to varying degrees, of knowledge, skills and attitudes. Attending rounds remain a space for "top-down" transmission and supervision, even though some approaches involve learner initiatives and peer group logic.

Notre recherche anthropologique vise à mettre en lumière les approches pédagogiques à l'œuvre durant les grandes visites. Comment les domaines d'apprentissages visés, la socialisation professionnelle et l'environnement d'apprentissage sont-ils influencés par les différentes manières de les conduire ? Deux formes de visites sont retrouvées : la forme IN (le cas est présenté au lit du patient) et la forme OUT. Six approches pédagogiques ont été identifiées. La forme de grande visite influence les approches pédagogiques mobilisées. Celles-ci contribuent à développer, à des degrés variables, des savoirs, savoir-faire et savoir-être. Les grandes visites restent un espace de transmission « top-down ¼ et de surveillance, même si certaines approches encouragent les initiatives des apprenants ainsi que les logiques de groupes de pairs.

Anti-SARS-CoV-2 Titers Predict the Severity of COVID-19.

Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 is associated with a wide spectrum of disease, ranging from asymptomatic infection to acute respiratory distress syndrome. Some biomarkers may predict disease severity. Among them, the anti-SARS-CoV-2 antibody response has been related to severe disease. The aim of this study was to assess the correlation between the anti-SARS-CoV-2 serological response and COVID-19 outcome. Demographic, clinical, and biological data from nasopharyngeal-PCR confirmed COVID-19 hospitalized patients were prospectively collected between April and August 2020 at our institution. All patients had serial weekly serology testing for a maximum of three blood samples or until discharge. Two different serological assays were used: a chemiluminescent assay and an in-house developed Luminex immunoassay. Kinetics of the serological response and correlation between the antibody titers and outcome were assessed. Among the 70 patients enrolled in the study, 22 required invasive ventilation, 29 required non-invasive ventilation or oxygen supplementation, and 19 did not require any oxygen supplementation. Median duration of symptoms upon admission for the three groups were 13, 8, and 9 days, respectively. Antibody titers gradually increased for up to 3 weeks since the onset of symptoms for patients requiring oxygen supplementation with significantly higher antibody titers for patients requiring invasive ventilation. Antibody titers on admission were also significantly higher in severely ill patients and serology performed well in predicting the necessity of invasive ventilation (AUC: 0.79, 95% CI: 0.67-0.9). Serology testing at admission may be a good indicator to identify severe COVID-19 patients who will require invasive mechanical ventilation.

Challenges in the transition from resident to attending physician in general internal medicine: a multicenter qualitative study.

BACKGROUND: The attending physician in general internal medicine (GIM) guarantees comprehensive care for persons with complex and/or multiple diseases. Attendings from other medical specialties often report that transitioning from resident to attending is burdensome and stressful. We set out to identify the specific challenges of newly appointed attendings in GIM and identify measures that help residents better prepare to meet these challenges. METHODS: We explored the perceptions of 35 residents, attendings, and department heads in GIM through focus group discussions and semi-structured interviews. We took a thematic approach to qualitatively analyze this data. RESULTS: Our analysis revealed four key challenges: 1) Embracing a holistic, patient centered perspective in a multidisciplinary environment; 2) Decision making under conditions of uncertainty; 3) Balancing the need for patient safety with the need to foster a learning environment for residents; and 4) Taking on a leader's role and orchestrating an interprofessional team of health care professionals. Newly appointed attendings required extensive practical experience to adapt to their new roles. Most attendings did not receive regular, structured, professional coaching during their transition, but those who did found it very helpful. CONCLUSIONS: Newly appointed attending physician in GIM face a number of critical challenges that are in part specific to the field of GIM. Further studies should investigate whether the availability of a mentor as well as conscious assignment of a series of increasingly complex tasks during residency by clinical supervisors will facilitate the transition from resident to attending.

The consensus number of a cryptocurrency.

Many blockchain-based algorithms, such as Bitcoin, implement a decentralized asset transfer system, often referred to as a cryptocurrency. As stated in the original paper by Nakamoto, at the heart of these systems lies the problem of preventing double-spending; this is usually solved by achieving consensus on the order of transfers among the participants. In this paper, we treat the asset transfer problem as a concurrent object and determine its consensus number, showing that consensus is, in fact, not necessary to prevent double-spending. We first consider the problem as defined by Nakamoto, where only a single process-the account owner-can withdraw from each account. Safety and liveness need to be ensured for correct account owners, whereas misbehaving account owners might be unable to perform transfers. We show that the consensus number of an asset transfer object is 1. We then consider a more general k-shared asset transfer object where up to k processes can atomically withdraw from the same account, and show that this object has consensus number k. We establish our results in the context of shared memory with benign faults, allowing us to properly understand the level of difficulty of the asset transfer problem. We also translate these results in the message passing setting with Byzantine players, a model that is more relevant in practice. In this model, we describe an asynchronous Byzantine fault-tolerant asset transfer implementation that is both simpler and more efficient than state-of-the-art consensus-based solutions. Our results are applicable to both the permissioned (private) and permissionless (public) setting, as normally their differentiation is hidden by the abstractions on top of which our algorithms are based.

[Central venous catheter, PICC-line or Midline†: which catheter for my patient?] / Voie centrale, PICC-line ou Midline†: quel cathéter pour quel patient†?

Midline long peripheral venous catheters are an interesting alternative to central venous catheters and PICC-lines when the placement of a peripheral venous catheter is impossible or when the patient requires prolonged intravenous treatment. Midline catheters can be inserted at the patient's bedside and require no radiological verification after insertion. They can be kept in place for up to 14 days and allow for repeated blood sampling. The mechanical, infectious, or thrombotic complications and safety profile do not differ from other venous catheters, notably PICC-line.

Lorsque la pose d'un cathéter veineux périphérique est impossible ou que le patient nécessite un traitement intraveineux prolongé, les cathéters veineux périphériques longs, de type Midline, représentent une alternative intéressante aux cathéters veineux centraux et PICC-line (Peripherally Inserted Central Catheters). Les Midlines peuvent être mis en place au lit du patient, sans nécessiter un contrôle radiologique après la pose. Ils peuvent rester en place jusqu'à 14 jours et permettent d'effectuer des prélèvements sanguins répétés. Les complications mécaniques, infectieuses ou thrombotiques, et le profil de sécurité ne diffèrent pas des autres cathéters veineux, notamment des PICC-lines.

Transmission studies and the composition of prokaryotic communities associated with healthy and diseased Aplysina cauliformis sponges suggest that Aplysina Red Band Syndrome is a prokaryotic polymicrobial disease.

Aplysina cauliformis, the Caribbean purple rope sponge, is commonly affected by Aplysina Red Band Syndrome (ARBS). This transmissible disease manifests as circular lesions with red margins and results in bare spongin fibers. Leptolyngbya spp. appear to be responsible for the characteristic red coloration but transmission studies with a sponge-derived isolate failed to establish disease, leaving the etiology of ARBS unknown. To investigate the cause of ARBS, contact transmission experiments were performed between healthy and diseased sponges separated by filters with varying pore sizes. Transmission occurred when sponges were separated by filters with pore sizes ≥ 2.5 µm, suggesting a prokaryotic pathogen(s) but not completely eliminating eukaryotic pathogen(s). Using 16S rRNA gene sequencing methods, 38 prokaryotic taxa were significantly enriched in diseased sponges, including Leptolyngbya, whereas seven taxa were only found in some, but not all, of the ARBS-affected sponges. These results do not implicate a single taxon, but rather a suite of taxa that changed in relative abundance with disease, suggesting a polymicrobial etiology as well as dysbiosis. As a better understanding of dysbiosis is gained, changes in the composition of associated prokaryotic communities may have increasing importance for evaluating and maintaining the health of individuals and imperiled coral reef ecosystems.

[Roles and challenges of Point-of-Care Ultrasonography in internal medicine]. / Rôles et défis de l'ultrasonographie ciblée en médecine interne hospitalière.

Point-of-Care Ultrasonography (POCUS) is an emerging important diagnostic tool in internal medicine wards. The concept is to focus on specific or binary questions to rule in disease and has a proven additional benefit for procedural guidance in terms of patients' safety. Its advantages lie in its rapid and non-invasive use at the patient's bedside. It does not replace the traditional diagnostic procedures or specialists' investigations. Since medical decisions can be guided by ultrasounds results, it's important to remember that the diagnostic performance is largely operator dependent. Implementation of POCUS in internal medicine wards is still challenging regarding the small number of ultrasound experts to provide education programs and the lack of well-established learning objectives and training programs.

L'ultrasonographie ciblée (POCUS) a gagné en importance dans la pratique hospitalière comme aide pour l'orientation diagnostique. Devenue incontournable pour la réalisation de procédures invasives de façon sécuritaire, ses atouts résident dans sa capacité de répondre rapidement, au lit du malade, de façon binaire (oui/non), à des questions spécifiques. Il reste important de se souvenir que son recours ne remplace pas les démarches diagnostiques traditionnelles, ni l'examen du spécialiste, et que la qualité d'un examen et des conclusions en découlant est hautement dépendante du niveau de formation et des compétences de l'utilisateur. L'implémentation sécuritaire du POCUS en médecine interne reste encore un défi au niveau de la formation des cliniciens, notamment en termes de cursus, encore non clairement défini, et du faible nombre de formateurs.

Case Report: Stepwise Anti-Inflammatory and Anti-SARS-CoV-2 Effects Following Convalescent Plasma Therapy With Full Clinical Recovery.

In these times of COVID-19 pandemic, concern has been raised about the potential effects of SARS-CoV-2 infection on immunocompromised patients, particularly on those receiving B-cell depleting agents and having therefore a severely depressed humoral response. Convalescent plasma can be a therapeutic option for these patients. Understanding the underlying mechanisms of convalescent plasma is crucial to optimize such therapeutic approach. Here, we describe a COVID-19 patient who was deeply immunosuppressed following rituximab (anti-CD20 monoclonal antibody) and concomitant chemotherapy for chronic lymphoid leukemia. His long-term severe T and B cell lymphopenia allowed to evaluate the treatment effects of convalescent plasma. Therapeutic outcome was monitored at the clinical, biological and radiological level. Moreover, anti-SARS-CoV-2 antibody titers (IgM, IgG and IgA) and neutralizing activity were assessed over time before and after plasma transfusions, alongside to SARS-CoV-2 RNA quantification and virus isolation from the upper respiratory tract. Already after the first cycle of plasma transfusion, the patient experienced rapid improvement of pneumonia, inflammation and blood cell counts, which may be related to the immunomodulatory properties of plasma. Subsequently, the cumulative increase in anti-SARS-CoV-2 neutralizing antibodies due to the three additional plasma transfusions was associated with progressive and finally complete viral clearance, resulting in full clinical recovery. In this case-report, administration of convalescent plasma revealed a stepwise effect with an initial and rapid anti-inflammatory activity followed by the progressive SARS-CoV-2 clearance. These data have potential implications for a more extended use of convalescent plasma and future monoclonal antibodies in the treatment of immunosuppressed COVID-19 patients.

Transition to postgraduate practice: perceptions of preparedness and experience of the daily work of junior residents.

BACKGROUND: The transition from undergraduate to postgraduate training is a crucial career step for physicians. Several international studies have shown that graduates feel insufficiently prepared to perform various aspects of clinical practice. The publication of a national framework for undergraduate medical education triggered major curricular reforms at our institution. Through this study, we explored the perceptions of preparedness for practice of junior residents who graduated from the new curriculum. METHODS: This was a cross-sectional, triangulation mixed-methods quantitative and qualitative study among junior residents and senior physicians of 13 hospitals in western Switzerland. We administered two online questionnaires aimed at exploring perceptions in five areas of clinical competence (knowledge, clinical skills, clinical reasoning, communication and collaboration), as well in self-confidence and coping with the daily work. The qualitative part consisted of six semi-structured focus groups with junior residents, aimed at further clarifying the perceptions and circumstances of their preparedness. Verbatim transcriptions were analysed through thematic analysis. RESULTS: Fifty-nine (43.3%) junior residents and 68 (26.5%) senior physicians completed the questionnaire. Among residents, 54.2% considered the curriculum to have adequately prepared them for practice. However, residents felt they were underperforming particularly in developing therapeutic strategies, in communicating with patients’ relatives, and in writing discharge letters. 50.8% (95% confidence interval 37.5-64.1) of them felt overwhelmed by the workload and 39% felt unfulfilled at work. Perceptions of senior physicians about residents’ clinical competences most often agreed with those of their young colleagues. Nineteen residents volunteered to participate in six focus groups. Thematic analysis allowed us to highlight six areas associated with perceptions of underpreparedness: (1) the adequacy of undergraduate instruction; (2) the ability to work efficiently within an interprofessional team; (3) the ability to communicate with patients and colleagues; (4) the effect of the curriculum on the development of critical inquiry and their approach to learning; (5) difficulties in managing their daily clinical work; (6) the negative emotions experienced at the beginning of postgraduate training. CONCLUSIONS: Several important aspects of daily clinical practice appear to be insufficiently mastered in the first few months of residency. The resulting stress and anxiety negatively affect job satisfaction. This study provides concrete examples and guidance for program directors and educators on how to better prepare students for postgraduate training.

[Medical students at the bedside of COVID-19 patients†: motivations and challenges]. / Étudiant·e·s en médecine engagé·e·s au chevet des patient·e·s hospitalisé·e·s pour COVID-19 - Motivations et enjeux.

The SARS-CoV-2 pandemic is putting our healthcare system under exceptional pressure, given the number of affected patients. In a context of limited human healthcare resources, senior medical students represent a valuable workforce that can quickly be mobilized for patient care. This is the approach followed in Switzerland and other countries, in several outpatient structures or inpatient services, including the Department of Internal Medicine, of the Lausanne University Hospital (CHUV). In this article, we first give the floor to students who responded to our call. We conclude with important considerations in terms of students' clinical supervision. It is reminded that the involvement of students in the care of COVID-19 patients should only occur on a vo luntary basis.

La pandémie de COVID-19 met notre système de santé sous une pression exceptionnelle, au vu du nombre de patient·e·s atteint·e·s. Dans un contexte de ressources humaines médico-soignantes limitées, les étudiant·e·s en médecine avancé·e·s dans leur cursus représentent un renfort très précieux, rapidement mobilisable auprès des patient·e·s. C'est la démarche suivie en Suisse et ailleurs dans le monde par diverses structures ambulatoires ou services hospitaliers, dont le Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV). Dans cet article, nous donnons tout d'abord la parole aux étudiant·e·s qui ont répondu à notre appel. Nous terminons par des considérations importantes quant à l'accueil et l'accompagnement de ces étudiant·e·s. Il est rappelé que l'engagement d'étudiant·e·s auprès de patient·e·s souffrant de COVID-19 devrait se faire sur une base volontaire uniquement.

Improving the assessment of communication competencies in a national licensing OSCE: lessons learned from an experts' symposium.

BACKGROUND: As the communication competencies of physicians are crucial for providing optimal patient care, their assessment in the context of the high-stakes Objective Structured Clinical Examination (OSCE) is of paramount importance. Despite abundant literature on the topic, evidence-based recommendations for the assessment of communication competencies in high stakes OSCEs are scarce. As part of a national project to improve communication-competencies assessments in the Swiss licensing exam, we held a symposium with national and international experts to derive corresponding guidelines. METHODS: Experts were invited on account of their recognized expertise either in teaching or assessing communication competencies, or in conducting national high-stakes OSCEs. They were asked to propose concrete solutions related to four potential areas for improvement: the station design, the rating tool, the raters' training, and the role of standardized patients. Data gene.rated in the symposium was available for analysis and consisted of video recordings of plenary sessions, of the written summaries of group work, and the cards with participants' personal take-home messages. Data were analyzed using a thematic analysis approach. RESULTS: Nine major suggestions for improving communication-competencies assessments emerged from the analysis and were classified into four categories, namely, the roles of the OSCE scenarios, rating tool, raters' training, and simulated patients. CONCLUSION: In the absence of established evidence-based guidelines, an experts' symposium facilitated the identification of nine practical suggestions for improving the assessment of communication competencies in the context of high-stakes OSCEs. Further research is needed to test effectiveness of the suggestions and how they contribute to improvements in the quality of high-stakes communication-competencies assessment.

[Organizational Impacts and Clinical Challenges of the COVID-19 Pandemic on a Swiss Tertiary Internal Medicine Department]. / Impacts organisationnels et défis cliniques de la pandémie COVID-19 pour un service hospitalier de médecine interne universitaire.

The rapid progression of COVID-19 is an organizational challenge for all hospitals. To secure the patient overflow, the Department internal medicine of the University Hospital of Lausanne increased nurse and medical workforces as well as bed capacity by 65 %, with extraordinary help from other departments. The implemented crisis management stood upon three pillars : a crisis management team, steering documents and internal communication. In this new form, the Department had already taken care of 442 COVID-19 admissions by April 16, 2020. Alongside organizational challenges, clinical issues such as rapid respiratory distress, clinical suspicions with negative PCR and treatment uncertainties in the absence of sufficient evidence were overcome. Despite the peak of the pandemic appearing to have passed, the next phase could be just as complicated.

La progression rapide du COVID-19 constitue un défi organisationnel pour tous les hôpitaux. Pour anticiper un afflux important de patients, le service de médecine interne du CHUV a ainsi augmenté ses forces de travail médico-soignantes et son nombre de lits de 65 % avec un soutien extraordinaire de toute l'institution. Pour opérer ces changements majeurs, l'organisation de crise mise en place s'est appuyée sur trois piliers : une cellule de conduite, des documents de pilotage et une communication interne. Sous cette nouvelle forme, le service a pris en charge 442 hospitalisations COVID-19 jusqu'au 16 avril 2020. Si les enjeux organisationnels ont été majeurs, la gestion des situations complexes, comme les manifestations respiratoires et les multiples incertitudes cliniques diagnostiques et thérapeutiques, ont été également une gageure. Le pic de la pandémie semble passé, mais la prochaine phase pourrait constituer un nouveau défi organisationnel.

[PROFILES: typical portrait of the future Swiss doctors]. / PROFILES: portrait-type de nos futurs médecins !

In each professional practice, a greater or lesser part of the activity is devoted to teaching. Indeed, the transmission of the medical knowledge is an essential objective for the training of students and residents, but also an opportunity to adapt one's own practices to the current context, since fast changes are not necessarily easy to follow and assimilate. If the relationship with Medical school is rather straightforward in the university hospitals, it is not always the same for those who are more distant, but whose participation in teaching is desired, and clearly growing. In this way, it is therefore crucial that everyone is informed about recent changes to the undergraduated learning objectives (PROFILES) and the resulting needs for educational reforms for all Medical schools in Switzerland.

Dans chaque pratique professionnelle, une part plus ou moins grande de l'activité est dévolue à l'enseignement. En effet, la transmission de l'art médical représente un objectif essentiel pour la formation des étudiant·e·s et des jeunes collègues, mais aussi une opportunité pour adapter ses pratiques au contexte actuel, car les changements, rapides, ne sont pas forcément faciles à assimiler. Si, dans les hôpitaux universitaires, le contact avec les Facultés de médecine est plutôt aisé, il n'en va pas toujours de même pour ceux qui en sont plus distants, mais dont la participation à l'enseignement est souhaitée et croissante. En ce sens, il apparaît crucial que tou·te·s soient informé·e·s sur les modifications récentes des objectifs d'apprentissage prégradué (PROFILES) et sur les réformes qui en découlent pour les Facultés de médecine en Suisse.