Impact of a university teaching of integrative medicine on the social representations of undergraduate medical students.

Integrative medicine, need to be inoffensive, effective, and of quality (World Health Organization). In 2010, the American Society of Teachers of Family Medicine approved 19 competencies for teaching integrative medicine to residents. In 2018, the University of Rennes created a course: "Integrative Medicine and Complementary Therapies". Up until then, the only feedback from the courses was the students' opinions. We investigated the impact on medical students' social representation.We performed a sociological analysis of students' social representations before and after the course. The social representation is based on the way an individual creates his or her universe of beliefs and ideas. After hearing, "What word or group of words comes to mind when you hear people speak of integrative medicine and complementary therapies?", students were asked to provide 5 words/phrases, rank their importance, and show their attitude towards these words/phrases. The frequency and importance of these words/phrases were used to construct social representations (with central cores, and primary and secondary peripheries) before and after the course.Among the 101 students registered, 59 provided complete responses before and 63 after the course. Before, the central core comprised "hypnosis" and "alternative medicine", while after: "complementary care" and "global care". We only identified first periphery before the course: "acupuncture" and "homeopathy". 4 new contrasting elements: "integration with conventional treatment", "patient's choice", "personalisation of care", and "caring relationship of trust".This teaching course positively affected students' social representation of integrative medicine, and might promote their use during future practices.

Changes in French family medicine residents' perspectives about patient partners' participation in teaching: A qualitative study in co-facilitated practice exchange groups.

PURPOSE: The patient partner in teaching method is progressively developing for clinical training in France. Practice exchange groups (PEG) co-facilitated by patient partners in teaching are used during the training of family medicine (FM) residents. This study explored the FM residents' perspectives about patient partner in teaching's participation in co-facilitated PEGs and how they changed over time. STUDENTS AND METHODS: In 2020, qualitative focus groups were carried out with 26 FM residents before and after a 5-month intervention based on monthly PEGs co-facilitated by patient partners in teaching. A reflective thematic analysis of the focus group interviews was performed according to Braun and Clarke's approach. RESULTS: FM residents supported patient partners in teaching's facilitation role and had high expectations concerning their contribution to the development of their skills and competencies. They expected patient partners in teaching to bring their individual experience and also a collective knowledge. Some limitations mentioned by FM residents disappeared over time, such as the loss of the medical group feeling among physicians, while others persisted and required pedagogical support targeted to FM residents before PEG initiation. CONCLUSION: This study shows the good acceptance of patient partners in teaching by FM residents in the context of PEGs. Attention should be paid to make FM residents aware of patient partners in teaching's missions before their introduction.

Perspectives of patient educators about their participation in an interprofessional program for healthcare students and postgraduate medical students.

Including patients in interprofessional education (IPE) programs adds value to healthcare students' education. However, little is known about the perspective and experience of the involved patient educators (PEs). An IPE program (Interprofessional Seminars, IPS) that includes PEs was developed in France in 2009. The aim of this study was to describe the PEs' perspectives about their involvement in IPS. Data were collected using semi-structured interviews with 32 experienced PEs, and analyzed using a reflexive thematic analysis in the framework of an inductive approach. PEs had an identifiable profile. They were motivated by a sense of civic service, had well-developed communication skills, and were prepared to share their experiential knowledge with students. They were concerned about their capacity to express themselves in front of students and the need to consolidate their involvement through a structured partnership that involves briefing, collaboration, remuneration, and feedback. They proposed to establish compulsory interprofessional training for all students and to strengthen the collaboration between an interprofessional group of students and a PE. Our results highlight the PEs' desire to be involved in IPE and to develop a genuine patient-student partnership. These insights should support the systematic integration of PEs in IPE.

Service sanitaire des étudiants en santé : ancrer l'éducation pour la santé dans le cursus des étudiants.

INTRODUCTION: Established in France since 2018, the Student Health Service aims to train students to become actors in health education. METHODS AND RESULTS: A teaching system lasting the equivalent of six weeks full-time has been set up in the third year of medical school in Rennes. The aim is for students to develop the skills needed to carry out interventions based on a project approach, with a variety of audiences, on priority public health themes.New pedagogical approaches have been developed to integrate learning about health promotion and health education into the medical curriculum. Innovations have been implemented: work on the educational posture, tutoring of third-year students by medical interns, a forum for simulation of concrete actions under the supervision of a dual thematic and population-based expertise. Beyond the acquisition of knowledge, the training aims to encourage a reflective approach and is based on peer education.The 240 students of the faculty prepare their project in trinomials throughout the academic year. Their activities take place over ten half-days in more than a hundred establishments in the faculty subdivision and enable them to work with approximately 10,000 people per year. DISCUSSION: Education and health promotion now occupies a central place in the training of third-year students, an essential condition for the sustainable acquisition of this field of expertise by future health professionals.

Perspectives of deprived patients on diabetes self-management programmes delivered by the local primary care team: a qualitative study on facilitators and barriers for participation, in France.

BACKGROUND: Diabetes self-management education (DSME) is an effective intervention for patients with type 2 diabetes mellitus (T2DM); nevertheless, patient participation in this type of programme is low. Implementation of DSME programmes in primary care practices by the local multi-professional team is a potential strategy to improve access to DSME for T2DM patients. The aim of this study was to identify perceived facilitators and barriers by patients to participation in local DSME delivered by primary care professionals in France. METHOD: T2DM patients, informed and recruited during consulting with their usual care provider, who had attended a structured and validated DSME programme delivered by 13 primary care providers within a multi-professional primary care practice in a deprived area of 20,000 inhabitants, were invited to participate in this study. A qualitative study with semi-structured, in-depth interviews was conducted with study participants, between July 2017 and February 2018. A reflexive thematic analysis of the interviews was carried out. Coding schemes were developed to generate thematic trends in patient descriptions of facilitators and barriers to DSME participation. RESULTS: Nineteen interviews (mean length 31 min; [20-44 min]) were completed with T2DM patients. Four themes on facilitators for programme participation emerged from the data: geographical proximity of a DSME programme held in the local multi-professional primary care practice; effective promotion of the DSME programme by the local multi-professional team; pre-existing relationship between patients and their healthcare providers; and potential to establish new social interactions within the neighbourhood by participating in the programme. Three themes on barriers to attendance emerged: integrating the DSME programme into their own schedules; difficulties in expressing themselves in front of a group; and keeping the motivation for self-managing their T2DM. CONCLUSIONS: From the patient perspective, the programme geographical proximity and the pre-existing patient-healthcare provider relationship were important factors that contributed to participation. Healthcare providers should consider these factors to improve access to DSME programmes and diabetes self-management in deprived populations. Longitudinal studies should be performed to measure the impact of these programmes.

Parental reassurance concerning a feverish child: determinant factors in rural general practice.

BACKGROUND: Acute fever is the most common pediatric condition encountered in general practice and a source of parental concern that can result in inappropriate behavior. The main objective of this study was to describe and quantify parental reassurance concerning their feverish child in the context of visits to rural general practitioners (GPs). METHOD: The study included the parents of 202 feverish children, aged from 3 months to 6 years, consulting 13 representative rural GPs. Questionnaires were administered before and after the consultation. Uni- and multivariate analysis were performed to study variations of the levels of concern and associated factors. RESULTS: The duration of fever was 1.3 days (± 1.1). The mean score for parental concern was 4.8 out of 10 (± 2.2) before, and 2.4 (± 1.9) after the consultation (p < 0.0001). The concern correlated with the timing of the appointment relative to the usual wait (p = 0.0002), and a lack of knowledge about fever complications (p = 0.013). CONCLUSION: Facilitating access to consultations with a GP within the expected timeframe reduces parental concern. Increasing parental education about fever is also necessary.

Factors influencing the development of primary care data collection projects from electronic health records: a systematic review of the literature.

BACKGROUND: Primary care data gathered from Electronic Health Records are of the utmost interest considering the essential role of general practitioners (GPs) as coordinators of patient care. These data represent the synthesis of the patient history and also give a comprehensive picture of the population health status. Nevertheless, discrepancies between countries exist concerning routine data collection projects. Therefore, we wanted to identify elements that influence the development and durability of such projects. METHODS: A systematic review was conducted using the PubMed database to identify worldwide current primary care data collection projects. The gray literature was also searched via official project websites and their contact person was emailed to obtain information on the project managers. Data were retrieved from the included studies using a standardized form, screening four aspects: projects features, technological infrastructure, GPs' roles, data collection network organization. RESULTS: The literature search allowed identifying 36 routine data collection networks, mostly in English-speaking countries: CPRD and THIN in the United Kingdom, the Veterans Health Administration project in the United States, EMRALD and CPCSSN in Canada. These projects had in common the use of technical facilities that range from extraction tools to comprehensive computing platforms. Moreover, GPs initiated the extraction process and benefited from incentives for their participation. Finally, analysis of the literature data highlighted that governmental services, academic institutions, including departments of general practice, and software companies, are pivotal for the promotion and durability of primary care data collection projects. CONCLUSION: Solid technical facilities and strong academic and governmental support are required for promoting and supporting long-term and wide-range primary care data collection projects.

[What are the main factors assisting general practitioners in the development of educational strategies?] / Quels sont les facteurs prioritaires à mettre en œuvre pour développer une démarche éducative en médecine générale ?

General practitioners (GP) are in a special position to conduct educational strategies for their patients with chronic disease. Despite the GP's desire to be involved in patient education, this approach remains underdeveloped.Objective: To determine the factors required support the development of educational strategies in general practice from the GPs' perspective.Methods: Qualitative study based on a "modified nominal group technique" carried out among 21 GPs (not specifically trained in patient education) participating as investigators in an interventional study testing a structured educational strategy. The interventional study based on processes and tools specifically developed to suit general practice was held during their usual consultations. Thirty one patients with COPD were followed for 9 months.Results: GPs identified 23 specific factors restructured after the clarification-reformulation step in 6 main factors required for the development of educational strategies in general practice. The consensus revealed that reinforcement of initial and continuing medical training was the most frequently cited factor and was considered to be a priority. The development of inter- and intra-professional cooperation was the second leading factor to be taken into account.Conclusion: The improvement of GP training and the promotion of areas of cooperation could help GPs to develop educational strategies during their consultations. These results may provide insight to regional health agencies concerning the deployment of patient education in primary care.

[What Are the Main Factors Assisting General Practitioners in the Development of Educational Strategies?]

General practitioners (GP) are in a special position to conduct educational strategies for their patients with chronic disease. Despite the GP's desire to be involved in patient education, this approach remains underdeveloped.Objective: To determine the factors required support the development of educational strategies in general practice from the GPs' perspective.Methods: Qualitative study based on a "modified nominal group technique" carried out among 21 GPs (not specifically trained in patient education) participating as investigators in an interventional study testing a structured educational strategy. The interventional study based on processes and tools specifically developed to suit general practice was held during their usual consultations. Thirty one patients with COPD were followed for 9 months.Results: GPs identified 23 specific factors restructured after the clarification-reformulation step in 6 main factors required for the development of educational strategies in general practice. The consensus revealed that reinforcement of initial and continuing medical training was the most frequently cited factor and was considered to be a priority. The development of inter- and intra-professional cooperation was the second leading factor to be taken into account.Conclusion: The improvement of GP training and the promotion of areas of cooperation could help GPs to develop educational strategies during their consultations. These results may provide insight to regional health agencies concerning the deployment of patient education in primary care.

[Health expectations of the inhabitants of a health priority area: a qualitative study]. / Les attentes d'usagers d'un quartier prioritaire en termes de santé : une enquête qualitative.

INTRODUCTION: French law of 4 March 2002 instituted health democracy, making health system users a real partner and active stakeholder in the healthcare system. This role of health system users must be taken into account particularly in health priority areas in order to reduce social inequalities in health. In the context of primary care, multidisciplinary clinics would appear to be ideal places to develop the expression of health democracy. OBJECTIVE: Identify the health expectations of the users of the Villejean clinic (Brittany, France) situated in a health priority area. METHOD: Qualitative study based on individual and group interviews, conducted with Villejean health system users. Transcripts were analysed thematically by a grounded theory approach. RESULTS: Five group interviews and twenty-one individual interviews were conducted in 49 users. The interviewees described high expectations in terms of a quality relationship with healthcare professionals, who were considered to be real educative partners. Users also formulated high expectations in relation to facilitated access to cares, especially concerning financial aspects. CONCLUSION: Identification of users' expectations constitutes the first step in developing a primary care health democracy, in which access to care is a major priority. New multidisciplinary clinic projects must take these users' expectations into account. The creation of user committees could allow the citizen-users' views to be really taken into account.

[Patient's preferences for repeat prescriptions in general practice]. / Consultation de renouvellement d'ordonnance en médecine générale : qu'en attendent les patients ?

OBJECTIVE: The incidence of chronic diseases regularly increases thus focusing quality of care as a priority in chronically illness. In 2014, prescription renewal was the first reason of outpatient visit in French general practice. In fact, the follow-up of chronic disease may be somewhat longer and more complex than other standard cares. This work aimed to explore patients' preferences with regard to prescription renewal and its variation according to their own illness profiles. METHODS: Between June and July 2014, patient perceptions were collected through a self-administered questionnaire addressed to adults from 14 French GPs offices. RESULTS: In one month, 307 questionnaires were returned. More than two-third patients (69.7%) evaluated the physician intervention as important as for another reason. The prescription was essential or very important for 70%. Priority points were those related to share therapeutic options with the physician and to obtain more information on their own illness. Older were more seeking for information on symptoms and disease than younger (OR=1.14 [1.03-1.23]). CONCLUSION: Patients are dealing with their own monitoring of chronic diseases. They expect more information and they look for shared decisions. The term "renewal" does not match their expectations thus leading against patient preference: we advocate substituting it to "prescription revaluation".

Family physicians' professional identity formation: a study protocol to explore impression management processes in institutional academic contexts.

BACKGROUND: Despite significant differences in terms of medical training and health care context, the phenomenon of medical students' declining interest in family medicine has been well documented in North America and in many other developed countries as well. As part of a research program on family physicians' professional identity formation initiated in 2007, the purpose of the present investigation is to examine in-depth how family physicians construct their professional image in academic contexts; in other words, this study will allow us to identify and understand the processes whereby family physicians with an academic appointment seek to control the ideas others form about them as a professional group, i.e. impression management. METHODS/DESIGN: The methodology consists of a multiple case study embedded in the perspective of institutional theory. Four international cases from Canada, France, Ireland and Spain will be conducted; the "case" is the medical school. Four levels of analysis will be considered: individual family physicians, interpersonal relationships, family physician professional group, and organization (medical school). Individual interviews and focus groups with academic family physicians will constitute the main technique for data generation, which will be complemented with a variety of documentary sources. Discourse techniques, more particularly rhetorical analysis, will be used to analyze the data gathered. Within- and cross-case analysis will then be performed. DISCUSSION: This empirical study is strongly grounded in theory and will contribute to the scant body of literature on family physicians' professional identity formation processes in medical schools. Findings will potentially have important implications for the practice of family medicine, medical education and health and educational policies.

Early detection of chronic obstructive pulmonary disease in primary care: a randomised controlled trial.

BACKGROUND: Worldwide, chronic obstructive pulmonary disease (COPD) remains largely underdiagnosed. AIM: To assess whether the use of Global Initiative for Chronic Obstructive Lung Disease (GOLD) questions and COPD coordination, either alone or combined, would detect new COPD cases in primary care. DESIGN AND SETTING: GPs in Brittany, France, systematically enrolled patients aged 40-80 years over a 4-month period in this French multicentre cluster randomised controlled study. METHOD: GPs were randomly allocated to one of four groups: control (standard of care), GOLD questions (adapted from symptoms and risk factors identified by GOLD), COPD coordination, and GOLD questions with COPD coordination. New cases of COPD were those confirmed by spirometry: post-bronchodilator forced expiratory volume in 1 second over forced vital capacity of <0.7. RESULTS: In total, 11 430 consultations were conducted by 47 GPs, who enrolled 3162 patients who did not have prior diagnosed asthma or COPD. Among these, 802 (25%) were enrolled in the control, 820 (26%) in the GOLD questions, 802 (25%) in the COPD coordination, and 738 (23%) in the GOLD questions with COPD coordination groups. In the control group, COPD was not evoked, and no spirometry was prescribed. All new cases of COPD diagnosed (n = 24, 0.8%) were in the intervention groups, representing 6.8% of patients who performed spirometry. Statistically significantly more new cases of COPD were detected with COPD coordination (P = 0.01). CONCLUSION: Interventions that can be easily implemented, such as the GOLD questions and COPD coordination, can identify new cases of COPD. Studies are needed to identify the most appropriate case-finding strategies for GPs to detect COPD in primary care for each country.