[Can narrative medicine be an answer to patient physician relationship teaching according to students' demand in medical education curricula?]. / L'enseignement de la médecine narrative peut-il être une réponse à l'attente de formation des étudiants à la relation médecin-malade ?

INTRODUCTION: Coming from literature and medicine and medical humanities north American seminars, narrative medicine has applied narratology for analyzing patients' discourse and has been taught during a decade. METHODS: At Paris Descartes School of Medicine a twenty-hour narrative medicine elective program including whole class lectures and writing and reading small group exercises for second year medical students has been assessed using satisfaction questionnaires. RESULTS: Although several students were uncomfortable with the first writing and reading exercises, the whole satisfaction scores demonstrate that this new program is very well appreciated even when students did not choose this program because they were interested with the patient physician relationship. These results have been confirmed when all students state this program should be continued and when half of them state this program should be offered to more students or made mandatory. DISCUSSION: The primary focus on literary characteristics of patients' and physicians' discourses, without ignoring psychoanalysis theory, has shown to be safe for young students. Writing exercises are encouraged but not mandatory, and reading is optional if ever they feel embarrassed after producing their own texts. Narrative medicine impact on students' attitudes and behaviors has now to be assessed before implementing new educational programs.

[2003 clinical practice guideline: Standards, Options and Recommendations for pain assessment in adult and children with cancer (summary report)]. / Recommandations pour la pratique clinique: Standards, Options et Recommandations pour l'évaluation de la douleur chez l'adulte et l'enfant atteints d'un cancer (mise à jour)--rapport abrégé.

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the French Federation of Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVE: To update clinical practice guidelines for the assessment of pain in adult or children with cancer in collaboration with the French society for pain study and treatment. METHOD: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guideline has been defined, the document is submitted for review by independent reviewers. RESULTS: This article is a summary version of the full document presenting the clinical practice guidelines with algorithms. The main recommendations concern the means used to evaluate pain and its consequences and their use in specific cases (acute or chronic pain, patients able to communicate or not, children under or over 6 years old). Others recommendations were also established concerning the evaluation ofpsychological, social and family context, the evaluation of pain in hospital or at home, in terminal phase patients and for the establishment of a therapeutic strategy and follow-up of patient with pain.