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Medical education and evaluation, for both initial and continuing medical training of healthcare professionals, is experiencing profound conceptual and technical changes in the era of the digital society and economy. Using the concepts of active and blended learning, acquisition and maintenance of knowledge, skills and attitudes (KSA) now passes through upstream work before entering the Faculty of Medicine on Internet (MOOC, SPOC, OER), restitution in flipped and contextualized classrooms to solve problems and learn to learn, and ultimately on virtual platforms using mannequins (avatars) in virtual environ- ments, without risk to patients and actors. Here we provide some examples of this revolu- tion, and their development prospects.

Simulation in health care helps to raise health professionals' awareness of medical ethics and to understand the mechanisms involved in a difficult situation. They can thereby adopt a suitable form of behaviour and communication.

Simulation in healthcare is directly inspired by high-risk industries such as the aeronautical industry. The recent rapid growth in its use in healthcare is explained by the need to improve the quality and safety of care. It must go hand in hand with the development of a real safety culture.

The concept of risk has acquired an extremely important place in medical care in the course of various social developments. This concept plays a role in the physician-patient relationship, especially as the form in which the physician provides information to the patient; it is also a form of medical knowledge. We propose a cross-sectional medical course module on this concept of risk, intended for medical students; it can be included in module 1 of the curriculum for the national ranking examination. This class enables a new approach to medical care by showing the variety of definitions of risk and facilitating their perception and integration. Through a process that is simultaneously epistemological and practical, it aims to associate the medical knowledge we use every day with the concept of risk and thereby help the students take a critical distance relative to the mass of available knowledge. This approach to medical knowledge through the concept of risk makes the knowledge more operational and more pertinent within the context of individual clinical situations and thus optimizes medical care. Its pedagogical techniques combine standard classroom lectures with workshops involving role-playing in specific scenarios. This original course meets the needs of medical students who are in the process of becoming health care providers--needs related to the analysis and use of available medical knowledge in their clinical practice and to some aspects of the patient-provider relationship.

In the liver, the importance of apoptosis is not only evident during development and homeostasis of the biliary tree but plays also a prominent role in liver pathogenesis. Ligand binding to cell surface death receptors such as Fas activates the extrinsic pathway. This pathway predominates in autoimmune liver diseases, viral hepatitis, liver allograft rejection. Hepatocyte apoptosis is also significantly increased in patients with alcoholic hepatitis and nonalcoholic steatohepatitis and correlates with disease severity and hepatic fibrosis. We have used this specific susceptibility of the liver to apoptosis to develop two different approaches: 1) a cell therapy strategy based on a survival advantage to an apoptotic stimulus conferred to transplanted hepatocytes and 2) a new model of hepatocyte conditional ablation based on a controlled activation of the cell death program.

In 2010, the amniotic fluid embolism was the second leading cause of maternal mortality in France. The midwife has a role to play in the initial management of amniotic fluid embolism. The teaching of a rare disease is complex, and most modern training methods as high-fidelity simulation could improve training. We have concluded, according to a national survey, that the midwives and midwive students haven't an insufficient theoretical and clinical knowledge of the amniotic fluid embolism. This lack of knowledge in the management of a rare and critical case was also observed during a simulation session organized with twenty midwive students in their last year of the midwifery School in Paris. The improvement of this disease management is based on the training of professionals since their studies and controlling them knowledge within the medical teams.; En 2010, l'Embolie de Liquide Amniotique représente la deuxième cause de mortalité maternelle en France (12%). La sage-femme a un rôle primordial à jouer dans la prise en charge initiale de l'embolie amniotique. L'enseignement d'une pathologie rare est complexe, et des modalités plus modernes de formation comme la simulation haute-fidélité pourraient permettre d'améliorer cette formation. Nous avons conclu, suite à une enquête nationale, que les sages-femmes et étudiants sages-femmes manquent de connaissances théoriques et cliniques sur l'embolie amniotique. Le manque de connaissances sur les gestes d'urgences a également été révélé à travers cette enquête. Ce manque de connaissances à la gestion d'une situation rare et critique a également été observé lors d'une séance de simulation clinique organisée avec 20 étudiants sages-femmes de Paris en dernière année de cursus. L'amélioration de la prise en charge de cette pathologie repose donc sur la formation des professionnels dès les études et le contrôle des connaissances au sein des équipes.