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Administration of plasma therapy may contribute to viral control and survival of COVID-19 patients receiving B-cell-depleting agents that impair humoral immunity. However, little is known on the impact of anti-CD20 pre-exposition on the kinetics of SARS-CoV-2-specific antibodies. Here, we evaluated the relationship between anti-spike immunoglobulin G (IgG) kinetics and the clinical status or intra-host viral evolution after plasma therapy in 36 eligible hospitalized COVID-19 patients, pre-exposed or not to B-cell-depleting treatments. The majority of anti-CD20 pre-exposed patients (14/17) showed progressive declines of anti-spike IgG titres following plasma therapy, contrasting with the 4/19 patients who had not received B-cell-depleting agents (p = 0.0006). Patients with antibody decay also depicted prolonged clinical symptoms according to the World Health Organization (WHO) severity classification (p = 0.0267) and SARS-CoV-2 viral loads (p = 0.0032) before complete virus clearance. Moreover, they had higher mutation rates than patients able to mount an endogenous humoral response (p = 0.015), including three patients with one to four spike mutations, potentially associated with immune escape. No relevant differences were observed between patients treated with plasma from convalescent and/or mRNA-vaccinated donors. Our study emphasizes the need for an individualized clinical care and follow-up in the management of COVID-19 patients with B-cell lymphopenia.

To assess whether men and women are evaluated and treated differently by medical students. 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. 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. Medical students have a gender bias when evaluating patients with GAD and AAD. 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.

It is well established that burnout in medical students is associated with depression and anxiety at a syndromal level. Moreover, there is an ongoing debate about the extent to which burnout overlaps with depression and anxiety. The emerging network approach to psychopathology offers a new perspective on the interrelations between mental disorders focusing on symptom-level association. In this cross-sectional study, we exploratively investigated the associations among burnout, depression, and anxiety in 574 swiss medical students using a network analytic approach for the first time. Symptoms of depression and anxiety were assessed with the Patient Health Questionnaire and Generalized Anxiety Disorder respectively. Burnout was assessed with two single-item questions, one referring to emotional exhaustion and the other to depersonalization. We found a dense network in which at least one dimension of burnout was related to eleven of the sixteen included symptoms. This suggests that burnout is closely related to depression and anxiety but also has its own characteristics. Notably, suicidal ideation was not associated with either emotional exhaustion or depersonalization after adjusting for the influence of the remaining symptoms of anxiety and depression. Hence, the well-documented relationship between burnout and suicidal ideation in medical students may be entirely mediated by the experience of anxiety and depression. Hence, the well-documented relationship between burnout and suicidal ideation in medical students might be fully mediated by the experience of anxiety and depression. The collection of the sample after the first wave of infections during the SARS-CoV2 pandemic and the non-representativeness of the investigated sample limit the study's generalizability.

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 » et de surveillance, même si certaines approches encouragent les initiatives des apprenants ainsi que les logiques de groupes de pairs.

BackgroundVirus outbreaks such as the current SARS-CoV-2 pandemic are challenging for health care workers (HCWs), affecting their workload and their mental health. Since both, workload and HCW's well-being are related to the quality of care, continuous monitoring of working hours and indicators of mental health in HCWs is of relevance during the current pandemic. The existing investigations, however, have been limited to a single study period. We examined changes in working hours and mental health in Swiss HCWs at the height of the pandemic (T1) and again after its flattening (T2).MethodsWe conducted two cross-sectional online studies among Swiss HCWs assessing working hours, depression, anxiety, and burnout. From each study, 812 demographics-matched participants were included into the analysis. Working hours and mental health were compared between the two samples.ResultsCompared to prior to the pandemic, the share of participants working less hours was the same in both samples, whereas the share of those working more hours was lower in the T2 sample. The level of depression did not differ between the samples. In the T2 sample, participants reported more anxiety, however, this difference was below the minimal clinically important difference. Levels of burnout were slightly higher in the T2 sample.ConclusionsTwo weeks after the health care system started to transition back to normal operations, HCWs' working hours still differed from their regular hours in non-pandemic times. Overall anxiety and depression among HCWs did not change substantially over the course of the current SARS-CoV-2 pandemic.

BackgroundAdministration of plasma therapy may contribute to viral control and survival of COVID-19 patients receiving B-cell depleting agents that hinder the endogenous humoral response. However, little is known on the impact of anti-CD20 pre-exposition and the use of different sources of plasma (convalescent versus vaccinated) on the kinetics of SARS-CoV-2-specific antibodies and viral evolution after plasma therapy.MethodsEligible COVID-19 patients (n = 36), half of them after anti-CD20 targeted therapy, were treated with therapeutic plasma from convalescent (n = 17) or mRNA-vaccinated (n = 19) donors. Each plasma-transfused patient was thoroughly monitored over time by anti-S IgG quantification and whole-genome SARS-CoV-2 sequencing.ResultsThe majority of anti-CD20 pre-exposed patients (15/18) showed progressive declines of anti-S protein IgG titers following plasma therapy, indicating that they mostly relied on the passive transfer of anti-SARS-CoV-2 antibodies. Such antibody kinetics correlated with prolonged infection before virus clearance, contrasting with the endogenous humoral response predominantly present in patients who had not received B-cell depleting agents (15/18). No relevant differences were observed between patients treated with plasma from convalescent and/or vaccinated donors. Finally, 4/30 genotyped patients showed increased intra-host viral evolution and 3/30 included 1 to 4 spike mutations, potentially associated to immune escape.ConclusionsConvalescent and/or vaccinated plasma therapy may provide anti-SARS-CoV-2 antibodies and clinical benefit to B-cell depleted COVID-19 patients. Only a limited number of patients acquired viral mutations prior to clinical recovery, yet our study further emphasizes the need for long-term surveillance for intra-host variant evolution, to guide best therapeutic strategies.

Albumin has multiple physiological functions such as maintenance of oncotic pressure, binding of plasmatic molecule, immunomodulation and endothelial stabilization. Considering potential negative effects of hypoalbuminemia, the question of albumin substitution arises. For cirrhotic patients, indications for substitution are well established with a scientific consensus for spontaneous bacterial peritonitis, paracentesis-induced circulatory dysfunction and hepatorenal syndrome. However, in the case of hepatic encephalopathy or of hypoalbuminemia in non-cirrhotic patients, the scientific consensus is absent, and the results of clinical studies differ. In this article, we present the different indications of albumin substitution by examining the most recent studies.L’albumine exerce de multiples fonctions physiologiques, notamment : maintien de la pression oncotique, liaison à d’autres molécules plasmatiques, immunomodulation et stabilisation endothéliale. Face aux potentiels effets délétères de l’hypoalbuminémie, la question d’une substitution se pose. Chez le patient cirrhotique, les indications à la substitution sont bien définies avec un consensus scientifique pour la péritonite bactérienne spontanée, la dysfonction circulatoire postparacentèse de grand volume et le syndrome hépatorénal. Néanmoins, en cas d’encéphalopathie hépatique ou d’hypoalbuminémie chez le patient non cirrhotique, le consensus est absent et les résultats des études divergent. Dans cet article, nous présentons les différentes indications à sa substitution, en mettant l’accent sur les études récentes en la matière.

La prescription large des hemocultures expose a des faux positifs qui s’elevent a 10% des hemocultures positives. Comment differencier entre bacteriemie vraie et contamination?

Fehlendes Keimwachstum nach dreitagiger Bebrutung eines Paars oder mehrerer Paare Blutkulturen reicht nicht aus, um eine Bakteriamie auszuschliessen, wenn ein praanalytisches oder analytisches Problem vorliegt.

L’absence de croissance d’un germe apres 3 jours d’incubation d’une ou plusieurs paires d’hemoculture n’est pas suffisant pour exclure une bacteriemie face a un probleme soit pre-analytique, soit analytique.

Die breite Verschreibung von Blutkulturen fuhrt zum Risiko falsch positiver Ergebnisse, die 10% der positiven Blutkulturen ausmachen. Wie lasst sich zwischen Bakteriamie und Kontamination unterscheiden?

Background: Gender bias induces gender inequality in health. In this study, we evaluated gender bias during a local objective structured clinical examination (OSCE). Methods: We assessed gender bias by using two clinical cases—generalized anxiety disorder (GAD) and ascending aorta dissection (AAD)—during an OSCE performed among fifth-year medical students. For each situation, half of the students encountered male and half encountered female standardized patients (SPs). Except for gender, variables were identical in each clinical case. Patients, students, and examiners were blinded to the purpose of the study. Medical history, clinical examination, diagnosis, and management were compared between male and female SPs. The interaction between student and SP gender was analyzed. Results: A total of 110 medical students were observed (55% women). For GAD, students arrived at the correct diagnosis more often for female SPs than for male SPs (diagnosis completed, partially completed, and not completed in 47%, 16%, and 36%, respectively, of female SPs vs. 22%, 20%, and 58%, respectively, of male SPs, p = 0.02). The nature of their symptoms was more often asked of male SPs (completed, partially completed, and not completed in 51%, 4%, and 0% of male SPs, respectively, vs. 38%, 17%, and 0% of female SPs, respectively, p = 0.002), and associated physical symptoms were more often explored in female SPs (completed and not completed in 84% and 16% of female SPs, respectively, vs. 65% and 35% of male SPs, respectively, p = 0.03). For AAD, an emergency was better identified in female SPs (95% identified in female SPs vs. 76% in male SPs, p = 0.005) and examination of femoral pulses was more often performed in female SPs (88% completed in female SPs vs. 54% in male SPs, p < 0.0001). The interaction between SP and student gender was not significant. Conclusion: The gender bias observed supports the need to address unconscious biases and to raise student awareness of gender stereotypes likely to lead to underrecognition or subtreatment of disease in patients of both genders.

Convalescent plasma to treat coronavirus disease 2019 (COVID-19) is currently the focus of numerous clinical trials worldwide, but the criteria of treatment efficacy remain largely unknown. Here, we describe a severely immunosuppressed patient following rituximab and chemotherapy for chronic lymphoid leukemia, who became infected by SARS-CoV-2. His prolonged viral disease was successfully cured after four cycles of convalescent plasma. Its immunomodulatory properties led to the rapid improvement of inflammation, pneumonia and blood cell counts, already after the first cycle. Importantly, the cumulative increase in anti-SARS-CoV-2 neutralizing antibodies following each plasma transfusion was associated to progressive viral clearance, resulting in clinical recovery from infection. Our data provide insight into the different modes of action of plasma components. Understanding the underlying mechanisms will help to optimize the treatment of COVID-19 patients.

The objective of this review was to gain a better understanding of the interprofessional collaboration between health care professionals from the patients' point of view during hospitalisation; the influence of interprofessional collaboration on patient care, safety, and well-being; and patients' perspectives of their role in the interprofessional collaboration process.Interprofessional collaboration is a key factor in improving patient health care outcomes and safety through better communication between health care professionals, better teamwork, and better care coordination. However, implementing interprofessional collaboration in the clinical setting can prove complex. Patients are increasingly interested in becoming partners within the health care system. They have the potential to contribute to their own safety and to observe professionals during the care process, thus gaining a better understanding of the interprofessional collaboration process and facilitating changes in the behavior of health care professionals.This review considered qualitative research and mixed-method studies. Participants were hospitalized patients. Studies were included when they explored i) patients' perceptions of interprofessional collaboration, ii) the influence of interprofessional collaboration on patients' care, safety, or well-being, or iii) patients' perceptions of their own role in interprofessional collaboration. Qualitative studies focusing only on the care process or families' points of view were excluded.Searches of six databases including MEDLINE, CINAHL, Embase, Web of Science, PsycINFO, and Sociological Abstract, limited to English, French, and German were conducted from March 2017 to June 2018. Assessment of methodological quality of studies was performed using the JBI Qualitative Assessment and Review Instrument. Data were extracted using the standardized data extraction tool from JBI. Data synthesis following the JBI approach of meta-aggregation was performed. The level of confidence for each synthesized finding was established based on ConQual.A total of 22 studies were included, which resulted in 89 findings and 24 categories. Eight synthesized findings were generated: patients' perceptions of interprofessional collaboration based on personal experiences and observations; patients' experiences with effective or ineffective interprofessional communication; patients' experience with power imbalance and paternalistic attitudes; patients' perceptions of key factors for a confident relationship with the interprofessional health care team; patients' need for comprehension of discussions between health care professionals; patients' perceptions of their role in an interprofessional health care team; patients' perceptions of opportunities for empowerment in interprofessional health care teams; and patients' need for humanizing care from interprofessional health care teams. The level of confidence of synthesized findings varied from low to moderate according to ConQual.This systematic review synthesized the perspectives of hospitalized patients regarding interprofessional collaboration and their perceived role in collaborative practices. Hospitalized patients observe interprofessional collaboration, either directly or indirectly, and the way interprofessional collaboration is performed may impact both their care and their well-being. However, little evidence has been found regarding the impact of interprofessional collaboration on patient safety. Patients' perspectives on their perceived role is not unanimous; some patients want to play an active role in the collaborative process, whereas others prefer to trust the health care professionals' expertise. Health care professionals should consider patients' preferences and act accordingly regarding both the collaborative process and the inclusion of the patients in collaborative practices.

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.

Psychogenic polydipsia, as well referred to as « potomania », 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 « potomanie », 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.

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.

Aims We evaluated the effectiveness of a multidisciplinary transition plan to reduce early readmission among heart failure patients. Methods and results We conducted a before-and-after study in a tertiary internal medicine department, comparing 3 years of retrospective data (pre-intervention) and 13 months of prospective data (intervention period). Intervention was the introduction in 2013 of a transition plan performed by a multidisciplinary team. We included all consecutive patients hospitalized with symptomatic heart failure and discharged to home. The outcomes were the fraction of days spent in hospital because of readmission, based on the sum of all days spent in hospital, and the rate of readmission. The same measurements were used for those with potentially avoidable readmissions. Four hundred thirty-one patients were included and compared with 1441 patients in the pre-intervention period. Of the 431 patients, 138 received the transition plan while 293 were non-completers. Neither the fraction of days spent for readmissions nor the rate of readmission decreased during the intervention period. However, non-completers had a higher rate of the fraction of days spent for 30 day readmission (19.2% vs. 16.1%, P = 0.002) and for potentially avoidable readmission (9.8% vs. 13.2%, P = 0.001). The rate of potentially avoidable readmission decreased from 11.3% (before) to 9.9% (non-completers) and 8.7% (completers), reaching the adjusted expected range given by SQLape® (7.7-9.1%). Conclusions A transition plan, requiring many resources, could decrease potentially avoidable readmission but shows no benefit on overall readmission. Future research should focus on potentially avoidable readmissions and other indicators such as patient satisfaction, adverse drug events, or adherence.

The objective of this qualitative systematic review is to examine the available evidence on interprofessional collaboration from the patients' perspectives, specifically on: i) interprofessional collaboration in adult or pediatric wards during hospitalization; ii) the influence of interprofessional collaboration on the patient's care, safety and well-being in adult or pediatric wards during hospitalization; and (iii) the patient's role in the interprofessional collaboration process in adult or pediatric wards during hospitalization.

The electrocardiogram, chest x-ray, and skin lesion interpretation are a diagnostic process that applies image analysis. Knowledge and sufficient clinical experience are necessary to achieve expertise in these fields. However, recent advances in medical informatics, particularly in deep learning, are challenging this diagnostic process and physicians' performance. Only a fraction of clinical diagnostic support based on artificial intelligence (AI) has been validated in a clinical environment, limiting its use at the patient's bedside. Gradual AI integration into medical practice will require that the physicians remain able to assess the strengths and limitations of these new algorithms.La lecture d’un ECG, l’analyse d’une radiographie du thorax ou l’approche d’une lésion dermatologique mettent l’interprétation d’une image au centre de la démarche diagnostique. Elles imposent un apprentissage des bases théoriques nécessaires et une exposition suffisante en milieu clinique. Or, les avancées récentes en informatique médicale, en particulier du

Cet article a pour objectif de comparer les differentes modalites d`enseignement des competences cliniques transculturelles dans les facultes de medecine suisses, au niveau pregradue.

Eine 43-jahrige Patientin kommt aufgrund sich verschlimmernder Lumbalgien mit Schmerzausstrahlung in den suprapubischen Bereich und die Oberschenkel in die Notaufnahme. Sie berichtet ferner von rotem Urin.

Une patiente de 43 ans consulte les urgences en raison de pejoration de lombalgies avec irradiations douloureuses dans la region sus-pubienne et vers les cuisses. Elle rapporte egalement la presence d’urines rouges.

Das Ziel dieses Beitrags besteht darin, die unterschiedlichen Lehrformate transkultureller Kompetenzen in der Klinik an den medizinischen Fakultaten im Medizinstudium zu vergleichen.

• En medecine ambulatoire, il a ete estime que 1 patient sur 20 est victime d’une erreur diagnostique et que environ 30% des plaintes legales sont attribuees a des erreurs diagnostiques. • Les medecins sont souvent appeles a prendre des decisions rapidement. La prise de decision est alors facilitee par des strategies cognitives appelees heuristiques, qui permettent des «raccourcis de la pensee» vers une decision rapide. Elles sont la plupart du temps tres performantes mais parfois elles peuvent nous mener a l’erreur • Certaines situations nous exposent a un risque accru de biais cognitifs: c’est le cas des transmissions de patients, les contraintes de temps ainsi que certains facteurs lies au medecin (stress, fatigue) ou au patient (complexite clinique ou relationnelle) • La reconnaissance de ces situations permet d’appliquer des «habitudes» de raisonnement clinique plus explicites, capables de reduire le risque d’erreur cognitif.

In der ambulanten Versorgung erhalt schatzungsweise jeder 20. Patient eine Fehldiagnose und ca. 30% der gerichtlichen Klagen im medizinischen Bereich gehen auf das Konto von Fehldiagnosen.

Handoffs are defined as the transfer of mission specific information and care authority from one healthcare professional to another. Handoffs may create gaps that are especially vulnerable to errors and may have an impact on patient safety. Conceptualising handoffs that are safe gains in importance in medicine with the growing clinical complexity, the reduction of working hours, and a great amount of care fragmentation. Different strategies on the handoff procedure have been identified to improve patient safety. An institutional approach with adaptations to the specific characteristics of each medical discipline is necessary.Les transmissions médicales sont à risque de générer des discontinuités qui peuvent entraver la sécurité des patients. Avec la complexité croissante des situations cliniques, la réduction des heures de travail ainsi que la fragmentation des prises en charge, la conceptualisation de transmissions médicales sûres a gagné en importance dans le quotidien clinique. De nombreux modèles qui visent l’amélioration des transmissions médicales ont étés étudiés et se sont avérés efficaces pour augmenter la sécurité des patients. L’intégration d’un modèle de transmissions sûres nécessite un changement dans la culture institutionnelle ainsi qu’une approche adaptée aux spécificités de chaque discipline.

The evolution of modern medicine largely influenced the development of new postgraduate training programs, which requirements are more engaging and constraining. Time dedicated to education more and more often comes into competition with the resident's clinical and administrative activities. In this context, E-learning could be an interesting solution, if used complementary to the classical training which does not further overload the clinical activity. By focusing on the recognition of clinical images, and interpretation of functional tests, we target some well known knowledge gaps of our trainees. Our program allows every participant to be exposed to some important, prototypical or rare situations, independent of the clinical exposure. The quality of our program is ensured by the collaboration with several specialty departments of our hospital.L’évolution de la médecine est à l’origine du développement de programmes de formation postgraduée de plus en plus complexes et contraignants. Le contenu de cette formation est donc en pleine évolution et le temps dédié entre en compétition directe avec les activités cliniques et administratives du médecin assistant. Dans ce contexte, la formation en ligne

OBJECTIVES Primary care physicians (PCPs) should prescribe faecal immunochemical testing (FIT) or colonoscopy for colorectal cancer screening based on their patient's values and preferences. However, there are wide variations between PCPs in the screening method prescribed. The objective was to assess the impact of an educational intervention on PCPs' intent to offer FIT or colonoscopy on an equal basis. DESIGN Survey before and after training seminars, with a parallel comparison through a mailed survey to PCPs not attending the training seminars. SETTING All PCPs in the canton of Vaud, Switzerland. PARTICIPANTS Of 592 eligible PCPs, 133 (22%) attended a seminar and 106 (80%) filled both surveys. 109 (24%) PCPs who did not attend the seminars returned the mailed survey. INTERVENTION A 2 h-long interactive seminar targeting PCP knowledge, skills and attitudes regarding offering a choice of colorectal cancer (CRC) screening options. OUTCOME MEASURES The primary outcome was PCP intention of having their patients screened with FIT and colonoscopy in equal proportions (between 40% and 60% each). Secondary outcomes were the perceived role of PCPs in screening decisions (from paternalistic to informed decision-making) and correct answer to a clinical vignette. RESULTS Before the seminars, 8% of PCPs reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 33% foresaw having their patients screened in equal proportions (p

The year 2015 gave us many scientific publications, among whom some will have an impact on our daily practice and some will influence our way of considering some well known diseases. Chief residents in the Service of internal medicine of the Lausanne University hospital, gathered like every year, to share their readings together in order to presentyou a small part of the many publications of 2015, which have been considered to have an impact on our future daily practice.