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Resume Objectifs La pratique pediatrique est un exercice difficile ou il faut apprendre a distinguer parmi une multitude de recours pour des motifs benins des situations cliniques rares mais potentiellement graves. Notre but etait d’evaluer les connaissances des etudiants entrant en 3e cycle de medecine generale sur ces situations. Methodes Cent trois etudiants ont ete evalues sur les « feux tricolores » sous forme de 103 questions a choix multiple (QCM) a 2 modalites (vrai/faux). Ces feux tricolores avaient ete definis par des praticiens pediatriques du centre hospitalier universitaire (CHU) et des enseignants de medecine generale de Nantes comme des fondamentaux de la pediatrie : situations pieges, diagnostiques ou therapeutiques a ne pas manquer. Le degre d’urgence etait defini par la couleur, le rouge correspondant aux urgences vitales immediates. Resultats Trente-six pour cent des QCM (n = 103) ont eu un taux de bonnes reponses inferieur a 75 %. Trente-deux pour cent des QCM concernant des situations avec urgence vitale (« feux rouges ») (n = 37) ont eu un taux de bonnes reponses inferieur a 75 %. Quinze pour cent des questions (n = 103) ont eu un taux de bonnes reponses inferieur a 50 %, la moitie concernant des « feux rouges » (meningite, decouverte de diabete, choc). Les questions concernant les nourrissons (n = 24) ont eu significativement moins de bonnes reponses (taux de bonnes reponses inferieur a 50 % de 29 % versus 10 %, p = 0,047) Conclusions Certaines situations d’urgence ou concernant les nourrissons ne sont pas maitrisees par la majorite des etudiants. Il est donc indispensable de mener une reflexion sur l’optimisation de l’enseignement de la pediatrie au second cycle.

Resume Introduction La Conference de Consensus de 2000 recommandait un traitement symptomatique systematique des bronchiolites aigues du nourrisson, notamment par desobstruction rhinopharyngee et encourageait la kinesitherapie respiratoire, depuis remise en cause par differentes etudes. L’objectif principal de cette etude etait d’evaluer la concordance des prises en charge therapeutiques des bronchiolites aigues, en medecine generale, par rapport aux recommandations de la Conference de Consensus. Patients et methodes Ont ete inclus les nourrissons de 0 a 24 mois, presentant une bronchiolite, consultant un medecin generaliste, en Vendee ou en Loire-Atlantique, de novembre 2011 a avril 2012 et dont les parents ont accepte la participation a l’etude. Le critere de jugement principal etait la concordance des prises en charge therapeutiques par rapports aux recommandations (traitements instaures, orientation vers les urgences pediatriques). Les donnees ont ete recueillies via des questionnaires remplis par les medecins generalistes participants. Resultats Sur les 1236 questionnaires distribues, 134 ont ete remplis et 118 prises en charge therapeutiques ont pu etre analysees. Au total, 52,5 % de prises en charge therapeutiques etaient concordantes au regard des recommandations et 57,5 % en cas de premieres bronchiolites. Cinquante pour cent des nourrissons avec un critere imposant une hospitalisation selon la Conference de Consensus, ne l’ont pas ete, ce qui montre probablement l’interet de nouvelles recommandations, avec mise en exergue des criteres d’hospitalisation.

The Haute autorité de santé released clinical practice guidelines in 2000 to assist in the management of bronchiolitis. These guidelines emphasized supportive care with nasal suctioning and encouraged chest physiotherapy. The aim of this study was to examine the adherence to the french guidelines for the management of bronchiolitis by general practitioners.The study included infants less than 24 months of age with bronchiolitis, consulting a general practitioner in Vendée or in Loire-Atlantique, from November 2011 to April 2012 and whose parents accepted to participate to the study. The primary endpoint was the concordance of therapeutic practice with the french guidelines (administrated treatments, refer to pediatric emergencies). Data were collected through questionaires completed by general practitioners.Of the 1236 questionnaires distributed, 134 were completed and 118 therapeutic practice were analyzed. A total of 52.5% of therapeutic practice were concordant with guidelines and 57.5% in case of first bronchiolitis. 50% of infants with a hospitalization criteria according to the guidelines, have not been, which probably shows the interest of new guidelines, with highlighting of hospitalization criteria.

Pediatric practice is a difficult task requiring physicians to discriminate potentially serious situations among a variety of benign situations. The goal of this study was to assess the knowledge of students beginning their residency in family medicine on these situations.One hundred and three students were evaluated on pediatric "traffic lights" using 103 true/false questions. Pediatric and family medicine teachers of the Nantes University Hospital defined "traffic lights" as the fundamentals of pediatrics, misleading situations, and diagnosis and treatment that should not to be missed. Emergency levels were defined by colors, with "red light" corresponding to life-threatening emergencies.Thirty-six percent of the questions (n=103) had a correct response rate below 75%. Thirty-two percent of the questions on emergency situations ("red lights") (n=37) had a response rate below 75%. Fifteen percent of the questions (n=103) had a correct response rate below 50%, half of which were "red light" (e.g., on meningitis, diabetic acidocytosis, or shock). Questions concerning infants (n=24) had significantly fewer correct answers (correct response rate below 50%: 29% versus 10%; P=0.047). All the students answered seven questions correctly. The students' mean score (percentage of good answers) was 76% (±6%). No student had 100% or less than 50% good answers.Some life-threatening situations or situations concerning infants had not been mastered by most of the students. It is therefore essential to optimize the teaching of pediatrics during the second cycle of medical studies.