Chapitre 5 Profiles
Dans ce chapitre, nous listons les items PROFILES qui sont reliés de près ou de loin aux statistiques, à l’épidémiologie ou à la santé publique. Il existe trois types d’items :
General objectives (GO), correspondant à des savoirs et divisés en sept parties correspondant à sept rôles génériques attribués au médecin (expert, communiquant, collaborateur, leader, plaidoyer, chercheur, et professionnel) ;
Entrustable professional activities (EPA), correspondant à des compétences attendues du médecin ;
Situations as starting points (SSP), correspondant à des situations que le médecin devrait être capables de gérer.
Ces items s’entrecroisent, avec l’objectif de donner une vision holistique de la pratique médicale. Pour chaque item selectionné, nous discutons des liens avec les disciplines mentionnées, de comment ces sujets sont traités actuellement, et éventuellement de pistes ou d’idées de modification.
5.1 General objectives (GO)
5.1.1 GO 1.16
integrate the advancements produced by evidence-based scientific research into clinical practice
JR: Il me semble qu’il pourrait y avoir plus d’accent mis sur les potentiels problèmes et limites de la recherche. Sans aller jusqu’à une vraie lecture critique d’article, peut-être un exemple d’article problématique pour sensibiliser les étudiants aux problèmes de reproductibilité ? Il serait aussi possible de rajouter les niveaux de preuve selon les types d’étude, par exemple selon Cochrane.
5.1.2 GO 1.23
understand the population perspective as a core aspect of public health, and the application of basic principles of social medicine; advocate for the health and healthy environment of the local community and society as a whole
JR: Traité dans le chapitre 4.
5.1.3 GO 1.25
practice self-reflection and critical thinking related to evolution of the health system; recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
5.1.4 GO 2.8
assist patients in the adoption of health promoting habits and provide effective counselling in the use of personal data obtained through screening procedures, imaging, serologic or genetic findings (precision / prediction medicine)
JR: Facteurs de risques et données de santé dans le chapitre 4.
5.1.5 GO 2.9
improve patient’s and family’s health literacy by assisting them to identify, access, and make use of information and communication technologies to support their health care and the adoption of healthy lifestyles
JR: Pas vraiment traité, peut-être dans un autre cours ?
5.1.6 GO 4.1
understand the principles of population medicine and its strategies, and use the main tools which are used in epidemiology and public health. These include the gathering and use of health determinants and indicators, descriptive and explanatory statistics, risk and protective factors and the concepts of prevention and health promotion at individual, community and environmental levels
5.1.7 GO 4.2
define and illustrate health promotion and health-enhancing strategies at various levels, such as the monitoring and promotion of a safe environment and the promotion of effective public health policies and interventions. In doing so, they take into account financial, material and staffing resources, at both community and public health levels.
5.1.8 GO 4.3
recognize and respond to disease outbreaks, epidemics and pandemics
JR: Pas vraiment traité, peut-être rajouter R0 dans les indicateurs ?
5.1.9 GO 4.4
identify and address the special needs of vulnerable populations, showing awareness of the importance of equity in the delivery of care. They seek collaboration with social services if appropriate
JR: Insister plus sur les déterminants sociaux de la santé ?
5.1.10 GO 5.2
incorporate health surveillance activities into interactions with individual patients (discussing lifestyles, counselling). Such activities include screening, immunization and disease prevention, risk and harm reduction measures, and health promotion.
JR: Rajouter la vaccination dans les interventions de santé publique ?
5.1.11 GO 5.3
work with a community or population to identify the determinants of health that affect them, how to address them and promote system-level change in a socially accountable manner
JR: Rajouter l’exemple du projet North Karelia?
5.1.13 GO 6.2
apply principles of critical appraisal of sources to the best available evidence-based medical information. Identify ethical principles that apply to basic and clinical research
JR: Rajouter les aspects éthiques de la recherche ? Ou traité autre part ?
5.1.14 GO 6.3
demonstrate the critical use of information technology to access accurate and reliable (online) medical information, taking into account the levels of evidence provided by the medical literature, and integrating it into patient care
5.1.15 GO 6.4
understand the general theoretical principles of medical and scientific knowledge and show an awareness of its development, its problems and limits
JR: Peu de discussion des limites.
5.1.16 GO 6.5
identify and develop a research question or hypothesis, work out a procedure to address the issue, analyse and synthesize the results, and publish these as a scientific report or article. Effectively present medical information based on scientific evidence
5.2 Entrustable professional activities (EPAs)
5.2.1 EPA 3.4
Integrate the scientific foundations of basic medical sciences as well as epidemiological information (probability of diseases) into clinical reasoning, in order to develop a differential diagnosis and a working diagnosis, organized in a meaningful hierarchical way
JR: Il me semble que cela justifierait d’insister sur les probabilités conditionnelles et le théorème de Bayes.
5.2.2 EPA 4.2
Justify an informed, evidence-based rationale for ordering tests (when appropriate, based on integration of basic medical disciplines as they relate to the clinical condition); take into account cost-effectiveness of ordering
JR: Il y a une discussion du conflit entre sensibilité et spécificité au chapitre 2, mais pas de discussion des situations où il faudrait priviléfier l’une ou l’autre (screening vs confirmation).
5.2.3 EPA 4.6
As part of a routine check-up, advise patients and order screening tests or procedures to identify asymptomatic diseases or risk factors, weighing up their risks, benefits and predictive value; apply valid epidemiological data in selecting tests and procedures
JR: Traité au chapitre 2.
5.2.4 EPA 7.2
Use clinical scores and clinical decision rules/protocols to support decision (Bayesian approach) when appropriate.
JR: Manquant, proposition de rajout dans le nouveau chapitre 1.
5.3 Situations as starting points (SSP)
5.3.2 SSP 226
shared assessment of risks and benefits of screening and treating asymptomatic conditions