the limits of the initial and continuing training of doctors

the limits of the initial and continuing training of doctors

Every doctor, in his career, is confronted with the pain felt by patients, sometimes a sign of an incurable illness that can lead, in the more or less short term, to death. Know how to assess symptoms, relieve pain and take charge of a person’s existential distress; learn to communicate bad news; accompany those around you; understand everyone’s role, including that of volunteers visiting patients: the need for doctors to obtain these skills is at the heart of the debates of the citizens’ convention on the end of life. On April 2, she will give an answer to the question posed by the Prime Minister, Elisabeth Borne: “Is the end-of-life support framework adapted to the different situations encountered or should any changes be introduced? »

This confrontation with the limits of curative medicine, with the limits of life itself, requires practical and therapeutic experience which must be shared in health faculties. Since 1997, universities have been required to offer teaching in palliative care in the second cycle of medical studies, but student participation in these seminars, transformed into modules in 2002, has remained optional.

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In initial training, questions relating to the end of life occupy, according to the faculties, “between six and ten hours in the second cycleexplains Elise Perceau-Chambard, head of department and associate professor in palliative medicine at the Lyon-Sud university hospital center. It’s very little to talk about pain, end of life, ethics, even if there may be optional teachings that come in addition”. Et this is not the only limit to learning to accompany the dying.

No diploma but an awareness

The internship reform, in 2017, removed an additional mention of a diploma devoted to pain medicine and palliative medicine, a course which was validated without an exam but with the writing of a dissertation. “The choice was then made not to create a specialized teaching diploma qualifying to practice this specialty, on the pretext that committing to palliative medicine for life, when one is 24 years old, can seem a little violent and requires previous experience”relates Laurent Calvel, head of service at the Strasbourg University Hospital and president of the national college of teachers for university training in palliative care.

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From now on, interns who want to learn palliative medicine can follow a one-year “transversal specialized training”, “thought not as a specialty but as a coloring, an awareness” without leading to a diploma, specifies Mr. Calvel. In 2022-2023, around 60 students have made this choice. Among them, about fifteen will perhaps have the chance to integrate the only master’s degree in palliative medicine that exists in France, within the University of Paris-Est-Créteil, whose reception capacities are not expandable.

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