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Patrice DETEIX Dean Faculty of medicine 28 Place Henri Dunant BP 38 63001 Clermont-Ferrand cedex 1

Patrice DETEIX Dean Faculty of medicine 28 Place Henri Dunant BP 38 63001 Clermont-Ferrand cedex 1 France Tel. : 33 (0)473177903 Fax : 33 (0)473177913 Doyen.medecine@u-clermont1.fr. Linking Medical Schools with Teaching Hospitals Points of view Perspective of a Faculty Dean

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Patrice DETEIX Dean Faculty of medicine 28 Place Henri Dunant BP 38 63001 Clermont-Ferrand cedex 1

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  1. Patrice DETEIX Dean Faculty of medicine 28 Place Henri Dunant BP 38 63001 Clermont-Ferrand cedex 1 France Tel. : 33 (0)473177903 Fax : 33 (0)473177913 Doyen.medecine@u-clermont1.fr

  2. Linking Medical Schools with Teaching Hospitals Points of view Perspective of a Faculty Dean Patrice Deteix Faculté de Médecine Clermont - Université Clermont-Ferrand Vulcania

  3. Hospital changes, The new hospital has nothing to do with the old one

  4. Giovanni Ciudad = Saint Jean de Dieu Invents modern hospital 1495 Born in Montemor-o-Novo, Portugal 1550 Dies in Grenade, Espagne

  5. Hospice d'Ille sur Têt France XII/XIIIèmes siècles Livre de Vie Active Manuscrit enluminé de Jean Henry, vers 1482

  6. Buildings have changed !

  7. Doctors have changed also ! Mathieu Jaboulay, surgeon, Lyon (1905). Surgeon's view when using the da Vinci Surgical System (2006). First trials to treat cancer with X-ray, painted by Georges Chicotot, (1907).

  8. Patients Time is € Time Doctors and teaching doctors are increasingly involved in hospital administration (less time to teach) “All Cured” Hospital Inc.

  9. Is the University adapting enough to the way of life in the XXI century ? Perhaps not in France ; we need rapid progress but medical teaching is not too bad with the “Centre Hospitalier et Universitaire”, created in December 1958 by Robert Debré, Jean Dausset (Nobel prize) and Marcel Legrain. Professors and doctors work full time in the public hospital, taking care of patients and teaching mainly in the same place. A new professional body “hospitalo-universitaire” was established in French hospitals

  10. The 1958 French “model” Department of Education University Positions Teaching Research Faculty of Medicine Other Faculties or Institutes • « Centre Hospitalier et • Universitaire » • Director • Medical Director • Dean of the Faculty Hospital Faculty takes care of students from the first year at the university to the day of the diploma : 9 years (GP) to 12 years (surgery).

  11. The governance of the University Hospital is the responsibility of the Director, the Head of the Medical Board and the Faculty Dean

  12. But there is a difficulty because the classic structure is no longer so clear : • Hospital administrators have to : • build new units • organize nursing care • ensure care 24 hours a day • try to obtain funds in exchange for medical activity • pay physicians, nurses… • Doctors belonging to the Faculty and University have to : • take care of patients • do clinical or basic research • teach research Ten years ago the health minister Bernard Kouchner decided to provide money for clinical research. Funds were allocated by the Health Ministry to hospital administrators and not to the University. Now the main concern of hospital directors is research which allows them to obtain finance. There is no longer any clear line between the Faculty – University and the Hospital.

  13. Students Teachers Administrators • Medical Schools • have to define • What is necessary in the hospital departments to train medical students • Clinical programs to be followed in the unit (skills,…) • How many specific hours with students for teachers. • Assessment of teaching and what to do with results • Teaching Hospital • has to • ask for accreditation to receive students • pay students • build special areas for teaching. • provide permanent access to the Net for all the students.

  14. Perspectives in linking Medical Schools with Teaching Hospitals Patients do not stay very long in hospital and it is much more difficult now for the student to see patients at the bedside • We have to find more places in hospitals to receive medical students • To fill all places in the teaching hospital (in-patients, out-patients,…) • To send students to medical units of smaller hospitals after agreement between the unit and the Medical School • Hospital administrators have to allow physicians to spend time specifically for students at a moment when every minute is costed.

  15. Perspectives in linking Medical Schools with Teaching Hospitals We must be aware of the discrepancy between the patient profile seen by the general practitioner and the profile encountered in specialty units in the teaching hospital. The disease is the same (except its frequency) but the environment is different. We have to develop much more teaching tools (simulation on mannequins, to mimic patients…) in the hospital to complete students’ training. We have to send students on others training sites : GP office, health community center…

  16. Conclusions Le tubage - Paris Peinture, G.Chicotot, (1904). Don’t forget to teach students at the bed side as in 1904. Learning at hospital for students must be sometimes at specific moments but also through a more general involvement

  17. Thank you for your attention

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