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UNIVERSITY PERFUSION EDUCATION in FRANCE S. Reymond (Le Plessis Robinson) B. Touchot (Paris) D. Gaillard (Paris) E. Vicaut (Paris) P. Rougé (Toulouse) Statutory aspects of ECC in FRANCE Decree n°93-278 of January 16, 1991 Article 5 : the unity of cardiac surgery needs to have :

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University perfusion education in france l.jpg

UNIVERSITY PERFUSION EDUCATION in FRANCE

S. Reymond (Le Plessis Robinson)

B. Touchot (Paris)

D. Gaillard (Paris)

E. Vicaut (Paris)

P. Rougé (Toulouse)


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Statutory aspects of ECC in FRANCE

Decree n°93-278 of January 16, 1991

Article 5 : the unity of cardiac surgery needs to have :

- at least one nurse [clinical perfusionnist] having acquired the technique of ECC

- a medicine doctor [medical perfusionnist] having training or necessary practice to assume the medico-legal responsability of the ECC

Decree n ° 2002-194 of February 11, 2002

Article 8 : the nurse is authorized to carry out on written prescription, acts and following care provided that a medicine doctor can intervene at any time:

- preparation, use and surveillance of the ECC devices for cardiac surgery


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2 practitioners’ categories to run ECC

Distribution of ECC practitioners in health sectors

Livre Blanc de la CEC- Collège Français de Perfusiondécembre 1997


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How were trained the clinical perfusionists in France ?

initial qualification of CP in France

Livre Blanc de la CEC - CFP-1997

  • no national educational programme

  • no specific diploma

  • training in ECC is local at every center

  • - insured by peers

  • - duration : 3 to 15 months

  • - outside trainings in 50% of cases

  • - formal evaluation of theoretical

  • knowledge in only 20% of cases !

16%

20%

64%


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How were trained the medical perfusionists in France ?

no national educational program - no specific diploma

training in ECC is local at every center - insured by peers

initial qualification of MP in France

Who assures practical training of MP ?

23%

41%

34%

50%

9 %

43%

Livre Blanc de la CEC- Collège Français de Perfusion décembre 1997


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This situation was inacceptable !

  • Inconveniences are obvious :

    - heterogeneousness of trainings

    - heterogeneousness of practices

    - absence of academic work

  • It does not facilitate the elaboration and the recognition of practitioner's official status in ECC

  • It does not allow the development and the maintain of quality standards in cardiovascular perfusion that promote safety and protection of our patients.


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In the 90’s, four french leaders intoduced a theoretical and practical educational program in ECC

1991 - PARIS Lariboisière - D.Gaillard, B.Touchot & M.Duvelleroy.

« Diplôme d’Université de Circulation Extracorporelle et d’assistance circulatoire et respiratoire »

1990 - TOULOUSE - R.Barthélémy

« Diplôme d’Université de Circulation Extracorporelle en chirurgie et en assistance cardio-respiratoire »


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What is a Diploma of University ? theoretical and practical educational program

  • A Diploma of University is specific for the university which releases it.

  • The Diplomas of University are not recognized by the French National Council of Medicine Doctors for the validation of a professional qualification.

  • Whether it is for the MP or the CP, these 2 Diplomas of University in ECC give evidence of a minimum level of theoretical and practical knowledge, but they do not constitute a recognition of clinical competence.


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Diplomas of University theoretical and practical educational program Objectives of educational programs

  • 2 objectives - assure :

    - an initial training allowing allocation of a diploma for medicine doctors susceptible to become practitioners and responsible for the ECC in cardiac surgery centers.

    - a permanent training intended for researchers, biomedical engineers as well as for clinical perfusionists.

  • For the Clinical Perfusionists :

    - University of Paris issues simply a certificate of diligence

    - University of Toulouse issues a specific diploma


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General organization of Diplomas in ECC theoretical and practical educational program

  • Educational program is the same for CP and MP

  • On average, 80 hours of theoretical teaching.

    - in Paris : repartition in 5 seminars of 2 days

    - in Toulouse : repartition in 4 seminars of 2,5 days.

  • Practical training in cardiac surgery center is mandatory

    - certified MP to assure the clinical training of the applicant

  • Final written examination is organized in each University.


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Details of educational programmes theoretical and practical educational program

main topics :

BS = basic science

cECC = clinical ECC

(adult & pediatric)

S = safety

CA = circulation assist Devices


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Details of educational programs theoretical and practical educational program

  • In Toulouse, two clinical sessions on the animal are organized in the experimental laboratory surgery

  • Every experimental session lasts 4 hours

    - the first one is dedicated to the clinical manipulation of a system of extra-corporeal assistance

    - the second one is dedicated to the simulation of ununsual problems in ECC and behaviour to be held in practice in particular :

    - oxygenator failure and emergency replacement of membrane oxygenator

    - realisation of retrogade cerebral perfusion for treatment of massive air embolism.


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The distribution of applicants is different theoretical and practical educational program

MP : medical perfusionnists

CP : clinical perfusionnists


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The success of this training answers a need theoretical and practical educational program

  • 100 % of the MP and the CP certified by the Collège Français de Perfusion have obtained this diploma

  • Although the capacity of registration in these diplomas widely exceeds the real necessities of training, the number of registrations remains high every year

  • One does not know if perfusionist vocations arose after D.U. C.E.C. graduation  !


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Which future for theoretical and practical educational program these university educational programmes ?

  • A specific national educational program for the ECC will never be probably set up in France

  • imperative necessity of maintaining these university educational programs :

    - to be certified by the Collège Français de Perfusion, the applicant must be graduated from one of these 2 University Diplomas in ECC

    - the decree concerning the organization of cardiac surgery centers is in the course of updating :

    the new redaction of this decree would impose in every cardiac surgical center the presence of " at least a medicine doctor graduated from an University Diploma in ECC (D.U. C.E.C)”


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