{"id":6442,"date":"2020-10-06T09:10:18","date_gmt":"2020-10-06T07:10:18","guid":{"rendered":"https:\/\/wordpress-test.app.u-pariscite.fr\/sante\/?p=6442"},"modified":"2020-10-06T15:21:20","modified_gmt":"2020-10-06T13:21:20","slug":"pratiques-relations-formations-medicales-que-restera-t-il-des-adaptations-induites-par-la-gestion-de-la-crise-sanitaire","status":"publish","type":"post","link":"https:\/\/wordpress-test.app.u-pariscite.fr\/sante\/pratiques-relations-formations-medicales-que-restera-t-il-des-adaptations-induites-par-la-gestion-de-la-crise-sanitaire\/","title":{"rendered":"Pratiques, relations, formations m\u00e9dicales : que restera-t-il des adaptations induites par la gestion de la crise sanitaire ?"},"content":{"rendered":"

[et_pb_section bb_built=\u00a0\u00bb1″ next_background_color=\u00a0\u00bb#000000″ inner_width=\u00a0\u00bbauto\u00a0\u00bb inner_max_width=\u00a0\u00bbnone\u00a0\u00bb][et_pb_row][et_pb_column type=\u00a0\u00bb3_4″][et_pb_text admin_label=\u00a0\u00bbIntro\u00a0\u00bb _builder_version=\u00a0\u00bb3.22.1″ module_id=\u00a0\u00bbintro\u00a0\u00bb text_text_shadow_horizontal_length=\u00a0\u00bbtext_text_shadow_style,%91object Object%93″ text_text_shadow_vertical_length=\u00a0\u00bbtext_text_shadow_style,%91object Object%93″ text_text_shadow_blur_strength=\u00a0\u00bbtext_text_shadow_style,%91object Object%93″ link_text_shadow_horizontal_length=\u00a0\u00bblink_text_shadow_style,%91object Object%93″ link_text_shadow_vertical_length=\u00a0\u00bblink_text_shadow_style,%91object Object%93″ link_text_shadow_blur_strength=\u00a0\u00bblink_text_shadow_style,%91object Object%93″ ul_text_shadow_horizontal_length=\u00a0\u00bbul_text_shadow_style,%91object Object%93″ ul_text_shadow_vertical_length=\u00a0\u00bbul_text_shadow_style,%91object Object%93″ ul_text_shadow_blur_strength=\u00a0\u00bbul_text_shadow_style,%91object Object%93″ ol_text_shadow_horizontal_length=\u00a0\u00bbol_text_shadow_style,%91object Object%93″ ol_text_shadow_vertical_length=\u00a0\u00bbol_text_shadow_style,%91object Object%93″ ol_text_shadow_blur_strength=\u00a0\u00bbol_text_shadow_style,%91object Object%93″ quote_text_shadow_horizontal_length=\u00a0\u00bbquote_text_shadow_style,%91object Object%93″ quote_text_shadow_vertical_length=\u00a0\u00bbquote_text_shadow_style,%91object Object%93″ quote_text_shadow_blur_strength=\u00a0\u00bbquote_text_shadow_style,%91object Object%93″ header_text_shadow_horizontal_length=\u00a0\u00bbheader_text_shadow_style,%91object Object%93″ header_text_shadow_vertical_length=\u00a0\u00bbheader_text_shadow_style,%91object Object%93″ header_text_shadow_blur_strength=\u00a0\u00bbheader_text_shadow_style,%91object Object%93″ header_2_text_shadow_horizontal_length=\u00a0\u00bbheader_2_text_shadow_style,%91object Object%93″ header_2_text_shadow_vertical_length=\u00a0\u00bbheader_2_text_shadow_style,%91object Object%93″ header_2_text_shadow_blur_strength=\u00a0\u00bbheader_2_text_shadow_style,%91object Object%93″ header_3_text_shadow_horizontal_length=\u00a0\u00bbheader_3_text_shadow_style,%91object Object%93″ header_3_text_shadow_vertical_length=\u00a0\u00bbheader_3_text_shadow_style,%91object Object%93″ header_3_text_shadow_blur_strength=\u00a0\u00bbheader_3_text_shadow_style,%91object Object%93″ header_4_text_shadow_horizontal_length=\u00a0\u00bbheader_4_text_shadow_style,%91object Object%93″ header_4_text_shadow_vertical_length=\u00a0\u00bbheader_4_text_shadow_style,%91object Object%93″ header_4_text_shadow_blur_strength=\u00a0\u00bbheader_4_text_shadow_style,%91object Object%93″ header_5_text_shadow_horizontal_length=\u00a0\u00bbheader_5_text_shadow_style,%91object Object%93″ header_5_text_shadow_vertical_length=\u00a0\u00bbheader_5_text_shadow_style,%91object Object%93″ header_5_text_shadow_blur_strength=\u00a0\u00bbheader_5_text_shadow_style,%91object Object%93″ header_6_text_shadow_horizontal_length=\u00a0\u00bbheader_6_text_shadow_style,%91object Object%93″ header_6_text_shadow_vertical_length=\u00a0\u00bbheader_6_text_shadow_style,%91object Object%93″ header_6_text_shadow_blur_strength=\u00a0\u00bbheader_6_text_shadow_style,%91object Object%93″ z_index_tablet=\u00a0\u00bb500″]<\/p>\n

C\u00e9line Lef\u00e8ve, co-directrice de l\u2019Institut La Personne en m\u00e9decine, Ma\u00eetre de Conf\u00e9rences en philosophie \u00e0 l\u2019Universit\u00e9 Paris Cit\u00e9 et titulaire de la Chaire coop\u00e9rative \u00ab\u00a0Philosophie \u00e0 l\u2019h\u00f4pital\u00a0\u00bb (ENS\/AP-HP) revient sur quelques-unes des implications de la crise sanitaire sur les pratiques et les relations m\u00e9dicales, mais aussi sur les formations en sant\u00e9 et le r\u00f4le que peuvent y jouer les humanit\u00e9s m\u00e9dicales.<\/p>\n

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Durant la crise sanitaire, de nouvelles pratiques m\u00e9dicales ont vu le jour et d\u2019autres se sont d\u00e9ploy\u00e9es \u00e0 grande \u00e9chelle. Pensez-vous que cette crise sanitaire a permis une transformation durable des pratiques et relations m\u00e9dicales ?<\/strong><\/p>\n

Parmi les nombreuses implications que la crise a eu sur les pratiques et relations m\u00e9dicales, qu\u2019il est impossible de lister ici tant elles sont importantes, l\u2019une des plus \u00e9videntes est le d\u00e9veloppement de la m\u00e9decine \u00e0 distance. L\u2019enjeu \u00e0 pr\u00e9sent est de l\u2019int\u00e9grer \u00e0 des pratiques et des relations \u00e9thiques de soin.<\/p>\n

Il me semble que, pour certaines maladies ou \u00e0 certains moments de l\u2019\u00e9volution d\u2019une maladie, il est permis de ne pas \u00eatre nostalgique de la pr\u00e9sence incarn\u00e9e du m\u00e9decin aupr\u00e8s du patient. Par exemple, la consultation t\u00e9l\u00e9phonique – pour prendre l\u2019exemple le moins sophistiqu\u00e9 de t\u00e9l\u00e9m\u00e9decine – pourrait avoir des avantages qu\u2019il faudra \u00e9tudier avec pr\u00e9cision, en particulier dans la maladie chronique. Il permet au patient d\u2019\u00e9viter les transports, d\u2019attendre, de se fatiguer davantage. La consultation t\u00e9l\u00e9phonique conf\u00e8re une certaine souplesse et permet peut-\u00eatre de faire des points d\u2019\u00e9tape plus brefs mais plus fr\u00e9quents et adapt\u00e9s \u00e0 l\u2019\u00e9tat, aux besoins et demandes des patients. C\u2019est \u00e9galement la possibilit\u00e9 pour le patient d\u2019adresser, par mail, en amont de la consultation, ses questions et ses inqui\u00e9tudes au m\u00e9decin afin qu\u2019ils y portent, ensemble, une attention particuli\u00e8re lors de la consultation. C\u2019est enfin et surtout une fa\u00e7on de maintenir la continuit\u00e9 fondamentale du soin dans les maladies chroniques.<\/p>\n

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\u00a0\u00a0\u00a0\u00a0\u00a0 C\u00e9line Lef\u00e8ve<\/em><\/h6>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row][et_pb_column type=\u00a0\u00bb3_4″][et_pb_text _builder_version=\u00a0\u00bb3.22.1″ module_id=\u00a0\u00bbcontenu\u00a0\u00bb text_text_shadow_horizontal_length=\u00a0\u00bbtext_text_shadow_style,%91object Object%93″ text_text_shadow_vertical_length=\u00a0\u00bbtext_text_shadow_style,%91object Object%93″ text_text_shadow_blur_strength=\u00a0\u00bbtext_text_shadow_style,%91object Object%93″ link_text_shadow_horizontal_length=\u00a0\u00bblink_text_shadow_style,%91object Object%93″ link_text_shadow_vertical_length=\u00a0\u00bblink_text_shadow_style,%91object Object%93″ link_text_shadow_blur_strength=\u00a0\u00bblink_text_shadow_style,%91object Object%93″ ul_text_shadow_horizontal_length=\u00a0\u00bbul_text_shadow_style,%91object Object%93″ ul_text_shadow_vertical_length=\u00a0\u00bbul_text_shadow_style,%91object Object%93″ ul_text_shadow_blur_strength=\u00a0\u00bbul_text_shadow_style,%91object Object%93″ ol_text_shadow_horizontal_length=\u00a0\u00bbol_text_shadow_style,%91object Object%93″ ol_text_shadow_vertical_length=\u00a0\u00bbol_text_shadow_style,%91object Object%93″ ol_text_shadow_blur_strength=\u00a0\u00bbol_text_shadow_style,%91object Object%93″ quote_text_shadow_horizontal_length=\u00a0\u00bbquote_text_shadow_style,%91object Object%93″ quote_text_shadow_vertical_length=\u00a0\u00bbquote_text_shadow_style,%91object Object%93″ quote_text_shadow_blur_strength=\u00a0\u00bbquote_text_shadow_style,%91object Object%93″ header_text_shadow_horizontal_length=\u00a0\u00bbheader_text_shadow_style,%91object Object%93″ header_text_shadow_vertical_length=\u00a0\u00bbheader_text_shadow_style,%91object Object%93″ header_text_shadow_blur_strength=\u00a0\u00bbheader_text_shadow_style,%91object Object%93″ header_2_text_shadow_horizontal_length=\u00a0\u00bbheader_2_text_shadow_style,%91object Object%93″ header_2_text_shadow_vertical_length=\u00a0\u00bbheader_2_text_shadow_style,%91object Object%93″ header_2_text_shadow_blur_strength=\u00a0\u00bbheader_2_text_shadow_style,%91object Object%93″ header_3_text_shadow_horizontal_length=\u00a0\u00bbheader_3_text_shadow_style,%91object Object%93″ header_3_text_shadow_vertical_length=\u00a0\u00bbheader_3_text_shadow_style,%91object Object%93″ header_3_text_shadow_blur_strength=\u00a0\u00bbheader_3_text_shadow_style,%91object Object%93″ header_4_text_shadow_horizontal_length=\u00a0\u00bbheader_4_text_shadow_style,%91object Object%93″ header_4_text_shadow_vertical_length=\u00a0\u00bbheader_4_text_shadow_style,%91object Object%93″ header_4_text_shadow_blur_strength=\u00a0\u00bbheader_4_text_shadow_style,%91object Object%93″ header_5_text_shadow_horizontal_length=\u00a0\u00bbheader_5_text_shadow_style,%91object Object%93″ header_5_text_shadow_vertical_length=\u00a0\u00bbheader_5_text_shadow_style,%91object Object%93″ header_5_text_shadow_blur_strength=\u00a0\u00bbheader_5_text_shadow_style,%91object Object%93″ header_6_text_shadow_horizontal_length=\u00a0\u00bbheader_6_text_shadow_style,%91object Object%93″ header_6_text_shadow_vertical_length=\u00a0\u00bbheader_6_text_shadow_style,%91object Object%93″ header_6_text_shadow_blur_strength=\u00a0\u00bbheader_6_text_shadow_style,%91object Object%93″ z_index_tablet=\u00a0\u00bb500″]<\/p>\n

Ces pratiques vont sans doute s\u2019amplifier. Avez-vous pu d\u2019ores et d\u00e9j\u00e0 identifier des points de vigilance \u00e0 observer ou des limites dans ces nouvelles pratiques\u00a0?<\/strong><\/p>\n

Il faudra, sans aucun doute, \u00eatre attentif aux moments cruciaux et \u00e9thiquement d\u00e9licats de la relation m\u00e9dicale. Par exemple, interpr\u00e9ter les r\u00e9sultats d\u2019un examen et annoncer une complication, d\u00e9lib\u00e9rer et d\u00e9cider ensemble d\u2019un nouveau traitement ou d\u2019une intervention, tout cela continuera de demander une ou plusieurs rencontres physiques et des temps d\u2019\u00e9change les plus libres et complets possibles. Il faudra aussi \u00eatre attentif aux effets des mots employ\u00e9s au t\u00e9l\u00e9phone ou par mail pour \u00e9viter des malentendus voire des blessures morales (aussi en fonction des cat\u00e9gories socio-professionnelles et de la compr\u00e9hension des patients). On peut aussi imaginer que ces nouvelles pratiques de consultation \u00e0 distance pourraient donner lieu \u00e0 des attitudes paternalistes, le m\u00e9decin se donnant la possibilit\u00e9 de d\u00e9cider ou de prescrire seul derri\u00e8re son \u00e9cran, sans tenir compte des r\u00e9actions ou du consentement du patient. La relation patient-m\u00e9decin va se transformer. Ce sont l\u00e0 des points de vigilance, parmi tant d\u2019autres, pour lesquels un nouvel apprentissage pourra s\u2019av\u00e9rer n\u00e9cessaire.<\/p>\n

[\/et_pb_text][\/et_pb_column][et_pb_column type=\u00a0\u00bb1_4″][\/et_pb_column][\/et_pb_row][et_pb_row][et_pb_column type=\u00a0\u00bb3_4″][et_pb_text _builder_version=\u00a0\u00bb3.22.1″ module_id=\u00a0\u00bbcontenu\u00a0\u00bb text_text_shadow_horizontal_length=\u00a0\u00bbtext_text_shadow_style,%91object Object%93″ text_text_shadow_vertical_length=\u00a0\u00bbtext_text_shadow_style,%91object Object%93″ text_text_shadow_blur_strength=\u00a0\u00bbtext_text_shadow_style,%91object Object%93″ link_text_shadow_horizontal_length=\u00a0\u00bblink_text_shadow_style,%91object Object%93″ link_text_shadow_vertical_length=\u00a0\u00bblink_text_shadow_style,%91object Object%93″ link_text_shadow_blur_strength=\u00a0\u00bblink_text_shadow_style,%91object Object%93″ ul_text_shadow_horizontal_length=\u00a0\u00bbul_text_shadow_style,%91object Object%93″ ul_text_shadow_vertical_length=\u00a0\u00bbul_text_shadow_style,%91object Object%93″ ul_text_shadow_blur_strength=\u00a0\u00bbul_text_shadow_style,%91object Object%93″ ol_text_shadow_horizontal_length=\u00a0\u00bbol_text_shadow_style,%91object Object%93″ ol_text_shadow_vertical_length=\u00a0\u00bbol_text_shadow_style,%91object Object%93″ ol_text_shadow_blur_strength=\u00a0\u00bbol_text_shadow_style,%91object Object%93″ quote_text_shadow_horizontal_length=\u00a0\u00bbquote_text_shadow_style,%91object Object%93″ quote_text_shadow_vertical_length=\u00a0\u00bbquote_text_shadow_style,%91object Object%93″ quote_text_shadow_blur_strength=\u00a0\u00bbquote_text_shadow_style,%91object Object%93″ header_text_shadow_horizontal_length=\u00a0\u00bbheader_text_shadow_style,%91object Object%93″ header_text_shadow_vertical_length=\u00a0\u00bbheader_text_shadow_style,%91object Object%93″ header_text_shadow_blur_strength=\u00a0\u00bbheader_text_shadow_style,%91object Object%93″ header_2_text_shadow_horizontal_length=\u00a0\u00bbheader_2_text_shadow_style,%91object Object%93″ header_2_text_shadow_vertical_length=\u00a0\u00bbheader_2_text_shadow_style,%91object Object%93″ header_2_text_shadow_blur_strength=\u00a0\u00bbheader_2_text_shadow_style,%91object Object%93″ header_3_text_shadow_horizontal_length=\u00a0\u00bbheader_3_text_shadow_style,%91object Object%93″ header_3_text_shadow_vertical_length=\u00a0\u00bbheader_3_text_shadow_style,%91object Object%93″ header_3_text_shadow_blur_strength=\u00a0\u00bbheader_3_text_shadow_style,%91object Object%93″ header_4_text_shadow_horizontal_length=\u00a0\u00bbheader_4_text_shadow_style,%91object Object%93″ header_4_text_shadow_vertical_length=\u00a0\u00bbheader_4_text_shadow_style,%91object Object%93″ header_4_text_shadow_blur_strength=\u00a0\u00bbheader_4_text_shadow_style,%91object Object%93″ header_5_text_shadow_horizontal_length=\u00a0\u00bbheader_5_text_shadow_style,%91object Object%93″ header_5_text_shadow_vertical_length=\u00a0\u00bbheader_5_text_shadow_style,%91object Object%93″ header_5_text_shadow_blur_strength=\u00a0\u00bbheader_5_text_shadow_style,%91object Object%93″ header_6_text_shadow_horizontal_length=\u00a0\u00bbheader_6_text_shadow_style,%91object Object%93″ header_6_text_shadow_vertical_length=\u00a0\u00bbheader_6_text_shadow_style,%91object Object%93″ header_6_text_shadow_blur_strength=\u00a0\u00bbheader_6_text_shadow_style,%91object Object%93″ z_index_tablet=\u00a0\u00bb500″]<\/p>\n

Durant cette crise, tous les \u00e9tudiants du secteur sant\u00e9 se sont tr\u00e8s largement mobilis\u00e9s, \u00e0 tous les niveaux, pour venir en soutien des \u00e9quipes en place. Que pensez-vous que cette exp\u00e9rience de terrain, hors norme, aura apport\u00e9 \u00e0 leur formation ?<\/strong><\/p>\n

Incontestablement, la pand\u00e9mie marquera d\u2019une profonde empreinte toute une g\u00e9n\u00e9ration d\u2019\u00e9tudiants en m\u00e9decine et en soins infirmiers notamment. Pour eux, cette \u00e9pid\u00e9mie a constitu\u00e9 une incroyable et brutale \u00ab formation acc\u00e9l\u00e9r\u00e9e \u00bb aux questions \u00e9thiques relatives au soin. Elle aura aussi jou\u00e9 comme un extraordinaire effet de loupe sur l\u2019\u00e9thique ordinaire du soin.<\/p>\n

Ils ont \u00e9t\u00e9 confront\u00e9s \u00e0 des d\u00e9c\u00e8s massifs et imm\u00e9diats de patients, dans des conditions de souffrances physiques et morales extr\u00eames. Ce sont donc d\u2019abord aux limites, \u00e0 l\u2019incertitude et \u00e0 l\u2019impuissance de la m\u00e9decine qu\u2019ils ont d\u00fb faire face. Ils ont par exemple \u00e9t\u00e9 t\u00e9moins de l\u2019isolement et de l\u2019absence d\u2019accompagnement des patients et des proches en fin de vie et dans le deuil, ce qui les a sensibilis\u00e9s \u00e0 l\u2019\u00e9thique de l\u2019accompagnement. Cette \u00e9pid\u00e9mie les a aussi introduits aux questions \u00e9thiques de justice, et \u00e0 l\u2019implication des choix politiques, \u00e9conomiques et sociaux sur l\u2019\u00e9thique du soin. Ils ont \u00e9t\u00e9 plac\u00e9s \u00e0 des postes notamment d\u2019aide-soignants pour lesquels ils n\u2019\u00e9taient pas encore form\u00e9s, expos\u00e9s au risque et \u00e0 l\u2019angoisse d\u2019\u00eatre contamin\u00e9s et de contaminer leurs proches, t\u00e9moins de la p\u00e9nurie et du rationnement de mat\u00e9riels de protection (masques, surblouses) et de m\u00e9dicaments. Ils ont aussi exp\u00e9riment\u00e9 les questionnements \u00e9thiques relatifs au triage et \u00e0 l\u2019acc\u00e8s en r\u00e9animation des patients les plus \u00e2g\u00e9s ou atteints de comorbidit\u00e9s. Ils ont constat\u00e9 les risques de discrimination des patients dans l\u2019acc\u00e8s aux soins. Ils ont pris conscience que ces questions \u00e9thiques doivent \u00eatre regard\u00e9es en face, \u00e9tudi\u00e9es et explicit\u00e9es dans la pratique m\u00e9dicale.<\/p>\n

Les \u00e9tudiants sont devenus de facto<\/em> des acteurs impliqu\u00e9s et responsables. Leur vocation a \u00e9t\u00e9 renforc\u00e9e par le fait d\u2019avoir \u00e9t\u00e9 utiles, ils seront sans doute tr\u00e8s engag\u00e9s dans les choix d\u2019avenir du syst\u00e8me de sant\u00e9.<\/p>\n

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Vous enseignez la philosophie de la m\u00e9decine aux \u00e9tudiants de m\u00e9decine d\u2019Universit\u00e9 Paris Cit\u00e9. Selon vous, quel(s) r\u00f4le(s) peuvent jouer la philosophie et, plus largement, les sciences sociales et les humanit\u00e9s dans la formation m\u00e9dicale dans ce contexte ?<\/strong><\/p>\n

Une des questions est en effet de savoir comment enseigner la maladie dans ses multiples dimensions, physique, psychique et sociale, \u00e0 celles et ceux qui ne la vivent pas eux-m\u00eames. C\u2019est une question fondamentale pour moi qui enseigne la philosophie de la m\u00e9decine et qui cherche \u00e0 exercer les futurs m\u00e9decins \u00e0 une certaine souplesse dans l\u2019aller-retour entre la compr\u00e9hension de l\u2019exp\u00e9rience des patients et leur propre approche biom\u00e9dicale de la maladie et des traitements. \u00c0 cet \u00e9gard, l\u2019alliance d\u2019enseignements de philosophie et de sciences sociales avec des films de cin\u00e9ma, portant sur les exp\u00e9riences de la maladie et du soin, me para\u00eet une m\u00e9thode efficace pour faire voir, faire ressentir et in fine<\/em> mieux conna\u00eetre ces exp\u00e9riences.<\/p>\n

C\u2019est en ce sens qu\u2019au-del\u00e0 de mes enseignements \u00e0 la facult\u00e9, j\u2019anime, depuis 2017, dans le cadre de l\u2019Institut La Personne en m\u00e9decine<\/a>, le cin\u00e9-club \u00ab Barberousse. M\u00e9decine et soin au cin\u00e9ma \u00bb. Les films approchent le point de vue exp\u00e9rientiel des patients et des soignants. Ces projections sont suivies de d\u00e9bats avec des m\u00e9decins et des chercheurs en sciences humaines et sociales. L\u2019Institut construit d\u2019autres outils p\u00e9dagogiques dans cette optique.<\/p>\n

Les sciences humaines et sociales auront, je le crois, un r\u00f4le particulier d\u2019\u00e9clairage et de mise en perspective des questions politiques, sociales et \u00e9thiques concernant le syst\u00e8me de sant\u00e9 que l\u2019\u00e9pid\u00e9mie vient de r\u00e9v\u00e9ler et qu\u2019elle va profond\u00e9ment transformer.<\/p>\n

 <\/p>\n

D\u00e9couvrez le programme Interdisciplinaire La Personne en m\u00e9decine<\/a><\/p>\n

Programmation du cin\u00e9-club Barberousse. M\u00e9decine et soin au cin\u00e9ma<\/em><\/a><\/p>\n

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\u00a0<\/h6>\n
Barberousse. M\u00e9decine et soin au cin\u00e9ma<\/strong><\/em><\/a><\/h6>\n
C\u00e9line Lef\u00e8ve anime le cin\u00e9-club Barberousse. M\u00e9decine et soin au cin\u00e9ma,<\/em> avec Jean-Michel Frodon, critique de cin\u00e9ma et professeur associ\u00e9 \u00e0 Sciences Po, et Fran\u00e7ois Cr\u00e9mieux, directeur g\u00e9n\u00e9ral adjoint de l\u2019AP-HP.<\/h6>\n

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\u00a0<\/h6>\n
Outils p\u00e9dagogiques propos\u00e9s par l’Institut La Personne en m\u00e9decine<\/strong><\/h6>\n