BackgroundTriage errors in emergency departments (EDs), including undertriage and overtriage, pose significant risks to patient safety and resource allocation. With increasing patient volumes and staffing challenges, artificial intelligence (AI) integration into triage protocols has gained attention as a potential solution. ObjectiveThis study aims to develop and compare 3 AI models—natural language processing (NLP), large language model (LLM), and Joint Embedding Predictive Architecture (JEPA)—for predicting triage outcomes according to the French Emergency Nurses Classification in Hospital (FRENCH) scale and to assess their performance relative to nurse triage and clinical expert consensus. MethodsWe conducted a retrospective analysis of prospectively collected data from adult patients triaged at Roger Salengro Hospital ED (Lille, France) over 7 months (June-December 2024). Three AI models were developed: TRIAGEMASTER (NLP with Doc2Vec + MLP), URGENTIAPARSE (LLM with FlauBERT + Extreme Gradient Boosting [XGBoost]), and EMERGINET (JEPA with variance-invariance-covariance regularization). Of 73,236 ED visits, 657 (0.90%) had complete audio recordings and structured data. Data were split 80:20 into training and validation sets with stratification. Gold-standard labels were established by senior clinician consensus (minimum 5 years of ED experience). The primary outcome was concordance with the gold-standard FRENCH triage level, assessed using weighted κ, Spearman correlation, F1-score, area under the receiver operating characteristic (AUC-ROC) curve, mean absolute error (MAE), and root mean square error (RMSE). Secondary analyses evaluated Groupes d’Etude Multicentrique des Services d’Accueil (GEMSA) prediction and performance by input data type. ResultsURGENTIAPARSE demonstrated superior performance, with a composite z score of 2.514 compared with EMERGINET (0.438), TRIAGEMASTER (–3.511), and nurse triage (–4.343). URGENTIAPARSE achieved an F1-score of 0.900 (95% CI 0.876-0.924), an AUC-ROC of 0.879 (95% CI 0.851-0.907), a weighted κ of 0.800 (P<.001), a Spearman correlation of 0.802 (P<.001), an MAE of 0.228, and an RMSE of 0.790. Exact agreement was 90.0%, with near-agreement (+1 or –1 level) of 92.8%. However, training showed perfect accuracy (1.0) with poor validation performance (~0.5), indicating overfitting. EMERGINET achieved moderate performance (F1-score=0.731, AUC 0.686), while TRIAGEMASTER and nurse triage performed poorly (F1-score=0.618 and 0.303, respectively). For GEMSA prediction, URGENTIAPARSE maintained superiority (κ=0.863, Spearman=0.864, P<.001). Class 1 (highest acuity) was underrepresented (4/657, 0.61%), limiting undertriage risk assessment. ConclusionsThe LLM-based architecture (URGENTIAPARSE) demonstrated the highest accuracy for ED triage prediction among the tested models, outperforming traditional NLP, JEPA, and current nurse triage practices. However, severe overfitting, extreme selection bias (657/73,236, 0.90%, inclusion), a monocentric design, and sparse high-acuity representation limit clinical applicability. Before deployment, the model requires regularization, external validation across diverse EDs, prospective testing, and comprehensive safety evaluation, particularly for undertriage detection. Integration of AI triage support systems shows promise but demands rigorous validation, bias mitigation, and transparent uncertainty quantification to ensure patient safety.

BACKGROUND:Out-of-hospital cardiac arrest (OHCA) shows marked geographic variability. Socio-economic deprivation may contribute to this variability, but evidence from mixed urban-rural regions remains limited. We aimed to identify spatial clusters of OHCA incidence in northern France and to assess whether these clusters were associated with deprivation, care processes and outcomes. METHODS:We conducted a retrospective, population-based cohort study using data from the French National Out-of-Hospital Cardiac Arrest Registry for all OHCAs managed by mobile intensive care units between 1 July 2015 and 30 June 2016 in Nord-Pas-de-Calais. Age-adjusted and sex-adjusted standardised incidence ratios were smoothed with a Besag-York-Mollié Bayesian model. Spatial scan statistics identified incidence clusters. Cluster-level socioeconomic indicators, care processes and outcomes were compared RESULTS: Incidence was mapped across 1541 municipalities. Among 2867 OHCAs, mean annual OHCA incidence was 68.8 per 100 000 inhabitants (range <0.5 to >1.5 across municipalities). Two high-incidence clusters (relative risk between 1.61 and 1.68) and three low-incidence clusters (relative risk between 0.48 and 0.66) were detected. High-incidence clusters displayed greater deprivation and lower median income. Bystander basic life support was less frequent (26.7%) and 12-month survival lowest (1.4%) in the most deprived cluster. CONCLUSIONS:Pronounced spatial inequality in OHCA burden exists within northern France. Municipalities with higher deprivation experience disproportionately higher incidence and poorer long-term survival. Targeted cardiopulmonary resuscitation training and strategic automated external defibrillator deployment should prioritise these vulnerable communities.

Objective In the absence of clear French law on the application of a medicolegal obstacle (MLO) when drawing up a death certificate, the objective of the present study was to evaluate pre-hospital practice by emergency medical team (EMT) physicians in Northern France. Material and methods This retrospective, observational study was based on the extraction and analysis of data from the information system used by EMT physicians to fill out medical records during pre-hospital care for deaths between August 1st, 2023 and October 31st, 2023. The proportion of death certificates with an MLO was calculated. Data on age, the cause of death, the type of intervention site, the patient's medical history, and the reasons for intervention were extracted and compared in the MLO group versus the no MLO group. To measure the consistency of MLO application, a logistic regression model was trained on the study data. Results An MLO was recorded on 100 (29%) of the 238 death certificates. Individuals with an MLO were significantly younger and more likely to have a trauma-related cause of death. The regression model demonstrated that the MLO was applied consistently. Conclusion Although the MLO appeared to have been applied in a consistent manner when drawing up a death certificate, some situations had been missed. Additional training on MLOs for EMT physicians would be useful.

Triage errors, including undertriage and overtriage, remain major challenges in emergency departments (EDs), especially with growing patient volumes and staff shortages. This study compared three AI models-TRIAGEMASTER (NLP), URGENTIAPARSE (LLM), and EMERGINET (JEPA)-in predicting triage outcomes against the FRENCH scale and clinical practice, using data from adult patients over seven months at Roger Salengro Hospital ED (Lille, France). Performance was assessed through F1-Score, Weighted Kappa, Spearman, MAE, RMSE, and AUC-ROC. The LLM model, URGENTIAPARSE, achieved the highest accuracy (composite score 2.514; F1 = 0.900; AUC-ROC = 0.879), outperforming EMERGINET (0.438; 0.731; 0.686), TRIAGEMASTER (-3.511; 0.618; 0.642), and nurse triage (-4.343; 0.303; 0.776). Secondary analyses confirmed URGENTIAPARSE's superiority in predicting hospitalization (GEMSA) and its robustness with both structured and raw data. Overall, LLM-based AI offers the most reliable triage predictions, suggesting its integration could enhance ED efficiency and patient safety, provided model limitations and ethical transparency are addressed.

Background Saint Vincent de Paul Hospital is using a post-emergency teleconsultation solution (TELESCOPE). Target patients are discharged early, freeing up examination rooms and hospital beds, and the patient's clinical evolution is monitored by teleconsultation 24 hours after discharge. This study aims to evaluate this pioneering procedure, firstly to assess the impact of TELESCOPE on ED overcrowding, and secondarily to evaluate 72-hour post-emergency hospitalization rates, throughput times, and patient satisfaction. Methods This is a prospective, comparative, before/after type study. The National Emergency Department Overcrowding Scale (NEDOCS) score was used to measure the impact of TLC on ED congestion. It was calculated every hour, every day during the two study periods. The 72-hour post-emergency hospitalization rates were cross-compared for the patients who had a TLC, those who did not have a TLC during the same period, and those from the control period. The patient flow was evaluated by comparing the average length of stay of patients invited to a TLC against those from the control period. The patient’s satisfaction was measured through a telephone survey. Findings The mean difference in NEDOCS score is −3.1 [−4.14; −1.85]. Compared to the control phase, ED spent an additional 160 hours at a ‘normal’ level during the test period. The time spent in the ‘busy’ or ‘overcrowded’ categories was reduced by 129 and 19 hours. There is a significant reduction in the hospitalization rate between teleconsultation patients and all other patients. The patients discharged and invited to a TLC waited 87 minutes longer on average [56 minutes; 119 minutes]. Patient satisfaction is high (91.8%). Interpretation Additional statistical strength would be needed to prove a reduction in overcrowding. The low hospitalization rate reflects adequate recruitment. ED visit times were unexpectedly longer. TELESCOPE seems useful for defining a new type of care. A further multicentre study is scheduled for 2024.

In the context of the introduction of advanced practice nurses in emergency departments (APNs), the Collège de Médecine d'Urgence du Nord-Pas-de-Calais teamed up with the Unité de Formation et de Recherche des Sciences de la Santé et du Sport at the University of Lille to conduct a survey of emergency department management teams, with the aim of gaining a better understanding of their needs. The results revealed a number of obstacles and levers to the implementation of APNs, and led to a better understanding of the patient pathways in these departments. As a result, the content of the university teaching program could be reviewed with a view to meeting the needs expressed in the field.

In the context of the introduction of advanced practice nurses in emergency departments (APNs), the Collège de Médecine d'Urgence du Nord-Pas-de-Calais teamed up with the Unité de Formation et de Recherche des Sciences de la Santé et du Sport at the University of Lille to conduct a survey of emergency department management teams, with the aim of gaining a better understanding of their needs. The results revealed a number of obstacles and levers to the implementation of APNs, and led to a better understanding of the patient pathways in these departments. As a result, the content of the university teaching program could be reviewed with a view to meeting the needs expressed in the field.

Introduction and objectives: In out-of-hospital cardiac arrest, early recognition, calling for emergency medical assistance, and early cardiopulmonary resuscitation are acknowledged to be the three most important components in the chain of survival. However, bystander basic life support (BLS) initiation rates remain low. The objective of the present study was to evaluate the association between bystander BLS and survival after an out-of-hospital cardiac arrest (OHCA). Methods: We conducted a retrospective cohort study of all patients with OHCA with a medical etiology treated by a mobile intensive care unit (MICU) in France from July 2011 to September 2021, as recorded in the French National OHCA Registry (ReAC). Cases in which the bystander was an on-duty fire fighter, paramedic, or emergency physician were excluded. We assessed the characteristics of patients who received bystander BLS vs. those who did not. The two classes of patient were then matched 1:1, using a propensity score. Conditional logistic regression was then used to probe the putative association between bystander BLS and survival. Results: During the study, 52,303 patients were included; BLS was provided by a bystander in 29,412 of these cases (56.2%). The 30-day survival rates were 7.6% in the BLS group and 2.5% in the no-BLS group (p < 0.001). After matching, bystander BLS was associated with a greater 30-day survival rate (odds ratio (OR) [95% confidence interval (CI)] = 1.77 [1.58-1.98]). Bystander BLS was also associated with greater short-term survival (alive on hospital admission; OR [95%CI] = 1.29 [1.23-1.36]). Conclusions: The provision of bystander BLS was associated with a 77% greater likelihood of 30-day survival after OHCA. Given than only one in two OHCA bystanders provides BLS, a greater focus on life saving training for laypeople is essential.

Introduction: Although most localized odontogenic infections can be managed successfully without complications, some can cause extensive morbidity through the onset of cervicofacial cellulitis. The management of these more severe infections generally requires emergency treatment, including surgical treatment under general anesthesia, and prolonged length of hospital stay. Material & Methods: In this work, we assessed the impact of the provision of a hospital-based dental emergency department on the regional incidence of severe odontogenic cellulitis in a socioeconomically precarious region. Monthly case rates of odontogenic cellulitis treated between January 2010 and December 2019 at the hospital-based dental emergency department of Lille Medical University Hospital were collected. Results: The mean number of monthly severe odontogenic cellulitis cases treated under general anesthesia was significantly higher before than after the inception of the hospital-based dental emergency service [14.07 (5.83) vs 8.79 (4.42); p<0.0001]. Conversely, the monthly mean number of collected odontogenic cellulitis cases treated under local anesthesia was significantly lower before the emergency service was set up [22.42 (12.73) vs 43.32 (23.41); p<0.0001]. Conclusion: The provision of a hospital-based dental emergency department resulted in a decrease in severe dental infections in a region with high indices of socioeconomic precarity, morbidity and mortality. Greater accessibility to dental care allows for the rationalization of care through more precocious and fewer burdensome procedures.

RATIONALE, AIMS, AND OBJECTIVES:The human body is regulated by intrinsic factors which follow a 24-hour biological clock. Implications of a circadian rhythm in the out-of-hospital cardiac arrest (OHCA) are studied but the literature is not consistent. The main objective of our study was to identify temporal cluster of high or low incidence of OHCA occurrence during a day.METHODS:Multicentre comparative study based on the French national OHCA registry data between 2013 and 2017. After describing the population, the detection of significant temporal clusters of OHCA incidence was achieved using temporal scan statistics based on a Poisson model adjusted for age and gender. Then, comparisons between identified patients clusters and the rest of the population were performed.RESULTS:During the study, 37 163 medical OHCA victims were included. The temporal scan revealed a significant 3-hour high incidence temporal cluster between 8:00 am and 10:59 am (Relative R = 1.76, P < .001). In the identified cluster, OHCA occurred more out of the home with fewer witnesses, and advanced life support was less attempted in the cluster. No difference was observed on the return of spontaneous circulation, survival at hospital admission, and survival 30 days after the OHCA or at hospital discharge.CONCLUSIONS:We observed a three-hour morning high incidence peak of OHCA. This high incidence could be explained by different physiological changes in the morning. These changes are well known and the evidence of a morning peak of cardiovascular disease should enable medical teams to adapt care strategy and hospital organization.

Purpose To compare intraosseous access with peripheral venous access on adults out-of-hospital cardiac arrest (OHCA) patients’ clinical outcomes. Methods A national retrospective multicentre study was conducted based on the French National Cardiac Arrest Registry. Comparison of patients (intraosseous vs. peripheral venous access) was conducted before and after a matching using a propensity score. The propensity score included confounding factors: age, time between the call (T0) to epinephrine (to take account of how quickly vascular access was achieved), the aetiology of OHCA, the shock and the patient initial rhythm at MMT arrival. Results A total of 1576 patients received intraosseous access, and 27,280 received peripheral intravenous access. Before matching, OHCA patients with intraosseous access were less likely to survive at all stages (return of spontaneous circulation (ROSC), 0-day survival and 30-day survival). No significant difference in neurological outcome was observed. After propensity score matching, no significant differences in 30-day survival rates (OR = 0.763 [0.473;1.231]) and neurological outcome (OR = 1.296 [0.973;1.726]) were observed. However, intraosseous patients still showed lower likelihood of short-term survival (ROSC and 0-day survival) even after propensity score matching was implemented. Conclusion The populations we investigated were similar to those of other studies suggesting that intraosseous access is associated with reduced survival and poorer neurological outcome. Our findings suggest that intraosseous access is a comparably effective alternative to peripheral intravenous access for treating OHCA patients on matched populations.

BackgroundOligo-analgesia is common in the emergency department (ED). This study aimed at reporting, when initiated by triage nurse, the superior efficacy of inhaled methoxyflurane plus standard of care (m-SoC) analgesia versus placebo plus SoC (p-SoC) for moderate-to-severe trauma-related pain in the hospital ED.MethodsA randomised, double-blind, placebo-controlled trial was conducted at eight EDs. Adults with pain score ≥4 (11-point numerical rate scale, NRS) at admission were randomised to receive one or two inhalers containing m-SoC or p-SoC. Primary outcome measure was time until pain relief ≤30 mm, assessed on the 100-mm Visual Analogic Scale (VAS).ResultsA total of 351 patients were analysed (178 m-SoC; 173 p-SoC). Median pain prior to first inhalation was 66 mm, 75% had severe pain (NRS 6–10). Median time to pain relief was 35 min [95% confidence interval (CI), 28–62] for m-SoC versus not reached in p-SoC (92 – not reached) [hazard ratio), 1.93 (1.43–2.60),P < 0.001]. Pain relief was most pronounced in the severe pain subgroup: hazard ratio, 2.5 (1.7–3.7). As SoC, 24 (7%) patients received weak opioids (6 versus 8%), 4 (1%) strong opioid and 44 (13%) escalated to weak or strong opioids (8 versus 17%, respectively,P = 0.02). Most adverse events were of mild (111/147) intensity.ConclusionsIn this study, we report that methoxyflurane, initiated at triage nurse as part of a multimodal analgesic approach, is effective in achieving pain relief for trauma patients. This effect was particularly pronounced in the severe pain subgroup.

Le syndrome coronarien ou coronaire aigu (SCA) est constitue des manifestations cliniques, electrocardiographiques et biologiques liees a la rupture d’une plaque d’atherome ayant induit la formation d’un thrombus limitant le flux sanguin dans le reseau arteriel coronaire. Les SCA sont classes en SCA avec elevation (ou sus-decalage) du segment ST (SCA ST+) et en SCA sans elevation du segment ST (SCA non ST+). Dans les SCA ST+, le thrombus est constitue principalement de fibrine entrainant une occlusion coronaire aigue totale responsable d’une necrose complete du tissu myocardique dans les 6 heures, tandis que dans les SCA non ST+, il est plutot de type plaquettaire n’obstruant pas completement la lumiere arterielle. La douleur thoracique est le signe d’appel le plus courant. Le facteur temps est l’element cle dans la prise en charge des SCA. Le role des SAMU-SMUR-Centres 15 est essentiel, permettant une prise en charge rapide. L’electrocardiogramme 18 derivations (six derivations standards et 12 derivations precordiales V1-V9 et V3r, V4r, VE) est l’examen a realiser en toute priorite. Il permet de distinguer les SCA ST+ des SCA non ST+. Quel que soit le type de SCA, le traitement comporte la prise d’aspirine, de clopidogrel, d’heparine, une anxiolyse et un traitement antalgique. La strategie de reperfusion des SCA ST+ repose sur la thrombolyse prehospitaliere suivie d’une angioplastie si le delai douleur-traitement est inferieur a 3 heures. Au-dela, une angioplastie eventuellement facilitee par l’administration d’antiglycoproteine (anti-GP) IIbIIIa doit etre envisagee si elle est realisable dans un delai de 90 minutes. Dans les SCA non ST+, l’evaluation des marqueurs biologiques de souffrance myocardique (troponine) peut permettre une orientation diagnostique et therapeutique des la phase prehospitaliere. La fibrinolyse est clairement contre-indiquee. L’administration d’anti-GP-IIbIIIa peut etre envisagee chez les patients a haut risque qui vont beneficier d’une angioplastie.

Background: Epinephrine effectiveness and safety are still questioned. It is well known that the effect of epinephrine varies depending on patients' rhythm and time to injection. Objective: We aimed to assess the association between epinephrine use during out-of-hospital cardiac arrest (OHCA) care and patient 30-day (D30) survival. Methods: Between 2011 and 2017, 27,008 OHCA patients were included from the French OHCA registry. We adjusted populations using a time-dependent propensity score matching. Analyses were stratified according to patient's first rhythm. After matching, 2837 pairs of patients with a shockable rhythm were created and 20,950 with a nonshockable rhythm. Results: Whatever the patient's rhythm (shockable or nonshockable), epinephrine use was associated with less D30 survival (odds ratio [OR] 0.508; 95% confidence interval [CI] 0.440-0.586] and OR 0.645; 95% CI 0.549-0.759, respectively). In shockable rhythms, on all outcomes, epinephrine use was deleterious. In nonshockable rhythms, no difference was observed regarding return of spontaneous circulation and survival at hospital admission. However, epinephrine use was associated with worse neurological prognosis (OR 0.646; 95% CI 0.549-0.759). Conclusions: In shockable and nonshockable rhythms, epinephrine does not seem to have any benefit on D30 survival. These results underscore the need to perform further studies to define the optimal conditions for using epinephrine in patients with OHCA. (C) 2020 Elsevier Inc. All rights reserved.

ImportanceRocuronium and succinylcholine are often used for rapid sequence intubation, although the comparative efficacy of these paralytic agents for achieving successful intubation in an emergency setting has not been evaluated in clinical trials. Succinylcholine use has been associated with several adverse events not reported with rocuronium.ObjectiveTo assess the noninferiority of rocuronium vs succinylcholine for tracheal intubation in out-of-hospital emergency situations.Design, Setting and ParticipantsMulticenter, single-blind, noninferiority randomized clinical trial comparing rocuronium (1.2 mg/kg) with succinylcholine (1 mg/kg) for rapid sequence intubation in 1248 adult patients needing out-of-hospital tracheal intubation. Enrollment occurred from January 2014 to August 2016 in 17 French out-of-hospital emergency medical units. The date of final follow-up was August 31, 2016.InterventionsPatients were randomly assigned to undergo tracheal intubation facilitated by rocuronium (n = 624) or succinylcholine (n = 624).Main Outcomes and MeasuresThe primary outcome was the intubation success rate on first attempt. A noninferiority margin of 7% was chosen. A per-protocol analysis was prespecified as the primary analysis.ResultsAmong 1248 patients who were randomized (mean age, 56 years; 501 [40.1%] women), 1230 (98.6%) completed the trial and 1226 (98.2%) were included in the per-protocol analysis. The number of patients with successful first-attempt intubation was 455 of 610 (74.6%) in the rocuronium group vs 489 of 616 (79.4%) in the succinylcholine group, with a between-group difference of -4.8% (1-sided 97.5% CI, -9% to ∞), which did not meet criteria for noninferiority. The most common intubation-related adverse events were hypoxemia (55 of 610 patients [9.0%]) and hypotension (39 of 610 patients [6.4%]) in the rocuronium group and hypoxemia (61 of 616 [9.9%]) and hypotension (62 of 616 patients [10.1%]) in the succinylcholine group.Conclusions and RelevanceAmong patients undergoing endotracheal intubation in an out-of-hospital emergency setting, rocuronium, compared with succinylcholine, failed to demonstrate noninferiority with regard to first-attempt intubation success rate.Trial RegistrationClinicalTrials.gov Identifier: NCT02000674.

Emergency management of deliberate self-poisoning (DSP) by drug overdose is common in emergency medicine. There is a paucity of data about the prehospital care of these patients. The principal aim was to describe the intensity of care received by patients with DSP who were managed by prehospital emergency medical service (EMS) physicians. A 48-h cross-sectional study was conducted in 319 EMS and emergency units in France. Patient and poisoning characteristics and treatments administered were recorded. Complications of poisoning, hospitalization, intensive care unit admission and death were recorded until day 30. The primary endpoint was the probability of receiving prehospital intensive care, including fluid resuscitation, vasopressor therapy, invasive ventilation, or antidotal treatments, depending whether prehospital treatment was carried out by an EMS physician or not. Data from 703 patients (median age was 43 [30–52] years, 288 (40%) men) were analyzed. One hundred and fifteen (16%) patients were attended by an EMS physician. Patients attended by EMS physicians were more likely to receive intensive treatment in the prehospital setting [odds ratio (OR) 7.4, 95% confidence interval 4.3–12.9]. These patients had more severe poisoning as suggested mainly by a lower Glasgow Coma Score (13 [8–15] vs. 15 [15–15]; p < 0.001) and a higher rate of admission to an intensive care unit [29 (25%) vs. 15 (2%), p < 0.001]. Patients with DSP attended by prehospital EMS physicians frequently received intensive care. The level of care seemed appropriate for the severity of the poisoning.

Purpose of the study: Intraosseous access is currently considered as a safe and quick procedure for administrating drugs in vital emergencies. The latest guidelines acknowledge the efficacy of this access in adults in out-of-hospital cardiac arrest (OHCA) care. However, the literature contains conflicting results regarding survival when comparing patients with intravenous access versus intraosseous access. This study objective was to assess 30-days survival in adult medical OHCA patients who had intraosseous access versus peripheric intravenous access on adjusted populations.

The authors declare no conflict of interest.

Dans le cadre de la création du diplôme d’études spécialisées de médecine d’urgence (DESMU), l’intégration d’un programme national de simulation est difficile à promouvoir face à la grande variabilité des ressources de chaque université. Nous proposons une méthodologie de conception et de mise en oeuvre d’un programme de formation par simulation (PFS) fondée sur les spécificités de chaque université et intégrant une démarche évaluative selon une approche par compétences. La méthode du modèle logique a été utilisée pour définir les objectifs en lien avec le contexte de formation, préciser les ressources disponibles puis décrire le processus de mise en oeuvre et d’évaluation d’un PFS intégré au DESMU de l’université de Toulouse. La méthode du modèle logique a permis la conception d’un PFS à partir de six étapes successives : 1) l’objectif qui tient compte du contexte ; 2) les ressources ; 3) les activités ; 4) les groupes visés par le programme ; 5) les produits issus des activités ; 6) les résultats à court, moyen et long termes. Il a permis d’intégrer la simulation dans le cursus de formation des DESMU selon une approche réaliste et adaptée aux ressources locales avec un processus d’évaluation cohérent (satisfaction, mobilisation des compétences en situation de soins et impact sur l’organisation des soins). Dans le cadre d’une approche par compétences dans le cursus des DESMU, le modèle logique a mené à la conception, à la mise en oeuvre et à l’évaluation d’un PFS cohérent avec comme défi de rester dynamique afin d’intégrer l’évolution des variables pendant la période du projet.