ABSTRACTObjectivesConducting research during medical school is a commonly described way to strengthen the physician-scientists workforce. The aim of this study is to compare the strength of association of Expectancy, Value and Cost regarding a research activity with future research intentions, and to explore differences between students with or without research experience during medical school.Design, setting and participantsAn online questionnaire was sent to final-year medical students – who had already chosen their specialty – in three French-speaking Belgian universities with non-mandatory research programmes. Exploratory factor analysis (EFA) and multiple regression analysis were conducted.Main measuresResearch intention (outcome measure) was assessed using a 3-item scale. The motivational beliefs were assessed using a 10-item scale adapted from a validated scale based on the Expectancy-Value- Cost theory. Responses were recorded on a 6-point Likert scale.ResultsParticipation rate was 28% (n=237). EFA revealed 4 factors with high internal consistency. 21.5% of students had positive research intentions (score 5 or above). Our model explained 82.8% of research intention variance (p < 0.001), of which three motivational beliefs had statistically significant coefficients: i) Value given to a research activity (β = 0.72, p < 0.001); ii) perceived Cost of a research activity (β = -0.11, p < 0.01); iii) Expectancy of success (β = 0.10, p < 0.05). Students with a positive research experience or students without research experience but who had strongly considered achieving one were 11.5 times more likely (95% CI, 5.0 – 26.2) to have positive research intentions at the end of medical school than other students.ConclusionsValue given to a research activity is the key factor regarding students’ motivation to undertake research. Our study confirms the positive relationship between non-mandatory research and future research intentions, although some students without a research experience showed high motivation as well.

Background Several European countries face a shortage of general practitioners (GPs), in part due to GP attrition. Most studies of GP attrition have focussed on why GPs decide to leave. Yet understanding why GPs decide to remain may also elicit potential interventions to reduce attrition. Objectives This study examined GP graduates’ career trajectories and underlying decisions to elucidate the factors influencing GP attrition. Methods We conducted semi-structured interviews of early to mid-career general practice graduates having completed training in Belgian French-speaking universities between 1999 and 2013. We sampled participants from three categories: full-time GPs, part-time GPs, no longer working as GPs. We analysed each participant’s career trajectory and broke it down into major phases. We performed thematic analysis of the factors influencing participants’ trajectories. We compared and contrasted trajectories to develop a typology of career trajectories. Results We identified six types of career trajectories: ‘stable’ (never considered leaving general practice), ‘reaffirmed’ (had considered leaving but made substantial changes whilst remaining), ‘reactional reorientations’ (had left to escape the challenges of general practice), ‘inspired reorientations’ (had left to pursue a different job), ‘reorientations out of loyalty’ (had never wanted to practice as GPs and had remained true to their original professional aspirations) and ‘mobiles’ (valued change and did not want to set-up practice). Conclusion Reasons GPs leave the profession are multiple. The typology that emerged indicates that only some of the career trajectories would benefit from interventions to reduce attrition such as improving working conditions and providing psychological support for GPs.

General practitioners (GPs) are first-line clinicians in melanoma diagnosis. It is, therefore, important to ensure that they maintain their melanoma diagnostic accuracy over time. The objective of this study was to assess the short- and long-term competences of GPs after a training session in naked-eye melanoma diagnosis. An interventional prospective study was conducted whereby, over a 6-month period, GPs attended a 1-h melanoma diagnostic training session. To assess their acquired competences, GPs were asked to fill in a questionnaire on basic melanoma knowledge and to evaluate 10 clinical images of pigmented skin lesions prior to training, immediately after and 1 year later. In total, 89 GPs completed the questionnaire prior and immediately after training. As expected, the number of GPs who appropriately managed ≥ 50

General practitioners (GPs) are among the main actors involved in early melanoma diagnosis. However, melanoma diagnostic accuracy and management are reported to be insufficient among GPs in Europe. The primary aim of this observational prospective study was to shed light on melanoma diagnostic practices among French-speaking Belgian GPs. The second aim was to specifically analyse these GPs’ pigmented skin lesion diagnostic accuracy and management. GPs from the five French-speaking districts of Belgium were asked to complete a questionnaire, before taking part in a melanoma diagnostic training session. First, we assessed the GPs’ current melanoma diagnostic practices. Then, their pigmented skin lesion diagnostic accuracy and management were evaluated, through basic theoretical questions and clinical images. These results were subsequently analysed, according to the GPs’ sociodemographic characteristics and medical practice type. In total, 89 GPs completed the questionnaire. Almost half of the GPs (43%; CI = [33;54]) were confronted with a suspicious skin lesion as the main reason for consultation once every 3 months, while 33% (CI = [24;43]) were consulted for a suspicious lesion as a secondary reason once a month. Prior to training, one-third of the GPs exhibited suboptimal diagnostic accuracy in at least one of six “life-threatening” clinical cases among two sets of 10 clinical images of pigmented skin lesions, which can lead to inadequate patient management (i.e. incorrect treatment and/or inappropriate reinsurance). This study underlines the need to train GPs in melanoma diagnosis. GPs’ pigmented skin lesion diagnostic accuracy and management should be improved to increase early melanoma detection.

BACKGROUND:The clinical approach to a prolonged cough, i.e. a cough lasting more than three weeks, is challenging for general practitioners as well for primary care pediatricians. What the recommended clinical approach in primary care is, how cough duration or cough characteristics impact the diagnosis, and what the efficiency and safety of antibiotics or symptomatic treatments are remain in question for primary care physicians.OBJECTIVE:The last Belgian guidelines were published in 2006 and needed to be reviewed. Those background questions were used to conduct our guideline updating procedure.METHODS:We systematically performed a pyramidal literature search between the periods 2006-2014 in order to write evidence based guidelines. The data of the literature was summarized, discussed by the authors, experts and the Belgian primary care guidelines committee. Recommendations were formulated and scored following the GRADE classification.RESULTS:The consultation history as well as the physical examination should be directed towards searching for warning signs (GRADE 1B) and towards the common etiologies depending on cough duration (GRADE 2C). If the cough lasts for more than eight weeks, chest radiography and spirometry should be considered (GRADE 2C). An antibiotic is recommended for a prolonged wet cough (over eight weeks) if prolonged bacterial bronchitis is suspected (GRADE 1B). In the absence of clinical signs of a specific etiology of a cough, no drug can be recommended (GRADE 1B). For all cases, it is initially suggested to avoid irritants (GRADE 1C) as well as to take into account the concerns of parents and inform them about the natural development of a cough.CONCLUSIONS:More research is needed to provide evidence on the clinical pathway on prolonged cough for primary care. Cough duration of more than eight weeks and prolonged wet cough are the most useful cough characteristics. Regarding a specific cough treatment, no medication has proved any effect greater than placebo. Attention to environmental triggers and patient-centered care remain the keystones of interventions.

Introduction: This study described the professional activities of graduates of the Advanced Master of General Practice of the Belgian French-speaking universities from 1999 to 2013 and identified factors influencing their situation. Methods: Between November 2014 and June 2015, all graduates were asked to complete a questionnaire concerning their professional activities. The first part of the analysis described the respondent's socio-demographic and professional characteristics. The second part aimed at detecting possible factors influencing GPs' professional situation. Results: The main results of the study showed that 78.5% of graduates still worked as GPs and 21.5% left and had another activity. The way graduates worked in General Practice was also highly diverse in terms of both working time and types of activities. Only a minority of them were exclusively performing General Practice (8.5%). 45.8% of GPs worked part-time, and were more commonly women and GPs in group practice. This survey confirmed feminisation of the profession and increasing work in associations. Among factors influencing retention in General Practice, preference for specialising in General Practice at time of graduation in medicine and duration of practice influence retention in practice. Conclusion: Our survey put the emphasis on the evolution of practice: job and vocational training planning should not be performed based only on previous generations. There is no one predefined way to practise; the blurred boundaries of General Practice activities do not allow for the drafting of a reference frame that could help workforce planning.

Construct: The purpose of this study was to provide initial evidence of the validity of written case summaries as assessments of clinical problem representation in a classroom setting.BACKGROUND:To solve clinical problems, clinicians must gain a clear representation of the issues. In the clinical setting, oral case presentations-or summaries-are used to assess learners' ability to gather, synthesize, and "translate" pertinent case information. This ability can be assessed in Objective Structured Clinical Examination and Virtual Patient settings using oral or written case summaries. Evidence of their validity in these settings includes adequate interrater agreement and moderate correlation with other assessments of clinical reasoning. We examined the use of written case summaries in a classroom setting as part of an examination designed to assess clinical reasoning.APPROACH:We developed and implemented written examinations for 2 preclerkship general practice courses in Years 4 and 5 of a 7-year curriculum. Examinations included 8 case summary questions in Year 4 and 5 in Year 5. Seven hundred students participated. Cases were scored using 3 criteria: extraction of pertinent findings, semantic quality, and global ratings. We examined the item parameters (using classical test theory) and generalizability of case summary items. We computed correlations between case summary scores and scores on other questions within the examination.RESULTS:Item parameters were acceptable (average item difficulty = 0.49-0.73 and 0.59-0.68 in Years 4 and 5; average point-biserials = 0.21-0.24 and 0.18-0.21). Scores were moderately generalizable (G coefficients = 0.40-0.50), with case-specificity a substantial source of measurement error (10.2%-19.5% of variance). Scoring and rater had small effects. Correlations with related constructs were low to moderate.CONCLUSIONS:There is good evidence regarding the scoring and generalizability of written case summaries for assessment of clinical problem representation. Further evidence regarding the extrapolation and implications of these assessments is warranted.

This work was carried out in collaboration between all authors. Author SL wrote the protocol and wrote the first draft of the manuscript. Authors SV and SL managed the literature searches and analyses of the included articles. Author MDJ participated in the critical appraisal of the literature and the discussion. All authors read and approved the final manuscript. ABSTRACT Aims: New cough guidelines recommend a wait, watch child’s cough. Providing parents with informative, illustrated booklets had an effect on the parents’ knowledge and intention to consult about such symptoms. Conclusion: Our findings support the recommendation of giving information to parents. Placebo seemed to be more efficient than nothing. Its proper use should be specified. There is a need for other studies on which approach works in which circumstances, and when placebo or sugar syrups could be useful.

The provision of care in general practice has changed significantly over recent years due to changes in the lifestyles of both doctors and patients. Moreover, the "inappropriate" use of emergency services is a critical issue which requires urgent attention. We conducted a review of both the Belgian and international literature to examine how frontline care has adapted and what issues these developments raise. In many countries, specific structures, such as walk-in clinics, out-of-hours centers, the deputizing services, have emerged creating a professional system of frontline care delivery. In Belgium, the Health and Disability Insurance system delegates the organization of out-of-hours primary care to local general practice assemblies who can develop services according to local requirements. In effect, new service delivery systems draw from a variety of models implemented in countries such as Canada, the United States or The Netherlands.

Nous rapportons chez un enfant de quatre ans le tableau clinique caracteristique d’une cellulite periorbitaire preseptale provoquee par une pile bouton obstruant le canal lacrymonasal. L’association d’un ecoulement nasal unilateral et d’une cellulite periorbitaire ipsilaterale doit faire evoquer l’obstruction du canal lacrymonasal par un corps etranger qui doit etre recherche et retire sans delai. Malgre la presence intranarinaire de la pile bouton pendant un mois chez notre patient, il a pu beneficier d’une extraction de la pile bouton, restee intacte, sous anesthesie locale et d’une guerison sans sequelle.

Analyse de : White SL, Yu R, Craig JC, et al. Diagnostic accuracy of urine dipsticks for detection of albuminuria in the general community. Am J Kidney Dis 2011;58:19-28. Question clinique : Cette etude, de bonne qualite, montre qu’une recherche de proteinurie negative a la tigette urinaire permet d’exclure une macroalbuminurie, mais sa force excluante (2,8) n'est pas suffisante pour en faire un test de depistage de la microalbuminurie. La valeur predictive positive de la tigette est par contre faible (47,2) ; un resultat positif doit etre suivi d'une confirmation de laboratoire. Conclusion Minerva : Quelle est la valeur diagnostique de la tigette urinaire pour le depistage de la proteinurie dans la population generale en comparaison a la detection par le calcul du ratio albumine/creatinine ?

Prolonged cough, defined as a cough lasting more than three weeks, is frequent in population studies however we don't know if a lot of them are consulting their general practitioner. The aim of this study was to evaluate the frequency of this complaint in general practice and to explore what diagnoses and treatments general practitioners give for it. Every child between 5 and 17 years consulting their physicians (N=34) were prospectively recruited over a period of two weeks. The data of this consultation and from their field were analyzed. 10.7% of the children had suffered from prolonged cough in the six months preceding the consultation. Diagnoses were by order of frequency: asthma, lower respiratory tract infection, ENT causes, gastro-oesophageal reflux. Inhaled medications were the most frequently prescribed treatment followed by antitussive drugs and antibiotics. In conclusion, prolonged cough was a frequent problem for the general practitioner. They thought about the most importance etiology according to the Belgian guideline expect environmental etiology.