UNIVERSITY PERFUSION EDUCATION in FRANCE

1. UNIVERSITY PERFUSION EDUCATION in FRANCE S. Reymond (Le Plessis Robinson) B. Touchot (Paris) D. Gaillard (Paris) E. Vicaut (Paris) P. Rougé (Toulouse)

2. 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

3. 2 practitioners’ categories to run ECC Distribution of ECC practitioners in health sectors Livre Blanc de la CEC- Collège Français de Perfusiondécembre 1997

4. 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%

5. 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

6. 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.

7. 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 »

8. What is a Diploma of University ? • 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.

9. Diplomas of University 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

10. General organization of Diplomas in ECC • 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.

11. Details of educational programmes main topics : BS = basic science cECC = clinical ECC (adult & pediatric) S = safety CA = circulation assist Devices

12. Details of educational programs • 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.

13. The distribution of applicants is different MP : medical perfusionnists CP : clinical perfusionnists

14. The success of this training answers a need • 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  !

15. Which future for 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)”