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BackgroundIn order to address the challenges of an ageing population the Belgian government decided to allocate resources to the creation of geriatric day hospitals (GDHs). Although GDHs are meant to be a strategy to support general practitioners (GPs) caring for the frail elderly, few Belgian GPs seem to refer to a GDH. This study aims to explore the barriers and facilitating factors of GPs' referral to GDHs.MethodsA qualitative study using focus group discussions (FGDs) was conducted. Fifteen FGDs were organized in the different Belgian regions (Flanders, Wallonia, Brussels).ResultsContextual factors such as the unsatisfactory cooperation between hospital and GPs and organizational barriers such as the lack of communication on referral procedures between hospital and primary health care (PHC) were identified. Lack of basic knowledge about the concept or the local organization of GDH seemed to be a problem. Unclear task descriptions, responsibilities and activities of a GDH formed prominent points of discussion in all FGDs. Nevertheless a lot of possible advantages and disadvantages of GDHs for the patient and for the GP were mentioned.ConclusionsIn the case of poor referral to GDHs, focusing on improving overall collaboration between primary and secondary health care is essential. This can be achieved by actively delivering adequate information, permanent communication and more involvement of PHC in the organization and functioning of GDHs. The absence of a transparent health care system with delineated role definitions, seems to hinder the integration of new initiatives like GDHs in the care process. Strategies to enhance referral to GDHs should use a comprehensive approach.

Introduction: Focusing on the monthly prevalence of health problems and recourse to different levels of care of the population is an interesting approach to demonstrate the respective roles of different levels of health care. In the present study, the ecology of health care was studied in the region of Liè ge, Belgium. Method: A survey questioning people about their health problems was conducted in 2009 in two communes of the province of Liè ge. For each health problem, 'health care' was defined as contact with any qualified care provider. For each consultation, three elements were recorded: the profession of the health care provider; the place where the care was provided and the kind of health care received. Results: A total of 537 people were interviewed. The monthly prevalence of people who experienced a health problem during the previous month was 85.1%. The monthly prevalence of people who turned to a health care provider at least once during the month was 62.2%. The proportion of people turning to doctors, primarily local doctors, for a simple consultation was important (49.2%). Discussion: Our results are highly comparable with those of other studies. Recourse to a doctor is high (49%), which probably reflects the broad accessibility of health care in Belgium and maybe its overuse. Additional questions on the current and future organisation of the Belgian health care system are debated.

Résumé -Objectif : Le présent article se donne comme objectif de répondre, en 20 questionsréponses, aux principales préoccupations que les équipes d'enseignants potentiellement intéressées par le test de concordance de script (TCS) peuvent se poser. Les questions et objections souvent rapportées par les étudiants sont également prises en compte. Exégèse : Les principes qui sous-tendent le TCS sont rappelés. Ses atouts et ses limites sont évoqués. Les étapes de construction, de validation, de passation, de calcul de la note sont développées. Les auteurs illustrent le propos en s'appuyant sur une expérience concrète menée au Département de médecine générale de l'Université de Liège. Abstract -Objective:Most teacher concerns about Script Concordance Tests (SCT) are the object of some 20 questions and answers. The questions and objections most commonly reported by students are also taken into account. Analysis: The principles of SCT are described. Their strengths and limitations are discussed. The steps in designing, validating, testing and calculating scores are developed. The authors depict the concepts based an experiment led in the

Résumé -Contexte : Le cours de médecine palliative est dispensé aux étudiants en avant-dernière année des études médicales de 2 e cycle par deux enseignants, un médecin généraliste et un médecin hospitalier. Ce cours est dispensé depuis 10 ans selon un format traditionnel magistral. De nouveaux objectifs et de nouvelles modalités pédagogiques ont été introduits en 2010-2011. Ce dispositif concerne 95 étudiants. But : Cet article a pour objet de décrire le dispositif pédagogique du cours d'introduction à la médecine palliative et de fin de vie. Matériel et méthodes : L'objectif principal du dispositif pédagogique est l'apprentissage réflexif des étu-diants. Les outils pédagogiques sont le portfolio électronique, une vignette clinique évolutive, l'accompagnement à distance de chaque étudiant par un tuteur, des cours pluridisciplinaires en présentiel. Résultats : Le dispositif a eu lieu comme prévu. Tous les étudiants ont ouvert et complété leur portfolio. Conclusions et perspectives : Le dispositif pédagogique sera reconduit l'année académique prochaine en tenant compte des résultats de l'évaluation certificative des portfolios et de l'analyse du dispositif par les étudiants, tuteurs et enseignants. Abstract -Context:Students take the palliative medicine course in the year preceding their last year of medical studies. The two teachers, a general practitioner and a hospital-based physician, have been giving the course in a traditional lecture format for 10 years. New goals and new teaching methods were introduced in 2010-2011. The device involved 95 students. Purpose: The article aims to describe the educational device used in the palliative medicine and end-of-life course. Material and methods: The device is mainly designed to enhance students' reflexive learning. Teaching tools include the electronic portfolio, clinical vignettes (case reports), remote tutor support for all students and multidisciplinary courses held in a Article publié par EDP Sciences Article publié par EDP Sciences