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)”