At the beginning of his career, Jean-Jacques expressed an lively interest for the teaching of medicine and specialist training. csotcina.comedic surgeon like his father, who was pupil of , it directs himself towards an academic career with a predilection for the pediatric csotcina.comedics. He completed his university life as senior of the medical college of the where he implemented the reform of the medical studies according to the statement of Bologna. At the time of its , it recalls us the broad outlines of his course.

. : You were departmental manager in csotcina.comedy?

: Yes, of the university department of csotcina.comaedics of the University Private clinics Luc Saint who is related to the pulpit of csotcina.comedy of the University   Catholique   of Leuwen. This pulpit was created in 1954 for Pierre . It is André Vincent successor of Pierre who opened the service in Brussels in 1976. The university private clinic Saint Luc is one of the three university hospitals of Brussels. It then contained three unities “  adult  ” and an csotcina.comedic unity of pediatric surgery. The unit made about 90 beds.

. : You had which speciality?

: I started my career in Leuwen with Pierre de and André Vincent. Our objective was to form a complete csotcina.comedic department in which each aspect of the speciality would be covered. Insofar as André Vincent were a surgeon of the rachis and hip and where Pierre De was a surgeon of the tumors who also dealt with traumatic after-effects, I dealt with that of which they were not occupied. I.e. in the adult of the surgery of the upper limb, a little surgery of the foot and all the aspects of the pediatric surgery which did not concern the spine surgery. In fact, I made 25 years of my career with André Vincent as departmental manager i.e. I became most of my career as an assistant.

. : But when you, was this was departmental manager intricate to manage a general-purpose service?

: It was a rather extraordinary opportunity to arrive at the management of a service which was not built in a way pyramidal, but consisted of a whole of specialists who collaborated and who had already reached a certain maturity. There was inevitably a certain number of fields which were to be developed.  I was convinced that the main difficulty was going to be to follow the development of traumatology because the University Private clinics Luc Saint to develop their role of public service in the agglomeration   of Brussels.   I was convinced that the charge of traumatology was to increase. This is why I prepared with the of service by developing my expertise in traumatology by one sabbatical year at the Cantonal Hospital   Universitaire   of Geneva where I tied very close contacts with the .

. : Thus didn't general-purpose management pose a problem to you?

: That did not pose a problem. We had lived during the years' 80, the departmentalization.   the   administrative management and financial concerned the head of department. with the department head, it is responsible for the medical operation of its service and the teaching which is given to it… Within the service we had set up a participative management where one tried to have a consensus on the techniques and the choice of the hardware of osteosynthesis and joint replacement which was selected within the service. With regard to teaching one had set up the meeting of the morning, well-known of the French institutions. The 24 hours cases previous are forwarded and are discussed. I had enormously pleasure with these meetings of the morning, to discuss the indications and to manage to create a spirit of school. That requires a share of the every day and a certain constancy, and especially a knowledge of the literature if one wants to be able to interfere with the various specialists. The service was made up surgeons seniors including three aggregate. Similar structure has its own brittleness  :  high level surgeons are inevitably solicited by outside. It is what one lived. From the moment when other important hospital structures put posts of head of department of csotcina.comaedics at recruitment, some of my assistants did obviously not wish to finish their career like assistant and were tried by these of service. Thus which had succeeded André Vincent for the spine surgery had to take the management of the service of Jean . A few years after one saw leaving Pascal towards a private activity. I think that the main difficulty, and it is what my successor Christian Delloye lived, was to keep an excellence in all the fields in spite of this natural evolution which wants that the most powerful specialists are brought to leave us. But that also gave us the possibility of making very interesting alternative recruitments. Thus we brought back from Paris Thibaut for the surgery of the foot.

. : For does the interns how that do? 

: The service is one of the three French-speaking university services which ensures with affiliated services the training of the candidates specialists in csotcina.comedic surgery. The university department head ensures the coordination i.e. it organizes a training program to which a certain number of Masters of peripheral training courses of hospital adheres. In fact it is a network of formation, a little as that exists in Canada. We propose to the applicants, training program a six years which generally understands the passage in four to eight services of training course. We ensure the selection of the candidates specialists. The selection is done on the level of each university institution. The selection is organized by the department of surgery. The service takes part and negotiates in it the number of post with the department of surgery which will contribute to general surgical training during the first two years. It is a contest where intervene the curriculum vitae, a written test of anatomy, a training course pre-contest two months minimum in the csotcina.comedic structure and a structured interview. At the time where I was department head, I made an interview structured very often on items of the British Medical Journal which is Leitartikeces. For example, an item which one used regularly was: “Is it Necessary to make a radiography of cranium to traumatized cranial as an emergency room? For and against”.

. : How is the program cut out?

: Two years of general surgery in collaboration with the department of surgery, two years of bone surgery generally in affiliated hospitals, and one or two years in an university hospital of reference, in fact the service. If the number of candidates is too high compared to the number of posts in the service it is the occasion to send the candidates abroad one year in a famous university service. Thus does it of it is a training program which is flexible according to the wishes of the candidate in proportion to the posts available and the hospital needs.

. : How the medical student choose does?

: The candidate with the speciality can postulate in each of the three French-speaking universities of Brussels. But the selection criteria are such as one is automatically favoured in his institution compared to the other institutions. The speciality is thus done generally in the university where his studies of medicine were made. In the course of formation of the crossings are possible, but they are too rare. We had exchanges with Switzerland and even with France, I think of Gilbert of Strasbourg which came to be formed on our premises during nearly four years. The system of selection of the candidates specialists in Belgium supports nevertheless the continuation of the studies specialized within the same university as that which allots the basic diploma.

. : With all the work of management of an csotcina.comedic department, how did you make to become senior?

: It is to some extent the after-effect of my 25 years like assistant of Andre Vincent. For the moment when a career of assistant is accepted it is necessary to have its secret garden if not it is not livable. My secret garden related to primarily activities within medical faculty. The lack of interns and external in the service at one given moment put to me in anger and led me to go to see how the trainees and the candidates specialists within our institution were divided. I have, of needle and thread, wanted to amend the things and I thus became responsible for the administration of the training courses. Once one is responsible for the administration of the training courses, the senior in place asks you for consultings. And at this time, the difficulty of the specialist training arose, whose senior of the time which was fundamentalist did not have any idea. With his request, I occupied myself to structure specialized trainings and to create DES. That led me to acquire an expertise in the field of vocational training, in particular the training of the candidates specialists which was my point of interest. Once one is implied in the last years of medicine one interests inevitably in what occurs before and thus I was interested in the preliminary training of the doctors. One was at this time during one critical time since the medical faculty of the was a Faculty which ensured a teaching very theoretical and rather far away from the patients. The senior of the time had asked for an evaluation of medical faculty according to the North-American model and our evaluation proved to be strong critic.

. : What did one reproach your program of study?

: To have an excessive separation enters the fundamental theoretical teaching of the first cycle and the high school. The first cycle lasts three years in Belgium and the high school himself was separate in two parties with the first two years which were the training of pathology without hardly of contact with the private clinic, then two years full-time of contact with the patients where the student arrived little prepared at the knowledge to make practical. In fact these aspects of medical pedagogy it was rather the field of my wife who had been formed in Geneva with Jean-Jacques and with Jean-François     and . It ensures the responsibility for a unity of medical pedagogy as a nonacademic expert. In 1993 Andre Lambert, the person responsible for the reform of the program died suddenly after a meeting and it should have been replaced in the urgency. As a person responsible for the training courses, I was solicited to succeed to him and became responsible for the program of the studies of medicine to the what took to me from 93 to 98 and which badly did not interfere with my of service. Having finished this reform of the medical studies, I had decided to give up the management of Faculty and to center my activity within the service. A few years later, at the end of the of Didier Moulin there was no candidate for his succession and one asked to me whether I did not want to take again service within faculty. In short, in 2002, Faculty had need for a senior, me I were 60 years old, Christian Delloye had 50 of them. The service could thus be begun again by somebody who had maturity necessary and a scientific luggage more than sufficient…

. : To what had related the reform of the studies of medicine?

: With the purpose of supporting the integration of basic sciences and clinical sciences, the first stage was the sectorization  : one evolved to a sectorization by system  : cardiology, pneumology, locomotor… Conventional systems. The second stage was the enlargement of the clinical training courses with access to the hospital as of the 4th year of studies whereas before, the student was to wait the sixth year before as trainee.

. : Why did you make this choice? Were you relieved not to take the responsibility for a service more?

: Not, because in fact at this time I intended to still keep the responsibility for the service, and me a little was forced the hand. But I continued to operate. I was the first senior to continue to have an clinical activity with the  ; I had two mornings of consultation and a surgical day. That was inevitably surbedded with time and this clinical activity decreased. What is extraordinary, it is that for this last period I could center me on what was my main interest, the hip and the foot of the child. I was likely to be able to recruit a collaborator of greatest quality, Pierre-Louis , and one could make together a trade-guild of a few years so that the pediatric patients who were in the course of processing within the service are taken again by somebody who had the same philosophy of assumption of responsibility as the person responsible who left. My hobby-horse at the time was especially the congenital hip dislocation and the resumptions of the failures of processing of luxation. I really could forward all this experiment. My philosophy was following the  : for the moment when one does not operate much any more it is obviously necessary not to make a surgery of routine. It would be aberrant to want to make total prostheses of hip by doing only one per month in a service where one is not really integrated. On the other hand, to operate a teratological luxation by bloody reduction or to contribute to operate a vesical , these are things that in any event one makes only one or twice a year, therefore the expertise which one could accumulate during 25 or 30 years it is worth to forward it and to exploit it.

. : As did senior, which files await you on your desk?

: It is simple, the large file at the time related to the management of the in medicine which had been decided in 1997 with first implementation in 2004. It is a file which had been very badly tied up. The legislative texts were difficult to implement and were by certain unjust aspects with respect to the students.

. : Which were the stakes?

: In fact, academic works depend in our small federal country on the community. Therefore, one has a Community Minister for teaching. Specialist training does not concern teaching, it concerns the public health. Thus it concerns a federal minister. The communities were not in favor of a number limited medical students while the federal one under the pressure of professional associations was in favor of the limitation of the number of the doctors. The only solution to which the federal one can appeal it is a selection at the entry of specialized training. One arrived at this aberration at the Belgian  : a selection at the end 7 years of studies which is defined by the federal one whereas the universities depending on the communities could form a theoretically unlimited number of graduates doctors. One was likely to have graduates doctors who could not return in a vocational training (3rd cycle) which since 1995 is essential to practice in Europe including general medicine.

. : There was not the possibility of producing much general doctors who them stop at 7 years?

: Not, the general doctors do not stop at 7 years, one is in a European system or a third cycle is needed. The third cycle, including for the general doctors, depends on the federal one. Thus the doctor produced by the community, by the university education, was likely to find himself in a situation where it could not practice medicine. One has to organize on the level of the communities a selection which adapts the number of graduates to the number of candidates specialists which can enter the procedures of formation which are controlled by the federal one. One adopted two attitudes completely different between the Flanders and the French Community. The Flanders chose an entrance exam, and not of contest, in order to increase the level of the candidates being studied in medicine and to prepare 10 years to later reduce the duration of the studies in medicine from 7 to 6 years, which we are about to make now. French-speaking side, the first selection was installation by a socialist government social-Christian which estimated that the entrance exam was too and thus founded a late system of selection which was to allow to the students emanating various social environments from being able to level itself and to be able to contribute. The selection was thus made after the third year of the medical studies, at the end of the first cycle.

. : Flemish side there is an entrance exam…

:  Yes, it is not a contest, it is an examination with a qualification level to be reached. Thus thus years ago when it of had selected there too much, then years when there was of it too little.  It of selected there too much the first year, too little the following years, but the difficulty of the examination was adapted then. These is thus a contest which did not want to say its name and which could act only by feedback. When they had too many candidates who had succeeded, the following year the examination was made more difficult. It is like that that continues to function in the Flemish Community.

. : In the French Community, which made is those which fail in third year?

: Those which set up the system in the French Community wanted a selection after a university formation. The model which prevailed it was the North-American model and the objective in the French community was to have studies in 4 years medicine and medical pre studies of three years. The idea of the designers was to give a diploma of first cycle. Among the graduates of first cycle, a party went towards medicine, others towards biomedical sciences, others finally could be recycled in other scientific professions. But misfortune it is that this system was not implemented in a correct way with regard to the reorientations which remained limited to biomedical sciences. So that there was a rejection this selection at the end of a first cycle. This rejection was the subject of recourse to the which was multiple during years 1999,2000,2001, and led to the abandonment of this selection at the end of the third year by the socialist minister for the time, Mrs . One found oneself with what is called “  the years  ”. I.e. what one feared arrived. A great number of students could cross the selection at the end of the third year without finally undergoing it. They will be found in excess compared to the quota federal by finishing their studies of medicine. It is the situation which was to be corrected, and at the time of a change of government in the French community, new the minister, Mrs , a selection at the end of the first year set up. One finds oneself now in this beautiful country which is Belgium with a Flanders which selects before the first year and a French community which selects after the first year with the well-known perverse effect of the stuck receipts, and the stuck receipt is again something which is not currently accepted and is the object recourse in the authorities.

. : Isn't the problem of the still regulated?

: Not. As a senior I felt responsible to lead the federal one to accept these graduate students who because of inconsistency between the federal legislation and the community legislation arrived at the end of the studies of medicine with a bond of doctor of medicine without being able to exert. Finally that was worth me to be a little the carry-flag of a group of seniors and thus I was a senior of the seniors. I spent much time to negotiate compromise solutions with the federal one and the medical trade unions so that nobody is stopped. Until now none graduates was prevented from entering in third cycle and thus a medical practice on the basis of numerical criterion only. But the file is not solved that remains a negotiation tended permanently.

. : Afterwards, which were the other files on yours office?

: In Belgium as in France, it is the file of the process of Bologna aiming at creating the European space of the university education. Our country was a very good pupil in the organization of the studies according to the principles of the statement of the Sorbonne and the statement of Bologna which preaches inter alia the separation of the cycles… On the 27 countries of Europe, there are only two of them which introduced that quickly it is Denmark and Belgium. In 2005, one found oneself with a Community decree called “  decree Bologna  ” which organized the studies in , and Doctorat, with a completely rigid framework which was appropriate perfectly for all the studies safe at the medical college. It was unsuited to the program of the medical students, since all the teaching share of the years `90 had been to integrate basic sciences and clinical sciences. This decree again has just introduced a discontinuity into medical education by separating the first cycle from the second cycle. It is the return to the system which I had fought during the Nineties.

. : How could one implement that?

:  The program of the medical studies starts with a baccalaureat (license) three years during which basic biology and sciences are taught, and then one makes four years of clinical training which give . After the , the speciality becomes a vocational training containing an academic flap called of complementary second cycle (complementary ). The Doctorate, it is the doctorate of search. The bond of doctor in Belgium henceforth does not return any more but to that which defended a doctoral thesis which is a fundamental thesis which takes 4 years of search independently of the basic training. We are thus far from the 5/3/8 symbolic system of the  : the doctor is trained in 9 years for the general practitioner, in 13 years for a surgeon for example to which the doctoral thesis   possibly comes to be added: 3 + 4 + (3 to 6 for the bond of specialist and the complementary ) + 4 (doctoral thesis of 3rd cycle)…

. : How to implement that to a surgeon?

:  The system if it is implemented in a rigid way places the surgeons apart from the clinical practice during a certain number of years. To make the doctorate in the official form which is that Christian Delloye made, they are indeed 4 years moreover. Thus on the whole they is 7 years of studies in medicine, 6 years of specialized training and four years of doctorate. It is unplayable and thus that is the subject of the third file which is hardly outlined. In fact what we wish to do now, it is to be able to propose with those which wish it to make a career associating the private clinic with search. It is a question of integrating the doctorate of search and the training of specialist, by keeping a contact with the private clinic, for example while taking part in guards or a consultation per week during the years of search. That would make it possible to reduce by 2 years the course.

. : What becomes the bond of doctor of medicine?

:  The bond of doctor of medicine, in the spirit of the decree of Bologna, disappears. The academic bond it is . The bond of specialist in French community is called complementary . The bond of doctor of medicine or that of veterinary doctor of medicine is professional and nonacademic bonds. They do not correspond under doctor of medical science which sanctions the formation of search and the defense of an original thesis to him.

. : What thinks the senior of the examinations based on the critical analysis of an item?

. : The critical analysis of an item currently does not form part of the proofs that the medical students in Belgium undergo. I think that the problem is the training of the students to the information access. It is something which one tests of set up in first year.  One used the critical system of analysis of an item only during three years, at the time or the selection was in the middle of the third year. I.e. one made a critical proof of analysis of items in basic sciences and social sciences. In fact in fact items built especially for the proof and contained a certain error count statistical, incomplete curves, false curves, to identify by the candidate. That was a procedure of selection during three years, but which does not exist any more in a formal way in the program of the medical students, just as we do not have a thesis in French community, nor in Flanders.  The Community decree of March 31st, 2004 says “Decree of Bologna” introduces the obligation of a report, which will be finally a thesis of end of study as you for a long time know it in France. Thus the students who are now in 4th year will defend a report in 7th year for the first time in 2011.

. : Let us retrogress; you were a departmental manager in Geneva before being a departmental manager in Belgium?

: Not department head! In fact at the time or the instructor his career it finished was out of Bi-céphalie with   the instructor for the management of the csotcina.comedic private clinic. This last was appointed only with the head of a service which was gigantic with its 250 beds. wished to have an assistant but the pupils of were still young. The decision which the cantonal hospital made was to put at recruitment for two years an invited post of professor, which would be responsible for the csotcina.comedic surgical private clinic with Mr . In fact, this post was internationally open. I postulated and I was likely to occupy this post during one year and Richard who is the current chairman of the of csotcina.comedy was that which occupied the post office the second year.

. : You wanted to see country?

: I.e. in preparation for the contest of access to the of service to the I wished to deepen two things, on the one hand my knowledge in basic sciences and on the other hand my knowledge in traumatology. I had examined two opportunities for one sabbatical year. One was to make in London, which enabled me to improve my English and to look further into sciences of bases, but finally for a whole series of reasons it is the other option which was selected. This Genevan opportunity had a first favors is to insert me in a medium of strong tradition, in addition it is a private clinic where there was a real scientific activity, in particular in kinesiology which was a field which interested me. Lastly, the last element was opportunity for my wife of working to WHO with Jean Jacques who was the person responsible for the training of the health workforce.

. : You go to Switzerland to specialize you in traumatology, but which was your formation before?

: I left the Catholic University of Leuwen in 1966, there is more than 40 years, at the time or it was still in the Flemish city of . I made my formation in the university private clinics of where the owners were Jean for the general surgery and Pierre for csotcina.comedy. Pierre and Jean had aggregated great quality who were Paul Jacques and André Vincent. My the first two years occurred over there in general surgery and csotcina.comedy. He was of tradition at the time spending two six-month periods in the university services others that the basic service and I was likely to spend six months to with Yves and Georges , and six months at at the time of , , Hugo and the others. After this formation, I am turned over as senior registrar of Andre Vincent with Pierre De .

. : How was this at ?

: I learned enormously at . On the technical plan was in advance in spine surgery. In arthroplasty it was not advances some, but it was a specific school with techniques by former channel that I did not know. André Lemoine was a defender of the intertrochanteric osteotomy pushed to the extreme and one found a preserving surgery which was already a little disappearing with the introduction from the prosthesis from Mr. . Especially, it was the rigor of the seminars  ! What struck me much at it was its rigor, the presentations of case, the analysis of the files were structured certainly than than one knew in our hospitals. Ghost of Paris, Jean and me, we endeavoured to introduce into our structures these presentations of file and these discussions of clinical examples which did not exist really before. What was remarkable in the service at the time it is that it was already a service organized with many specialists who were only consultants. It was the occasion, the afternoon Parisian of going in the various private clinics of or , where one learned from the heaps of things by assisting the “owners” into private.

. : Then you return to Vincent…

: I return to Vincent, it was the time when there was still a military service which I was to begin. I had one a little free period and it is as that which I left for Finland at to supplement training in hand surgery and surgery of rheumatism. After that I left to make my military service with , in the east of Germany for nth. While I was in , Pierre is suddenly deceased of an infarction in a hotel after having eaten a coq au vin sprinkled well. André Vincent was 42 years old and it was appointed department head with as only assistant Pierre De who was 30 years old. That was an opportunity which led me to join this small core, it was into 71. It is the moment when Leuwen bursts  !

. : What did it occur to Leuwen?

:  The linguistic laws in Belgium go back to 1962, the law . In fact this law of 1962 supports the territorial and the catholic university of Leuwen was a structure which had escaped there. But during the Sixties to 70, at the time where the linguistic questions were extremely tended, it was taken the decision to separate the University of Louvain or one taught in French and Flemish, in two universities  : the Flemish   would remain in and the catholic university of Leuwen would go anywhere in francophonie apart from Leuwen. Pierre during the last years of his life was senior and Director of the hospital and it had to work out with others the project of removal of the university and hospital towards a territory or to speak French was suitable, which was not any more the case in Leuwen. Thus the university moved towards Leuwen the New one with an extraordinary project to create in full shift a new city. For the medical college and the hospital, we thought that an urban environment was necessary and one chose to settle in periphery of Brussels. It is one time when one could dream and one had the chance to have a large hospital equipped very well with a completely adequate surgical unit. For somebody who begins his career, the idea to find itself at 35 years in a new structure, in a new city it was an extraordinary challenge.

. : How do you live this permanent splitting of the country in two clans?

: In fact I feel neither Walloon, nor Flemish, having been born in Antwerp from a Flemish father and a Walloon mother. Personally, I did not live well this bursting of the University of Louvain, but I think nevertheless that was a development appropriateness since that placed at the disposal of the university means which it would never have had differently. But we always live this dichotomy with nevertheless attempts at reconciliation after the divorce. This process goes back to centuries since the Flemish movement was initiated following a a little excessive Francization of the country during the 19th century with finally a relatively late arrival of the university education in the Flemish language. My father was Flemish, as I said, it made its studies with Gent of which it was graduate in 1933 and it belonged to one of transitory promotions between French and Flemish teaching. Itself had a teaching which was partially in Flemish. The clinical exchange rates, where the patients were present, were given in Flemish whereas at that time there the theoretical exchange rates were still given in French to Gent.

. : What led you to csotcina.comedy?

:  I had a serious csotcina.comedic atavism since my father was itself csotcina.comedic surgeon and was a pupil of and of , of which it was assisting it at the moment or it was stopped. At the time where I was born and where my father was in captivity in Germany, my mother was strongly supported by Jean .

. : Why your father was stopped?

: It was the time of resistance and of the raids and he was military surgeon. Antwerp is a city which has a very important Jewish community and where there were true pogroms in the years 1940. My father being doctor contributed to prevent a certain number of things and in addition he was officer doctor having been evacuated but he had kept his weapons at his place. That made several reasons so that one sends it in . Extremely fortunately, it returned 5 years from there afterwards.

. : You remember this period?

: Not but I remember his return in 1945. This moment, it started again a training in csotcina.comedic surgery at Jean . When I was 5 years old my father was assistant with (an csotcina.comedic hospital of the style ) and the family lived in the hospital with large numbers of people which everywhere had been just formed in csotcina.comedic surgery. It is one period of my life which I remember very well and who gave me an attractive image of the trade of csotcina.comedic surgeon.

. : In will conclusion, whatever the division studies of medicine, he be necessary well that the training of the surgery is done by the trade-guild?

: Yes but in a way which will evolve/move. The techniques of simulation which are used for example for the training of the pilots of aircraft, will have at one moment or another being introduced into the training of the surgeons. The training requires a “schooling”. Historical schooling in surgery is work in room of dissection and on corpse. But work on corpse does not form the reactivity of the surgeon and does not confront it with the unexpected situations. One will have one day to teach that by means of simulation. I think that really it is the innovation which one can wait in the years to come for practical reasons and also for ethical reasons.