Thank you for your invitation. I don't think France could be an example for initial perfusionist education compared to some others countries, but I will talk to you about continuing education set up by the French College of Perfusion.

In France, we are about 260 perfusionists for 65 cardiac surgery centers. To practice perfusion, the only legal obligation is that, this act has to be performed under medical responsibility, by doctors themselves or by nurses in the presence of a doctor. A very large disparity exists regarding the perfusionist background and training. Oldest perfusionists on the job mainly provide the perfusion specific training. A university diploma is available for medical staff, opened also to perfusionist nurses, anesthetists and surgeons. It represents 100 hours theoretical courses and doesn't represent perfusion practice authorization. Perfusion is considered as a part of nurse's job as all other different kinds of specialities nurses could find during the practice of their profession, after graduation.

That's why, perfusionist training in France will consist in continuing professional education:

• First with the "adaptation plan for the job of perfusionist". The CFP educational committee works on it since 1996 and face to many problems. The health ministry doesn't want to accept initial education for perfusionist because there is no possibility to create a new specialisation for nurses (there are only four and they have post graduate schools with diploma issued as for anesthetist nurses for example).
• Secondly with continuing education.

Continuing education in France is well organised for all kind of professions since it was legalised in 1971. Continuing education is a right for employees and an obligation for employers. They have to consecrate about 1% of the wage bill to finance their employees' continuing education if they ask for. Many different and various kinds of continuing education exist for nurses and doctors, provided by specialised institutions. Unfortunately, nothing is adapted for the specific practice of perfusion.

One of the main purposes of French College of perfusion (CFP), created in 1995, is to promulgate initial training and continuing national education for perfusionists. The CFP educational committee have succeeded in setting up continuing education sessions since 1997, thanks to the work of its members, regional delegates and the devotedly participation of requested specialists.

About Organisation

The ten first sessions were organised between 1997 and 1999 in five regions, in the way to match to our objectives:

• to create a real continuing education totally independent of the congress, without any sponsoring.
• to facilitate access to a maximum of perfusionists all around the country.
• to involve different cardiac surgery centers in national education
•  

Five general topics, mainly perfusion basis, were treated twice a year that is to say in different available dates: This organisation was very hard to manage, required a lot of work and availability from the teaching staff and represented high accommodation cost for the CFP, even if all the people who took in charge sessions were voluntary and unpaid. On the other hand, regarding the work legislation, voluntary helps are out of the law for education provided with admission fees. The CFP has to be considered as an employer by this way, and had to pay taxes. Also the educational committee try to find an agreement with continuing education existing institutions. This approach, until now, has failed because a few professionals are concerned and this education would represent too low return of investments for institutions. So they are not interested by this speciality.

Anyway the CFP continues to assume perfusionists continuing education but with a new organisation:

• only one site centralised in Paris
• 2 modules per year and 3 trainers paid according to salary scales laid down with regulations.

One of the modules is devoted to specific perfusion topic, the other one to a very general topic in relation with perfusion. The CFP educational committee chooses, according to their skills and experiences in some particularities, all members of teaching staff among perfusionists, anesthetists, and well-known referents on specific topics. For every modules, complete documentation is given to the applicants. The agenda has to be sent to cardiac centers one year in advance to be registered on the educational plan. Most of the time, the employers accept to take care of application fees and to pay part of travelling / accommodation expenses, on an inclusive basis, as it is provided for any continuing education.

On these slides the last program.

One subject on Methodology with the approach of statistics, data processing, Internet, reading and interpretation of publications, and about oral communication skill.

The other subject was Pharmacology. With the review of current events about drugs used in cardiac surgery.

Just to give you an idea of the previous perfusionists participation. In 2001 the sessions must be cancelled for organisation reasons (discrepancy between CFP agenda and usual education plan in hospitals).

Next year it will be: Stress management

• with ethnologist's participation. She will expose operating theatre environment study, stress and mechanisms of individual defenses.
• with psychiatrist' s participation for neuro-psychiatric basis on vigilance, concentration and panic phenomenon
• with also psychologist in charge of aeronautical staff education.

The other module will treat different types of Cardiac supplies.

Previous Continuing education possibilities in France

Before the only way to get informed to the new technology and practice in perfusion was:

• National meeting once a year as was the CECEC ( the last one took place in 1995) Specialists very well presented the subjects, with quite a very high scientific level in relation with publications. Most of the time perfusionists did not really follow them. The interesting part of these congresses was found inside exhibitors' stands where perfusionists could exchange each others their own concrete practical experiences.
• Later was creating the GEP (studies in perfusion group) interesting mainly anesthesiologists and medical perfusionists. This meeting takes place once a year and provides scientific conferences followed by round table discussions welcomed by perfusionists.
• International congress. Some people as fringe benefits could consider them, and they could lead to some jealousy compared to others continuing education.
• The medical industry provides also education by the way of workshop or informal meeting to present new products or to make round-table discussion.
• The annual national of CFP congress

Why do perfusionists need continuing education? : Continuing education purposes are:

• To provide perfusionists matter for serious reflections about their practice
• To get them informed on equipment, technical and practical evolutions
• To favor exchanges between various persons taking part in cardiac surgery
• To maintain and increase perfusionists competence
•  To gain professional recognition

In the future, the CFP hope to conclude an agreement with a continuing educational institution for perfusionists' education, which will include:

• adaptation plan for the job of perfusionist for initial education, as recommended by the health ministry, composed by post basic modules
• and continuing education composed of advanced modules.

These modules will give opportunities to gain points for national and European perfusion certifications and re-certifications. In the future, educational committee would like to elaborate recommendations, standards and directives for practical training of new perfusionists, attention to Cardiac Surgery Centers as references provided by the C.F.P. and also to recommend the use of a logbook for the student evaluation.

The main problems, nowadays, are:

• there is no obligation to follow any existing education, 
• it makes no difference if perfusionists are or not CFP or EBCP certified and re-certified,
• there is no obligation also to be member of the French national society CFP,
• the relative low numbers from the professionals concerned
• this kind of education will have a cost when in fact, perfusionist's education on the job, as it is today, is free of charge for surgical centers. 

One of the great hopes is that hospitals and surgical centers apply for national accreditation, in the way to advance their quality of patients care. We can be sure that they will appreciate if they can prove, in their documentation, that their perfusionist staff is certified and maintains his education despite the fact there is no obligation.