MOHAMMED V DE RABAT
FACULTE DE MEDECINE ET DE PHARMACIE - RABAT
DOYENS HONORAIRES :
1962 – 1969 : Professeur Abdelmalek FARAJ 1969 – 1974 : Professeur Abdellatif BERBICH 1974 – 1981 : Professeur Bachir LAZRAK 1981 – 1989 : Professeur Taieb CHKILI
1989 – 1997 : Professeur Mohamed Tahar ALAOUI 1997 – 2003 : Professeur Abdelmajid BELMAHI 2003 - 2013 : Professeur Najia HAJJAJ – HASSOUNI
ADMINISTRATION :
Doyen
Professeur Mohamed ADNAOUI
Vice-Doyen chargé des Affaires Académiques et estudiantines Professeur Brahim LEKEHAL
Vice-Doyen chargé de la Recherche et de la Coopération Professeur Toufiq DAKKA
Vice-Doyen chargé des Affaires Spécifiques à la Pharmacie Professeur Jamal TAOUFIK
Secrétaire Général
1 - ENSEIGNANTS-CHERCHEURS MEDECINS ET PHARMACIENS
PROFESSEURS : DECEMBRE 1984
Pr. MAAOUNI Abdelaziz Médecine Interne – Clinique Royale
Pr. MAAZOUZI Ahmed Wajdi Anesthésie -Réanimation Pr. SETTAF Abdellatif Pathologie Chirurgicale NOVEMBRE ET DECEMBRE 1985
Pr. BENSAID Younes Pathologie Chirurgicale
JANVIER, FEVRIER ET DECEMBRE 1987
Pr. LACHKAR Hassan Médecine Interne
Pr. YAHYAOUI Mohamed Neurologie
DECEMBRE 1989
Pr. ADNAOUI Mohamed Médecine Interne –Doyen de la FMPR
Pr. OUAZZANI Taïbi Mohamed Réda Neurologie
JANVIER ET NOVEMBRE 1990
Pr. HACHIM Mohammed* Médecine-Interne
Pr. KHARBACH Aîcha Gynécologie -Obstétrique
Pr. TAZI Saoud Anas Anesthésie Réanimation
FEVRIER AVRIL JUILLET ET DECEMBRE 1991
Pr. AZZOUZI Abderrahim Anesthésie Réanimation- Doyen de FMPO
Pr. BAYAHIA Rabéa Néphrologie
Pr. BELKOUCHI Abdelkader Chirurgie Générale Pr. BENCHEKROUN Belabbes Abdellatif Chirurgie Générale
Pr. BENSOUDA Yahia Pharmacie galénique
Pr. BERRAHO Amina Ophtalmologie
Pr. BEZAD Rachid Gynécologie Obstétrique Méd. Chef Maternité des Orangers
Pr. CHERRAH Yahia Pharmacologie
Pr. CHOKAIRI Omar Histologie Embryologie
Pr. KHATTAB Mohamed Pédiatrie
Pr. SOULAYMANI Rachida Pharmacologie- Dir. du Centre National PV Rabat Pr. TAOUFIK Jamal Chimie thérapeutique V.D à la pharmacie+Dir. du CEDOC +
DECEMBRE 1992
Pr. AHALLAT Mohamed Chirurgie Générale Doyen de FMPT
Pr. BENSOUDA Adil Anesthésie Réanimation
Pr. CHAHED OUAZZANI Laaziza Gastro-Entérologie
Pr. CHRAIBI Chafiq Gynécologie Obstétrique
Pr. EL OUAHABI Abdessamad Neurochirurgie
Pr. FELLAT Rokaya Cardiologie
Pr. GHAFIR Driss* Médecine Interne
Pr. JIDDANE Mohamed Anatomie
Pr. TAGHY Ahmed Chirurgie Générale
Pr. ZOUHDI Mimoun Microbiologie
MARS 1994
Pr. BENJAAFAR Noureddine Radiothérapie
Pr. BEN RAIS Nozha Biophysique
Pr. CAOUI Malika Biophysique
Pr. CHRAIBI Abdelmjid
Endocrinologie et Maladies Métaboliques Doyen de la FMPA
Pr. EL AMRANI Sabah Gynécologie Obstétrique Pr. EL BARDOUNI Ahmed Traumato-Orthopédie Pr. EL HASSANI My Rachid Radiologie
Pr. ERROUGANI Abdelkader Chirurgie Générale – Directeur du CHIS-Rabat
Pr. ESSAKALI Malika Immunologie
Pr. ETTAYEBI Fouad Chirurgie Pédiatrique Pr. HASSAM Badredine Dermatologie
Pr. IFRINE Lahssan Chirurgie Générale
Pr. MAHFOUD Mustapha Traumatologie – Orthopédie Pr. RHRAB Brahim Gynécologie –Obstétrique
Pr. SENOUCI Karima Dermatologie
MARS 1994
Pr. ABBAR Mohamed* Urologie Directeur Hôpital My Ismail Meknès Pr. ABDELHAK M’barek Chirurgie – Pédiatrique
Pr. BENTAHILA Abdelali Pédiatrie
Pr. BENYAHIA Mohammed Ali Gynécologie – Obstétrique Pr. BERRADA Mohamed Saleh Traumatologie – Orthopédie Pr. CHERKAOUI Lalla Ouafae Ophtalmologie
Pr. LAKHDAR Amina Gynécologie Obstétrique
Pr. MOUANE Nezha Pédiatrie
MARS 1995
Pr. ABOUQUAL Redouane Réanimation Médicale
Pr. AMRAOUI Mohamed Chirurgie Générale Pr. BAIDADA Abdelaziz Gynécologie Obstétrique
Pr. BARGACH Samir Gynécologie Obstétrique Pr. DRISSI KAMILI Med Nordine* Anesthésie Réanimation Pr. EL MESNAOUI Abbes Chirurgie Générale Pr. ESSAKALI HOUSSYNI Leila Oto-Rhino-Laryngologie
Pr. HDA Abdelhamid* Cardiologie Inspecteur du Service de Santé des FAR Pr. IBEN ATTYA ANDALOUSSI Ahmed Urologie
Pr. OUAZZANI CHAHDI Bahia Ophtalmologie Pr. SEFIANI Abdelaziz Génétique
Pr. ZEGGWAGH Amine Ali Réanimation Médicale DECEMBRE 1996
Pr. AMIL Touriya* Radiologie
Pr. BELKACEM Rachid Chirurgie Pédiatrie Pr. BOULANOUAR Abdelkrim Ophtalmologie Pr. EL ALAMI EL FARICHA EL Hassan Chirurgie Générale
Pr. GAOUZI Ahmed Pédiatrie
Pr. MAHFOUDI M’barek* Radiologie
Pr. OUZEDDOUN Naima Néphrologie
Pr. ZBIR EL Mehdi* Cardiologie DirecteurHôp.Mil. d’Instruction Med V Rabat NOVEMBRE 1997
Pr. ALAMI Mohamed Hassan Gynécologie-Obstétrique
Pr. BEN SLIMANE Lounis Urologie
Pr. BIROUK Nazha Neurologie
Pr. ERREIMI Naima Pédiatrie
Pr. FELLAT Nadia Cardiologie
Pr. KADDOURI Noureddine Chirurgie Pédiatrique
Pr. KOUTANI Abdellatif Urologie
Pr. LAHLOU Mohamed Khalid Chirurgie Générale
Pr. MAHRAOUI CHAFIQ Pédiatrie
Pr. TOUFIQ Jallal Psychiatrie Directeur Hôp.Ar-razi Salé Pr. YOUSFI MALKI Mounia Gynécologie Obstétrique
NOVEMBRE 1998
Pr. BENOMAR ALI Neurologie Doyen de la FMP Abulcassis Pr. BOUGTAB Abdesslam Chirurgie Générale
Pr. ER RIHANI Hassan Oncologie Médicale
Pr. BENKIRANE Majid* Hématologie
JANVIER 2000
Pr. ABID Ahmed* Pneumo-phtisiologie
Pr. AIT OUAMAR Hassan Pédiatrie
Pr. BENJELLOUN Dakhama Badr.Sououd Pédiatrie Pr. BOURKADI Jamal-Eddine Pneumo-phtisiologie Directeur Hôp. My Youssef Pr. CHARIF CHEFCHAOUNI Al Montacer Chirurgie Générale
Pr. ECHARRAB El Mahjoub Chirurgie Générale Pr. EL FTOUH Mustapha Pneumo-phtisiologie
Pr. EL MOSTARCHID Brahim* Neurochirurgie
Pr. MAHMOUDI Abdelkrim* Anesthésie-Réanimation Pr. TACHINANTE Rajae Anesthésie-Réanimation Pr. TAZI MEZALEK Zoubida Médecine Interne NOVEMBRE 2000
Pr. AIDI Saadia Neurologie
Pr. AJANA Fatima Zohra Gastro-Entérologie
Pr. BENAMR Said Chirurgie Générale
Pr. CHERTI Mohammed Cardiologie
Pr. ECH-CHERIF EL KETTANI Selma Anesthésie-Réanimation
Pr. EL HASSANI Amine Pédiatrie - Directeur Hôp.Cheikh Zaid
Pr. EL KHADER Khalid Urologie
Pr. EL MAGHRAOUI Abdellah* Rhumatologie
Pr. GHARBI Mohamed El Hassan Endocrinologie et Maladies Métaboliques
Pr. MDAGHRI ALAOUI Asmae Pédiatrie
Pr. ROUIMI Abdelhadi* Neurologie
DECEMBRE 2000
Pr.ZOHAIR ABDELLAH * ORL
Pr. BALKHI Hicham* Anesthésie-Réanimation Pr. BENABDELJLIL Maria Neurologie
Pr. BENAMAR Loubna Néphrologie
Pr. BENAMOR Jouda Pneumo-phtisiologie Pr. BENELBARHDADI Imane Gastro-Entérologie
Pr. BENNANI Rajae Cardiologie
Pr. BENOUACHANE Thami Pédiatrie
Pr. BEZZA Ahmed* Rhumatologie
Pr. BOUCHIKHI IDRISSI Med Larbi Anatomie Pr. BOUMDIN El Hassane* Radiologie
Pr. CHAT Latifa Radiologie
Pr. DAALI Mustapha* Chirurgie Générale Pr. DRISSI Sidi Mourad* Radiologie
Pr. EL HIJRI Ahmed Anesthésie-Réanimation Pr. EL MAAQILI Moulay Rachid Neuro-Chirurgie Pr. EL MADHI Tarik Chirurgie-Pédiatrique Pr. EL OUNANI Mohamed Chirurgie Générale
Pr. ETTAIR Said Pédiatrie - Directeur Hôp. d’EnfantsRabat Pr. GAZZAZ Miloudi* Neuro-Chirurgie
Pr. HRORA Abdelmalek Chirurgie Générale
Pr. KABIRI EL Hassane* Chirurgie Thoracique Pr. LAMRANI Moulay Omar Traumatologie Orthopédie
Pr. LEKEHAL Brahim Chirurgie Vasculaire Périphérique Pr. MAHASSIN Fattouma* Médecine Interne
Pr. MEDARHRI Jalil Chirurgie Générale Pr. MIKDAME Mohammed* Hématologie Clinique Pr. MOHSINE Raouf Chirurgie Générale
Pr. NOUINI Yassine Urologie - Directeur Hôpital Ibn Sina
Pr. SABBAH Farid Chirurgie Générale
Pr. SEFIANI Yasser Chirurgie Vasculaire Périphérique Pr. TAOUFIQ BENCHEKROUN Soumia Pédiatrie
DECEMBRE 2002
Pr. AL BOUZIDI Abderrahmane* Anatomie Pathologique
Pr. AMEUR Ahmed * Urologie
Pr. AMRI Rachida Cardiologie
Pr. AOURARH Aziz* Gastro-Entérologie Pr. BAMOU Youssef * Biochimie-Chimie
Pr. BELMEJDOUB Ghizlene* Endocrinologie et Maladies Métaboliques
Pr. BENZEKRI Laila Dermatologie
Pr. BENZZOUBEIR Nadia Gastro-Entérologie Pr. BERNOUSSI Zakiya Anatomie Pathologique Pr. BICHRA Mohamed Zakariya* Psychiatrie
Pr. CHOHO Abdelkrim * Chirurgie Générale Pr. CHKIRATE Bouchra Pédiatrie
Pr. EL ALAMI EL Fellous Sidi Zouhair Chirurgie Pédiatrique Pr. EL HAOURI Mohamed * Dermatologie
Pr. FILALI ADIB Abdelhai Gynécologie Obstétrique
Pr. HAJJI Zakia Ophtalmologie
Pr. IKEN Ali Urologie
Pr. JAAFAR Abdeloihab* Traumatologie Orthopédie
Pr. KRIOUILE Yamina Pédiatrie
Pr. MABROUK Hfid* Traumatologie Orthopédie Pr. MOUSSAOUI RAHALI Driss* Gynécologie Obstétrique Pr. OUJILAL Abdelilah Oto-Rhino-Laryngologie Pr. RACHID Khalid * Traumatologie Orthopédie Pr. RAISS Mohamed Chirurgie Générale Pr. RGUIBI IDRISSI Sidi Mustapha* Pneumo-phtisiologie
Pr. RHOU Hakima Néphrologie
Pr. SIAH Samir * Anesthésie Réanimation
Pr. THIMOU Amal Pédiatrie
JANVIER 2004
Pr. ABDELLAH El Hassan Ophtalmologie
Pr. AMRANI Mariam Anatomie Pathologique Pr. BENBOUZID Mohammed Anas Oto-Rhino-Laryngologie Pr. BENKIRANE Ahmed* Gastro-Entérologie
Pr. BOULAADAS Malik Stomatologie et Chirurgie Maxillo-faciale
Pr. BOURAZZA Ahmed* Neurologie
Pr. CHAGAR Belkacem* Traumatologie Orthopédie Pr. CHERRADI Nadia Anatomie Pathologique
Pr. EL FENNI Jamal* Radiologie
Pr. EL HANCHI ZAKI Gynécologie Obstétrique Pr. EL KHORASSANI Mohamed Pédiatrie
Pr. EL YOUNASSI Badreddine* Cardiologie
Pr. HACHI Hafid Chirurgie Générale
Pr. JABOUIRIK Fatima Pédiatrie
Pr. KHARMAZ Mohamed Traumatologie Orthopédie Pr. MOUGHIL Said Chirurgie Cardio-Vasculaire Pr. OUBAAZ Abdelbarre * Ophtalmologie
Pr. TARIB Abdelilah* Pharmacie Clinique
Pr. TIJAMI Fouad Chirurgie Générale
Pr. ZARZUR Jamila Cardiologie
JANVIER 2005
Pr. ABBASSI Abdellah Chirurgie Réparatrice et Plastique Pr. AL KANDRY Sif Eddine* Chirurgie Générale
Pr. ALLALI Fadoua Rhumatologie
Pr. AMAZOUZI Abdellah Ophtalmologie
Pr. AZIZ Noureddine* Radiologie
Pr. BAHIRI Rachid Rhumatologie Directeur Hôp. Al Ayachi Salé
Pr. BARKAT Amina Pédiatrie
Pr. BENYASS Aatif Cardiologie
Pr. DOUDOUH Abderrahim* Biophysique Pr. EL HAMZAOUI Sakina * Microbiologie
Pr. HAJJI Leila Cardiologie (mise en disponibilité
Pr. HESSISSEN Leila Pédiatrie
Pr. JIDAL Mohamed* Radiologie
Pr. LAAROUSSI Mohamed Chirurgie Cardio-vasculaire Pr. LYAGOUBI Mohammed Parasitologie
Pr. RAGALA Abdelhak Gynécologie Obstétrique
Pr. SBIHI Souad Histo-Embryologie Cytogénétique Pr. ZERAIDI Najia Gynécologie Obstétrique
AVRIL 2006
Pr. ACHEMLAL Lahsen* Rhumatologie
Pr. AKJOUJ Said* Radiologie
Pr. BELMEKKI Abdelkader* Hématologie
Pr. BENCHEIKH Razika O.R.L
Pr. BIYI Abdelhamid* Biophysique
Pr. BOUHAFS Mohamed El Amine Chirurgie - Pédiatrique
Pr. BOULAHYA Abdellatif* Chirurgie Cardio – Vasculaire. Pr. CHENGUETI ANSARI Anas Gynécologie Obstétrique
Pr. DOGHMI Nawal Cardiologie
Pr. FELLAT Ibtissam Cardiologie
Pr. FAROUDY Mamoun Anesthésie Réanimation Pr. HARMOUCHE Hicham Médecine Interne Pr. HANAFI Sidi Mohamed* Anesthésie Réanimation Pr. IDRISS LAHLOU Amine* Microbiologie
Pr. JROUNDI Laila Radiologie
Pr. KARMOUNI Tariq Urologie
Pr. KILI Amina Pédiatrie
Pr. KISRA Hassan Psychiatrie
Pr. KISRA Mounir Chirurgie – Pédiatrique Pr. LAATIRIS Abdelkader* Pharmacie Galénique Pr. LMIMOUNI Badreddine* Parasitologie
Pr. MANSOURI Hamid* Radiothérapie Pr. OUANASS Abderrazzak Psychiatrie
Pr. SAFI Soumaya* Endocrinologie
Pr. SEKKAT Fatima Zahra Psychiatrie
Pr. SOUALHI Mouna Pneumo – Phtisiologie
Pr. TELLAL Saida* Biochimie
Pr. ZAHRAOUI Rachida Pneumo – Phtisiologie DECEMBRE 2006
Pr SAIR Khalid Chirurgie générale Dir. Hôp.Av.Marrakech OCTOBRE 2007
Pr. ABIDI Khalid Réanimation médicale Pr. ACHACHI Leila Pneumo phtisiologie Pr. ACHOUR Abdessamad* Chirurgie générale
Pr. AIT HOUSSA Mahdi * Chirurgie cardio vasculaire Pr. AMHAJJI Larbi * Traumatologie orthopédie
Pr. AOUFI Sarra Parasitologie
Pr. BAITE Abdelouahed * Anesthésie réanimation Directeur ERSSM Pr. BALOUCH Lhousaine * Biochimie-chimie
Pr. BOUTIMZINE Nourdine Ophtalmologie Pr. CHERKAOUI Naoual * Pharmacie galénique Pr. EHIRCHIOU Abdelkader * Chirurgie générale
Pr. EL BEKKALI Youssef * Chirurgie cardio-vasculaire Pr. EL ABSI Mohamed Chirurgie générale
Pr. EL MOUSSAOUI Rachid Anesthésie réanimation Pr. EL OMARI Fatima Psychiatrie
Pr. GHARIB Noureddine Chirurgie plastique et réparatrice Pr. HADADI Khalid * Radiothérapie
Pr. ICHOU Mohamed * Oncologie médicale
Pr. ISMAILI Nadia Dermatologie
Pr. KEBDANI Tayeb Radiothérapie
Pr. LALAOUI SALIM Jaafar * Anesthésie réanimation Pr. LOUZI Lhoussain * Microbiologie
Pr. MADANI Naoufel Réanimation médicale Pr. MAHI Mohamed * Radiologie
Pr. MARC Karima Pneumo phtisiologie
Pr. MASRAR Azlarab Hématologie biologique
Pr. MRANI Saad * Virologie
Pr. OUZZIF Ez zohra * Biochimie-chimie Pr. RABHI Monsef * Médecine interne Pr. RADOUANE Bouchaib* Radiologie Pr. SEFFAR Myriame Microbiologie Pr. SEKHSOKH Yessine * Microbiologie Pr. SIFAT Hassan * Radiothérapie
Pr. TABERKANET Mustafa * Chirurgie vasculaire périphérique Pr. TACHFOUTI Samira Ophtalmologie
Pr. TAJDINE Mohammed Tariq* Chirurgie générale Pr. TANANE Mansour * Traumatologie-orthopédie Pr. TLIGUI Houssain Parasitologie
Pr. TOUATI Zakia Cardiologie
DECEMBRE 2008
Pr TAHIRI My El Hassan* Chirurgie Générale MARS 2009
Pr. ABOUZAHIR Ali * Médecine interne
Pr. AGADR Aomar * Pédiatrie
Pr. AIT ALI Abdelmounaim * Chirurgie Générale Pr. AIT BENHADDOU El Hachmia Neurologie
Pr. AKHADDAR Ali * Neuro-chirurgie
Pr. ALLALI Nazik Radiologie
Pr. ARKHA Yassir Neuro-chirurgie Directeur Hôp.des Spécialités Pr. BELYAMANI Lahcen* Anesthésie Réanimation
Pr. BJIJOU Younes Anatomie
Pr. BOUHSAIN Sanae * Biochimie-chimie
Pr. BOUI Mohammed * Dermatologie
Pr. BOUNAIM Ahmed * Chirurgie Générale Pr. BOUSSOUGA Mostapha * Traumatologie-orthopédie
Pr. CHTATA Hassan Toufik * Chirurgie Vasculaire Périphérique Pr. DOGHMI Kamal * Hématologie clinique
Pr. EL MALKI Hadj Omar Chirurgie Générale Pr. EL OUENNASS Mostapha* Microbiologie Pr. ENNIBI Khalid * Médecine interne Pr. FATHI Khalid Gynécologie obstétrique Pr. HASSIKOU Hasna * Rhumatologie
Pr. KABBAJ Nawal Gastro-entérologie
Pr. KABIRI Meryem Pédiatrie
Pr. KARBOUBI Lamya Pédiatrie
Pr. LAMSAOURI Jamal * Chimie Thérapeutique Pr. MARMADE Lahcen Chirurgie Cardio-vasculaire
Pr. MESKINI Toufik Pédiatrie
Pr. MESSAOUDI Nezha * Hématologie biologique Pr. MSSROURI Rahal Chirurgie Générale
Pr. NASSAR Ittimade Radiologie
Pr. OUKERRAJ Latifa Cardiologie
Pr. RHORFI Ismail Abderrahmani * Pneumo-Phtisiologie OCTOBRE 2010
Pr. ALILOU Mustapha Anesthésie réanimation Pr. AMEZIANE Taoufiq* Médecine Interne Pr. BELAGUID Abdelaziz Physiologie Pr. CHADLI Mariama* Microbiologie
Pr. CHEMSI Mohamed* Médecine Aéronautique Pr. DAMI Abdellah* Biochimie- Chimie Pr. DARBI Abdellatif* Radiologie
Pr. DENDANE Mohammed Anouar Chirurgie Pédiatrique
Pr. EL HAFIDI Naima Pédiatrie
Pr. EL KHARRAS Abdennasser* Radiologie
Pr. EL MAZOUZ Samir Chirurgie Plastique et Réparatrice
Pr. EL SAYEGH Hachem Urologie
Pr. ERRABIH Ikram Gastro-Entérologie Pr. LAMALMI Najat Anatomie Pathologique Pr. MOSADIK Ahlam Anesthésie Réanimation Pr. MOUJAHID Mountassir* Chirurgie Générale
Pr. NAZIH Mouna* Hématologie
DECEMBRE 2010
Pr.ZNATI Kaoutar Anatomie Pathologique MAI 2012
Pr. AMRANI Abdelouahed Chirurgie pédiatrique Pr. ABOUELALAA Khalil * Anesthésie Réanimation Pr. BENCHEBBA Driss * Traumatologie-orthopédie Pr. DRISSI Mohamed * Anesthésie Réanimation Pr. EL ALAOUI MHAMDI Mouna Chirurgie Générale Pr. EL KHATTABI Abdessadek * Médecine Interne Pr. EL OUAZZANI Hanane * Pneumophtisiologie Pr. ER-RAJI Mounir Chirurgie Pédiatrique
Pr. JAHID Ahmed Anatomie Pathologique
Pr. MEHSSANI Jamal * Psychiatrie
Pr. RAISSOUNI Maha * Cardiologie
* Enseignants Militaires FEVRIER 2013
Pr.AHID Samir Pharmacologie
Pr.AIT EL CADI Mina Toxicologie
Pr.AMRANI HANCHI Laila Gastro-Entérologie
Pr.AMOR Mourad Anesthésie Réanimation
Pr.AWAB Almahdi Anesthésie Réanimation
Pr.BELAYACHI Jihane Réanimation Médicale Pr.BELKHADIR Zakaria Houssain Anesthésie Réanimation Pr.BENCHEKROUN Laila Biochimie-Chimie
Pr.BENKIRANE Souad Hématologie
Pr.BENNANA Ahmed* Informatique Pharmaceutique Pr.BENSGHIR Mustapha * Anesthésie Réanimation Pr.BENYAHIA Mohammed * Néphrologie
Pr.BOUATIA Mustapha Chimie Analytique et Bromatologie Pr.BOUABID Ahmed Salim* Traumatologie orthopédie
Pr BOUTARBOUCH Mahjouba Anatomie
Pr.CHAIB Ali * Cardiologie
Pr.DENDANE Tarek Réanimation Médicale
Pr.DINI Nouzha * Pédiatrie
Pr.ECH-CHERIF EL KETTANI Mohamed Ali Anesthésie Réanimation Pr.ECH-CHERIF EL KETTANI Najwa Radiologie
Pr.EL FATEMI NIZARE Neuro-chirurgie Pr.EL GUERROUJ Hasnae Médecine Nucléaire Pr.EL HARTI Jaouad Chimie Thérapeutique
Pr.EL JAOUDI Rachid * Toxicologie
Pr.EL KABABRI Maria Pédiatrie
Pr.EL KHANNOUSSI Basma Anatomie Pathologique
Pr.EL KHLOUFI Samir Anatomie
Pr.EL KORAICHI Alae Anesthésie Réanimation Pr.EN-NOUALI Hassane * Radiologie
Pr.ERRGUIG Laila Physiologie
Pr.FIKRI Meryem Radiologie
Pr.GHFIR Imade Médecine Nucléaire
Pr.IMANE Zineb Pédiatrie
Pr.IRAQI Hind Endocrinologie et maladies métaboliques
Pr.KABBAJ Hakima Microbiologie
Pr.KADIRI Mohamed * Psychiatrie
Pr.MAAMAR Mouna Fatima Zahra Médecine Interne
Pr.MEDDAH Bouchra Pharmacologie
Pr.MELHAOUI Adyl Neuro-chirurgie
Pr.MRABTI Hind Oncologie Médicale
Pr.NEJJARI Rachid Pharmacognosie
Pr.OUBEJJA Houda Chirugie Pédiatrique
Pr.OUKABLI Mohamed * Anatomie Pathologique
Pr.RAHALI Younes Pharmacie Galénique
Pr.RATBI Ilham Génétique
Pr.RAHMANI Mounia Neurologie
Pr.REDA Karim * Ophtalmologie
Pr.REGRAGUI Wafa Neurologie
Pr.RKAIN Hanan Physiologie
Pr.ROSTOM Samira Rhumatologie
Pr.ROUAS Lamiaa Anatomie Pathologique Pr.ROUIBAA Fedoua * Gastro-Entérologie
Pr SALIHOUN Mouna Gastro-Entérologie
Pr.SAYAH Rochde Chirurgie Cardio-Vasculaire Pr.SEDDIK Hassan * Gastro-Entérologie
Pr.ZERHOUNI Hicham Chirurgie Pédiatrique Pr.ZINE Ali* Traumatologie Orthopédie
AVRIL 2013
Pr.EL KHATIB MOHAMED KARIM * Stomatologie et Chirurgie Maxillo-faciale MAI 2013
Pr.BOUSLIMAN Yassir Toxicologie
MARS 2014
Pr. ACHIR Abdellah Chirurgie Thoracique Pr.BENCHAKROUN Mohammed * Traumatologie- Orthopédie Pr.BOUCHIKH Mohammed Chirurgie Thoracique
Pr. EL KABBAJ Driss * Néphrologie
Pr. EL MACHTANI IDRISSI Samira * Biochimie-Chimie
Pr. HARDIZI Houyam Histologie- Embryologie-Cytogénétique
Pr. HASSANI Amale * Pédiatrie
Pr. HERRAK Laila Pneumologie
Pr. JANANE Abdellah * Urologie
Pr. JEAIDI Anass * Hématologie Biologique
Pr. KOUACH Jaouad* Gynécologie-Obstétrique
Pr. LEMNOUER Abdelhay* Microbiologie
Pr. MAKRAM Sanaa * Pharmacologie
Pr. OULAHYANE Rachid* Chirurgie Pédiatrique Pr. RHISSASSI Mohamed Jaafar CCV
Pr. SABRY Mohamed* Cardiologie
Pr. SEKKACH Youssef* Médecine Interne
Pr. TAZI MOUKHA Zakia Gynécologie-Obstétrique AVRIL 2014
PROFESSEURS AGREGES :
DECEMBRE 2014
Pr. ABILKASSEM Rachid* Pédiatrie
Pr. AIT BOUGHIMA Fadila Médecine Légale Pr. BEKKALI Hicham * Anesthésie-Réanimation Pr. BENAZZOU Salma Chirurgie Maxillo-Faciale Pr. BOUABDELLAH Mounya Biochimie-Chimie
Pr. BOUCHRIK Mourad* Parasitologie
Pr. DERRAJI Soufiane* Pharmacie Clinique
Pr. DOBLALI Taoufik* Microbiologie
Pr. EL AYOUBI EL IDRISSI Ali Anatomie
Pr. EL GHADBANE Abdedaim Hatim* Anesthésie-Réanimation Pr. EL MARJANY Mohammed* Radiothérapie
Pr. FEJJAL Nawfal Chirurgie Réparatrice et Plastique
Pr. JAHIDI Mohamed* O.R.L
Pr. LAKHAL Zouhair* Cardiologie
Pr. OUDGHIRI NEZHA Anesthésie-Réanimation
Pr. RAMI Mohamed Chirurgie Pédiatrique
Pr. SABIR Maria Psychiatrie
Pr. SBAI IDRISSI Karim* Médecine préventive, santé publique et Hyg. AOUT 2015
Pr. MEZIANE Meryem Dermatologie
Pr. TAHRI Latifa Rhumatologie
JANVIER 2016
Pr. BENKABBOU Amine Chirurgie Générale
Pr. EL ASRI Fouad* Ophtalmologie
Pr. ERRAMI Noureddine* O.R.L
Pr. NITASSI Sophia O.R.L
JUIN 2017
Pr. ABI Rachid* Microbiologie
Pr. ASFALOU Ilyasse* Cardiologie
Pr. BOUAYTI El Arbi* Médecine préventive, santé publique et Hyg.
Pr. BOUTAYEB Saber Oncologie Médicale
Pr. EL GHISSASSI Ibrahim Oncologie Médicale
Pr. OURAINI Saloua* O.R.L
Pr. RAZINE Rachid Médecine préventive, santé publique et Hyg.
Pr. ZRARA Abdelhamid* Immunologie
2 - ENSEIGNANTS-CHERCHEURS SCIENTIFIQUES
PROFESSEURS/Prs. HABILITES
Pr. ABOUDRAR Saadia Physiologie
Pr. ALAMI OUHABI Naima Biochimie-chimie
Pr. ALAOUI KATIM Pharmacologie
Pr. ALAOUI SLIMANI Lalla Naïma Histologie-Embryologie
Pr. ANSAR M’hammed Chimie Organique et Pharmacie Chimique Pr .BARKIYOU Malika Histologie-Embryologie
Pr. BOUHOUCHE Ahmed Génétique Humaine
Pr. BOUKLOUZE Abdelaziz Applications Pharmaceutiques Pr. CHAHED OUAZZANI Lalla Chadia Biochimie-chimie
Pr. DAKKA Taoufiq Physiologie
Pr. FAOUZI Moulay El Abbes Pharmacologie
Pr. IBRAHIMI Azeddine Biologie moléculaire/Biotechnologie
Pr. KHANFRI Jamal Eddine Biologie
Pr. OULAD BOUYAHYA IDRISSI Med Chimie Organique
Pr. REDHA Ahlam Chimie
Pr. TOUATI Driss Pharmacognosie
Pr. ZAHIDI Ahmed Pharmacologie
Mise à jour le 10/10/2018 Khaled Abdellah
My beloved Mother, my beloved Father,
There are a lot of things I would love to say about them. And what a beautiful teaching lesson, to anyone trying to learn the art of parenting. My parents didn’t tell me what to do or who to be, because truly they already were what they wanted me to be and what I wish I could be. My parents never pushed me towards anything, from my young age until now. They didn’t try to live their unfulfilled dreams through me. But they let me be. They liberated me to life, to my Own Life. My parents never pushed me to strive for anything, never have I felt any kind of pressure. Instead they truly raised us in an understanding and free environment, make our steps and experience the world. My parents never tried to hide an ugly truth or a suffering from me; instead they taught me how to face it with grace and dignity. My parents loved me beyond any measure and never lost any moment to show it to me and to anyone around me. Never.
Father taught me that a man is a man by what he stands for, by how he cares for his loved ones and how he treat them. That strength of character comes from a good and kind heart firstly, by pure and kind intentions, by patience, by generosity. Watching him be who he is thought me that kindness is for the strongest, those who can spread love without any return. Mother taught me perseverance and strength of character too. Who know her knows it well. I watched her, when I was only 10 years old, study for a new other degree at her forties, simply for love of education and knowledge. She thought me my love of books and science. And both thought me to have a dream and goal and work for it. Wholeheartedly and unconditionally. They made me realize how I can stand for myself and never let anybody violates or defile what I am, all while being kind and gentle. They thought me to say No when it was a No and to never betray myself. Being parented by such beings made me someone who doesn’t pursue money or material, to be cool or fall into a standard. It made me a woman of impact. A woman who strives for excellence, kindness, and generosity of knowledge. To have and impact, whether I could perceive it, measure it, or not, impact and to be the best
person I can be is all I live for, all I wish for, because I know how a living impact feels
To my big brother
We surely know how to argue, that’s for sure. And I realize how lucky I got to grow up with you as my big brother, teaching me how to stand by my opinion, how to argue, always pushing me to do and be more; I remember when we used to race at who would read a certain part of encyclopaedia first (oh yes!), who would win at French chest first, who would beat who at the rubix cube, who would simply know more etc. Man we were geeks. But I realize how lucky we got it, to grow in our loving home. We don’t express it enough, I certainly don’t express my feeling too often, but know for sure that love is always there and will always be.
To my little sister, my kitty
We don’t express it enough too, that’s how we are, but surely we show it. I love you beyond words my little kitty, you will always have my support, encouragement and simply everything you will ever need.
To my big sister, Sarah Hamaz
What a beautiful addition to our family. I would like to thank you for your kind ear for your reliability, for your availability, for your kind heart and being the great and amazing woman you are to the people in your life.
To my friends and family
I am also immensely thankful to my friends Basma Karrakchou a unique and priceless women and human being in this world, I thank her for sharing this long long journey with me, and to whom I wish the best of the world, my study partner, my best friend. And to my best friend Mohamed Sobhi Jabal, a true partner and best friend to whom I wish the best of the world too. The most pure and kindhearted men I know. The most ambitious and strong person I know, forever thankful for having you in my life. To
Ouiam Hrora, I thank her for being a true friend, a strongminded, unique and one of a
kind women, to whom I wish all success in the world, always can count on me. To my family Mehdi Benammi, Sarah Hamaz and Fatima Zahra Benammi, thank you for you support. Last, but not least, I thank and respect my parents Lahsen Benammi and
Naima El Majdi, for all the love, validation and support they showered me with. For all
the sacrifices, for all the efforts they have made to offer us everything we needed and more. For the education and values they thought us. I thank them for the priceless heritage they offered us, above all : values of hard work, compassion, empathy, perseverance and love of Allah. Anytime life put me on my knees, I only had to remember how their faces illuminated every time they saw me, and all was well, again. I am grateful that they are, have always been and will always be the warm wind beneath my wings. My love and gratitude goes beyond words. Truly.
To my paternal and maternal grandparents, in the loving memory of my Grandfather may you rest in peace, to Khalti Hafida, Ami Damir, khalti Fatima, Ami Hasan, Ami Housin,
Khalti Zakiya, Khalti Mina, Khalti Samira, Khalti Leila, to my beautiful little cousins
To The Gorgeous People Sobhi jabal, Basma Karrakchou, Meryem mountassir, Basma Lahmer, Ouiam Hrora, Houda Elkhyari, Zainab Benslimane, Maha Elmaati.
And also I would like to thank Pr. Bouterbouch Mahjouba, Pr. Azzedine Ibrahimi, Pr. Dakka Taoufik, Pr. Aziz Benbrahim for everything.
To Professor Jihane Belayachi ; Director of thesis
Professor of Medical Intensive Care
First of all, I would like to express my sincere respect and gratitude to my advisor Pr. Jihane Belayachi, professor of medical intensive care. I thank her for her constant availability, her guidance and advices, her understanding and support, her patience. For all of that, I am grateful. Thank you for guiding me through every step I undertook through research, for giving me the love and passion for research by allowing me to see the beauty in it. Thank you for everything.
To Professor Redouane Abouqal; President of thesis
Professor of Medical Intensive Care
I also would like to express my profound gratitude to Pr. Redouane Abouqal, professor of medical intensive care, head of AMU, for allowing this study to take place in his ward as much as all my other study projects. To thank him for taking this study and all the others to a higher level by his admirable expertise in biostatistics and his wisdom acquired through years of research and practice, being a role model for his students and trainees. I am very grateful for the incredible amount of support and encouragement he offered me through the years since our first encounter in my third year, and for being my research mentor.
To Professor Naoufel Madani, Jury of thesis
Professor of Medical Intensive Care
I would like to thank Pr. Naoufel Madani, professor of medical intensive care, for the training, the guidance, the understanding he offered me during my incredible training in the unit of UMH during my intern years.
I owe this study to Pr. Redouane Abouqal and Pr. Jihane Belyachi, and Pr. Naoufel Madani. I would like to thank them for choosing me for all the amazing opportunities they generously offered me. Lastly, I would like to thank them for the training they offered me during my intern years in their department. I dreamed of becoming an intern and to have one of my training in their incredibly formative department, where you learn the values of medicine beyond the knowledge. To all of them, I thank them for accepting to be members of the jury to evaluate my work and judge my merit to carry the title of Medical Doctor.
To Professors Rachid Razine Jury of thesis
Professor of Public Health
I thank Pr. Rachid Razine for accepting to be member of the jury to evaluate my work and judge my merit to carry the title of Medical Doctor.
To Professor Abdelmalek Hrora; Jury of thesis
Professor of General surgery
To Pr. Abdelmaled Hrora, Professor of General Surgery, my gratitude goes beyond words. I truly and sincerely thank him for everything. I thank him first of all for being a true role model and a mentor. I thank him for the incredible amount of encouragement, support, guidance, understanding, patience, kindness, and training. I value the benefice of being around a contagious spirit of ambition and inspiration that he carries. I am very grateful and consider myself very lucky to have encountered such role model along my carrier, and to have the privilege to be in his team. I thank him for every opportunity, everything he thought me, not only knowledge of medicine but also the values and principles of a good doctor. I would love to express my deep respect, admiration and gratitude for the priceless knowledge he generously thought me. And I thank him for somehow believing in me, and hope to live up to the quality of training he offered me. And finally, I thank him along with Pr. Mohamed Raiss for allowing me to dream of becoming an intern and succeed as much as I can. Finally, I thank him for accepting to be member of the jury to evaluate my work and judge my merit to carry the title of Medical Doctor.
To Professor Mohamed Raiss
Professor of General surgery
To Pr. Mohamed Raiss, I would also love to express my deep gratitude, respect and admiration. I would also love to express my gratitude beyond words for being such a mentor. I thank him for his priceless guidance, patience, and generosity, understanding and support. Evidently, I am grateful for everything.
To Professor Mohamed Ahallat
Professor of General surgery
To Pr. Mohamed Ahallat, Professor of General Suregery, I simply can’t express enough how grateful I am for all the support and guidance he generously offered me. I thank him for believing in me and taking me under his wing. I realize how lucky I am to have met such an inspiring mentor and admirable doctor and human being. I can’t emphasize enough of how much I respect him and appreciate everything he generously offered me.
LIST OF FIGURES AND TABLE
Figure 1: Acute Medical Unit team composition ... 10 Figure 2: Illustration of ego (C) an alter (A,B) connected by two links ... 11 Figure 3: Illustration of a non-oriented network and an oriented network .... 12 Figure 4: Illustration of a matrix’s network ... 13 Figure 5: Illustration of a network with members not connected between
them with links in fig4.(1) and connected with fig4.(2) ... 15
Figure 6: Illustration representing all existing links and possible links
between individuals of the network ABCDE: existing relationship symbolized in links A-C, C-B, and E-B, and possible links symbolized by the dash line. ... 16
Figure 7: Illustration representing an oriented network ABCDE including 5
individuals with a size of 6 links fig5.1 and table of all in-degree and out-degree links fig5.2 ... 17
Figure 8: Illustration representing an non-oriented network ABCDE. In Fig
7.1 representation of a ring network after removal of a central node the rest of nodes stays connected. Fig7.2 representation of a star network with disconnection of the nodes after removal of the central node. ... 18
Figure 9: Illustration of SNA survey and matrices used for calculation of
SNA measures ... 22
Figure 10: Percentage representation of sex ratio ... 29 Figure 11: Percentage representation of marital status ... 30
Figure 12: Percentage representation of the AMU team composition ... 31 Figure 13: Graph of AMU network Map ... 33 Figure 14: Graph of AMU node-metric: DEGREE CENTRALITY with
size of the node proportional to the percentage of degree centrality ... 36
Figure 15: Graph of AMU node-metric: BETWEENNESS CENTRALITY with size of the node proportional to the percentage of betweenness centrality... 38
LIST OF TABLE
Table 1: Summary of relevant network and node measures used in our
study. ... 23
Table 2: Professional characteristics of AMU team members ... 32 Table 3: Summary of network-level metrics ... 34
INTRODUCTION ... 2
PART I/ COMMUNICATON IN A MEDICAL SETTING: DEFINITION
ANDCHARACTERISTICS ... 2 PARTII/ACUTEMEDICALUNITDEFINITION ... 3
PART III/ ACUTE MEDICAL UNIT ORGANIGRAM AND OPTIMUM
WORKCONDITIONS ... 3
PART IV/ ROLE OF AN EFFICIENT COMMUNICATION IN AN
ACUTEMEDICALUNIT ... 4
PART V/ TOOL OF EVALUATION OF COMMUNICATION IN AN
ACUTEMEDICALUNIT ... 5 PARTVI/OBJECTIVES ... 6
MATERIAL AND METHODS ... 8
PARTI/STUDYDESIGN ... 8 A. TYPE OF THE STUDY ... 8 B. STUDY PERIOD ... 8 C. STUDY SETTING ... 8 D. INCLUSION CRITERIA ... 8 E. EXCLUSION CRITERIA ... 9 F. ETHICS COMMITTEE ... 9 PARTII/METHODSANDPROCEDURES ... 9
A. CHARACTERISTICS OF PARTICIPANTS ... 9 1. Socio-demographic and anthropometric characteristics ... 9 2. Professional characteristics ... 10 B. SNA INSTRUMENT ... 11 I. NETWORK DEFINITION ... 11 II. REPRESENTATION OF NETWORK ... 11 a- Graph ... 12 b- Matrix ... 12 II. SOCIAL NETWORK ANALYSIS ... 13 a. Rational SNA ... 13 b. SNA definitions ... 14 1. General description of network ... 15 2. Description of subgroups ... 19 C. PROCEDURE... 20 D. STATISTICAL METHOD ... 24
RESULTS ... 29
A.CHARACTERISTICSOFAMUTEAMMEMBERS ... 29
1. SOCIO-DEMOGRAPHIC AND ANTHROPOMETRIC... 29 2. PROFESSIONAL CHARACTERISTICS... 30 B. SOCIALNETWORKANALYSIS ... 33
2. NETWORK-LEVEL METRICS ... 34 3. NODE-LEVEL METRICS... 35 DISCUSSION ... 41 APPENDIX ... 48 REFERENCES ... 51 REFERENCES ... 52
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INTRODUCTION
PART I/ COMMUNICATON IN A MEDICAL SETTING:
DEFINITION AND CHARACTERISTICS
Webster’s Dictionary defines communication as “the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs” [1]. A good communication is more than the simple act of information exchange though, but an effective and consistent exchange of information thoughts and feelings, assurance of clear interpretation, and providence of consistent information availability. Communication is even more particular in a medical setting.
Nowadays the healthcare system is set in a complex manner where effective information exchange is vital. Often it involves implication of multiple health care practitioners with varying levels of education, specialty and training. It can also implicate for the patient multiple stationaries and steps during the process of seeking medical care. Thus effective clinical practice involves many crucial moments where critical information must be accurately communicated. Besides team collaboration is essential.
Collaboration in health care is defined “ as health care professionals assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patient care ” [1]. Good communication promotes continuity and clarity within the patient care team encourages collaboration, fosters teamwork, and helps prevent errors. We instinctively recognize that it is the “glue” that holds an organization together
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PART II/ ACUTE MEDICAL UNIT DEFINITION
Healthcare system is defined as “all institutions, organizations and resources whose primary purpose is to promote, restore and/or maintain health” [2]. Acute care departments are time sensitive healthcare services that aim to provide care for acute life-threatening injuries around the clock. Based on the necessity to define strict common descriptions in health service in general, and especially in acute care unit with its low to absent tolerance of error, it is necessary to define with unity in order to build these departments on tangible elements, and develop metrics for follow up and evaluations [3].
PART III/ ACUTE MEDICAL UNIT ORGANIGRAM AND
OPTIMUM WORK CONDITIONS
Acute medical unit or AMU is a collaborative structural organization and system that have emerged to service a demand of immediate and adequate care for life-threatening emergencies. The Austrian anesthesiologist Peter Safar first introduced the concept of “cardiopulmonary resuscitation” and “advanced life support” in 1950. The first cohesive network built of health professionals’ aiming to treat life-threatening issues was later established by the Danish anaesthesiologist BjørnAage Ibsenin 1953, facing a polio outbreak. The rise of a medical unit to service the serious epidemic was the ultimate result of a vital necessity to meet a demand and fill a need of managerial organization, in the context of polio epidemic [4][5].
Optimal modelling and organization is one of the major components of a high quality medical care [6]. Yet, acute medical unit has emerged in a context of restricted evidence base and statistics, have a variable staffing and structural
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model, and is a complicated subject due to its variant characteristics. As such, the acute medical unit model is still not consistently defined in literature. Finally non-physician providers play an important role in the healthcare team and their presence is key in multiple situations, although more often is underestimated.
PART IV/ ROLE OF AN EFFICIENT COMMUNICATION IN
AN ACUTE MEDICAL UNIT
The time-dependent, complex and multidisciplinary setting of an acute care unit makes it a high-risk structure. Such high-stake environment needs an efficient communication between the staff members for ensuring patient safety and reducing the risk of adverse effects, as poor communication has been identified as a causal factor in adverse incidents harming the patient [7][8]. Moreover, it has been proved that improvements of communication has decreased medical errors, as well as improved technical performances [7]. Better understanding of the crucial communication in acute care settings is essential for better team building, better patient’s safety, and better conception of assessment’s tool [7]. Yet despite the vital need of studying the communication in an acute medical unit, it is a subject less analysed in the healthcare field, and therefore not well understood.
The lack of research in the matter in middle-income and lower-income countries, with their many burdens and complex circumstances such as little infrastructure makes it even more of a complex question to rise, as well as vital matter for optimal care. Indeed, communication becomes particularly in middle-income and lower-middle-income countries a key managerial element for a more efficient medical care with better cost since it’s a reachable factor, unexpansive and inexhaustible resource.
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PART V/ TOOL OF EVALUATION OF COMMUNICATION IN
AN ACUTE MEDICAL UNIT
Social network analysis is a powerful tool used to analyse human behaviour, relationships and communication among a group. Dr. Jacob Levy Moreno (1930s) is one of the early founders and pioneers of Social Network Analysis as we now know it today. Social Network Analysis was conceived as a result of a necessity of studying the human social environment and relationships, and started therefore since the beginning of humanity. The development in Social Network Analysis has increased sharply over the last few decades due to its rising application. Social network analysis seeks to understand networks and their participants with two main focuses: the actors and the relationships between them. It defines the social capital in a network, the flow of information, the level of critical concentration of communication or information and it’s nature, defines specific groups and key elements, and finally dresses the network in a strategic and well-defined structure [9].
Literature review of social network analysis shows it beginnings and evolution evolving parallel to the social change along the years, and it use in multiple domains such as sociology, economics and sciences [9]. Indeed, Social Network Analysis has been used increasingly during the last ten years, and the domains where it’s application appeared to be crucial where e-Business, Network Security, Education and e-Health [10]. In epidemiology, with the development of our global society flow of trade and exchanges, the study of spread of infectious disease became essential. Social Network Analysis has proven its efficiency in epidemiology, analysing the way and tools of spread of an epidemic. Yet, applications in the health sector remain underutilized [11].
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So in conclusion, all these elements emphasize the need of strategic resource planning for the Acute Medical Unit staffing and organization, thus create an original study matter and a valuable opportunity for research. To our knowledge, our study is the first Moroccan study and middle lower income countries study aiming to analyse the social network and communication of an acute medical unit.
PART VI/ OBJECTIVES
- To study the communication flow in an Acute Medical Unit (AMU) of University Hospital of Rabat, Morocco.
- To analyse the social network of the AMU and relational patterns of the healthcare team members.
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8
MATERIAL AND METHODS
PART I/ STUDY DESIGN
A. TYPE OF THE STUDY:
The study is a descriptive trans-sectional study based on a face-to-face survey
B. STUDY PERIOD:
The study covered a period of 48 hours shift
C. STUDY SETTING:
The study was conducted in an Acute Medical Unit (AMU) of University Hospital Ibn-Sina in Rabat, Morocco. Based on the data of 2017, the university hospital has an average of 580 emergencies consult per day, and an average number of 96 hospitalizations per emergency room per day [12]. The AMU unit admits approximately 950 patients annually, with an average age of 40 years. Patients are admitted mainly from the emergency unit, falling into a wide range of medical illnesses.
D. INCLUSION CRITERIA
All members of the AMU team who were effective healthcare workers or student affiliated to the AMU at the time of the data collection were included. We established therefore a one-mode network since we included a single group of study (health workers).
9 E. EXCLUSION CRITERIA
We excluded 4 AMU staff members who are either inactive or refused inclusion.
F. ETHICS COMMITTEE
The study was conducted under local ethics committee approval number 1046/ 2018, and informed consent from all participants was obtained.
PART II/ METHODS AND PROCEDURES
A. CHARACTERISTICS OF PARTICIPANTS
We included multiple variables.
1. Socio-demographic and anthropometric characteristics
We collected socio-demographic and anthropometric data using a questionnaire (Appendix 1) evaluating:
Age of participants Gender (Male or female)
Matrimonial status including: Married or single, or divorced or widowed participants
Distance between hospital and permanent residence expressed in kilometres
Job title: nurse, medical student, junior physician, senior physician, hospital practitioner, healthcare technician (including health administrator)
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Years of experience Years of study
Number of sleep hours per night during the last 6 months Number of work hours per week during the last 6 months Numbers of shifts per week during the last 6 months
2. Professional characteristics
The unit staff members include: 3 senior physicians (SP), 3 hospital practitioners (HP), 14 junior physician (JP), 5 medical students (MS), 16 nurses (RN), 1 physiotherapist (PHT), 16 healthcare technician (HCT) including 1 secretary and 1 archivist, and 14 health unit coordinators (HUC).(Fig1)
11 B. SNA INSTRUMENT
We analysed communication using the Social Network Analysis SNA instrument.
I. NETWORK DEFINITION
A network summarizes a group of interconnected individuals or subjects with multiple variables and characteristics. The definition conceptualizes the social network as a set of social actors or subjects, connected with a set of lines or links representing one or more social relations among them [13].
The individual filling out the questionnaire are referred to as “ego”; the contacts that the ego reports on are called “alters” [14].
Figure 2: Illustration of ego (C) an alter (A,B) connected by two links
II. REPRESENTATION OF NETWORK
A network can be expressed in a form of graph or a matrix.
Fig2.1 : Network ABC of 3 individuals not linked (no communication)
C= interviwed person B and A = alters
Fig2.2 : Network ABC of 3 individuals linked ( presence of communication)
C= interviwed person B and A = alters
Fig2.3 : Network ABC made of 3 individuals
12 a- Graph:
Graphically, the network is made of nodes or points connected by links (fig3), representing the individuals within the network connected by relationships (for example, professional, marital, family, financial etc.). The links can be either segments if the network is non-oriented, or arrows if it’s oriented. In total, the network is displayed in a form of a diagram including nodes connected by links. A network can be either oriented or not oriented. Orientation is the distinction of two separate links between 2 same persons: A to B, and B to A (Fig 3).
Figure 3: Illustration of a non-oriented network and an oriented network
b- Matrix:
It takes form of a square matrix with as many lines and columns as the network’s individuals. This creates cells containing information regarding communication between two individuals. The link is read from the actor in the
Fig 3.1 Non-oriented graph representing a network ABC of 3 individuals
Fig 3.2 Oriented graph representing a network ABC of 3 individuals
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row to the one in the column, giving therefore a possibility of orientation with a vector. Therefore, a network is oriented by default. Though reporting a network’s data can either choose to reflect its orientation, or not. If in the network the links are not oriented, the matrix is symmetrical. The cell connecting an actor to him self is filled with zero and is not taken into account [15]. In our study we chose to draw a non-oriented network reporting the frequency of communication considering the maximal digit reported between two individuals making therefore symmetry (fig 4)
Figure 4: Illustration of a matrix’s network
II. SOCIAL NETWORK ANALYSIS a. Rational SNA
We studied patterns of communications of AMU healthcare personnel using SNA survey tool. We chose this method based on the following points:
1) SNA analyzes and reflects behaviors and interactions between
individuals as interdependent rather than independent, lively rather than static. Meaning they study behavior of interactions and dresses the dynamic rather
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than drawing a static picture.
2) Because communication and interactions between individuals are
indeed live and dynamic, depending on the environment.
3) And so SNA techniques is a powerful tool that help visualize those
dynamic interdependencies, relationships, and communication between individuals revealing patterns structure and quantitative measures of
pattern structure
4) These patterns and measures identify individuals or groups of
individuals that are in conclusion isolated or are powerful brokers of information dissemination for example, facilitators, and negotiators, associated with cliques etc.
5) SNA uses survey to obtain the data for documenting interactions and
communication between colleagues in the workplace, therefore accessible and easy.
6) And finally, SNA is viewed as a valuable tool in designing methods for improving quality and safety in healthcare.
b. SNA definitions:
SNA is the analysis of a community as a network, and mapping the relationships connecting the members for study. This allows us to analyse and measure the social connections and the exchanges SNA is the study of a community that gives us insights about structural properties of the network and its effect on social behaviour [11]. SNA study the network’s individuals, their relationships between them, and with their environment allowing us to map a graphic network and its social behaviours and characteristics. All this is done
15
using a set of measurements and definitions. Each measurement used in SNA has a precise definition that should be properly introduced. We will divide them into tree essential parts: tools of general description of network, tools of subgroups description, and tools of individual description. Table 1 displays summary of the basic terminology
1. General description of network
General description of the network is a group of definitions and scales that describes a social network as a whole.
- Size
The size represents the number of nodes in the network.
Figure 5: Illustration of a network with members not connected between them with links in fig4.(1) and connected with fig4.(2)
Fig5.1 Network ABCDE with members having no communication
Fig 5.2 Network ABCDE with members connected by links
16 - Density
The density of the network is the ratio of the number of existing links with the number of possible links. It is measured as a value between 0 and 1.Considering (n) is the size of a network, when oriented the density of a network is [n(n-1)], and when not oriented the density is [n(n-1)/2]. Density
gives knowledge of how fast the information will spread within the network.
Figure 6: Illustration representing all existing links and possible links between individuals of the network ABCDE: existing relationship symbolized in links A-C, C-B,
and E-B, and possible links symbolized by the dash line.
- Degree
Degree defines each node. If the network is not oriented, the degree of a node is the number of links established by the node within the network. If oriented, the degree gets divided into "in-degree" which is the number of links accepted by the node, and the “out-degree" which is the number of links emitted by the node.
Existing links Possible links
17 - Network centralization
Network centralization describes the inequality and asymmetry within a network. It reflects on the concentration of communication.
Network centralization is directly correlated to the number of highly central nodes. If they cease to exist then the number of component (non communicating segments of the same network) will increase, quickly fragmenting the network. In another word, a highly centralized network has
higher risk to collapse quickly as one or more central node hold its cohesion. While less centralized network has no weak point, since many nodes can cease yet the remaining nodes still reach each other
Centralization assesses the to which extent links are focused around one or a few people
B C D E In-degree= 1 Out-degree= 1 In-degree= 2 Out-degree= 0 In-degree= 1 Out-degree= 1 In-degree= 1 Out-degree= 2 In-degree= 2 Out-degree= 1 A
Figure 7: Illustration representing an oriented network ABCDE including 5 individuals with a size of 6 links fig5.1 and table of all in-degree and out-degree links fig5.2
Fig 7.2 – Table of in-degree and out-degree
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Figure 8: Illustration representing an non-oriented network ABCDE. In Fig 7.1 representation of a ring network after removal of a central node the rest of nodes stays connected. Fig7.2 representation of a star network with disconnection of the nodes after
removal of the central node.
Fig 8.2 Graph illustrating a star network. Centralization = Fig 8.1 Graph illustrating of a ring network. Centralization =
19 2. Description of subgroups
This approach is described as "macroscopic”
- External-Internal Index
A group EI Index reflect the probability of interactions and communications likely to occur between its own individuals (internal links) rather than with individuals outside their group (external links). The orientation is not taken into account.
It is measured as follows:
The values go on a scale of -1 to +1, with -1 being all links are external and +1 to all links are internal to group [16].
When applied the E-I Index reflex on the homophily of a network and degree to which it is composed of subgroups that interact within their limits and with one another, and the degree of partitioning or opening. Reflects on
the cohesion of a network
3. Description Of Individuals
Description of a network’s individuals encompasses a set of definitions and measurements that provide insight on the location of individuals within the network, and therefore the detailed network structure. Measures of centrality
reflect the prominence of actors/units within a network. They are among the most widely used actor-level measures that derive from network data.
External links - internal links
External links + internal links
20 - Degree centrality
Degree centrality is the simplest measure of node connectivity. It is a sum of all links held by the nodes. It reflects only direct links, and is generally
used to rank individuals based on their positioning level of activity within the network [17]. It can gives us an insight on the rank of the network’s
members based on their degree of prominence and influence on the flow of information and network [18].
- Betweenness centrality
Betweenness centrality is the measure of the number of times a node lies on the shortest path between other nodes. It gives us insight on the strategic
or central node, where the number of connections doesn’t matter as much as
the pattern of its links. Indeed, the pattern of the direct and indirect links of the node allow it to access all the nodes in the network quicker than any other by having the shortest paths. They are in an excellent position to monitor the
information flow in the network, influence, and have the best visibility into what is happening in the network. Therefore, the central node has more
choices in his interactions, is freer and less dependent on others.
C. PROCEDURE
We gathered the list of all AMU staff members, and included a total of 58 eligible participants. We interviewed every member separately in retrospect of the 48 hours. We asked about interaction of all members with every other team member over two 24-hour shifts beginning at morning rounds (8:30 am) and ending at the start of morning rounds the following day. Each SNA survey included the names of all eligible AMU personnel on the shift in question, and
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was personal to the participant interviewed. Each participant had to report the frequency of communication they established on a scale of 0 being no form of communication to +10 being more than ten times communication was established. We followed standard SNA practice and presented a single survey item on its own page and included a standard item stem: “Think only about this
shift. Record below the total number of times you initiated communication . . .”
The item stem was followed by the following statement representing the professional interaction:
- ...when you interact about health care situation. (Discussing patient care or medical advices)
We included all form of communication: 1. Face to face interaction
2. Phone call
3. Textual message
We created a sociometric (whole-network) questionnaire. The team’s social network is represented as a square matrix including all team members who completed the questionnaires (rows) and their named discussion partners (columns). Each cell takes the value of frequency of communication from 0 to +10. We considered the highest frequency reported between two individuals and the reciprocity of the reported interaction, drawing a symmetrical non-oriented network. In other words, if the participant A reported a certain frequency of communication with B we reported the highest number, and if A reported having communicated with B but B didn’t reported it, we retained communication being held.
22 A1 1 A2 0 B1 8 B2 0 B3 +10 A1 A2 B1 B2 B3 A1 A2 B1 B2 1 0 8 +10 B3 Name = MOHAMED ……
ID= B2 ………. The invisigator use only ID asigned
List of AMU staff members
Frequency of communication
The interrogated individual aka Ego
The individual you spok e with How many times you spoke with him/her
Abstracting answers from paper surveys into SNA matrices for analysis
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Measure DESCRIPTION
Size Number of nodes in the network.
Density Ratio of the number of existing links with the number of possible links
Gives knowledge of how fast the information will spread within the network
Network centralization A network-level measure that assess the degree to which network
links are focused on one or a few nodes in the network. Network centralization is directly correlated to the number of highly central nodes. If they cease to exist then the network will get fragmented and some individuals will be isolated. At the network level, the centralization metric provides an overall indicator of how clustered ties are to one or a few individuals in the network
E-I index A group EI Index reflect the probability of interactions and communications likely to occur between its own individuals (internal links) rather than with individuals outside their group (external links). Reflects on the cohesion of a network
Degree centrality Measure of the node connectivity. It is a sum of all links held by the nodes. It reflects only direct links, and is generally used to rank individuals based on their positioning level of activity within the network
Betweenness centrality It gives us insight on the strategic or central node, where the number
of connections doesn’t matter as much as the pattern and localisation of its links. Betweenness centrality is the measure of the number of times a node lies on the shortest path between other nodes (strategic). Refers to the number of times a member connects with other network members that would not otherwise be connected
24 D. STATISTICAL METHOD
To describe characteristics of team members, continuous variables are expressed as mean ± standard deviation (SD) or as median ± interquartile range value. Normality of data distribution was evaluated using the Kolmogorov-Smirnov test. Categorical variables are expressed as frequency and percentage. We defined five indicators: network density, network centralization, degree and betweenness centrality, and homophily.
Network density is the most widely used SNA measure, and is the
proportion of existing communication relationships between members (presence or absence) at the dyadic level divided by the total possible number of communication ties at the dyad level [18]. Values for density range from 0 to 100 with higher values indicating greater cohesion and frequent communication among all members in a defined network [18].
Network centralization assesses the degree to which the network is
influenced by one or a few members according to the number of direct connections they have with other individuals. The index is valued from 0 to 1,
with 0 defining the most symmetrical network where all individuals share connections between them. And 1 defines the most unequal network where all individuals are connected to one central node. A higher score indicates that
only a few individuals influence the network, and a lower score indicates that individuals within the network have a similar number of ties. Low
centralization (or decentralization) indicates greater distribution of
communication across teammates with no single team member enjoying a high level of communication over any other team member in the network. In
