Isabel Pifarré Coutrot, a Ph.D. student of the RITM laboratory at Université Paris-Saclay, supervised by Sandra Cherreire Petit, will defend her Ph.D. thesis entitled “Practicing medicine in a digital era: exploring the role of proximity in the learning process of general practitioners. A systemic approach”, on December 5, 2025. The PhD defense will be held in the Gaudemet Room (Building D of the Jean Monnet Faculty).

Composition of the jury:

  • Marie-Ève Laporte, Professor at Université Paris-Saclay – Examiner
  • Mathias Béjean, Professor at Institut Polytechnique Paris  – Examiner
  • Johanna Habib, Professor at Aix-Marseilles University – Reviewer
  • Damien Talbot, Professor at IAE Clermont Auvergne – Reviewer

PhD Thesis Abstract: For over 25 years, French public authorities have piloted the deployment of digital technologies within the health care system. However, the health system is complex to manage due to the numerous stakeholders involved and the generation of feedback loops that make it unpredictable. While digital tools facilitate communication, collaboration, and knowledge sharing, they can also significantly transform work and create tensions for health care professionals. Research finds that the main barrier to implementation of digital technologies is organizational, stemming from health professionals’ difficulties in appropriating and using digital tools. However, current research on e-health mainly focuses on understanding and predicting the acceptability of these tools. Therefore, developing new ways to understand the learning process, in its multidimensional, dynamic, and relational nature, is essential. This thesis addresses one central question: What is the learning process of general practitioners in relation to digital tools, and what role does proximity play in this process? We adopt a comprehensive and systemic approach to answer this question. Our research is grounded in three main theoretical fields: learning, innovation, and proximity. In terms of methodology, we first conducted an exploratory single-case study analysing the role of proximity in spatial medicine. Then, we performed an embedded multiple-case study examining the learning process of five different groups of digital tools among 33 general practitioners in France, who we interviewed between January and July 2023. This thesis contributes to the enrichment of learning and innovation theories. We provide in-depth analysis of digital tools’ impact on general practitioners, and the tensions that hinder or obstruct the learning process. Our findings emphasize the importance of understanding these professionals’ practices, values, visions of their role, as well as their relationships with stakeholders. These insights help us further understand their learning process, particularly the knowledge interpretation phase, which is critical for appropriating digital tools. We propose a model that outlines the individual learning process related to digital tools, that help understand mechanisms and identify obstacles, as well as facilitators, that affect implementation. Our observations also reveal that while single-loop learning tends to occur at the interpersonal level, double-loop and deutero learning are more likely at the collective and systemic levels. Furthermore, this thesis extends Boschma’s conceptual framework by developing proximities that are pertinent to interindividual relationships. We expand geographical proximity to include physical and digital proximities, enhance social proximity with a relational type, extend organisational proximity with an operational type, and further develop institutional proximity to include moral proximity. These interindividual proximities play a crucial role in the learning process by facilitating the development of long-standing relationships. Our results also indicate that non-geographical proximities can partially compensate for the geographical distance between doctors and their patients or colleagues, regardless of whether it is linked to digital tools.