Medical school in France

18th century

Under the old system, medicine was one of four faculties and generally only accessible through the faculty of arts. Teaching was mostly theoretical and involved lectures and readings from authorities. Practical components were gradually introduced from approximately 1750, although until the Revolution in 1789, doctors and surgeons were considered to be separate professions. Surgeons were known as barber surgeons.

The university system was abolished in 1793 and replaced the following year by four medical schools in Paris, Montpellier, Bordeaux and Strasbourg. With the creation of the Imperial University in 1808, medical schools reopened their faculties and expanded across France.

19th century

In the 19th century, new practical training schools were established in response to the rapid technical evolution of medicine and the mediocrity of university theoretical teaching. Acceptance into these practical training programs was restricted and highly sought after, as hospitals were synonymous with the elite. Medical students began to neglect their faculty examinations to prepare for these practical training entrance examinations and it was possible that upon completing their studies, they had not seen a single patient.

20th century

Hospital reforms in 1958 merged the teaching functions of hospitals and universities, creating the position of Practicing University professor (Professeur des universités – Praticien hospitalier, PUPH). A goal of the reforms was to reduce the number of graduates moving to private practice.

Following the events of May 1968 protests in France, practical training entrance restrictions were removed: all medical students received practical training. Practical and theoretical training were finally combined into a single course for all, based on the 1958 ideal of the Centre Hospitalier Universitaire. Following the Faure reform, medical colleges were integrated into universities as UER (from 1984, research and teaching centres "UFR").

This reform, along with the general population increase, led to a large surge in student numbers. In response, since 1971 students compete for a fixed number of training places in an exam at the end of the first year of medical studies.

Until the 1990s, any doctor could become a specialist, either by taking the selective hospital residential pathway, or by taking the open access university pathway resulting in a lower-status certificate of specialized studies (THESE). The result was a two-speed medical system, divided between THESE graduates and “former interns” and “former senior hospital registrars”. A reform dropped the THESE medical certificates, returning to obligatory internships for the “ordinal qualification” specialists, through diplomas of specialized studies (OF) to complement the diploma of doctor of medicine. Interns were required to spend part of their training in a non-academic “peripheral hospital” belonging to a regional hospital centre (CHR).

Recent changes

Until 2004, future general practitioners did not sit the entrance exams for internships. Their second cycle was followed by two and a half year “résidanat” (three years for residents starting in or after 2001). Since 2004, a new reform has been applied: all medical students must pass the national classifying examination. The résidanat was replaced with an internship in general medicine, helping to raise the status of general practice as a profession.

From the 2010 academic year, the medical first year course is common with pharmacy, dentistry and midwifery, and medical studies fall under the process of Bologna.

Organization

Medical studies proceed in three cycles within a university having a unit of "formation" and medical research (sometimes a combination of medicine and pharmacology), associated with the one of the 29 university hospitals. Their total duration varies from nine years (general medicine) to 12 years (another speciality plus a sub-speciality).

First cycle of medical studies

The first cycle of medical studies (in summary PCEM) takes two years, with a "concours" (competitive final exam) at the end of the first year selecting students admitted to continue medical or dental studies.

National law specifies that the teaching of the first cycle and the first year of the second cycle must teach the following disciplines or disciplinary units:

Teaching must also include foreign languages, epistemology, psychology, medical ethics and deontology.

First year (until 2009)

The first year of the first academic cycle medical is common to the study of medicine, dentistry, and midwifery.

Requisites of the first year include: physics, biophysics, chemistry, biochemistry and molecular biology, cellular biology, physiology, anatomy, histology, and embryology.

First year (as from 2010)

The first year of the studies of health (PAES) is common to the medical studies, odontological, pharmaceutical and midwife (sometimes of kinesitherapy). It is divided into two six-month periods.

To be allowed to be registered in first year of the studies of health, the candidates must have one of the following qualifications:

As for any formation of system LMD, the year is cut out in two six-month periods and “units of teaching” (EU) which are seen allotting a certain number of appropriations ECTS.

In first half of the year, the lesson is common to all the dies. Tests are organized at the end of this one; the badly classified students can be reorientated in other dies of the university.

With the second half-year, the students choose one or of the EU specific (S) to a die, in addition to the common formation. The students pass a contest to the end of the year leading to four classifications.

It should be noted that the doubling of this first year is authorized only once. After two failures, you can not pass anymore, it is definitive.

Second year

The second year (in summary PCEM 2 or P2) begins with four weeks of obligatory and non-remunerated nurse placement. It takes place during the holidays preceding the re-entry by the students admitted in second year of medicine or odontology.

Lastly, a more medical matter, the semiotics, traditionally taught in third year, is at the present time transferred in second year in the majority from the universities, in order to improve the range of the clinical training courses of second and third years (usually called “training courses of checklist” or “training course of semiotics”).

The first cycle of the medical studies follows a national plan, but the organization between the two years varies between the universities. In the same way, there exist three types of teaching:

Second cycle of medical studies

In four years, the student receives a formal training and practical on the various pathologies segmented in modules: transverse modules (more or less interdisciplinary) or modules of body. These modules are the classifying official program of the national examination (see low), and include/understand a numbered list of items which correspond either to pathologies, or with clinical or therapeutic situations.

Third year of medicine

The third year of medicine (in summary DCEM 1 or D1) is one year of transition where the student learns bioclinic sciences (pharmacology, bacteriology, virology, parasitology, etc.) which make the interface between fundamental sciences of the first cycle and lesson of pathology. He also learns how to carry out the anamnèse (medical history) and the clinical examination of a patient at the time of his clinical training courses (called “training courses of checklists”, because the clinical examination linear and is structured, with boxes which one notches) associated with teaching with semiology. He starts the first modules.

Certain universities make begin the hospital training courses in third year, the clinical training course of second year is then developed more.

This year is particularly favourable with the Erasmus exchanges.

Externship

The three following years constitute the “externat”. This term of everyday usage (which is a survival of the old contest of the externat removed following the demonstrations of 1968) does not exist officially. The official texts and the internal texts of the CHU and the universities speak about “hospital students”, because the students are remunerated by the hospital complex to which the university is attached. They are paid under limited time contract, attached to a social security office not coed.

The student, under the responsibility for an intern (nonofficial) or of a senior (senior registrar or hospital practitioner), learns how to recognize the various signs of a disease. It does not have at this stage of therapeutic responsibility, nor the right to prescribe. The student is however responsible for his acts (civil responsibility, which requires the subscription of a suitable insurance).

The externat generally consists of four training courses per annum, three months each one in services of specialities, chosen by grids at the beginning of each year or quarter, either by classification with the merit, or by alphabetical classification. The training courses consist of five mornings per weeks in the services. Certain training courses are obligatory from the statutory texts (pediatrics, obstetric gynaecology surgery, internal medicine and emergency medicine.), and can then integrate theoretical teaching (the external one is then present at the hospital all the day). Conversely, certain services do not have the external ones, that depends on the agreements made with the university.

Certain universities replaced the half-time (mornings) permanent by one full-time by alternation: the external ones are then present all the day but only 6 weeks over 3 months, the 6 remaining weeks being devoted to the lesson, the examinations, the preparation of the ECN…

During the externat, the lecturing, replaced more and more by directed work, is done in alternation with hospital training courses: this teaching is a true trade-guild, where the external one approaches by “clinical cases” of true situations lived in the services.

The external one must, during its three years of externat, to carry out 36 guards of 12, 18, or 24 hours (according to the service and the day of the week), that is to say approximately a guard per month, remunerated 26 euros rough.

The remuneration of the training courses is as for it “symbolic system” (remuneration rough: 122 euros per month in fourth year, 237 euros in fifth year, 265 euros in sixth year), but the external student has the statute of paid and cotise to the paid mode of the social security, and the pension fund. The pension fund complementary to external is the IRCANTEC, as it is the case for the interns and the hospital practitioners. The external ones, like any employee, have five weeks of paid vacations.

Since 2004, the second cycle of the medical studies is sanctioned by a diploma (recognized in the European Union). Module 11 of the second cycle is the old certificate of clinical and therapeutic, essential synthesis to replace a general doctor.

Third cycle of the medical studies

Can reach the third cycle of medical studies (TCEM):

Classifying national tests

Tests are organized for the candidates quoted above.

According to its classification, the student chooses his university hospital (and thus its city) of assignment, like its die. This choice is carried out initially by Internet (phase of pre-choice and simulations), the final choice taking place during a “amphitheatre of garrison” which brings together all the students by sections of classification. This procedure makes it possible the student to choose his station by being informed fully of the places available.

The 11 existing dies in 2008 are, with the number of places available, on 5704 stations on the whole:

In 2005, a thousand of stations were not provided, certain students preferring to retry rather than to choose a speciality by default.

Hospital training

Although it has the statute of student and that it has a supervision, the intern is already an autonomous professional, since it can prescribe and carry out replacements in liberal cabinets (provided it on the one hand validated a certain number of six-month periods, and on the other hand obtained a “licence of replacement” from the departmental council about the doctors). It acts more than one initial track records that real studies (more especially as France is one of the rare countries to regard the interns as students).

The boarding school of general medicine lasts three years, and is validated when the whole of the six months training courses necessary were carried out (diploma of specialized studies of general medicine) and it is followed of a thesis of exercise. It consists of six months training courses remunerated, being able to be hospital, but also near a general doctor, or of an extra-hospital structure of care. The student takes completely charges his patients, but remains of them under the responsibility of a “senior” (see supra): clinical examination, regulation of complementary examinations and treatment. Teaching is primarily practical there.

The boarding school of speciality lasts four years or more. According to the speciality chosen, the student must make a minimum number of training courses remunerated in hospital services where its role is similar. Its boarding school is validated when the whole of the six months training courses necessary were carried out. It also supports a thesis of exercise generally relating to a topic of the speciality, generally in the last year of boarding school. The speciality is sanctioned by the diploma of specialized studies, after defence of a report, which is sometimes confused with the thesis (thesis-memory, when this one is constant in the last year of boarding school and relates to a subject of the speciality).

The diploma of State of doctor of medicine is conferred after defence successfully thesis of exercise.

Registrarship and assistantship

For certain specialities, in particular surgery, complementary studies are required: either at a university clinic of two to four years, or an assistantship of speciality for at least 1 year. The total training for these specialities therefore ranges from 12 to 15 years.