For the past couple of years, the medical education in France has evolved. However, it has also met with a lot of criticism due to its teaching and course content. But the principles that provide the basis of the French medical education has remained unchanged. According to the Faculty of Medicine at the University of Paris, just like a host of other West European nations France has been facing a shortage of doctors since the 1990s and efforts have been made to improve the situation.
Being a republic, France is very centralized and hence oriented towards strong control at national level. Important decisions regarding education and health are done by the central government and professional organizations do not play a large role as they do in the United States of America and The United Kingdom. There is not a high level of distinction between the curriculum in under graduation and post-graduation.
In France, the medical academia has a very centralized role in defining the medical curriculum. The curriculum must be conformed to national rules and is jointly promulgated by the Ministry of Health and Higher Education.
Selection of students
Individuals who have obtained the French baccalaureate are open to enroll into the 1st Year with students taking only pre-requisites before heading into their area of concentration. Only written exams are conducted in the 1st year. Unsuccessful candidates may repeat their first year. According to the Medical Faculty in Nancy, 30% pass their Year 1 for the second year. While the remaining 70% repeating their first year, in general the average medical student in France takes 7 years to complete under graduation.
First Cycle (Year 1-2)
As mentioned above, 1st year consists mostly of pre-requisites also known as pre-clinical subjects. Beginning of the second year comprises of introduction of nursing along with clinical skills of around 200 hours of study:
Second Cycle (Year 3-6)
Theory centric Teaching
3rd Year consists of 900-1000 hours of teaching with the aim to reinforce the basic sciences and introduce the terminology of the clinical disciplines. There is a complementary clinical skills course of an additional 200 hours. The second cycle consists mostly of repetitive courses rather than the courses by organ or specialization. Methods of teaching are influenced towards self-directed learning and interdisciplinary; utilize problem-based and case-based learning techniques in groups. With written examination being part of the student assessment, each faculty member is allowed to decide the criteria for passing for the next year.
Clinical teaching
In year 4, there are clerkship rotations ( which varies between 2-4 months)- the practice of medicine for the purpose of experience( just like an internship for business), which is central to clinical teaching
These students are responsible for examining and interviewing patients along with being with them during their hospitalization, under the supervision of a senior. In spite of rotations being part of the curriculum, students are not required to pass an objective structured clinical examination (OSCE) or other performance-based assessment prior to undertaking clinical rotations. Students are assessed with an oral examination at the end of each rotation. Assessment is mostly theoretical and a list of skills must be acquired by the students in order to be considered competent. Students receive a diploma at the end of the second cycle (Year 6) which is equivalent to an MD in the US or a MB in the UK.
Third Cycle (postgraduate or residency training)
All those who have successfully completed their 2nd cycle, enter their 3rd cycle, involving training in a specialty, which includes family medicine. However before that, students have to give an anonymous national ranking examination and based on their rankings they can pursue a specialty they and the region they would prefer to study. Once that is done, the specialty programme consists of clinical rotations and theoretical teaching which takes 3 years for general medicine and 4-5 years for the specialty. The clinical and theoretical aspects of the third cycle are assessed and a final essay to a panel of judges from their specialty is to be submitted. Once completed with these requirements, students are issued with a state diploma and are required to register and be listed with the Ordre des Me´decins in order to be eligible to practice, but can only practice in the specialty in which they hold a university diploma. This is just like being registered at the Medical council of India for an Indian national in order to be able to practice in India.
Now, working in an actual medical environment requires not only a diploma and knowledge in advance science but the competence to behave professionally and rationally in a constantly complex changing environment, especially dealing with evolving patient expectations. To all this, France has yet to invent this sort of model curriculum.
