Medical education in France is administered by departments within universities called Unités de formation et de recherche de médecine (UFR) (Medical Training and Research Units). The training takes a minimum of ten years after the baccalauréat and concludes with a clinical thesis defence. Upon the successful presentation of their thesis, the medical student is awarded a diplôme d'études spécialisées (DES), based on their specialty. Certain high-achievers are awarded a diplôme d'études spécialisées complémentaire (DESC).
French medical training is one of the longest schooling paths in French higher education. It consists of both theoretical and practical training, starting from being more theoretical, moving to more practical aspects as training progresses.
History
Rennaissance Medical instruction in France initially developed outside of any institutional framework, but in the 13th century universities in Paris, Toulouse and Montpelier began a form of institutional training in medicine. Montpelier's is the oldest continually-running medical university in the world.
18th century Under the Ancien Régime, medicine was one of four faculties and generally only accessible through the Faculté des Arts de Paris.See :fr:Faculté des arts de Paris Teaching was mostly theoretical and involved lectures and reading of authoritative texts. Until the French Revolution in 1789, doctors and surgeons were considered to be separate professions. Doctors' experience was more abstract, learned from lectures and books, and was based on the theories of Galen. Surgeons' experience was practical and they were known as barber surgeons.
The university system was abolished in 1793 and replaced the following year by four medical schools in Paris, Montpelier, Bordeaux and Strasbourg.
19th century In 1802 established a scholarship system for students from any part of France who qualified through a competitive exam. These students would have begun their studies in universities, but would live at and serve internships from then in hospitals and go on to make up the medical elite. Students began neglecting the university exams to devote themselves to preparation for the internship exams because this was the only clinical experience they could get. During this time, hospitals became more prestigious than medical schools.
The law of 19 Ventôse année XI (March 10, 1803) reorganized the profession and stipulated that "no one can henceforth practice medicine or surgery without having been a doctor" except for health officers () in rural, medically under-served areas. Officiers de santé were like physician assistants or barefoot doctors and qualified through either 6 years apprenticeship with a doctor, 5 years apprenticeship in a hospital or 3 years at a medical school. They were licensed to practice by juries of medical doctors in their area. They were limited to basic and mid-level procedures, barred by law from practicing advanced medicine. With the creation of the University of France in 1808, medical schools reopened their faculties and expanded across France. At this time, the hospital became more prestigious than the medical school. Doctors, working part-time as volunteers, had great autonomy and used the work to build up their private practices. Gradually, a hierarchy evolved with prestigious doctors directing important services at the apex above specialists in private practice, with the general practitioners at the base.
20th century Hospital reforms in 1958 merged the teaching functions of hospitals and universities, creating the position of University Professor and Hospital Practitioner (PUPH), a full-time hospital/university teacher, as well as teaching hospitals. One goal of the reforms was to reduce the number of elite graduates moving to private practice.
Following the events of the 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, based on the 1958 ideal of the 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 1971 this resulted in a fixed number of training places in exams at the end of the first year of medical studies, a Numerus clausus system.
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 supplement 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 take entrance exams for internships. Their second cycle was followed by a two and a half year “résidanat” (three years for residents starting in or after 2001). In 2004, a new reform was applied, stating that 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.
Since the 2010 academic year, the medical first year course was organized as common first year of healthcare studies with pharmacy, dentistry and midwifery. This year was commonly viewed as "very difficult".
This system changed in 2019 via a major reform into a hybrid model. On the one hand, students can still access a second year in healthcare studies via a modified version of the traditional first year model (parcours accès santé – PASS). In doing so, they have to choose a minor in another subject in which they can continue, should they fail the selection process into the second year. On the other hand, universities now offer undergraduate degrees (licence accès santé – LAS) in many subjects that include a minor in healthcare, allowing them to take the selective exams that grant access to the second year of healthcare studies.
Organization Medical studies proceed in three cycles within a university having a unit of medical research and training (sometimes a combination of medicine and pharmacology), associated with one of the 29 university hospitals. Their total duration varies from nine years (general medicine) to eleven years (another speciality plus a sub-speciality).
First cycle of medical studies The first cycle of medical studies (also known as the 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 instruction of the first cycle and the first year of the second cycle must include the following disciplines or disciplinary units: physics, biophysics, and image processing; chemistry, biochemistry, cellular, and molecular biology; anatomy, embryology, developmental, and reproductive biology; cytology, histology, and pathological anatomy; bacteriology, virology, and parasitology; fundamental hematology, immunology, and oncology; genetics and biotechnologies; physiology and nutrition; pharmacology and major classes of drugs; epidemiology and biostatistics; clinical and biological semiotics and medical imagery terminology; first aid; demography, health economics, and health systems.
Teaching must also include foreign languages, epistemology, psychology, medical ethics and deontology.
First year (until 2009) The first year academic cycle for medical students is common with dentistry and midwifery.
Requirements during the first year include: physics, biophysics, chemistry, biochemistry and molecular biology, cellular biology, physiology, anatomy, histology, and embryology.Decree of March 18, 1992 relating to the organization of the first cycle and the first year of the second cycle of the medical studies, article 8
First year (since 2010) The first year of the studies of health (ex-PACES, currently called PASS) is common to the medical studies, dental, pharmaceutical and midwife (sometimes also 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: a baccalauréat degree; a diploma of "access to academic works"; a French diploma or foreign diploma that can be considered equivalent to the baccalauréat pursuant to the national regulation; a qualification or an achievement considered to be sufficient.
As for any formation of system LMD, the year is divided 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 fields.Decree of October 28, 2009, article 3 Tests are organized at the end of this one; the badly classified students can be reorientated in other university fields.Decree of October 28, 2009, article 5
With the second half-year, the students choose one or of the EU specific (S) to a field, in addition to the common formation. The students pass a competition at the end of the year leading to four classifications.Decree of October 28, 2009, article 8
The first year may only be repeated once. The grade is final if the student fails to pass twice.
Second year The second year (in summary PCEM 2 or P2) begins with four weeks of obligatory and non-remunerated nurse placement.Decree of March 18, 1992 relating to the organization of the first cycle and the first year of the second cycle of the medical studies, article 15 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 most 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: linear teaching: each matter is taught separately (anatomy, histology, biophysics, etc.). This type of teaching does not require great coordination between the professors, but it can lead to great redundancies, even with contradictions. integrated teaching: the students have modules gathering of the lesson of various disciplines around the same apparatus. For example, a module of neurosciences includes/understands the anatomy and the histology of the nervous system, sensory biophysics and the neurobiochimy. The student follows then a cardiopulmonary module, a digestive module, etc. coeducation: certain aspects are presented in integrated teaching, others in linear teaching.
Second cycle of medical studies
In four years, the student receives a formal and practical training 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 a numbered list of items which correspond either to pathologies, or with clinical or therapeutic situations.
Third year of medicine