Siân Knight, studentBMJ

The French prime minister, Lionel Jospin, has officially announced drastic changes to the country’s system of medical education. Currently, nine out of 10 French medical students are rejected after their first year of medical training, and plans are now being introduced to broaden the intake of medical applicants and make it easier for students to change courses should they wish to do so. The reforms have come about after two years of consultation between the ministries of education, employment, health, and student representatives and will be introduced for the 2001 student intake.

The current medical education system involves initially studying for a two year Diplôme d’Étude universitaires générales (DEUG), which is taken in a scientific field of learning. Then follows a year of intensive medical study to pass an extremely competitive exam, which an astounding 85-90% of candidates fail. This failure rate keeps the numbers of medical students down to 7000. These successful candidates usually then study for another competitive exam, the internat exam, which, if passed, gives access to training for the most prestigious medical specialisations. Passing the internat usually entails following expensive, tailor made lectures—a form of cramming that is technically illegal in France. A third of those who fail the internat turn to general medicine, forming a two tier system of medical training.

The reforms to medical education will include allowing applicants with a non-scientific DEUG to be accepted on to the medical course, but only those who have passed the exam with merit. A year’s training programme will then follow, covering the fundamental medical sciences, such as biochemistry, physiology, and genetics, before a selection exam is taken which an estimated 75% of candidates will pass. This year will be common to all students accepted for all types of medical studies, whether those are pharmaceuticals, dentistry, or medicine. The quarter of students who fail will be awarded credits which will count towards studies in other disciplines.

For the successful candidates under the reforms, after six years of post-baccalaureate study, they will receive a master’s degree in medicine. Although this does not allow them to become practising doctors it does make students eligible for work in medical research, journalism, or economics. To become a practising doctor the revised internat must be taken. This will no longer include multiple choice questions, but it will examine the reasoning and analysis of candidates in their chosen field.

Details of the reforms were given in Le Quotidien du Médecin, a medical daily paper, and Claude Allegre, France’s education minister, was quoted as saying that the current state of affairs in medical training was a “waste of human endeavour.” Calling the competitive exam “terrible,” he went on to say: “This selection is extraordinarily brutal, and France is the only country in the world which has this system.” The French government has also promised financial aid for students from less well off backgrounds.” Medical studies must correspond to an intellectual elitism not a social elitism,” said Mr Allegre.