Studying in France
Michel Lièvre and Behrouz Kassai describe what it takes to be a "docteur en médecine"
The medical curriculum lasts from eight and a half to 11 years and ends with a viva that confers the title of "docteur en médecine" (MD). This curriculum is being reformed and the new version should theoretically be in place in 2002. It will go some way to harmonising it with other European systems.
The French healthcare system is split into the public
and private sectors, to which patients have unrestricted
access. Funding is basically ensured by the state social
security system. This reimburses medical, surgical, and
prescription expenses up to a certain level, known as
the conventional rate. The difference between the conventional rate and the real expense or "ticket modérateur" is paid by the patient or by the patient's private healthcare insurance. The social security system has
accumulated a large deficit, which an inventive set of
taxes has not succeeded in making up.
Major problems
Because of the anticipated increase in the medical
needs of an ageing population and the age profile of
the doctors at present working, the number of
trainees needs to increase.
There is a widening psychological gap between
the state - mainly the social security system - and the
private sector, which rejects any kind of control and
generally is not interested in containing costs.
A poor penetration of evidence based medicine
may contribute to the relentless increase in health expenditure.
Who can study medicine?
Theoretically, anyone with the equivalent of
A levels can study medicine. Practically, however, chances of success depend on the type
of A levels students have. More than 90% of
medical students have a scientific A level,
some have economic and social ones, and
only a few have studied literature.
Students can study in any one of the
43 faculties of medicine in the public
university system (including one in
Guadeloupe) or in the unique free
Catholic faculty in Lille.
At the end of the first year of
the first cycle of medical studies, students take a classifying exam. In 1999, 3730 (16.5%) passed.
The qualifying exam may be taken only twice.
Three cycles of medical studies
The first cycle comprises two years and a transitional year. The
teaching includes biology, physiology, anatomy, biochemistry,
pharmacology, and bacteriology and is mostly based on lectures.
Most students take their own notes in the first year, but after that
two students take notes which are printed and distributed to subscribers to one of the student organisations.
During the second cycle the teaching is mainly in the clinical
specialties and therapeutics, and there are four training courses
of three months in hospital.
The third cycle is essentially a practical training. It lasts four or
five years for students who want to be specialists and two and a
half years for students who want to be general practitioners. All
students must write a thesis if they want to practise. They must
also register with the Ordre des Medecins, the French equivalent to the UK's General Medical Council. Both regulate the profession using similar powers and a similar code of practice. Once qualified, specialists can work in the private or public sector. General practitioners are all private and run a fee for service system.
Life as a student
Tuition fees are low (FF849 (£77) a year plus FF1100 for social
security). Although grants are available, they are small and
their size depends on means testing of parental income.
Low rate state loans are available for a small number of students. It is now relatively easy to find a room in a hall of residence (FF1200 a month), and waiting lists are short.
Interns generally find low cost rooms in the hospital.
Sports facilities are usually not available in medical
schools because sport has no dedicated place in the
curriculum and is not promoted by academics.
Students can use other university sports facilities
at very low cost. But students who decide to take
the internship classifying exam have little time
to spare for sport. Cultural or social activities are also rare.
photo ©AFP
Dr Michel Lièvre, Service de Pharmocologie Clinique
Email: michel.lievre@upcl.univ-lyon1.fr
Dr Behrouz Kassai, Service de Pharmocologie Clinique, University of Lyon Institute of Medicine
Email: bk@upcl.univ-lyon1.fr
studentBMJ 2000;08:303-346 September ISSN 0966-6494
