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MEDICAL TRAINING in FRANCE

2. MEDICAL STUDIES in FRANCE General overview of a professionnal course at the university. age : 18 years Baccalaurat (S, ES or L)* First 2 years)Competitive examination of P.C.E.M 1 : Numerus claususIntroductory course in care - P.C.E.M 2* Under-Graduate studies (4 years)D.C.E.M

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MEDICAL TRAINING in FRANCE

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    1. MEDICAL TRAINING in FRANCE

    2. 2 MEDICAL STUDIES in FRANCE General overview of a professionnal course at the university age : 18 years Baccalauréat (S, ES or L) * First 2 years) Competitive examination of P.C.E.M 1 : Numerus clausus Introductory course in care - P.C.E.M 2 * Under-Graduate studies (4 years) D.C.E.M 1 to D.C.E.M 4 age : 24 years Final : « Examen national classant » (National ranking examination) * Post-Graduate studies (3-5 years) Internat of speciality (4-5 y), of general medicine (3 y, former Residency) ; with complementary training courses (12-18 months) age : 28-29 years Thesis for medical practice (Medical council) age : 28-31 years National competitive selection for « Chef de clinique - Assistant » or « Assistant hospitalier universitaire : AHU » (2 to 4 y) age : 32-35 years Competitive examination for « Maïtre de conférences des universités - Praticien hospitalier : MCU-PH » age : 40 year + National competitive examination for « Professeur des universités - Praticien hospitalier : PU-PH »

    3. 3 MEDICAL STUDIES in FRANCE Some sources of information « www.aventispharma.fr » : Heading Etudiants en santé « www.dcav.u-bordeaux2.fr » : Annuaire national des diplômes d’université médecine « www.bdsp.tm.fr » : Annuaire des sites et Répertoire des formations de santé françaises ouvertes aux étrangers (1997, et non actualisé) « www.chu-rouen » : CISMeF sites médicaux francophones « www.quotimed.com » : Guide des DU et DIU « www.legifrance.fr » : Textes réglementaires « www. sante.fr/concours/DHOS/Internat »

    4. 4 Organised in one of the 43 Medical schools (or Faculty) of the 32 Universities which include one (or sometimes several) Medical schools Common competitive examination in medecine, dentistery and, from 2002, midwifery 20% of the mark for a module in human § social sciences Numerus clausus (the agreed number of students) is published each year at a ministerial level, both Health § Higher education, with the total number and the distribution by Medical schools, eg,in 2004 : 5600 in medecine (5100 en 2003) ; 930 in dentistery and 975 in midwifery Other selction than PCEM 1 for Pharmacy : 2600 in 2004 MEDICAL STUDIES in France Competitive examination of PCEM 1 : some key points (1)

    5. 5 MEDICAL STUDIES in France Competitive examination of PCEM 1 : some key points (2) Very selective (22%). Rank within each Medical school, in so-called « rang utile » A maximum of 2 registrations per candidate Gateways to D.E.U.G (First 2 years in general studies) for students so-called « reçus-collés » Foreign students (non EU members states) : + 8% per Faculty, if classified in « rang utile  » and then possible acknowledgement of previous years of training, up to D CEM 4

    6. 6 Paris = 1288, among them : Paris 5 (Cochin-Necker-Broussais) = 318 Paris 7 (Bichat-Beaujon, Lariboisière-St Louis) = 280 Paris 6 (Pitié-Salpétrière, St Antoine) = 258 Paris 12 - Créteil = 123 Paris 11 - Kremlin Bicètre = 110 Paris-Ile de France Ouest = 100 Paris 13 - Bobigny = 99 Lille 2 = 323 + 67 Faculté libre = 390 Lyon 1 = 328 Bordeaux 2 = 285 Aix-Marseille 2 = 283 Nancy 1= 208 Toulouse 3 = 203 Strasbourg 1 = 187 Montpellier 1 -Nimes = 1180 Rouen = 150 Nantes = 145 Tours = 144 Dijon = 138 Rennes 1 =135 Amiens = 133 Reims = 132 Grenoble 1 = 131 Clermont-Ferrand 1 = 129 Caen = 127 Poitiers = 128 Besançon = 114 Angers = 110 Nice = 107 Brest = 104 Limoges = 101 St Etienne = 94 Antilles Guyane - Pointe-à-Pitre = 48 St Denis-de-la-Réunion = 20 Polynésie = 5 Nouméa = 3 Total = 5550. .. MEDICAL STUDIES in FRANCE DISTRIBUTION by University Hospital, University and Medical school, in 2003-2004 (1)

    7. 7 MEDICAL STUDIES in FRANCE DISTRIBUTION by University Hospital, University and Medical school, in 2003-2004 (2) In addition : * + 8% max per Faculty for foreign students (non EU), if classified in « rang utile » * 150 for Army forces : 90 in Lyon 1 § 60 in Bordeaux 2 * 30 extra for some paramedical State diplomas distributed in 7 different universities * direct access in 2nd year for 25 / 27 students from Luxembourg * direct access in 3rd year from specific Schools : 50 in medicine § 2 in odontology * other type of selection for 6 in pharmacy

    8. 8 * No personal legal reality, but contract between two independant partners : the C.H.R (Regional hospital), with sometimes several entities, managed by a Director general, and the Medical chool (so-called also Faculty or Unité de formation et de recherche : U.F.R), managed by a Dean, elected within the University, which is itself managed by a President, also elected, including several Schools or Faculties, sometimes medical ( eg, 4 à Lyon 1) * 27 CHR-U in France, including only one for Paris - Ile-de-France region : l’Assistance publique - Hôpitaux de Paris (AP-HP) * Three objectives : Specialied hospital care, Training and Research * Some departments are qualified for university training activities in some other hospitals than the CHU, by contract with a university, registered by the Ministry in charge of higher education and by the Ministry of health. eg : hôpital Sainte Anne / Paris René Descartes University for five medical specialities MEDICAL STUDIES in France The CHR-U (so-called « CHU »)

    9. 9 * DCEM 1 : same courses as for PCEM 2 (basic sciences, semiology, foreign languages) and introductory course to hospital activities * DCEM 2 : training courses in diagnostic and treatment involvement in hospital activities = Hospital student status, paid 121 € per month in 2002 * DCEM 3 : same ; paid 235 € * DCEM 4 : same; paid 263 € per month * Examination : « Examen national classant » (National ranking examination) for validation of the Undergraduate studies, then for ranking and selection of the specialist course (Internat) MEDICAL STUDIES in France Undergraduate STUDIES

    10. 10 * Internat of speciality (4-5 years) according to some specialities = Qualification in specialised medicine, with specific D.E.S = General medicine or other specialities * Thesis for practice, with specification of the speciality = State Diplôma as Doctor in medicine * Registration at « Ordre des médecins », with specification of the speciality and selection of an exclusive medical practice = Authorization to practice medicine in France, with specific conditions of nationality, of diplomas …. MEDICAL STUDIES in France Post-Graduate STUDIES : General overview

    11. 11 * Organised by the Ministry of health (DHOS-CNCI) in 7 inter-region DRASS (Ile-de-France, Lorraine, Nord-Pas-de-Calais, Rhône-Alpes, Pays-de-Loire, Languedoc-Roussillon et Aquitaine) * National Competitive examination based on a programme in general medicine ; with a maximum of 2 registrations per candidate * Tests over 2 days : clinical exercises ; diagnostic and therapeutic records * Number of postes, in qualifying hospital departments, published by decision of the MoH. eg : 1843 in 1999-2000 * Classification and choice each semester according to the rank, (1st of November and 1st of May) * Paid by the hospital, interne or resident. eg, in 2002 : 1300 € for the 1st year and 2000 € the 5th year Duration : 4 years (8 semesters) for the medical specialities and 5 years (10 semesters) for the surgical, with 2 out of a CHU. Validation of the D.E.S. Possible registration of a D.E.S.C, with 2 or 3 extra semesters * At the end : choice of a specific and exclusive D.E.S- D.E.S.C for practice MEDICAL STUDIES in FRANCE Post-Graduate : National ranking examination

    12. 12 « General » Internat and Specific Internats were 4 different ways of access to the same training and, at the end, the same diploma : the D.E.S (Diplôme d’études spécialisées) and the DESC (D.E.S Complémentaire) * Two of them are abolished in 2004, the General Internat and the specific Internat in occupational medicine, but with a 2nd round Two Internat will be maintained : - European Internat : - registration conditions : french, andorrans or EU country members, doctors in medicine with 3 years of professional practice - organization : DRASS Aquitaine - - 100 postes in 2002 - Foreign Internat MEDICAL STUDIES in France Post-Graduate : Competitive examination of specific Internats

    13. 13 MEDICAL STUDIES in France Foreign Internat Foreign Internat, reformed in 2002 Replace the former Foreign Internat (old version) and the so-called D.I.S : remember, the former competitive examination called « DIS » (Diplôme inter-universitaire de spécialisation), specifically for foreign doctors, was abolished in 1999, but some trainees are still in the hospitals - registration conditions : non EU doctors in medicine - organization : Ministry of health (Direction de l’hospitalisation et de l’offre de soins : DHOS - Centre national des concours de l’internat : CNCI) See « www.sante.gouv.fr - Rubrique Emplois et concours - DHOS - Concours Internat étranger » - competitive examination by speciality - 1st test in French embassies or in Paris - final test in Paris, with a number of applicants twice the number of places given (100 in 2004 ?). Start the 1st of May

    14. 14 * Both for D.E.S and D.E.S.C - National diploma , with a ministerial decision, both for Faculty authorization and agreement of the pedagological frameworks - One coordinator by speciality in each Faculty - Combination of hospital semesters with obligatory internships according to a speciality, directed internships for some specialities (eg : in pedo-psychiatry for the D.E.S in paediatrcs,) and free internships * Specific - Number : 32 D.E.S and 32 D.E.S.C - Duration : * D.E.S : 4 years for medical specialities and 5 years for surgical * D.E.S.C : open to some D.E.S : 2 - 3 years, with half before the end of the Internat and the other half after MEDICAL STUDIES in France Post-Graduate : D.E.S and D.E.S.C : some key points

    15. 15 MEDICAL STUDIES in FRANCE Post-Graduate : DIPLÔME D’ETUDES SPECIALISEES (D.E.S) Duration : 4 - 5 years 10 disciplines and 32 specialities of the D.E.S : Medical (18) : Pathology - Dermatology - Endocrinology - Gastroenterology - Medical genetics - Hematology - Internal medicine (5 years) - Nuclear medicine - Rehabilitation and physical medicine - Nephrology - Neurology - Oncology (medical ou radiotherapy) - Cardiovascular diseases - Paediatrics - Pneumology - Radiology - Rhumatology - Medical gynecology Occupational medicine (1) : 4 years - Public health (1) : 4 years Surgical (5) : General surgery - Neurosurgery - (5 years) - Ophtalmology - Eye-Nose § Throat (ENT) - Stomatology Medical biology (1) : 4 years Psychiatry (1) : 4 years Gynecology and obstetrics (1) : 5 years - Paediatrics (1) : 4 years Anesthesiology and surgical resuscitation (1) : 4 years General medecine : 3 years

    16. 16 MEDICAL STUDIES in FRANCE DIPLÔME D’ETUDES SPECIALISEES COMPLEMENTAIRES (D.E.S.C) * Group I (no qualification) D.E.S.C in Medicine (16), 4 semesters : Addictology - Allergology and clinical immunology - Andrology - Cancerology - Face and neck surgery - Geriatry (6 semesters) - Hematology and transfusion - Forensic medicine and medical expertises - Reproductive medicine and medical gynecology - Vascular medicine - Nutrition - Maxillo-facial orthopaedics-- Infectious and tropical diseases, clinical and biological - Clinical pharmacology andt therapeutical evaluation - Psychiatry of the child and teeanger - Medical rescuscitation D.E.S.C in Medical biology (8), open to D.E.S of pharmacy, 4 semesters : Hormonal and metabolic biochemistry - Biology of infectious agents - Molecular biology - Human cytogenetics - Biological hematology - Pharmacology and drugs metabolism - Radiopharmacology and radiobiology - Biological toxicology * Groupe II (qualification) : D.E.S.C of Surgery (8), 6 semesters : Paediatric Surgery - Maxillo-facial and traumatological Surgery - Orthopaedics and traumatological Surgery - Plastic Surgery, reconstructive and aesthetic - Thoracic and cardio-vascular Surgery - Urology - Vascular Surgery - Digestive Surgery

    17. 17 MEDICAL STUDIES in France Post-Graduate : CAPACITES - D.E.S.S - D.U § D.I.U (1) CAPACITES D’HABILITATION NATIONALE conditions : all medical officers, french or foreigners, general practitionners or specialists, with a preliminary examination national diploma, with a complementary qualification duration : 1 year : Aeronautic medicine - Sport medicine and biology - Medicine of the disasters; or 2 years : Allergology - Angiology - Pain evaluation and treatment - Gerontology - Hydrology and medical climatology - Medicine in prison - Tropical medicine - Emergency medicine / CAMU - Medicine and justice practices - Transfusion technology - Addictions and alcoology DIPLÔME D ’ETUDES SUPERIEURES SPECIALISEES (D.E.S.S) conditions : professional training, non clinical, limited accesss national diploma ; duration : mainly one year ; number of types : about 40

    18. 18 MEDICAL STUDIES in FRANCE Post-Graduate : CAPACITES - D.E.S.S - D.U § D.I.U (2) D.U (DIPLÔME d’UNIVERSITE) et D.I.U (DIPLÔME INTER-UNIVERSITAIRE) conditions : access with baccalauréat diploma with local regulations, at the level of each institution duration : large spectrum, from some weeks to 5 years number : about 2000 for the health sector, most of them from 1 to 2 years

    19. 19 MEDICAL STUDIES in France HOSPITAL INTERNSHIPS On hospital budget Internship for introduction to hospital care, so-called « nursing », PCEM 2 Internships for introduction to hospital activities : compulsory and unpaid, Hospital student, compulsory in the morning, paid from DCEM 2 to DCEM 4 Interns of speciality or Residents in general medicine : full time Faisant fonction d’internes (F.F.I), from vacant positions of Internes, or short-term basis hospital positions, or with medical « vacations », with preliminary and compulsoy registration in A.F.S or A.F.S.A (decree February 1992), but not in D.U § D.I.U Foreign associated trainees, with no university registration but with an international inter-hospitals agreement ; duration : 6 months, renewable (drcree 25.10.2002, but no specific order so far) Temporary authorization for practice, based on the decision of a commission Out hospital budget (personal, other french or foreign institution …) = Observer with no clinical responsability

    20. 20 MEDICAL STUDIES in France SPECIALISED TRAINING COURSES OPEN TO FOREIGN MEDICAL OFFICIERS (1) remember : D.E.S - D.E.S.C ; Capacités ; D.E.S.S ; D.U et D.I.U A.F.S (Attestation de formation spécialisée) - conditions : medical officer (non UE citizenship) in the process to be a specialist in their country of origine; with preliminary agreement from their university and the coordinator of the D.E.S required, in the selected French faculty of medecine certificates of the D.E.S = « partial » D.E.S duration : 2 to 4 semesters, without systematic salary from the hospital (sometimes a F.F.I position), and back in the country of origine to finish the speciality studies A.F.S.A (A.F.S approfondie) conditions : medical officer (non UE citizenship), already qualified as a specialist in their country of origine; with preliminary agreement from the coordinator of the D.E.S.C required, in the selected french Faculty certificates of the D.E.S.C. = « partial » D.E.S.C. - Duration : 1 or 2 semesters

    21. 21 MEDICAL STUDIES in France TRAINING COURSES for/by la RESEARCH MS.B.M - D.E.A - University Thesis (PhD) - H.d.R (1) M.S.B.M (Maitrise des sciences biologiques et médicales) conditions : registration in a training course in the field of health (medicine, pharmacy, ondontology, veterinary), from the 2nd year of studies (PCEM 2 for medicical students) and success at 3 certificates among a selection of 27 national diploms given at the end of the Under-graduate studies near abolition D.E.A (Diplôme d’études approfondies) conditions : preliminary M.S.B.M or equivalent ; duration : one year national diploma near abolition

    22. 22 MEDICAL STUDIES in France TRAINING COURSES for/by RESEARCH MS.B.M - D.E.A - PhD in Sciences - H.d.R (2) University thesis (PhD) in sciences : 3 years for Doctorate H.d.R (Habilitation à diriger des recherches) conditions : preliminary Doctorate and a D.E.A, or equivalent ; Acknowledgement of a high scientific level of a candidate for student training capacities Both medical and scientific courses is now becoming compulsory for a university hospital career, whatever the speciality

    23. 23 MEDICAL STUDIES in FRANCE Under-Graduate (DCEM 2 to 4) Studies Reform Started to be implemented in 2002 1st part : 11 modules cross-disciplines and themes Learning medical practice - From conception to birth- Maturation and vulnerability - Handicap, uncapability and dependence - Ageing - Pain, palliative care and support - Health and environment, communicable diseases - Immunopathology, reaction and thrombosis - Cancerology, onco-hematology - Clinical and therapeutical synthesis : from complaint of the patient to medical decision, emergencies 2nd part : Diseases and important syndroms eg : Chronic renal failure 3rd part : Diagnostic trends in front of ... : eg : Headaches

    24. 24 MEDICAL STUDIES in France Post-Graduate Studies Reform Internat in medicine Reform in 2004 * Abolition of the competitive examination (organization only of the 2nd session of the former « Internat of speciality ») * « Examen national classant » (National ranking examination) taken into account after validation of DCEM (clinical questions), organized in 7 inter-regions : Paris - Lyon - Marseille - Nantes - Bordeaux - Lille § Strasbourg then ranking and choice between the different specialities (D.E.S and D.E.S.C) : Internat in general medicine or in other specialities

    25. 25 MEDICAL STUDIES in FRANCE 1st § 2nd year Studies Reform - Organization in E.C.T.S (European credit transfer system), partly done - Competitive examination in PCEM 1, open to 14 health professions : presentely : medical doctors, dentists - midwifes, then possible for pharmacists, physiotherapists - nurses - occupational therapists - psychotherapists - orthoptists - pedicure - hearing aid specialists - radiology technicians - laboratory technicians ? With a numerus clausus for each profession, with different tests ? Pathways between health professions curricula ? and with other university curricula ?

    26. 26 MEDICAL STUDIES in France EUROPEAN REFORM ? Restructuring programme of the university studies, according to the new european general framework defined as « 3 - 5 - 8 », then « L-M-D », and based on : L = License, in 3 years (180 credits in 6 semesters) M = Master, Pro or Research, for non medical disciplines, in 2 years (300 credits in 10 smesters) will replace DESS and DEA, but not as a the post-Graduate level D = Doctorate (PhD), in 3 years (420 credits in 16 semesters) However, the university courses in the field of health have some important specificites, in every country of the European Union; eg : total duration of the specialist medical studies over 10 years Master degree in medical studies over 6 years, and not 4 years ….

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