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MEDICAL TRAINING in FRANCE MEDICAL STUDIES in FRANCE General

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MEDICAL TRAINING in FRANCE MEDICAL STUDIES in FRANCE General overview of a professionnal course at the university age : 18 years Baccalaur at (S, ES or L) * First 2 ... – PowerPoint PPT presentation

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Title: MEDICAL TRAINING in FRANCE MEDICAL STUDIES in FRANCE General


1
MEDICAL TRAININGin FRANCE
2
MEDICAL STUDIES in FRANCEGeneral 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
MEDICAL STUDIES in FRANCESome sources of
information
  •  www.aventispharma.fr  Heading Etudiants en
    santé
  •  www.dcav.u-bordeaux2.fr  Annuaire national
    des diplômes duniversité 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
MEDICAL STUDIES in FranceCompetitive
examination of PCEM 1 some key points (1)
  • 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

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
MEDICAL STUDIES in FRANCEDISTRIBUTION by
University Hospital, University and Medical
school, in 2003-2004 (1)
  • 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.
  • ..

7
MEDICAL STUDIES in FRANCEDISTRIBUTION 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
MEDICAL STUDIES in FranceThe CHR-U (so-called
 CHU )
  • 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 lAssistance
    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

9
MEDICAL STUDIES in FranceUndergraduate STUDIES
  • 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)

10
MEDICAL STUDIES in FrancePost-Graduate STUDIES
General overview
  • 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 .

11
MEDICAL STUDIES in FRANCEPost-Graduate
National ranking examination
  • 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

12
MEDICAL STUDIES in France Post-Graduate
Competitive examination of specific Internats
  •  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 détudes 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

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
    lhospitalisation et de loffre de soins DHOS -
    Centre national des concours de linternat
    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
MEDICAL STUDIES in France Post-Graduate D.E.S
and D.E.S.C some key points
  • 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

15
MEDICAL STUDIES in FRANCE Post-Graduate
DIPLÔME DETUDES 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
MEDICAL STUDIES in FRANCE DIPLÔME DETUDES
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
MEDICAL STUDIES in France Post-Graduate
CAPACITES - D.E.S.S - D.U D.I.U (1)
  • CAPACITES DHABILITATION 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
MEDICAL STUDIES in FRANCE Post-Graduate
CAPACITES - D.E.S.S - D.U D.I.U (2)
  • D.U (DIPLÔME dUNIVERSITE)
  • 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
MEDICAL STUDIES in FranceHOSPITAL 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 dinternes (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
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
MEDICAL STUDIES in France TRAINING COURSES
for/by la RESEARCHMS.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 détudes approfondies)
  • conditions preliminary M.S.B.M or equivalent
    duration one year
  • national diploma
  • near abolition

22
MEDICAL STUDIES in FranceTRAINING COURSES for/by
RESEARCHMS.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
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
MEDICAL STUDIES in FrancePost-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
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
MEDICAL STUDIES in FranceEUROPEAN 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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