French medical studies are undergoing radical changes, not only because of their integration into the Bologna process but also as a result of a reform which is introducing a common first year for trainee doctors, dental surgeons, pharmacists and midwives under the renamed 'health studies'.
The Bologna process, which started in 1989 in Europe, is having very direct effects on medical education. It took some time for medical education to be included in the process - this only happened in 2007 - because Bologna mainly involved ministers of education while postgraduate medical education falls under the remit of health ministries.
"But Bologna has been an opportunity for deep reforms in higher education that were not possible before," said Madalena Patricio, President of the Association for Medical Education in Europe, AMEE.
"One of the focuses of Bologna is on the student and learner and not the teacher or the content. The focus is on the objectives of medical training, rather than knowledge," she said, adding that this would help increase the mobility of medical professionals between countries.
France has been introducing the Bologna process into medicine, with degree equivalence already accomplished at bachelor and masters levels, and with doctoral integration underway.
Ingrid Bastide, president of the medical students' association ANEMF, said it was "already the case" that students were keen to go abroad for part of their medical studies, but not many countries were yet participating in the process.
In 2009-10, 4,121 European students studied medicine, dentistry or pharmacy in France, including 3,525 from the European Union.
About 40,000 school-leavers a year enrol to study medicine in France. As with other initial university courses there is no pre-selection process - and this has annually resulted in a brutal cull at the end of the first year, when only between 10% and 20% of medical students pass the concours, the competitive examination.
Even some candidates who achieve a pass mark can be refused entry to the second year because of the numerus clausus - the government quota on numbers, fixed according to the nation's perceived medical needs.
The first objective of the reform was "to fight against the human wastage which for a majority of students in the first year of health studies represents", said Valérie Pécresse, Minister for Higher Education and Research, last year.
The reform, introduced at the start of the current 2010-11 academic year, will not cut the high failure rate but gives rejected students the opportunity to transfer more easily to other disciplines, paramedical or otherwise, without having to start from scratch. It offers new options and more choices.
Under the reform the first year of medicine has become the first year of 'health studies', which begin with a common curriculum for all students for the first semester then divide into four courses of medicine, dentistry, pharmacy and midwifery. Students may sit end-of-year exams in one or more of these disciplines.
From the first-semester exams the weakest students can be directed to change to other bachelor-level courses. Those desperate to study medicine can re-enrol for the first year if they acquire further scientific knowledge.
To qualify as a medical doctor requires nine years for a general practitioner, or 11 for a specialist; six years for dentists and pharmacists; and five years for midwives.
All articles in the Special Report: The Internationalisation of Medical Education
GLOBAL: Internationalisation and medical education
ASIA: World-class medicine pursuit drives collaboration
MIDDLE EAST: Medical cities seek foreign academics
INDIA: Medical education gets international flavour
CARIBBEAN: Medical schools battle to retain US access
SOUTH AFRICA: Cuba helps to train rural doctors
AUSTRALIA: Overseas doctors fill large gaps
FRANCE: Medical reform aims to fight 'human wastage'
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