IMPLEMENTATION OF THE BOLOGNA PROCESS IN FRANCE Prof B. CHARPENTIER Honorary Dean FACULTY of MEDICINE-UNIVERSITY PARIS SOUTH 11 Past President of the French Medical Deans’council Member of the French Academy of Medicine

THE ANSWER IS NO ! WHY ? A levels # Baccalauréat Bologna Process French Medical Training -L1 -PACES -L2 -P2 -L3 -D1 -M1 -D2 -M2 -D3 -D1 -D4 -D2 -RESIDENCY: 3-5 Y -D3 -M D: 2+4+3/5= 9-11 Y DOCTORATE 3+2+3=8 Y - Chef de Clinique: 2-4 Y

TWO PARTICULAR FEATURES OF THE FRENCH EDUCATIONAL SYSTEM : (1) Grandes Ecoles vs University: How to select the Elites ? CPGE1+1 High Schools Doctorate X-ENS-Centrale less 40% A Levels 4 Y 3Y (Baccalauréat) candidates University (85) L1 L3 ( -60%) -50% filière G ( S-ES-L/A ) M1 M2 ( -30%) -25% filière T-V D1 D3 -25% filière P-V -Success rate: 86%

TWO PARTICULAR FEATURES OF THE FRENCH EDUCATIONAL SYSTEM : (2) PACES PACES (S1/S2– 2 inscriptions ) chemistry biology physics anatomy social sciences Students Medicine 7500 Pharmacy 3595 Dentistry 1200 Midwife 1017 Physiotherapy Speech therapy L1 ? ECTS

FRENCH FACULTY OF MEDICINE - Derogatory clause within University - Competitive selection for entrance -Professionnal School « we teach the job we are doing, we do the job we are teaching… », What’s about the applicated job of Professors of canon law, of sanskrit, of esperanto ? -French Faculties of Medicine are linked to several teaching hospitals where all faculty members must teach, doing research and clinical/biological patient care.

FRENCH TRAINING TRENDS - USUAL TRAINING: 3 steps 1) TRAINING 2) GUIDANCE 3)SELECTION - FRENCH TRAINING: 2 steps -1) TRAINING 2) SELECTION ( BUSINENESS- ADMINISTRATION-MEDICINE ) - NO BY-PASS/BRIDGE - CONCLUSION: eveything is done at 20 y.o. !!! -

A STRONG EXAMPLE FOREIGN STUDENTS/MD -PACES: 8%----less 1% vs 17% -D1---upon personal file examination -D4

BY-PASS seats - GRANDES ECOLES AFTER CURSUS COMPLETION ( 6 y) - Ph D ( 8 y )

BASIC SCIENCES -PACES anatomy --P2 physiology…. --D1 semiology…

CLINICAL TRAINING -D1: introduction with nursing care + semiology teaching at the bed side -D2-D4: ½ time to the bed side + on call+teaching pathology/therapeutics -RESIDENCY ( 3 y GP/ 4-5 Others): full time bed side+ on call+ teaching specialty -Early contact at the bed side-strong clinical training

ECN ( National Ranking Examination ) 7000 D4 1 specialty+location -39 Faculties of Medicine/7 regions -All Faculties are ranked along with the students ranking -Location 1st choice: big campus ( Paris, Lyon, Marseille…) - GP 50%, second half 2 D. exam 9 clinical cases + questions + 2 paper analysis 7000

RESIDENCY -GP: 3y training course mostly in GP office -SPECIALTIES: 4-5 y in University Hospitals -Courses must follow the national teaching program -Examination: attendance+ thesis MD + specialist in… (+9/+11 y)

-Temporary seniorship: 2+1+1=4 - Job: teaching+researching+care - Located in University Hospitals - DESC validation ( subspecialty ) - Goals: Academic/public activity ( HP to PU-PH ) Private activity CHEF de CLINIQUE-ASSISTANT

SPECIAL TRAINING FOR MD+PhD -M2 during residency ( 1y in a research lab) -Ph D during CCA ( 3y+X in a research lab) -Post-Doc abroad ( 2-3 y, publish or perish ) -EXAMINATION: Habilitation à diriger des recherches -National Competitive Examination to a full tenure track position ( PU- PH/MCU-PH):CV+Publications+teaching activity+oral test in front of 2 successive board of examiners (national+local): yo !

FRENCH TRAINING COURSES FOR FOREIGN MEDICAL OFFICER 1 – Attestation de formation spécialisée ( AFS ) - Medical officer non UE: agreements of both Universities+french specialty coordinator+open post - Gaining partial certificates of the specialty - Duration: 1 or 2 y and back in the country 2 – AFS+A=AFSA -Specialist qualification in their country:agreements of both Universities+french specialty coordinator+open post -Gaining highly selective knowledge ( robotics, endovascular manip. -6 or 12 months

BOLOGNA PROCESS AND FRENCH MEDICAL TRAINING MOBILITY IN EUROPE -1) Europe to France-2 nd cycle D1-D4 Belgium-Germany-Netherlands-Spain-Switzerland-Italy -2) Europe to France- Residency ( part or full/special examination) Belgium-Germany-Netherlands-Spain-Switzerland-Italy -3) France to Europe-2 nd cycle -Few ones ( languages limitation), except Belgium-Switzerland -4) France to Europe-1st cycle: PACES in Romania

BOLOGNA PROCESS AND FRENCH MEDICAL TRAINING ADVANTAGES -Master grade level at the end of D4 ( 5vs6 y) ?for « escaping » medicine with a diploma -ECTS for European mobility ( Socrates, Erasmus…) -validation of different courses in Europe for medical training -European Doctoral Schools ( Masters and Doctorates/thesis in co- supervision)

BOLOGNA PROCESS AND FRENCH MEDICAL TRAINING DRAWBACKS -TIME OF THE CURSUS VERY DIFFERENT ( 8 vs 9-14 y), French cursus too long ? -FEW GATEWAYS ( Phd----D1) -Intensive clinical training vs less basic training -Tight control of the government ( teaching hours, program, numerus clausus, specialties volume, training of foreign students,…) -weak french mobility in Europe ( the goal is to pass an exam in order to have a job…)

BOLOGNA PROCESS: Last Minute ! « the european higher education space is not a model to be exported, Africa, Asia, Norh/South America have their own specificities and needs » EUA Lesley Wilson, General Secretary- 16/04/2012, address to the European Higher Education Ministies for the Bucarest meeting (26-27/04/2012)

EUROPEAN DREAMS IN AN O.R. !

The Reasons for my existence have not yet been established…but