The French National Ranking
Examination
past and future
Pr Charles-Hugo Marquette
Time course of medical studies
years 1 to 3
Anatomy
Physiology
years 4 to 6
The diseases
Residency
half time at hospital
as students
years 7 to 10 (or 11)
Internship
Full time at hospital
True responsibilities
national
ranking
examination
National Ranking Examination – the issues
years 1 to 6
core curriculum
national ranking examination
years 7 to 10 (or 11)
specialization
National Ranking Examination – the issues
internship
anywhere else
national ranking examination
years 1 to 6
native university
National Ranking Examination – the issues
Gynecology
0.4%
Biology
1.2%
Public health
1.2%
Occupational medicine
1.7%
Obstetrics
specialization
quotas
2.4%
Pediatry
4.1%
Anesthesiology
4.4%
Psychiatry
Surgery
Medical specialties
General medicine
6.4%
7.7%
16.6%
54.0%
National Ranking Examination – the issues
geographic
quotas
National Ranking Examination – the issues
where ?
what ?
where ?
what ?
where ?
what ?
where ?
what ?
where ?
what ?
where ?
what ?
where ?
what ?
where ?
what ?
where ?
what ?
where ?
what ?
National Ranking Examination – organization
Ministry of education & research
Ministry of health
Scientific boards
National center for health management
Writing & choice of
questions & topics
Organisation of
examination
Results & allocation of
positions
National Ranking Examination – program
345 items
National Ranking Examination – program
42
43
86
106
113
115
116
120
124
135
157
193
197
198
211
226
227
254
276
312
317
324
336
Addictologie : TABAC
Ex: Pulmonology 23 items
Troubles du sommeil de l’adulte
lower respiratory tract infections
Tuberculose
Allergie et hypersensibilité de l’adulte
Allergies respiratoires chez l’enfant et chez l’adulte
Pathologies auto immunes
Interstitial lung diseases
Sarcoïdose
Thrombose veineuse profonde et embolie pulmonaire
Lung cancer
Détresse respir aiguë. Corps étranger des voies aériennes
Douleur thoracique aiguë et chronique
Dyspnée aiguë et chronique
Œdème de Quincke et anaphylaxie
Asthme de l’enfant et de l’adulte
Bronchopneumopathie chronique obstructive
Insuffisance respiratoire chronique
Pneumothorax
Pleural effusions
Hémoptysie
Opacités et masse intra-thoraciques
Toux chez l’enfant et chez l’adulte (avec le traitement).
Program items and pedagogic objectives
Ex N° 86 lower respiratory tract infections
Ministry of education:
1. Establish the diagnosis of a bronchiolitis, pneumonia or broncho-pneumonia
2. Identify emergency situations & their management
3. Chose appropriate therapy and organize follow up
National college of teachers
1. Know the main clinico-radiologica presentations of community acquired LRTI :
acute bronchitis, pneumococal pneumonia, atypical pneumonia, complicated
pneumonia (empyema, abcess, ARDS)
2. Know the main micro-organismes responsible of LRTI according to underlying
comorbidities and epidemiological factors
3. Know signs and symptomes of severe LRTI
4. Identify and prioritize indication for hospitalization in LRTI (decision scores)
5. Know diagnostic means, indications
6. Know the epidemiology of nosocomial pneumonias
7. ……
8. …..
9. ….
10. Know prevention factors of LRTI
Examination – modalities
Nine stories
National
data
bank
• Likely medical stories
• Including imaging
• 6 to 8 independent questions
 answer: 4 to 8 key words
• 90% of final score
Critical comment of medical paper
• One published scientific paper
• 10% of final score
Examination – modalities
1. Clinical records
• Built in each university
• Sent to the scientific committee of the National Ranking
Examination
• Reviewing process
 Board of experts
 Less than 20 % enter the national data bank
• Obsolescence = 5 years
• Size of the national data bank : 150 – 300 stories
Examination – modalities
2. Critical reading of a medical paper
• Built in less than 10 universities
• Sent to the scientific committee of the NRE
• Reviewing process
 Board of experts
• Size of the national data bank : unknown
• Major issue : translation from English to French
Ex: Clinical record
A 65 years old man who worked a an insulator was discovered a 25 mm
pulmonary nodule. He smoked on pack/d since the age of 15. He
reports minimal hemoptysis with a normal CXR 8 months earlier. Chest
CT and spirometry show following results.
pré BD
norme
post BD
VEMS (L)
2,31
3,62
2,46
CVF (L)
4,37
4,4
4,42
1. What are the arguments favoring the malignant nature of
the nodule ?
 Presence risk factors
– age > 50 ans
– Smoking story > 3PY
– Asbestos exposure
 hemoptysis
 de large size (> 2 cm)
 Rapid growing (normal CXR 8 months earlier)
 Suspicious morphology :
– irréguliar (poorly limited)
2. What anbormalities are present on the spirometry & what
are they related to?
3. Considering his pulmonary function do you think the patient
could undergo lobectomy ?
Positon emission tomography
shows hypermetabolism of the
right hilum and of subcarinal, and
left and right paratracheal lymph
node areas
4. List four means to obtain
histological proof of the
nature of the tumor
Ex: Critical reading of medical litterature
1.
2.
3.
4.
5.
Summarize this paper in 250 words
What king of study is this ? Justify
Describe and comment the means of
consent of the patients in this study
Is there a difference in mortality between
groups ?
How do you understand the sentence
regarding the trend in major hemmorrage
in the long duration group of treatment ?
How could one confirm this trend ?
Examination – modalities
Tree days long
Nine stories
 9 x 100 points
• Duration: 1 hour per story
= 3 X 3 hours
 Monday afternoon
 Tuesday morning
 Tuesday afternoon
Critical comment of a medical paper  1 x 100 points
• Duration: 3 hours
 Wednesday morning
Wednesday afternoon … in case …
National Ranking Examination – the facts
National Ranking Examination – the facts
8 000 students
7 examination centers
500 supervisors
3 days
National Ranking Examination – the facts
Centralized distribution
National Ranking Examination – the facts
Centralized correction
National Ranking Examination – the facts
The jury
• manual correction
• two weeks long
• 500 professors
• In Paris
Results: 6 weeks later
Total score
National Ranking Examination – the facts
0.03 points between each student !!!
Discrimination ?
Rank
National Ranking Examination – the facts
only 129 items (38%)
Completeness
of evaluation ?
National Ranking Examination – the facts
4 millions €
Computerized National Ranking Examination
cNRE - 2015
Need for change
• Heavy & expensive
• Questionable relevance of ranking
• Increase of number of students
According to following principles
• Need for competent doctors
• Respect autonomy of Universities
• Promote collaborative approaches
• Chose an adaptable system
cNRE – 2015 - objectives




Rank 8000 to 10000 students
Increase accuracy of final ranking
Diversify docimology
Bring the cNRE closer to university tests &
examinations
 Harmonize chances of success at the national
level
 Avoid cramming
cNRE – 2015 - proposal
Fully computerized with automatic corrections
cNRE – 2015 - proposal
Computerized examination rooms
• Property of the University
• Logistic & computer certified
• Open source national software
• ~ 200 working places
• Safe, stable, aid stations
Computerized scientific board
cNRE - 2015
at the center of the network
Local data base
University 3
National data base
Local data base
University 2
Local data base
University 1
cNRE – 2015 - docimology

Two kind of questions
1. Closed answers (CA)




•
answer by checking a box
all answers are provided
one to several good answers
between 1 to 10 answers
Open answers (OA)



answer by tiping a text in a short field
spelling mistakes are automatically corrected
computerized correction
cNRE – 2015 - docimology
Four kind of tests
1. Isolated questions (Key-Features Problems)
= 20%
 70% CA
2. Short stories
= 50%
 CA or OA
 Progressive
3. Critical reading of a medical paper
= 10%
4. Script Concordance Tests
= 20%
Isolated questions (CA)
A 72 years old man with COPD stage 3 complains of dyspnea increase over the
past 6 months. When you look at his fingers you find something wrong. This
abnormality
A.
B.
C.
D.
E.
F.
Closed answer: A B C E
Is usually painless
Should prompt to search for
pulmonary cancer
Should prompt to search for
pulmonary fibrosis
Should prompt to search for
respiratory insufficiency
Can disappear once the
cause has been treated
Il always associated with
pain and swelling of wrist
and ankles
Isolated questions (OA)
Chest CT performed in the context of low grade fever and subacute dyspnea.
What is the most probable diagnosis ?
Open answer: miliary tuberculosis