Implementation of the European
higher education recommendations
regarding medical studies in Nice
Jacques LEVRAUT
Medical Education Commission
Organization of medical studies
in France until 2010
• First cycle of medical studies (basic sciences)
– PCEM1
• About 1200 students at Nice
• Anatomy, physiology, biochemistry, cell biology, human and
social sciences, histology, embriology, biophysics
• Competitive exam at the end : numerus clausus (12%)
• According to the rank: medicine (135), dentistry (40),
maieutic (30), physiotherapy (40)
• Authorization of repetition once
– PCEM2 : continuing education
• About same disciplines
• Initiation to semiology (60 hours in the hospital)
Organization of medical studies
in France until 2010
• Second cycle of medical studies (medical sciences)
– DCEM1
• Basic sciences + medical sciences
• Semiology, microbiology, pharmacology, pathology, oncology,
immunology, hematology
• Training at the hospital (semiology) : 160 hours
– DCEM2  DCEM4 :
• Externship every mornings
• 345 items divided in 11 modules + various issues
• French National Ranking Examination
– Choice of specialty and city exercise
– Internship lasting from 3 to 5 years
Third cycle
Second cycle
First cycle
Externship
Local competitive
examination
DCEM1
DCEM2
process
PCEM2
Bologna
PCEM1
DCEM3
DCEM4
Internship
National ranking
examination
The purpose of the Bologna Process is the creation of the
European Higher Education Area by making academic
degree standards and quality assurance standards more
comparable and compatible throughout Europe
The basic framework adopted is of three cycles of higher
education qualification. The cycles are defined in terms of
qualifications and European Credit Transfer and
Accumulation System (ECTS) credits:
• 1st cycle: typically 180–240 ECTS credits, usually awarding
a Bachelor's degree. In France : a Licence degree
• 2nd cycle: typically 90–120 ECTS credits (a minimum of 60
on 2nd-cycle level). Usually awarding a Master's degree
• 3rd cycle: Doctoral degree. No ECTS range given.
France : LMD system
Third cycle
Second cycle
First cycle
Externship
PCEM2
DCEM1
Bologna
Local competitive
examination
DCEM2
DCEM3
?
PACES
L1
S1
S2
L2
S3
L3
S4
?
Master ?
Licence
S5
M1
Internship
DCEM4
National ranking
examination
process
PCEM1
M2
Doctorate
?
?
S6
From September 2010 in France, implementation of PACES instead of PCEM1.
First year joint study of health
1st Semester
Common Teaching Units
Examinations 1st semester
2nd Semester
Reorientation of
students who
arrived late
ranking (last 15%)
Ranking
Choice of the students to attend
one or more specific TU
Common Teaching Units
Specific TU
Medicine
Specific TU
Dentistry
(+ Physiotherapy)
Specific TU
Pharmacy
Specific TU
Maieutic
Examinations 2nd semester
Five different rankings
Ranking
Medicine
Ranking
Physiotherapy
Ranking
Dentistry
Ranking
Pharmacy
Ranking
Maieutic
Decree of 22 March 2011 published on 13 April 2011 Official Journal
Acquisition of 180 European credits over
six semesters allowing students to acquire
a license level of general education
in medical sciences
Knowledge acquisition based on four principles:
- Rejection of exhaustiveness
- The active participation of the student
- The multidisciplinary
- The opening on knowledge
Eleven integrated teaching units
Digestive system
Nutrition
Cardiovascular system
Musculosqueletal system
Respiratory system
Endocrinology, reproduction
Immunopathology and immune response
Kidney, urinary tract, male reproductive system
Skin surface
Neurosensory system, psychiatry
Blood tissue
Ten thematic teaching units
General semiology
English
Blood tissue and immune system
Molecular and cellular pathology
Pathobiology and exploration methods
Genetics
Biostatistics
Health Society and Humanity
Infectious agents, hygiene: general issTUs
Molecular and cellular basis of drugs
Multidisciplinary
Rejection of exhaustiveness
Hospital training course
400 hours (10 x 40 hours)
Active
participation
of the student
Teaching units freely chosen
Complementary units
Research course
Opening to other
knowledges
Distribution of teaching units
between L2 and L3
• Regulatory requirements
– Each year should enable the student to acquire 60
European credits (ECTS)
– Each year must include the validation of two
semesters of 30 ECTS each
– One ECTS credit is an average of 10 hours of
instruction
• Educational wishes
– Enable the student to benefit from
pathophysiological basis as soon as L2
– Finalize each integrated teaching by a suited
hospital training period
L2
Name of the teaching unit
L3
ECTS
General semiology
English
Blood tissue and immune system
Molecular and cellular pathology
Pathobiology and exploration methods
Digestive system
Nutrition
Cardiovascular system
Musculosqueletal system
Respiratory system
Sub-total 1
2
3
3
3
4
7
4
7
6
7
46
Hospital training (200 hours)
Sub-total 2
10
56
Teaching freely chosen
Two complementary teachings
or
One research course
Total
2x2
4
60
Name of the teaching unit
ECTS
Genetics
Biostatistics
Health Society Humanity
Infectious agents, hygiene: general
issues
Molecul and cell basis of drugs
Endocrinology reproduction
Immunopatho and immunointervention
Kidney, urinary tract, male reproductive
system
Skin surface
Neurosensory system. Psychiatry
Blood tissue
Sub-total 1
4
7
3
46
Hospital training (200 hours)
Sub-total 2
10
56
Teaching freely chosen
Two complementary teachings
or
One research course
Total
3
2
3
7
2
6
3
6
2x2
4
60
Organization of L2
• Gathering of integrated teachings (organ seminars)
• Full time hospital training at the end of each seminar
TU English
Semester 3
Feb
Mar
hospital
general
Hospital
musculosquel
Apr
May
Semester 4
Jun
Exam 4
TU Gen semiol
Jan
TU musculosq
system
Exam 3
TU Mol Cell Pathol
Dec
Exam 2
Nov
TU Digest
TU
system Nutrition
Exam 1
Oct
Hospital
thorax
TU Cardiovasc TU Respir
system
system
TU Blood tissue and immune
Hospital
digestive
TU Biopath and expl meth
How to cope with the implementation
of integrated teaching
BEFORE
NOW
Physiology
CV system
Cardiac physiology
Pulmonary physiology
Digestive physiology …
Cardiac physiology
Electrophysiology
Cardiac anatomy
Cardiac semiology …
Biophysics
X rays
Electrophysiology ...
Semiology
Cardiac semiology
Pulmonary semiology …
Pulmonary system
X rays
Pulmonary physiology
Pulmonary anatomy
Pulmonary semiology …
BEFORE
Teacher of
Physiology
Teacher of
Anatomy
Teacher of
Histology
Teachers of
Semiology
Teacher of
Biophysics
CV system
Head
Lung cells
Med semiol
Electrophysiol
digestive system
Chest
Brain cells
Surg semiol
X rays
respiratory system
Abdomen
Heart cells
Biol semiol
Nuclear
neurosensory system
Pelvis
Gut cells
Radio semiol
Ultrasounds
NOW
CV system
Teacher of
Physiology
Teacher of
Anatomy
Teacher of
Histology
Allows coordinating teaching
Highlights the clinical interest
Prevents redundancy
Avoids different messages
Teacher of
Semiology
Teacher of
Biophysics
Example: one day of CV teaching
• Morning
–
–
–
–
8h00 to 9h00: Anatomy of the endocardium
9h00 to 10h00: Histology of conductive tissue
10h00 to 11h00: Biochemistry of Na and K channels
11h00 to 12h00: Electrophysiology
• Afternoon
– 14h00 to 15h00: The normal EKG
– 15h00 to 16h00: Semiology of syncope
– 16h00 to 17h00: illustrative disease: AV block
Key requirement: the prior discussion
Clinician
(cardiologist)
Anatomist
Teacher of
basic sciences
What are the main difficulties we
had to face ?
• Matching the availability of the different teachers
• Duplicate some teachings in this transition period
(coexistence of L2 and DCEM1)
• Challenging for teachers of basic science involved in
many TU
• Divide the TU between periods to meet the
regulatory requirements regarding the number of
ECTS (30 per semester)
• Find enough full-time hospital interships for all
students
• Control of the knowledge
Control knowledge
• Validation of the S3
– Two groups of teaching units to validate
• Group 1 : TU CV system, respiratory, digestive (21 ECTS)
• Group 2 : TU General semiol, PME, MCP (9 ECTS)
– A group of units is validated if the average is greater
than 10/20 and in the absence of failing score less
than 8/20
• Validation of the S4
– Two groups of teaching units to validate
• Group 3 : TU nutrition, musculosquel (10 ECTS)
• Group 4 : TU Blood tissue and immune, English (6 ECTS)
– Hospital training courses (10 ECTS)
– Freely chosen units (4 ECTS)
What are the initial feedback from
students about this reform?
• What they like
–
–
–
–
Organ seminars
“Medicalization” of basic sciences
Illustrative pathologies
Early full-time hospital internship
• What they like least
– Poor distribution of the workload over the year
– More exams over the year (4 instead of 2)
And now ...
Implementation of the L3 for next year
Thank you for your attention !!