Admission into healthcare education in France: Half-baked reform that further complicates the system

Abstract

France has undertaken the most ambitious reform of healthcare education in more than 10 years. It has resulted in a hybrid system with multiple pathways, granting admission into the healthcare professions after competitive exams. The reform continues the trend to increase the quotas limiting the number of second year healthcare students, and also creates new local access options to healthcare education. However, the heterogeneity in implementation has led, in conjunction with the difficulties caused by the Covid-19 pandemic, to great dismay among students and parents. This article seeks to outline the historical underpinnings of the reform program(s) and argues that the core question – selecting students from the very high number of candidates in a fair and effective manner – remains largely unresolved.

Keywords:

• Undergraduate medical education
• healthcare professions
• selection
• workforce shortage

Acknowledgements

The analysis draws on literature and interview data collected during the project REF-SANTE. The authors wish to thank Patrick Hassenteufel, Ulrike Lepont, Patrick Castel and Henri Bergeron for their kind support, and Alexander Parry for editing the manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Numerus clauses (latin term for ‘closed number’): is a means to limit the number of students admitted to a university program. Often set regionally or at the national level, the numerus clausus regulates, eventually, the number of graduates in a given discipline. Typical examples include the admission to medical schools in France or Germany.

Notes

1 https://cache.media.enseignementsup-recherche.gouv.fr/file/2019/12/7/NF_8_2019.04.17_1112127.pdf

2 The parameters to choose a student are defined by the universities, and not all of them are public.

3 This first year was termed PACES – Première Année Commune aux Etudes de Santé, see also (Collet 2019). In 2020, 62% of the students admitted to the second year of healthcare studies were medical students. Note that universities could and can choose to add physiotherapy to this admission system. As an alternative, and in contrast to all other clinical disciplines mentioned, candidates can also apply to private schools of physiotherapy with a distinct selection process.

4 This article uses the term healthcare studies for the analysis of these four disciplines only.

5 In this context, it is important to note why the Ministry of Health has such a high stake in the regulation of quotas: in France, the salary of medical residents is mainly borne by this Ministry. Hence, any candidate for a medical curriculum represents a later resident who directly affects the Ministry’s budget.

6 This percentage varied from 7.8% to 23.1% among universities for the period 2018–2021; see https://www2.assemblee-nationale.fr/content/download/339333/3324450/version/1/file/Mission+sant%C3%A9+-+communication+14.04+CORRIGE.pdf

7 See https://www.lemonde.fr/campus/article/2017/02/06/apres-un-echec-en-fac-de-medecine-que-sont-ils-devenus_5075102_4401467.html

8 This reflects a French particularity in that key positions within the administration are held by ‘elites of welfare’, senior officials with long careers specializing in health policy issues (Genieys and Hassenteufel 2015).

9 There currently is no data on the impact of a common first year of healthcare studies on (in)equalities of access. The latter are mostly attributed to social origin, currently a very salient issue in French social and education politics. Note in this context that the current reform has renewed the role of private tutor firms for healthcare education. They have set up dedicated websites and counseling in order to ‘accompany’ candidates for the various access options (e.g. https://pass-sante.com). It seems obvious that paid counseling, in particular when it comes to choosing the ‘right’ minor or major, reinforces social inequalities.

Additional information

Funding

This article has received support overseen by the French National Research Agency (ANR) as part of the “Investissements d’Avenir” program LIEPP [ANR-11-LABX-0091, ANR-11-IDEX-0005-02] and the Université de Paris IdEx [ANR-18-IDEX-0001].

Notes on contributors

Matthias Brunn

Matthias Brunn, MD, PhD, is a physician and affiliated researcher at the Laboratory for Interdisciplinary Evaluation of Public Policies (LIEPP) at Sciences Po Paris.

William Genieys

William Genieys, PhD, is a CNRS research director at the Centre for European Studies and Comparative Politics at Sciences Po Paris.