Implementation of the European higher education recommendations regarding medical studies in Nice Jacques LEVRAUT Medical Education Commission.

Implementation of the European higher education

recommendations regarding medical studies in Nice

Jacques LEVRAUTMedical 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

PCEM1 PCEM2 DCEM1 DCEM2 DCEM3 DCEM4

First cycle Second cycle Third cycle

Internship

Local competitiveexamination

National rankingexamination

Externship

Bolo

gn

a

pro

cess

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

PCEM1 PCEM2 DCEM1 DCEM2 DCEM3 DCEM4

First cycle Second cycle Third cycle

Internship

Local competitiveexamination

National rankingexamination

Externship

Bolo

gn

a

pro

cess

Licence

PACESL1 L2 L3

Master ?

M1 M2 ? ?

? ?

Doctorate

S1 S2 S3 S4 S5 S6

From September 2010 in France, implementation of PACES instead of PCEM1.

First year joint study of health

Common Teaching Units

1st S

em

est

er

Examinations 1st semester

Five different rankings

RankingMedicine

RankingPhysiotherapy

RankingDentistry

RankingPharmacy

RankingMaieutic

Reorientation ofstudents whoarrived late

ranking (last 15%) Choice of the students to attendone or more specific TU

Ranking

2n

d S

em

est

er Common Teaching Units

Specific TUMedicine

(+ Physiotherapy)

Specific TUDentistry

Specific TUPharmacy

Specific TUMaieutic

Examinations 2nd semester

Acquisition of 180 European credits oversix semesters allowing students to acquire

a license level of general educationin medical sciences

Knowledge acquisition based on four principles:- Rejection of exhaustiveness - The active participation of the student - The multidisciplinary - The opening on knowledge

Decree of 22 March 2011 published on 13 April 2011 Official Journal

Eleven integrated teaching units

Ten thematic teaching units

Digestive systemNutritionCardiovascular systemMusculosqueletal systemRespiratory systemEndocrinology, reproductionImmunopathology and immune responseKidney, urinary tract, male reproductive systemSkin surfaceNeurosensory system, psychiatryBlood tissue

General semiologyEnglishBlood tissue and immune systemMolecular and cellular pathologyPathobiology and exploration methodsGeneticsBiostatisticsHealth Society and HumanityInfectious agents, hygiene: general issTUsMolecular and cellular basis of drugs

MultidisciplinaryRejection of exhaustiveness

Hospital training course400 hours (10 x 40 hours)

Active participation

of the student

Teaching units freely chosenComplementary units

Research course

Opening to otherknowledges

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 L3Name of the teaching unit ECTS Name of the teaching unit ECTS

General semiologyEnglishBlood tissue and immune systemMolecular and cellular pathologyPathobiology and exploration methodsDigestive systemNutritionCardiovascular systemMusculosqueletal systemRespiratory systemSub-total 1

Hospital training (200 hours)Sub-total 2

Teaching freely chosenTwo complementary teachings orOne research course

Total

2333474767

46

1056

2x2

4

60

GeneticsBiostatisticsHealth Society HumanityInfectious agents, hygiene: general issuesMolecul and cell basis of drugsEndocrinology reproductionImmunopatho and immunointerventionKidney, urinary tract, male reproductive systemSkin surfaceNeurosensory system. PsychiatryBlood tissueSub-total 1

Hospital training (200 hours)Sub-total 2

Teaching freely chosenTwo complementary teachings orOne research course

Total

3237

2636

473

46

1056

2x2

4

60

Organization of L2

• Gathering of integrated teachings (organ seminars)• Full time hospital training at the end of each seminar

Oct Nov Dec Jan Feb Mar Apr May Jun

TU Cardiovascsystem

TU Respirsystem

TU Digestsystem

TUNutrition

TU musculosqsystem

Hosp

ital

thora

x

Hosp

ital

dig

esti

ve

Hosp

ital

mu

scu

losq

uel

hosp

ital

gen

era

l

Exam

1

Exam

2

Exam

3

Exam

4

Semester 3 Semester 4

TU Mol Cell Pathol

TU Gen semiol

TU English

TU Blood tissue and immuneTU Biopath and expl meth

How to cope with the implementation of integrated

teaching

Physiology

Biophysics

Semiology

Cardiac physiologyPulmonary physiology

Digestive physiology …

X raysElectrophysiology ...

Cardiac semiologyPulmonary semiology …

CV system

Pulmonary system

Cardiac physiologyElectrophysiologyCardiac anatomy

Cardiac semiology …

X raysPulmonary physiologyPulmonary anatomy

Pulmonary semiology …

BEFORE NOW

Teacher ofPhysiology

CV system

BEFORE

Teacher ofAnatomy

Teacher ofHistology

Teachers ofSemiology

Teacher ofBiophysics

NOW

Teacher ofPhysiology

CV system

Teacher ofAnatomy

Teacher ofHistology

Teacher ofSemiology

Teacher ofBiophysics

Allows coordinating teachingHighlights the clinical interestPrevents redundancyAvoids different messages

digestive system

respiratory system

neurosensory system

Head

Chest

Abdomen

Pelvis

Lung cells

Brain cells

Heart cells

Gut cells

Med semiol

Surg semiol

Biol semiol

Radio semiol

Electrophysiol

X rays

Nuclear

Ultrasounds

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

Teacher ofbasic sciences

Clinician(cardiologist)

Anatomist

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 !!