This is the first year that the reform of medical studies applies to these 6th year students.
“It is organized in a context of desire to change the competition,” explains Carla*, a student at a Parisian university: “So that it is simpler for the students, not in terms of studies, but simpler to live with for the well-being of students.
This is the first year to undergo this reform.
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The principle, on paper, seems clear: instead of a single written exam at the end of the sixth year of study, the exam consists of a written exam at the beginning of the year and an oral exam at the end. .
“The idea was to avoid cramming,” explains Carla, “but the workload is terrible, especially since we have less time to prepare for the competition.
Even if setting up an oral exam is very interesting, as much as being evaluated on our clinical skills and our ability to empathize with patients.
But in reality it is a disaster.
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A disaster that is all the more stressful for the students because their grade at the end of the test counts for 30% of their final grade.
“One point less on the final mark and we lose 1,000 places in the ranking”, worries James, in 6th year in Tours who after the writings could have a chance of finishing his studies in the same city as his girlfriend, she is also in 6th grade.
Because the year is decisive for these students: once the competition has passed, their ranking determines both the specialty they can pursue, but also the city in which they can settle for the first years of their career.
The stakes of such an exam are high and the pressure to perform well is great.
An unfair test
The oral exam, over two days, requires them to solve 10 diagnoses based on acting games defined in advance.
An organization which must be established before D-day and which the mock orals on March 12 should make it possible to do so.
Although they only composed 5 clinical cases, the course of the tests gave them a cold sweat.
“Each topic lasts 8 minutes,” explains Carla, “and we have a jury, one member of which comes from our university and the other person from outside.
We have to play the role of the doctor and in front of us there are standardized patients, from civilian life and not necessarily trained in the medical world.
First of all, we may have had one of the doctors on the jury on internship who may not have liked us during our internship, then, the standardized patients make mistakes or sometimes forget their text!
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Louis took the oral exams at the University of Tours.
“We had a scenario where the patient was an 80-year-old person who fell at home and we interacted with the patient's brother or sister.
We had to look for all the causes that could contribute to falls at home.
When I asked my actor what he had seen, he told me that he had gone to the toilet so factually I could ask him fewer questions regarding the circumstances of the fall.
Other people told me their actor responded that he was sitting next to the patient and saw him fall.
Yet the patient is supposed to be standardized!
», regrets Louis: “We do not have the same methods of accessing knowledge.
Same thing: when I asked if his brother took medication, the actor gave me a prescription while a friend replied 'I don't know', he had to give the word prescription so that he can give it to him.
But we only have 8 minutes to investigate everything that exists, we don't have time to reformulate our requests in three different ways!
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An oral exam different from a French baccalaureate for example, which requires explaining a work and what we have understood about it.
“For us, there is an interaction with someone who is simulating, who can make a mistake or react.
It's artificial and far from being real", illustrates James who adds: "In real life, we must provide global care for the patient, and above all not be harmful, whereas in OSCEs, the aim of the The game is to find what 'keywords' are in the grid so as not to lose points, even if it means losing the initial objective which is: to heal.
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“We know that the tests are unfair!
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The students launched a petition which has now collected more than 7,000 signatures and intend to go further.
“We are considering using a lawyer to initiate an emergency procedure.
We do not want to remove these oral presentations but make them validating instead of classifying.
That they make it possible to evaluate the ability to have empathy and to listen to the patient, yes, but not that they classify the students", continues Carla: "We know that the tests are unfair, that there are had topics leaked, that the standardized patients did not say the same thing to the students!
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The configuration of the rooms itself poses a problem.
Even if Tours acted as a good organizer for James and Louis, once through the exam door, difficulties arose.
“Some stations will be quieter, especially when we have to mime a clinical examination.
Given that the walls are thin, I can hear the station next door talking, which I have either already passed or not yet passed… In some universities, these are screens which allow the stations to be separated!
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The jury, which has two minutes after the candidate's exit, must deliberate on the latter's passage and clear the tables of any draft or note that could influence the next candidate.
“Unfortunately it happened that we were referred when we did not necessarily have the diagnosis,” regrets Louis who does not point the finger at the examiners, “present from 6:30 a.m. to 5 or even 6 p.m.”.
“They are human,” James continues, “and sometimes they nod or make facial expressions that direct the candidates.
But they can't hold back with the wear and tear of the day!
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Any developments to come?
On the ministry side, we are trying to reassure students.
“The OSCE training day on Tuesday March 12 was intended to test the examination centers in preparation for the National OSCEs in May,” explains the Ministry of Higher Education: “A certain number of difficulties were encountered. detected (…).
As indicated in the ANEMF press release, we are in contact with them, and we are committed, with the Ministry of Health, to being transparent on the anomalies observed and on the responses that we will provide for the national tests in May.
The conference of medical deans and the National Management Center will also shed light on the dysfunctions observed and the responses provided.
Everyone's commitment is therefore total in this final stretch: services from the ministries of higher education and research, the ministry responsible for health, university services in conjunction with the deans of medicine and the national management center. .
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When contacted, the Conference of Deans did not respond to us but assured in a press release that it supports the reform although being aware of the problems that these tests can raise: “The 'classifying' nature of the OSCE imposes very significant organizational constraints (...) The conference is very vigilant about the implementation of the system and has been advocating a gradual ramp-up since February 2023.
Moreover, most countries which organize such examinations do so within a simply validating framework.
» Enough to give a little hope to the students, even if “this organization being governed by a decree in the Council of State, the modification of the rules will be delicate and the test next May can only be the subject of minor adjustments.
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For the moment, there is nothing to calm the students' discontent.
“We know very well that a good number of students will be ready to appeal if things go badly,” points out Carla.
“If students refuse to take these oral exams, and therefore repeat a year, we could further reinforce the shortage of interns in hospitals.
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(* first names have been changed)