“Half a point less and we lose 1,000 places”: medical students warn about their 6th year competition

This is the first year that the reform of Medicine studies is applied 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: “To make it easier for students, not in terms of studies, but easier to live for good – be of students. This is the first year that it undergoes this reform. »

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 because we have less time to prepare for the competition. Although organizing an oral exam is very interesting, as is being evaluated on our clinical skills and our ability to empathize with patients. But it’s actually a disaster. »

A disaster that is even more stressful for students because their grade at the end of the exam counts for 30% of their final grade. “One point less in the final grade and we lose 1,000 places in the classification,” worries James, in his 6th year in Tours, who after the writings could have the possibility of finishing his studies in the same city as his girlfriend, who is also in 6th grade. Because the year is decisive for these students: once they have passed the competitive examinations, their classification determines both the specialty they will be able to pursue and the city in which they will be able to settle during the first years of their career. There is a lot at stake in such an exam 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 previously defined acting games. An organization that must be created before D-Day and that the oral drills on March 12 should allow it to be done. Although they only made up 5 clinical cases, the course of the tests caused them to break out into some cold sweats. “Each song lasts 8 minutes,” explains Carla, “and we have a jury, one member of which comes from our university and the other 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. Firstly, there may be one of the doctors in the practice jury who did not like us during our practices, then the standardized patients make mistakes or sometimes forget their text. »

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 his house 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 bathroom, so I could ask him fewer questions about the circumstances of the fall. Other people told me that his actor responded that he was sitting next to the patient and saw him fall. However, the patient is supposed to be standardized! », Louis laments: “We do not have the same methods to access knowledge. The same thing: when I asked if his brother took medication, the actor gave me a prescription while a friend responded ‘I don’t know’, he had to put in the word prescription so I could give it to him. But we only have 8 minutes to research everything out there, we don’t have time to rephrase our requests in three different ways! »

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 is artificial and far from real,” James illustrates, adding: “In real life, we must provide the patient with comprehensive care and, above all, not be harmful, while in OSCE the objective of the game is to find the that “The keywords are on the grid so as not to lose points, even if that means losing the initial objective which is: cure. »

“We know the tests are unfair! »

The students launched a petition that has already collected more than 7,000 signatures and they intend to go further. “We are considering turning to a lawyer to initiate an emergency procedure. We do not want to eliminate these oral presentations but rather make them validating rather than classifying. “That allow us to evaluate the ability to have empathy and listen to the patient, yes, but not to classify the students,” Carla continues: “We know that the tests are unfair, that topics have been leaked, that the standardized patients did not say the same to the students! »

The very configuration of the rooms poses a problem. Although Tours acted as a good organizer for James and Louis, once they crossed the exam door, difficulties arose. “Some stations will be quieter, especially when we have to simulate a clinical exam. As the walls are thin, I can hear the station next door talking, which I have already passed or have not passed yet… In some universities, these are partitions that allow the stations to be separated! »

The jury, which has two minutes after the candidate leaves, must deliberate on their passage and clear the tables of any draft or notes that could influence the next candidate. “Unfortunately, they referred us when we did not necessarily have the diagnosis,” laments Louis, who does not point out 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 contain themselves with the wear and tear of the day! »

Any news to come?

On the part of the ministry, we try to reassure the students. “The OSCE training day on Tuesday, March 12, aimed to test the examination centers in preparation for the national OSCEs in May,” explains the Ministry of Higher Education: “Some difficulties have been detected (…). As indicated in the ANEMF press release We are in contact with them and we commit, with the Ministry of Health, to be transparent about the anomalies observed and the responses we will give to 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 collaboration with the deans of medicine and the national management center. »

When contacted, the Conference of Deans did not respond to us but assured us in a statement that it supports the reform although being aware of the problems that these tests can pose: “The ‘classification’ nature of the OSCE imposes very important organizational limitations (…) The The conference is very attentive to the implementation of the system and has been advocating for a gradual rollout since February 2023. Furthermore, most countries that organize such exams do so within a simple validation framework. » Enough to give a little hope to the students, although “this organization is governed by a decree of the Council of State, the modification of the rules will be delicate and the test next May can only be subject to small adjustments. »

At the moment, nothing can calm the discontent of the students. “We know very well that a good number of students will be willing to resort if things go wrong,” says Carla. “If students refuse to take these oral exams, and therefore repeat a year, we could further reinforce the shortage of interns in hospitals. »

(*names have been changed)

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