Question 15074 — medicine

Summary

Mr. Philippe Juvin draws the attention of the Minister of Health, Families, Autonomy and Persons with Disabilities to the reform of the competition for access to medical internships, implemented in 2024 pursuant to article 2 of Law No. 2019-774 of July 24, 2019 relating to the organization and transformation of the health system. If this reform legitimately aimed to improve the level of training of future doctors, to better guide students and break with a system based exclusively on ranking, it nevertheless raises several significant difficulties in its concrete implementation. After six years of externship, students must now take the national electronic examinations (EDN), which determine access to the objective and structured clinical examinations (OSCE). A minimum score of 14/20 for so-called rank A knowledge, considered as essential to the practice of medicine, is required to continue the course. Otherwise, students must attend a remedial session. At the end of this and in the event of persistent failure, it would seem that they can only repeat a year once, with a new failure then leading to definitive exclusion from access to the third cycle. If the overall success rate remains high (greater than 95% after remediation), this reform nevertheless introduces a major break: for the first time, certain students, although having completed six years of demanding medical studies, may find themselves definitively excluded from continuing their medical training. The threshold set for this test, combined with the limitation on repetition, thus constitutes a source of intense stress for students and psychological distress for those who fail, in a context where their level of anxiety already remains particularly high. Furthermore, several stakeholders interviewed as part of the parliamentary evaluation mission stressed that the reform had not made it possible to “decompress” the second cycle, with students having the feeling of having to acquire an equivalent volume of knowledge in a shorter time, which further reinforces the pressure weighing on them. In this context, Mr. Deputy would like to know on what precise criteria this disqualifying threshold of 14/20 was set, even though the general average required for OSCE is only 10/20 and whether it would be relevant to consider lowering it to 10/20 in order to preserve a level of requirement while limiting the effects of brutal exclusion. He also wishes to know what concrete measures are put in place to support the reorientation of permanently excluded students. access to the third cycle, in accordance with recommendations aimed at better recognizing their skills and promoting pathways to other health professions. Indeed, these students have a solid base of knowledge and skills, the loss of which would constitute a waste for both human and health system. Finally, he would like to know if the Government plans to develop this reform in order to better reconcile the requirement for quality and safety of care with the need to support students and limit the deleterious effects in terms of mental health and demotivation.

Machine translation from French. The official text remains authoritative.

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