ANEMF opposes the establishment of a one-year compulsory internship in a medical desert

Paris, Saturday 18 June 2022 – The organization of medical studies is currently in the midst of a revolution, with a reform of the first year of medicine, which has experienced a few problems, and a reform of the internship competition, which will take shape in 2024. In addition, medical students regularly challenge the government on the deterioration of future doctors’ mental health, on their precariousness, and on increasingly high-profile cases of harassment. To discuss these various issues, JIM interviewed Alexis Loupan, a fourth-year medical student and president of the National Association of Medical Students in France (ANEMF). Two years after implementation, how do you see the reform of the first year of medicine? Do not you think that there is a hidden numerus clausus left?

Alexis Loupan: There is a hidden numerus clausus in the sense that there is a numerus apertus, which limits the number of places that each university allocates in the second year. If there are no more numerus clausus as such, there is still some form of selection.

Ultimately, the results of the reform of the first year are mixed. There is a commendable desire to diversify the profile of students entering the second year. The problem is that there are some students in LAS (Editor’s note: health access license, the second access path in 2th year with PASS) who do not have a scientific profile, which is far away from the hard sciences, and who must enter the second year with an insufficient academic level to continue their studies.

But above all, it means increased reception and training capacity to let a large number of 2nd year students pass, this is still not the case and it jeopardizes our quality of education. Criticism of the reform of the first year focused especially on the oral exams. Do you think these oral words should be reformed or even abolished?

Alexis Loupan: That is the great mistake of the reform. There is a great lack of preparation by the organizers and the students. Tests were very poorly experienced and contested by the students. There is a lack of communication about expectations. Students attend an extremely important oral without knowing what is expected of them, it should not happen.

“The ECNs should be removed”

The oral speech must not be deleted, but must fulfill their purpose, that is, diversify the profiles and allow students not only to be selected on MCQs. It is an interesting goal, but the oral must be organized fairly and not burdened by lack of preparation. From 2024, the ECNs will be replaced by a new exam. Do you think it was necessary to remove the ECNs and if so, why?

Alexis Loupan: They had to be removed. ECN is three years of stupid and ugly stuff, with a strong impact on students’ mental health. The study is based on memorized learning, which does not make sense, for example, it is useless to know the dosage of all the specialties, as in the end only one is chosen. Replacing this with learning a more limited common ground is a step in the right direction, the reform was, in our view, necessary. The new exam is based on a matching procedure that has been recently explained. Are you not worried that the new system is too complex? In your opinion, is there a danger of a return to co-optation?

Alexis Loupan: There are safety precautions to prevent orals from leading to cooptation abuse. Among the two censors, there will always be one outside the faculty. It would have been disturbing if we had only been judged by the professors at his faculty. It should also be remembered that the written exam with MCQs and a standardized correction still makes up 60% of the grade. Care must be taken to avoid the same pitfalls as with first-year orals.

We still have questions about the practical application of the reform, but not about the rules of the game, which are quite well established: rank A (common base) must be validated 14/20 while rank B corresponds to the chosen specialty. There are still questions about the supporting documents that must be submitted to justify his career by the end of 6th years (internship abroad, summer job, language level, etc.). We regularly remind the services of this to clarify the situation. But once again, the rules of the game seem clear to us. The government wants to create a new year of internships for GPs, which will be conducted in a “medical desert”. What do you think of this proposal? What do you think more generally about the various proposals aimed at restricting doctors’ freedom of establishment?

Alexis Loupan: ANEMF is clearly against the establishment of a year of compulsory internship in a medical desert. We are not in principle opposed to any kind of reform, but we will definitely know in which areas we will be sent, what the remuneration will be. We do not know any of these preconditions, and therefore we have decided to mobilize against this reform. There is a high level of unpreparedness, the aim of the reform is clearly to use the captured workforce represented by trainees. They will be sent to a sub-tight area without adequate supervision. This is a danger to patients and an ethical operation.

“The outsiders are simply asking for the same remuneration as the other interns”

More generally, ANEMF considers that restricting the freedom of installation is not effective. This may deter future doctors. We only add uncertainty for students about their future and this does not solve the problem of medical deserts. It is better to take measures to comfort and encourage young doctors to settle and especially to stay in underserved areas. ANEMF recently questioned the government about the insecurity of medical students. Do you think it is financially possible to increase the remuneration of external employees?

Alexis Loupan: The state is committed to investing in the health care system, we are waiting for action. As a reminder, an intern is usually paid 390 euros a month. The outsiders are simply asking for the same remuneration. I myself am external to AP-HP, I am only paid 208 euros a month while watching patients and I perform qualified actions every day. It is a measure of social justice and, above all, an emergency to combat the precariousness of medical students.

In addition, outsiders traveling during their activity, especially in low-density areas, should be paid like any other official, that is, at the actual cost per capita. kilometer. Currently, students receive a compensation of 130 euros per month for their trip, the rest is on their own money. Several recent studies have reported on the deterioration of medical students’ mental health. What measures do you think are sufficient to combat student malaise?

Alexis Loupan: We can not separate this question from the uncertainty. You can not rest easy if you do not have enough to live on. 10% of students are constantly overweight, 25% are reluctant to continue their studies for financial reasons and 20% report suicidal thoughts. Medical students are vulnerable, so we need to protect them from harassment and abuse, whether at the faculty or in practice, and protect them from insecurity by giving them financial security. Ten years of underpaid studies, an overload of work and situations of harassment and aggression that are not sanctioned, this is not acceptable. It is regularly said that medical students are often victims of “abuse” or “harassment”, especially by their superiors. Has things gotten better in recent years? What device could allow you to curb this phenomenon?

Alexis Loupan: We see that many cases of harassment are reported and yet not treated. The Ministry of Education has promised us the training of referees at all institutions by 2023, this has not yet been done, so we will follow it with vigilance. We then ask that every proven case of harassment or aggression be sanctioned. If a hospital or faculty is not diligent enough to sanction cases of harassment, the responsibility of the institution must be committed and it must be sanctioned financially.

On sexual violence, “there are many fine words but few actions”

The mentality has evolved, but the units are struggling to keep up. We have been discussing this topic with the deans for several years, there are many fine words but little action. We are promised, for example, the establishment of devices and procedures that do not happen. What is your view on the matter at the Medical Faculty of Tours (as a reminder, the dean is accused of having “protected” a student accused of rape) and on the reaction of the administration?

Alexis Loupan: ANEMF had gone up to the plate and had done everything to publicize the affair. We wanted to make the University of Tours live up to its responsibilities. Why did you not do something when students who were allegedly victims of rape had warned the dean? Fortunately, we got the ministry to conduct an investigation.

In this type of situation, administrative disciplinary measures and the protection of victims must be put in place. This does not prejudge the criminal investigation or the guilt of the accused. We welcome this study, but if it is not followed up by the establishment of effective procedures so that it never happens again, it has been useless and there is a risk of similar cases every year. Once again, we regret that no concrete measures were taken on the spot after this investigation.

Interview by Quentin Haroche

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