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

This is the first year that the revision of medical studies is applicable to the 6th year students. “It is organized in the context of the desire to change the competition,” explains Carla*, a student of the Parisian University: “so that it is easier for students to live not in terms of studies, but for the well. – Being of students. This is the first year to go through this reform. »

The principle, on paper, seems clear: instead of a 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. Carla explains, “The idea was to avoid cramming, but the workload is terrible, especially since we have less time to prepare for the competition. Although arranging an oral exam is very interesting, as much as the assessment is on our clinical skills and our ability to empathize with patients. But in reality it is a disaster. »

A disaster that is even more stressful for students because their grade at the end of the test counts for 30% of their final grade. “One point short of the final mark and we lose 1,000 places in the ranking”, worries James, a 6th year in Tours who after writings can get the chance to finish his studies in the same city as his girlfriend, also 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 in such exams are high and the pressure to perform well is high.

Unfair test

The oral exam, over two days, requires them to solve 10 diagnoses based on pre-defined acting games. An organization that should be established before D-Day and that should make it possible to do mock orals on March 12. Although they only composed 5 clinical cases, the course of tests gave them a few cold sweats. Carla explains, “Each topic lasts 8 minutes and we have a jury, one member of which comes from our university and another person from outside. We have to play the role of a doctor and in front of us are standard patients from civilian life and not necessarily trained in the medical world. First of all, we may have doctors on the jury at the internship who did not like us during our internship, then, standard patients make mistakes or sometimes forget their writing! »

Louis took an oral exam at the University of Tours. “We had a scenario where the patient was an 80-year-old man who fell at home and we had a conversation with the patient’s brother or sister. We had to find out all the reasons that could have contributed to the fall in the house. When I asked my actor what he saw, he told me that he had gone to the toilet so I could actually ask him fewer questions about the circumstances of the fall. Others told me that their actor replied that he was sitting next to the patient and saw him fall. Yet the patient has to standardize! », Louise regrets: “We don’t have the same methods of acquiring knowledge. Same thing: When I asked if his brother had taken medicine, the actor handed me a prescription when the friend replied ‘I don’t know’, he had to word the prescription so he could give it to him. But we only have 8 minutes to check everything that exists, we don’t have time to revise our requests in three different ways! »

For example an oral exam different from the French Baccalaureate, which requires explaining the work and what we understand about it. “For us, an imitation is an interaction with a person, who can make a mistake or react. It is artificial and far from being real”, explains James, who adds: “In real life, we should provide global care for the patient, and not be the most harmful, while in the OSCE, the aim of 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. »

“We know the tests are unfair! »

The students started a petition that has now collected more than 7,000 signatures and wants to go further. “We are considering using a lawyer to start the emergency process. We do not want to eliminate these oral presentations but want to validate them rather than categorize them. That they make it possible to assess the ability to empathize and listen to the patient, yes, but not that they classify the students”, Carla continues: “We know that the tests are unfair, that there were subjects leaked, that the standard The patients did not tell the students the same thing! »

The arrangement of the room itself poses a problem. Even if Tours acted as a good organizer for James and Louis, difficulties arose once out of the examination gates. “Some stations will be quiet, especially when we have to simulate a clinical exam. Given that the walls are thin, I can hear the nearby station talking, which I have already passed or haven’t yet passed… In some universities, these are screens that allow the stations to be separated! »

The jury, who have two minutes after the exit of a candidate, must deliberate on the latter passage and clear the tables of any drafts or notes that might influence the next candidate. “Unfortunately it happened that we were referred when we didn’t have the necessary diagnosis,” laments Louise, who doesn’t point the finger at the examiners, “who attend from 6:30 in the morning to 5 or even 6 o’clock.” James continues, “They are human, and sometimes they make nods or facial expressions that direct candidates. But they can’t hold back with the wear and tear of the day! »

Any developments to come?

On the ministry side, we are trying to reassure the students. The Ministry of Higher Education explains: “The purpose of the OSCE training day on Tuesday 12 March was to test the examination centers in preparation for the national OSCE in May: “Some difficulties were encountered. Discovered (…). As indicated in ANEMF Press Release We are in touch with them, and we are committed to being transparent with the Ministry of Health, about the discrepancies observed and the responses we will provide to the national tests in May. A conference of the Medical Dean and the National Management Center will also highlight the deficiencies observed and the responses given. So the commitment of everyone in this final phase is complete: the services of the Ministry of Higher Education and Research, the Ministry responsible for health, the Dean of Medicine and the University Services in conjunction with the National Management Center. . »

Contacted, the Dean’s Conference did not respond to us but confirmed in a press release that it supports the reform despite being aware of the problems these tests could pose: “The ‘categorical’ nature of the OSCE imposes very important organizational constraints.” is (. ..) very cautious about the implementation of the conference system and is advocating a gradual ramp-up from February 2023. Moreover, most of the countries that conduct such examinations do so only within approved frameworks. Enough to give hope, even though “this institution is governed by a decree of the Council of State, the changes in the rules will be subtle and the exam next May may be the subject of only minor adjustments. »

For the moment, there is nothing to quell the students’ discontent. “We are well aware that a good number of students will be prepared to appeal if things go badly,” Carla points out. “If students refuse to take these oral exams, and therefore repeat a year, we can reinforce the lack of interns in hospitals. »

(* first names have been changed)