This week I’ve been out to a few events through a website called “meetup”.I have been to an English and French conversation session which was useful. After skim-reading the site, I also signed up for a trip, which I thought was to St Maxime – a beautiful coastal town. It turns out that it was actually to St Maximin – a small town with a big cathedral and not much else. It transpired that the trip had been organised around a medieval fair… I can’t say that I would’ve chosen to do this normally, but I ended up in full armour with a ridiculous helmet, unable to see a thing and swinging a heavy sword at a Frenchman. Worse things have happened! I did get chance to speak quite a lot of French so it was a productive day in the end.
I’ve been trying to get a better understanding of how the ins and outs of the French health care system and training compare to the UK.
After chatting to some of the nurses, in most hospital services, nurses only work days or nights, with the night shift workers being reimbursed only an extra euro per hour. Shifts at “cliniques” are even more unsocial, usually running midday-midnight or midnight-midday. Nurses (from my experience in the A+E) carry out all of the clinical investigations (bloods, cannulas, catheters, arterial blood gases) and the doctors are much more focused on the actual patient management. Another little difference is that in Aix, arterial blood gases (ABGs) go to the lab as there is no ABG analyser in the department so results take up to an hour to come back.
As far a medical students’ training goes, in France pretty much everyone is accepted into the first year, however, only the top ~10% or so progress to the next year after sitting a competitive exam – the concours. If you fail, you are allowed one attempt to re-sit the year (and a third attempt if you have exceptional circumstances). In the UK, this selection process takes place before actually starting at university. When medical students in France pass into their fourth year they start playing a very active role in patient care, managing patients with supervision from seniors and by the end of their degree able to carry out 80-90% work that will be required when they start work (they are able to prescribe during this time too). During this time they are paid a nominal amount (~€125/month, with more in 5th and 6th years). In the UK generally I think the tendency is more towards observing as a student and carrying out small parts of patient care rather than playing an active role in the management as it is in France. For this experience in France they pay €300 a year, compared to the UK’s £9,000. Talking to some of the interns about this, I am told that they get a lot of students from other European countries coming to France to train (for the financial benefit and the way the way the training is run).
At the end of university training both countries have a national exam in order to be ranked against each other (person who comes first gets their first choice, last person gets whatever is left). In France the exam in knowledge base exam – focusing on basic understanding of management of acutely unwell patients across most speciailities. Whereas in the UK the majority of this rank (60 points) is made up by the SJT (situation judgment test), academic achievement has relatively less importance (up to 14 points) and all candidates start with 34 points to make a 100.
However, once someone graduates from medical school in France they are a ‘Médecin’, but don’t actually get the title “Docteur” until ~3 years later when they have submitted a thesis. Sounds pretty tough!
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