LAUSR

Dear Editor, The healthcare systems in the UK and France have many similarities. Both states have a comparable population size with a health service largely financed by the government through taxation and contributions such as National Insurance contribution and general social contribution.[1,2] However, the medical education system differs considerably between the two states. In the UK, entrance to medical schools is a competitive process due to stringent requirements. Having excellent grades is merely a requisite to be eligible to apply. Most UK medical schools use the UK clinical aptitude test to select candidates with the most appropriate mental abilities, attitudes and professional behaviour to become successful clinicians.[3] Candidates who secure a good score at the test are shortlisted for interview. Offers are made to well-rounded candidates. In comparison, the entry requirements in French medical faculties are less rigorous. Students with a French Baccalaureate are eligible to enrol for the first general year. The selection occurs at the end of the general year. Students sit a written examination which determines continuation on the course. The cohort rank is based on performance in the test and a small number of students progress to the second year. The selection test is extremely competitive as the number of students enrolled in second year is strictly limited by the French state. Most students are not permitted to continue and have to switch to other subjects including pharmacy and midwifery. It is common for students to repeat the first year if they are not successful initially.[4] British medical schools design and deliver their own curriculum while French medical faculties deliver a curriculum defined at a national level. The teaching style in France has remained predominantly didactic. The course consists largely of lecture-based teaching supported by tutorials, laboratory work, practical and bedside demonstrations.[4] There is a strong emphasis on learning core sciences in France. In the first year of the programme, students spend the majority of the time learning basic sciences. In contrast, the British medical education system has evolved from the traditional style. The uptake of innovative methods of teaching and learning such as virtual learning and problem based learning have been popular among British universities. The French medical education system lags behind the British system in the integration of innovative methods of teaching and learning. Communication skills have become an integral theme in the curriculum of British Universities. Students have the opportunity to enhance communication skills through sessions with simulated patients. Clinical skills performance and competence in skills including communication, prescription and physical examination are formally assessed through objective structured clinical examinations (OSCE). French medical faculties do not have the same focus on communication skills as their British counterparts. This can be explained by the cultural difference in the doctor–patient relationship between France and the UK. Medical students in France learn consultation and communication skills through experience acquired during their clinical placements. The emphasis on apprenticeship in French medical education is very strong. Medical students are expected to play an active role in the team throughout the clinical years. The contribution of medical students in assisting doctors is significant in France. British medical students rarely contribute actively to the care of patients except in their final year as part of the mandatory student assistantship. British medical schools have recently introduced the portfolio as a learning and assessment tool. Students are encouraged to engage in reflective learning practice and collect evidence of their competencies in preparation for postgraduate training.[5] The portfolio is a key element in specialty application and beyond specialty training in the UK. In France, it plays no role in the application to specialty training. The selection to specialty is based solely on a written national test at the end of medical school. Students are ranked and matched to the specialty programme of their choice. The differences in the medical education system between France and the UK are partly due to a set of founding values reflected in each society. French medical education system promotes social equality by allowing access to medical faculties without selection at entrance. The stringent selection process of UK medical schools prevents applicants from lower socio-economic backgrounds from studying medicine. Despite their differences, France and the UK will benefit from exchange programmes to encourage sharing of experience among educators and students.