French Medical School Research Articles

Variance due to the examination conditions and factors associated with success in objective structured clinical examinations (OSCEs): first experiences at Paris-Saclay medical school

BackgroundWe aimed to measure the variance due to examination conditions during the first sessions of objective structured clinical examinations (OSCEs) performed at a French medical school and identify factors associated with student success.MethodsWe conducted a retrospective, observational study using data from the first three OSCEs sessions performed at Paris-Saclay medical school in 2021 and 2022. For all sessions (each organized in 5 parallel circuits), we tested a circuit effect using a linear mixed-effects model adjusted for sex and the average academic level of students (according to written tests). Then, we studied the factors associated with student success at one station using a multivariate linear mixed-effects model, including the characteristics of students, assessors, and standardized patients.ResultsThe study included three OSCEs sessions, with 122, 175, and 197 students and a mean (± SD) session score of 13.7(± 1.5)/20, 12.7(± 1.7)/20 and 12.7(± 1.9)/20, respectively. The percentage of variance due to the circuit was 6.5%, 18.2% (statistically significant), and 3.8%, respectively. For all sessions, the student’s average level and station scenario were significantly associated with the score obtained in a station. Still, specific characteristics of assessors or standardized patients were only associated with the student’s score in April 2021 (first session).ConclusionThe percentage of the variance of students’ performance due to the examination conditions was significant in one out of three of the first OSCE sessions performed at Paris-Saclay medical school. This result seems more related to individual behaviors rather than specific characteristics of assessors or standardized patients, highlighting the need to continue training teaching teams.National clinical trial numberNot applicable.

Impact of hospital internships on success in university summative objective structured clinical examinations: Large-scale experience in a French medical school.

Objective structured clinical examinations (OSCEs) are extensively used in many medical schools worldwide with the stated objective to assess students' clinical skills acquired during internships. The objective of the present study was to assess the factors associated with success in university summative OSCEs, especially the impact of previous hospital internships in corresponding disciplines and supervision during internships. This was a cross-sectional study assessing the results in the summative OSCEs of 4th year medical students during the 2021-2022 academic year in a French medical school. The summative OSCEs included five stations for each student. Each student answered a survey at the end of summative OSCEs about previous internships, the supervision they had and perceived difficulty levels for each station. The scores in each station were assessed according to previous hospital internships in the corresponding discipline. Analysis of predictive factors of success in OSCEs, defined by a score ≥ 10/20 at each station, were performed using univariate and multivariate logistic regression. Out of the 220 students participating in the summative OSCEs, 182 (83%) answered the survey. One hundred and forty-four (79%) of these students had carried out hospital internships in at least one of the disciplines evaluated during the OSCEs. Students having completed an internship in the corresponding discipline had significantly higher OSCEs scores for interrogation, communication, therapeutic education and procedure stations compared to those who had not. Previous internship in corresponding disciplines was independently associated with success in OSCEs in interrogation (OR 9.45 [1.34-66.8] p = 0.02), clinical examination (OR 6.93 [1.88-25.57] p = 0.004, and therapeutic education (OR 3.09 [1.22-7.82] p = 0.02) stations. Previous hospital internships in the discipline evaluated by the OSCEs are associated with success in summative OSCEs. This reinforces the importance of student involvement during their hospital internships.

Exploring Medical Career Choice to Better Inform Swiss Physician Workforce Planning: Protocol for a National Cohort Study.

A medical student's career choice directly influences the physician workforce shortage and the misdistribution of resources. First, individual and contextual factors related to career choice have been evaluated separately, but their interaction over time is unclear. Second, actual career choice, reasons for this choice, and the influence of national political strategies are currently unknown in Switzerland. The overall objective of this study is to better understand the process of Swiss medical students' career choice and to predict this choice. Our specific aims will be to examine the predominately static (ie, sociodemographic and personality traits) and predominately dynamic (ie, learning context perceptions, anxiety state, motivation, and motives for career choice) variables that predict the career choice of Swiss medical school students, as well as their interaction, and to examine the evolution of Swiss medical students' career choice and their ultimate career path, including an international comparison with French medical students. The Swiss Medical Career Choice study is a national, multi-institution, and longitudinal study in which all medical students at all medical schools in Switzerland are eligible to participate. Data will be collected over 4 years for 4 cohorts of medical students using questionnaires in years 4 and 6. We will perform a follow-up during postgraduate training year 2 for medical graduates between 2018 and 2022. We will compare the different Swiss medical schools and a French medical school (the University of Strasbourg Faculty of Medicine). We will also examine the effect of new medical master's programs in terms of career choice and location of practice. For aim 2, in collaboration with the Swiss Institute for Medical Education, we will implement a national career choice tracking system and identify the final career choice of 2 cohorts of medical students who graduated from 4 Swiss medical schools from 2010 to 2012. We will also develop a model to predict their final career choice. Data analysis will be conducted using inferential statistics, and machine learning approaches will be used to refine the predictive model. This study was funded by the Swiss National Science Foundation in January 2023. Recruitment began in May 2023. Data analysis will begin after the completion of the first cohort data collection. Our research will inform national stakeholders and medical schools on the prediction of students' future career choice and on key aspects of physician workforce planning. We will identify targeted actions that may be implemented during medical school and may ultimately influence career choice and encourage the correct number of physicians in the right specialties to fulfill the needs of currently underserved regions. DERR1-10.2196/53138.

Performance of ChatGPT in French language Parcours d'Accès Spécifique Santé test and in OBGYN.

To evaluate the performance of ChatGPT in a French medical school entrance examination. A cross-sectional study using a consecutive sample of text-based multiple-choice practice questions for the Parcours d'Accès Spécifique Santé. ChatGPT answered questions in French. We compared performance of ChatGPT in obstetrics and gynecology (OBGYN) and in the whole test. Overall, 885 questions were evaluated. The mean test score was 34.0% (306; maximal score of 900). The performance of ChatGPT was 33.0% (292 correct answers, 885 questions). The performance of ChatGPT was lower in biostatistics (13.3% ± 19.7%) than in anatomy (34.2% ± 17.9%; P = 0.037) and also lower than in histology and embryology (40.0% ± 18.5%; P = 0.004). The OBGYN part had 290 questions. There was no difference in the test scores and the performance of ChatGPT in OBGYN versus the whole entrance test (P = 0.76 vs P = 0.10, respectively). ChatGPT answered one-third of questions correctly in the French test preparation. The performance in OBGYN was similar.

Validity Evidence of A Screening Tool for Early Detection of Clinical Crisis-Related Anxiety Amongst Medical Students

Construct: Psychological distress among students is a growing concern in medical education, even more so with the advent of COVID-19 pandemic. Anxiety is among students’ mental health issues. High and persistent anxiety has many negative impacts on students’ academic and personal life. Early detection is essential for timely intervention. Background: Currently, medical student anxiety is assessed using tools primarily designed for psychiatric purposes. Despite their excellent validity evidence, these tools contain sensitive items and do not explore stressors related to clinical activities. There is a need for contextualized tools to better identify anxiety-provoking factors specific to the medical education environment. Approach: We previously developed the Crisis Experience Rating Scale (CERS-7), a short screening tool to identify early on anxious students participating in clinical activities during the first wave of the COVID-19 pandemic. The present study sought to produce further validity evidence for the CERS-7. Medical students in their clinical years at two Swiss and one French medical school, all involved in COVID-19 clinical activity during the second wave of the pandemic, completed the CERS-7 and the State Anxiety Inventory (STAI-A), the best known and widely used tool to measure for general anxiety. We evaluated internal structure using confirmatory factor analysis (CFA) and relation to other variables using linear regression (LR) and receiver operating characteristic (ROC) curves with thresholds defined using the Youden index. Findings: There were 372 participants. CFA confirmed the two-factor structure of the CERS-7 scale from first-wave dataset. The CERS-7 total scale and subscales demonstrated validity evidence in relationship to the STAI-A scores and categories. A CERS-7 total scale score < 27.5 identified 93% of severely anxious students. Conclusion: The CERS-7 produces reliable scores to use for monitoring anxiety status when assigning students to clinical settings as well as for improving training conditions during clinical crisis.

Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school.

Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing number of students admitted to medical schools, and the necessity of objectively evaluating practical skills. This study aimed at investigating the relationships between OSCE grades and current evaluation modalities. Three-hundred seventy-nine 4th-year students of University-of-Paris Medical School participated to the first large-scale OSCE at this institution, consisting in three OSCE stations (OSCE#1-3). OSCE#1 and #2 focused on cardiovascular clinical skills and competence, whereas OSCE#3 focused on relational skills while providing explanations before planned cholecystectomy. We investigated correlations of OSCE grades with multiple choice (MCQ)-based written examinations and evaluations of clinical skills and behavior (during hospital traineeships); OSCE grade distribution; and the impact of integrating OSCE grades into the current evaluation in terms of student ranking. The competence-oriented OSCE#1 and OSCE#2 grades correlated only with MCQ grades (r = 0.19, P<0.001) or traineeship skill grades (r = 0.17, P = 0.001), respectively, and not with traineeship behavior grades (P>0.75). Conversely, the behavior-oriented OSCE#3 grades correlated with traineeship skill and behavior grades (r = 0.19, P<0.001, and r = 0.12, P = 0.032), but not with MCQ grades (P = 0.09). The dispersion of OSCE grades was wider than for MCQ examinations (P<0.001). When OSCE grades were integrated to the final fourth-year grade with an incremental 10%, 20% or 40% coefficient, an increasing proportion of the 379 students had a ranking variation by ±50 ranks (P<0.001). This ranking change mainly affected students among the mid-50% of ranking. This large-scale French experience showed that OSCE designed to assess a combination of clinical competence and behavioral skills, increases the discriminatory capacity of current evaluations modalities in French medical schools.

Discordances entre les référentiels des collèges d’enseignants en médecine et leur impact sur les étudiants en médecine

Textbooks endorsed by national medical specialty societies and colleges are used as official references for faculty and national examinations. Oncology is transdisciplinary, practiced and taught by oncologists but also by other specialists. We aimed at identifying discrepancies between chapters on cancers in different official specialty textbooks and evaluating their impact on students. Volunteer 6th-year medical students of the Sorbonne University faculty were paired and asked to list the discrepancies between all official specialty textbooks addressing a given cancer and then individually asked to evaluate the impact of discrepancies on their learning experience. In March 2018, the 17 cancers listed in the French medical school education program were addressed in 14 official specialty textbooks (2 to 4 textbooks/cancer). Out of a class of 390 students, 78 volunteered and were paired; each cancer was analyzed by 3 pairs of students (1 or 2 cancers/pair); 154 discrepancies were reported (range: 4-18 per cancer). Discrepancies induced doubt and anxiety in students; 85% considered that harmonization should be achieved for all topics of the national medical school program. Discrepancies between official textbook are frequent, generate anxiety in students and impact learning experience.

Predictive factors of success at the French National Ranking Examination (NRE): a retrospective study of the student performance from a French medical school

BackgroundThe national ranking examination (NRE) marks the end of the second cycle (6th university year) of French medical studies and ranks students allowing them to choose their specialty and city of residency. We studied the potential predictive factors of success at the 2015 NRE by students attending a French School of Medicine.MethodsFrom March 2016 to March 2017, a retrospective study of factors associated with the 2015 NRE success was conducted and enrolled 242 students who attended their sixth year at the school of medicine of Reims. Demographic and academic data collected by a home-made survey was studied using univariate and then multivariate analysis by generalized linear regression with a threshold of p < 0.05 deemed significant.ResultsThe factors independently associated with a better ranking at the NRE were the motivation for the preparation of the NRE (gain of 3327 ± 527 places, p < 0.0001); to have participated in the NRE white test organized by la Revue du Praticien in November 2014 (gain of 869 ± 426 places, p < 0.04), to have participated in the NRE white test organized by la conférence Hippocrate in March 2015 (+ 613 places ±297, p < 0.04). The factors independently associated with poor NRE ranking were repeating the first year (loss of 1410 places ±286, p < 0.0001), repeating a year during university course (loss of 1092 places ±385, p < 0.005), attendance of hospital internships in 6th year (loss of 706 places ±298, p < 0.02).ConclusionsThe student motivation and their white tests completion were significantly associated with success at the NRE. Conversely, repeating a university year during their course and attendance of 6th year hospital internships were associated with a lower ranking.

Noninvasive Peripheral Artery Disease Screening Tools: A Deficient Knowledge among French Vascular Residents from 4 Medical Schools

Ankle-brachial index (ABI) at rest, postexercise ABI, and toe-brachial index (TBI) are essential diagnostic tools recommended for peripheral artery disease (PAD) diagnosis. Our study investigates the level of knowledge on these 3 tests among vascular medicine residents from 4 French medical schools in France. We included 19 vascular medicine residents in a cross-sectional study. During an annual obligatory seminar, all residents accepted to fill 3 questionnaires concerning knowledge about these 3 tests. All residents accepted to fill 3 questionnaires. None of the residents correctly knows how to perform all pressure measurements (ABI, postexercise ABI, and TBI). Two residents had the knowledge to perform the whole ABI at rest procedure, whereas no resident had the knowledge to perform neither the postexercise ABI (P=0.48) nor the TBI (P=0.48). Twelve residents correctly completed the question regarding the interpretation of ABI at rest, whereas 2 correctly completed the postexercise ABI question (P=0.001) and 4 the TBI question (P=0.02). The number of residents who have performed more than 20 measurements is higher regarding ABI at rest than postexercise ABI and TBI (84%, 5%, and 37% respectively; P<0.001 and P=0.006 respectively) and significantly less often in postexercise ABI than TBI (5% vs. 37%; P=0.04). This study shows for the first time that residents' knowledge of pressure measurements (resting-ABI, postexercise ABI, and TBI) of 4 French medical school are insufficient although the importance of pressure measurement has been strongly highlighted by the newly released PAD guidelines (2016) for PAD diagnosis.

Highights in the history of epilepsy: the last 200 years.

The purpose of this study was to present the evolution of views on epilepsy as a disease and symptom during the 19th and the 20th century. A thorough study of texts, medical books, and reports along with a review of the available literature in PubMed was undertaken. The 19th century is marked by the works of the French medical school and of John Hughlings Jackson who set the research on epilepsy on a solid scientific basis. During the 20th century, the invention of EEG, the advance in neurosurgery, the discovery of antiepileptic drugs, and the delineation of underlying pathophysiological mechanisms, were the most significant advances in the field of research in epilepsy. Among the most prestigious physicians connected with epilepsy one can pinpoint the work of Henry Gastaut, Wilder Penfield, and Herbert Jasper. The most recent advances in the field of epilepsy include the development of advanced imaging techniques, the development of microsurgery, and the research on the connection between genetic factors and epileptic seizures.

Cerebellar vermian epidermal cyst

From the first description of an epidermoid cyst in 1807 by an artist in a French medical school, intracranial epidermoid cysts have been encountered in neurosurgical practice frequently, enough to constitute 0.2%–1.0% of all intracranial tumours. Epidermoid cyst arising from the cerebellar vermis occur very rarely, with only two cases reported in the literature1,2 so far. We report a case of an epidermoid cyst arising from the cerebellar vermis, growing into the fourth ventricle, with the floor of the fourth ventricle being completely free, allowing a complete excision of the tumour through a suboccipital approach. The patient was discharged without any neurological deficit. We describe the clinical picture, MRI and operative findings of the case.

Knowledge, attitudes, and beliefs of French medical students about antibiotic prescribing and resistance

ObjectivesWe had for aim to learn about medical students’ knowledge and perspectives on antibiotic prescribing and bacterial resistance. MethodsPenultimate and final year students at a French medical school were invited to participate in an anonymous online survey in summer 2012. ResultsThe response rate was 20% (60/297). Penultimate and final year students gave similar answers. Students felt more confident in diagnosing an infection, and less confident in choosing the correct dose and interval of antibiotic administration. Seventy-nine percent of students wanted more training on antibiotic treatments. Sixty-nine percent of students knew that antibiotic prescriptions were inappropriate or unnecessary in 21–60% of the cases, and 95% believed that these prescriptions were unethical. Only 27% knew that more than 80% of antibiotic prescriptions were made in community practice. Students believed that the most important causes of resistance were that too many prescriptions were made and broad-spectrum antibiotic use; 27% believed poor hand hygiene was “not at all important”. Ninety-four percent believed resistance was a national problem, and 69% mentioned it as a problem in their hospital. Sixty-three percent thought that the antibiotics they would prescribe would contribute to resistance, and 96% thought resistance would be a greater problem in the future. Twenty-two percent knew MRSA bacteremia rates had decreased over the past decade in France. ConclusionsMedical students are aware that antibiotic resistance is a current and growing problem. They would like more training on antibiotic selection.

Factors affecting students performance on the National Ranking Examination in a French Medical School

Results on the National Ranking Examination (NRE) taken at the end of 6 years of medical school determine how much choice students have about the medical specialty and geographic area where they will perform their residency. Our objective was to identify academic and non-academic factors predicting performance on the NRE. We conducted a database study of all medical students who completed the 6 years of medical studies at Creteil medical school (Paris 12 University) and who took the NRE between 2004 and 2008 (n = 473). Correlations between students' characteristics and the NRE rank were analysed using multivariate linear regression models. The students were also divided into three categories based on whether their NRE rank was in the top quartile, bottom quartile, or middle two quartiles. Those 3 groups were compared using multivariate multinomial logistic regression models. Factors independently associated (p < or = 0.05) with rank on the NRE were repeating the first year of medical school (coefficient: 11.92 [95%IC 8.69-15.15]); rank on the first-, fifth-, and sixth-year examinations (0.14 [0.05-0.22]; 0.19 [0.12-0.26] and 0.32 [0.22-0.42] respectively); number of years with at least one failed examination (3.94 [1.08-6.80]); and failure to attend a practice NRE session (13.0 [12.39-13.61]). Factors associated with the worst NRE performance were similar to those found when the NRE rank was handled as a continuous variable. Socio-economic characteristics of students were strongly associated with medical school performance and, therefore, were not independently associated with rank on the NRE. Performance on the NRE was strongly associated with previous performance on medical school examinations, ever since the first year of medical school. Students were informed of these results which will help us to identify high-risk students who require early remedial help.

EVALUATION OF A GERIATRICS ROTATION FOR POSTGRADUATE RESIDENTS IN LEBANON

As we enter the 21st century, increasing numbers of older adults will reside, either temporarily or permanently, in nursing homes. Training in nursing home care must become an integral part of the curriculum for internal and family medicine residency programs. The changing demographics of the Lebanese population have created an imperative for medical schools to increase their emphasis on the education and training of residents in the care of the elderly. A four-week block rotation was started for residents in the family medicine department in Hotel Dieu (The French Medical School). The rotation is taking place at the comprehensive Geriatric Program at Ain Wazein Community Hospital. The goal of the rotation is to provide formal training in nursing home care to family practice residents as a component of the geriatrics curriculum. The organization and the curriculum content of the rotation are presented. The initial evaluation of the rotation by the residents showed that the residents became more comfortable with elderly issues by the end of the rotation. Residents responded on a scale of one to six regarding four constructs. The rotation was positively evaluated by residents and staff. Consequently, the rotation has been incorporated into the curriculum of family medicine residents in Hotel Dieu.

Assessment by physicians of their initial training in a French medical school and the education they received there: a study of four graduating classes of medical students, 8-11 years after completion of their initial training

(1999). Assessment by physicians of their initial training in a French medical school and the education they received there: a study of four graduating classes of medical students, 8-11 years after completion of their initial training. Medical Teacher: Vol. 21, No. 4, pp. 426-427.

An in-vitro evaluation of the activity of chlorine against environmental and nosocomial isolates of Aeromonas hydrophila

A chlorine preparation was tested against 34 strains of Aeromonas hydrophila isolated from a hospital water facility and patients with nosocomial infections in a French medical school hospital. In-vitro bactericidal activity was determined by a macro- and micromethod, using specific interfering substances over a range of dilutions and temperatures, after 1 and 5 minute exposure times. A 10 5-fold reduction in the challenge inoculum was taken as the criterion of efficacy. Results obtained by both methods agreed and indicated a median minimal bacterial concentration of chlorine of from 0·95 ppm without interfering substances to 297 ppm in the presence of interfering substances. These data indicate that Aeromonas hydrophila isolates are relatively resistant to chlorine, thus precluding the use of chlorine alone as a disinfectant for water supplies contaminated with Aeromonas spp.

Foley catheter in removal of a foreign body from rectum.

<h3>To the Editor.—</h3> Foreign bodies in the rectum are of such variety that no single procedure for their removal can be mandated.¹Each case represents a special problem in its management. It must be remembered that careless removal is more likely to result in injury than that which resulted from its insertion. Recently, we have extracted a light bulb from the rectum using insertion of two Foley catheters and its success has prompted us to report this technique. <h3>Report of a Case.—</h3> A 50-year-old man was seen in the emergency room of French and Polyclinic Medical School and Health Center on July 30,1971, with discomfort in the rectum following insertion of a light bulb a few hours before. Rectal examination revealed a light bulb three inches above the anal verge with the screw end of the bulb projecting towards the examiner. The metallic screw part of the bulb was