France's rigorous system of medical training, which rejects up to nine out of ten students after their first year, faces wide-ranging changes to broaden the intake of students, weed out failures less brutally and make it easier for them to transfer to courses leading to other professions.
After two years of consultations between the ministries of education, employment and health, and teacher and student representatives, prime minister Lionel Jospin has officially announced the government's intention of introducing reforms from 2001.
At present, after taking the initial two-year scientific DEUG (diplome d'etudes universitaires generales), medical students study for one year before taking a competitive examination, which 85 to 90 per cent of candidates fail in line with the numerus clausus limiting numbers to about 7,000.
Most students feel pressurised to enter the stream leading to the tough competitive internat exam, which gives access to the most prestigious specialisations, rather than the alternative general medicine course. The most likely way to pass the internat is by following tailor-made lectures - expensive, and technically illegal, commercial crammers.
The third of candidates who fail usually resort to studying for general medicine - what former health minister Bernard Kouchner, now United Nations chief representative in Kosovo, called "the absurdity of students who are going to study general medicine being selected by failure".
Giving details of the reforms in the medical daily, Le Quotidien du Medicin, education minister Claude Allegre condemned current practice as a "waste of human endeavour" and called for an end to the "terrible" competitive exam. "This selection is extraordinarily brutal and France is the only country in the world which has this system," he said, while indicating he did not intend to change the numerus clausus.
Under the reform, intake will be widened to include applicants with a DEUG in non-scientific fields such as literature, law, history or social sciences, but restricted to those who pass the exam with merit. Mr Allegre also wants a DEUG in health studies.
All students accepted for medical studies, whether planning to enter medicine, pharmaceuticals or dentistry, will follow a year's common programme covering genetics, biochemistry, physiology, economy and ethics after which a "definitive selection" will be made through a competitive examination, which, it is estimated, about three-quarters of the 10,000 or so candidates will pass.
Those who do not make the grade will be awarded credits that will count towards studies in other fields. "Selection will therefore be more progressive, without use of the axe," said Mr Allegre.
Three years later, after a total of six years' post-baccalaureate study and training, students will reach the level of master's degree in medicine, a qualification that will not entitle them to practise as doctors but will be adequate for entry to medical research, and relevant for work in such fields as medical journalism or law, or as a health economist.
The final hurdle for those continuing their medical studies is the reformed internat, which will be compulsory for all. A major change is that it will no longer include multiple choice questions but will allow for better assessment of students' abilities of reasoning and analysis.
Mr Allegre hopes that the reform, which is designed to fit in with European harmonisation, will lead to more research "notably in clinical research but also in medical computer science and telemedicine".
He has also promised financial aid for students from poor families. "Medical studies must correspond to an intellectual elitism not a social elitism," he said.