Howard Fischer
Uppsala, Sweden

 

“Never memorize something you can look up.” – Albert Einstein
“If you’re going through hell, keep going.” – Winston Churchill

 

Photo by JESHOOTS.COM on Unsplash.

Première Année (literally “First Year”) is a 2018 French film. In it, we meet and follow two young men in their first year of medical school. Benjamin, like most of his classmates, enters directly from high school, where he was a high achiever. Antoine is starting the first year for the third time. He is repeating the year because of the system of promotion in all thirty-eight French medical schools. This system, known by the acronym PACES, puts all students who wish to study medicine, dentistry, pharmacy, physical therapy, and midwifery into the same first-year class. They must pass a highly competitive, stressful exam, in which they have two minutes to answer each question. The exam secures a place in the second year, at which time students declare which branch they will follow.¹ On the first day of the first year, the dean tells the assembled students that out of the 2000 students before him, 300 (15%) will make it to the second year.

Benjamin and Antoine become friends, which is advantageous for both of them. Benjamin is brilliant and organized. He is the son of a surgeon, but less motivated to become a physician than the plodding, working-class Antoine. The school’s goal for the first year is to “remove the weak ones,”² and the students’ goal is to pass the exam and enter the second year. Anything learned that does not help on the exam is incidental and superfluous. Students have no time to think about humane attitudes, empathy, or curiosity. They go to classes and then study many hours a day. They quiz each other during meals and post facts all over their apartment walls, even in the shower stall. In one scene, one of the friends stacks the year’s reading in a pile and is overwhelmed by its height.

They have no free time. Some students form study groups, which make the weaker members feel more inadequate and depressed. Exhausted and stressed, Antoine starts acting out and undergoes a brief period of hospitalization before resuming his studies. The film convincingly shows the “meat-grinder” that the students are put through. In this system success, and even survival, are accomplishments. On a practice exam after Christmas, Benjamin scores well, but his parents think he could have done better. Students’ parents do not know and cannot imagine what their children are going through.³

At the end of the movie, Benjamin gets a very high score on the entrance exam to the second year, while Antoine gets a borderline score. Benjamin does not declare his choice of branch of study, which leaves a place for Antoine, who finally makes it to the second year.

Medical school in France lasts six years. Basic sciences are taught in year one. Some courses must be watched on closed circuit television because the auditoria cannot hold all the students at once. After the “drastic selection,”⁴ those in the second and third years continue with courses, laboratory sessions, and clinical rotations. Years four through six consist of clinical rotations. A thesis is required at the end of their medical studies.

Tutoring of junior students by their seniors (“godfathers and godmothers”) is arranged by the school, and 90% of students, in one study, make use of it. 20% of students take private courses from tutoring firms.⁵ The same study indicated that the average age of the students is nineteen, and that 30% of students have a parent in some medical field. In the second year, 50% of students have a physician parent. More than half of the first-year students study at least fifty to sixty hours per week. They believe that for the exam, memorization is more important than understanding. At some time during the first year, two-thirds of students think about quitting.⁶ In 2018, 22.5% of first-year students got into the second year.⁷

In the 2020/2021 academic year, the PACES system was modified and given a new name, PASS. Students are separated according to branch of study upon entering the first year. Entry to the second year is obtained by one of several pathways: students with very high grades in the first year may enter the second year directly, while students with “only” passing grades must take an oral examination that will determine their chance of getting into year two.

If students are denied entry to year two, they may not repeat the first year in the same branch. They must pick a different branch (e.g., dentistry, physical therapy) and start a first year in that new branch.^8,9 The first year is still very hard under this system, and there is still much competition among students.¹⁰

The film’s screenplay was written by Thomas Lilti, M.D. (born 1976). Première Année is part of a trilogy that started with Hippocrate (Hippocrates: Diary of a French Doctor), 2014. In that film, Benjamin, a newly graduated doctor, is an intern on the medical service run by his father. The second film was Médecine de Campagne, 2016 (literally “Country Doctor,” but released internationally as “Irreplaceable.”)¹¹ Lilti always wanted to make films but his surgeon father did not like the idea.¹² In 2014, Lilti said, “I no longer say I’m a doctor, but that I make movies.”¹³

This is an interesting, well-acted movie, especially for those who do not know about the crushing competition inherent in some European medical schools. One critic¹⁴ called the film a “sweet and sour comedy” that shows that doctors are not exaggerating when they describe the rigors of that first year.

 

References

1. NA. “Programme cours médecine: de la première année au diplôme,” Premed, 2021. premed.fr.
2. Thomas Lilti. Première Année [film], 31 Juin Films, 2018.
3. Christelle Point. “Critique Cinéma: Première Année – un point c’est (pas) tout,” 2018.
4. Programme cours.
5. Claire Gueguen and Line Moulin.”Bien-être et strategies d’ap-rentissage des étudiants en première année commune aux études de santé,” Thesis, 2015.dune.univ-angers.fr
6. NA. “Réforme PACES- Le dossier pour comprendre les études de santé,” 2021.cours-thales.fr
7. Ibid.
8. NA. “PASS de Médecin: Le sésame pour les études de santé,” 2021.cours-thales.fr
9. NA. “La réforme PASS/LAS: Les 4 informations à savoir,” 2021.hermion.co
10. Pauline Bluteau. “Le PASS, entre idées reçues et réalité,” 2021.l’etudiant.fr
11. Thomas Lilti, Wikipedia.
12. Thomas Lilti, Wikipédia. fr.wikipedia.org.
13. Aurélien Ferenczi. “Thoma Lilti: Aujourd’hui je ne dis plus je suis médecin, mais je suis cinéaste,” 2014. archive-wikiwix.com.
14. Point, “Critique.”

 

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HOWARD FISCHER, M.D., was a professor of pediatrics at Wayne State University School of Medicine, Detroit, Michigan.

 

Summer 2022  |  Sections  |  Education