French Medical Schools: from hierarchy to anomy 1

In order to successfully match students and jobs in the medical profession of their choice, and at the same time meet the country's health care needs, it has become evident that access to medical schools and the various medical professions should be tightly regulated, in particular by a numerus clausus . In most Western countries, medical schools are applying different selection methods and approaches that seem to be working well, although they often tend to displace — rather than address — the fundamental problem of professional insertion. Using research that we conducted over several years on medical education in France, we will begin our discussion by showing that it is distinct from medical studies offered in many other European countries in that it is permeated by a competitive culture based on a meritocracy principle that is common to the training of other French elites. We then explain how managing the flow of medical students in such a centralised manner has produced a very rigid system that leaves little room for universities to develop innovative pedagogical approaches and improve the quality of the education they offer. We also show how this classification system – at both individual and national level — greatly influences not only the behaviour of medical students, but also of medical schools whose capacity to distinguish themselves has become very limited.