The transition from the PACES selection mechanism to the PASS system marked a pivotal change. However, a significant increase in student diversity was predominantly observed in the L.AS pathway. This increase was relatively modest, considering L.AS represented 17% of student enrollments into second year of medical studies. A year subsequent to the implementation of this reform, the initiative to increase diversity among medical students achieved limited results, raising questions about its ability to meet its stated goals.
The reform entry prerequisites stipulated for PASS, that the curriculum have a majority of health science subjects and an elective (non-health sciences) which would be chosen by the student, and inversely so for the L.AS. The aim of increasing student diversity through modifying the PACES selection process was not achieved. The PACES student profile (i.e., high honors or highest honors in their scientific baccalaureate results), was merely transferred to the PASS students. However, entry via the L.AS stream resulted in a new category of students with standard pass or honors for their scientific baccalaureate results. The following year, this diversity via the L.AS entry stream fell, and the L.AS became as competitive as the PASS.
In examining second-year medical students, it was noted that fewer had parents residing in the University City. The percentage declined from an average of 63% over the prior three years to 47%. This suggests an increased proportion of students originating from locations more distant from the university. Among the French medical faculties, the L.AS pathway curriculum varies depending on the resources available at each university. This curriculum heterogeneity could partly explain why students residing beyond the Centre-Val de Loire region, chose to apply outside their region. However, the openings provided by the L.AS stream to students coming from surrounding areas, diminished during the post-reform year.
It is crucial to acknowledge the potential for self-censorship among applicants. The PASS pathway, designed to replace PACES, may be perceived as especially competitive, whereas L.AS is viewed as an alternate entry route to medical studies. This perception of PASS's heightened competitiveness might promote self-censorship tendencies among potential applicants. External factors, such as social background or the proximity of a student's family home to the university, may also influence the selection process. A notable overrepresentation of students from the white-collar and knowledge professional sectors within PASS, compared to the general population ratio and in contrast to L.AS, lends credence to the hypothesis of student self-censorship during enrollment. Comprehensive research, inclusive of all first-year applicants and not just those who succeeded as in our current study, is necessary to ascertain the influence of these factors on medical student selection.
Parents enrolling their children into first year medicine, understandably, would wish to optimize their child’s chances for success. One could hypothesize that certain candidates believed that the less competitive L.AS stream, would increase their likelihood acceptance into medical studies. The proportional increase of higher scoring students in L.AS in the post-reform year supports this hypothesis. In addition, our observations would indicate that high school students strategically modify their performance and choices in relation to the selection system. This adaptive approach to course selection could in the end, render moot real diversification. In summary, the L.AS stream entry to second year medicine enabled access to a wider range of student profiles, albeit temporarily.
Concurrent with the pedagogic reform at the Medical Faculty of the University of Tours, there was a notable rise in the intake for medical studies. The intake increased by 22.2% (60 additional students) in 2021–2022, in contrast to a 3.7% rise (10 additional students) over the previous two years. In response to parental concerns about the first-year medical reform, the French Council of State mandated the Faculty of Medicine in Tours, along with 14 other such faculties in France, to admit a larger number of students into the second year of medicine[5]. The French Council of State recognized that seats in the second year of medical studies were largely allocated to students from the previous system, PACES, even if the intention was to ensure fairness for the new first-year students in the recently introduced courses, PASS and L.AS. Even though PACES students represented 30% of the first-year cohort, they were given nearly 48% of the positions in the second year. Additionally, the Council of State pointed out that fifteen universities had not sufficiently expanded their second year enrollment capacity. This posed a risk that the reform could disadvantage PASS and L.AS students.
There is growing scientific evidence that a diverse health care workforce will contribute to improve national health care for the population[6–8]. Medical schools must cultivate a broader applicant base that mirrors the demographic composition of the general population, ensuring a representative mix among medical students[9]. According to our findings, achieving a diverse health care workforce is still a distant objective, and its realization hinges on the inclusiveness of the national medical student population.
The observations of this study should take into account certain limitations, such as the non-inclusion of “transfer” students – who enter second year medicine via an alternative selection pathway who remain outside the average student profile. Nevertheless, the number of transfer students remains modest, averaging approximately ten students per academic year. Another limitation of this study lies in its monocentric nature. However, this approach is still more favorable than a multicentric comparison which could involve data from varied and inconsistent admission systems.
