“The status quo is not sustainable”: the Court of Auditors report advocates the end of PASS and LAS for access to health studies

The medical competition, as it existed before 2010, where the best 300 or 400 were taken! Midi Libre – MICHEL PIEYRE

The 2019 reform relating to access to health studies was sifted through the Court of Auditors, in a thick report published on December 18. “Marred by design flaws”, “deployed with difficulty”, the verdict is in: four years after the reform, simplification is essential, or even the killing of the two streams that are the PASS and the LAS.

From reform to reform of the reform… the gateway to health studies may well have had its day if we are to believe the report of the Court of Auditors published a few days ago.

This reform provided for by the law of July 24, 2019, relating to the organization of the health system, was supposed to lower the failure rate in the very selective “medical competition”, and improve reorientation.

Desired to “save these 25,000 students who go from the status of excellent high school student to one who fails the single competition“, this umpteenth reform had sown confusion, and let's face it, chaos and distress in the test year. A period that has lasted for four years and which from the outset had cast a fog over health studies, which has never dissipated.

Information on admission processes, scales and selection criteria are not always clear or well communicated, generating stress and frustration among aspiring medical students. And their families.

Too many failures with PACES

In summary, the first common year of health studies (PACES) has been, since 2010, a year of preparation for selection tests to enter health training. It concerned 57,000 students in 2019 and selected 9,700 medical students, 3,900 pharmacy students, 1,400 dentistry students and 1,000 midwifery students. But ultimately, this PACES was criticized for its high proportion of failures: the need to develop the system had become apparent.

And here it is replaced by the PASS (specific health access pathway) and the LAS (health access license) at the start of the 2020 school year, in the midst of a health crisis. “If you claim to have understood everything about the reform, it's because you haven't understood anything about it!”, people were annoyed at the time.

The reform therefore set up two licenses, each allowing students to begin studies in medicine, midwifery, dentistry, pharmacy or physiotherapy (MMOPK). Faced with the labyrinthine paths proposed, the reform is experienced as a form of unfair selection and little capable of selecting the right profiles.

Students wandering in non-chosen sectors

Proof by example: in pharmacy today, in Montpellier as elsewhere, it is difficult to recruit. And those who have been admitted, find themselves there by default if they failed medicine, when others who are very motivated, have not been able to access it.

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Difficulties in understanding the organization of the courses due to the existence of multiple access routes after the baccalaureate, lack of clear support, faced with the confusing nebula of modalities, the report of the Court of Auditors was eagerly awaited. And the verdict has fallen. It is final: it is necessary to simplify.

“An untenable status quo”

“In view of all the difficulties raised by the reform and its implementation, maintaining the status quo is untenable”, it is noted.“A real simplification is essential, which would put an end to the coexistence of PASS and LAS and would confirm the primacy of health education in access to the studies that fall under them. The only viable scenario then consists of setting up a single access route to MMOP studies, centered on the student and maintaining the principle of progression in studies. This simplification should be accompanied by a policy of territorialization of access to health studies guaranteeing equitable access, which is not the case to date”.

“Shame on this reform!”

“Shame on this reform which is a bitter failure!”, react several doctors after reading the report of the Court of Auditors, in a letter addressed to the Ministers of Higher Education, National Education, Health, in particular.“Shame on this system of inhuman algorithms […] which forces our students to switch to degrees, to hell, to the absurd worthy of Kafka. Who would force a future surgeon to study 18th century literature, a future physiotherapist to take criminal law exams, a future midwife to study Renaissance art ? […] The PASS medicine reform destroys our students, discourages them, sends them towards orientations out of spite, worse forces them to stop their studies!”

The return to the single track does not mean that we must return to the old PACES, a model that is equally rejected, which notably excludes repeating a year. The failures of the system and the dozens of recommendations detailed throughout the 140 pages of the Court's report will be analyzed. The question remains, given the political impasse and the ongoing budgetary crisis: when can they be implemented ?

A reform with too many objectives

The law of July 24, 2019 relating to the organization and transformation of the health system has thus profoundly renovated access to the first cycle of medicine, midwifery, dentistry and pharmacy (MMOP) training by eliminating, as of the 2020 academic year, the PACES and the numerus clausus.

Access to the first cycle, which remains demanding and selective, is now possible from three new pathways access:

– The pathway with specific health access (PASS), managed by the university's health component, including a health major and a non-health minor

– The degree with health access option (LAS), managed by a non-health component, conversely including a non-health major and a health minor

– Bridges from certain training courses leading to a state title or diploma of medical auxiliary.

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