The general practice placement during the second cycle of medical education allows students to be supervised by university-accredited general practitioner tutors. This setting promotes observation and guided practice of consultations, offering a privileged opportunity to identify potential student difficulties, whether in communication, doctor–patient relationship, physical examination, or clinical reasoning. However, for students identified as having difficulties in one or more of these skills, the duration of the placement, which is mostly 3 to 6 weeks in region XXX, does not allow for optimal progress.The primary objective of this study was to explore the experiences of students who participated in a formative Objective Structured Clinical Examination (OSCE) that included individual debriefing following a general practice placement during which difficulties were observed.This was a qualitative study using an interpretative phenomenological approach, conducted among 4th- and 5th-year medical students. Students experiencing difficulties were identified using an internship assessment form based on the skills listed in the Learning Progress Booklet. The selected students took part in a formative and personalized OSCE session followed by an individual debriefing. Two months later, semi-structured interviews were conducted with volunteer participants to explore their perceptions.Seventeen of the twenty-four students selected participated in interviews between March 2023 and March 2024. They appreciated the clarity of instructions, the supportive environment and the individualized feedback, which helped build their confidence, understand theirs difficulties and support their progress. Analysis of interviews led to the identification of four distinct student profiles: the emotive, overwhelmed by stress and self-doubt; the perfectionist, driven by a pursuit of excellence; the technician, focused on methodological rigor; and the uninvolved, displaying limited engagement.The formative OSCE, combined with individual debriefing, proved to be an interesting tool to support students based on their specific needs. To our knowledge, this study is the first to describe profiles of students experiencing difficulties in their second-cycle general medicine placement.A larger-scale evaluation is needed to confirm its long-term benefits on clinical skills and its feasibility.

In XXX, most of undergraduate medical education takes place in hospitals and it has been noted that students have little knowledge of primary care and general medicine. As a result, an optional “Primary Care” course was introduced in 2023–2024 for medical students.To describe and evaluate an optional primary care teaching program implemented for second-cycle medical students.This was a mixed-methods observational study combining qualitative and quantitative approaches, conducted among students who participated during the 2024–2025 academic year. Data collection was carried out through direct, in-person, non-participant observation using an observation grid equivalent to a structured field note logbook. The evaluation of the optional course was conducted using a questionnaire distributed to participants.The program consisted of 34 hours of teaching sessions, 8 hours of clinical placement and 14 hours of independent work covering four main themes: chronic diseases, women’s health, child and adolescent health, and occupational health. Teaching methods were diverse and primarily based on clinical cases and small-group work, supplemented by role-playing activities and multimedia resources. Student attention appeared to be greater when teaching methods were varied, based on real clinical situations, and when group work was limited to short durations. Students gave the course an average rating of 7.67/10 and largely recommended it. The most appreciated teaching methods were discussions based on clinical situations encountered by teachers in general practice, small-group work on clinical cases, and the use of alternative materials (videos, graphic novels, testimonials).Primary care remains insufficiently visible to second-cycle medical students despite their interest. Highlighting this specialty early in medical education could lead to a better understanding of the role and place of general practitioners in the healthcare system.Primary care teaching in the second cycle of medical studies should be further developed using innovative teaching methods. Keywords: primary care, professionalism, medical students

In X, communication skills training for general practice residents begins with a simulated consultation followed by a debriefing. Debriefing is a well-established educational tool that aims to engage learners and support skills acquisition. Debriefings need to be refined in order to fulfill these goals.The primary objective of this study was to explore how debriefing sessions are conducted. The secondary objective was to explore structural components of debriefing associated with hight facilitation.We performed a quantitative analysis of transcripts from 48 simulated consultation debriefing sessions. Several criteria were assessed: speaking time, whether or not each phase of a four-phases debriefing structure were present (reaction, description, analysis, synthesis), the number of educational points addressed, the number of learning recommandation made to the learner, and the level of facilitation, assessed using a Likert scale.Facilitation was rated as hight in 31% of debriefing sessions. The learner’s mean speaking time was 4 minutes and 29 seconds, representing 29% of the total debriefing duration. Learners addressed an average of 3.8 educational points, compared with 6 points addressed by teachers. Learners formulated an average of 0.8 learning recommandations, versus 2.5 by teachers. When facilitation was hight, learner speaking time was higher (p < 0.001) and communication students addressed more educational points (p=0.006) .Debriefing can be more or less reflective in nature. Hight facilitation reflects a reflective debriefing, in which the learner is placed at the center of the learning process and the teacher acts as a catalyst for reflection. Reflective debriefings are associated with better knowledge retention, increased motivation, and enhanced self-assessment skills. However, to allow novice learners to focus on core concepts, a more explicit approche, characterized by a lower facilitation, may be used.Reflective debriefing, characterized by hight facilitation and associated with greater learner speaking time and learner-generated educational points, appears to promote durable learning. Further research could explore the role of reflexivity in interprofessional debriefing within primary care settings.

Despite increases in physician numbers in France, the aging of both the population and the medical workforce has expanded underserved areas. General practice, the primary care specialty, faces declining student interest, particularly in the Île-de-France region. Understanding the determinants of specialty choice is essential to address this crisis.To identify factors influencing specialty selection among medical students using Beaulieu's validated French-language questionnaire, adapted to the French medical education context.The adapted questionnaire was distributed to three cohorts of medical students across three Parisian universities. Responses from 792 students (19.82% intending to pursue general practice) were analyzed using exploratory factor analysis and logistic regression.Factor analysis yielded constructs that diverged from the original validation, with certain questionnaire items requiring individual treatment. The logistic regression model explained over 60% of variance in specialty choice. Intention to pursue general practice was significantly associated with completion of ambulatory general medicine clerkships during clinical training, societal commitment, and preference for reduced training requirements. Conversely, perceived limited scope of practice, hospital career orientation, and completion of clerkships in the desired future specialty were negatively associated with choosing general practice. These findings highlight the critical role of ambulatory clerkship exposure and suggest that inadequate representation of general practice during medical training may contribute to declining interest in the field. General practice selection is primarily driven by desires for professional autonomy and flexibility, yet the specialty remains underrepresented in students' clinical experiences.

In France, the specialty “general practice” was created in 2004. It is accessible after a national competitive examination taken by sixth-year medical students. Students choose their specialty according to their ranking.To evaluate the attractiveness of the “general practice” specialty in France from 2004 to 2024.This was a retrospective descriptive study including all students assigned after the national ranking exam at the end of the sixth year (Legifrance database). The data collected included: year of the exam, gender, rank, specialty, and residency city. Unfilled positions were also recorded. An attractiveness indicator “I” was calculated for general practice, then for each training city. The indicator ranges from 0 (high attractiveness) to 1 (low attractiveness).Between 2004 and 2024, 141,477 students were assigned to residency positions across 28 cities, of whom 61,504 (43.4%) entered general practice. Women account for 64% of the students ranked in general practice. Over 20 years, 91.4% of the positions opened in general practice were filled. The percentage of unfilled general practice positions decreased from 33.1% in 2004 to 1.5% in 2024. Over the study period, general practice became more attractive in France: I = 0.91 in 2004; I = 0.78 in 2024 (p < 0.05). The three most attractive cities for general practice were Rennes (I = 0.68), Grenoble (I = 0.68), and Nantes (I = 0.72), while the least attractive were Reims (I = 0.87), Limoges (I = 0.89), and Amiens (I = 0.89). Over the period 2010–2024, the attractiveness of general practice was higher among women than among men (0.85 in 2010 to 0.77 in 2024 vs. 0.89 in 2010 to 0.80 in 2024, p < 0.05).The “I” indicator accounts for the variability in the number of positions offered over time, allowing comparisons across years and cities.The attractiveness of general practice has improved since the creation of its specialty in 2004. Differences in attractiveness persist between training cities.

Primary care (PC) and its main actors, general practitioners, are facing a crisis of attractiveness. The choice of general practice is influenced by experiences gained throughout medical training. In France, between 2016 and 2022, all medical students took a National Ranking Examination (ECNi) in their 6th year, which determined their choice of specialty and residency location. Based on the principle that assessments can influence learning and potentially career choices ('assessment drives learning'), we aimed to describe the representation of PC in the ECNi.To quantify the proportion of progressive case study questions in the ECNi (2016–2022) that place the student in a Primary Care context and to describe the characteristics of these questions.All questions from the progressive case studies of the ECNi between 2016 and 2022 were studied. The healthcare level (primary, secondary, or tertiary) and the characteristics of the questions (fundamental, clinical, skills assessed, and complexity according to the revised Bloom's taxonomy) were assessed by two researchers blinded to the other’s findings, with recourse to a third party in case of disagreement.Out of 1,858 questions analyzed, 407 (21.9%) were related to a Primary Care context. This proportion varied from 7.8% in 2017 to 34.3% in 2020. The competencies most frequently assessed in this context were clinical examination (21.1%), management strategy (19.9%), and medical interview (19.7%).This is the first study evaluating the place of PC in a high-stakes ranking examination. The contexts (setting/specialty) were not always explicit; however, a double reading helped to limit this bias.PC was underrepresented in the ECNi compared to its importance in the health system. This imbalance could contribute to a poor understanding of the role and missions of general practice by limiting students' exposure to its specificities via the assessment. It thus appears necessary to better represent PC in medical education assessment methods. The introduction of Objective Structured Clinical Examinations (OSCEs) in the new ranking examinations (EDN/ECOS) since 2023 represents an opportunity to better highlight PC-specific competencies.

The ecology of care, theorized by White (1961), conceptualizes the population’s use of health services and highlights the pivotal role of primary care (PC) and its main providers, general practitioners (GPs). The content of high-stakes examinations guides students' learning and may convey a specific vision of the health system. In France, medical students take a national ranking examination in their 6th year, which determines their choice of specialty. No study had described the ecology of care for patients encountered in this examination.To describe the ecology of care for patients encountered in the French National Ranking Examination (ECNi) between 2016 and 2022.A quantitative descriptive study was conducted on all questions from the progressive case studies of the ECNi between 2016 and 2022. The levels of care (primary/secondary/tertiary) and the care settings (ambulatory/hospital) were assessed by two researchers blinded to the other’s findings, with recourse to a third party if there was disagreement. To model the ecology of care for patients present in the ECNi case studies, White’s methodology was used and adapted to the data. A monthly rate of healthcare utilization per 1000 patients is presented.In total, 1,858 questions from 126 progressive case studies were examined. The ecology of care shows that for 1000 patients who sought care at least once during a month (consultation or hospitalization), 355 consulted a GP at least once, 566 consulted another specialist, and 152 were admitted to a tertiary care hospital.This is the first study to evaluate the ecology of care in a high-stakes examination. The levels/settings were not always explicitly stated; however, a double reading helped to limit this bias.The ECNi presented an unbalanced ecology of care, overrepresenting secondary and tertiary utilization compared to general practice, relative to the reality of the French health system. This discrepancy could bias students' clinical reasoning and negatively influence their perception of general practice, as well as their career orientation.