Article: Thomas Colleony, Luc Mc Aigle, Edward Jezeque
The Ecoles Militaires de Santé de Lyon Bron (EMSLB)
Cradle of the medical and paramedical personnel serving in the French Defence Health Service
It is with great pleasure that we respond to the invitation from the EMMJ to present the French Military Medical School – l’ Ecole de Santé des Armées (ESA). Together with the medical university of Lyon 1, ESA provides medical training for all the French military physicians and pharmacists during the two first cycles of medical studies. ESA belongs to the EMSLB which has also been the home of l’Ecole du personnel paramédical des armées – the paramedical army school – for over four years now.
Dynamic and resolutely future-oriented, ESA continually adapts to the pressing needs of an increasingly demanding civilian university curriculum and to the requirements of the army medical training designed for our current students and soon-to-be military healthcare professionals.
Records are made to be broken and this year the ESA’s own graduating ratio for first- year medical students has never been higher, exceeding last year’s record-high success rate in the first-year competitive final exam.
This is in line with current increasing recruitment efforts that have to be made to expand headcount within the Service de Santé des Armées – the French Army Health Service. We also broke another record, hosting more than 950 students on site. To make it possible, an ambitious building program has begun this year, designed to accommodate all our officer cadets and nursing students by 2024. This is concomitant with the heavy maintenance work
which is to be pursued until 2028.Finally, we are convinced that this year will mark a decisive and positive turning point towards the end of the COVID crisis. At least for our students who, fully vaccinated and strengthened by their experience, will be able to complete the requirements of a dual curriculum as they have done since spring 2019. They will also be able to resume an active military lifestyle with its traditions, culture and physical activities. These two last points are neither folklore nor leisure since it is clear that our schools do not only deliver technical skills and academic knowledge: they shape and mold complete individuals whose acquired soft skills are widely recognized and coveted, and go beyond the scope of officers and
non-commissioned officers’ duties. This short article will mainly deal with the curriculum of our student practitioners.
In 1856 in Strasbourg, the first military medical school was opened to train the French land forces physicians also known as “Les carabins rouges.” The imperial French military medical school eventually closed its doors after the city surrendered, which led Alsace to integrate the German empire in 1871. In 1888 a new Army Health Service school was established in Lyon due to the excellent reputation of both its medical university and the staff of its hospital that was located on avenue des Ponts du Midi, later renamed avenue Berthelot. Simultaneously, a school opened in Bordeaux for physicians specialized in the navy and colonial troops. In 1988, the city of Bron (located to the south-east of Lyon) welcomed the French Army Health Service (ESSA) on a former air base. This 30-hectare site is conveniently located close to all three medical universities, the Faculty of Pharmacy in Lyon, the hospital complex in the east of Lyon and the Desgenettes military teaching hospital. In addition to student accommodation facilities, the site has 3 lecture theatres, numerous classrooms and work rooms, a library, an entire room dedicated to simulating the management of certain specific medical emergencies, practical work rooms as well as a vast sports complex including: a football pitch, a rugby field, a gymnasium, a fencing hall, an athletics track, a weights and fitness room and a 25-meter swimming pool. Nevertheless, this complex has suffered... from the weight of the years and even if it still allows our students to exercise and practice sports freely on a daily basis, it is urgent that we give our sports facilities a makeover! As part of the general overhaul of the French Military Health Service (SSA), the school in Lyon-Bron was selected in 2008 to become the only school for initial training of physicians, pharmacists, dentists and veterinarians of SSA. It has been the only military medical school recruiting medical officer cadets since August 2009. In July 2011, the Armed Forces Health School (ESA) thereby inherited all the traditions from various Army Medical schools including those of Lyon and Bordeaux but also the School of Strasbourg and the naval schools of medicine founded in 18th and 19th centuries. Since 2018 the school in Lyon-Bron has been the home of the School of Armed Forces Paramedical Personnel (EPPA), thus becoming the Military Health Schools in Lyon-Bron(EMSLB).
The school in a few figures
We follow the academic career of about 950 students, i.e., 677 physicians, 22 pharmacists, 3 veterinarians, 249 nurses, and 2 nurse’s aides. The percentage of women is 54.4%. To ensure the success and well-being of our students, and to provide training for them, approximately one hundred civilian and active duty military personnel along with twenty reservists work on a daily basis within the EMSLB. The success rate (all sectors combined) for admission to the 2nd year of medicine was over 88% for the last academic year. 95% of our nursing students obtained their registered nursing diplomas. Regarding military training 66% and 28% of medical and nursing students respectively leave school with a military certificate (parachuting, commando, diving….).
Which are the recruitment terms and onditions for students?
Today the SSA recruits an average of 110 to 120 first-year medical students (PASS). After a selective written examination (mathematics, physics, chemistry, biology, French and English) in the middle of the last year of high school (1,971 candidates this year), a specific number are selected to come to the school and take a sports tests and an oral examination on the EMSLB site in mid-June to test their motivation to commit themselves to this demanding future profession and long studies. Additional recruitment also allows us to meet the student headcount requirements, with an average of fifteen to twenty students who join our military cadets during the course of the curriculum, mainly in the second year but also during the second cycle.
Studying course of a student practitioner at ESA
Classified as a Grande École de la Défense and a member of the Conférence des Grandes Écoles (CGE), ESA is the only military school responsible for the initial training of future army doctors and pharmacists (first six years of study). The students are both medical or pharmacy students and career officers with all the requirements that this entails. They follow the same training and examinations as their civilian counterparts (attached to and administered by the University of Lyon 1) and an additional 1800 hours of complementary education specific to medical practice within the armed forces, spread over the six years, given at the ESA. These 1800 hours correspond to a 7th year of training. They are valued by obtaining a Master’s degree specialised in Army health delivered by the CGE, which makes it a real specificity for our students’ curriculum.
It scrupulously follows the requirements of the French faculties and of the University of Lyon 1. The ESA studies office interacts mainly with the faculty to adapt the university curriculum to the specific military or medical-military training of our students. During their studies, they will complete at least one internship in general medicine in a military medical unit and one internship in a military hospital allowing them to understand certain specificities of their future profession. In addition, within the framework of freely chosen optional teaching units (UELC), for the second cycle, the school has obtained that these UELCs are positioned on the particular needs of the service, namely tropical medicine in the 4th year, sports medicine and extreme environment in 5th grade and tactical medicine in 6th grade. The reform of the first two cycles of medical studies which began a year ago, is a major upheaval in the university world that we are following very closely. For the first cycle, it has required a rapid adaptation of the teaching staff to best support our students in the success of this first year of medicine, which remains very selective. Currently made up of nine teachers seconded from the national education system, they will be reinforced next year by two new biology teachers. The other upheaval is the major change in the new sixth-grade National Ranking Examination (ECN) which allows a choice of specialty. The SSA has recently chosen to return to the system prior to the ECN reform. From 2024 onwards, all sixth-year students will take a first specialized study diploma (DES) in general medicine and then, after three years spent in a medical unit, they will be able to apply for a hospital speciality DES through a competitive examination (assistantship) if they wish. These speciality DES positions will be opened according to the hospital needs of the SSA. All these reforms are a legitimate source of concern and questioning to which the command responds as best and positively as possible while hoping for a rapid clarification from the academic and political institutions of the last remaining uncertainties on this major reform.
It is spread out progressively throughout the six years of study both in the military and command fields and in the teaching of combat rescue. After an initial 15-day military training at the start of the first year, students follow an additional three-week military training the following year and a one-week specialized military training (more command-oriented) at the end of the third year. At the end of the second year, they complete a three-week training course in a regiment, the main objective of which is to immerse them in the units and to discover the art of leadership. Finally, throughout their curriculum, they have the opportunity to take military qualification certificates, the main ones being the parachuting certificate, the skier and mountaineer certificate, the on-board diver course and the commando course. They can also participate in commando training courses in France, Guyana and even at the school, which has had its own course since last year. This military training is coupled with English language training, communication, management and command courses. For our sixth-year students, all of this additional training ends with the writing of a dissertation on a military health issue, which sometimes leads to the beginning of reflection for their future thesis work. This dissertation therefore validates the CGE’s specialized master’s degree in military health.
As mentioned above, ESA is monitoring the ongoing academic reforms. For the first cycle, this entails more help and support for the first years; for the second cycle, it means preparing our current 4th year students for the new ECN exam methods. Regarding the military part, we are continuing and adapting combat and rescue simulation exercises with high-fidelity dummies. The integration in their training of a CBRN module with the initial decontamination batch of the SSA has been in place since this year. In partnership with the faculty’s anatomy laboratory, one day is devoted to advanced combat and rescue techniques that our 6th year students carry out on cadavers.
The ESA is resolutely turned towards the future taking into consideration both the reform of the two first university courses and making sure that the military medical preparation is as close as possible to the needs linked to the strategic issues and the French health service institution. The increase in recruited staff and the use of modern teaching techniques geared towards the digital and simulation will enable the French health service institution to meet tomorrow’s many challenges
MC COLLEONY Thomas, commandant le 1er Bataillon
MC AIGLE Luc directeur des études des EMSLB
AM JEZEQUEL Edward, élève de 2e année de médecine
Source: EMMS 2022