title: Educating doctors in France and Canada: are the differences based on evidence or history?
abstract: BACKGROUND
  Despite many economic and political similarities between France and Canada, particularly in their health care systems, there are very significant differences in their systems of medical education.
  
  
  OBJECTIVE
  This work aims to highlight the sociohistorical values of each country that explain these differences by comparing the medical education systems of the 2 countries, including medical schools (teachers, funding), key processes (curriculum, student selection) and quality assurance methods.
  
  
  CONCLUSIONS
  In France, means and processes are standardised and defined at a national level. France has almost no national system of assessment of medical schools nor of students. By contrast, Canada leaves medical schools free to design their medical curricula, select students and appoint teachers using their own criteria. In order to guarantee the homogeneity and quality of graduates, the medical profession in Canada has created independent national organisations that are responsible for accreditation and certification processes. Each country has a set of founding values that partly explain the choices that have been made. In France these include equality and the right to receive free education. In Canada, these include equity, affirmative action and market-driven tuition.
  
  
  CONCLUSIONS
  Many of the differences are more easily explained by history and national values than by a robust base of evidence. There is a constant tension between a vision of education promoted by medical educators, based on contextually non-specific ideas such as those found in the medical education literature, and the sociopolitical foundations and forces that are unique to each country. If we fail to consider such variables, we are likely to encounter significant resistance when implementing reforms.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Faculté de Medecine, Université Denis Diderot, Paris 7, France. christophe.segouin@sap.ap-hop-paris.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Segouin
authors.forename: Brian
authors.initials: B
authors.lastname: Hodges
mesh_terms: D002170:Canada; D003469:Culture; D003479:Curriculum; D004501:Education, Medical / Q000191:economics / Q000458:organization & administration*; D005249:Fees and Charges; D005380:Financing, Government; D005602:France; D010560:Personnel Selection / Q000458:organization & administration; D012570:School Admission Criteria; D012577:Schools, Medical / Q000191:economics / Q000458:organization & administration*; D013663:Teaching / Q000379:methods*