[Historical, educational, and organizational determinants shaping medical education in France and Quebec].

Abstract

This review aims to clarify the historical foundations and the pedagogical and organizational specificities of the French and Quebec medical education systems through a narrative and comparative analysis of the available literature. In France, medical curricula have primarily been shaped by political and institutional reforms, which have influenced medical pedagogy without being explicitly grounded in any specific educational theory. In Canada, by contrast, medical education has been conceived as an educational construct informed by the dominant educational theories available at the time of curricular development. In France, medical education has largely remained based on a Flexnerian model centred on transmissive teaching, large-group instruction, and a predominantly biomedical and disciplinary approach. At the Université de Montréal, however, students are engaged from the outset in interactive team-based and transdisciplinary learning, integrating both biomedical and social dimensions within a clearly socio-constructivist pedagogical framework. The competency-based approach emerged in France nearly two decades later than in Quebec, notably through the adoption of the seven competency domains derived from the Canadian "CanMEDS flower" framework and through the implementation of formative and summative OSCEs, which constitute one of its most tangible expressions. This historical, epistemological, institutional, and pedagogical overview of medical education in France and Quebec helps clarify the differences and similarities currently observed between the two educational systems and provides a better understanding of how, and under what conditions, the French system may draw inspiration from Quebec models.