Certification of residents in general practice as competent professionals: example of a French post-graduate training program and evaluation process

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In France, there is a national register of professional certifications (Répertoire National des Certifications Professionnelles, RNCP). Objectives To analyse the training and evaluation process of RNCP-certified professions that have common competences with general practice, in order to compare them with the postgraduate program in general practice in Toulouse medical school, France. This comparison aimed to assess whether the existing model in Toulouse could potentially align with RNCP standards, thus paving the way for a recognized French certification in general practice. Methods Two researchers conducted a systematic review of the RNCP database and analysed independently 22643 records. Professions with at least 8 common competences with the French competency framework in general practice were identified. Results 15 professions were identified and analysed. Their training could include theoretical teaching (simulation, acquisition of resources, reflexivity), practical teaching (internship), formative evaluation (internship logbook, portfolio) and tutoring. All had intermediate and final evaluations. The training course in general practice in Toulouse medical school seems comparable. It is based on simulated and real-life situations in a competency-based approach. Conclusion The training course in Toulouse seems valid to allow a certification in general practice. Strengths: This research was conducted on a validated national database. Each stage was separately analysed by two researchers. Limitations: There was no validated analysis model for the study of such a database, which included sometimes very heterogeneous records. There may have been a selection bias. The minimum level of competence for certification expected at the end of the course needs to be defined. certification accreditation competences postgraduate training general practice Figures Figure 1 INTRODUCTION Certification in general practice: a societal requirement Starfield and al showed in 2005 a relationship between strong primary care and improved health outcomes for the population ( 1 ). It is recognised that the training and services offered by medical schools have an impact on the health status of society. The European Academy of Teachers in General Practice (EURACT) states that the development of an efficient European educational medical infrastructure has become an urgent issue, in order to provide patients with highly competent health professionals ( 2 ). WONCA Europe wishes for a common undergraduate family medicine curriculum, postgraduate specialist training and continuous professional development for family doctors in all European countries ( 3 ). General practitioners should achieve 6 core competences: primary care management, person-centered care, specific problem-solving skills, comprehensive approach, community orientation, and holistic modeling ( 4 ). Staudenmann and al. analysed in 2023 in a systematic literature review the wide variety of medical specialty certification methods, showing how in Europe and around the world postgraduate medical training differ substantially from country to country ( 5 ). Therefore, implementing a unified certification system seems difficult. Yet certification examinations provide the last opportunity to identify physicians who do not yet qualify for unsupervised practice, which underlines the need to reach common guidelines. The training course in general practice in France, and an example of the program in Toulouse Since 2002, French medical schools have switched from a teaching to a learning paradigm. Postgraduate medical training is no longer based on the transmission of knowledge but rather on the acquisition of competences in authentic situations ( 6 ). The national reform of 2017 gave official guidelines for medical schools to follow a progressive and personalized post-graduate program ( 7 ). Its objective is to guarantee a high level of training for all students and to improve quality of care. Training is individualized through tutoring and a portfolio containing written assignments based on real-life situations. Post-graduate medical training in general practice is based on a competency-based approach ( 8 ). It lasts forty-eight months and includes eight six-month internships. A tutor, different from the internship supervisor, accompanies the resident throughout the four years of training. Following these national guidelines, the training program in general practice in Toulouse medical school has been built around intermediate objectives that follow the resident’s progression ( 9 ), and ten groups of medical situations that cover the scope of general practice. It is based on three pillars: 1) theoretical teaching, based on simulated situations discussed during university courses and seminars; 2) practical teaching, with internships based on real-life situations, six of which in a general practice; 3) formative evaluation based on an internship logbook completed by the internship supervisor, and written assignments based on real-life situations, placed on a portfolio and corrected by a tutor. In France practicing physicians are now subjected to mandatory periodic recertification every six years since January 2023 ( 10 ). Despite the implementation of this recertification process, a framework for a specific certification at the end of the postgraduate training program has not yet been established. The French National Register of Professional Certifications: a national database The French National register of professional certifications (Répertoire National des Certifications Professionnelles, RNCP) ( 11 ) is a national database that collects courses in all sectors which certify competent professionals. Certification for the listed professions is based on a defined training program and a sanctioning assessment (intermediate and final). Objectives In the absence of a European certification, the objective of the study was to conduct a comparison between the current methods of training and evaluation in general practice in Toulouse medical school and those of the different professions that benefit from a certification by the National Register of Professional Certifications (RNCP) and have common competences with general practice. This comparison aimed to assess whether our existing model in Toulouse could potentially align with RNCP standards, thus paving the way for a recognized French certification in general practice. METHODS A review of the RNCP database was conducted by two researchers (MP, HP) between November 2015 and August 2016. We selected professions with common competences with general practice and analysed their training and evaluation methods in order to compare these methods with the current postgraduate training in general practice in Toulouse medical school. This selection of RNCP-certificated professions was carried out in 3 stages: 1) We eliminated duplicate professions and applied the exclusion criteria: diplomas without a professional purpose, state-guaranteed diplomas, validation of acquired experience, unlimited or undefined period of validity; 2) We compared the competences of the RNCP-certified professions with the 21 competences of the French competency framework in general practice (Référentiel Métier et Compétences de Médecine Générale, RMC-MG) ( 12 ) (Appendix 1). We identified the professions with more than two common competences with the RMC-MG; 3) We selected professions with common competences beyond the third quartile, corresponding to at least 8 common competences with the RMC-MG. We calculated Cohen’s kappa coefficient in stage 2 and 3. A third researcher (AS) was contacted in case of disagreement. For each profession selected at the end of the third stage, we researched their training and evaluation methods in the literature and by direct telephone contact with the academic institutions. The data was classified in Microsoft Word tables. The training methods were grouped according to theoretical teaching, practical teaching, formative assessment (written assignments, internship logbook), use of a portfolio, presence of a tutor, other teaching methods to allow a comparison with the post-graduate training program in Toulouse. The assessment methods used were divided into intermediate and final assessments and compared to the methods used in Toulouse: theoretical evaluation, practical evaluation, formative evaluation, summative evaluation. RESULTS Review of the RNCP database 22643 RNCP records were analysed independently by the two researchers (MP, HP). 15 professions were selected (Fig. 1 ) : industrial engineering manager, osteopath, air traffic controller, captain of the merchant navy, industrial and organizational psychologist, private detective, firefighter group leader for fire and disaster control operations, health safety and environment coordinator, human ressources manager, marine firefighter senior fire and rescue technician, international industrial business manager, chemical biochemical and biological laboratory technician, crisis communication and mediation advisor, sustainable development manager, chiropractor. We found a chapter dedicated to medical practitioners but it did not contain any professional certifications. Training modalities for the selected professions Two (13.3%) professions with at least 8 competences in common with general practice, 'osteopath' and 'industrial engineering manager', used all the training methods of the post-graduate training program in Toulouse (Table 1 ). No other training methods were found. Table 1 Training modalities for the 15 selected professions Theoretical training Practical training Formative evaluation Tutoring Simulation (problem solving skills) Acquisition of ressources Reflexivity development Internships Internship logbook (specific professional skills) Written assignment (portfolio) Industrial engineering manager ✓ ✓ ✓ ✓ ✓ ✓ ✓ Osteopath ✓ ✓ ✓ ✓ ✓ ✓ ✓ Air traffic controller ✓ ✓ ✓ ✓ ✓ - ✓ Captain of the merchant navy ✓ ✓ ✓ ✓ ✓ - ✓ Industrial and organizational psychologist ✓ ✓ ✓ ✓ ✓ - ✓ Private detective ✓ ✓ ✓ ✓ ✓ - ✓ Firefighter group leader for fire and disaster control operations ✓ ✓ ✓ ✓ - - ✓ Health, safety and environment coordinator ✓ ✓ ✓ ✓ - - ✓ Human ressources manager ✓ ✓ ✓ ✓ - - ✓ Marine firefighter senior fire and rescue technician ✓ ✓ ✓ ✓ - - ✓ International industrial business manager ✓ ✓ - ✓ ✓ - ✓ Chemical, biochemical and biological laboratory technician ✓ ✓ - ✓ - - ✓ Crisis communication and mediation advisor ✓ ✓ - ✓ - - ✓ Sustainable development manager ✓ ✓ - ✓ - - ✓ Chiropractor ✓ ✓ - ✓ - - - Evaluation methods for the selected professions All professions had an evaluation process for theoretical and practical teaching, 13 (80%) had one for the formative evaluation. Theoretical training was evaluated by: - attendance (12 (80%) professions) - a written examination (9 (60%) professions) - an oral examination (4 (26.7%) professions). Two (13.3%) professions, 'chiropractor' and 'chemical, biochemical and biological laboratory technician', combined the three theoretical evaluation methods. Practical training was evaluated by: - evaluation of the internship by the trainer (11 (73.3%) professions) - evaluation through a real-life simulated situation (6 (40%) professions) - an internship report (4 (26.7%) professions) - validation by presence alone (1 (6.7%) professions). The formative evaluation was based on a dissertation exploring a professional problematic developed throughout the training in 10 (66.7%) professions. The dissertation also served as a final evaluation. It was combined with an internship report in 3 (20%) professions. The 'osteopath' profession was the only one to require an IMRAD-type dissertation (introduction, methods, results, discussion). The firefighter professions ('Firefighter group leader for fire and disaster control operations', 'Marine firefighter senior fire and rescue technician') used formative evaluation grids based on skill-levels. These grids were completed by the student and the trainer, then compared and analysed. All selected professions had an intermediate and final assessment (Table 2 ). Table 2 intermediate and final assessment methods for the 15 selected professions Intermediate evaluation Final evaluation Theoretical evaluation Practical evalution Formative evaluation Summative evaluation Attendance Written examination Oral examination Evaluation of the internship by the trainer Internship report Evaluation through a real-life simulated situation Validation by presence alone Written assignements based on real-life simulated situations Evaluation grids Summation of credits Validation of internships Validation of competences in an internship logbook Defence of a dissertation in front of a jury Real life situation in front of a jury for evaluation Comparison to the postgraduate training program in general practice in Toulouse medical school ✓ - - ✓ ✓ - - ✓ ✓ ✓ ✓ ✓ ✓ - Air traffic controller ✓ ✓ - ✓ - ✓ - ✓ - ✓ ✓ - ✓ ✓ Private detective ✓ ✓ - ✓ ✓ ✓ - ✓ - ✓ - - ✓ ✓ Industrial and organizational psychologist ✓ ✓ - ✓ ✓ - - ✓ - - ✓ - ✓ ✓ International industrial business manager ✓ ✓ - ✓ - - - ✓ - ✓ ✓ ✓ ✓ - Crisis communication and mediation advisor - ✓ ✓ ✓ ✓ - - ✓ - ✓ ✓ - ✓ - Industrial engineering manager ✓ - - ✓ - ✓ - ✓ - - ✓ ✓ ✓ - Osteopath ✓ - - ✓ - - - ✓ - ✓ ✓ - ✓ ✓ Human ressources manager ✓ ✓ ✓ - - - ✓ - ✓ ✓ - ✓ - Chemical, biochemical and biological laboratory technician ✓ ✓ ✓ ✓ ✓ - - - - ✓ - - ✓ - Sustainable development manager ✓ - - ✓ - ✓ - ✓ - ✓ ✓ - ✓ - Chiropractor ✓ ✓ ✓ - - - ✓ - - ✓ ✓ - - ✓ Captain of the merchant navy - ✓ - - - - - ✓ - ✓ ✓ ✓ - - Health, safety and environment coordinator ✓ - - ✓ - - - - - ✓ ✓ - ✓ - Marine firefighter senior fire and rescue technician ✓ - - - - ✓ - - ✓ ✓ - - - ✓ Firefighter group leader for fire and disaster control operations ✓ - - - - ✓ - - ✓ ✓ - - - - DISCUSSION Main results 15 professions had at least 8 common competences with the RMC-MG. All had practical and theoretical training involving simulation and the acquisition of resources. 10 (66.7%) had theoretical training based on reflexivity. 7 (46.7%) had a formative evaluation: 7 (46.7%) using an internship logbook, 2 (13.3%) clinical written assignments on a portfolio. 14 (93.3%) had a tutoring approach. We did not find any other training method in the database. All had intermediate and a final assessment, which consisted most often in a summation of credits (13 (86.6%) professions) or a defence in front of a jury (11 (73,3%) professions). Comparison with the post-graduate training program in general practice in Toulouse Training methods We did not identify any other training methods than those used in the post-graduate program in general practice in the University of Toulouse. In Toulouse, the training program to progress to the status of competent professional in general practice is based on three pillars: theoretical training, practical training and formative assessment, similarly to the other 15 professions analysed. Two (13.3%) professions with at least 8 competences in common with general practice, 'osteopath' and 'industrial engineering manager', used all the training methods found: theoretical teaching (simulation, acquisition of resources, development of reflexivity), practical teaching (internship), formative evaluation (internship logbook, written assignements), and tutoring. These training methods are based on a competency-based approach which has been described as the most suitable method for training competent physicians ( 10 , 13 , 14 ). Evaluation methods All 15 professions included an intermediate evaluation in their educational program. Most often it consisted of credits to be validated before the final evaluation. Similarly, several intermediate evaluations take place in the training program in general practice in Toulouse. They are completed each semester by the resident’s internship supervisor and tutor and are required before the final evaluation. Each semester, the internship supervisor completes a logbook with the resident, which is divided into 3 parts: 1) a list of 812 items corresponding to specific professional skills covering the large scope of general practice; 2) an evaluation of intermediate objectives that describe the professional approach needed to respond to medical situations in primary care; 3) an end of semester evaluation summarizing progress during the internship. A separate tutor accompanies the resident throughout these years, validates written assignments on a portfolio and completes an end of semester evaluation. These intermediate evaluations meet distinct pedagogical objectives. The items in the internship logbook trace the acquisition of professional tasks or specific competences. They are sorted into 10 groups of medical situations and 5 dimensions that cover the scope of general practice. The majority of these 812 items are to be validated before taking the final evaluation. According to the WONCA Europe, solving specific medical problems is one of the main skills of general practitioners ( 15 ). The evaluation of intermediate objectives, that is completed by the supervisor three times during the semester, traces the acquisition of the resolution process specific to primary care ( 11 ). The written assignments allow the resident to reflect in writing on real situations encountered, to acquire resources, to mobilize, combine and modulate them, and to develop his/her reflexivity ( 16 ). The two end of semester evaluations completed separately by the resident’s internship supervisor and tutor summarise the resident’s progress through the internships and the written assignments, and include pedagogical advices for the following semesters. With the increasing demand of society to train doctors as competent professionals, assessment in medical education needs to have a summative function ( 17 ). All 15 studied professions had a final assessment, most often in the form of a dissertation, with sometimes a defence in front of a jury. The final evaluation in general practice in Toulouse is also based on the defence of a dissertation in front of a jury. The dissertation contains a research paper on general practice, a summary of the internships, a summary of the portfolio and of the internship logbook testifying of the acquisition of competences, and a summary of the intermediate evaluations. It underlines the resident’s progression throughout the years of post-graduate training. In 2023 Staudenmann and al. reviewed in a systematic review of literature a wide variety of medical specialty certification methods ( 5 ). According to the consensus statement and recommendations from the Ottawa 2010 conference, the following 7 criteria should be achieved by final evaluations to allow good assessment (Ottawa Quality Criteria): validity, reproducibility, equivalence, feasibility, educational effect, catalytic effect, acceptability. In his study, no medical specialty certification examination filled all seven criteria. The terminology of specialty examinations differed significantly from country to country. The most common final examinations included multiple choice questions, structured oral exams with expert discussions, objective structured clinical examinations, essay questions, dissertation appraisal and clinical experience. A large majority of universities used a combination of different modalities, with at least a combination of one written and oral method to allow medical specialty certification. The study included however mostly publications from English speaking countries. In our study, we found other evaluation methods that were not included into the post graduate training program in general practice in Toulouse medical school: written and oral theoretical evaluations, practical evaluation through a real-life simulated situation, final evaluation through a real-life situation in front of a jury. In France, written and oral evaluations are validated earlier during the training, during the Epreuves Dématérialisées Nationales (EDN) that take place during the fifth and sixth year of medical school. This national examination also includes objective structured clinical examinations with simulated patients. Evaluations during the post-graduate training program in general practice then mainly rely on the trainer (internship supervisor) and the tutor. All educational programs are then to be accredited to ensure their quality and efficiency. Frank and al. discussed the role of accreditation of educational programs in a report of an international consensus group ( 18 ). Accreditation was defined as 'the process of formal evaluation of an educational program, institution, or system against defined standards by an external body for the purposes of quality assurance and enhancement'. The authors state that accreditation can enhance health care outcomes because of its ability to influence the quality of training programs, continuously enhance curriculum to align with population needs, and improve learning environments. A common framework was designed by a group of international experts to facilitate accreditation of educational programs and could be used by varied international universities. Strengths and limitations This research project had several strengths. It was an original research, based on a validated national database. The competences of each profession were compared to the RMC-MG, which is a document validated in France for general practitioners. Each step was double-checked twice by two researchers. Cohen’s kappa coefficient was used. A third researcher was contacted in case of disagreement. This research had some limitations. There was no validated analysis model for the study of such a database, which contained sometimes very heterogeneous records. The selection of professions could sometimes be subjective. Finally, the use of the RMC-MG as a comparative tool could constitute a limitation in itself. For example, this reference framework does not develop the notion of safety of care or the knowledge of scientific English, which can nevertheless be important points in the training of a general practitioner. Perspectives It is known that training a competent general practitioner takes time considering 'the broad range of generic knowledge and clinical skills, the uncertainties and complexities of the workplace, and the practice management that is needed nowadays' ( 19 , 20 ). European educational training requirements for general practice were issued in 2018 ( 20 ). It is recommended that the training should be outcome-based, learner-centered and mostly be in the workplace itself. Trainees should be 'observed and assessed in the workplace across different practice contexts and use feedback and scores to develop and grow professionally.' The training and assessment methods in Toulouse seem to be in line with these requirements and therefore valid to allow a certification in general practice. The minimum level required for certification at the end of the training course still needs to be decided. In this perspective, a working group supported by the French National College of Teaching General Practitioners (Collège National des Généralistes Enseignants) has developed a new tool to assess competences of residents in general practice at the end of their post-graduate training ( 21 ). This new tool seems to make it possible to validate the resident’s level of competence at the end of the training course in a reasoned and criterion-based manner. It could be used by the various French universities. Its use in practice could then be evaluated. The number of items to be validated in order to decide on the student's level should also be specified. The European certification of residents in general practice could be based on the validation of the practical, theoretical and formative evaluations, the acquisition of the minimum level required, and the realization of a research paper centered on general practice. The validation of the defence in front of a jury could lead to an official university certification. CONCLUSION The training and assessment methods for the 15 professions selected (out of 22,643 RNCP records) seem overall comparable to the post-graduate training program in general practice in Toulouse: they are based on simulated and real-life situations in a competency-based approach. The training course in Toulouse medical school seems to be in line to allow a certification in general practice. The minimum level required at the end of program still needs to be defined to allow certification of residents as competent professionals. Declarations Clinical trial number: not applicable Ethics approval and consent to participate: Not applicable Consent for publication: Not applicable Availability of data and materials: The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: None Authors' contributions: MP, HP, AS designed the study. MP and HP collected and analysed the data. PM and FP wrote the manuscript in consultation with AS and EE. PM prepared the tables and figures. All authors read and approved the final manuscript. Acknowledgements: The authors would like to thank the members of the University Department of General Practice in Toulouse for their help during the study, their contribution and advice. References Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502. Windak A. Harmonizing general practice teachers’ development across Europe. Eur J Gen Pract. 2012;18(2):77–8. WONCA Europe. 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MUNIER","email":"data:image/png;base64,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","orcid":"","institution":"University Department of General Practice, Toulouse-Rangueil Faculty of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Pauline","middleName":"","lastName":"MUNIER","suffix":""},{"id":486725954,"identity":"7091385a-8165-405c-8dc7-f3084ce0fd77","order_by":1,"name":"Florent PORTET","email":"","orcid":"","institution":"University Department of General Practice, Toulouse-Rangueil Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Florent","middleName":"","lastName":"PORTET","suffix":""},{"id":486725955,"identity":"23d5ddb9-c4a9-4ce8-abbf-67a9a5f40838","order_by":2,"name":"Marania PENANHOAT","email":"","orcid":"","institution":"University Department of General Practice, Toulouse-Rangueil Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Marania","middleName":"","lastName":"PENANHOAT","suffix":""},{"id":486725960,"identity":"006f239a-90de-4699-ba2b-e94613fb25b6","order_by":3,"name":"Hélène PERUZZETTO","email":"","orcid":"","institution":"University Department of General Practice, Toulouse-Rangueil Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hélène","middleName":"","lastName":"PERUZZETTO","suffix":""},{"id":486725961,"identity":"b2b66d64-d2a9-4c8d-ad49-6746d968edc0","order_by":4,"name":"Emile ESCOURROU","email":"","orcid":"","institution":"University Department of General Practice, Toulouse-Rangueil Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Emile","middleName":"","lastName":"ESCOURROU","suffix":""},{"id":486725962,"identity":"de6c9619-de63-490a-ae6b-d752271e6065","order_by":5,"name":"André STILLMUNKES","email":"","orcid":"","institution":"University Department of General Practice, Toulouse-Rangueil Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"André","middleName":"","lastName":"STILLMUNKES","suffix":""}],"badges":[],"createdAt":"2025-07-03 14:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7039403/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7039403/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87181066,"identity":"091d95cc-78d2-40d6-a6bd-10509b21e3be","added_by":"auto","created_at":"2025-07-21 09:45:48","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":76187,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the review of the RNCP database\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7039403/v1/817d182cee76cf7b353460cd.jpg"},{"id":87184421,"identity":"5e45262f-26ed-4cb9-8315-fad152201034","added_by":"auto","created_at":"2025-07-21 10:09:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1420084,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7039403/v1/2a9ea460-957a-41fb-bd2c-ddd9da9e63a1.pdf"},{"id":87182976,"identity":"25fb1d16-7437-40a6-8703-31e138054440","added_by":"auto","created_at":"2025-07-21 10:01:48","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16912,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7039403/v1/bed1d466770b049889a7d93d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCertification of residents in general practice as competent professionals: example of a French post-graduate training program and evaluation process\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e\u003cem\u003eCertification in general practice: a societal requirement\u003c/em\u003e\u003c/p\u003e\u003cp\u003eStarfield and al showed in 2005 a relationship between strong primary care and improved health outcomes for the population (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is recognised that the training and services offered by medical schools have an impact on the health status of society. The European Academy of Teachers in General Practice (EURACT) states that the development of an efficient European educational medical infrastructure has become an urgent issue, in order to provide patients with highly competent health professionals (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). WONCA Europe wishes for a common undergraduate family medicine curriculum, postgraduate specialist training and continuous professional development for family doctors in all European countries (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). General practitioners should achieve 6 core competences: primary care management, person-centered care, specific problem-solving skills, comprehensive approach, community orientation, and holistic modeling (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStaudenmann and al. analysed in 2023 in a systematic literature review the wide variety of medical specialty certification methods, showing how in Europe and around the world postgraduate medical training differ substantially from country to country (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Therefore, implementing a unified certification system seems difficult. Yet certification examinations provide the last opportunity to identify physicians who do not yet qualify for unsupervised practice, which underlines the need to reach common guidelines.\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe training course in general practice in France, and an example of the program in Toulouse\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSince 2002, French medical schools have switched from a teaching to a learning paradigm. Postgraduate medical training is no longer based on the transmission of knowledge but rather on the acquisition of competences in authentic situations (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The national reform of 2017 gave official guidelines for medical schools to follow a progressive and personalized post-graduate program (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Its objective is to guarantee a high level of training for all students and to improve quality of care. Training is individualized through tutoring and a portfolio containing written assignments based on real-life situations. Post-graduate medical training in general practice is based on a competency-based approach (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). It lasts forty-eight months and includes eight six-month internships. A tutor, different from the internship supervisor, accompanies the resident throughout the four years of training.\u003c/p\u003e\u003cp\u003eFollowing these national guidelines, the training program in general practice in Toulouse medical school has been built around intermediate objectives that follow the resident\u0026rsquo;s progression (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), and ten groups of medical situations that cover the scope of general practice. It is based on three pillars: 1) theoretical teaching, based on simulated situations discussed during university courses and seminars; 2) practical teaching, with internships based on real-life situations, six of which in a general practice; 3) formative evaluation based on an internship logbook completed by the internship supervisor, and written assignments based on real-life situations, placed on a portfolio and corrected by a tutor.\u003c/p\u003e\u003cp\u003eIn France practicing physicians are now subjected to mandatory periodic recertification every six years since January 2023 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Despite the implementation of this recertification process, a framework for a specific certification at the end of the postgraduate training program has not yet been established.\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe French National Register of Professional Certifications: a national database\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe French National register of professional certifications (R\u0026eacute;pertoire National des Certifications Professionnelles, RNCP) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) is a national database that collects courses in all sectors which certify competent professionals. Certification for the listed professions is based on a defined training program and a sanctioning assessment (intermediate and final).\u003c/p\u003e\u003cp\u003e\u003cem\u003eObjectives\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn the absence of a European certification, the objective of the study was to conduct a comparison between the current methods of training and evaluation in general practice in Toulouse medical school and those of the different professions that benefit from a certification by the National Register of Professional Certifications (RNCP) and have common competences with general practice. This comparison aimed to assess whether our existing model in Toulouse could potentially align with RNCP standards, thus paving the way for a recognized French certification in general practice.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eA review of the RNCP database was conducted by two researchers (MP, HP) between November 2015 and August 2016.\u003c/p\u003e\u003cp\u003eWe selected professions with common competences with general practice and analysed their training and evaluation methods in order to compare these methods with the current postgraduate training in general practice in Toulouse medical school.\u003c/p\u003e\u003cp\u003eThis selection of RNCP-certificated professions was carried out in 3 stages: 1) We eliminated duplicate professions and applied the exclusion criteria: diplomas without a professional purpose, state-guaranteed diplomas, validation of acquired experience, unlimited or undefined period of validity; 2) We compared the competences of the RNCP-certified professions with the 21 competences of the French competency framework in general practice (R\u0026eacute;f\u0026eacute;rentiel M\u0026eacute;tier et Comp\u0026eacute;tences de M\u0026eacute;decine G\u0026eacute;n\u0026eacute;rale, RMC-MG) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) (Appendix 1). We identified the professions with more than two common competences with the RMC-MG; 3) We selected professions with common competences beyond the third quartile, corresponding to at least 8 common competences with the RMC-MG.\u003c/p\u003e\u003cp\u003eWe calculated Cohen\u0026rsquo;s kappa coefficient in stage 2 and 3. A third researcher (AS) was contacted in case of disagreement.\u003c/p\u003e\u003cp\u003eFor each profession selected at the end of the third stage, we researched their training and evaluation methods in the literature and by direct telephone contact with the academic institutions. The data was classified in Microsoft Word tables. The training methods were grouped according to theoretical teaching, practical teaching, formative assessment (written assignments, internship logbook), use of a portfolio, presence of a tutor, other teaching methods to allow a comparison with the post-graduate training program in Toulouse. The assessment methods used were divided into intermediate and final assessments and compared to the methods used in Toulouse: theoretical evaluation, practical evaluation, formative evaluation, summative evaluation.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cem\u003eReview of the RNCP database\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e22643 RNCP records were analysed independently by the two researchers (MP, HP). 15 professions were selected (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) : industrial engineering manager, osteopath, air traffic controller, captain of the merchant navy, industrial and organizational psychologist, private detective, firefighter group leader for fire and disaster control operations, health safety and environment coordinator, human ressources manager, marine firefighter senior fire and rescue technician, international industrial business manager, chemical biochemical and biological laboratory technician, crisis communication and mediation advisor, sustainable development manager, chiropractor.\u003c/p\u003e\n\u003cp\u003eWe found a chapter dedicated to medical practitioners but it did not contain any professional certifications.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTraining modalities for the selected professions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTwo (13.3%) professions with at least 8 competences in common with general practice, \u0026apos;osteopath\u0026apos; and \u0026apos;industrial engineering manager\u0026apos;, used all the training methods of the post-graduate training program in Toulouse (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eNo other training methods were found.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTraining modalities for the 15 selected professions\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eTheoretical training\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePractical training\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eFormative evaluation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTutoring\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSimulation (problem solving skills)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcquisition of ressources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReflexivity development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternship logbook (specific professional skills)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWritten assignment (portfolio)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndustrial engineering manager\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOsteopath\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAir traffic controller\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaptain of the merchant navy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndustrial and organizational psychologist\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrivate detective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirefighter group leader for fire and disaster control operations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth, safety and environment coordinator\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHuman ressources manager\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarine firefighter senior fire and rescue technician\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInternational industrial business manager\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eChemical, biochemical and biological laboratory technician\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrisis communication and mediation advisor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSustainable development manager\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eChiropractor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eEvaluation methods for the selected professions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll professions had an evaluation process for theoretical and practical teaching, 13 (80%) had one for the formative evaluation.\u003c/p\u003e\n\u003cp\u003eTheoretical training was evaluated by:\u003c/p\u003e\n\u003cp\u003e- attendance (12 (80%) professions)\u003c/p\u003e\n\u003cp\u003e- a written examination (9 (60%) professions)\u003c/p\u003e\n\u003cp\u003e- an oral examination (4 (26.7%) professions).\u003c/p\u003e\n\u003cp\u003eTwo (13.3%) professions, \u0026apos;chiropractor\u0026apos; and \u0026apos;chemical, biochemical and biological laboratory technician\u0026apos;, combined the three theoretical evaluation methods.\u003c/p\u003e\n\u003cp\u003ePractical training was evaluated by:\u003c/p\u003e\n\u003cp\u003e- evaluation of the internship by the trainer (11 (73.3%) professions)\u003c/p\u003e\n\u003cp\u003e- evaluation through a real-life simulated situation (6 (40%) professions)\u003c/p\u003e\n\u003cp\u003e- an internship report (4 (26.7%) professions)\u003c/p\u003e\n\u003cp\u003e- validation by presence alone (1 (6.7%) professions).\u003c/p\u003e\n\u003cp\u003eThe formative evaluation was based on a dissertation exploring a professional problematic developed throughout the training in 10 (66.7%) professions. The dissertation also served as a final evaluation. It was combined with an internship report in 3 (20%) professions. The \u0026apos;osteopath\u0026apos; profession was the only one to require an IMRAD-type dissertation (introduction, methods, results, discussion).\u003c/p\u003e\n\u003cp\u003eThe firefighter professions (\u0026apos;Firefighter group leader for fire and disaster control operations\u0026apos;, \u0026apos;Marine firefighter senior fire and rescue technician\u0026apos;) used formative evaluation grids based on skill-levels. These grids were completed by the student and the trainer, then compared and analysed.\u003c/p\u003e\n\u003cp\u003eAll selected professions had an intermediate and final assessment (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eintermediate and final assessment methods for the 15 selected professions\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003eIntermediate evaluation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eFinal evaluation\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eTheoretical evaluation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003ePractical evalution\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eFormative evaluation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eSummative evaluation\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAttendance\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWritten examination\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOral examination\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEvaluation of the internship by the trainer\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInternship report\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEvaluation through a real-life simulated situation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValidation by presence alone\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWritten assignements based on real-life simulated situations\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEvaluation grids\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSummation of credits\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValidation of internships\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValidation of competences in an internship logbook\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDefence of a dissertation in front of a jury\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReal life situation in front of a jury for evaluation\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparison to the postgraduate training program in general practice in Toulouse medical school\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAir traffic controller\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrivate detective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndustrial and organizational psychologist\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInternational industrial business manager\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrisis communication and mediation advisor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndustrial engineering manager\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOsteopath\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHuman ressources manager\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eChemical, biochemical and biological laboratory technician\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSustainable development manager\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eChiropractor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaptain of the merchant navy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth, safety and environment coordinator\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarine firefighter senior fire and rescue technician\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirefighter group leader for fire and disaster control operations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e\u003cem\u003eMain results\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e15 professions had at least 8 common competences with the RMC-MG.\u003c/h3\u003e\n\u003cp\u003eAll had practical and theoretical training involving simulation and the acquisition of resources. 10 (66.7%) had theoretical training based on reflexivity. 7 (46.7%) had a formative evaluation: 7 (46.7%) using an internship logbook, 2 (13.3%) clinical written assignments on a portfolio. 14 (93.3%) had a tutoring approach. We did not find any other training method in the database. All had intermediate and a final assessment, which consisted most often in a summation of credits (13 (86.6%) professions) or a defence in front of a jury (11 (73,3%) professions).\u003c/p\u003e\u003cp\u003e\u003cem\u003eComparison with the post-graduate training program in general practice in Toulouse\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTraining methods\u003c/span\u003e\u003c/p\u003e\u003cp\u003eWe did not identify any other training methods than those used in the post-graduate program in general practice in the University of Toulouse.\u003c/p\u003e\u003cp\u003eIn Toulouse, the training program to progress to the status of competent professional in general practice is based on three pillars: theoretical training, practical training and formative assessment, similarly to the other 15 professions analysed.\u003c/p\u003e\u003cp\u003eTwo (13.3%) professions with at least 8 competences in common with general practice, 'osteopath' and 'industrial engineering manager', used all the training methods found: theoretical teaching (simulation, acquisition of resources, development of reflexivity), practical teaching (internship), formative evaluation (internship logbook, written assignements), and tutoring. These training methods are based on a competency-based approach which has been described as the most suitable method for training competent physicians (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEvaluation methods\u003c/span\u003e\u003c/p\u003e\u003cp\u003eAll 15 professions included an intermediate evaluation in their educational program. Most often it consisted of credits to be validated before the final evaluation.\u003c/p\u003e\u003cp\u003eSimilarly, several intermediate evaluations take place in the training program in general practice in Toulouse. They are completed each semester by the resident\u0026rsquo;s internship supervisor and tutor and are required before the final evaluation.\u003c/p\u003e\u003cp\u003eEach semester, the internship supervisor completes a logbook with the resident, which is divided into 3 parts: 1) a list of 812 items corresponding to specific professional skills covering the large scope of general practice; 2) an evaluation of intermediate objectives that describe the professional approach needed to respond to medical situations in primary care; 3) an end of semester evaluation summarizing progress during the internship.\u003c/p\u003e\u003cp\u003eA separate tutor accompanies the resident throughout these years, validates written assignments on a portfolio and completes an end of semester evaluation.\u003c/p\u003e\u003cp\u003eThese intermediate evaluations meet distinct pedagogical objectives.\u003c/p\u003e\u003cp\u003eThe items in the internship logbook trace the acquisition of professional tasks or specific competences. They are sorted into 10 groups of medical situations and 5 dimensions that cover the scope of general practice. The majority of these 812 items are to be validated before taking the final evaluation. According to the WONCA Europe, solving specific medical problems is one of the main skills of general practitioners (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe evaluation of intermediate objectives, that is completed by the supervisor three times during the semester, traces the acquisition of the resolution process specific to primary care (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe written assignments allow the resident to reflect in writing on real situations encountered, to acquire resources, to mobilize, combine and modulate them, and to develop his/her reflexivity (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe two end of semester evaluations completed separately by the resident\u0026rsquo;s internship supervisor and tutor summarise the resident\u0026rsquo;s progress through the internships and the written assignments, and include pedagogical advices for the following semesters.\u003c/p\u003e\u003cp\u003eWith the increasing demand of society to train doctors as competent professionals, assessment in medical education needs to have a summative function (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAll 15 studied professions had a final assessment, most often in the form of a dissertation, with sometimes a defence in front of a jury. The final evaluation in general practice in Toulouse is also based on the defence of a dissertation in front of a jury. The dissertation contains a research paper on general practice, a summary of the internships, a summary of the portfolio and of the internship logbook testifying of the acquisition of competences, and a summary of the intermediate evaluations. It underlines the resident\u0026rsquo;s progression throughout the years of post-graduate training.\u003c/p\u003e\u003cp\u003eIn 2023 Staudenmann and al. reviewed in a systematic review of literature a wide variety of medical specialty certification methods (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). According to the consensus statement and recommendations from the Ottawa 2010 conference, the following 7 criteria should be achieved by final evaluations to allow good assessment (Ottawa Quality Criteria): validity, reproducibility, equivalence, feasibility, educational effect, catalytic effect, acceptability. In his study, no medical specialty certification examination filled all seven criteria. The terminology of specialty examinations differed significantly from country to country. The most common final examinations included multiple choice questions, structured oral exams with expert discussions, objective structured clinical examinations, essay questions, dissertation appraisal and clinical experience. A large majority of universities used a combination of different modalities, with at least a combination of one written and oral method to allow medical specialty certification. The study included however mostly publications from English speaking countries.\u003c/p\u003e\u003cp\u003eIn our study, we found other evaluation methods that were not included into the post graduate training program in general practice in Toulouse medical school: written and oral theoretical evaluations, practical evaluation through a real-life simulated situation, final evaluation through a real-life situation in front of a jury. In France, written and oral evaluations are validated earlier during the training, during the Epreuves D\u0026eacute;mat\u0026eacute;rialis\u0026eacute;es Nationales (EDN) that take place during the fifth and sixth year of medical school. This national examination also includes objective structured clinical examinations with simulated patients. Evaluations during the post-graduate training program in general practice then mainly rely on the trainer (internship supervisor) and the tutor.\u003c/p\u003e\u003cp\u003eAll educational programs are then to be accredited to ensure their quality and efficiency. Frank and al. discussed the role of accreditation of educational programs in a report of an international consensus group (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Accreditation was defined as 'the process of formal evaluation of an educational program, institution, or system against defined standards by an external body for the purposes of quality assurance and enhancement'. The authors state that accreditation can enhance health care outcomes because of its ability to influence the quality of training programs, continuously enhance curriculum to align with population needs, and improve learning environments. A common framework was designed by a group of international experts to facilitate accreditation of educational programs and could be used by varied international universities.\u003c/p\u003e\u003cp\u003e\u003cem\u003eStrengths and limitations\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis research project had several strengths. It was an original research, based on a validated national database. The competences of each profession were compared to the RMC-MG, which is a document validated in France for general practitioners. Each step was double-checked twice by two researchers. Cohen\u0026rsquo;s kappa coefficient was used. A third researcher was contacted in case of disagreement.\u003c/p\u003e\u003cp\u003eThis research had some limitations. There was no validated analysis model for the study of such a database, which contained sometimes very heterogeneous records. The selection of professions could sometimes be subjective. Finally, the use of the RMC-MG as a comparative tool could constitute a limitation in itself. For example, this reference framework does not develop the notion of safety of care or the knowledge of scientific English, which can nevertheless be important points in the training of a general practitioner.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePerspectives\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIt is known that training a competent general practitioner takes time considering 'the broad range of generic knowledge and clinical skills, the uncertainties and complexities of the workplace, and the practice management that is needed nowadays' (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). European educational training requirements for general practice were issued in 2018 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). It is recommended that the training should be outcome-based, learner-centered and mostly be in the workplace itself. Trainees should be 'observed and assessed in the workplace across different practice contexts and use feedback and scores to develop and grow professionally.'\u003c/p\u003e\u003cp\u003eThe training and assessment methods in Toulouse seem to be in line with these requirements and therefore valid to allow a certification in general practice.\u003c/p\u003e\u003cp\u003eThe minimum level required for certification at the end of the training course still needs to be decided. In this perspective, a working group supported by the French National College of Teaching General Practitioners (Coll\u0026egrave;ge National des G\u0026eacute;n\u0026eacute;ralistes Enseignants) has developed a new tool to assess competences of residents in general practice at the end of their post-graduate training (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This new tool seems to make it possible to validate the resident\u0026rsquo;s level of competence at the end of the training course in a reasoned and criterion-based manner. It could be used by the various French universities. Its use in practice could then be evaluated. The number of items to be validated in order to decide on the student's level should also be specified.\u003c/p\u003e\u003cp\u003eThe European certification of residents in general practice could be based on the validation of the practical, theoretical and formative evaluations, the acquisition of the minimum level required, and the realization of a research paper centered on general practice. The validation of the defence in front of a jury could lead to an official university certification.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe training and assessment methods for the 15 professions selected (out of 22,643 RNCP records) seem overall comparable to the post-graduate training program in general practice in Toulouse: they are based on simulated and real-life situations in a competency-based approach. The training course in Toulouse medical school seems to be in line to allow a certification in general practice. The minimum level required at the end of program still needs to be defined to allow certification of residents as competent professionals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number: not applicable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e MP, HP, AS designed the study. MP and HP collected and analysed the data. PM and FP wrote the manuscript in consultation with AS and EE. PM prepared the tables and figures.\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors would like to thank the members of the University Department of General Practice in Toulouse for their help during the study, their contribution and advice.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStarfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWindak A. Harmonizing general practice teachers\u0026rsquo; development across Europe. Eur J Gen Pract. 2012;18(2):77\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWONCA Europe. European Family Doctors call for Joint Action with Heads and Hearts! 2016 [cited 2023 Apr 18]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.woncaeurope.org/kb/wonca-europe-2016-copenhagen-european-family-doctors-call-for-joint-action-with-heads-and-hearts%21\u003c/span\u003e\u003cspan address=\"https://www.woncaeurope.org/kb/wonca-europe-2016-copenhagen-european-family-doctors-call-for-joint-action-with-heads-and-hearts%21\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllen J, Gay B, Crebolder H, Heyrman J, Svab I, Ram P. The European definitions of the key features of the discipline of general practice: the role of the GP and core competencies. Br J Gen Pract J R Coll Gen Pract. 2002;52(479):526\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStaudenmann D, Waldner N, L\u0026ouml;rwald A, et al. Medical specialty certification exams studied according to the Ottawa Quality Criteria: a systematic review. BMC Med Educ. 2023;23:619. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12909-023-04600-x\u003c/span\u003e\u003cspan address=\"10.1186/s12909-023-04600-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJouquan J, Bail P. A quoi s\u0026rsquo;engage-t-on en basculant du paradigme d\u0026rsquo;enseignement vers le paradigme d\u0026rsquo;apprentissage ? P\u0026eacute;dagogie M\u0026eacute;dicale. 2003;4(3):163\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR\u0026eacute;forme du 3e cycle des \u0026eacute;tudes. de m\u0026eacute;decine: une formation r\u0026eacute;nov\u0026eacute;e, modernis\u0026eacute;e et simplifi\u0026eacute;e [Internet]. enseignementsup-recherche.gouv.fr. [cited 2023 Apr 20]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.enseignementsup-recherche.gouv.fr/fr/reforme-du-3e-cycle-des-etudes-de-medecine-une-formation-renovee-modernisee-et-simplifiee-49202\u003c/span\u003e\u003cspan address=\"https://www.enseignementsup-recherche.gouv.fr/fr/reforme-du-3e-cycle-des-etudes-de-medecine-une-formation-renovee-modernisee-et-simplifiee-49202\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChartier S, Breton JL, Ferrat E, Compagnon L, Attali C, Renard V. L\u0026rsquo;\u0026eacute;valuation dans l\u0026rsquo;approche par comp\u0026eacute;tences en m\u0026eacute;decine g\u0026eacute;n\u0026eacute;rale. Exercer. 2013;24(108):171\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMunier P, Stillmunkes A, Roug\u0026eacute;-Bugat M\u0026Egrave;, Bismuth M, Mesthe P, Oustric S, et al. 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GMS J Med Educ. 2017;34(5):Doc69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHummers-Pradier E, Beyer M, Chevallier P, Eilat-Tsanani S, Lionis C, Peremans L, et al. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: Specific problem solving skills. Eur J Gen Pract. 2010;16(3):174\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe reflective practitioner. - guidance for doctors and medical students [Internet]. [cited 2023 Apr 18]. 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The role of accreditation in 21st century health professions education: report of an International Consensus Group. BMC Med Educ. 2020;20(1):305.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO\u0026rsquo;Shea BE. Extension of Training for General Practice: A Review of the Evidence. Educ Prim Care. 2009;20(1):15\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMichels NRM, Maagaard R, Buchanan J, Scherpbier N. Educational training requirements for general practice/family medicine specialty training: recommendations for trainees, trainers and training institutions. Educ Prim Care. 2018;29(6):322\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAriza M, Lajzerowicz C, Onaisi R, Hofferer A, Macabrey J, Rabiaza A. Elaboration d\u0026rsquo;un outil d\u0026rsquo;\u0026eacute;valuation des comp\u0026eacute;tences en fin de troisi\u0026egrave;me cycle de m\u0026eacute;decine g\u0026eacute;n\u0026eacute;rale. Exercer. 2022;(185):327\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"certification, accreditation, competences, postgraduate training, general practice","lastPublishedDoi":"10.21203/rs.3.rs-7039403/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7039403/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDespite a societal demand, there are no guidelines for a certification in general practice in the world. In France, there is a national register of professional certifications (R\u0026eacute;pertoire National des Certifications Professionnelles, RNCP).\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo analyse the training and evaluation process of RNCP-certified professions that have common competences with general practice, in order to compare them with the postgraduate program in general practice in Toulouse medical school, France. This comparison aimed to assess whether the existing model in Toulouse could potentially align with RNCP standards, thus paving the way for a recognized French certification in general practice.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eTwo researchers conducted a systematic review of the RNCP database and analysed independently 22643 records. Professions with at least 8 common competences with the French competency framework in general practice were identified.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e15 professions were identified and analysed. Their training could include theoretical teaching (simulation, acquisition of resources, reflexivity), practical teaching (internship), formative evaluation (internship logbook, portfolio) and tutoring. All had intermediate and final evaluations. The training course in general practice in Toulouse medical school seems comparable. It is based on simulated and real-life situations in a competency-based approach.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe training course in Toulouse seems valid to allow a certification in general practice. Strengths: This research was conducted on a validated national database. Each stage was separately analysed by two researchers. Limitations: There was no validated analysis model for the study of such a database, which included sometimes very heterogeneous records. There may have been a selection bias. The minimum level of competence for certification expected at the end of the course needs to be defined.\u003c/p\u003e","manuscriptTitle":"Certification of residents in general practice as competent professionals: example of a French post-graduate training program and evaluation process","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-21 09:45:44","doi":"10.21203/rs.3.rs-7039403/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-06T07:43:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T12:07:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185236620523005161739292187021150288588","date":"2025-09-26T13:50:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146963222845760688676438209102471591253","date":"2025-09-22T06:02:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122161198046105521855866432027574094791","date":"2025-09-17T15:01:39+00:00","index":"hide","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-19T20:15:39+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-16T17:03:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-16T16:44:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-16T15:02:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-07-16T13:12:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f29d90d2-54c3-464e-befb-d2f24cc411d0","owner":[],"postedDate":"July 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T09:45:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-21 09:45:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7039403","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7039403","identity":"rs-7039403","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}