2024-03-22 16:51:14
A report on the status of supervisory staff of training structures and teacher-researchers in the context of the universalization of paramedical training formulates 24 recommendations including the creation of a status of clinical teacher-researcher or even that of hospital student. Synthesis.
The context
Initiated in 2009 with nursing training, the universalization of paramedical professions is engaged in a continuous process of overhauling paramedical training to include it in the training architecture of higher education, License Master Doctorate, while responding to the challenges of student and professional attractiveness, and transformations of professions.
After an initial phase which allowed the recognition of the bachelor’s or master’s degree for 95% of paramedical students, a second era opened from 2018 with the development of advanced practice, the creation of sections of the National Council of Universities ( CNU) health, 91 for rehabilitation sciences and 92 for nursing sciences, and the recruitment of the first paramedical teacher-researchers.
Experiments have been authorized allowing universities to offer new training schemes facilitating “the strengthening of exchanges between health training courses, the establishment of common teaching and access to training through research”. These developments are leading to profound transformations in training organizations. They bring to light the need for new skills and lead us to question the impacts on the human resources of the actors involved in the broad field of paramedical training.
In this dynamic, the Minister of Higher Education and Research and the Minister of Health and Prevention confirmed their desire to complete the universityization of paramedical training and entrusted an operational support mission to Professor Christine Ammirati with specific attention to four areas: diploma and engineering, conventional, student rights, research and supervision.
The study
To instruct this last component, research and supervision, the ministers asked the General Inspectorate of Social Affairs (IGAS) and the General Inspectorate of Education, Sport and Research (IGESR), by mission letter dated February 22, 2023, to establish an inventory and formulate recommendations on the status of supervisory staff of training structures and teacher-researchers in the context of the universalization of paramedical training. Monthly discussion times were organized with Professor Ammirati in order to fuel mutual reflections.
The inventory established by the mission covers all paramedical professions regulated by Titles I to VII of Book III of Part IV of the Public Health Code. These professions can be schematically divided into three groups:
state-certified nurses, including the three nursing specialties (nurse anesthetists,
operating room and childcare workers), and advanced practice nurses; rehabilitation and rehabilitation professions which mainly include
physiotherapists, chiropodists, occupational therapists,
psychomotor therapists, speech therapists, orthoptists, hearing aid specialists and dieticians; medical-technical professions including electroradiology technicians,
medical laboratory technicians.
No study had been conducted until this report on the state of human resources, trainers, supervisors and paramedical teacher-researchers.
The mission began with a first step of stabilizing the scope which led it to take into account data of different types, not consolidated at the national or regional level, due to the very heterogeneity of the training institutes and structures, numerous different legal statuses irrigating the national territory. Travel and interviews in six metropolitan regions and an overseas region, supplemented by a survey organized by the mission, as well as numerous meetings made it possible to understand more closely the training levels of the supervisory teams, the challenges of transforming the professions, the needs for new skills to support in particular the development of paramedical research which underpins the integration of the LMD system. The inventory also focused on the levers and difficulties to be addressed at the statutory level to support ongoing developments between universities and training institutes and develop the pool of teacher-researchers.
The report draws up, in its first part, the map of paramedical training which is distinguished into two categories according to the nature of the diploma awarded:
training leading to a national higher education diploma delivered by universities, or for high schools with sections of higher technicians, training leading to a state diploma delivered by the regional prefect, provided by institutes, managed by a public health establishment, or by a private manager. These public and private training institutes fall under the authorization and financing powers transferred by the State to the regional councils since the decentralization law of 2004.
State of play
After bringing together different sources, the mission was able to establish the number of trainers supervising nearly 140,000 paramedical students at 5,000.. In terms of number of institutes, as well as student numbers, the network of nursing training institutes is by far the most extensive, with more than 300 IFSIs and 95,000 students registered in 2021. It is supplemented by nursing specialties. The second sector in terms of staff is that of rehabilitation-reeducation,
with more than 30,000 students, then the medical-technical sector with 10,000 students.
The observations made on the supervisors highlight a population in the process of evolving with heterogeneous academic backgrounds and partially equipped to respond to academic challenges. Public training institutes are still mainly run by care directors, numbering 184 at the start of 2022, in decline for ten years. Statutorily trained at the School of Advanced Studies in Public Health (EHESP) but without university recognition (master’s or doctorate), the mission wondered about the evolution of their training.
Nursing supervisors are still in the middle in terms of level of training, with 55% holding a master’s degree. However, the mission also noted a positive trend in recent years, despite the health crisis and thanks to the increasingly widespread coupling of health executive training with a master’s degree but also the recruitment of non-managerial master’s or doctorate holders. Statutory recognition for the latter is also addressed by the mission.
Regarding the aspects of research and appointment of teacher-researchers, the mission establishes mixed findings which must however be put into perspective of the still recent context of the creation of the CNU 91 and 92 sections and the measures to support the development of paramedical research. The mission identified thirty appointments in sections 91 and 92 after three recruitment campaigns to which are added twelve ongoing recruitments under
The teacher-researchers interviewed question the single-owner status combined with a care activity, which poorly responds to remuneration issues for the oldest among them, but also to their expectations of satisfactory working conditions to carry out the work. all of their missions. France’s positioning is still weak, despite the dynamic of paramedical research that the mission was able to support at the national level with the hospital paramedical research program, and its regional relay, or in establishments. France occupies 30th place in the world in number of publications in the field of nursing sciences, for example, and support for research courses is not yet structured in a clear way, nor financed.
Finally, the report points out the statutory obstacles that exist between training institutes and universities in the numerous collaborative projects which accompany the ongoing transformations of paramedical training. Provision remains the only tool that can be easily mobilized by default by institutions but raises questions about bringing strengthened collaborations to a large scale. The non-eligibility of personnel made available to receive the
additional index treatment resulting from the Ségur de la santé agreements also makes this position less attractive for the staff concerned.
24 recommendations
In view of these findings, the report formulates, in its second part, 24 recommendations to respond to the challenges of attractiveness of training and professions by structuring paramedical teacher-researcher sectors and supporting partnership and territorial dynamics in ongoing transformations of training
paramedical.
To improve the attractiveness of the status of teacher-researcher and encourage the creation of a pool through early support through and for research, the mission proposes to:
provide a specific legal basis for tenured and non-tenured paramedical teacher-researchers opening an attractive and mixed clinical dual-member status, hospital or outpatient, several recommendations specifying the management methods accompanying the creation of this new status; create a status of university clinical teacher (ECU) like university clinical heads; facilitate early guidance towards pursuing a master’s then doctoral course with targeted measures at the different levels of the course; extend the hospital student status currently enjoyed by second cycle medical students in hospitals to paramedical students also in second cycle, in initial training or continuing their studies; set up doctoral contracts within the framework of multi-year programs managed and financed by the ministries.
The report then formulates recommendations to support the pursuit of university education and promote the essential complementarity and the need for diversity of skills through appropriate statutory responses:
the establishment of a 2024-2030 national program providing in particular for the recruitment of 136 tenured teacher-researchers, i.e. 4 teacher-researchers (two for each of sections 91 and 92) for 34 universities with a health component; supporting teaching teams to generalize the Master 2 qualification of supervisors and supporting the careers of doctoral students. To this end, an update of the professional framework must also integrate the new educational organization expectations. The adaptation of the training of care directors is proposed in this context. statutory changes to recognize all professionals who have embarked on a university degree course and are entrusted with research or training management missions; depending on the choices made locally, certain university-training institute collaborations will take the form of organic integration and risk finding themselves confronted with difficulties in offering a host status ensuring the maintenance of hospital remuneration. Several statutory options are formulated, including, among other things, the opening of access to the positions of engineers and technical research personnel and
training.
Read the report
Human resources and status of supervisors and teacher-researchers in university paramedical training coursesNadiège BAILLE, Françoise ZANTMAN, Jean DEBEAUPUIS (General Inspectorate of Social Affairs); Hélène MOULIN-RODARIE, Anne-Marie ROMULUS, Pierre VAN DE WEGHE (General Inspectorate of Education, Sport and Research), IGAS REPORT N°2023-017R / IGESR N° 22-23 001, March 2024.
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