La première année commune des études de santé (PACES) est une année difficile en raison du concours et d’un contexte compétitif qui met à rude épreuve la santé des étudiants. Dans le cadre de la réforme des études de santé (rentrée 2010) qui réunit les quatre filières (médecine, odontologie, maïeutique et pharmacie), un nouveau programme a été proposé en laissant la possibilité aux étudiants de choisir plusieurs concours. Cette réforme qui permet à l’étudiant de redéfinir ses choix est apparue comme un nouveau facteur de stress que nous avons voulu évaluer tout en ciblant notre intérêt sur les conséquences physiques et psychologiques de la santé des étudiants et sur leur qualité de vie. Au cours de l’année universitaire de PACES de 2011–2012, la qualité de vie, le stress et la santé physique et psychologique des étudiants ont été évalués en début et en fin d’année. Les résultats de cette cohorte composée de plus de 1000 étudiants ont montré une qualité de vie des étudiants bien dégradée, comparée à d’autres filières, un stress spécifique élevé et des conséquences tant physiques que psychologiques qui nécessitent de développer des actions préventives auprès de ces jeunes populations qui sont des soignants en devenir.

The first year of health sciences studies is a challenging time given the many changes in: learning, work habits, autonomy acquisition, new responsibilities, and establishing a break between educational and psychosocial activities (Lahire, 1997). Experiencing so many changes requires time to adjust and development of coping resources. This is why student health has become an important issue for the authorities responsible for this aspect of campus life. These authorities have been particularly affected by recent revelations concerning the living conditions and difficulties that students encounter during their studies. In Europe (Belghith et al., 2011), and more specifically in France (Belghith et al., 2011; Lafay et al., 2003), several health reports point out the physical, psychological and financial difficulties that students are experiencing, all of which portend a complicated future perspective. Regarding students in health sciences studies specifically, some Anglo-Saxon research highlights reports of high levels of anxiety and depression disorders along with suicidal ideation manifested by medical students (Schwenk et al., 2010; Garnier, 2010). The results suggest that future doctors could be predisposed to depression and that their overall health profile would not be comparable to a general age-comparable population (Rosenthal, 2005). Little research has been carried out in France where the first year of health sciences studies (known as PACES) is a common year for different healthcare professions (doctors, dentists, physical therapists, midwives). The present study was conducted with a sample of students from this population. The first year of PACES is widely acknowledged to be a difficult year because of competition between students that can severely impact their health. As part of a proposed health sciences studies reform (September 2010), a new program has been developed allowing students the opportunity to choose more than one career objective (as noted above, doctors, dentists, physical therapists, midwives). This reform is presented as a potential stress factor. In this study, both the way the students perceive and experience the first year of PACES, as well as the impact on their quality of life, physical, and psychological health were evaluated with the objective to propose possible prevention and intervention strategies.

University of Nantes PACES students (academic year 2011–2012) were asked to participate in this longitudinal study composed of two separate evaluations at six months interval. Nine hundred and thirty-six students completed questionnaires directly on the university website at time 1 and 657 at time 2, six months later. Information about their living conditions were collected (general and academic information, practical aspects of academic, social support, and their physical health) along with a generic quality of life questionnaire the SF-36 (Leplege et al., 1998, 2001), a specific questionnaire on perceived student stress [the Freshman Stress Questionnaire (Boujut and Bruchon-Schweitzer, 2009)], an index of psychosomatic symptoms, SCL-90 (Laugaa, 2004) and the level of anxiety and depression with the HAD (Lépine, 1986). Regarding student quality of life, on a analogical scale rated from 1 to 7 (from ‘poor’ to ‘very good’), students expressed an average quality of life of 4.0 (±1.3). Similarly, all dimensions of the SF-36 demonstrated declining scores between September and March and were consistently lower than the threshold scores particularly for the physical and psychological limitation dimensions. Concerning stress, on a scale rated from 1 to 7 (low to high), students expressed an average perceived stress of 4.7 (±1.4); this was expressed at exam times as well 4.5 (±1.6) and 4.0 with regards to competition (±1.3), respectively. They also expressed a greater stress in all domains explored by the survey except for the stress linked to isolation. As for anxiety and depressive symptoms, the results obtained by the HAD showed that 56% of the students in September and 60% in March reported high levels of anxious symptoms; and 64% of students in September and 70% in March reported high levels of depressive symptoms. Finally, an increase of somatic complaints perceived during the year as the competition approached with for main symptoms of headaches, pains of back and muscle, diffuse pains and symptoms specific to stress (digestive, cardiac, respiratory) was observed.

These preliminary results highlight the intensity of stress inherent to the competitive context. While a possible motivator, this stress can also have consequences in the short, medium, and longer term on the psychological and physical quality of life of certain students made vulnerable by this first university experience. It is crucial to identify those in difficulty and to develop a preventative approach through training and workshops for stress management and emotional regulation very early in a health sciences program. For students who do not succeed in this first year, it is also important to consider ways to help them to advance in other programs.