[The Pharo School: a century of teaching in tropical medicine]

1907-2007: one hundred years separate this year's intake from the first students to enroll at the Pharo School. 1907: in February, the first class, called the "Marseillaise", entered the new School of Colonial Medicine (Ecole d'application du Service de santé des troupes coloniales), where they received theoretical and practical training in tropical medicine. 2007: the latest class, recruited through a national examination, will join the Tropical Medicine Institute of the Army health service in May, for the first autonomous training program in supervised ambulatory primary care. The past hundred years have seen many upheavals. After the colonial period and the two world wars, followed by decolonization and technical assistance for young independent nations, globalization has brought the continents together, shrunk distances, and led to an intermingling of populations. Pharo students are still posted overseas, but no longer on the same types of mission. The lengthy postings to the Sahara, sub-Saharan Africa, Madagascar, Southeast Asia and Oceania have been supplanted by shorter stays and overseas operations in a variety of theaters (not just the intertropical regions), to provide healthcare support for French military forces and medical assistance to local populations. The teaching of tropical medicine has had to adapt to these changes. The concept itself has evolved too: from exotic diseases to colonial medicine, from major endemics to public health, and from humanitarian medicine to international healthcare. The increase in migratory fluxes and cultural exchanges means that tropical medicine is now a global discipline. This teaching activity potentially caters for all physicians, as malaria, dengue or cholera could strike at any time in the very heart of our provinces, or invite themselves into the general practitioner's office. Although mainly confronted by imported diseases, physicians specializing in travel medicine and infectious diseases, along with microbiologists and parasitologists, must also be specialists in tropical medicine. Others must master the theoretical and practical aspects of the discipline--especially therapists called on to work overseas with humanitarian missions, in war situations or after catastrophes. This is notably the case of military doctors. The teaching aims are not only to recognize, diagnose and treat diseases that are prevalent in intertropical regions. Practitioners must also be capable of adapting to local conditions, which can be extremely tough or hostile, and be able to manage diseases that are more often cosmopolitan than specifically tropical. Modern teaching of tropical medicine must comprise a common core that is obligatory for all medical students during their basic training. It can be completed by diplomas in different disciplines (epidemiology, medical biology, special surgeries, pediatrics, vaccination, combating malaria, etc.), possibly during continuous medical training. Cutting-edge training will be reserved for physicians who are called on to practice far from their university or hospital base, in isolated or difficult situations. Thus, a hundred years after their peers of the old "Marseillaise", the 2007 Pharo class will be first to take a diploma in overseas medical missions--the latest in a series of change intended to keep pace with a rapidly changing world