Monday, September 10, 2007

About that Italian Doctor looking down your throat...

I've been asked to write this post more times than I can count, so here goes!

This week, Italy's future doctors where chosen according to established tradition. Like most countries, entrance to medical school is very competitive. So what determines who comes in and who stays out?
  • * Italian High School Grades? No! They don't matter!
  • * Letters of recommendation? No! They don't matter!
One exam is given to all aspiring doctors a month before medical school starts. Those who get the top score on that one exam enter! (about 10%). Period. If you are a foreigner but have a work visa, family visa, or live long term in Italy you must compete with the entire pool of Italian students.

Last week around
4,000 Roman students filed nervously one by one into classrooms to take the standardized test that would shape their future. They eyed each other jealously knowing very well that only a lucky few would be admitted.

medical school admission exam questions look like this (but in Italian):

Here are the previous exams: 2006-2007 2005-2006 2004-2005

Take note that this year's exam is made up of:

  • 33 Culture and Logic (like the ones above)
  • 13 Math and Physics questions
  • 13 Chemistry questions
  • 22 Biology questions
As you can see, the largest section is CULTURE, how can Americans compete with Italians on art and poetry?

Yes, I've done my share of human cadaver dissections and long nights at the hospital.

Yes, I've also done my share of European museums and in 2002 I even studied Italian literature in an Italian University (academic year 782).

...but do you have any idea how many passages and authors there are in Italy? We're talking over a thousand years of literature! How many wars and battles in Europe? How many masterpieces and painters?

I simply will not, and cannot play a game of:
  • "Who restored what chapel and in what year?",
  • "which of the following masterpieces is not in the Louvre?"
  • (believe it or not, that was one of this year's med school questions!)
  • "which historic building is where?"
  • "who made what Italian film in what year?"
  • "this verse is from what Italian book made in what year by whom?".
How can an American even begin to study such a list? Is there even such a list?

People will immediately write to me and say that's why "American medical schools are the best"! Others will say "Hey! European medical schools are doing amazing work".

That's not my point... I'm just saying that on top of challenging medical studies, be prepared to fine tune your history and culture skills!

Take note! In Italy they study medicine right after high school!

In Italy, an American Undergrad Degree
= Italian High School diploma (!)

You can only apply on for the visa on May of each year, and your documents take a while to be translated and given "Italian equivalence value". If you're documents are late, you must wait a year!

FYI...I plan to do my residency in the United States, but I wanted to live abroad for a few years before that since I love the Italian life-style, but American work ethic. (Where can I have both?!)

I hope this post helped those who wanted to study medicine in Italy (though I think most probably turned around
and ran by now!)

To everyone else, sorry for boring you!


sognatrice said...

OK, well I'm not interested in going to med school in Italy, but you may have just convinced me to go elsewhere for a doctor! Sheesh!

Farfallina said...

Oooops!! :)

I hope Italians don't get offended with me, but I've read the past 5 year's admission tests and I STILL can't get over at how many poetry and art questions there are in that medical school admission test!

...more art than physics (!)

Leanne said...

Mio dio! You have not bored me but you certainly have baffled me...Thank god I do not want to be a doctor.
Best of luck to you.

qualcosa di bello said...

perplexing to say the least! i'm now curious about the content of their med school curriculum...

Jul said...

Those questions are too funny. I love it!

Kathy said...

Umm....I also hope not to offend anyone, but what the heck does knowing who restored a chapel have to do with becoming a doctor???

I don't want to study medicine, but this is a fascinating post!

Dana said...

This is a fascinating post! I understand that need for knowledge of history and art, but for me those would definitely take a back seat when picking a doctor! :)

Julia said...

You should update yourself on the scandals going on right now though...Most people don't make it past the exams so they PAY...

Anonymous said...

come saprai i test di ammissione nelle facoltà sono un argomento "caldo" in questi giorni, ci sono decine di articoli sull'argomento.
Queste domande impossibili servono solo a rispettare il numero chiuso, e non a selezionare gli studenti migliori. E' un vero peccato...

Anonymous said...

Oops, hope you don't mind I wrote that in Italian!

daisies said...

no inclinations towards being a doctor but i do have a career on the policy side of the health care system and find this fascinating :)

Farfallina said...

Yey everyone!! So you see what I see???

phew! {relief!} So we're all on the same page here!

You have no idea how these art questions have been weighing in on me ! and I stood there in amazement puzzled wondering if it was just me who felt this was ahm silly?

Farfallina said...

Julia, thanks for the link! I read it just now and I'm speechless, really.

Enrico, va benissimo se mi scrivi in Italiano :)

When I wrote the post I didn't know about the med school scandal going on in Italy! NOW I'M FASCINATED!!

simon said...

that is truly amazing.

Anonymous said...

Farfallina - I've been reading all the articles in the Italian paper which Enrico refers to re the scandal of the "numero chiusi" (ie the well connected who are given the exam questions in advance) and university entrace exams in Italy. Basically, if you are one of the chosen few you memorize certain things and pass the exam. If you're just some poor non-connected schmuck you're out of luck. This is why they ask these irrelevant questions. Ever wondered why being a doctor runs so strongly in families in Italy?

Apart from anything else - I wonder how many of those people who do well on the exam have actually read Homer's The Iliad voluntarily and not as an assigned text at school. Do they understand art and architecture or have they just memorized the dates when various chapels were constructed? To me that's not cultural knowledge, that's rote memorization.



Julia said...

Hey Kataroma -
The scandals have nothing to do with being well connected but rather having extra cash to pay for the answers. The investigations say that students forked out 30,000 euro to faculty and council members in order to pass the exam.

Anonymous said...

Julia - ooooh I didn't read that it was Euro 30K for the answers! My God - someone is making a tidy sum there.

I was under the impression that if mummy or daddy knew the right people at the university you'd be directed in the right way in your studies. Maybe I'm wrong?

At any rate, this is one of many reasons why if we ever have kids there is no way in hell we're staying here long enough for them to go to university here.

In Australia (where I went to uni), they still base university admissions 100% on end of high school exam mark. Maybe not the best system ever but at least it's transparent and based on something related to what you'll end up studying.


Farfallina said...

Kataroma, after surprise, disbelief, humor, shock...I did finally reach "angry", too.

This experience paints a larger picture of an unbalanced Italian system, which of course is not limited to entrance exams!

This scandal is symptomatic of an overall structural problem in the Italian system and I sat there thinking of what I'm up against, and wondered...

Yesterday I wrote, but deleted, a comment about a couple students who earned one of the top biology scores but will not be attending medical school since their art scores did not measure up!

What Enrico and you said about the irrelevant questions is exactly right! and it is just the beginning, since once you enter medical school, you must deal with the subjectivity of oral exams!

Most of you know that in Italy you do not have written exams, but a verbal interview at the end of the year! no quizzes, no midterms, just a verbal final with no written proof of your response!

Today I read about Italian medical schools where a student gave a brilliant response but failed, yet another student gave a mediocre response and earned a great score!

So you see, I'm afraid this does not start or stop with art questions on an entrance exam!

I'm not saying that it happens in every exam and every school, but the system doooes lend itself for this sort of things to happen!

Farfallina said...

Julia... 30,000 Euro for medical school exam questions, wow!

Though given the enormous number of applicants, I cannot imagine that a bunch of them could just walk up to admissions and offer 30k! I think there must be connections, too!

I'm still can't get over my surprise that high school grades don't count AT ALL. Just one brief exam!

Only 13 chemistry questions to enter med school? Ignoring 12 years of studies!

Poor Italian students...

Anonymous said...

Farfallina - this is what the V-day protests were partly about (although I doubt much will change.) The system here is all about connections and money - in a much more blatant way than in other countries I've lived in. It's a huge culture shock on many levels for many of us foreigners - and in ways you wouldn't predict.

For example, when I first came here I noticed that most of boyfriend's Italian friends were much less "success" or "career" focussed than my friends back home. I slowly realised that a lot of this has to do with the fact that if you are a career success here, rightly or wrongly, it's seen as due mainly to your connections/unscrupulousness not merit or hard work. In the US and Australia, career success is generally seen as mostly about your hard work and smarts - so university and working life can be much more competitive. It's sort of bad and sort of good here depending on how career focussed you are.



Farfallina said...

So true! and now that you mention it, I did sense the enormous thirst for change when I wrote a V-Day post, since that week-end my blog was absolutely flooded by Italian readers and it took me by surprise.

Yes, Italians want change, and so do Americans here, though like you showed us, it's far more complicated than "will and want". Everyone has a roll to play and for each one to change their ways takes time!

Raindreamer said...

Well if it is any consolation: my Spanish medical student friends, who considered themselves outdated in the field of medicine, considered Italian medical education worth of shit, while they were doing Socrates studies.

They were last year students and told me that if I ever get sick they don't let me go to the doctor there, but send me directly home. I am not a medical expert, but I understood that they saw some serious malpractice there and this was one of the med schools (university).

This may not apply to whole Italy, but gives a picture about the situation. Huh!

Anonymous said...

That's not comforting, raindreamer. I'm kind of stuck here in Italy if I get sick since I'm resident here. :(


Farfallina said...

Hi Raindreamer,

I was actually just thinking about the Socrates-Erasmus program! :)

Now that you mentioned Socrates studies, the thoughts that have been going through my mind today was since Italy is a beautiful country, and I've already invested so much planning and effort, then I'd go to Rome for the first year, then try the Erasmus program of another European country, and most likely return home to California (or US) for my second half of med school and residency.

Since I've already worked for many years in American hospitals, I definitely want to check out the European system.

Like you said, it gives us a picture of the situation! and it will be an eye opening experience.

I hope after all this I'll learn what are the strengths and weaknesses from the inside and have a better idea of what's going on out there :)

Kataroma said...

farfallina - finally logged in here. One thing is that I wouldn't draw any conclusions about the rest of Europe from seeing how things work in Italy. Things work very differently, for example, in my boyfriend's native Netherlands...

Jeanne said...

I love all that you share with us

Anonymous said...

I probably misunderstood what you said, but you don't just take 1 exam per year! It's an exam for each subject (is that the right word?;) which can be written or a verbal interview as you said. I read an interesting post on "cross-cultural moments" (which is one my favorites blogs)re the oral exams; here's the link, if you're interested:

Penso che l'Università italiana non sia poi così male come altri poster hanno scritto, altrimenti perché tanti italiani, soprattutto ricercatori, vengono accolti a braccia aperte in Europa e negli USA?
Just my 0.02 ;)


Farfallina said...


You're right, and that's why I want to do a year in a medical Erasmus program in Europe, see how things are outside Italy :) I'm quite curious...


Ciao Enrico!

Yes, an exam per subject :) At least that is how it was at the Universita' degli Studi di Padova where I studied.

Italian students are brilliant! at the University of California, Davis when I returned from Padova, there were 3 Italians friends of mine who spent one year in engineering at UCD and they received the top engineering scores! One was chosen as a teaching assistant from the professors and he felt the subject matter was more difficult in Italy!

Most of us have a problem with "the system" which allows a few students to be corrupt, and a system that favors some...

We'd like to see an Italian system where people advance based *on merit* and hard work, more than on "who you know". That's all...

I love the Italian life, the people, art, cities, food and culture, but the "work structure" is a puzzle to me! :(

Anonymous said...

"We'd like to see an Italian system where people advance based *on merit* and hard work, more than on "who you know". That's all..."

AMEN to that!


Italiana Americana said...

ciao! That is so interesting I never heard about that before. I have a friend of mine who is from caserta i think he studies at Universita di Napoli and hes studying to be a Urologist..much like his dad. I'm going to ask him bout his med school entrance exam. I know he studies all the time though!! so we'll see!! :)

Farfallina said...

Ciao Italiana Americana :)

If you're curious and have the time, I posted the link to the previous 3 year's medical school entrance exams.

Italy makes one exam and all colleges must give this exam.

The links are about halfway down the post :)

Audra said...

So wait, I'm confused... do foreigners HAVE to take the arts and culture test?? Ma vaaa!

Farfallina said...

Ciao Audra!

The art culture test is actually the main part of the Italian medical admission test.

Yes, technically all should take it. It's like the Italian MCAT, except in Italy only the MCAT counts, grades don't.

So, they line up the names according to this exam's score, and only the top scores enter.

Whether foreigners must take the test depends on the year and university. The past two years they haven't had to take the test... an admission letter from the embassy is all you need.

Audra said...

Hmm, in our past conversations you said the number of foreign applicants was so low they didn't even need to take any test at all.

Which one is it?

Farfallina said...

Same thing Audry :)

The embassy letter is all you need, there are so few embassy letters, that the past two years no one who's had that visa has had to take the test.

But it depends on the year, though as the Euro goes up, I've seen a downward trend...

Audra said...

An embassy letter? Che cos'e'?

Scusa la mia ignoranza!

Farfallina said...

Ciao Audry,

Okay, so after your bachelor's degree with pre-med courses you also take the MCAT.

1) You get the "dichiarazione di valore" which may take a while.

2) You take an Italian Language test (the consulate will tell you where or how to do this).

2) BY MAY each year, you submit an application for Italian med school through the US consulate/embassy

3) Around late July, August you'll receive a letter of whether you were admitted o not, but the university will send the letter to the embassy, and they will notify you.

4) You take the letter from the University and apply for the Student Visa.

5) Arriving to Italy the university will apply a second Italian Language test to make sure you're fluent in Italian

6) Depending on the number of foreigners at the University, if they gave 40 visas but only have 20 spots that year for foreigners,then on Septmeber they all must take this "Admission Test" and the top scores are given a spot.

The rest can go to med schools in other cities which foreigners didn't apply to... or return home.

Though the past 2 years I've seen that all who where given the med school study visa, at least Rome and Florence, didn't have to take that test.

I think that at first the visa is temporary, considering you actually enroll in med school, and you must renew it each year.

You can only renew the visa if you pass all of your exams.

Physician friends who studied med school in Europe but are practicing medicine in the US said to take a test each year to give American value to your coursework in the US, which will allow you to bypass European residency and apply to residency in the US. But I'll worry about that half way through the first year...

Other friends said they actually tested into 3rd year since in the US we already completed pre-med, but Italian students enroll right after high school. I'd have to check in to that when I get there, too.

Just that, simple no?

Maddie said...

I find this rather endearing -
although intimidating i am sure:)

I can just imagine a doctor
during an operation getting all
"Oh look at his blood with that
unusual saffron tinge to it "


NancyQ said...

Oh my oh my.....
Hello! Iam back, and as i tried to visit you on your spanish blog i found out that you have it only for special guests? =(
Well i'm glad you have this one open so i can say hello and wish you the best of luck!

Devil Mood said...

No, not a bother. This is very interesting! Just goes to show how some educational methods and rules are so out of place and date - knowing which pieces are at the Louvre will never make you a better doctor, so...
Over here in Europe, it's all about the grades - you have to get over 18 (in 20) in your high school grades and exams, which is higher than 90%. But if you really want to get into the best school, you need over 95%...

Devil Mood said...

How sleepy am I? I meant, over here in Portugal, not in Europe, of course. :P

hope_fairy said...


And over here in England, you have to do an entrance test, write a personal statement, get a good reference from teachers, attend an interview (and for that you need to do background reading, etc.)...! I'd take the Italian method any day.. ;)


La delirante said...

Oh wow...this is really buffling. I can't understand why art and poetry are so determinant to attend the Medicine school...Thanks for sharing, it is a very very interesting post.

Have a lovely week,

Miguel said...

Hello! ... I tried to visit you on your spanish blog i found out that you have it only for special guests?

disculpa pues no hablo correctamente inglés, espero recibas este mi latino mi Abrazo.

nyc/caribbean ragazza said...

very interesting. maybe anatomy = painting/sculpture?

bella said...

Fascinating. Truly fascinating.

tongue in cheek said...

A high school Italian diploma is equal to an undergrad studies in the states. In France it is the same.

It sounds like another way of admittance. Most American universities try to find well rounded students, isn't that true? Students who will add a variety of personality charisma to the university as well as smarts. Maybe this test is something like that... not just IF you are smart enough, but if you have more to offer as well?

Good Luck.

american girl in italy said...

My husband went to med school in Milano, as did his business partner, and one of his friends. Our cousin went to medical school in Brescia, and I am not sure where our Doctor friend went to University, but i know not one of them got in because of who they knew, or by cheating. My husband was actually bitching about the latest scandal of students and teachers cheating.

I am sure it works that way in some parts of Italy but not in those cases... so maybe there is hope? hehe

I would prefer my doctor be well rounded in education, then someone who got into/out of med school by cheating. How scary is that! I need to ask him when he gets home about the cultural part of his exams, and if he had to do that.

Our cousin went to England for 6 months to study in a hospital that specializes in baby surgeries. She was amazed at how lax they were wrt to cleanliness/sterile environments and some proceedures, compared to how they are in her hospital in Italy.

So, fear not, there are some good doctors and oral surgeons in Italy! :OD

Diana said...

this post is really funny. finally you got it how it is the real italian life!... that one we, the fortunately people who live in italy, use to have every single day, and you still don't work with italians!.
this is just the visible part of the iceberg... do you think is just a case that beppe grillo made up that thing called V day (vaffanculo day)?
by the way, in mexico also you could start with medicine after the high school, you must choose the right "preparatoria" area, i don't remember if it is area 2 or 3. i studied area 1, mathematics and physics.

Tina said...

Hey, where are you these days? I miss reading your posts!

Farfallina said...

I'm here Tina! With my head in work and books, but I take peaks in to you guys' blogs :) there's a nice balance to my work now :) How I missed the blogosphere :)

Maddie you're too cute! :) I'll definitely remember your phrase and tease them endlessly with it, hehe...

Nancy and Miguel, you guys aaaare special people! my Spanish blog is on hold for a little bit :) just for a little. You'll see me in yours, though :)

Devil mood and Hope Fairy,
You're right! There are many more steps in Portugal and UK... actually, I think in most of the world! So in the end I should keep that in mind. Fairy, you can come to Rome with me! It should be fun :) hope you like art!

Thanks Delirante :) Te he extranado mucho!

NYC, hope all is well in your project in Canada :)

Ciao Bella! (it's so fun saying that:) hehe :)

Tongue in cheek,
I do tell myself exactly what you wrote, as I try to keep things under perspective! It's one of the few things that actually help as I think of the list of artworks to learn!

American girl, now I'm curious to know what your husband said! Before deciding to go to Italy, I did speak with several friends in Italian med school and doctors before deciding that Rome would be good for me. Despite the scandal I am determined and have faith since I keep in mind the big picture and comments like yours remind me of that :) Grazie!

Ciao Diana! That's funny, and yea, you're right! I had it coming to me, hehe... Si, de hecho estoy renovando todas mis materias a la prepa pues decidi pedir mi visa en el DF, vamos a ver como me va! Meanwhile, enjoy Italy for me :)

Ben-Bob said...

Absolutely fascinating! Having gone through the education mill in both the humanities and medicine, I'm not sure which door I'd choose at this point, myself....

Elizabeth said...

Wow--just came upon this post and its aftermath!
And to think my 18 year old is considering medicine for next year....

Two points. The students being tested are coming from different high school tracts (classico, scientifico and even technical schools), while in the US the medical exams take place AFTER a "pre-med" cycle and an undergraduate degree in which everyone has taken the same subjectslike organic chemistry etc...
It would be like taking the entry exams here after two years of university study. so what can you test but general high school knowledge -- math, science, art, history, literature, current events -- to see if they have learned anything in high school and paid attention to world around them, not just videogames etc. To this end, the general culture section is not wildly out of line and probably favors the liceo over the technical school kids (a subtle but effective entrance barrier to keep the lower class in its place)

Then, if you don't pass the capricious test, like a friend's brilliant and motivated daughter, you can just sign up for a degree in biology and do the first year courses (which are basically the same ones as the medical school program). Then IF you get excellent results for the year (like the girl in question) you can request to pass to the medical school program -- she had such high grades that she has entered directly into the second year of medical school. So "where there is a will there is a way" even here --if you are really good, dedicated, motivated and prove yourself through merit (top grades in your first year).
She'll be a great doctor!

Second point is that there are excellent doctors here. You just have to know how to identify them -- the never-ending Italian game -- it takes having the right channels to figure out who is the best and how to reach him/her. You can't/shouldn't count just on "the system". We did our homework and went up to the public hospital in Bergamo years ago for an inner ear operation for my son, to one of the best ENT surgeons in Europe and perfectly acceptable creature comforts too.

Anonymous said...

But Elizabeth - how do you find these great doctors without just relying on the "system" if you dont have lots of doctor connections? Obviously not all of us have doctors in the family.

Personally, I just go to whoever my primary care doctor sends me too and I've had some really bad experiences. I have lots of Italian friends but none of them have any doctors in the family or know any doctors. \


Elizabeth said...

It's a big, if not the biggest Italian mystery that we foreigners will never figure out -- just how Italians get their information, the "passaparola" way that it meanders its way around to the right people. I have identified a few people who always seem to "know" or "know who knows" and I use them! Doctors are not necessarily the best people to ask about doctors -- they may tend to send you to a friend or just someone they know. As I said it is the greatest of all Italian mysteries!