Medical studies have long enjoyed an excellent reputation. Seen as prestigious, the degree has career prospects that attract many students. The problem is that these highly coveted programmes have far fewer places than applicants, resulting in fierce competition.
Between 1999 and 2022, admissions to medicine, dentistry, and veterinary medicine in Italy were based on a national multiple-choice test with 60 questions covering biology, chemistry, physics, mathematics, logic, and general knowledge. After a few years of reforms that sought to find the fairest way to select students — in a way that balanced knowledge and motivation — the 2025-2026 academic year introduced a radically different approach to admissions. Inspired by the French selection model, admission now depends on completing a semestre filtro, filter semester, in order to obtain access to health-related degree programs.
How it works
The so-called “semester” lasts barely three months. During this time, universities enroll roughly four times the usual number of students and have proved ill-equipped to handle the influx. University courses in Italy normally begin in October, but health-related academic programmes started in September with in-person classes. Once other programmes began, space became limited, forcing the unusually large cohort to attend remotely. Beyond exam pressure, first-year health students face an isolating start to university life, unable to build relationships with future classmates and professors — hurting both social and academic outcomes.
See Università degli Studi di Milano (La Statale di Milano), whose filter semester began on September 1st. At the end of this semester future medical students faced two days of examinations to secure a seat. Students juggle biology, physics, and chemistry, each exam occurring in one-hour intervals. Afterwards, they receive their marks for each subject.
In the Italian system, grades are expressed out of 30, with a minimum of 18 to pass. Students may accept their grade, or reject it and re-sit in hopes of a higher score; if rejected, the initial mark is forfeited. Twenty days later, medical students at La Statale di Milano had their second — and final — opportunity to take the exams. At the end of this second session, the three scores were combined for a final grade out of 90; students are ranked nationally. The allocation of spots depends on exam results, the preferred universities of each candidate, and the number of seats available at those universities. If two students achieve the same score, the younger candidate is given priority by date of birth.
The total number of students enrolled in the national filter semester is 64,825, including 54,313 aspiring doctors, 4,473 dentists, and 6,039 veterinarians. They compete for 16,890 places in Medicine, 1,114 in dentistry, and 1,222 in veterinary medicine. La Statale di Milano offers 556 seats in medicine, 60 in dentistry, and 100 in veterinary medicine. Across these three fields, about 3,800 students compete for 716 places, giving them a success rate of just 18.8 per cent.
A Sisyphaen endeavour
When we analyse the data, we often look at the success rate, but given the huge number of students who do not pass, it is more relevant to look at the fail rate: 74 per cent. This outcome is not only academically disappointing — it is emotionally and psychologically damaging. The typical health science student has a defined profile: serious, studious, resilient, and above all, ready to do whatever it takes to succeed. Students invest countless hours and financial resources, making personal sacrifices that often put their social lives, well-being, and even mental health on hold. When they ultimately are rejected, many experience a deep sense of failure, frustration, and loss of purpose.
In this new system, students spend half of an academic year studying intensively, hoping to succeed in exams that do not automatically guarantee a place in the following year’s medical programme. Those who fail have a few alternatives, able to enroll in a related degree programme from a limited list. These related degrees — biology, biotechnology, pharmacy, biomedical sciences, nursing, and sports science — require students to pass every exam in the filter semester. Failure in even one subject disqualifies the student, leaving them in January without any university spot.
Another issue is that these students are reassigned to related programmes mid-year, joining half a semester behind their peers. All the first semester activities are not repeated by universities due to time, space, and resource constraints. This penalises the academic progress of students in the filter semester. In nursing for instance, other students have already completed practical training in clinical procedures and patient interaction, essential prerequisites for clinical internships.
What shortage?
For years we have been told that there are not enough doctors in Italy. Yet with so many motivated applicants, the shortage is hard to believe. The obvious fix is to increase the number of university spots to allow more students to become doctors, but this solution risks simply postponing the problem. After six years of medical training, graduates face another bottleneck: the national entrance exam for specialisation.
The Italian government aims to have the most equitable selection for future medical students, but this new reform does not make a difference. As a result, the “filter semester” simply shifts the burden rather than resolving it. Instead of facing a single high-stakes test at the beginning of the year, students now undergo months of continuous evaluation, stress, and uncertainty, only to face similar odds of rejection in the end. The process may appear fairer on paper, but in practice it prolongs anxiety, increases academic pressure, and continues to produce a very high exclusion rate.
