How to Get Into Medical School in Europe: Numerus Clausus, Entrance Exams, and Country Routes Compared

Germany: grades, an aptitude test, and additional criteria

Germany centralizes medicine admissions through Hochschulstart . Thirty percent of places go to applicants with the strongest Abitur grade average, ranked first within their federal state and then merged into a national list. The remaining places go through each university's own additional-criteria quota, which weighs a medical aptitude test (such as the TMS or HAM-Nat), relevant vocational training, or other selection criteria that vary by university.

This system rewards a near-perfect final school grade or a strong result on a medical aptitude test. If neither route suits your profile, look at universities that weigh vocational experience or interviews more heavily in their additional-criteria quota.

France: PASS/LAS and the move to a single pathway

French medical studies run through the PASS/LAS system, where your first year combines health-focused coursework with continuous assessment, and only top-ranked students progress into the second year of medicine, dentistry, pharmacy, or midwifery. The French government is replacing this with a single national access pathway, starting with students who begin their first health-studies year in September 2025, meaning the first cohort under the new system enters second year in September 2027.

Selection intensity is not changing, only the structure of the pathway. Confirm the current-year rules directly with your target university health faculty before applying, since the transition affects programs differently by institution.

Italy: IMAT for English-taught programs, an open semester for Italian-taught

If you want to study medicine in English in Italy, you sit IMAT (International Medical Admissions Test), the national entrance exam for English-taught medicine, dentistry, and some veterinary programs at public universities, held once a year through the Universitaly portal.

Italian-taught medicine changed for the 2025-26 academic year. The government abolished the upfront TOLC-MED entrance test and replaced it with an open filter semester: any student enrolls and attends classes from September to November, then sits exams in biology, chemistry, and physics at the end of the term, with only top performers continuing into the program, according to university guidance on the reform . This change applies only to Italian-taught programs. English-taught medicine still uses IMAT.

Belgium: one national entrance exam

Belgium's French-speaking universities (UCLouvain, ULB, ULiege, UNamur, UMons) share a single national concours for medicine and dentistry, run by ARES. You register for a specific university and field, medicine or dentistry, in advance, and both choices are final. The exam runs in Brussels at a single, centralized location once a year, with no option to sit it elsewhere, and it is scored separately for each field, according to ARES exam guidance .

Poland, Romania, and Spain: other realistic routes

Poland and Romania run their own university-set entrance routes rather than a single national exam. Most medical universities in both countries test biology and chemistry knowledge directly, often alongside an interview, and both countries run established English-taught medicine programs aimed partly at international and European students. Requirements and test content differ by university, so check each faculty's admission page directly rather than assume one national standard.

Spain selects medicine applicants for public universities mainly by ranking your EVAU/Selectividad grade average, and the cutoff for medicine sits near the top of all subjects most years. Private universities run their own entrance exams and admit directly, at a significantly higher tuition cost. If your grade average will not clear a Spanish public medicine cutoff, a private Spanish university or an English-taught program in Poland or Romania widens your options.

Comparing the main routes at a glance

Tuition alongside admission difficulty

Admission difficulty and cost do not move together in a fixed pattern. Public university medicine in Germany, France, Belgium, and Spain runs at low, government-set tuition, even though admission is highly selective. Private medical tuition in Spain, and self-funded English-taught programs in Poland and Romania, cost considerably more, but accept a wider range of grade profiles. Weigh your realistic admission chances against what your family affords for the full length of a medicine degree, typically five to six years, before you commit to one country.

Comparing your realistic options

Match the system to your profile before you commit years of preparation to one route. A near-perfect final school grade fits Germany's grade quota or a Spanish public university. A strong result on a standardized science test fits Italy's IMAT or Belgium's concours. A willingness to prove yourself over a full semester, rather than in a single exam, fits France's pathway or Italy's new filter-semester system for Italian-taught medicine.

Apply to more than one country's system where your budget allows. Entrance exams and grade-quota systems grade on different scales, so a result that falls short in one country still clears the bar in another.