Medical School Abroad: My Journey Studying Medicine in Spain 

Abstract: This article presents an American student’s firsthand account of pursuing medical school in Spain. The author describes adapting to a post-high school medical program with rigorous, exam-focused curriculum while navigating language barriers, visa challenges, and the COVID-19 pandemic. Key contrasts between U.S. and Spanish systems include affordability, accessibility, and Spain’s universal care philosophy. The piece explores personal growth from international study and career advantages of an EU medical degree. It concludes by discussing BigSisterMD, an initiative supporting students considering medical education abroad.

Who Am I? 

Born and raised in Connecticut until age 13, I learned early that adaptability would become one of my greatest strengths. Moving from Connecticut to Nebraska, and eventually to Colorado where I completed high school, taught me that home is wherever you make it. Throughout these transitions, one constant remained: my unwavering desire to become a doctor. While my desired specialty has evolved over the years, my passion for helping others has never wavered. 

I had always dreamed of living abroad but didn’t speak another language, making the UK seem like the most logical choice. That changed completely when I visited Spain on vacation and fell in love with the culture, people, and lifestyle. What truly captivated me, however, was discovering the Spanish medical education system: no undergraduate degree required, no four years of prerequisites before the MCAT, no need to spend hundreds of thousands on basic education before medical school. You could jump straight into medical school from high school, and I was sold. 

Returning to the United States with newfound purpose, I immersed myself in Spanish culture and language. I listened to Spanish music, watched Spanish films with subtitles, practiced my limited vocabulary with anyone willing to listen, and enrolled in AP Spanish classes. My high school offered a medical careers pathway that included introductory anatomy and physiology classes alongside CNA certification, which felt like a natural progression. I graduated in three years, earning my CNA certification, gaining clinical experience, and completing AP Spanish. Feeling confident and prepared, I applied to medical school in Spain that very September. 

The Reality Check 

What became immediately clear upon arriving in Madrid was that my preparation, while admirable, wasn’t sufficient. My AP-level Spanish fell short of what I needed to understand technical, rapid-fire lectures from professors. I also discovered a significant educational gap between the US and European systems. Spanish universities assumed I already possessed advanced knowledge in chemistry, biology, physics, and mathematics. I was overwhelmed, but I refused to give up. 

After withdrawing shortly after classes began, I dedicated myself to an intensive year of study. I enrolled with a local academy that helped me master biology, chemistry, physics, and mathematics in Spanish while simultaneously improving my speaking, grammar, and overall fluency. After a full year of tutoring and practice exams, I felt ready to try again. 

I was accepted to medical school for the second time, but shortly after starting, a family emergency called me home. What was meant to be a five-day trip extended to over a year due to visa complications. I made the most of this setback by working in a dermatology clinic and gaining valuable experience. When I finally returned to Spain and started medical school for the third time, I had the academic foundation, legal qualification, and Spanish fluency necessary to succeed. 

Why Spain? 

The Spanish medical education system offers compelling advantages that drew me in. Medical school begins directly after high school and lasts six years, with tuition costs that are shockingly low compared to US standards. Public university tuition ranges from 800 to 1,400 euros (about $1,000 to $1,620) per year, while private institutions cost between 10,000-20,000 euros (between $11,000 and $23,000) annually. Both the financial and time factors influenced my decision significantly. 

Beyond the practical benefits, Spain’s healthcare system shaped my understanding of medicine itself. The country maintains both public and private healthcare sectors, with the public system being completely free and funded through taxes. This universal access creates a fundamentally different healthcare mentality. While American patients often avoid emergency rooms due to high costs, the Spanish system encourages early intervention and preventive care. Local health centers staffed with doctors and nurses provide primary care, emergency screening, and even house calls, all government-funded. This comprehensive approach contributes to a healthcare philosophy focused on accessibility and early intervention. 

Navigating Challenges 

Living and studying in a foreign country presents both expected and unexpected challenges. The obvious difficulties: being away from family and friends, language barriers, proved manageable with modern technology and determination. However, several surprising obstacles emerged that tested my resilience. 

Legal issues became my first major hurdle. Managing my student visa independently, I quickly discovered that Spanish bureaucracy is extraordinarily complex and time-consuming. Incomplete paperwork, incorrectly filled forms, and numerous office visits consumed significant time, mental energy, and financial resources. After several years, I realized that student visas offer no path to citizenship, regardless of study duration. This prompted extensive consultations with lawyers about visa changes and long-term residency options. 

The second challenge was life itself continuing during medical school. The pandemic hit during my first year, forcing me to navigate the frightening, stressful situation thousands of miles from my family, completely alone in a foreign country. Throughout medical school, I experienced breakups, grieved the loss of close friends and family members, and said goodbye to my childhood pet. These life-changing events unfortunately occurred during exam periods, making it nearly impossible to focus or study effectively. Maintaining mental health while isolated from your support system remains one of medical school’s greatest challenges, regardless of location. 

The Spanish Medical Education System 

The application process in Spain is refreshingly straightforward compared to the US. There are no essays, letters of recommendation, or personal statements – only grades matter. High school transcripts undergo translation through a process called “Homologación”, and this score combines with entrance exam results (PCE for public universities, individual exams for private institutions) to create a ranking system. Schools admit students from the top down, it’s brutal and impersonal. The timeline is also dramatically different, with public schools completing the entire process from application to admission in just a few weeks. 

Fundamentally, Spanish medical school is structured differently from American programs. The six-year curriculum typically dedicates the first three years to pre-clinical studies, followed by fourth and fifth years combining coursework with limited clinical rotations. The sixth year focuses exclusively on rotations and the TFG (Trabajo Fin de Grado), a thesis presentation. 

From the very first year, the entire system prepares students for the MIR, the post-graduation exam that determines residency placement. This singular focus shapes every aspect of medical education in Spain. 

Academic Challenges 

Three primary challenges distinguish the Spanish medical system from American education: the correction factor, emphasis on memorization, and clinical rotations. 

The “factor de corrección” eliminates guessing on multiple-choice exams by deducting anywhere from 0.25-0.5 points for incorrect answers, sometimes even for blank responses. This system forces careful consideration, eliminates random guessing, and makes achieving passing grades significantly more difficult. Negative scores become possible when incorrect answers outnumber correct ones, a reality that’s not uncommon. Medical schools implement this system from year one to prepare students for the MIR exam structure. 

The second major challenge involves the heavy emphasis on memorization and lack of continuous evaluation. American students expect constant feedback through assignments, projects, quizzes, and regular exams. Spanish medical education provides none of this support, and requires students to be much more independent and organized. Classes rarely assign homework, offer minimal projects or quizzes, and rely almost entirely on final exams that determine the majority of your grades. Most courses allocate 10-20% of grades to mandatory laboratory work, occasionally including small maximum 5% attendance buffer percentages, with final exams comprising 75-90% of the total grade. 

Students receive two opportunities to pass: the “ordinaria” (first attempt) where buffer percentages are factored in, and “extraordinaria” (second attempt), where buffer percentages and lab grades are often removed, making the exam worth 80-100% of the final grade. The pressure is immense, and exam content heavily favors memorization over critical thinking or problem-solving skills. Retention after exams often suffers due to this approach. 

Regarding clinical rotations, I found the system disappointing. Despite expecting hands-on learning and clinical skill development, I encountered upper-year medical students unable to correctly take manual pulses or blood pressure measurements. The system prioritizes MIR preparation over clinical professional development. A common saying in Spain acknowledges that students learn “real medicine”, practical skills and clinical knowledge, during residency, not medical school. 

As a hands-on learner, I actively sought extracurricular rotations to gain deeper specialty specific understanding, and improve clinical skills. Medical school truly becomes what you make of it. Resources exist, but students must actively network and seek additional clinical experience, research opportunities, and publications if they so desire. 

Looking Toward Residency 

While returning to the United States for residency remains possible, I’ve set my sights on Switzerland or Ireland. Residency in the US would require applying as an international medical graduate and completing the necessary examinations, processes that Spanish medical schools neither discuss nor facilitate. Having fallen in love with European life, I personally cannot imagine living outside the EU. 

The advantage of earning an EU medical degree is automatic recognition throughout the European Union, allowing residency applications anywhere within the EU without degree verification concerns. Switzerland particularly interests me due to their medical advancements, streamlined application process, and the highest resident salaries in Europe. The most difficult requirement for English speakers is advanced proficiency in German, French, or Italian. Ireland offers easier entry for US nationals, with English-language instruction throughout. 

I have no plans to permanently return to the United States. While American salaries attract many people, comprehensive analysis of cost of living, insurance requirements, transportation costs, and quality of life considerations makes Europe highly competitive. Spanish salaries may seem modest compared to US standards, but factoring in these additional elements creates compelling alternatives. 

Earning an EU medical degree opens numerous doors: lower tuition costs, easier travel, reduced living expenses, better healthcare access, superior public transportation, opportunities for multilingual development, and networking within a global community. At any point after graduation, during residency, or throughout your career, you retain the option to return to the United States while also having the freedom to remain in Europe or explore opportunities elsewhere entirely. 

How I Can Help 

I created BigSisterMD to empower, guide, and assist other international medical students considering studying, completing residency, or working abroad. I offer free one-to-one consultations to answer questions, and explain the general flow of Spain’s medical education system. Through strategic partnerships with a PCE preparation academy, a Spanish language academy, and legal professionals, I can provide resources to those who need them. 

Most importantly, I’ve made numerous mistakes throughout my journey from American high school graduate to Spanish medical student. By sharing my story, I hope others can avoid similar pitfalls and navigate their international medical education more successfully. 

Final Thoughts 

I encourage other pre-medical students considering international education to explore all available options thoroughly. Whether you’re still in high school or hold a college degree, it’s never too early nor too late to investigate alternatives and make the best decision for your future. I would not have been able to afford my education and lifestyle in the United States without massive student loans, and ultimately, I am far happier living in the European Union than I ever was in the United States. 

The path isn’t easy, but it’s absolutely worth it. Every challenge has strengthened my resolve, every setback has taught valuable lessons, and every success has reinforced my belief that pursuing medicine abroad was the right choice for me. If you’re considering this journey, know that with determination, flexibility, and proper preparation, you too can achieve your dreams of becoming a physician while experiencing the richness of international education and cultural immersion.