On September 17, 2024, thousands of hopeful students took part in the International Medical Admission Test (IMAT) in hopes of gaining admission into one of the 18 programmes for medicine and dentistry in English at public Italian universities. This year’s exam, however, left many students shocked and in a state of worry. Let’s perform a “post-mortem” autopsy and figure out everything that happened. In this article, we (Serra and San) will dissect the reason for the unusual nature of the 2024 IMAT, conduct an analysis of each section, discuss particularly contentious questions, and give our unfiltered commentary on the whole ordeal.
Why was the 2024 IMAT Unique?
Before directly addressing the 2024 IMAT, it is important to understand the context of IMAT changes over the past several years. From 2011 to 2022, the IMAT exam was designed, planned, and administered by Cambridge Assessment on behalf of the Italian Ministry of University and Research (MUR), providing continuity and familiarity to medicine in English applicants. In late 2022, Cambridge announced their departure from the IMAT exam, leaving MUR scrambling to organise the 2023 IMAT paper. This brought an overnight shift to the “predictability” and character of the new IMAT.
In their twelve-year construction of the IMAT, Cambridge often packaged hidden logic and problem-solving into the already theory-heavy biology and chemistry sections. Particularly notorious were “multi-statement questions” that featured three to four statements with answers such as:
(A) 1 only
(B) 1 and 3 only
(C) 1, 2, and 3
(D) 2 only
(E) none of them.
Students, therefore, were not only expected to know theory but also to apply it. For example, question #31 from the 2018 IMAT (shown on the right) expected students to understand and dissect four mini questions in order to correctly answer the overall question.
These types of questions gave the IMAT a reputation of higher difficulty compared to its Italian counterpart, the test medicina. In fact, other medicine entrance exams written by Cambridge — including the BMAT and the Italian test medicina from 2013-2015¹ ² ³ — had a similar distinction.
In 2023, MUR’s IMAT brought forth several changes, including the number of questions per section. MUR kept Cambridge’s multi-statement questions. However, some of its topics were more challenging than anything before. For example, question #31 on 2023 IMAT on oxidative phosphorylation of cellular respiration required a significantly specific level of detail to answer correctly. While high schoolers are often familiar with the existence of complexes of the electron transport chain (ETC), their teachers often only mention in passing the functions of each and every complex and do not expect students to know them.
Thus, while the initial somewhat similarity to Cambridge’s IMAT was a relief, the level of detail required became much more unpredictable.
Leading up to fall 2024, students prepared as others had in previous years, with many focusing on and devoting more time to the more difficult, and higher question-load biology section. It was, thus, an unwelcome surprise to learn that the 2024 IMAT was — dare we say — too easy. MUR seems to have over-corrected for the level of difficulty in their 2023 paper: they completely eliminated multi-statement questions, removed almost all diagrams and tables, and designed extremely simple, straightforward, factual questions, making the biology section a borderline joke. One of the 2024 questions on bioenergetics simply asked “Which process occurs within mitochondria?” — which is at most, middle school knowledge.
This is in stark contrast to MUR’s 2023 IMAT question on oxidative phosphorylation. In fact, this style of question-writing is identical to MUR’s approach of awarding simple, foundational knowledge in their Italian test medicina.
Could we have predicted the 2024 IMAT paper? (Featuring TOLC-MED and test medicina)
In the summer of 2024, AcadIMAT provided translations with shuffled answers of the past ten years of the Italian test medicina exams for its private premium community, as part of a fundraiser. (N.B., The test medicina is the admissions exam for public medicine and dentistry courses in Italian. The exam was changed to CISIA’s “TOLC-MED” but only for 2023, as it was subsequently altered. The Italian exam is still commonly referred to as test medicina.) The AcadIMAT team noticed that the 2024 test medicina syllabus and the number of questions per section exactly matched that of the IMAT 2024 syllabus. With the exception of a couple of years, MUR exclusively wrote this exam, so we hoped that these papers would supplement students’ preparation for the new IMAT. We, however, did not expect HOW ALIKE the two exams would be.
The current test medicina has a more straightforward style, rewarding basic and theoretical knowledge rather than problem solving like the Cambridge style IMAT. This is particularly the case for the biology and chemistry sections of the Italian test, which are remarkably simpler compared to their Cambridge counterparts. On the flip side, the logical reasoning section — specifically the reading comprehension questions — seem a lot more convoluted.
Though the massive shift in the 2024 IMAT was certainly not predictable, students in our community who used the translated test medicina as part of their preparation reported that they were not as shocked to see the straightforward nature of the 2024 questions. While MUR might throw another curve ball for the 2025 IMAT (if the IMAT doesn’t get cancelled) once again overcorrecting and this time maybe making the exam significantly more difficult, the test medicina may serve as good supplements to future IMAT applicants. The original, unshuffled exams in Italian (with all answers A) can be found on the official MUR website here. However, if you would like the translated test medicina with shuffled answers, stay tuned while we relaunch our community!
One aspect that did not change was the number of questions per section. The 2023 IMAT overhaul by MUR saw a drastic increase in the number of biology questions to 23, accompanied by a decrease in the number of general knowledge, logical reasoning, and problem solving questions.
2024 vs 2023 IMAT Dissection: Trends and Review
| IMAT Overall Scores | 2023 | 2024 |
| Maximum | 83.6 | 87.0 |
| Minimum | -12.6 | -14.5 |
| Mean | 24.5 | 42.2 |
| Median | 23.2 | 42.6 |
| Standard Deviation | 15.2 | 17.5 |
| IMAT Overall Scores | 2023 | 2024 |
| Maximum Possible | 90.0 | 90.0 |
| Minimum Possible | -24.0 | -24.0 |
| # of Test Takers | 10257 | 10931 |
All the changes to the IMAT culminated in a significant shift in overall scores, despite the same number of questions per section, same maximum possible score, same minimum possible score, and similar number of test takers.
10931 students took the 2024 IMAT, a slight increase from the 10257 in 2023.
From 2023 to 2024 IMAT total scores, the mean saw a change of +17.7 points and the median +19.4 points. This was not the only statistically significant shift we observed. Below, we cover in depth each IMAT section and its corresponding changes.
Review of IMAT “General Knowledge and Logical Reasoning”
| IMAT GK + LR Scores | 2023 | 2024 |
| Maximum | 13.5 | 13.5 |
| Minimum | -3.6 | -3.6 |
| Mean | 4.1 | 4.8 |
| Median | 4.1 | 4.8 |
| Standard Deviation | 3.3 | 3.4 |
| IMAT GK + LR Scores | 2023 | 2024 |
| Maximum Possible | 13.5 | 13.5 |
| Minimum Possible | -3.6 | -3.6 |
Here, we will combine the review the first two sections — “Reading Skills and Knowledge Acquired during Studies” and “Logical Reasoning and Problem Solving” — as they account for only 9 questions out of the total 60 (since 2023).
The overall consensus was that the two sections were relatively fair. Surprisingly, however, the 2024 IMAT did not ask questions regarding knowledge of Italian history, literature, or politics as was done in past papers, including 2023. One of questions (#04) asked about grammar, something seen on past test medicina papers but not on the IMAT exam.
The AcadIMAT team also noticed an interesting strategy of test takers skipping the “General Knowledge and Logical Reasoning” questions completely, promptly scoring 0.0 for that section. 535 students or 5% of all students completely skipped the aforementioned questions in 2023 while 347 students or 3% in 2024 (ignoring outliers).
We also found the full, original source for the reading skills question #02, shown below. It seems that MUR translates and abridges Italian texts instead of using English sources. This is just like the test medicina that uses original Italian texts. You can potentially expect such translated passages on future IMAT papers.
“INTRODUZIONE
In base ai documenti storici, possiamo dire che moltissimi popoli antichi escogitarono alcuni simboli per rappresentare i numeri e le soluzioni di problemi matematici: ma anche se l’uomo pensante ha cominciato ben presto a fare i primi passi verso la matematica, si può affermare che soltanto con la civiltà greca questa dottrina è giunta a quei caratteri di astrattezza e di generalità che le sono specifici e che ne fanno una scienza, anzi una scienza del tutto particolare, come vedremo.
La lentezza con la quale è avvenuta la evoluzione della matematica verso lo stato di scienza astratta e generale può essere considerata come significativa, anche se noi oggi siamo portati a bruciare le tappe, anzi forse proprio per questo: i documenti delle civilizzazioni precedenti la greca testimoniano del fatto che le soluzioni di problemi matematici erano note soltanto in casi particolari e concreti, e danno l’impressione che le nozioni matematiche fossero comunicate a spizzico, in modo non metodico, come notizie utili e dedicate a risultati pratici, o addirittura in modo accidentale.”
Momenti del Pensiero Matematico (1976), Carlo Felice Manara, Gabriele Lucchini⁴
Review of IMAT Biology
| 2023 IMAT Biology Scores | 2023 | 2024 |
| Maximum | 34.5 | 34.5 |
| Minimum | -9.2 | -7.3 |
| Mean | 14.0 | 23.9 |
| Median | 14.1 | 25.8 |
| Standard Deviation | 7.6 | 8.1 |
| 2023 IMAT Biology Scores | 2023 | 2024 |
| Maximum Possible | 34.5 | 34.5 |
| Minimum Possible | -9.2 | -9.2 |
We have made most of our comments for the biology section in the “Why was the 2024 IMAT Unique?” section above. To recap, the 2024 IMAT biology section was much simpler and became the biggest point of contention for medicine applicants. The significant change may have been a response to last years difficult paper. Interestingly, the new biology questions were very similar to that of the test medicina that we translated for our premium community in summer 2024.
In preparation for our 2025 IMAT bootcamp, we analysed and categorised by topic every single question that has ever been asked in the IMAT. We found that, historically, the anatomy and physiology category from the official IMAT syllabus was by far the most frequently tested. Thus, it came as a shock to us and test-takers that not even a single question from this category was asked on the 2024 IMAT.
Review of IMAT Chemistry
| 2023 IMAT Chemistry Scores | 2023 | 2024 |
| Maximum | 22.5 | 22.5 |
| Minimum | -6.0 | -6.0 |
| Mean | 5.2 | 6.8 |
| Median | 3.7 | 5.6 |
| Standard Deviation | 6.2 | 6.3 |
| 2023 IMAT Chemistry Scores | 2023 | 2024 |
| Maximum Possible | 22.5 | 22.5 |
| Minimum Possible | -6.0 | -6.0 |
Notably, the 2024 IMAT Chemistry section did not include any chemical structures for its questions. In past years, organic structures features questions on simple organic reactions, functional groups, and nomenclature. In fact, this year’s section did not feature any diagrams or extensive paragraphs on experiments. Previous questions have posed stoichiometry details of chemical reactions as previously mentioned, the multi-statement questions were also removed from this section. Interestingly, questions #43 and #44 required memorisation of standard atmospheric pressure at sea level and Avogradro’s constant. This is reminiscent of the current test medicina, which asks questions on involving common constants.
Review of IMAT Physics & Mathematics
| 2023 IMAT Physics and Maths Scores | 2023 | 2024 |
| Maximum | 18.0 | 19.5 |
| Minimum | -5.2 | -3.3 |
| Mean | 1.2 | 6.7 |
| Median | 0.7 | 6.3 |
| Standard Deviation | 2.8 | 4.3 |
| 2023 IMAT Physics and Maths Scores | 2023 | 2024 |
| Max Possible | 19.5 | 19.5 |
| Min Possible | -5.2 | -5.2 |
The new physics and mathematics section does not feature such a drastic change in difficulty compared to that of biology. Still, the questions themselves were more straightforward in nature, as reflected by the change of +5.5 points in the mean and +5.6 points in the median. It might also be interesting to factor in that anecdotally speaking, students found the 2023 IMAT Maths & Physics section considerably more difficult compared to previous years, which is reflected in the stats.
As usual, the maths section tested students on algebraic inequalities, rational equations, trigonometry, exponent rules, function notation, probability, and geometry. Interestingly, one maths question (number 53) asked for the calculation of cylindrical volume, without the provision of the corresponding formula, V = πr²h. Volume questions have not historically asked on past IMATs, so many test takers were caught off guard.
N.B.: offered as an answer choice in geometry question 52 was the word “explementary,” used to describe the nature of two angles that add up to 360 degrees, sometimes referred to as “conjugate” angles. This is a rather obscure term, not as commonly used as the words “complementary” or “supplementary.” It is possible that MUR directly translated this from the word “esplementare” which showed up in the 2024 test medicina database.
The physics section, similarly to the others, no longer features multi-statement questions.
Now for the elephant in the room: question 55. This was an unsolvable physics question that asked test-takers to solve for the value of power, the rate of work done, given the associated force on a system and distance traveled by the system. However, without a time elapsed of the movement or the speed of the system, it is impossible to solve. In fact, MUR mentions a speed “v” but never mentions it later in the problem. Likely, the test writers made a typo and forgot to include the factor “v” in the answer choices.
Question Typos, Errors, Reporting, and Corrections
Among various IMAT communities, there was organized effort to get question 55 reported and cancelled. MUR nullified the erroneous question and corrected the scoring as if all test-takers had answered the correctly. In other words, those who had answered “incorrectly” gained +1.9 points, left blank +1.5 points, and “correctly” 0.0 points. (Though there was no official announcement from MUR, students reported that this correction was made to their test scores. Moreover, our 2024 IMAT score analysis showed that +1.5 points was added to every physics and mathematics score.)
Though post-exam score corrections are not a common occurrence, it has happened before. In 2013, MUR made corrections to the IMAT exam in an announcement, stating, “All answers to questions n. 5 and n.54 were scored as correct.” ⁵
MUR also made typos:
- In question #01, MUR misspelled the name of the 20th-century English writer Virginia Woolf as “Wolf.”
- In question #18, MUR wrote “intercellular compartmentalisation” instead of “intracellular” when referring to organelles.
In Summary: Why the 2024 score increase?
The biggest culprit, as shown by our statistical analysis, was the ease of the 2024 biology section. We can see how much the scores were skewed toward higher results in that section. In the addition, the more difficult 2023 physics and mathematics section skewed the scores negatively. Combined with other contributing factors detailed above, we can see why the scores shifted.
Considering the similar number of IMAT test takers between the two years, you can be assured that the exam did not suddenly become significantly more competitive nor that the caliber of applicants improved overnight. Instead, the easier and more straightforward style of the exam allowed a lot more students to achieve higher scores.
The statistical distribution in both year were fairly normal. Likely, if the paper had been just as easy and straightforward in 2023, the score distribution would have been similar.
What does this mean for the future?
First of all, let this be an example of why IMAT scores are completely unpredictable. We have always been opposed to creating articles or videos that attempt to predict the cutoffs for future years, even though such content would generate many views and clicks. Unfortunately, nothing is predictable, and no one could have guessed that the biology section, after 12 years of consistency, would suddenly experience such a drastic shift.
To those who were unable to secure a seat this year, this is not the end of the road. You can always attempt the IMAT again next year, explore entry opportunities to medicine in other countries, or find productive work to fill your gap year. There is absolutely nothing wrong with exploring various options. Whatever the result, keep your head up, and best of luck in your future endeavors!
For those planning to reattempt the IMAT in 2025, or for first-time takers, solve IMAT past papers. It is the top strategy of top scorers, and it is a very simple and free way to maximise your preparation. However, it is also essential to contextualize your practice scores with past IMAT papers. For example, if you score 40 on the 2017 paper, do not be discouraged. Similarly, if you score 60 on the 2024 paper, do not assume that have exceeded your preparation goals. Only compare your IMAT scores to others in the same year.
If you would like a more tailored preparation experience for the 2025 IMAT, consider joining us in person (in Italy or Turkey) for the IMAT Bootcamp. There, we will not only break down trends from previous IMAT papers but also cover the most challenging concepts in the syllabus. More information is available here!
Sources
- Decreto Ministeriale del 12 giugno 2013, n. 449 Modalita’ e contenuti delle prove di ammissione ai corsi di laurea ad accesso programmato a livello nazionale – anno accademico 2013/2014; Gazzetta Ufficiale della Repubblica Italiana
- Decreto Ministeriale del 5 febbraio 2014, n. 85; Gazzetta Ufficiale della Repubblica Italiana
- Decreto Ministeriale del 3 luglio 2015, n. 463; Gazzetta Ufficiale della Repubblica Italiana
- Momenti del Pensiero Matematico (1976), Carlo Felice Manara, Gabriele Lucchini; Photocopy by Biblioteca Matematica, Servizio Bibliotecario d’Ateneo, Università degli Studi di Milano
- Accesso Programmato IMAT 2013. Ministro dell’Università e della Ricerca, Minister of University and Research
- Accesso Programmato IMAT 2024. Ministro dell’Università e della Ricerca, Minister of University and Research