Grades have long been a system to compare students, with many negative implications. Instead of being used to gauge a student’s performance and areas of weakness to improve, they have become a source of shame for many. It’s no surprise that medicine attracts some of society’s most competitive, high performers. But do grades really still matter once you’ve made it into medical school, knowing you’ll end up with the same title in the end?
In this era, it is increasingly evident that traditional grading systems are becoming obsolete. Numerous compelling video essays explain why academic systems should all just switch to pass/fail. Many of the world’s top medical schools such as Karolinska institute are adopting this change, as research repeatedly shows that it leads to higher overall student success and performance. Despite these findings, traditional grading and it’s associated public shame persists in many cultures. Given the intense competition in today’s world, particularly in the healthcare field, we should encourage ourselves to stop judging ourselves so harshly. In this article, we aim to summarise how grading works in Italian medical schools, the opportunities it unlocks, and why we should all stop caring about it, and enjoy life instead.
How Are Grades Calculated in Italian Universities?
First of all, it’s important to understand how grades in Italian universities work, about which we’ve written a full article. We highly recommend reading it to understand oddities such as the ability to reject your grades, but to summarize the system:
- 18 points is the minimum to pass.
- 30 is the maximum grade.
- 30 con lode counts as 31 out of 30 for those who really go above and beyond.
Interestingly, even though the exam grading system is out of 30, the diploma grading is out of 110. This is how the final diploma grading works at Sapienza, but I’m pretty confident it would be similar at other universities.
Your arithmetic average, calculated from all your exam grades (x/30), is computed as a percentage of 110 points instead of 100. You can earn up to 7 additional points for your thesis, and bonus points from other activities such as participating in Erasmus for 6-24 months (1-2 points), earning up to 6 ‘lode’ in past exams (1-2 points), and graduating on time (1-2 points), among others. If you reach a score of 113/110, you graduate ‘cum laude’, or with honours, on your diploma.
As an example demonstration, let’s calculate the following students final grade:
- 28.4 Average
- Has received 4 lodes through out academic career
- Received full 7 points for the thesis
- Graduated in September instead of June
This student will receive:
- 104 points from their average
- 1 Extra point for 4 lode (6 is needed for 2 points)
- 7 extra points for the thesis
- 1 extra point for graduating on time, but slightly later
- Final grade: 113/110 ⇒ 110/110 cum Laude (With Honours)
When Do Grades Actually Matter in Medical School?
Unfortunately, we still live in an era where grades are heavily used by academics and society to judge people. They are also used as a tool for comparison among peers, and even worse, as a measure of our own self-worth. Despite the flaws in this system, here are the situations where having a higher average might matter in an Italian medical school.
Doing an Erasmus Period Abroad
Doing Erasmus as a medical student is an incredible opportunity that as many people as possible should take advantage of. It’s not only a paid period where you get to travel abroad and study in another university for a period of time, but it also grants you bonus points on your diploma, making it a two-for-one deal. You’ll get to meet people, experience new things, get paid to do it, and get a bonus on your diploma. We have two articles on Erasmus that we recommend reading to understand more about it, but essentially, the opportunity to go on Erasmus is decided by the number of credits you have, as well as the grades you hold.
It works in a system very similar to the IMAT EU scrolling. Each student indicates their preferred destination country (each university has its own learning agreements with others, so the available countries vary greatly). Students are then ranked along with EVERYONE in the faculty based on the number of credits and their average. The higher you are on the list, the greater your chances of getting your top choice for studying abroad. It’s important to note that almost everyone will have the opportunity to go abroad, but it might not be the country you had your heart set on if you’re lower on the list.
While your grades do matter for this, the number of credits you have is considerably more important. If two students from the same year apply, even if one student’s average is 29 versus the other’s 25, if the student with a 29 average has one less exam than the student with a 25 average, they will be a considerable number of positions below in the ranking.
Wanting to Write Your Thesis in a Competitive Department
Writing a thesis is a necessary part of the timeline to graduate from a medical school in Italy. The thesis is usually written in a department that you have a strong interest in, as you’ll need to spend a lot of time there, possibly over a year. In certain competitive specialties, where many students might request to write their thesis, selection may be based on their average. In my personal experience at La Sapienza University, even when professors have said they would take into account the “curriculum vitae” (essentially meaning your average), I’ve never seen a student be denied a request to write their thesis there. Just in case that is a consideration, as it’s highly variable from professor to professor and department to department, having a higher average certainly wouldn’t hurt.
Going for Residency in Certain Countries
Your grades, or your final diploma score, can have some impact on your post-graduation options, but not to a significant degree.
- Italian Specialty Training: If you graduate “con Lode,” you can earn an extra 1-2 points on the SSM concorso, a MCQ exam out of 140 points that determines your specialty and city of practice.
- UK Foundation Training: This is possibly subject to change as of 2024, but historically, the August before graduation, your decile ranking in comparison to your classmates for grades and credits is submitted for the UK foundation programme application. Based on your decile ranking, you are awarded a certain number of points which help with getting placed into a higher choice deanery and hospital in the end. It does not impact your eligibility for applying to the UKFP, as they accept every candidate as long as they meet the application criteria.
Should You Care About Your Grades as a Medical Student?
In the Italian University system, particularly in medical school, there is an element of public shame. In almost every university, your grades are read out loud during oral exams, your average is announced during graduation, and it can even be printed on your diploma. As anxiety-inducing as this seems, it’s actually so commonplace that people become really accustomed to it and eventually stop caring, as hard as that may seem.
This is incredibly tough advice to take, but seriously, don’t worry about your grades. It’s hard to see it at the time, and extremely difficult not to hold yourself to those arbitrary standards, but grades don’t really matter and will never reflect your abilities. You need to accept your passes and move on with your life; otherwise, you’ll be stuck forever and become “fuori corso”. How are grades a fair assessment when one of your classmates has to work part-time every single day, do their own shopping, and can’t afford all of the top resources compared to your very rich classmate who’s never had to worry about money, can get private tutoring if needed, has their house cleaned, and all their meals cooked for them, etc.? The point is that grades will never reflect intelligence, just life circumstances which you, to some degree, cannot control.
The most important thing to aim for is not actually getting good grades, but learning things well for the sake of understanding them. If you work hard to genuinely understand concepts, instead of memorising minute details to raise your grade, and use the motivation of being knowledgeable for clinical reasoning instead of sacrificing evenings to get a 29 instead of a 26, you will be a happier, and better doctor, guaranteed.
As much as I can rant and rave about why grades don’t matter, here’s a concrete list of reasons why they don’t matter as much as you might think:
- When you reject grades to maintain a high average, you risk falling behind on exams and credits. This can not only affect your scholarship but also your visa status, and possibly hinder your plans to graduate on time, which would earn you bonus points anyway.
- The number of credits matters far more for rankings (Erasmus, for example) than grades. Therefore, having an average grade but being on time with exams is worth its weight in gold compared to just having a high average with barely any credits.
- Graduating on time and participating in Erasmus will boost your final score for the diploma. So you might as well have as many credits as possible, to do as much erasmus as possible, and graduate as early as possible. 🙂
- Once you graduate and are working in the hospital in a few years, absolutely no one is going to ask you what grade you got in what subject. A patient is never going to stop and ask if you scored above 80% in your 1st-year histology class.
In Conclusion
Grades shouldn’t matter, but as society still cares about them, it’s your responsibility to ensure they affect your life as little as possible. You might get unlucky in an exam, you might get sick the day before and barely perform during the oral portion, or you might have studied from the wrong material or the wrong syllabus. Sometimes, you’re going to have to accept the loss to move on with your life, prioritising your mental health and happiness. Aim to finish as early as possible and enjoy your long summers. If you finish all your exams in the first few weeks of June, you will have four complete months off every summer instead of having to do exams in every single session available. You’ll never have to experience the dread of being behind in your studies. Grades are never going to be a reflection of your true capabilities, so stop holding yourself to these standards.
Medical school is going to be the longest, shortest, best, and worst years of your life. There is no need to make your life even harder than it needs to be; even the guy with the lowest grades in the entire class will have the same title and degree. Focus on clinical reasoning and understanding things to be the best doctor you can be. It sounds obvious, but how you prioritise learning will determine a lot.
8 thoughts on “Do Grades Actually Matter in Italian Medschool?”
I needed to hear this. I’m taking the IMAT next year and I’m worried but try to not let the fear of failure/ failure get the best of me. Both my parents work away and I practically raise my two brothers, cook, clean sort finances and study. I have friends who have much more than me and do better in exams but I am still happy for them. What you say about grades and exams is so correct. We all get there in the end and are on our own individual journey, wether we take the short road or the long road
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Hi. I finished high school last year and i got DDD at A levels in biology chemistry and maths.i wanted to study medicine in italy but im not sure ill get admission in one with this results.However i heard of the imat and how good scores in it can get you admission at a medical university.I want to know if i can take the imat with this kind of results?
And if do and get good marks in imat will i be able to get admission despite my A level grades?
From a university point of view, they do not care about your highschool grades. The only thing that matters is your IMAT score. However if you need to apply for a visa, there is a small possibility that the consulate will care. It is best to check with them to be 100% sure.
So does that mean they don’t require high school grades
Not usually no
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