Imagine two female students. Both dream of becoming doctors, study hard and are willing to sacrifice time, energy and social life for that white coat. The first one sees the filter semester as an opportunity: the chance to really prove her merit over time, without the heavy stress of a quiz. The second, however, looks at that same reform with fear: six months of expense, uncertainty and continuous pressure, and all this before even knowing whether it will continue. It is this divide, between hope and fear, that makes the debate on the filter semester in Medicine so heated.

European comparison as a key

In the European panorama, access to medical studies does not follow a single model, but all the solutions adopted seek a balance between selection, the right to study and sustainability for students. It is precisely in this comparison that the Italian filter semester shows its specificity and its criticalities.

In Germany, access is strongly anchored to high school results: about 30% of places are allocated on the basis ofAbitur grades (baccalaureate exam), 60% through criteria set by the universities (which include grades and aptitude tests such as the TMS), and the remaining 10% through special quotas, e.g. waiting periods or routes reserved for students with special conditions. Selection therefore takes place before matriculation, without forcing students to invest months of university study without guarantees.

In Spain and Portugal, the principle is similar: written tests or diploma-related criteria allow for prior selection, with admission rates that in some cases exceed 50-60%. Here, the logic is clear: the economic investment and psychological burden are borne only by those who have a real chance of continuing, reducing the insecurity and risks associated with an incomplete course.

France represents the closest case to the Italian model. The common first-year system (PACES) provided for internal selection, with continuation rates between 15% and 25%. Precisely because of the high drop-out and inequality generated, that model has been the subject of reforms in recent years, in an attempt to reduce extreme competition and make the pathway more equitable. This shows how even traditionally internal systems may require adjustments to balance equity, sustainability and meritocratic selection.

The Italian filter semester thus fits in as an original solution, but also as an experiment that, compared to other countries, shifts the burden of risk more directly onto the students, making preparation and personal investment the real initial filter.

A selection moved inside the university

The reform, which came into force in the 2025/26 academic year, abolished the traditional multiple-choice entrance tests and introduced free access to the first semester. Students matriculate and attend three core courses – Biology, Chemistry and Physics – taking the relevant exams. Only those who pass all three tests with a minimum of 18/30 are placed on the national ranking list for access to the second semester.

The basic idea is clear: to assess merit not on a few hours of testing, but on an extended period of study, closer to university reality. In this perspective, the filter semester is presented as a more ‘authentic’ selection, capable of rewarding method, constancy and the ability to withstand intense workloads – essential qualities for medical training.

Merit and study over time: the promise of reform

For supporters of the filter semester, this approach marks a paradigm shift in the selection of medical students. Evaluating a student on months of study, rather than on a test concentrated in a few hours, would mean rewarding skills that go beyond notional preparation: method of work, perseverance, ability to organise oneself and to withstand prolonged pressure, all qualities considered central to the training of a future doctor.

From this perspective, merit is no longer measured in how quickly one answers a quiz, but in one’ s ability to cope with the pace and load of university. Also reinforcing this approach is the formative value of the semester, which allows one to accrue university credits that can be spent on other courses, mitigating the immediate exclusionary effect of the old test.

This is the promise that accompanies the reform: to reduce the weight of randomness, to move the selection over a longer period of time and to bring the access criterion closer to the real needs of medical training. An ambitious promise, which aims to replace the ‘all in a day’ logic with a continuous and structured evaluation.

Economic risk and rigid selection

Attending the filter semester means investing time, energy and money without any certainty of continuing. Fees, books, transport, often even accommodation: it all weighs on the student’s shoulders. And if after six months one does not pass the course, the effort is in vain. The reform, as it stands, transfers an enormous risk, both economic and psychological, onto the students.

The numbers speak for themselves: Of the 50,800 or so registered for the first roll call, less than half passed at least one examination. According to initial surveys, only 10-15% of the students managed to complete all three tests. Physics confirms the difficulty: only 10-12% passed; Chemistry and Biology fared a little better, but not more than 24-30%.

In other words, the vast majority of students are at risk of being excluded, not for lack of effort, but because the system is designed to eliminate almost everyone at the first attempt.

These initial percentages, although not uniform and not yet likely to change definitively with the full national rankings, show that a large majority of students failed all three tests on their first attempt.

A reform that questions the right to study

The central question is not whether the filter semester is better or worse than the placement test, but to ask to whom the cost of selection is passed on. The data and European comparisons suggest that the Italian system passes on a high risk, both in material and psychological terms, to students – especially those with fewer economic and social resources.

A reform aiming at equity should question not only merit, but also starting conditions. Without adequate safeguards, the filter semester risks not widening access, but redefining exclusion: no longer before university, but within it, after an investment that not everyone can afford to lose.

In this sense, rather than a definitive solution, the filter semester appears to be a still unbalanced system that raises a question of public interest: how to select without turning university education into a gamble reserved for those who can afford to fail. The debate is not just about students, but about the country’s ability to guarantee fair access to the health professions, which are fundamental to the collective well-being.