The International Medical School of the University of Milan is taking a major step toward attempting to ensure that its graduates will be able to do residencies throughout the entire United States. It is the first English-language med school in Italy to apply for California medical board accreditation.

The Vice Rector in charge of international affairs of the University of Milan, Monica DiLuca, announced at a meeting last week that the English-language IMS has started applying for recognition of its degree by the medical board of California. Among English-language MD programs in Italy, IMS–Milan appears to be the first to announce such an application. In this blog post, I am going to put into detail everything I have been able to figure out about the decision, which has the potential to greatly expand career possibilities, into the US and Canada, for graduates of the IMS-Milan. There may be errors in this post; please let me know if you find any.

Dr. DiLuca held a meeting with student and faculty representatives last week, in which she explained that the university Rector — equivalent to the university president — has endorsed the application of IMS-Milan for California accreditation. As I have explained in a previous post, California accreditation opens huge doors for Italian English-language med school graduates who wish to do residencies in the United States. Currently, the English-language med school degrees are not recognized by California, which explicity prohibits clinical practice by anyone whose only medical degree comes from an English-language medical program that is not in an English-speaking university — except when the English-language program has individual, specially-granted accreditation. As the California medical board puts it,

The English language programs are not recognized unless specifically stated, e.g., “University of Pecs Faculty Medicine” and “Pecs University Medical School English Program (6-year English Program).” The English language programs must apply for recognition and receive approval from the Medical Board of California for the education received from the English language program to be eligible to qualify an applicant for licensure requirements in California.

It is exactly this approval for which IMS-Milan is now applying. If it gets approval, then IMS-Milan graduates will be probably be able to apply to residencies in almost every, if not all, US states.

That is because many US states determine eligibility to practice and do a residency based on whatever decision the board of California — the most populous state — makes about a specific school. Examples of such states that “follow California” have been listed by other sources and include — but are by far not limited to — Alaska, Arkansas, Colorado, Kansas, Idaho, Indiana, New Mexico, Oregon, Tennessee and Vermont. Since the English-language medical school programs in Italy are maximum six years old, basically no state has had to make a definitive decision on whether to recognize these degrees or not, because no one has yet applied for a US residency (except, perhaps, two people from Pavia, which I have only heard about second-hand). With official California accreditation, IMS-Milan would be legitimized in the eyes of medical boards across the United States (and, presumably, Canada, because of the tight cooperation and mutual recognition of medical licensure between the two countries).

Stanford Hospital, in California

Stanford Hospital, in California

According to university officials, IMS-Milan first contacted California’s medical board some months ago. California responded that the process will take 2-5 years to get accreditation. One senior administrator here in Milan told me that not only does she predict the application will be successful, but also that it should be on the shorter end of that timeframe — in her words, a “fast track” of around 2 years, or even perhaps less. That is because the University of Milan’s Italian-language medical schools have long been accredited by California, and the university is highly-ranked worldwide in clinical medicine (69th in the 2015 US News and World Report rankings, the highest in Italy). Indeed, for decades, doctors have graduated from Italian universities and worked in the United States, including one of my personal heroes, Gino Strada, who is the founder of Emergency, similar to Doctors Without Borders, a Milan-based international medical humanitarian aid organization which works in crisis zones. Strada got his degree in medicine and trauma surgery from the University of Milan (in Italian) in 1978, and went on to work at Stanford Hospital in California and the University of Pittsburgh’s medical center in Pennsylvania, as well as the UK and South Africa, before starting Emergency.

IMS-Milan says that the university’s legal office will now contact the California board’s legal office, in a letter signed by the Rector. Furthermore, the university’s institutional affairs office will notify the Italian national education ministry; an adminstrator told me that she expects “no problem” in getting a green light from the Italian federal government in applying for recognition. The rest of the application process has not been totally clarified, but it does seem possibly to require IMS-Milan to submit a 25-page self-assessment form (unless, perhaps, the school is fast-tracked.) It is important to note that California’s requirements are strict. Furthermore, if approval is gained, it will be incumbent upon IMS-Milan graduates to perform at the highest levels of US professional practice, once they arrive on American soil. One of the reasons that California originally barred graduates of English-language programs in non-English speaking universities is because some came to the US and ended up commiting malpractice or proving not really to know medicine.

Another important question is whether accreditation would apply retroactively to students already in the IMS. There are three possibilities: 1) only people who start the program after accreditation is granted will have their degrees recognized by California, 2) people who are currently in the program when accreditation occurs will have their degrees recognized, or 3) all graduates will be recognized, with the oldest ones grandfathered into recognition. According to the administrator I spoke to, option 2 is the most likely. That is, current first-year students would for sure be recognized (assuming 5 years, the maximum time to accreditation, is needed), and upper-year students might be, depending on how quickly accreditation is achieved.

As far as I know, no other English-language med school in Italy has applied for California board recognition, although there have been movements among students in Naples pressing for it to happen there. If IMS-Milan succeeds, then it may make it easier for the other state schools with already-accredited Italian programs — in Pavia, Rome, Naples, and Bari — to follow. This is incumbent, of course, on them maintaining high-quality English-language programs, and the willingness of California officials to approve them. For some private universities in Italy, such as Humanitas, it appears that California accreditation may be a longer process, because they do not have a long tradition of degree recognition of their Italian-language courses.

What is the upshot of all this for applicants to English med programs in Italy? If you care about the possibility of doing your residency and specialization in the United States, or working someday in the US and Canada, then IMS-Milan is a good choice, because it currently is the only school which is taking major official, institutional steps toward making that a reality. This may be particularly appealing to US-Americans or Canadians who are considering Italy as their med school option, and would like to go home to practice someday. All of this is not to say that you should automatically put Milan as your first choice school. All of the medical schools in Italy offer wonderful experiences, and each has its own advantages. Furthermore, Pavia, Rome, Naples, Bari, and the non-state schools may soon follow Milan in applying for accreditation. Finally, if you go to one of the other Italian English-language med schools, you still may be able to get a residency in the United States depending on which state you are applying to — particularly if it is one that does not follow California — see the previous post for more details.

The US is one of the world’s most dynamic countries for medical research and clinical specialty education. If Milan’s application is successful, Italy and the US may begin to develop considerably stronger ties between their medical education communities. Many bright, fluent, English-language trained Italians and other non-US-Americans could end up doing residencies in the US, and US-Americans may end up coming to do their MD in Italy, enriching the courses here with a new international perspective.

Erik Campano (Milan)

Erik Campano (Milan)

Blog Editor
Erik Campano is a consultant to the English medical school of the University of Turin and doing a Master's degree studying artificial intelligence applications in global health at the University of Umeå, Sweden. He completed his Bachelor’s of science in Symbolic Systems at Stanford University, and then he worked for about eight years as a radio news anchor, before moving to biomedical scientific study and research at the University of Paris and Columbia University. His goal is to develop AI technologies for international emergency humanitarian aid organizations like Doctors without Borders, and to combine medicine and journalism. Erik grew up in Connecticut, and is a citizen of the United States and Germany.
Erik Campano (Milan)