Lost in translation: why is it challenging for medical students to continue their studies abroad?

How to “transfer” your medical education to another country? Overview of the situation and experience of the Freedom Degree

Thousands of people were compelled to flee their countries after the full-scale conflict in Ukraine broke out, including citizens of Belarus and Russia. Many of them are teachers and students who no longer have the chance to work and study in their accustomed academic setting. Some found themselves under bombing in the war zone, others were expelled from their home due to political beliefs, and some are unable to find opportunities to continue their education after being forced to emigrate.

There are other issues that medical students deal with. Transferring from one university to another is more difficult for medical students than for students studying the humanities or IT because medical education is strongly tied to national healthcare system standards. Accreditation requirements, practical training hours, exam lists, and even lists of approved medications for treatment vary by country. The transfer process is extremely difficult but still feasible.

Freedom Degree has worked with both practicing physicians and medical students. The difficulties of transfer in medical education will be discussed in this new article, and our academic curators will offer their own educational experiences as well as their knowledge of dealing with similar cases at Freedom Degree.

Direct translation of medical specialties

If we are talking about a direct track, that is, when you are only studying to become a doctor in Russia and wish to have your education recognised in another country, it is very difficult to "translate" your medical speciality. It involves more than just accumulating credits; it also involves having specific medical knowledge and credentials. Polina, our academic curator, talks about her experience working with medical students through the Freedom Degree experience. In one case, a student who wanted to transfer to another country but had not finished his medical education in Russia sought assistance from the Freedom Degree.

We made an effort to contact a number of UK institutions at a fairly high level. We wrote to professors, who were courteous in their responses, but ultimately, the most they would do was admit the student for the first year of Bachelor education. Because no one knows how to convert these medical courses taken in another country, the negotiations in some cases just ended in failure.

Academic curators of the Freedom Degree, Polina and Faya, note that if a person already has a medical degree, the path back to the profession, although still difficult, becomes more realistic. They can pass a language test, then retake the certification exam (PLAB in the UK or comparable exams in another country) and obtain medical registration. In certain situations, they must also finish a clinical practice program in hospitals that is comparable to a Russian residency.

Some emigrants return to their profession in this manner: they get limited medical registration and start clinical training simultaneously after passing the exams. Although it is more challenging, some medical professionals decide to pursue an academic path that blends science and medical practice. The situation is considerably more challenging without a diploma, though, as one will typically have to begin the first year of a Bachelor's degree program.

According to Polina, it can be challenging to decide to return to the first year:

When a person has already completed six years of study in another country, has come a long way, and only has state exams left, it is difficult to decide to go back to the first year

A person's clinical residency status in Russia does not ensure international recognition. For instance, in Russia, there are frequently limited specialisations, such as only psychiatric or only therapeutic, but in the local system, residency must include both therapy and surgery. Full registration cannot be obtained if surgery was not covered in the training. Because of this, people who have finished their clinical residency in Russia sometimes have to start over in a new country, just like if they had just graduated from college.

However, it is not necessary to continue clinical practice education at a university abroad. There are other alternatives.

From clinical practice to research

The shift from medical practice to medical research is arguably the easiest and most direct choice. In this instance, your chances of getting credit for the theoretical portion of your Russian medical education and continuing to work overseas, this time as a researcher, are significantly higher. In addition, some countries' healthcare systems view pauses in medical practice negatively. Studying for a research master's or doctoral degree, however, can explain this gap.

Our academic curator Polina graduated from the Faculty of Fundamental Medicine at Moscow State University with a degree in medicine, then pursued a research track and enrolled in a master's programme at Imperial College London. She is an immunology specialist, and in 2020, her London lab was even used to create a COVID-19 vaccine. Polina is currently working on her PhD thesis. In order for her medical speciality to be recognised, she is simultaneously completing the so-called medical registration process in England, passing language and exam requirements:

I have no practical experience because I did not finish an internship or clinical residency, so even in this instance, I will only be granted partial registration. I am limited to practicing medicine at the most basic level.

Polina claims that entering the research track was easy for her:

Conversely, it's more advantageous: I chose to enrol in a research program rather than a clinical one. Although I have a medical background, I do not claim to be able to perform clinical procedures for the university. Going from being a doctor to a researcher is a different and simpler path.

How can practicing doctors avoid exams? Fellowship track

The only way to bypass formal exams and registration is through a fellowship program designed for practicing doctors. Those who have already gained full-time work experience as a doctor in Russia, rather than just as a student, can apply for a scholarship through employment. Here's what Faya and Polina have to say about this track:

Yes, indeed, if you are already a practicing doctor and work in a certain country, there is a possibility of transfer through programs such as fellowships. These are special positions that allow you to avoid standard exams and registration procedures. Of course, you still need to pass a language exam at a very high level, but then you can be hired directly as a doctor. Such options do exist, although you need to actively search for them.

In such cases, the hospital offering the fellowship position takes responsibility: it conducts interviews, evaluates the candidate's experience, and, if it considers them suitable, sponsors their participation in the program directly. In contrast to this path, more general academic scholarships or programs do not offer such opportunities, as they do not have medical expertise and do not take on such risks.

Fluency in the language and passing the same tests as for a full medical licence are frequently prerequisites for these medical positions, which are typically scarce for non-EU nationals in EU. For instance, after receiving a complete licence or, at the very least, passing an exam in the necessary subjects, a Russian doctor may apply for a clinical residency in Germany.

The Freedom Degree has expertise assisting individuals with their applications for medical fellowship programs abroad. After completing his residency and graduating from university in Russia, Yuri worked for a few years as an intensive care physician before deciding to leave the country when the war in Ukraine broke out:

I didn't really understand how the system worked at the time, so I tried to find opportunities to move right away. I realised that getting "confirmed" in the UK was not too difficult. I was able to get advice and connect with a renowned professor in the field of intensive care from University College London thanks to the Freedom Degree. He got back to me rather quickly, and after our Zoom-conversation, he introduced me to the fellowship program's academic director.

Following that, Yuri had two interviews and was offered a position. Due to the lengthy process of verifying his education, Yuri was unable to choose the simplest option:

One possibility is that a hospital will ask you to work there. They bargain with the local government's medical regulator and request that they grant a licence to the physician they intend to employ. If you have consistent work experience, you can take this path. Unfortunately, leaving Russia caused a pause in my career.

Yuri passed a European online exam for critical care physicians after departing Russia. About a year and a half passed between when he got the invitation from the UK and when he began working:

For the past two years, I have been employed at UCL Hospital, which is a part of the National Health Service (NHS). It's likely that you've heard complaints from people all over Europe about the medical systems' breakdown and the difficulty in scheduling a doctor's appointment. Like the majority of European healthcare systems, this one has numerous issues. Still, I enjoy my work. One of the benefits I would point out when discussing the differences with Russia is the medical training system; it is far more effective. Though the process is gradual and the amount of responsibility increases gradually, you are taught to be independent.

Undergraduate studies for medical school preparation

Some educational systems offer a "pre-med track," which is a route to get ready for medical school but is not medical school itself. In essence, it is a standard Bachelor's degree: students can enrol in courses like chemistry, biology, or neuroscience, for instance, and complete a number of prerequisite courses to earn credit towards their Bachelor's degree, which will help them in medical school. For those who attended a Russian medical school but were unable to transfer directly, this is particularly an option. They can take this route rather than attempting to pursue their medical education transfer, which is nearly impossible, according to Faya:

This way, even if a person has already completed two or three years of medical school in Russia, they can return to the US education system from scratch, but through a more flexible and accessible route.

Given the high cost of education, the challenge is that your path gets longer and, more importantly, much more expensive. Medical school in the United States costs between $50,000 and $70,000 per year, while in the United Kingdom, international students must pay between £30,000 and £45,000. In Russia, the EU, some Asian countries, and some Latin American countries, medical education is far more accessible to foreigners.

Nursing

Due to the severe lack of specialists in many European countries, Russian medical professionals have other job options. Becoming a nurse is one choice. Typically, you must finish an adaptation program or pass a competency exam to be admitted to the profession.

Healthcare professionals in the UK are required to register as foreign professionals. You must first verify your proficiency in English before passing a two-phase professional exam that consists of a practical clinical exam and a computer-based theoretical knowledge test. You can then become fully registered in the nation's healthcare system. Similar systems are in place in EU nations.

As a result, Russian medical professionals can find employment in Europe, but they must first verify their credentials, which may involve internships, tests, and retraining. Because nursing training programs are more uniform across nations, this path is typically shorter than that of doctors.

There are also many foreign nurses working in Persian Gulf countries such as the UAE and Saudi Arabia. A nursing degree and at least three years of work experience are typically prerequisites for Russian specialists, who must also pass the pertinent exam and verify their credentials here. Since English is frequently used in clinics in the area, you must be proficient in it and occasionally pass an international language exam. The region's nursing shortage presents some new opportunities. For instance, hospitals in the United Arab Emirates hire groups of foreign medical specialists and give them a brief orientation course.

Exiled doctors

In post-Soviet countries, where mutual recognition or streamlined processes are typically in place, some physicians with Russian training work. After the large-scale conflict in Ukraine began, many of them left the nation on principle. In their reports, journalists recall that more than 17,000 Russian doctors and nurses signed an open letter opposing the war, and that among those who fled were hundreds of novice doctors as well as well-known medical professionals. After mobilisation started in September 2022, thousands of doctors fled the country, according to the Radio Liberty and Current time article.

It seems that a large number of them made Kazakhstan their home. Foreigners must pass an exam here, which is also administered in Russian, before they can begin working as doctors. Integration is simpler because Russian is widely spoken in the country. Similarly, certain Eurasian Economic Union (EAEU) nations have formal agreements that make it easier for them to recognise each other's medical credentials. To become a licensed clinical specialist, one must still pass a local exam in each country. Due to their reputation as skilled professionals with high-quality education, Russian physicians are in high demand in Kazakhstan.

Many immigrants in Israel hold degrees from Russian universities. Israel has developed unique transition programs in response to the large-scale Jewish exodus from Russia in the 1990s and 2000s. To assist medical professionals in becoming acquainted with local customs and language, the Ministry of Health has introduced training programs. Doctors from Russia can take a state exam to obtain a license and may have to complete a short observation period, while doctors with extensive experience are sometimes exempt from the exam.

In summary, it can be said that a direct transition from studying to becoming a clinical specialist in the same position in another country is a very difficult task, which is only possible in exceptional cases.

You can still do medicine, though, with a different focus—as a researcher, a practicing physician (who can combine practice and research), or an undergraduate student on a preparatory track—by utilising a variety of subtleties and workarounds.

For assistance and support, get in touch with Freedom Degree.