IMAT Exam: What It Is and How Italy's English-Language Medical Test Works

What the IMAT is, and who takes it

Italy has two separate front doors into a Medicine degree, and they lead different applicants to different exams. The IMAT — International Medical Admissions Test — is the one built for international students: it’s the admission test for the Medicine and Surgery degree programmes that a number of Italian universities teach entirely in English, aimed at candidates who want to study medicine in Italy without first learning Italian. According to the admissions page for the “Medicine and Surgery Harvey” programme at the University of Pavia, the IMAT is a pen-and-paper test, marked by hand rather than on a computer: a written exam in the fullest sense, taken on a single day.

Registration for the IMAT goes through Universitaly.it, the same national portal Italy uses for every other route into a public university — including, as the last section of this Recap covers, the different path that Italian-language applicants have followed since a 2025 reform.

Format and scoring

The University of Pavia’s admissions page describes the IMAT as a multiple-choice test of 60 questions in total, each offering five possible answers with only one correct. There is no partial credit for a near-miss: a candidate either identifies the single correct option among the five, or doesn’t. The maximum score achievable across all 60 questions is 90 points.

Practical example: with 60 questions worth a maximum of 90 points combined, no single question is worth a flat, round number of points on its own — the weighting isn’t evenly split one point per question. That’s a detail candidates checking their practice-test results against the real scale should keep in mind, rather than assuming a simple one-question-one-point conversion.

What the exam covers, subject by subject

The 60 questions aren’t spread evenly across subjects. Per the University of Messina’s IMAT information page, for the 2026/2027 intake the exam is organised into five thematic areas:

Biology carries the single largest share of the paper, well over a third of all questions, with chemistry a distant second; physics and mathematics, logical reasoning, and reading skills and general knowledge round out the rest with far fewer questions each. A candidate weighing how to divide study time across subjects is, in effect, looking at this same table.

Timing, and who can get more of it

Candidates have 100 minutes to complete the IMAT. The University of Pavia’s admissions page notes one accommodation: anyone diagnosed with a learning disorder, or living with a serious illness, can submit a medical certificate to the university’s dedicated office (SAISD) and receive 30% extra time — pushing the standard 100 minutes up for that candidate alone, rather than changing the clock for everyone.

Registering for the IMAT

Registration for the IMAT is handled centrally, through Universitaly.it — the same portal that manages admissions for every publicly funded university course in Italy, whatever the language of instruction. An international applicant doesn’t register directly with a single university’s admissions office; the process runs through this shared national system, much like the requirements a foreign national needs to check before ever sitting the exam, starting with the visa formalities that the Italian Ministry of Foreign Affairs sets out for study abroad.

Why so few seats, and why the process is centralised

The IMAT exists because the number of English-language Medicine places in Italy is fixed and limited well below the number of applicants who want one — a mismatch between a scarce supply and a large demand that isn’t unlike the trade-offs studied in microeconomics and macroeconomics, where a capped supply meeting high demand is precisely what turns a place into something worth competing for through a ranked exam rather than first-come, first-served registration.

Italy’s other route: the open semester

The IMAT is not the only door into Medicine in Italy, and it isn’t the one Italian-language applicants use. Since a 2025 reform, students applying to Medicine and Surgery, Dentistry, or Veterinary Medicine in Italian no longer sit an entrance test at all. Instead, they register on Universitaly.it for what Italy’s Ministry of University and Research calls the “open semester”: a run of actual university coursework in chemistry, physics and biology, closed by three separate subject exams rather than a single multiple-choice paper. The academic calendar for that pathway runs from September to November, a window comparable to how term dates vary across the continent, as this Recap on school start dates in Europe sets out for other countries.

In the 2025-2026 academic year, the first under the new rules, the Ministry reported 64,825 students enrolled in the open semester across the three degree tracks; 54,313 of them, the large majority, chose Medicine and Surgery. None of those students sat the IMAT: it remains a separate exam, reserved for the English-language track, and the reform that created the open semester left it untouched. The change itself followed the ordinary sequence for turning a law into a working procedure: a bill, a law, then an implementing decree with the operational detail, the same layered process explained in this Recap on how a legal norm moves from principle to practice.