How to prepare for the SSM exam: Italy’s entrance exam for medical specialty training

The short answer

The SSM exam (concorso SSM) is Italy’s national exam for entry to the specialty schools (scuole di specializzazione) where doctors train in a specialty. It is taken on computer and is the same across Italy: 140 multiple-choice questions with five options, mostly built on clinical scenarios, in 210 minutes, scored +1 for a right answer, −0.25 for a wrong one and 0 for a blank. On top of the exam’s 140 points come up to 7 points for qualifications: degree mark, exam average, an experimental thesis and a PhD. The total places you in a single national ranking, from which you choose schools and universities. The last two exams were held on 22 July 2025 and 21 July 2026 (calls published by Italy’s Ministry of University and Research, Directorial Decrees 647/2025 and 77/2026).

The exam covers the whole medical degree, so the preparation that holds up is long and spread out: from fifth year, keep every subject you’ve already passed in rotation, with reviews at growing gaps, instead of relearning everything in the six months before. In the last months work through questions, first by subject and then mixed, look hard at every mistake, and sit full mocks of 140 questions in 210 minutes. In a randomised trial with medical residents, repeated testing left final scores of 39% about six months later, against 26% after repeated study (Larsen, Butler & Roediger, 2009).

What the SSM exam is, and who can sit it

In Italy, doctors enter specialty training through an annual national competition based on qualifications and an exam. The rules are in the regulation of Ministerial Decree no. 130 of 10 August 2017, amended several times, most recently in 2021; each year the Ministry of University and Research (MUR) publishes a call (bando), which the regulation says comes out by 31 May. The latest is Directorial Decree no. 77 of 21 May 2026, for the 2025/26 academic year: the exam was held on Tuesday 21 July 2026 and the schools start on 2 November 2026. The year before, the exam was on 22 July 2025. As of November 2026 the next call has not been published: your exam’s dates will be in it.

Watch the academic year in the call’s title: the July 2026 exam was for 2025/26, because the schools start in November.

You can sit it if you hold the Italian master’s degree in Medicine and Surgery by the date the call sets: for the latest exam it was Tuesday 14 July 2026, a week before the exam. To start at a school you must be licensed to practise and registered with the Order of Physicians (Ordine) by the time teaching starts; since 2020 the Italian degree in Medicine and Surgery itself qualifies you to practise. For the 2026 exam, applications ran on the Universitaly portal from 28 May to 10 June, with a €100 fee.

The exam: questions, time and scoring

The exam is on computer, identical across Italy, held at local sites on the same day and at the same time. It has 140 multiple-choice questions, each with five possible answers, on the core subjects of the Italian degree in Medicine and Surgery and on the disciplines of the different types of school, listed in an annex to the call. Most of the questions ask you to assess clinical, diagnostic, laboratory, therapeutic and epidemiological data within scenarios drawn from one discipline or several, each with 1 to 5 questions. The exam is in Italian.

You get 210 minutes. In 2026 the exam started at 14:00, on computers with no internet connection, used with the mouse only; you can’t leave the room before time is up, and if you do leave you can’t come back. At the end your exam score is shown on your screen. Candidates with a diagnosed specific learning disorder get up to 30% more time.

Scoring is 1 point for each right answer, 0 for each blank and −0.25 for each wrong one, up to 140 points. Qualifications are worth up to 7 points: the degree mark up to 2 (110 with honours 2 points, 110 1.5 points, 108–109 1 point, 105–107 0.5 points, on Italy’s scale out of 110), the credit-weighted average of your exams up to 3 (from 3 points for at least 29.5 out of 30 down to 0.5 for at least 27), and other qualifications up to 2 (0.5 points for an experimental thesis and 1.5 for a PhD in a medical or health field). The maximum is 147. Qualification points aren’t given to those who already hold a specialty diploma or a specialty training contract, who hold or are taking the general practice training, or who are doctors employed by Italy’s national health service or an accredited provider. Neither the regulation nor the latest call sets a minimum score.

The ranking, choosing schools, and the number of places

Your qualification points and exam score together place you in a single national ranking. On equal totals, the higher exam score goes first, then the younger candidate, then the higher exam average, then the higher degree mark.

After the ranking you choose schools: you can list from one to every type of school and university, in whatever order of preference you like, and once the choice phase closes the order can’t be changed. You’re assigned to the best choice your position allows, given the choices of those above you. For the latest exam the ranking came out on 6 August 2026 and choices were made from 16 to 22 September.

The number of places is set each year by decree: for 2025/26 the ministry announced 15,221 specialty training contracts, 14,631 funded by the state and 564 by the regions, against 15,088 the year before.

The method: the whole degree kept in rotation

At the end of the degree the exam asks about subjects you may have passed four years earlier, as clinical cases that combine several of them. Rereading everything in the last months is the most expensive way to get there. Henry Roediger and Jeffrey Karpicke (2006) found that practising recall of a text leaves far more of it remembered than restudying it, even though restudying makes people feel more confident; John Dunlosky and colleagues’ review of ten study techniques (2013) rated practice testing and spreading study out over time as the most useful, and rereading and highlighting as of low use.

The same holds in medicine and over months. In a randomised trial by Douglas Larsen, Andrew Butler and Henry Roediger (2009), paediatric and emergency medicine residents were taught two topics: one they reviewed by taking tests with feedback, the other by rereading a summary with the same information. About six months later they averaged 39% on the tested topic and 26% on the restudied one.

1. For each subject keep one set of notes, the ones you prepared its exam with, and keep adding to them instead of starting again from a new textbook.
2. After each exam in fifth and sixth year, don’t shelve the subject: put it in rotation, with reviews at gaps that grow longer, sooner for what you get wrong.
3. Review by recalling, not rereading: for each topic ask yourself the differential diagnosis, the first-line test, the first-choice treatment and the complications, and answer before you look.
4. Link the subjects: one disease runs through pathophysiology, clinical medicine, pharmacology and imaging, and that’s how the interdisciplinary scenarios present it.
5. Add a small daily block of questions on the subjects you’ve done early on, so the five-option format is familiar long before the exam.
6. Keep a log of mistakes, with the reason for each: what you didn’t know, what you mixed up, what you misread.

Questions, mocks and spaced review: how to use them, and where Breef helps

How far apart should reviews be? In Nicholas Cepeda and colleagues’ study of more than 1,350 people (2008), the best gap was about 20 to 40% of the time until the test when that was a week, and about 5 to 10% when it was a year. With the exam a year or more away, a subject you know well can come back every few weeks or months, with the gaps shortening as the exam gets closer.

Question banks, from prep courses and dedicated apps, are the main tool of the last months, but they only pay off if every mistake becomes a review: read the explanation, write the point you were missing in one line, and put it back in rotation. Memorising a bank’s answers isn’t enough: the questions on the day will be different. The only official archive the ministry has published covers past exams, in a format different from today’s.

The scoring changes how to answer. With five options and −0.25 per mistake, a pure guess is worth nothing on average (a fifth of 1 point, minus four fifths of 0.25); if you can rule out one option for sure it rises to about +0.06, and with two ruled out to about +0.17. So answer when you’ve narrowed it down, and leave it blank when you have no idea. The time works out at a minute and a half per question.

Keeping a whole degree in rotation by hand is hard, and it’s the work Breef does. You can record a lecture or a seminar in a note and Breef writes it up as study notes, with the key points and what the lecturer stressed. Each note comes back for review at gaps fitted to how fast you forget, with three questions written from it, and notes link into a map that shows where subjects cross. When the call sets the date, give it to the project: every note that would fade by then gets a last review in the days before. “Question :: answer” lines become cards you can export to Anki, and to count the days left and split up the subjects there are Breef’s free exam countdown and study planner (breef.app/exam-countdown and breef.app/study-planner).

A plan from fifth year to the exam

The plan below assumes an exam at the end of July, as in 2025 and 2026; when your year’s call comes out, move it to the exam date.

1. Fifth year: prepare each clinical exam with the SSM already in mind, with notes and questions you can reuse. After each exam put the subject in rotation and start a small daily block of questions on the subjects you’ve done.
2. Sixth year, first semester: keep that up with the new subjects, and go back to the third- and fourth-year subjects you’ve never reviewed, starting with those that weigh most in clinical cases.
3. About six months before the exam: a systematic pass through every subject, one or two at a time, each closed with a block of questions on it and a look at the mistakes. Keep your thesis and last exams in the calendar, since your degree mark and average count as qualifications.
4. The last three months: mixed questions every day and one full mock a week, 140 questions in 210 minutes, in the afternoon as on the day. Go through each mock in full, not just its score.
5. The last month: more mocks, your mistake log and the topics you get wrong most often; no new material.
6. The last week: light reviews, documents and the exam site checked, regular sleep. The day before, rest.

Common mistakes

Starting only after graduating. The exam covers six years of subjects, and the early ones come back far more easily if they never left the rotation.

Doing thousands of questions without going over the mistakes. Scores go up when every mistake becomes something reviewed, not when the count of questions done grows.

Recognising questions instead of reasoning. If you remember a bank’s answer because you remember the question, you aren’t measuring what you know.

Studying only by subject. The scenarios can cross disciplines: mix questions as well as doing them by subject.

Guessing blind with −0.25 per mistake. A pure guess is worth zero on average: answer when you’ve ruled out at least one option.

Reaching the exam without ever sitting a full mock. 210 minutes of concentration take practice like everything else.

Relying on last year’s dates. The call, its deadlines and its requirements change every year: read the call for your exam.