Medical School Without a High School Diploma: From Nurse to Medical Student – Podcast Ep. 2

A career choice at 16 — and a door that was already closed before it ever opened

Francesco knew he wanted to become a doctor by the age of 16 or 17. The problem: he was never the best student. And so he made a decision that tens of thousands of young people in Germany make every year — he did not even try.

"I was never the best student and I wrote off the Abitur from the outset. I didn't even attempt it."

Instead he began training as a nurse, thinking: that's the medical field too. Within a short time he realised it was not enough for him. He bought medical textbooks and started reading up on his own at home.

Years in the clinic — and the feeling of always stopping at the same boundary

Francesco completed his training and then worked for several years as a registered nurse: in hospital in orthopaedics and trauma surgery, on a private-patient ward and later in out-of-hospital intensive care and ventilation nursing. On top of that came two further qualifications — specialist nurse for out-of-hospital intensive care and wound care expert.

It was precisely those years that made the wish grow rather than fade:

"The doctor always sets the leading course of treatment. As a nurse you may have the chance to have your say — but the decision is the doctor's. And sometimes I read a report and didn't understand the content one hundred percent. That's when I realised: I want to go deeper into the subject."

The people around him saw it differently. An uncle told him in the garden that you needed a top grade point average for that and he would never manage it. His class teacher at nursing school also took a very sceptical view of the idea.

The detour that did not work: A-levels by distance learning alongside shift work

Francesco's first plan was the obvious one: catch up on the Abitur through a distance-learning school, alongside the job. He had heard of the German route into higher education for people with vocational qualifications — but also that this route is anything but easy.

The distance-learning school failed against the reality of hospital life:

"With a full-time job in hospital on a three-shift system, it was very, very hard to fit together. I simply couldn't put in as much time for the distance-learning school as I would have needed."

Anyone working rotating shifts knows the problem: distance learning demands self-organisation and fixed study times — exactly what a rotating shift plan systematically destroys. That Francesco did not manage it says nothing about his ability. It says something about the combination of the two.

The turning point came on the drive back from that very distance-learning school:

"I was driving from Darmstadt back to the Saarland and thinking about studying medicine. Suddenly it came into my head: I've seen a video of Marcel where he said you can study medicine without A-levels. So I booked an appointment for the consultation at a motorway service station."

Until then it had never occurred to him that studying without A-levels might be possible abroad at all — he had assumed it was "a German thing".

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The key: nostrification — how a nursing qualification becomes a university entrance qualification

This is the substantive core of the episode, and it is the reason this route works.

In Germany, nursing training is a vocational qualification — not a university entrance qualification. In Bosnia and Herzegovina, by contrast, there is the school type known as the medical secondary school, a long-established institution in the former Yugoslavia. Its leaving qualification carries the title "medical technician" and corresponds in content roughly to a registered nurse — but additionally includes the Matura, that is, the university entrance qualification.

In the nostrification procedure, Francesco's German qualification was treated as equivalent to precisely that domestic qualification. With it he received the university entrance qualification as well — and was able to study medicine through the regular route.

"My qualification was treated as equivalent to that of a medical secondary school, specialising as a medical technician, with the Matura passed. And that is why, on the basis of the nostrification, I could study medicine entirely through the regular route."

This is how the procedure worked in practice:

• The application itself involved little paperwork — a large part was handled by the Medschool Experts team.
• For the nostrification, all documents had to be submitted as notarised copies, with an apostille and a certified translation into Serbian.
• The procedure ran in parallel with the first year of study — the decision arrived while he was already studying.

To stay honest: that overlap is nerve-racking. Francesco describes having doubts right up to the end about whether the nostrification would go through — and only really believing it when he held the copy of the decision in his hand.

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The entrance test: biology and chemistry instead of a school grade

Instead of a grade, an entrance examination decides admission at the university. The concrete figures from Francesco's examination:

• Two subjects: biology and chemistry
• 20 questions each per subject, roughly 20 to 30 minutes of working time
• At least 11 correct answers per subject to pass
• Plus a letter of motivation to the university

That is the real difference from the German system: a grade cut-off measures how you performed at school years ago. An entrance test measures what you know today — and you can prepare for that in a targeted way. Francesco says that studying for the test "actually went very well".

The study location: Faculty of Medicine Foča, University of East Sarajevo

Francesco studies at the Faculty of Medicine in Foča, a faculty of the University of East Sarajevo in Bosnia and Herzegovina. Because this location is barely known in Germany, here are the key facts at a glance.

Programmes and language. Human medicine and dentistry are offered, both entirely in English. Serbian is taught as a compulsory subject in the first two years of study so that students can speak with patients during the clinical stage.

Tuition: 1,750 EUR per semester. That amounts to 3,500 EUR per year — according to our ongoing market overview, the least expensive medical programme in Europe with no grade cut-off. For comparison: at western European locations, fees are regularly three to six times higher. German statutory child benefit therefore covers the tuition almost in full.

Accreditation and recognition. The faculty is listed in the ANABIN portal of the German Standing Conference of the Ministers of Education with the status H+. It also holds international accreditation to WFME standard, granted by the Hungarian accreditation agency MAB and valid until 10 July 2033. The dean of the faculty is Prof. Dr. Dejan Bokonjić, a consultant paediatrician.

Final practical year optionally in Germany. The sixth year of study can, if you wish, be completed entirely at a German teaching hospital — a considerable advantage for anyone who sees their professional future in Germany and wants to build contacts early.

Official contractual partner. Medschool Experts is an official contractual partner of the faculty and is listed on its English-language website among the official representatives for international students — see studiesinenglish.mef.ues.rs.ba.

The town of Foča. Foča lies in the east of the country on the Drina, in the immediate vicinity of the mountains of eastern Bosnia. The nearest international airport is Sarajevo. It is a manageable town, not a metropolis — which for many students is an advantage: short distances, low living costs and an environment in which the international cohort quickly grows together.

Alone to Bosnia — and the whole programme in English

In October, Francesco boarded a plane alone for the first time in his life, heading for a country he had never visited and whose language he did not speak.

His English at that point was, by his own assessment, more bad than good — school English, unused for years. That worry dissolved faster than expected:

"After two or three months I understood a great deal. I wasn't the only one who wasn't so good at English — and by now we have all passed the most important examinations. Nobody failed because of the English."

The reason is simple: classes in English, international fellow students, everyday life in English. You are forced to speak — and that accelerates language acquisition enormously.

The cohort comprises a good 100 students, of whom around 10 or 11 are German. The rest come from Italy, Greece, England, the USA, Morocco, Serbia, North Macedonia, Nigeria and Sudan. Francesco describes exactly that as one of the most valuable experiences — friendships from the first day at university, because everyone was in the same new situation. Today the place feels like a second home to him.

The first year of study: subjects and examination formats

The subjects in the first year:

• Anatomy
• Histology and embryology
• Cell biology and human genetics
• Medical terminology and Latin
• Serbian
• Clinical skills (first aid, wound care, first ward placements, X-ray images)
• Medicine and Society (social medicine, sociology, medical ethics)
• Medical informatics
• Introduction to medical research

Worth noting: Sophie, who is herself in her third year of study in Germany, observes that she only encounters some of these subjects in the clinical stage.

The examinations are structured differently depending on the subject. In anatomy there were three colloquia spread across the year — bones, muscles, skull bones — as multiple-choice tests on the computer, 20 questions each with at least 11 correct answers. These colloquia had to be passed in order to be admitted to the examination at all. The examination itself consists of a practical part (projected anatomical images with structures obscured, two structures asked per image) and a written part with 50 questions, of which at least 26 must be correct.

An honest detail Francesco volunteers himself: in histology he failed the practical part at the first attempt — like many others in his cohort. At the second attempt he passed. Sentences like that are missing from most success stories, and that is exactly why they are here.

There is no dissection of body donors at this location — too few are available. A plastinated whole-body specimen is used in practical anatomy teaching, and the practical examination runs via anatomical images.

Learning how to learn: Francesco's method

The biggest break was not the country and not the language — it was learning itself. Years out of school, a full-time job behind him, and suddenly volumes of material that school never involved.

"First I had to learn how to learn properly. At school, honestly, I never studied — I went there, came home, and that was that."

What helped him concretely:

• Timed units: 50 minutes of study, 10 minutes' break — four times in a row. Then a long break of one to two hours, deliberately without a phone, with movement and a walk. During the examination period, two to three such blocks a day.
• Anki cards: newly discovered for himself in the last examination period and described as the single biggest lever.
• Past questions: to get a rough overview of a topic quickly.
• What did not work: hours of copying content out by hand. Lots of paper, little retention.

Important for anyone afraid of the comparison: fellow students with A-levels and with an applied university entrance qualification were also overwhelmed in the first semester. The volume of material hits everyone equally.

What nursing training really brings to the degree

Francesco's prior experience pays off measurably — not as a shortcut, but as a head start:

• Anatomical terms such as humerus or radius were familiar from everyday ward work
• X-ray images he could already interpret in clinical skills sessions
• First aid and wound care were not new content but daily practice
• Clinical presentations from orthopaedics and trauma surgery were familiar

On top of that comes a perspective you cannot acquire by reading: Francesco continues to work in nursing during the lecture-free period — and describes understanding medical decisions differently today than he used to, while conversely knowing how the same order feels on the ward. Knowing both sides is no disadvantage in later professional life.

One further structural difference: there is no separate nursing placement there of the kind required in Germany. Instead, a large practical component is firmly built into the individual subjects during the clinical stage.

Francesco's tips for applicants with a vocational qualification

Asked what he would advise others with nursing training:

1. Work on your English. Anyone coming in via a vocational qualification or an applied university entrance qualification often has not spoken English for a long time. That is the one area you can tackle beforehand.
2. Find out your own learning type. For him it took a semester. Anyone who looks into it beforehand saves exactly that time.
3. Don't start cramming before the programme begins. Instead, deliberately enjoy the time between the offer and the start of study — holiday included.

"I haven't regretted a single second so far and I've finally arrived where I always wanted to be. I would do it exactly the same way again."

Studying medicine without A-levels: Marcel Kloos's assessment

The most expensive filter in German medical education is not the grade cut-off — it is the belief it creates. Francesco did not attempt the Abitur because the people around him assured him it was pointless anyway. An uncle and a class teacher very nearly ended a medical career before it began. I encounter this mechanism in consultations almost weekly.

What convinces me most about his story is not the happy ending but the qualification that was almost overlooked along the way: several years of ward experience, intensive care nursing, wound care expertise. A selection procedure that filters out such applicants and instead favours someone with top grades and no patient contact at all is not selecting the better doctors. It is selecting the better pupils. That is not the same thing.

After more than 500 study places arranged by now, I can say one thing with some confidence: applicants with a vocational qualification and no A-levels bring different challenges with them than school leavers — but they complete the degree with the same success.

What this group never lacks is motivation. Anyone who has completed vocational training, worked years on a ward and then deliberately chosen a fresh start abroad knows very precisely what they are doing it for. That clarity about your own why is not soft decoration in a medical degree but the decisive factor — it carries you through the examination periods in which others start to doubt.

What generally has to be made up for are gaps from school: scientific foundations, English, and above all learning technique itself. This point puts itself into perspective faster than many assume. The workload in a medical degree so clearly exceeds upper secondary level anyway that practically all first-year students have to discard their previous methods and start again — school leavers with top grades included. Anyone starting from zero therefore loses less than it first appears.

This is precisely where our study coaching comes in: we rebuild learning from the ground up with our students — structure, method, examination preparation. The supposed disadvantage at the start evens out within the first year of study.

We believe in everyone who brings the will to take this path and to make the move abroad. Our data and the successes of our students — Francesco is one of many — confirm that stance year after year.

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