Moving to Sweden as a doctor: Practical exam

This blog post is about my experiences in preparing for the practical part of the medical license exam in Sweden. I have provided relevant links and study tips for the practical exam in this post.

Everyone who passed the theory part of the exam is eligible to appear for the practical part. One is eligible to appear for the exam for a maximum of three times. The exam happens four to five times an year and the exam centres are Umeå and Göteborg (although they say Göteborg for all practical purposes, the exam actually happens in the Mölndals sjukhus, which is located in the Mölndal kommun). You get your turn to participate in the exam based on a priority ordering – those who cleared the theory earlier than you get a higher queuing time and they get prioritised in the waiting list for the practical exam. Thus, it is possible that you will need to wait for around 3-6 months for getting a chance to appear for the practical exam after clearing the theory part. Meanwhile, it is important to not lose patience and study systematically.

When I went through the practical exam questions, I figured out that I could learn easily if I have study partners. The practical exam is all about testing how you approach a patient, and this approach differs from country to country. You’ll need to learn the Swedish way of approaching patients. If you study on your own, chances are that you sometimes reinforce your own mistakes by misinterpreting the answer scheme or by not understanding some subtle aspects of the questions. Having study partners means that they can see the question from a fresh perspective and they can bring new ideas to the table. They can also correct your mistakes and teach you the topics that you are weak at. So, I strongly recommend that you prepare for the practical exam with study partners, at least half of your study time. From my experience, studying as a group online via Zoom also works well. The ideal group size according to me is three. If you are more than 5-6 people, it gets messier, so it is better to split yourselves into two groups of three people.

You can find all previously asked questions here (link requires UmU Moodle access). Ensure that you also go through the latest previous questions asked at Umeå University for their medical students which they update here (Moodle access required). I was late to find out about this and I regret that I did not go through it sooner. There were instances where these questions were repeated at the practical exam. Having contacts with those attending the KUL program at Umeå University is also helpful as they are likely to have access to a lot of reading material for the practical exam. The exit test for KUL program is the Day 1 (6 minute stations) of the practical exam, so the KUL students are essentially preparing for the same exam as you.

Most of the questions and concepts are repeatedly asked, so ensure that you study these repeating questions thoroughly. However, there will be new questions too, so it is important that you have a basic understanding about the commonly found disease conditions in Sweden. Read all the previous questions, and then make a clear plan about how you will approach each of the cases. Chart out a timeline for what topics you will study and when. Find study partners from the facebook or telegram group for foreign doctors in Sweden. There is also a Whatsapp group for Indian doctors in Sweden (contact me for details). It is also possible to go to Moodle>Kunskapsprov för läkare>Deltagare and search for those registered for the exam by using the keyword ‘Anmälda till praktisk prov’ and find those students who will appear for the exam with you. Find the profiles of these people and write direct messages to them.

It is good if you have access to KTC (every University has one, check at the University hospital near you), where you can practice clinical examination on dummies and perform procedures such as catheterising and diluting medication. You can buy suturing set, Peak Expiratory Flow Meter, BP monitor, knee hammer, tuning fork and other common devices online on Amazon.de or Wish.com. I also bought a Mini Anne from HLR-butiken to practice HLR. Buying all these stuff costs a lot of money, but my thought was that it was better to spend money and pass, rather than to save money and fail the exam.

You can email to the head of the departments at hospitals near you and ask if they can allow you to practice with ophthalmoscope, slit lamp and otoscope. This is easily said than done, as hospitals do not want to take the trouble of having a student hanging around. Most people I know accomplished this by working as a nursing assistant or as a researcher at some hospital, building contacts there, and using these contacts to go to the relevant department. With COVID-19 around, it has become harder to get an observership, so try to learn as much as you can from videos online. I sought help from my fellow doctors in India for learning radiology, ophthalmology and ENT. I even visited my medical school in India when I went there for vacation. I met my friends there, and discussed some concepts that I was doubtful about. I practiced HLR, BP monitoring, neurology and orthopedics examination using my colleagues at the research lab as ‘patients’.

There are some training programs for students appearing for the practical exam. Region Uppsala is conducting a training program for two days that covers the important topics for the exam. Lund University is also conducting a training program in Kristianstad for one week. Both these programs prioritise students who live in the same region (Uppsala or Skåne). I applied for both the programs, but got rejected, possibly because I live in a different region. Follow the news on the telegram group for foreign doctors in Sweden to get to know when it is time to apply for these courses. I also applied at the HLR centrum in Götenburg to participate in the A-HLR training, but I was rejected with the reason that they have no obligation to teach those employed outside of VG Region.

I appeared for the practical exam in November 2019 and failed for 2.5 marks (I got 127.5/200). It was a near miss, and I evaluate that the reasons for my failure were as follows:

  1. I studied in a group, but we did not practice the questions by role play. We simply sat down and read the questions and answers. Without role play, it was hard to learn to make quick decisions and to hold an uninterrupted conversation with the patient. I also was poor at time management.
  2. My Swedish wasn’t quite good. I was doing my SAS-G course when I appeared for the practical exam. I could understand what the patient said, but it was hard for me to find the right words to answer them back. The end result was that I spent more time finding the right words than addressing the patient’s concern.
  3. I did not repeat and reinforce many questions and answers. There is not enough time to think and plan while you are at the exam, so you have to have a clear plan about what exactly you will do for each question.
  4. I thought that I will get a clear fail if I give a wrong diagnosis, therefore I talked less and said only differential diagnoses. I always sounded unsure. You should not be afraid to say what exactly you suspect. If you are wrong, it doesn’t matter much unless you make a grave error. It is better to speak more than to speak less because the evaluator is looking for keywords in the conversation. You only get points if you say exactly those points and keywords specified in the answer sheet. Ensure that you speak loudly, because you don’t get marks if the evaluator does not hear you.
  5. I appeared for the exam while I was working full-time and doing part time Swedish course. I worked at the lab until the previous day of the exam. This wasn’t a good idea as it is important to revise all the important topics during the last two weeks before the exam.
  6. Those who appeared for the exam in 2017-18 will tell you that it is a breeze. At that time, some people prepared for less than a month and passed the exam. The exam has become tougher overtime and the situation in 2017 does not hold true now anymore. I would suggest at least three months of preparation, especially if you do not have experience in internal medicine or family medicine. It has become a fashion now to claim that one has finished learning Swedish and cleared both theory and practicals in the shortest possible time (six months or less). I would say that it is nearly impossible. Please don’t plan your career based on such exaggerated claims. I have known people who came to Sweden on visas lasting less than one year, and had to return to their home country after the expiration of the visa without even clearing the theory exam. A reasonable timeframe for the whole process (learning Swedish + clearing kunskapsprov) is two to three years.

After my first failure, my plan was to appear for the practical exam again in April 2020, but the exam got cancelled due to COVID-19. I had to wait until September 2020 to appear for the exam again. I had finished my PhD by then, but my Swedish classes were still ongoing. I also worked on the Författningskunskap course on Swedish law and ethics in the meantime. I studied for the exam with two other students and passed this time with 154/200 marks. The cut-off was 141 marks.

There is no one central place where you can get all materials needed for preparing for the exam. You need to search for them on the internet and ask fellow students to find them. Here are some reading material that turned out to be very useful for me:

  1. 200 sidor : An amateurish study material prepared by students
  2. OSCE by subject : OSCE questions divided up by subject
  3. OSCE material from Sahlgrenska: Material used by students at Sahlgrenska. Many students say that the exam at Göteborg is tougher than the exam at Umeå. I got the same feeling when I compared the past questions from Umeå and Göteborg. Umeå has a long legacy of conducting OSCE type exams, while Göteborg usually conducts oral case discussions for medical students.

Here are the videos that I have used for learning new techniques:

  1. Videos of a mock OSCE exam, Gynecological examination, respiratory system examination, diabetes foot examination, PEF use, rectoscopy and ABI examination are given on Läkareprogrammets filmer section of Moodle via UmUPlay.
  2. Nervous system examination here.
  3. Videos of orthopaedics examination from Lund University here.
  4. Videos of psychiatry examination here.
  5. Catheterisation video here.
  6. ABCDE simulation video here.
  7. Neurology and orthopaedics special tests on Physiopedia here (English).
  8. Ophthalmology tropias and phorias explained in simple language here and here (English).
  9. SBAR method for communication here.
  10. Fracture management here.
  11. HLR here.
  12. Helmich manöver here.
  13. ABG here (English).
  14. Direct ophthalmology here.
  15. Reaction Level Scale here.
  16. Audiogram here.
  17. Cardiac USG interpretation here (English).
  18. Emergency tracheostomy here (English).
  19. Examination of an unconscious patient here (English).
  20. Dix Hallpike’s manöver here.
  21. Epley’s manöver here.
  22. Weber v/s Rinne test here (English).
  23. Slit lamp examination here (English).
  24. HINTS exam here (English).

Here are some websites and books I used for learning concepts:

  1. OSCE Umeå : Question bank of previous questions of students at Umeå University
  2. Internetmedicin for understanding difficult concepts in the answering scheme.
  3. Läkamedelsboken and Hypocampus for verifying the approach to difficult cases
  4. På Klink has detailed descriptions, so it is best to focus on the summary boxes in the book.
  5. Procedurhandboken for knowing which types of procedures they expect you to know. Go to the tab innehållsförtechning in the link to the book given here and try to learn all the procedures listed there. No exam yet had procedures from outside of this book.
  6. Akut Medicin book was useful in thinking systematically around the differential diagnoses.
  7. Radiology Master Class for radiology.
  8. Ophthalmoscopy pictures (enter any random number as patient number and student number)

Other general tips:

  1. The exam consists of two days of hard work, so sleep and eat well. One of the fellow doctors who attended the exam with me fainted towards the end.
  2. All ‘patients’ at the exam are actors. You will not meet a real patient. All actors act extremely well.
  3. All cases you see at the exam are typical ones. The only atypical ones are the Allmänmedicin station for 14 minutes, where the patient has a range of symptoms and concerns.
  4. Follow three Fs whenever possible. Communication with the patient is very important in Sweden. You could fail at professional utvekling station not because you don’t know the concepts, but because you did not communicate well enough.
  5. Most people I know got lower points than expected, or even failed at HLR station. Take it seriously and train with friends many times. Many things can go wrong here, so be sure to know it inside out.
  6. Alcohol history, antibiotic allergy, decreased quality of life and stress are important questions that can cost you points if you miss them.
  7. The evaluator for the most part will be silent. You have to manage the situation on your own and explain your diagnosis to the patient in simple language as if you were a real doctor.

NB: I do not endorse any of the study material given in this post. It is possible that some of these sources contain wrong or outdated information. Please use your discretion to find out the latest and correct examination and management protocols.

Earlier posts in this series:

  1. Moving to Sweden as a doctor: PhD admission
  2. Moving to Sweden as a doctor: Learning Swedish
  3. Moving to Sweden as a doctor: Medical license exam

Later posts in this series:

  1. Moving to Sweden as a doctor: Practical training

Moving to Sweden as a doctor: Medical license exam

This blog post is about my experiences in appearing for the theory part of the medical license exam in Sweden.

Once you have learnt Swedish upto around SFI-D (between B1 and B2 levels, if you are following CEFR), I would suggest that you start going through the past years’ questions of the theory part of the medical license exam (kunskapsprov för läkare utanför EU). Details about learning Swedish has been explained in detail in my previous post. You can find the past questions here. It is likely that you don’t understand many terms, but you might be able to understand something at least. Medical vocabulary in Swedish is quite similar to that of English, so if you have understanding of Swedish grammar, learning medical terminology in Swedish would not take so much time.

To start with, you can translate the past questions to English in order to understand how tough it is. You can upload the pdf document to Google translate to get an English translation. My experience was that the theory exam in Sweden was easier than the post-graduate admission exam (NEET) in India. It is also less intensive in terms of having to memorize concepts. The medical license exam in Sweden focuses more on the basic concepts and practical applications of fundamental principles. This means that a good number of questions are case discussions, where you are asked to choose the most correct option about the diagnosis or management of a particular patient. Most often, the cases have typical signs and symptoms. Sometimes, the question only gives you hints about the patient’s symptoms, and ask you to choose a suitable treatment. In that case, it is upto you to work out the diagnosis first, consider the situation (if you are in primary care or tertiary care) given in the question and choose a diagnosis that is most appropriate for the situation. For example, the question might be about managing a patient who came with hemiparesis and slurred speech in primary care. First, you need to work out the diagnosis as stroke. Then, you need to consider that you are in primary care, and it is therefore not possible to manage the case in your hospital. The right answer would be to send the patient in an ambulance to the tertiary care hospital immediately. On the other hand, if the questions says that you are in a tertiary care, the option of doing thrombolysis might be the correct answer. In order to confuse you, both the options will be given to you. The key to cracking the exam is to visualize the situation in your mind, and then choose the option that sounds the most reasonable for you. Apply your common sense generously.

The theory exam consists of approximately 180 questions divided into three parts : a general part, a clinical part and interpreting a research article. The weightage of subjects can be found in this document. You can see in the document that medicine is the most important subject with 10% of the questions devoted to it. You will need to study pre-clinical subjects as well. I studied First Aid for the USMLE (Step 1) book for the pre-clinical part. This book is very condensed, so whenever I could not understand some concepts, I would look up my old textbooks to read elaborately about that topic. To some extent, Kaplan lecture notes for microbiology and pathology also helped, but I did not read them completely due to lack of time.

For the clinical part, I studied PLABABLE, the mobile app for preparing for the medical license exam in UK. As I was working full time while preparing for the exam, it was good to have the study material in mobile app format for me to study while I am traveling to work. I took longer to read Swedish text than English text, so PLABABLE was good for me since it was in English. In that way, I could grasp the concepts fast. I also subscribed to Hypocampus, but it had detailed descriptions for every disease, so I could not read much of it. There are differences in the ways by which diseases are managed in India and Sweden. In order to be mindful of these differences, I looked up the website internetmedicin to know the current Swedish guidelines. There is also a book and a mobile app called Läkemedelsboken that you can refer for the latest management protocols for common diseases in Sweden. These two resources are huge, so use them only as references. I also discovered two books from the library : Akut medicin and Akut kirurgi. These two books have condensed descriptions of commonly seen cases in Sweden. I used these two books for learning Swedish terms as well as for quick reference. There are similar ‘Akut’ books for orthopedics, radiology, psychiatry etc., but since these subjects were not as important for the exam as medicine and surgery, I did not read them. Sometimes, it was tiresome for me to study during the evening after a full day’s work, in which case I watched Osmosis videos passively while lying on the sofa.

I did not need to study for the research article part of the exam because my day job as a researcher helped me there. The most important parts of the research article are its aim and results (including tables). Make it a practice to read the questions first, and then read the relevant parts of the research article to find out the answer. If you instead read the article in full first, it is likely that you will not have sufficient time for answering the questions.

I think that the key to cracking the exam is to work out as many previously asked questions as possible. There is a lot of material out to study, and you can’t memorize all of them. You will need to prioritize some topics over the other, and you need to be familiar with past questions in order to know which topics are important. The previously asked questions do not repeat, but some subject areas are more frequently asked than others, so make a note of that by solving past question papers. All past questions can be found here. If you have time, solve past TULE and AT questions too. MCQs from Lund University are also in the same pattern as kunskapsprov, so practice them too. Whenever I solved past question papers, I looked up the concepts that I did not know and noted them in a notebook. I made it a practice to revise the contents of the notebook every three days or so.

Some people who were successful in the exam have watched videos on UmUplay (available on your moodle), participated in study-circles (find out if there is a study circle in your city) and attended the completion program for doctors educated outside of EU. I have not done any of these, and I studied alone. I studied only for two months or so, that too while working full time as a PhD candidate. But I had the habit of reading medical textbooks, popular science books and watching medicine related videos. Although I did this for fun, this habit helped me to keep my knowledge updated. Therefore, I did not need to study much for the exam. But even then, my first reaction after the exam day was that I would definitely fail. Fortunately for me, I passed the exam at the first attempt in May 2019. My score was 65.2%.

Earlier posts in this series:

  1. Moving to Sweden as a doctor: PhD admission
  2. Moving to Sweden as a doctor: Learning Swedish

Later posts in this series: 

  1. Moving to Sweden as a doctor: Practical exam
  2. Moving to Sweden as a doctor: Practical training

Moving to Sweden as a doctor: PhD admission

I have been receiving several phone calls and messages from doctors who want to move to Sweden. Most of them made the choice because their spouse is already in Sweden, while some others want to move to Sweden in search of good career opportunities, possibility to do research and quality lifestyle. When I started getting two or three queries every week or so, I decided that I write this blog post. If you have been directed to this blog post by me, please read it completely and ask me only follow-up questions. Thank you for understanding.

How and why did I move to Sweden?

I decided to move to Sweden for my then fiancé, who is now my life partner. While we met in 2015, I was doing my house-surgeoncy (internship) in India. My partner was doing his PhD in Sweden at that time. Besides this reason, I knew that post-graduate studies in India would mean 24*7 hardwork, stress, working in resource poor settings and zero fun. I was interested in volunteering for Wikipedia, painting and reading books in general. I knew that I will have to give up all these things I love in order to make my career as a specialist doctor in India.

I was interested in research, but I was good at clinical practice too. I didn’t have any past experience in research, but I had done my mandatory research project for MBBS with enthusiasm. I had assisted Wikipedians and post-graduates to do research. Opportunities for research were sparse in India, and most of them came without any funding or mentorship. While we were discussing career, my partner pointed out that I could try doing research in Sweden. I started gathering information about this possibility, and found that my MBBS from India is considered equivalent to a master’s degree (not specialist degree) in Sweden, because it offers a syllabus similar to the MD program in Sweden. Please note that MD is the basic medical degree in Sweden, equivalent to MBBS in India. When you specialize in a subspeciality in Sweden, you don’t get any extra degree, but you will be called as a specialist doctor in that subspeciality. For example, when you finish medical school in Sweden, you get an MD degree. Suppose you specialize in general medicine later on, your degree becomes MD (General Medicine).

I figured out that PhD admission in Sweden requires 4.5 years of university education in the relevant subject. Some PhD positions had specific requirements such as that the student should know fluent Swedish, that the student should have relevant experience in animal research and so forth. The application can be made free of cost, but please be aware that most PhD positions are highly competitive. The link to the application portal of Gothenburg University can be found here. It is not uncommon that as many as 200 applicants apply for one position. Fortunately for me, there were only around 30 applicants who applied for the PhD position that I later got selected for. Many applicants are likely to have a specialist degree in the subject area, so you have to show in your CV and letter of motivation that you have some unique skills that is useful for that particular PhD project. If you want to see what a CV and letter of motivation (LOM) looks like, please leave a comment in the comment box below with your e-mail ID and I shall send my CV and LOM to you.

If you are a medical doctor, you can choose to study either pre-clinical or clinical subjects. There are usually more research opportunities in pre-clinical subjects than clinical subjects. Some projects require that you have experience working with animals or cell cultures. When you apply for pre-clinical subjects, be aware that you are competing with those who have a masters in that particular topic. For example, an applicant with masters in microbiology is likely to have more knowledge about COVID-19 vaccine than you. Clinical researches usually involve working with patient data. If your project needs that you have patient contact, it is very likely that knowing Swedish is a requirement for application. Some projects might require that you have a Swedish medical license, because you might also have to involve in examining or treating patients. A lot of information about the project will be available on the application page, but you can also e-mail the responsible Professor and ask for more details if something is unclear. Don’t always expect fast replies, though.

It is the Professor’s discretion to choose the person they think is the most suitable for the PhD position. You are more likely to get a position if you know academic English, have published research papers in the past, worked as a research assistant or have any other relevant experience related to the research project. Make sure to write about these in your CV or letter of motivation. Knowing Swedish language is a plus, especially if you are applying for PhDs in clinical sciences. In clinical sciences, you will often need to communicate with patients for data collection, which is why Swedish is usually an important requirement for clinical PhDs. In my case, Swedish was not mandatory because a good part of data collection had already been done. Professors usually take one to two months after the application deadline to find the right candidate. Most PhD vacancies are sent out around January (after Christmas) and September (after summer vacation), but you can always find a few vacancies on the Gothenburg University’s job portal regardless of the time of the year.

I had two rounds of interviews over Skype. In the first interview, I was asked about general things in life, my interests, my future plans, my experiences as a doctor, my reasons for choosing an academic career and so forth. It felt more like a friendly discussion than like an interview. I was asked to read through the thesis of a past student before I appeared for the second round of the interview. I read through the thesis and found it interesting, although many terms and concepts were new to me. I looked up as many unknown concepts as I could. The second round interview was more focused on my knowledge related to medicine and research, although I can’t remember being asked any tough questions. A week after the interview, I was informed that I got the job.

After the successful interview, I was asked to send my original certificates to the University for verification. My partner was returning to Sweden from India at that time, so I sent the certificates with him. It took around a month for them to complete the verification process and I was informed about the PhD admission officially from the University. I had applied for a spouse visa to move to Sweden at that time, so I switched it to PhD visa. I did this so that my visa application would be processed faster, because the waiting time for the PhD visa was shorter than the spouse visa. You can check the present waiting times for all visa categories here.

The duration of the PhD program varies depending on whether you perform lab duties and teaching or not. I got a 4 year program that does not involve teaching or lab work. It is not unusual to have 5 year and 5.5 year programs. It is wise to choose a longer program with teaching included if you are planning to continue in academia, because, with teaching, you can gain the relevant experience needed to get promoted as an assistant professor in future. If you instead plan to go back to the clinic or to the industry, a 4 year program would be more suitable for you.

I applied in November 2015, got interviewed in early February 2016 and got accepted for the position in late February 2016. My certificates got verified in March 2016. I then waited for two more months to get my PhD visa, and started working as a PhD student from June 2016.

Later posts in this series:

  1. Moving to Sweden as a doctor : Learning Swedish
  2. Moving to Sweden as a doctor: Medical license exam
  3. Moving to Sweden as a doctor: Practical exam
  4. Moving to Sweden as a doctor: Practical training