Six years of long-distance running and a seven-month sprint: this is the MIR

Like many of her colleagues, Patricia Andrés began her particular challenge with the MIR by combining it with her last year of Medicine at the University of Navarra. A long-distance race that, in his case, lasted 17 months (and exclusively the last seven), until crossing the finish line on January 21, the date on which the 12,629 students competing for one of the 8,550 places were summoned. that the Ministry of Health has offered this year. The figures, from the outset, invite optimism, because never before has the ratio between places and candidates been so low: only 1.43 students for each job, a proportion that in any case does not reduce the hardness one iota. A few days later, and after all the accumulated tension, Patricia (the best grade in the MIR according to the staff that manages the Curso MIR Asturias preparation center) breathes with a mixture of relief and uncertainty: “What scares me the most and I want the most to avoid is to burn. Now we all have an immense desire to start working, to help and learn. But, from what I see every time I listen to the news, the norm seems to be the opposite,” she muses.

The hardness of the MIR, the test that annually allows medical graduates to access the training system in the different specialties (48) of the national health system, is noticeable from the beginning: since there is no previous syllabus, students will be able to find questions from any of the subjects of the degree (although not all subjects have the same weight). “Above all, they ask about aspects of clinical practice, which account for 60% of the exam, and this can be difficult for many, since it requires some experience in the diagnosis and treatment of patients,” says Dr. Jesús Corres, director Scientist at Promir. The call, which takes place every year between the end of January and the beginning of February, consists of 200 multiple choice questions (25 of them associated with an image) and four possible answers for each one, plus 10 in reserve (in case any of the previous ones are annulled or challenged), and a maximum time of four and a half hours.

Among the specialties most in demand each year there are always three: Dermatology and Plastic Surgery (which usually finish after the first 1,000) and Cardiology (which may be available up to 3,000, due to the greater number of places). This year, the specialty that offers the most places is Family Medicine (2,455), while the one that offers the least is a newcomer, Child and Adolescent Psychiatry (20), which will also not be available throughout the national territory. The duration of the medical residency (four or five years) will depend on the specialty.

Can I prepare the MIR on my own?

In theory, yes, but it is not recommended: it is a long and extraordinarily demanding path in which discipline, methodology and support are essential; and that is why most students go to centers such as CTO, Amir or Curso MIR Asturias. “A person can study it on her own; but an academy helps you select the syllabus, provides you with materials and many questions to be able to practice the corresponding drills, as well as emotional support”, explains Fernando de Teresa, CTO academic director. As he does not have a closed agenda, he adds, having the support of experts to help you prepare for the exam and knowing how to prioritize to make the most of your time is essential. “And having to study so many hours for so many months, it is essential to have pedagogical tools in different formats (audiovisual, graphic or gamified, for example) to see the content from different points of view.”

In most cases, preparing for the MIR exam means spending at least seven months intensively: from July, when the degree ends, to January, when the exam is held. But, as in the case of Patricia, many of them familiarize themselves with the exam during the last year of their degree, although at that time they only do so partially. “It should be done gradually, studying and assimilating the concepts most asked in each call and in the most important subjects,” recommends Alberto García Guerrero, deputy director of the MIR Asturias Course. And, once the degree is finished, an intensive preparation that usually arrives (and exceeds 10 hours a day). At MIR Asturias, for example, they recommend 11 hours of daily work, divided into seven hours of study, two practice hours with tests, and two revision hours through classes.

The day of the exam was, for Nora Hualde, a graduate of the University of Navarra (and, perhaps, a future specialist in cardiology), one more Saturday. “I went to the exam quite calm, trusting myself and thinking that all the work had already been done, that it was one more test of the many that I had done during the preparation and during the degree,” she says. It was, for all of them, the culmination of a long-distance sprint that had demanded the best of themselves. “These months are defined by one word: discipline.” Every week, six days of work and one day off, which was just as important as the rest, as was finding time to play sports during the week.

“Thanks to the drills provided by the academy, you can put yourself in an exam situation many times throughout the course, which helps to train exam technique. This will ensure that on the day of the test we have less nerves, since we will face it as just another drill”, adds Jaime Campos, founder of Amir. Nerves can become the worst of enemies, even when you have practiced incessantly: “The week before was the worst week of my preparation. I felt a lot of pressure on myself and I couldn’t stop thinking about all the possible results and inconveniences that could happen”, recalls Patricia Andrés, who today is debating between choosing a residency as an internist or in Hematology. “However, I stopped to think and decided that, since the exam was going to do it yes or yes, what was in my power was to enjoy it or not. So I tried to have a good time, as much as possible”.

repeat the MIR

The experience of Miguel Ángel Martín, a man from Malaga who graduated from the University of Valladolid, is a separate case (but not the only one): although this year he has achieved one of the best grades in all of Spain, it was not his first call , since he also applied (and approved) to the MIR in 2021. Then he got a good result, but not enough to go to the cities he wanted; He tried to adapt, but ended up giving up his place and trying again: “One of my big mistakes in the first MIR was arriving exhausted. Anxiety and nerves got the best of me and I rested very badly, and that caused me to make stupid mistakes on the day of the exam and even make a mistake when passing my answers to the template in a couple of questions, ”he recalls. For this reason, this time, “as the date got closer, I began to sleep more hours and study some less, prioritizing the most important and asked questions. This made me feel much better on the day of the exam, more rested and with the necessary mental speed”.

Approximately 30% of those who enroll in the MIR do so more than once, but it is a percentage that must be analyzed carefully, admits Campos, since approximately 10% of the students enrolled each year in the end do not show up to carry out the exercise. “Then there are those who do not pass the exam, which represent approximately 10% of those presented (the cut-off mark, which is usually located at 35% of the arithmetic mean of the 10 best marks, has been established this year at the 25%)”; then there is the impact of the quota reserved for non-EU citizens (6% expandable to 10%), and finally those who, even having passed, like Martín, decide to apply again, either to obtain a second specialty or to be able to choose a better destination.

The “luck” factor

It seems almost extravagant to talk about luck in a test consisting of 200 questions and preparing for so many months. And yet, it plays a role that can be decisive, beyond the undeniable fact that nothing replaces the effort, dedication and sacrifice necessary to face the MIR with certain guarantees. “(Luck) is not so decisive, but it influences something, especially taking into account that, in a range of 1,000 number positions in the order of the MIR, maybe there are six questions of difference between one and the other, and that It can mean the borderline between being able to choose a position or not”, warns De Teresa. Then, in addition, there is the fact that there is always a small number of questions (around 5%, the CTO’s academic director estimates) that raise doubts as to their correctness and that can be challenged by students –providing , for this, the corresponding scientific literature–.

However, these differences tend to be more marked in the middle area of ​​the results, since, as Campos explains, “at the extremes there are fewer students, and each question represents a lesser advance or regression, while as we approach the median , each tenth supposes many positions of difference”. And this without forgetting the doubts typical of a test-type exam: “In the MIR there are quite a few questions in which you are going to doubt between two options, and many times hitting or failing will depend on your intuition, on what is it that it sounds… and in others luck will intervene entirely; It is something that you cannot control ”, admits Martín, who is clear that he will opt for Cardiology “in Madrid or a large hospital in Andalusia, my land ”.

Can the MIR be improved?

The final grade of each student depends on 90% of the grade obtained in the exam, while the remaining 10% is reserved for the academic record. That, of course, leads one to wonder if a system that measures the effort of six years of university studies in so little is fair, an aspect in which both the students interviewed and those responsible for the different academies consulted for this report have an impact. But, to increase the weight of the degree, “it would first be necessary to work on a certain homogenization, or what is the same, that the academic record or scale that a student obtains does not depend on whether they have studied in one faculty or another ; a factor that is already being worked on in the conference of deans”, De Teresa argues.

The conclusion could be that the MIR Exam, although it is a good evaluation system, is far from being perfect, “because in a single day and with a test-type exam, the knowledge of the entire Medicine degree is evaluated. Meanwhile, aspects such as relationship skills with other professionals or the doctor/patient relationship are not taken into account,” says Miguel Castillo, Promir’s scientific director. Other options include including more clinical cases in the exam, increasing the number of questions, or even taking several tests on different weekends, “in order to reduce the variability of what can happen with 210 questions, for four and a half hours, any given day”, suggests Patricia Andrés.

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