When an Asian and a European Crossed Paths in North America

Lavanya Patnala, M.B.B.S.

Apollo Institute of Medical Sciences and Research, Hyderabad

As an International Medical Graduate from India, my trips to the US have been incredibly enriching, allowing me to meet people from all over the world and from diverse walks of life.

This time, I found myself at the Texas Medical Center in Houston, attending a short-term summer course in EEG/Epilepsy. I arrived not knowing what to expect and ended up making a new friend: Manuel Alanís Bernal, a 4th-year Neurology Resident at Vall d’Hebron University Hospital in Barcelona, Spain.

Over the next few weeks, I got to know Manuel and couldn’t resist asking him about residency in Spain—and everything else. We finally set up a rendezvous at Starbucks, and also invited our ever-reliable translator, ChatGPT 5. What followed was a fun conversation, full of laughter and frequent phone translations to keep up with each other.

Q: Can you explain how medical school works in Spain? And what made you go into Medicine?

After high school, students take the Selectividad exam (“Prueba de acceso a la Universidad “, PAU), which covers primary material. This is a Spanish University Access Tests It is a national exam taken to gain admission into Universities in Spain. Based on your results, you get to choose your career. Some careers have a very high cutoff, such as medicine or dual careers. I chose medicine.

“I knew that I liked science, but I only decided on it after the exam. I didn’t know for sure, but I knew it was one of the harder careers to get into.

About five years ago in Spain, the degree was called Licenciatura en Medicina y Cirugía. Since the Bologna Process, it is now called Grado en Medicina.”

The medical degree in Spain spans six years. The first two years focus on basic sciences and consist primarily of didactic lectures, similar to the system in India. Clinical exposure begins in the third year with hospital rotations. Training may vary slightly depending on the institution and region. In some departments, theoretical instruction is integrated with practical experience, although theoretical examinations are required in all subjects. In other departments, one or two months of hospital rotations are scheduled during the third, fourth, or fifth year. The sixth year is dedicated entirely to hospital-based training. At its conclusion, students undertake La evaluación clínica objetiva estructurada (ECOE), internationally known as the Objective Structured Clinical Examination (OSCE).

Q: What made you choose neurology as your specialty? And how do you get into a residency in spain?

“Why Neurology? That’s simple. Because it is the most interesting organ of the body.

And after graduating from medical school and obtaining a medical degree, we can take the MIR exam.”

The Médico Interno Residente (MIR) is a national standardized examination in Spain used to rank medical graduates for residency training positions. Based on their ranking, candidates select both their specialty and the hospital anywhere in the country. This system resembles that of India but differs considerably from the U.S. residency match process.

 Neurology residency training in Spain, however, is structured similarly to an ACGME-accredited program in the United States. The program lasts four years. The first year involves rotations across various hospital specialties, which may differ depending on the institution. From the second year onward, training is devoted entirely to Neurology, including a two-month rotation in Child Neurology.

Q: If you could highlight one aspect of the Spanish healthcare or residency system other countries should adopt, what would it be? Conversely, is there an element of neurology training abroad that you believe Spain could benefit from adopting?

“From my perspective, one of the strengths of Spain’s public healthcare system. I believe that it is both ethical and practical and that medical decisions are guided by necessity, which helps avoid unnecessary interventions. Conversely, one practice Spain could learn is the approach to teaching and classroom interaction. One of the most positive things I’ve seen here (in the US) is the emphasis on teaching. Even during downtime, there are well-prepared sessions for both residents and medical students. One thing that stands out to me is that students can interrupt teachers at any time to ask questions. This ensures that everyone understands the question in real time, rather than waiting until the end of class when context may be lost. Of course, this approach has its challenges, as the teacher can lose the flow of the lesson, but is great, if well managed.”

Q: What has been the most rewarding moment for you so far in residency?

“I think this is—well, it’s probably the same for everyone—but for me, the most rewarding part of residency was the people I met and the things I learned about medicine. Because you really learn when you’re doing. Studying beforehand helps, but you realize that you truly acquire knowledge when you apply it. I’m not sure if I have a better answer for this question.”

In true Koffee with Karan style, I posed a classic rapid-fire style question next!

Q: What is one thing about Spain you absolutely like? One thing that you absolutely dislike?

“Compared to other countries, what I appreciate most about Spain is that people are much more approachable. If I had to point out something I don’t like about Spain, it would be the education system. It’s largely based on a centrally defined syllabus, and knowledge is assessed through exams where you simply regurgitate what you’ve memorized. I feel that it doesn’t teach you to think critically, and sometimes not even to study effectively. A clear example is the level of English in Spain, though I think this could apply to many other subjects as well. Even the English class in Spain is taught in Spanish!”

Q: If you could give your younger self one piece of advice, what would it be?

For this question, Manuel paused for a few minutes before speaking into the phone, which then translated his words into English through ChatGPT. I was eager to see his response, only to burst out laughing when I read: “I don’t think I’m wise enough yet to give advice to my younger self.”

Q: Okay then, do you have any advice for someone going into residency, in Neurology?

“I think, personally, the most important thing in medicine is to relate well to patients, understand them, and have a solid foundation in general medicine—not just neurology. If you’re specializing in neurology, you should also know its basics. I also think it’s important to know when you don’t know something and where your limit is. That doesn’t mean you won’t study it later, you should, but you need to know how to ask for help when needed.”

I also discovered that most residents in Spain pursue fellowships abroad, and that international residents are primarily from Latin America. As we compared the medical education system in India, which occasionally caught him by surprise, we agreed that Spain’s system sits somewhere between those of India and the United States, offering a distinctive blend of structure, clinical exposure, and opportunity. By the end of our conversation, I walked away with a simple but powerful reminder: wisdom isn’t about having all the answers, it’s about pausing to reflect, staying curious, and embracing the ongoing process of learning.