Spain: MIR, EIR and FIR, the one-paper route into specialist training

Medical and health education in Spain

Medicine in Spain is a six-year degree (grado en Medicina, 360 ECTS) offered by more than forty universities, mostly public, in Spanish with regional languages in some regions. The National Agency for Quality Assessment and Accreditation (ANECA) and regional agencies evaluate programmes, and the Ministry of Universities and the Ministry of Health set the framework. Nursing and dentistry are four- and five-year degrees, and pharmacy takes five.

The degree does not give access to a specialty. To become a specialist, and in practice to work in the public system, a graduate must take the MIR (Médico Interno Residente) exam and complete a residency of four to five years. General practitioners now also train through the family-medicine MIR. Doctors need membership of the provincial medical college (colegiación), which is compulsory for practising. There is no separate national licensing exam beyond the MIR. Foreign degrees must be recognised (homologación) by the Ministry of Universities, which is the step most non-EU graduates need first.

The exam is the door to training, not to the licence

In Spain you become a doctor by finishing the Grado en Medicina. Nothing in the law asks you to pass a separate state exam to be a licensed generalist. What the system does ask is that anyone who wants to train as a specialist sits a single national paper, and the Ministry of Health has run that paper in the same way for decades. The MIR (Médico Interno Residente) is famous well beyond Spain, and every year it draws a large pool of candidates, including many graduates from Latin America whose degrees have been homologated.

The same system covers nurses (EIR), pharmacists (FIR) and, under the same call, other science graduates for their own tracks. The principle is the same: one paper, one ranking, and a national list of places from which you choose in order.

Who needs which exam in Spain

• Doctors, nurses, pharmacists who want a specialty: MIR, EIR or FIR respectively. Candidates can be Spanish, or foreign with a homologated degree.
• Midwives: registered nurses sit the EIR and choose Enfermería Obstétrico-Ginecológica. Foreign midwives need recognition or homologación of the specialist title.
• Dentists and physiotherapists: none. They register through the college after the degree.
• Non-EU graduates of any profession: homologación of the degree first, which is a paper process by the Ministry of Universities and may include a test.

Doctors: the MIR

The MIR is a multiple-choice exam of 200 questions plus 10 reserve questions, with four options each. The Ministry of Health publishes the call (convocatoria), the schedule and the number of places in the FSE portal. Wrong answers carry a penalty in the scoring, which changes how candidates handle uncertain items, so read the current call for the exact rule. The academic record also contributes a smaller share of the final rank.

Foreign graduates can apply, and the call reserves a quota of places for applicants from outside the EU. That is a notable feature: it recognises that the pool of Latin American and other international candidates is large. But the quota is small relative to the number of applicants, and the minimum rank needed varies by specialty. Candidates aiming at in-demand specialties such as dermatology or cardiology need a very high rank.

1. Homologate your degree if it is from outside the EU. The Ministry of Universities handles this under RD 889/2022 and may impose an aptitude test or complementary training.
2. Register for the MIR call on the Ministry of Health portal in the registration window.
3. Sit the exam. One paper, one day, nationwide.
4. Choose a place in rank order at the allocation (adjudicación).
5. Start residency, a paid training contract of several years depending on the specialty.

Nurses and midwives: the EIR

Nursing graduates qualify by degree and register with the provincial college. The Enfermero Interno Residente (EIR) is optional and leads to specialist training in areas such as family and community care, mental health, paediatrics, geriatrics and obstetrics-gynaecology (the midwife specialty). The exam format mirrors the MIR: 200 questions plus 10 reserve. Foreign nurses need homologación, and the Ministry may require an aptitude test or complementary training. Midwives who trained abroad need recognition of the specialist title as well.

Pharmacists: the FIR

The Farmacéutico Interno Residente (FIR) follows the same format and leads to specialist training, typically in hospital pharmacy. Registration to work in a community pharmacy needs only the degree and the college. Non-EU pharmacists need homologación.

Dentists and physiotherapists

Neither profession has an equivalent of the MIR. A graduate of the Grado en Odontología or Grado en Fisioterapia registers with the relevant college. Foreign dentists and physiotherapists need homologación, with a possible aptitude test or complementary training set by the Ministry. Spain does not run a dental specialty exam of the MIR type.

Exams at a glance

Language and recognition

The exams are in Spanish. For graduates whose first language is not Spanish, B2 is the level required. Latin American candidates already have the language but may find that clinical vocabulary and guideline references differ from home: Spanish national guidelines, drug names and the structure of the health system are tested through clinical cases. The homologación of a non-EU degree is a document-heavy process, and it often takes longer than preparing for the exam, so start it early.

Planning a Spanish exam year

The MIR, EIR and FIR calls follow an annual cycle: the call is published, registration opens, the paper is held on one day nationwide, provisional results and challenges follow, and then the allocation of places runs in rank order over several days. Candidates usually prepare for many months, and many sit more than once to improve their rank. Because the rank decides everything, the useful measure of readiness is not a pass mark but your score relative to the cut-off for the specialty you want in the previous year's allocation, which the Ministry publishes.

Two practical points. First, if your degree is foreign, finish the homologación before the registration window, or confirm in the call whether a pending application is accepted. Second, specialty choices are made in order of rank, so decide your preferences in advance, including which cities you would accept. The same logic applies to the EIR and the FIR, with smaller pools and different popular specialties.

Using this page

The Ministry of Health's FSE portal is the primary source for calls, dates and places, and the Ministry of Universities for homologación. Treat this page as a map. TriagePass is independent of the Spanish authorities and does not reproduce past papers.

Last reviewed October 2026