Nikolina Skandali: How can Greece tackle its shortage of healthcare staff?

The number of doctors leaving Greece to work abroad is causing a shortage of medical staff in Greece. As a medical student, I have experienced both the British and Greek medical educational systems. I completed my undergraduate medical degree in Athens and I am now finishing my doctoral studies at the Department of psychiatry, University of Cambridge. I think that reforming the Greek medical education system could help to tackle the shortage of medical staff in Greece.

There are two major differences between the British and Greek medical curriculums. While studying at Athens medical school, I gained a large body of knowledge, mostly through personal effort. During the first three years of studies, medical students are taught on a variety of preclinical subjects. High rates of duplication and overlap between subjects is a major problem. For example, during the first year, students are taught and required to sit two separate exams over two semesters that are both on the topic of physiology.

A lack of direct involvement with research is another drawback in Greek medical education. Research internships are not typically offered in a structured manner and a lack of support causes great dissatisfaction among medical graduates. [1] Students attend a number of compulsory workshops where traditionally a lab member will explain research methodologies and techniques often without any practical involvement of the students. Additionally there are no journal clubs to develop a critical approach towards research. A goal directed curriculum with the endpoint of nurturing medical practitioners who can produce and interpret scientific findings for the benefit of patients is needed.

Medicine is a profession where you need to be able to apply your knowledge in a practical context. During the three final clinical years of undergraduate medicine, Greek students gain a lot of clinical experience; the problem is that direct supervision and guidance is found in only a few clinics. Consequently, personal effort again plays a large role in driving personal professional development. In the British medical school system, medical graduates are required to keep track of their development and report on it in an online portfolio. They are therefore able to record their progress and demonstrate it when needed. [2] Reflecting on personal skills and learning points, and thinking about how further ones can be acquired is a good way for clinicians to manage the overwhelming set of skills that are needed for any medical specialty. [3] Yet Greece doesn’t carry out progress testing, including competency based assessment prior to the end of each placement, which is unhelpful in terms of continual improvement.

During the final year of medical school in Greece, which is equivalent to Foundation year 1 in the UK, medical students rotate among six main specialties including medicine and surgery as predefined by the curriculum. Therefore, choosing to rotate in a specialty that might be of future interest is not an option.

The quality of Greek medical graduates is very high, but it is largely due to individuals’ personal effort and interest. This should not be the case. Reforming the Greek education system is not an easy task. Priorities need to be set, starting with the introduction of a more focused curriculum, more clinical placements, and exams according to international standards. [4] Mostly, there needs to be guidance on how to use the knowledge acquired for patients’ benefit. We need to train a generation of medics who both understand and can perform high level biomedical research. This is the only path towards delivering high quality medical services combined with respect towards both patients and carers. The current economic climate poses a big challenge both financially and culturally. However it also represents a unique opportunity for deep reform of the Greek medical education system to make it more efficient and less time consuming for both staff and students. During 2010-2016 the Greek Medical Association processed certificates for more than 9,300 medical professionals to leave Greece and undertake specialty training abroad. Greece is currently facing a shortage of medical staff including in some of the largest hospitals. Redirecting university funding to research and setting up collaborations with European and international organisations and universities are some of the ways in which this could be tackled. [5]

Nikolina Skandali is a PhD-candidate at the University of Cambridge Department of Psychiatry and is working at Fulbourn hospital as junior doctor in old age psychiatry.

Competing interests: None declared.


  1. Makris GC, Trigkidis KK, Apiranthiti K, Malietzis G, Alexiou VG, Falagas ME. Medical training in Greece: A crisis in progress. Postgrad Med. 2015 Aug;127(6):591-9
  2. General Medical Council
  3. General Medical Council
  4. Botis J, Chatzigeorgiou A, Chatzilymperis G, Kalafatakis K, Katsouni E, Mylonas N, Skandali N, Skandalis A, Zarros, A. Inform, conform, reform and do not deform: a four axons’ framework for the Hellenic academic institutions facing the Greek crisis challenge. Journal of natural science, biology, and medicine 2013;4(1): 268
  5. Botis J, Chatzilymperis G, Kalafatakis K, Skandali N, Skandalis A, Mylonas N, Zarros A. Reaching the limits of reform: medical education and the Hellenic academic institutions facing the euro-crisis. Journal of Natural Science, Biology and Medicine 2015; 6(1): 278