Russian Language Requirements for MBBS in Russia 2026: Levels, Exams, Courses & Medical Russian Guide for Indian Students

There is no single Russian-language requirement that applies uniformly to all MBBS/General Medicine programs for MBBS in Russia. The requirement depends on the specific university, the program's medium of instruction, and the admission route. Sechenov University, for example, offers General Medicine in both Russian and English and requires a Russian-language entrance exam for both tracks. Kazan State Medical University separately lists Russian-medium and English-medium General Medicine programs with different entrance requirements, yet still includes a compulsory Russian-language discipline in its English-medium curriculum.

Do Indian Students Need Russian to Study MBBS in Russia in 2026?

Is Russian compulsory for all MBBS students?

No, not universally. Requirements are set at the university and program level, not by a single national rule that applies to every medical student in Russia.

Is Russian compulsory for Russian-medium MBBS?

Yes, both academically and practically. A student in a Russian-medium program needs sufficient Russian to follow lectures, take exams, and function in clinical settings from an early stage.

Is Russian required for English-medium MBBS?

This is where the distinction matters most. Separate these five things, because they are not the same question:

• Academic instruction: Conducted in English at English-medium universities/tracks
  

• Entrance examination: Several universities, including Sechenov, require a Russian-language exam even for English-medium applicants
  

• University requirements: Some universities fold a compulsory Russian-language discipline into the English-medium curriculum itself (Kazan does this)
  

• Clinical communication: Patients, nurses and hospital staff generally do not speak English
  

• Patient interaction: Becomes increasingly Russian-dependent from the clinical years onward

Can I study MBBS in Russia without knowing Russian?

Possible at some English-medium programs at the point of admission, but this is not the same as "Russian is unnecessary." Even where a university doesn't mandate a Russian entrance exam, real clinical training in a Russian hospital will demand functional Russian well before graduation.

Why Russian Language Matters Even for English-Medium MBBS

Classroom vs Hospital

Studying medical theory in English does not mean the hospital operates in English. In practice:

• Patients speak Russian, not English

• Nurses and hospital support staff generally speak Russian

• Case histories are conducted with the patient in Russian

• Everyday communication on the ward is in Russian

• Emergencies don't wait for a translator

Russian During Clinical Rotations

From the point a student enters a hospital ward, Russian becomes directly relevant to:

• Taking patient history

• Understanding reported symptoms

• Obtaining informed consent

• Giving basic instructions to a patient

• Conducting a physical examination with verbal guidance

• Ward communication with nurses and attending doctors

• Reading prescriptions and medical terminology

• General interaction with hospital staff

Why Medical Russian Is Different from General Russian

Conversational fluency and clinical fluency are not the same skill. A student who can navigate a Moscow metro conversation may still struggle to take a structured patient history in Russian. Medical Russian requires its own vocabulary, phrasing conventions, and listening practice specific to a clinical setting, covered in a later section of this guide.

Russian Language Levels Explained: A1, A2, B1, B2, C1 & C2

Important Editorial Note

Do not treat B2 as a universal legal requirement for MBBS in Russia; it isn't. B1/B2 are practical targets to aim for, but the actual admission requirements must be verified on a university-by-university and program-by-program basis. Treating B2 as mandatory everywhere is exactly the kind of generic claim that misleads students, and this guide deliberately avoids it.

What Is TRKI/TORFL? Russian Language Proficiency Exam Explained

TRKI (Тест по русскому языку как иностранному) and TORFL (Test of Russian as a Foreign Language) are the same exam. TRKI is the Russian-language name; TORFL is the English name used internationally. It is Russia's closest equivalent to a single, government-linked national Russian proficiency standard, administered under Russian federal legislation by thirteen nominated lead institutions, including the Pushkin Institute in Moscow and Kazan's own testing center.

TRKI vs TORFL: Are They the Same?

Yes. They refer to identical six-level testing systems; which name you see depends on whether the source is Russian-language or English-language material.

What Does the TRKI Exam Test?

The exam covers five components: grammar/vocabulary (a multiple-choice section), reading, writing, listening, and speaking. Passing generally requires scoring at least 66% on each subtest, not just an overall average.

Where Can Students Take TRKI?

At the Pushkin Institute in Moscow, at any of the thirteen authorized lead testing universities inside Russia (including Kazan, Moscow State University, and St Petersburg State University), and at select partner centers abroad. International test-center availability has fluctuated since 2022 and varies by country; confirm current availability directly with the Pushkin Institute or a listed partner center rather than relying on older lists.

How Long Is TRKI Valid?

TORFL/TRKI certificates do not carry a printed expiry date from the testing body itself. However, individual universities may still apply their own currency requirements for admission; verify this directly with the specific university's admissions office rather than assuming it is valid indefinitely.

What Russian Language Level Is Required for MBBS in Russia?

This is the highest-value section of this blog because a single blanket answer would be inaccurate. The table below shows the currently available 2026 admission information. Moreover, always cross-check directly with the university before you apply, as entrance exam policies are reviewed on a yearly basis.

This is a materially more useful answer than a blanket "B2 is required everywhere" claim, because it simply isn't true. Kazan's English-medium track, for instance, does not require a Russian entrance exam at all, even though Russian remains a compulsory subject once enrolled.

Russian Language Requirement at Top Russian Medical Universities

Sechenov University

Sechenov offers a six-year General Medicine program with tuition set at RUB 1,300,000/year for 2026/27. Applicants to both the Russian- and English-language tracks sit internal entrance exams, and the examination language can be chosen as either Russian or English for specialist-level programs. Still, a Russian-language exam is listed as mandatory even for students entering the English-taught track. No external certificate such as IELTS is required in its place.

Sechenov runs its own Preparatory Department, combining Russian-language training with subject preparation (chemistry, biology, physics) in Russian. For students with no or very limited Russian, the university's preparatory route commonly runs around 11 months; students who already have functional Russian can take a shorter track.

Kazan State Medical University

Kazan runs six-year General Medicine programs in both Russian and English. For the English-medium track, all lectures, practicals, laboratory work, seminars, and examinations are conducted in English. Still, Russian is included as a compulsory discipline within the English-medium curriculum, specifically to prepare students for clinical communication. International students on the Russian-medium track are required to complete preparatory Russian-language courses before or alongside their first year.

Kazan's entrance process for the English-medium General Medicine track consists of an online exam in Biology, Chemistry, and English; a separate Russian-language proficiency test is generally not required for admission to that track, though this should be confirmed for the current admission cycle before applying, as policies are reviewed annually.

Saratov State Medical University

Saratov offers General Medicine as a six-year program with both Russian and English listed as languages of instruction, and its current information on foreign admissions distinguishes between Russian-language and bilingual program tracks. As with the other universities in this guide, the exact Russian-language entrance requirement depends on which specific track a student applies to; verify directly with Saratov's international admissions office for the applicable 2026 requirements before applying.

Bashkir State Medical University, Pirogov RNRMU, Pavlov SPbSMU & Volgograd SMU

These four universities also run English- and Russian-medium General Medicine tracks with preparatory faculty options, broadly following the same pattern described above: English-medium academic instruction paired with a Russian-language expectation that grows over the clinical years. Because published entrance-exam requirements for these institutions vary by admission cycle and were not independently verified against a current 2026 official source at the time of writing, prospective applicants should confirm the specific Russian-language and entrance-exam policy directly with each university's international admissions office before applying, rather than relying on aggregator listings.

English-Medium MBBS in Russia: Do You Still Need Russian?

• English-medium academics: yes, theory is genuinely taught in English

• Russian-language admission requirements can vary; Sechenov requires it, Kazan's English track generally does not

• Russian during clinical years practically essential at nearly every university, English-medium or not

• Russian for patient communication essential; patients are Russian-speaking

• Russian for daily life highly useful for shopping, transport, medical appointments, and basic administration

• Russian for internships: the final-year internship is conducted inside a Russian hospital system, where Russian is the working language

Is IELTS Required for MBBS in Russia?

Is IELTS mandatory?

University-specific. Several Russian medical universities, including Sechenov, explicitly state that no external English-language certificate, such as IELTS, is required; English proficiency is instead assessed through the university's internal entrance examination, conducted in the applicant's chosen language.

IELTS vs Russian Language Requirement

These serve entirely different purposes and are not interchangeable. IELTS (where required at all) assesses English proficiency for an English-medium academic track; a Russian-language requirement, whether an entrance exam or a compulsory in-course discipline, exists for admission and clinical communication purposes, independent of English proficiency.

Can IELTS Replace TRKI?

Generally, no. Where a university specifically requires a Russian-language entrance exam or TRKI-level proficiency, an IELTS score does not substitute for it; the two exams test entirely different languages.

Is TOEFL Required for MBBS in Russia?

Treatment is broadly the same as for IELTS above: most Russian medical universities assess English proficiency through their own internal entrance exam rather than requiring an external certificate such as TOEFL. Confirm the specific university's current policy rather than assuming TOEFL is either required or unnecessary as a blanket rule.

Russian Language Entrance Exam for MBBS in Russia

What Is Tested?

• Grammar

• Vocabulary

• Reading

• Listening

• Writing

• Speaking

University-Specific Entrance Tests

Sechenov's internal entrance exams allow applicants to choose Russian or English as the examination language for specialist programs, but require a Russian-language component for General Medicine regardless of track. Kazan's English-medium entrance exam covers Biology, Chemistry, and English, without a separate Russian-language paper for that track.

Minimum Scores

Sechenov's entrance exams are scored out of 100 points per subject, with minimum passing scores set by the university for each admission campaign. These are published and updated annually, so treat any specific cutoff figure as needing reconfirmation for the exact year of application.

Online vs Offline Testing

Both formats are in active use across Russian medical universities. Exam dates and formats are typically communicated through each applicant's personal admissions portal account after document submission; confirm the format directly rather than assuming either is standard.

Russian Preparatory Course for MBBS Students

Russia's official Study in Russia portal confirms that international students can take university preparatory programs which typically last about one academic year to learn Russian and build subject knowledge before beginning their degree.

What Is a Preparatory Faculty?

Known in Russian as the Подготовительный факультет (Preparatory Faculty/Department), this is a dedicated one-year (approximately) program combining Russian-language instruction with foundational coursework in the sciences relevant to the student's intended degree.

Who Should Take It?

• Complete beginners in Russian

• Students at A1/A2 level who need to reach a functional level before starting medical coursework

• Students entering a Russian-medium program

• Students who feel underprepared for a university's entrance examination

What Do Students Study?

• Russian language (general and, at some universities, introductory medical Russian)

• Chemistry

• Biology

• Physics

• Mathematics where applicable

• Introduction to Russian culture and the education system

How Long Is the Course?

Duration varies by university; there is no single universal figure. Sechenov currently offers an 11-month preparatory track for students with little or no prior Russian, and a shorter route for those who are already functionally fluent. Kazan's preparatory department runs a 10-month course beginning 1 September, and explicitly states that completing it does not exempt a student from the university's regular entrance examinations; the preparatory course and the entrance exam remain two separate steps.

How Much Does a Russian Language Course Cost in Russia?

Costs vary by route. University preparatory programs are typically billed as a package alongside or as a precursor to the main tuition fee; standalone TRKI/TORFL examination fees at the Pushkin Institute currently run roughly RUB 5,000–6,500 (approximately ₹4,500–5,900) per sitting depending on level, with partner centers abroad setting their own local pricing. Private language institutes and online courses vary widely by provider and are not standardized; get a specific quote before budgeting rather than relying on a generic figure.

Can Indian Students Learn Russian Before Going to Russia?

Yes, and doing so genuinely eases the transition. The main options:

• Learn in India: Through a private institute or tutor before departure

• Online course: Self-paced foundation building, useful pre-departure

• Russian university preparatory faculty: Combines language with subject prep, done in Russia

• Private institute in Russia: Supplementary or intensive study alongside the academic program

• Hybrid: Foundational learning in India followed by the university's preparatory faculty for depth

How Long Does It Take to Learn Russian for MBBS?

Avoid promising fluency in an unrealistically short window. Progress genuinely depends on hours of structured study, immersion, and most importantly regular speaking practice, not calendar time alone. A student studying intensively with daily speaking practice will progress faster than one studying the same total hours spread thinly with no conversation practice.

Medical Russian for MBBS Students

This is where general Russian courses and clinical readiness genuinely diverge, and where this guide aims to go beyond a generic language overview.

Common Medical Russian Vocabulary Categories

• Body parts

• Symptoms

• Diseases

• Medicines

• Hospital departments

• Emergency terminology

• Patient history questions

• Physical examination instructions

• Instructions to patients

• Medical documentation terms

Essential Russian Words Every MBBS Student Should Know

A working starter vocabulary built on this list with structured medical Russian coursework rather than treating it as complete.

Russian Phrases Doctors Need in Clinical Practice

Do Indian MBBS Students Need Russian for Clinical Training?

The exact curriculum structure and degree of language exposure vary by university and program; this progression is a general pattern, not a fixed syllabus applicable to every institution.

Russian Language and Patient Communication

• Taking a structured medical history

• Explaining a procedure in plain terms

• Obtaining information from an anxious or unwell patient

• Communicating with nursing staff during rounds

• Managing emergencies without a translator available

• Understanding a patient's reported complaints accurately

• General bedside communication and reassurance

Russian Language and FMGE/NExT: Does Russian Affect Eligibility in India?

This section needs precise wording, because it's an area where informal claims frequently get it wrong.

Does learning Russian satisfy NMC's medium-of-instruction requirement?

No. Russian is an additional practical and academic skill relevant to clinical training and daily life in Russia; it is not, and cannot be, presented as a substitute for the NMC's English-medium-of-instruction requirement. A degree earned through a genuinely Russian-medium program does not meet this specific FMGL condition, regardless of how proficient the student becomes in Russian.

Does NMC require Russian?

Not as a universal medium-of-instruction requirement, no. NMC's requirement concerns English as the degree's instructional language.

Why is Russian still important, then?

Clinical communication, functioning within a hospital environment, interacting with patients, and daily life in Russia are practical necessities that exist independently of what NMC's FMGL regulations require for degree recognition. A degree can satisfy FMGL's English-medium condition and still leave a graduate underprepared for the Russian-language clinical environment in which they were actually trained, which is precisely why this guide treats the two as separate questions.

Does Russian improve preparation for FMGE/NExT?

Only indirectly, through better clinical exposure and comprehension during training. There is no evidence that Russian proficiency directly improves FMGE or NExT exam scores, and this guide does not claim otherwise.

Russian Language vs NMC Requirements: What Indian Students Must Understand

Can You Study MBBS in Russia Without Russian?

Scenario 1: English-medium university, no Russian entrance exam

Possible at admission, depending on the specific university (Kazan's English track is an example). Russian will still become practically important during clinical years.

Scenario 2: Russian-medium university

Russian is essential from day one both for admission and for following the entire academic program.

Scenario 3: English-medium academics with a mandatory Russian entrance exam or in-course discipline

Russian becomes highly important both for admission (where required, as at Sechenov) and, separately, for the clinical environment.

Scenario 4: Preparatory route

Students entering with little or no Russian typically use a university's preparatory faculty to build a foundation in the language (and often the subject) before formally starting the medical program.

Russian Language Requirement for MBBS in Russia vs Other Countries

This pattern an English-medium academic track sitting atop a non-English clinical environment is common across most MBBS-abroad destinations, not unique to Russia. See AMW's broader language requirements guide for the full comparison across all destinations.

Can Learning Russian Help Indian Students Get Admission?

Direct admission advantage

Depends on the university. Where a Russian-language entrance exam exists, stronger Russian directly improves admission prospects for that specific track.

Preparatory faculty

Provides structured pathway preparation for students who aren't yet ready for direct admission through the entrance exam.

Russian-medium programs

Russian proficiency is a necessary precondition, not just an advantage, for these tracks.

Scholarship/quota routes

Russian-language preparation may be practically relevant to competitive selection under some government quota routes, discussed below.

Can Russian Language Help Students Get Scholarships?

This deserves careful handling. Russia's official study portal describes government quota admissions for foreign citizens as a competitive process, with individual universities potentially applying their own additional procedures in addition to the central quota system.

• Government quota (Rossotrudnichestvo route)

• University-specific scholarships

• Preparatory-program pathways that feed into quota eligibility

• Russian-language preparation as one factor in a broader, competitive selection process

Russian Government Scholarship/Quota and Medical Education

• Russian government quota (administered via Rossotrudnichestvo) is a competitive, limited-seat route for foreign applicants

• Selection is based on the specific scheme's published criteria, not on Russian fluency alone

• Where awarded, coverage can include tuition, and in some cases a stipend and accommodation support, depending on the specific scheme

• Preparatory language training is commonly built into quota pathways for students who need it

• Not every medical student or even every quota applicant receives a full scholarship; treat this as a competitive, limited route rather than a default expectation

Russian Language Certifications Indian Students Can Consider

Where Can Indian Students Take Russian Language Exams?

• Pushkin Institute: Moscow (the primary national testing body)

• Authorized TORFL/TRKI centers inside Russia: Including Kazan, Moscow State University, St Petersburg State University, and other lead institutions

• University-run testing centers at the student's own institution, where available

• Select partner centers abroad: Availability varies by country and has changed since 2022; confirm current status directly rather than relying on older lists

• Online/remote sittings: Offered by some centers, subject to current availability

Always verify a testing center's current authorization for the 2026 cycle directly with the Pushkin Institute or the university in question before booking, rather than relying on older aggregator listings.

Russian Language Course in India vs Russia

Best Way for an Indian Student to Learn Russian Before MBBS

6-Month Russian Learning Plan for MBBS Aspirants

12-Month Russian Learning Plan Before MBBS

A more realistic pathway for students starting from zero, broken into structured stages:

• A1: Foundational alphabet, pronunciation, basic grammar and vocabulary

• A2: Everyday communication and simple structures

• B1: Intermediate communication, sufficient for most university entrance thresholds

• B1+: Consolidation and expanded academic vocabulary

• Medical Russian: Clinical vocabulary and structured phrase practice

• TRKI preparation: Targeted exam-format practice for the specific level required

Common Mistakes Indian Students Make About Russian Requirements

Mistake 1: "English-medium means I don't need Russian."

False; see the dedicated section above. Clinical years and, at several universities, the entrance exam itself, still require Russian.

Mistake 2: "TRKI B2 is compulsory everywhere."

False: Requirements are university- and track-specific, not a universal national rule.

Mistake 3: "IELTS replaces Russian."

False: They assess different languages for different purposes and are not interchangeable.

Mistake 4: "Russian is only needed during admission."

False: Clinical-year demand for Russian is typically greater than admission-stage demand.

Mistake 5: "I can learn medical Russian after reaching Russia."

Risky: Starting from zero during the clinical years leaves little runway; earlier preparation substantially reduces stress.

Mistake 6: "Any Russian certificate is accepted everywhere."

False: Confirm which specific certificate and level a given university actually recognizes.

Mistake 7: "An agent's language claim is enough."

Insufficient: Verify directly against the university's own official admissions page.

Mistake 8: "Russian language satisfies NMC's medium-of-instruction requirement."

False: NMC's FMGL requirement specifically concerns English as the medium of instruction; Russian proficiency is a separate, practical skill.

How to Check the Russian Language Requirement Before Applying

• Open the official university admission page directly, not an aggregator or agent summary.

• Check the exact General Medicine program and track you're applying to.

• Check the language of instruction for that specific track.

• Check the required entrance examinations, including whether a Russian-language component applies.

• Check any Russian-language requirements built into the curriculum itself, even if not required at admission.

• Ask the admissions office for written confirmation of the current-cycle requirement.

• Verify NMC/FMGL compatibility separately; medium of instruction, course duration, and internship structure are distinct questions from Russian-language policy.

Russian Language Requirements at Russian Medical Universities Comparison Table

Confirm every cell directly against the specific university's official 2026 admission page before applying; this table reflects the general pattern, not a substitute for institution-specific confirmation.

Cost of MBBS in Russia with and Without a Preparatory Russian Year

A preparatory year is a genuine additional cost, not a free add-on: a full extra year of hostel, food, insurance, and travel is included in the budget alongside the preparatory course fee itself. For the detailed line-by-line six-year cost framework, see AMW's MBBS Abroad Cost 2026 guide.

Is Learning Russian Cheaper Than Studying MBBS in India?

This should not be treated as a blanket claim either way; the honest comparison depends heavily on which specific Indian college and which specific Russian university and track are being compared.

Affordability depends heavily on the specific Indian college option a student would otherwise be considering, and on the specific Russian university and track chosen; this is a comparison to run with real numbers for a student's actual shortlist, not a general rule.

Advantages of Learning Russian Before MBBS

• Academic: Smoother transition into coursework and, where applicable, entrance exams

• Clinical: Meaningfully better patient and staff communication from the clinical years onward

• Social: Easier day-to-day integration and reduced early culture shock

• Daily life: Navigating shopping, transport, banking and administration independently

• Patient interaction: Stronger history-taking and bedside communication

• Part-time/non-medical communication: Broader ability to interact outside the university environment

• Long-term: A practical skill that outlasts the degree itself, useful in Russian-speaking healthcare or research settings

Disadvantages / Challenges

• Time: A genuine investment, particularly for students starting from zero

• Cost: Course fees, whether in India, online, or through a preparatory faculty

• Cyrillic alphabet: An initial hurdle distinct from Latin-script languages

• Grammar: Russian's case system requires sustained, structured practice

• Medical vocabulary: A distinct additional layer beyond conversational Russian

• Pronunciation: Meaningfully different from English or Hindi phonetics

• Need for continuous practice: Proficiency can lapse without regular use

Is Russian Difficult for Indian Students?

Practically speaking, most Indian students find three areas the steepest: the Cyrillic alphabet at the very start (a genuine but short-lived hurdle), Russian's six-case grammatical system (which has no direct equivalent in English and requires sustained practice), and pronunciation patterns that differ meaningfully from both English and Hindi. Vocabulary building is comparatively straightforward with consistent exposure. None of this makes Russian uniquely difficult among foreign languages; it simply requires structured, sustained study rather than casual exposure, as with any language with a different script and grammatical structure.

Career Benefits of Russian for Indian Medical Graduates

Worth stating plainly, without overselling: Russian proficiency can support communication in Russian-speaking healthcare settings, participation in research collaborations, broader international exposure, and, where legally available, residency or work opportunities in Russian-speaking environments. But licensing to practice medicine in India or elsewhere is governed entirely by the relevant regulatory body's own requirements, not by language proficiency. Treat Russian fluency as a genuinely useful professional skill, not as a substitute for meeting FMGE/NExT or any other licensing requirement.

Frequently Asked Questions

Is B1 enough for MBBS in Russia?

B1 satisfies many universities' baseline entrance-level expectations, but clinical-year communication generally benefits from progressing toward B2.

Is B2 required for MBBS in Russia?

Not as a universal rule; B2 is a strong practical target, not a documented blanket legal requirement across every university.

Is TRKI compulsory for MBBS?

University-specific. Some universities require a Russian entrance exam (which may follow TRKI-aligned levels); others, like Kazan's English-medium track, generally do not require it for admission.

What is TRKI?

TRKI (Тест по русскому языку как иностранному) is Russia's standardized Russian-language proficiency testing system, with six levels aligned to the CEFR scale from A1 to C2.

Is TORFL the same as TRKI?

Yes, TORFL is the English name for the same six-level testing system known as TRKI in Russian.

Can I study MBBS in Russia without Russian?

Possible at some English-medium tracks at the point of admission, but Russian typically becomes practically necessary during clinical years regardless.

Can I study MBBS in Russia in English?

Yes, at several universities' English-medium General Medicine tracks; Sechenov and Kazan both offer this, among others.

Is IELTS required for MBBS in Russia?

Not universally; many Russian medical universities assess English through their own internal entrance exam rather than requiring an external certificate.

Is TOEFL required for MBBS in Russia?

Same pattern as IELTS generally not required as a blanket rule; internal university exams are more common.

Can IELTS replace Russian?

No, they test different languages for different purposes and are not interchangeable where a university specifically requires Russian.

Do English-medium medical students need Russian?

Often yes, in practice for the entrance exam at some universities, and for clinical communication at nearly all of them.

Do I need Russian for clinical rotations?

Practically, yes, at almost every Russian medical university, regardless of the academic medium of instruction.

Do I need Russian to communicate with patients?

Yes, patients in Russian hospitals are generally Russian-speaking, regardless of the program's academic language.

Can I take TRKI from India?

Availability at partner centers has varied since 2022; confirm current in-country availability directly with the Pushkin Institute rather than assuming a fixed list.

What is TRKI Level 1?

TRKI-I / TORFL-I, equivalent to CEFR B1, an intermediate level generally sufficient to apply to a Russian university.

What is TRKI Level 2?

TRKI-II / TORFL-II, equivalent to CEFR B2, a higher competence level generally required to be awarded a bachelor's, master's or PhD degree at most Russian universities.

Is B2 Russian enough for clinical practice?

B2 provides strong clinical communication skills; C1 offers additional fluency, though it is not typically required for MBBS purposes.