That may be true. A friend, who went to medical school in Italy, often mentioned that all of the training was out of the textbooks and that class attendance was not mandatory; indeed, in some courses, he and his fellow students merely appeared only for their oral final exams. The real learning came when they interned back here in the States.
I knew a doctor who couldn’t get into medical school in the states, so he went to Italy. Really nice guy, but very unsure of himself, and not the best doctor.