National Licensing Research Articles

How does ChatGPT-4 preform on non-English national medical licensing examination? An evaluation in Chinese language.

ChatGPT, an artificial intelligence (AI) system powered by large-scale language models, has garnered significant interest in healthcare. Its performance dependent on the quality and quantity of training data available for a specific language, with the majority of it being in English. Therefore, its effectiveness in processing the Chinese language, which has fewer data available, warrants further investigation. This study aims to assess the of ChatGPT's ability in medical education and clinical decision-making within the Chinese context. We utilized a dataset from the Chinese National Medical Licensing Examination (NMLE) to assess ChatGPT-4's proficiency in medical knowledge in Chinese. Performance indicators, including score, accuracy, and concordance (confirmation of answers through explanation), were employed to evaluate ChatGPT's effectiveness in both original and encoded medical questions. Additionally, we translated the original Chinese questions into English to explore potential avenues for improvement. ChatGPT scored 442/600 for original questions in Chinese, surpassing the passing threshold of 360/600. However, ChatGPT demonstrated reduced accuracy in addressing open-ended questions, with an overall accuracy rate of 47.7%. Despite this, ChatGPT displayed commendable consistency, achieving a 75% concordance rate across all case analysis questions. Moreover, translating Chinese case analysis questions into English yielded only marginal improvements in ChatGPT's performance (p = 0.728). ChatGPT exhibits remarkable precision and reliability when handling the NMLE in Chinese. Translation of NMLE questions from Chinese to English does not yield an improvement in ChatGPT's performance.

Performance of ChatGPT, Bard, Claude, and Bing on the Peruvian National Licensing Medical Examination: a cross-sectional study.

We aimed to describe the performance and evaluate the educational value of justifications provided by artificial intelligence chatbots, including GPT-3.5, GPT-4, Bard, Claude, and Bing, on the Peruvian National Medical Licensing Examination (P-NLME). This was a cross-sectional analytical study. On July 25, 2023, each multiple-choice question (MCQ) from the P-NLME was entered into each chatbot (GPT-3, GPT-4, Bing, Bard, and Claude) 3 times. Then, 4 medical educators categorized the MCQs in terms of medical area, item type, and whether the MCQ required Peru-specific knowledge. They assessed the educational value of the justifications from the 2 top performers (GPT-4 and Bing). GPT-4 scored 86.7% and Bing scored 82.2%, followed by Bard and Claude, and the historical performance of Peruvian examinees was 55%. Among the factors associated with correct answers, only MCQs that required Peru-specific knowledge had lower odds (odds ratio, 0.23; 95% confidence interval, 0.09-0.61), whereas the remaining factors showed no associations. In assessing the educational value of justifications provided by GPT-4 and Bing, neither showed any significant differences in certainty, usefulness, or potential use in the classroom. Among chatbots, GPT-4 and Bing were the top performers, with Bing performing better at Peru-specific MCQs. Moreover, the educational value of justifications provided by the GPT-4 and Bing could be deemed appropriate. However, it is essential to start addressing the educational value of these chatbots, rather than merely their performance on examinations.

Alcohol licensing legislation and licensing system in South-West Nigeria: Implications to regulate physical availability of alcohol.

The proliferation of alcohol outlets has led to increased physical availability of alcohol, harmful alcohol consumption and related harm in Nigeria. This study explored alcohol licensing legislations and licensing systems across local government councils (LGC) in South-West, Nigeria. Twenty-four LGCs across three states participated in the study. Data were generated from: (i) documents containing LGC liquor licensing legislations; and (ii) semi-structured interviews conducted with 50 LGC officials (16 legislative council clerks and 34 finance officers [director of finance, rate officers and revenue collectors]) were thematically analysed using NVivo. Nine of the sampled LGC enacted liquor licence bylaws. These mostly specified categories of liquor licences issued and licensing fees. None of the liquor licence bylaw contained regulations for controlling physical availability of alcohol and outlet density. Finance officials were licensing officers and there were no licensing committees across the LGCs. The LGC officials were unanimous in stating that generating revenue from licensing fees was the main objective for licensing alcohol outlets. The LGCs licensed alcohol outlets indiscriminately and failed to regulate outlet density. The absence of regulations for controlling outlet density has implications for physical availability of alcohol in Nigeria. Our findings strongly suggest the need to develop national liquor licensing legislation with public health objectives and implementing regulations for controlling temporal and spatial availability of alcohol. Each LGC should inaugurate a licensing committee with clearly defined roles and responsibilities for licensing stakeholders such as LGC health officials, law enforcement agencies and community members.

Evaluating the impacts of the demerit points system on traffic law violations and driver involvement in road accidents in Israel

Demerit points systems (DPS) have been used in many countries as a means for improving road safety, by monitoring traffic law violations of drivers and applying corrective measures to repeat offenders, while knowledge on their safety impacts is yet incomplete. This study examined the DPS impacts on committing traffic offenses and accident involvement of drivers, in Israel, based on files of the national Licensing Authority and complementary accident files. Models were developed to evaluate changes in violation and accident rates of drivers, who underwent the DPS corrective measures, in after the treatment related to the before period, and accounting for changes observed in the matched comparison-groups. The findings showed that during the three-year period after the measures' implementation, the decrease in committing violations was of 70%, and simultaneously, there was a decrease in drivers' accident involvement, on average, of 1% in severe accidents and of 11% in total injury accidents. The effects were consistent across various groups of drivers by the corrective measures applied and the type of license. The study results support the continued use of the DPS, to improve drivers' behaviors and road safety. To increase its impacts at the national level, the DPS implementation should be supported by stable police enforcement and publicity efforts.

Evaluation of Incremental Validity of Casper in Predicting Program and National Licensure Performance of Undergraduate Nursing Students: Protocol for a Mixed Methods Study.

Academic success has been the primary criterion for admission to many nursing programs. However, academic success as an admission criterion may have limited predictive value for success in noncognitive skills. Adding situational judgment tests, such as Casper, to admissions procedures may be one strategy to strengthen decisions and address the limited predictive value of academic admission criteria. In 2021, admissions processes were modified to include Casper based on concerns identified with noncognitive skills. This study aims to (1) assess the incremental validity of Casper scores in predicting nursing student performance at years 1, 2, 3, and 4 and on the National Council Licensing Examination (NCLEX) performance; and (2) examine faculty members' perceptions of student performance and influences related to communication, professionalism, empathy, and problem-solving. We will use a multistage evaluation mixed methods design with 5 phases. At the end of each year, students will complete questionnaires related to empathy and professionalism and have their performance assessed for communication and problem-solving in psychomotor laboratory sessions. The final phase will assess graduate performance on the NCLEX. Each phase also includes qualitative data collection (ie, focus groups with faculty members). The goal of the focus groups is to help explain the quantitative findings (explanatory phase) as well as inform data collection (eg, focus group questions) in the subsequent phase (exploratory sequence). All students enrolled in the first year of the nursing program in 2021 were asked to participate (n=290). Faculty will be asked to participate in the focus groups at the end of each year of the program. Hierarchical multiple regression will be conducted for each outcome of interest (eg, communication, professionalism, empathy, and problem-solving) to determine the extent to which scores on Casper with admission grades, compared to admission grades alone, predict nursing student performance at years 1-4 of the program and success on the national exam. Thematic analysis of focus group transcripts will be conducted using interpretive description. The quantitative and qualitative data will be integrated after each phase is complete and at the end of the study. This study was funded in September 2021, and data collection began in March 2022. Year 1 data collection and analysis are complete. Year 2 data collection is complete, and data analysis is in progress. At the end of the study, we will provide the results of a comprehensive analysis to determine the extent to which the addition of scores on Casper compared to admission grades alone predicts nursing student performance at years 1-4 of the program and on the NCLEX exam. RR1-10.2196/48672.

On Putting an End to the Backlash Against Electrophysical Agents.

Electrophysical agents (EPAs) are core therapeutic interventions in academic physical therapy curricula around the world. They are used concomitantly with several other therapeutic interventions such as exercise, manual therapy techniques, medications, and surgery for the management of a wide variety of soft tissue disorders. Over the past decade, the practice of EPAs has been the subject of intense scrutiny in the U.S. This has been colored by some physical therapists publicly engaging in bashing rhetoric that has yet to be officially and publicly addressed by the guiding organizations which, together, regulate the practice of physical therapy in this country. Published in world renowned public media are unsubstantiated mocking remarks against the practice of EPAs and unethical allegations against its stakeholders. This rhetoric suggests that EPA interventions are "magical" treatments and that those practitioners who include them in their plans of care may be committing fraud. Such bashing rhetoric is in striking contradiction to the APTA's Guide to Physical Therapist Practice 4.0, which lists EPAs as one of its categories of interventions, the CAPTE's program accreditation policy, and the FSBPT's national licensing exam. The purpose of this commentary is to expose the extent of this discourse and to call to action the APTA, CAPTE, and FSBPT organizations, as well as physical therapists, with the aim at putting an end to this rhetoric.

Pharmacy School and Pharm.D. Program in the United States of America

Pharmacy schools in Japan started to offer the 6-year undergraduate program in 2006. Currently, students are eligible for the national licensing examination to become a pharmacist only after completing the six-year program and receiving a bachelor's degree. Meanwhile, pharmacy schools offer the four-year graduate program in the United States of America (U.S.A.). In addition to the length of the program, there are several significant differences between pharmacy schools in Japan and the U.S.A. In the U.S., students receive a professional doctoral degree in pharmacy, doctor of pharmacy (Pharm.D.), after completion of the program. Fourth-year pharmacy students in the U.S. spend 1600 h in their clinical rotations, which is considerably longer than those in Japanese programs. It is also unique that pharmacists and pharmacy students are authorized to administer vaccines in the U.S. upon completion of immunization training. This symposium review aims to introduce the pharmaceutical education and the Pharm.D. program offered in the U.S.

Performance of ChatGPT on the Peruvian National Licensing Medical Examination: Cross-Sectional Study.

ChatGPT has shown impressive performance in national medical licensing examinations, such as the United States Medical Licensing Examination (USMLE), even passing it with expert-level performance. However, there is a lack of research on its performance in low-income countries' national licensing medical examinations. In Peru, where almost one out of three examinees fails the national licensing medical examination, ChatGPT has the potential to enhance medical education. We aimed to assess the accuracy of ChatGPT using GPT-3.5 and GPT-4 on the Peruvian National Licensing Medical Examination (Examen Nacional de Medicina [ENAM]). Additionally, we sought to identify factors associated with incorrect answers provided by ChatGPT. We used the ENAM 2022 data set, which consisted of 180 multiple-choice questions, to evaluate the performance of ChatGPT. Various prompts were used, and accuracy was evaluated. The performance of ChatGPT was compared to that of a sample of 1025 examinees. Factors such as question type, Peruvian-specific knowledge, discrimination, difficulty, quality of questions, and subject were analyzed to determine their influence on incorrect answers. Questions that received incorrect answers underwent a three-step process involving different prompts to explore the potential impact of adding roles and context on ChatGPT's accuracy. GPT-4 achieved an accuracy of 86% on the ENAM, followed by GPT-3.5 with 77%. The accuracy obtained by the 1025 examinees was 55%. There was a fair agreement (κ=0.38) between GPT-3.5 and GPT-4. Moderate-to-high-difficulty questions were associated with incorrect answers in the crude and adjusted model for GPT-3.5 (odds ratio [OR] 6.6, 95% CI 2.73-15.95) and GPT-4 (OR 33.23, 95% CI 4.3-257.12). After reinputting questions that received incorrect answers, GPT-3.5 went from 41 (100%) to 12 (29%) incorrect answers, and GPT-4 from 25 (100%) to 4 (16%). Our study found that ChatGPT (GPT-3.5 and GPT-4) can achieve expert-level performance on the ENAM, outperforming most of our examinees. We found fair agreement between both GPT-3.5 and GPT-4. Incorrect answers were associated with the difficulty of questions, which may resemble human performance. Furthermore, by reinputting questions that initially received incorrect answers with different prompts containing additional roles and context, ChatGPT achieved improved accuracy.

Undergraduate dermatology education: The importance of curriculum review.

In this letter, we highlight the considerable diversity in undergraduate dermatology training in the United Kingdom and acknowledge the barriers faced in implementing the revised national undergraduate curriculum provided by the British Association of Dermatologists (BAD). We provide a pragmatic approach of ensuring that our dermatology placement aligns with the BAD national undergraduate curriculum and Medical Licensing Assessment (MLA) content map, in the face of limited clinician time and placement length. We urge other medical schools to adopt our approach of curriculum mapping, particularly in light of the upcoming MLA, and sustainable educational resource development.

Design, delivery and effectiveness of health practitioner regulation systems: an integrative review

BackgroundHealth practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions.MethodsWe conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework.FindingsThis large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures–processes–outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners.ConclusionWe identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.

Novel innovative computer-based test (Inno-CBT) item types for national licensing examinations for health care professionals

BackgroundAn effective test mechanism to evaluate clinical knowledge and skills of the entry-level healthcare professionals is important for providing clinical competency and improving patient care. This study aimed to develop novel, innovative computer-based test (Inno-CBT) item types for application in the national examination of Korean healthcare professionals.MethodsThis exploratory study was conducted from May 2021 to March 2022 by a team of faculty members from pharmacy schools in South Korea. A literature search using PubMed, Google Scholar, RISS, Web of Science, and KoreaMed was performed. Forum presentations, media articles, and previous reports by the Korea Health Personnel Licensing Examination Institute (KHPLEI) were included. Workshops were held, information and ideas were collected and conceptualized, and item types were designed, drafted, and refined. By repeating this process, the Inno-CBT item types were finalized.ResultsForty-one Inno-CBT item types with 28 subtypes were developed. New digital technologies, such as a reactive responsive media interface, an animation insertion, multimedia embedding, and network surfing, were utilized in these novel types. It was anticipated that these Inno-CBT item types would effectively measure abilities in healthcare knowledge, problem-solving skills, and professional behaviors. Some potential barriers to implementing the Inno-CBT item types include item difficulty, operational unfamiliarity, complexity in scoring protocols, and network security.ConclusionsA variety of styles of novel Inno-CBT item types were developed to evaluate the multifaceted and in-depth professional abilities required for healthcare professionals. Prior to implementing these item types in the national examination, item validation and technical support should be conducted.

Poster 396: Barriers and facilitators to national licensure for US medical professionals: what Covid has taught us and using sports medicine as a launch pad

Objectives: GLOBAL AIM: Increase license portability across state lines for all US medical professionals. SPECIFIC AIM: Increase the ability to provide medical care nationwide for all US sports medicine physicians (who have a CAQ for their specialty) across state lines and set a precedent for other licensed healthcare professionals by 2026. The aim is to extend the portability of medical licensure across state lines to all sports medicine professionals (not just those who care for professional teams) and use this as a precedent eventually for all types of healthcare workers. Currently sports medicine physicians for professional teams are allowed to provide care across state lines which is legislated by “The Sports Medicine Licensure Clarity Act” (SMLCA) in 2018. As July 22, 2022, licensure is allowed for at least telemedicine across state lines for 23 states and has been extended by the HHS as part of Covid healthcare measures that were implemented in 2020. Methods: Review of current policies, barriers and facilitators has been performed using various search strategies and qualitative techniques. Current state and national laws were reviewed and will be presented. California has a large population where there is no reciprocity for other medical professionals, therefore meetings have been set with the Business Professions Committee with a plan to submit a bill sponsored by a state assemblyman to expand access to licensure across state lines in 2023. Results: One barrier is the loss of states’ autonomy as well as the individual authority and stature a medical professional may gain from being on a licensing board. Most US states have no reciprocity and not all have the licensure process standardized. Some states have a non-transparent process and others do not wish to participate in regional compacts such as California. Even more concerning, some states are found to more-likely censure doctors of color and perform sham peer review. This is an example of bias in medical credentialing that can impede diversity and inclusion efforts. The European Union allows medical licensure across national borders. Doctors need to pass a language proficiency test for the country they wish to practice in, regardless of which European country they received their medical training. Given that English is the only language of instruction in the US, proficiency can be easily evaluated. Language should not be a barrier to license portability, especially if one is already licensed in one US state even for foreign medical graduates. The Covid pandemic showed licensure is obtainable in a relatively rapid fashion across state lines. In addition, federal health care facilities such as the VA system already allow practitioners licensed in one state to practice in another without a license to that specific state. Portability across state-lines aids practitioners who practice on state borders in both rural and urban areas, such as the NH and VT border(rural), and NY and DC metro areas (urban) as well as telehealth for both an immobile and mobile populations, enhancing equitable healthcare access. This also removes financial barriers of cost for licensing fees for practitioners and staff resources to process licenses. Conclusions: The US has one of the most restrictive medical licensures of all developed countries, making mobilization of healthcare workers extremely difficult. Removing this barrier will be beneficial when medical staff is needed across state lines for pandemics, natural disasters, intake of refugees/immigrants, and global sporting events held in the US such as the World Cup in 2026, and Olympics in 2028. This could also extend access for the general US population to healthcare providers via “tele-medicine” (virtual/video visits), to essentially all populations (socio-economically disadvantaged, immigrants, those with mobility and transportation barriers, rural locations etc). This will ensure higher quality care, better follow-up along with more timely and equitable healthcare, which are all currently limited by restricting portability and requiring licenses for each individual state.

The Ethiopian Anesthetist Licensing Examination and Associated Improvement in in-School Student Performance: A Retrospective Study.

Ethiopia introduced a national licensing examination (NLE) in response to growing concerns about the competence of graduates and the quality of education. This study aimed to assess the associated in-school student performance changes in anesthetist training programs following NLE implementation. Academic records of 1493 graduate anesthetists were retrospectively obtained from eight universities before (n=932) and after (n=561) NLE implementation. Four universities were first-generation (oldest), three were second-generation, and one was third-generation (newest). We compared the yearly (Y1 to Y4) and cumulative grade point averages (GPA) to assess if there were in-school student performance differences between the two periods. The Kruskal-Wallis and Mann-Whitney U-tests were used to compare groups. Results are presented as a median, interquartile range, a 95% confidence interval (CI) for median differences, and Cohen's r effect size. Overall, there was a small to moderate improvement in student academic performance following NLE implementation. However, the statistically significant differences were limited to first-generation university students and those entering directly from high school. We found considerable positive differences in all five performance measures in first-generation university students, with Year-1 GPA and cumulative GPA measurements exhibiting large effect sizes (Cohen's r = 0.96 and 0.79, respectively, p <0.005). Those entering from high school demonstrated significant differences in four of five performance measures, with the largest positive gains on the year-1 GPA (median before [n=765] and after [n=480]: 3.11-3.30, 95% CI (0.09, 0.22), r=0.46, p <0.005)). Second- and third-generation university students showed no significant differences, while nurse entrants exhibited a significant difference in their Y2GPA scores only with an actual drop in performance. The Ethiopian anesthetist NLE is associated with an overall modest in-school academic performance improvement, supporting its use. The stagnant or declining performance among nurse entrants and the newest (second and third) generation university students deserve further scrutiny.

Development and Maintenance of Cohort Data at Chonnam National University Medical School

The aim of this study was to systematically collect data for evaluating short- and long-term outcomes using Kirkpatrick’s four-level evaluation model, Chonnam National Medical School has established plans for developing and managing a database of student and graduate cohorts. The Education Evaluation Committee, with assistance from the Medical Education Office, manages the development and maintenance of cohort data. Data collection began in the 2022 academic year with first- through fourth-year medical students and graduates of the year 2022. The collected data include sociodemographic characteristics, admission information, psychological test results, academic performance data, extracurricular activity data, scholarship records, national medical licensing exam results, and post-graduation career paths. The Education Evaluation Committee and the Medical Education Office analyze the annually updated student and graduate cohort data and report the results to the dean and relevant committees. These results are used for admissions processes, curriculum improvement, and the development of educational programs. Applicants interested in using the student and graduate cohort data to evaluate the curriculum or conduct academic research must undergo review by the Educational Evaluation Committee before being granted access to the data. It is expected that the collected data from student and graduate cohorts will provide a sound and scientific basis for evaluating short- and long-term achievements based on student, school, and other characteristics, thereby supporting medical education policies, innovation, and implementation.

Easing the Entry of Qualified International Medical Graduates to U.S. Medical Practice.

Almost one quarter of physicians and physicians-in-training in the United States are international medical graduates (IMGs), meaning they have graduated from a medical school not accredited in the United States. Some IMGs are U.S. citizens and others are foreign nationals. IMGs, many of whom have years of training and experience gained in their countries of origin, have long contributed to the U.S. health care system, especially by providing care to populations that have been historically underserved. Additionally, many IMGs contribute to the diversity of the health care workforce, which can enhance the health of the population. The diversity of the United States is increasing, and racial and ethnic concordance between a physician and a patient has been linked to improved health outcomes.IMGs must meet national- and state-level licensing and credentialing standards like any other U.S. physician. This assures the ongoing quality of the care provided by the medical workforce and protects the public. However, at the state level, variation in standards and standards that may be more challenging to meet than those for U.S. medical school graduates may hamper IMGs' contributions. IMGs who are not U.S. citizens also face visa and immigration barriers.In this article, the authors present insights gleaned from Minnesota's model IMG integration program as well as changes made in 2 states in response to the COVID-19 pandemic. Improving and streamlining processes for IMGs to be licensed and credentialed as well as the policies governing visas and immigration, where appropriate, can ensure that IMGs will be willing and able to continue to practice when and where they are needed. This, in turn, could increase the contribution of IMGs to addressing health care inequities, improving health care access through service in federally designated Health Professional Shortage Areas, and reducing the impact of potential physician shortages.

Impact of anesthetist licensing examination on quality of education in Ethiopia: a qualitative study of faculty and student perceptions

BackgroundEthiopia drastically increased the anesthesia workforce density by training ‘associate clinician anesthetists’ as a task-shifting and sharing strategy. However, there were growing concerns about educational quality and patient safety. Accordingly, the Ministry of Health introduced the anesthetist national licensing examination (NLE) to assure the quality of education. However, empirical evidence is scarce to support or refute the overall impact of NLEs, which are relatively costly for low- and middle-income settings. Therefore, this study aimed to explore the impact of introducing NLE on anesthetists’ education in Ethiopia.MethodsWe conducted a qualitative study using a constructivist grounded theory approach. Data were prospectively collected from ten anesthetist teaching institutions. Fifteen in-depth interviews were conducted with instructors and academic leaders, and six focus groups were held with students and recently tested anesthetists. Additional data were gathered by analyzing relevant documents, including versions of curricula, academic committee minutes, program quality review reports, and faculty appraisal reports. Interviews and group discussions were audiotaped, transcribed verbatim and analyzed using Atlas.ti 9 software.ResultsBoth faculty and students demonstrated positive attitudes toward the NLE. Student motivation, faculty performance, and curriculum strengthening were the three primary changes that emerged, resulting in three subsequent spin-offs on assessment, learning, and quality management practices. Academic leaders’ dedication to evaluating examination data and turning these into action led to changes that improved education quality. Increased accountability, engagement, and collaboration were the predominant factors facilitating change.ConclusionOur study indicates that the Ethiopian NLE has prompted anesthesia teaching institutions to improve their teaching, learning, and assessment practices. However, more work is required to improve exam acceptability among stakeholders and drive broader changes.

A Survey on Perceptions of the Direction of Korean Medicine Education and National Licensing Examination.

Recent changes in medical education and assessment led to a focus on occupational competency, and this study investigated the perceptions of Korean medicine doctors (KMDs) on the national licensing examination for KMDs (NLE-KMD). The survey aimed to understand KMDs' recognition of the current situation, items to improve, and items to emphasize in the future. We conducted the web-based survey from 22 February to 4 March 2022, and 1244 among 23,338 KMDs answered voluntarily. Through this study, we found the importance of competency-related clinical practice and Korean standard classification of disease (KCD), and the presence of a generation gap. KMDs considered clinical practice (clinical tasks and clinical work performance) and the item related to the KCD important. They valued (1) the focus on KCD diseases that are frequently seen in clinical practice and (2) the readjustment and introduction of the clinical skills test. They also emphasized KCD-related knowledge and skills for the assessment and diagnosis of KCD diseases, especially those frequently treated at primary healthcare institutes. We confirmed the generation gap in the subgroup analysis according to the license acquisition period, and the ≤5-year group emphasized clinical practice and the KCD, while the >5-year group stressed traditional KM theory and clinical practice guidelines. These findings could be used to develop the NLE-KMD by setting the direction of Korean medicine education and guiding further research from other perspectives.

Student’s perspective on NLE examination

This study aims to investigate the students' perspective on the National Licensure Examination (NLE). The NLE serves as a crucial evaluation tool for students, assessing their knowledge, skills, and competency in their respective fields. However, little research has focused on understanding the students' perceptions and experiences regarding this examination. The study employs a quantitative research design with a sample size of 300 students. The participants are selected from various educational institutions from Lahore who have recently taken the NLE examination. A questionnaire consisting of Likert-scale and open-ended questions is used to collect data on students' perceptions, attitudes, and experiences related to the NLE examination. Preliminary findings from the study indicate that a majority of students perceive the NLE examination as a highly challenging and stressful experience. Many students reported feeling anxious and pressured due to the significance of the examination for their academic and professional careers. However, despite the stress, a significant number of students also acknowledged the importance of the NLE examination in ensuring the quality and standardization of professionals in their field. Furthermore, the study explores the students' perceptions regarding the content and format of the NLE examination.

Analysis on Validity and Academic Competency of Mock Test for Korean Medicine National Licensing Examination Using Item Response Theory

The national licensing examination is used to evaluate the medical competency at the time of graduation, however no study has been performed on the validity of traditional Korean medicine license examination yet. The purpose of this study was to develop learning analytics using item response theory (IRT) to examine the validity and academic competency of the mock test of the national licensing exam. Classical test theory and IRT were used to evaluate the validity of test items, and IRT was used for test validity and competency analysis. The correlation between competency score of 12 subjects was analyzed using Pearson’s correlation. The distribution of students’ latent competencies was examined by gender and administrative group using a Kernel density map, Latent Profile Analysis, and χ&lt;sup&gt;2&lt;/sup&gt;. The guessing parameter of 340 items was relatively high, and the information level of 12 subjects were relatively low. Significant correlations (r = 0.49–0.83, &lt;i&gt;p&lt;/i&gt; &lt; 0.05) were observed between the competency scores of total and 12 subjects. Two (high and low) latent academic competency groups were identified based on the competency score of 12 subjects. The low academic competency group requiring intensive management has a significantly higher frequency of male students with the experience of academic fail in the seven-year course. This study presented the quantitative learning analytics for the national licensing exam of traditional Korean medicine. The multifaceted item and test validities of the mock license test were provided, and an evidence-based approach to competency-based student management and national licensing exam of traditional Korean medicine was suggested.

Measuring the effect of vehicle safety on road traffic crash severity in Iran: using structural equation modeling

Objective: Vehicle safety plays a key role in reducing the number of road traffic deaths and serious injuries. This study aims to investigate the effect of vehicle safety on the severity of traffic crashes in Iran using structural equation modeling (SEM).&#x0D; Methods: This was a comparative cross-sectional study of all imported vehicles with Aras free trade zone license plate as well as all domestic vehicles (cars produced in Iran) commuting on Tabriz-Jolfa road. The study population included drivers who had accidents on Tabriz-Jolfa road over a period of one year from September 22, 2020 to September 21, 2021 and were injured or their vehicles had been damaged (n=652). Data was collected using set of questionnaires with 10 sections. The effect of independent variables, as exogenous latent variables (human, vehicle, and environmental factors), on a dependent variable, as an endogenous latent variable (crash severity) was measured using SEM. All data were analyzed using Mplus 8.0 software.&#x0D; Results: In the structure part of the model with foreign vehicles group, the effect sizes of three exogenous variables, i.e., human, environmental, and vehicle factors, on the dependent variables were found to be 0.412, 0.396 and 0.358, respectively. The effect sizes in the model with domestic vehicles were found to be 0.312, 0.702 and 0.820, respectively. &#x0D; Conclusion: Vehicle factors (variables related to car safety) had a high impact on crash severity in the national license plate and domestically manufactured vehicle group, indicating the necessity of improving vehicle safety.