National Licensing Exam Research Articles

Medical Student’s Attitudes towards Implementation of National Licensing Exam (NLE) – A Qualitative Exploratory Study

The introduction of the post-qualification National Licensing Examination (NLE) in Pakistan has been met with resistance from the medical students. They are the main stakeholders of medical colleges. Objective: To explore the opinions of medical students regarding the feasibility of NLE. Methods: An exploratory, qualitative study was conducted at Riphah International University, Islamic international medical college, Rawalpindi and Gomal Medical College, D.I. Khan, KP using in-depth interviews. A sample of 12 medical students from different medical colleges in Pakistan was included. The recorded interviews transcribed verbatim. Thematic analysis was then conducted using NVivo V2 and coded into nodes and daughter nodes, of which 5 themes and 17 subthemes emerged. Results: A total of five themes and 17 themes were created. NLE was deemed as a good standardization tool for assessing the competence of medical graduates. Students believed that current MBBS assessment lacks in clinical skills assessment and did not prepare to treat patients upon graduation. However, they did not want to take another exam after the professional exams especially when no incentives are offered to graduates upon clearing. They suggested NLE should be used as a means of constructive feedback for institutions and students to allow them to work on weak areas. Conclusions: There were mixed opinions regarding the acceptance of the exam. If medical institutions across the country focus their curricula on developing clinical skills and incentives are provided to the doctors upon clearing, the students would readily accept the exam

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.

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.

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<sup>2</sup>. 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, <i>p</i> < 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.

Trajectories of learning approaches during a full medical curriculum: impact on clinical learning outcomes

BackgroundNo consensus exists on whether medical students develop towards more deep (DA) or surface learning approaches (SA) during medical training and how this impacts learning outcomes. We investigated whether subgroups with different trajectories of learning approaches in a medical students’ population show different long-term learning outcomes.MethodsPerson-oriented growth curve analyses on a prospective cohort of 269 medical students (Mage=21years, 59 % females) traced subgroups according to their longitudinal DA/SA profile across academic years 1, 2, 3 and 5. Post-hoc analyses tested differences in academic performance between subgroups throughout the 6-year curriculum until the national high-stakes licensing exam certifying the undergraduate medical training.ResultsTwo longitudinal trajectories emerged: surface-oriented (n = 157; 58 %), with higher and increasing levels of SA and lower and decreasing levels of DA; and deep-oriented (n = 112; 42 %), with lower and stable levels of SA and higher but slightly decreasing levels of DA. Post hoc analyses showed that from the beginning of clinical training, deep-oriented students diverged towards better learning outcomes in comparison with surface-oriented students.ConclusionsMedical students follow different trajectories of learning approaches during a 6-year medical curriculum. Deep-oriented students are likely to achieve better clinical learning outcomes than surface-oriented students.

Development and national consensus finding on patient-centred high stakes communication skills assessments for the Swiss Federal Licensing Examination in Medicine

ObjectiveTo describe and evaluate a consensus finding and expert validation process for the development of patient-centred communication assessments for a national Licensing Exam in Medicine. MethodsA multi-professional team of clinicians and experts in communication, assessment and role-play developed communication assessments for the Swiss Federal Licensing Examination. The six-month process, informed by a preceding national needs-assessment, an expert symposium and a critical literature review covered the application of patient-centred communication frameworks, the development of assessment guides, concrete assessments and pilot-tests. The participants evaluated the process. ResultsThe multiple-step consensus process, based on expert validation of the medical and communication content, led to six high-stakes patient-centred communication OSCE-assessments. The process evaluation revealed areas of challenge such as calibrating rating-scales and case difficulty to the graduates’ competencies and integrating differing opinions. Main success factors were attributed to the outcome-oriented process and the multi-professional exchange of expertise. A model for developing high stakes patient-centred communication OSCE-assessments was derived. ConclusionsConsensus finding was facilitated by using well-established communication frameworks, by ensuring outcome-orientated knowledge exchange among multi-professional experts, and collaborative validation of content through experts. Practice implicationsWe propose developing high-stakes communication assessments in a multi-professional expert consensus and provide a conceptual model.

Does Pass/Fail on Medical Licensing Exams Predict Future Physician Performance in Practice? A Longitudinal Cohort Study of Alberta Physicians

ABSTRACT The purpose of this longitudinal study was to gather extrapolation evidence of validity by assessing whether performance on a national medical licensing exam, in addition to practice and socio-demographic variables, is predictive of future physician performance in practice. The study focused on a cohort of 3,404 physicians who were registered with the College of Physicians and Surgeons of Alberta (CPSA) and who completed the Medical Council of Canada Qualifying Examination (MCCQE) Parts I and II between 1992–2017. Separate multivariate quasi-Poisson regression models were run to assess the degree of relationship between first-time pass/fail status on the MCCQE I and II, and several CPSA socio-demographic variables and several CPSA socio-demographic variables, in addition to complaints/physician and various prescribing flags. Candidates who failed the MCCQE I on their first attempt had 27% more complaints lodged against them, compared to those who passed. Physicians who failed the MCCQE II on their first attempt prescribed 2+ benzodiazepines and 2+ opioids to 30% more patients than those who passed. Conclusions: Performance on the MCCQE Part I and II is an important predictor of physician performance. Combined with other critical variables, these measures provide important evidence to aid in risk modeling efforts and to guide educational interventions for physicians at an early stage of their careers.

COMPARATIVE ANALYSIS OF STUDENTS’ ACADEMIC PERFORMANCE IN DISTANCE AND IN-CLASS LEARNING

COVID-19 pandemic has had immense impact on usual daily life and working activities, forced to adapt to new circumstances. The system of medical education has to solve a number of pressing issues on changing the mode of teaching and learning. Distance learning is often described as a flexible and effective system of non-stop professional education, sensitive to the needs of the society. Distance learning extensively uses internet technologies for communication through video conferences, emails, providing access to learning materials, including multimedia presentations, videos, visual aids, etc. However, this form of learning is not widespread in the training of medical professionals. Notwithstanding the advantages, distance learning needs constant improvement of all parties of educational process that is possible only after analyzing its shortcomings based on own experience and described in relevant reports. The study was aimed at compare the students’ academic performance demonstrated during distance learning and traditional in-class learning. The material of the study included the grades, which medical students got during distance learning and grades they got before the spring quarantine. We also used the data on students' grades for the identical periods of the 2018-2019 academic year. Distance learning during the quarantine was scheduled in accordance with the existing curriculum, and conducted by all educators of the Department of Pathological Anatomy with Autopsy Course and based on the combination of two online platforms: Zoom and Google classroom. During the video conferences at the Zoom platform, the faculty staff explained and discussed the theme material using multimedia presentations, engaged students into different learning activities. To monitor student’s understanding of important concepts, we created online quizzes with seven different question types which are graded automatically Google Classroom. Results can be viewed in a summary format, by individual respondents, or by specific question answers. Quizzes can be assigned to a Google Classroom class and quiz results can be exported to the Google Classroom group. Google classroom was widely used in training students to the national licensing exam “Krok 1. General Medicine”. Our study showed a decline in students’ academic performance through the online learning period. The comparison of students’ academic performance data for the same period of the previous academic year demonstrated that academic progress of students during distance learning decreased compared to the same period of the previous academic year. Thus, several questions arise: what causes this decline and whether it is possible to grant high-quality online learning on the course of pathomorphology. Since it was the first experience when higher medical educational setting faced such a challenge, we can find a clear answer only based on multifactorial analysis of students' academic performance. We can conclude on distance learning and analysis of students’ academic performance that this format did not provide high-quality knowledge acquisition in pathomorphology. Thorough study of all factors impacting students’ learning outcomes and ways to improve distance learning is of great importance in order to prevent any possible challenges in future.

Repercussions of the COVID-19 pandemic on the well-being and training of medical clerks: a pan-Canadian survey

BackgroundThe COVID-19 pandemic has been an unprecedented and potentially stressful event that inserted itself into the 2019–2020 Canadian medical curriculum. However, its impact on stress and subsequent professional pathways is not well understood. This study aims to assess the impact of the COVID-19 pandemic on the mental well-being, training, and career choices of Canadian medical clerks within the first three months of the pandemic. It also aims to assess their use of university support systems and their appreciation of potential solutions to common academic stressors.MethodsAn electronic survey composed of four sections: demographics, stressors experienced during the pandemic, World Health Organization (WHO) well-being index, and stress management and resources was distributed to Canadian clerks.ResultsClerks from 10 of the 17 Canadian medical faculties participated in this study (n = 627). Forty-five percent of clerks reported higher levels of stress than usual; 22% reconsidered their residency choice; and 19% reconsidered medicine as a career. The factors that were most stressful among clerks were: the means of return to rotations; decreased opportunities to be productive in view of residency match; and taking the national licensing exam after the beginning of residency. The mean WHO well-being index was 14.8/25 ± 4.5, indicating a poor level of well-being among a considerable proportion of students. Clerks who reconsidered their residency choice or medicine as a career had lower mean WHO well-being indices. Most clerks agreed with the following suggested solutions: training sessions on the clinical management of COVID-19 cases; being allowed to submit fewer reference letters when applying to residency; and having protected time to study for their licensing exam during residency. Overall, clerks were less concerned with being infected during their rotations than with the impact of the pandemic on their future career and residency match.ConclusionThe COVID-19 pandemic had a considerable impact on the medical curriculum and well-being of clerks. A number of student-identified solutions were proposed to reduce stress. The implementation of these solutions throughout the Canadian medical training system should be considered.

The introduction of a standardised national licensing exam as a driver of change in medical education: A qualitative study from Switzerland

Introduction Only a few studies have described the impacts, strengths and needs for further development of national licensing exams (NLE). To gain such insights regarding the Swiss NLE, which includes a multiple-choice and a standardised clinical skills exam, we explored the perceptions of involved experts and stakeholders. Methods We explored participants’ perceptions in four focus group discussions. The interviews were recorded, transcribed verbatim and qualitatively analysed using a thematic analysis approach. Results The analysis resulted in five perceived impacts, two strengths and two needs for further developments of the NLE. Perceived impacts were (1) steering students’ learning behaviour, (2) supporting teachers and assessors to align teaching to competencies, (3) elevating the importance of the Swiss Catalogue of Learning Objectives, (4) setting incentives for the further development of curricula, and (5) fostering the collaboration between the faculties of medicine. Perceived strengths were the blend of assessment formats, including their competency-based orientation, and the collaborative development approach. Perceived needs lay in the NLE’s further development to sustain its fit for purpose and in incentives for people involved. Conclusion According to our study, this NLE had, and has, notable impacts on medical education in Switzerland. Our insights can be useful for others planning a similar undertaking.

Preparation for practice and the arguments for standardisation in view of the forthcoming medical licensing exam: A literature review

Aims: The aim of this paper is to address whether the introduction of a national licensing exam will improve preparedness for practice. This review will explore and identify the areas in which UK medical graduates are feeling underprepared. In addition, this review will discuss the need for the Medical Licensing Assessment in the UK.Methods: A literature search of several databases was performed in December 2018. Studies which identified the areas in which medical graduates were prepared/unprepared for, and those which explored whether UK medical schools were adequately preparing their graduates for practice, were included. Studies exploring the preparedness of international medical graduates were excluded.Results: Sixteen articles met the final inclusion criteria and are included in this review. All the final studies are cross-sectional and are varied in their use of methods used, with the vast majority using questionnaires to identify the preparedness of medical students and junior doctors.Conclusions: This review conveys that junior doctors are mostly underprepared in emergency work. This can be associated to a lack of exposure to emergency situations during their undergraduate training. Moreover, this review suggests that the preparedness of medical graduates may remain unaffected by the implementation of the MLA.

The International Landscape of Medical Licensing Examinations: A Typology Derived From a Systematic Review.

Background: National licensing examinations (NLEs) are large-scale examinations usually taken by medical doctors close to the point of graduation from medical school. Where NLEs are used, success is usually required to obtain a license for full practice. Approaches to national licensing, and the evidence that supports their use, varies significantly across the globe. This paper aims to develop a typology of NLEs, based on candidacy, to explore the implications of different examination types for workforce planning. Methods: A systematic review of the published literature and medical licensing body websites, an electronic survey of all medical licensing bodies in highly developed nations, and a survey of medical regulators. Results: The evidence gleaned through this systematic review highlights four approaches to NLEs: where graduating medical students wishing to practice in their national jurisdiction must pass a national licensing exam before they are granted a license to practice; where all prospective doctors, whether from the national jurisdiction or international medical graduates, are required to pass a national licensing exam in order to practice within that jurisdiction; where international medical graduates are required to pass a licensing exam if their qualifications are not acknowledged to be comparable with those students from the national jurisdiction; and where there are no NLEs in operation. This typology facilitates comparison across systems and highlights the implications of different licensing systems for workforce planning. Conclusion: The issue of national licensing cannot be viewed in isolation from workforce planning; future research on the efficacy of national licensing systems to drive up standards should be integrated with research on the implications of such systems for the mobility of doctors to cross borders.

National licensing exam or no national licensing exam? That is the question.

National licensing exam or no national licensing exam? That is the question.

Variation in assessment and standard setting practices across UK undergraduate medicine and the need for a benchmark.

ObjectivesThe principal aim of this study is to provide an account of variation in UK undergraduate medical assessment styles and corresponding standard setting approaches with a view to highlighting the importance of a UK national licensing exam in recognizing a common standard.MethodsUsing a secure online survey system, response data were collected during the period 13 - 30 January 2014 from selected specialists in medical education assessment, who served as representatives for their respective medical schools.ResultsAssessment styles and corresponding choices of standard setting methods vary markedly across UK medical schools. While there is considerable consensus on the application of compensatory approaches, individual schools display their own nuances through use of hybrid assessment and standard setting styles, uptake of less popular standard setting techniques and divided views on norm referencing.ConclusionsThe extent of variation in assessment and standard setting practices across UK medical schools validates the concern that there is a lack of evidence that UK medical students achieve a common standard on graduation. A national licensing exam is therefore a viable option for benchmarking the performance of all UK undergraduate medical students.

Is a single national licensing exam for doctors a good idea?

The General Medical Council has unveiled its plans for a single licensing exam for medical doctors from the United Kingdom and overseas. Abi Rimmer looks at potential concerns about the introduction of such an assessment

Pattern recognition as a concept for multiple-choice questions in a national licensing exam.

BackgroundMultiple-choice questions (MCQ) are still widely used in high stakes medical exams. We wanted to examine whether and to what extent a national licensing exam uses the concept of pattern recognition to test applied clinical knowledge.MethodsWe categorized all 4,134 German National medical licensing exam questions between October 2006 and October 2012 by discipline, year, and type. We analyzed questions from the four largest disciplines: internal medicine (n = 931), neurology (n = 305), pediatrics (n = 281), and surgery (n = 233), with respect to the following question types: knowledge questions (KQ), pattern recognition questions (PRQ), inverse PRQ (IPRQ), and pseudo PRQ (PPRQ).ResultsA total 51.1% of all questions were of a higher taxonomical order (PRQ and IPRQ) with a significant decrease in the percentage of these questions (p <0.001) from 2006 (61.5%) to 2012 (41.6%). The proportion of PRQs and IPRQs was significantly lower (p <0.001) in internal medicine and surgery, compared to neurology and pediatrics. PRQs were mostly used in questions about diagnoses (71.7%). A significantly higher (p <0.05) percentage of PR/therapy questions was found for internal medicine compared with neurology and pediatrics.ConclusionThe concept of pattern recognition is used with different priorities and to various extents by the different disciplines in a high stakes exam to test applied clinical knowledge. Being aware of this concept may aid in the design and balance of MCQs in an exam with respect to testing clinical reasoning as a desired skill at the threshold of postgraduate medical education.

The lebanese society of cardiology: plans and perspectives, navigating against contrary winds and progressing against all odds.

Scientific societies in medicine theoretically aim to improve a medical field as a science; however, this role is expanding nowadays to seeking also the improved practice of a certain medical field. In this regard, the current Lebanese Society of Cardiology (2013–2015) has laid many plans and considered many perspectives. These concern mainly, but not exclusively, the increase of public awareness regarding prevention, investment in research, implementation of guidelines, support of continuous medical education, organization of cardiology symposia and congresses, and achievement of national registries regarding main cardiac conditions, as well as the society’s main objective of decreasing the burden of cardiovascular diseases in Lebanon. Nonetheless, the implementation of such plans and perspectives is facing contrary winds related to a multifaceted phenomenon: the dominance of private medicine with a subsequent lack of teamwork, the dominance of private media, the social and political unrest in Lebanon, significant discrepancies in the scientific background of cardiologists, and the absence of a standardized national cardiology licensing exam. Importantly, the implementation of such plans and perspectives requires individual commitment, along with the cooperation of the Order of Physicians, the Syndicate of Hospitals in Lebanon (representing private hospitals) and the Ministry of Health. Moreover, industry must be more committed to medical scientific societies; the support of cardiology events organized without the auspices of the Lebanese Society of Cardiology is not encouraged because of the presence of significant conflict of interest.

Gifted Students’ Academic Performance in Medical School: A Study of Olympiad Winners

Background: The present study examines the performance of academically talented students (i.e., those who received awards in Olympiads, the international competitions for gifted students in science or mathematics) in medical school. Purpose: The goal is to investigate whether students exceptionally talented in science and mathematics excel in medical school. Methods: A retrospective analysis of 13 cohorts of medical students (N = 475) was conducted to compare learning outcomes of academically talented students (ATS) with their peers in terms of their grade point averages (GPAs) and national licensing exam (KMLE) scores. Results: ATS outperformed their peers in total GPAs (p < .001); yet there was a statistical trend of gradually diminishing performance gap between the groups as they progressed into the later years of the program. KMLE scores were comparable between the groups (p = .89). In addition, there was no significant difference in GPAs and KLME scores among ATS regardless of their areas of excellence. Conclusions: Academic merit alone is not a strong predictor of success in medical school, even among those with exceptional talent. Better understanding of nonacademic factors associated with medical school performance is warranted to improve our selection processes and to better help academically talented students succeed in medical school.

Medical education in Vietnam

Background: Vietnam is one of the most populous countries in Southeast Asia, yet it displays an unsettling lack of doctors.Aims: Medical education is an important factor contributing to this issue, yet little is known about the system currently in place in Vietnam.Methods: Through an extensive literary search of medical schools’ and Ministry of Health's data, we have examined the current medical education system in Vietnam.Results: At present, there are 12 medical universities, and the general curriculum at each university follows a national framework but tends to vary from university to university. Medical training lasts either 4 or 6 years, with competitive graduates attending residency programs following graduation. While examinations are required to graduate, the lack of a national licensing exam makes it difficult to ensure that a nation-wide standard of quality exists, both at the medical universities themselves as well as amongst the doctors graduating from them.Conclusions: The development and institution of a national exam would introduce a standard of training throughout Vietnam's medical education system. Further, a substantial portion of a doctor's education is in subjects that are loosely related to medicine. When looking forward it will be important to evaluate whether or not these non-medical subjects detract from the quality of medical training.

Predictive validity of the Medical College Admissions Test Writing Sample for the United States medical licensing examination steps 1 and 2.

Despite the amount of published research on the predictive validity of the Medical College Admissions Test (MCAT) taken as a whole, few published reports separate the individual predictive validity of the Writing Sample. The purpose of this study is to provide data on the predictive validity of the Writing Sample for the national licensing exam used in the United States. Subjects consisted of 1992-1995 matriculants from a publicly owned medical school in the Southeastern United States. Independent variables were undergraduate grade point average, and four section scores on a required admissions test (Biological Sciences, Physical Sciences, Verbal Reasoning, and Writing Sample). The dependent variables were Steps 1 and 2 on the three step licensing examination. Steps 1 and 2 of the examination are taken during medical school. Multiple regression models calculated additional variance accounted for by the addition of the Writing Sample to a model containing grade point average and the other admissions test section scores. In multivariate analyses, when grade point average and all admissions test scores were considered as predictors of licensing exam scores, the Writing Sample variable did not add to the ability to predicting the Step 1 or Step 2 scores. The results of this study suggest that the Writing Sample has limited predictive validity for assessing success on a national licensing exam. However, as others suggest, the value of the Writing Sample and other surrogates of communication probably lie in predicting performance in the clinical years of medical school and beyond. Additional work should include evaluating the predictive validity of the Writing Sample and other pre-medical school measures of communication with widely acceptable measures of performance in clinical settings, including physician-patient communication.