National Licensing Examination Research Articles

Does higher performance in a national licensing examination predict better quality of care? A longitudinal observational study of Ethiopian anesthetists.

Ethiopia made a national licensing examination (NLE) for associate clinician anesthetists a requirement for entry into the practice workforce. However, there is limited empirical evidence on whether the NLE scores of associate clinicians predict the quality of health care they provide in low-income countries. This study aimed to assess the association between anesthetists' NLE scores and three selected quality of patient care indicators. A multicenter longitudinal observational study was conducted between January 8 and February 7, 2023, to collect quality of care (QoC) data on surgical patients attended by anesthetists (n = 56) who had taken the Ethiopian anesthetist NLE since 2019. The three QoC indicators were standards for safe anesthesia practice, critical incidents, and patient satisfaction. The medical records of 991 patients were reviewed to determine the standards for safe anesthesia practice and critical incidents. A total of 400 patients responded to the patient satisfaction survey. Multivariable regressions were employed to determine whether the anesthetist NLE score predicted QoC indicators. The mean percentage of safe anesthesia practice standards met was 69.14%, and the mean satisfaction score was 85.22%. There were 1,120 critical incidents among 911 patients, with three out of five experiencing at least one. After controlling for patient, anesthetist, facility, and clinical care-related confounding variables, the NLE score predicted the occurrence of critical incidents. For every 1% point increase in the total NLE score, the odds of developing one or more critical incidents decreased by 18% (aOR = 0.82; 95% CI = 0.70 = 0.96; p = 0.016). No statistically significant associations existed between the other two QoC indicators and NLE scores. The NLE score had an inverse relationship with the occurrence of critical incidents, supporting the validity of the examination in assessing graduates' ability to provide safe and effective care. The lack of an association with the other two QoC indicators requires further investigation. Our findings may help improve education quality and the impact of NLEs in Ethiopia and beyond.

Policy Reform on the Qualification Pathway of Internationally Educated Nurses in Greenland and Its Relationship With the Danish System: A Qualitative Discourse Analysis.

The nursing profession in Greenland, particularly in rural and remote areas, faces challenges due to geographical limitation and a lack of interdisciplinary collaboration. The registration process and status of internationally educated nurses (IENs) in Greenland are unclear. This article aimed to analyze existing policies and propose recommendations for an independent registration process for IENs in Greenland. A qualitative discourse analysis was used to critically discuss existing policies and regulations governing nursing registration in Greenland. Relevant legislation, government reports, and official documents were reviewed. Legislative regulations protect the title of registered nurse in both Greenland and Denmark. To work in Greenland, an IEN must have a residence permit. With recent health agreements between Greenland and Denmark, both countries have streamlined the permit acquisition process for foreign healthcare professionals, making it more accessible. However, the process of acquiring a license to work as a registered nurse for IENs lacks clarity. Policy reform is needed to establish a group of diverse nurse experts under the National Board of Health responsible for the assessment and registration of IEN qualifications. There is also a need for a bridging education program or national licensure examination which could facilitate faster IEN recognition. Mutual recognition of nurse licenses between Greenland and Denmark should be established to ensure efficient healthcare delivery and maintain professional standards. Embracing IENs can address nursing shortages and improve healthcare services in Greenland.

ChatGPT (GPT-4) passed the Japanese National License Examination for Pharmacists in 2022, answering all items including those with diagrams: a descriptive study.

The objective of this study was to assess the performance of ChatGPT (GPT-4) on all items, including those with diagrams, in the Japanese National License Examination for Pharmacists (JNLEP) and compare it with the previous GPT-3.5 model’s performance. The 107th JNLEP, conducted in 2022, with 344 items input into the GPT-4 model, was targeted for this study. Separately, 284 items, excluding those with diagrams, were entered into the GPT-3.5 model. The answers were categorized and analyzed to determine accuracy rates based on categories, subjects, and presence or absence of diagrams. The accuracy rates were compared to the main passing criteria (overall accuracy rate ≥62.9%). The overall accuracy rate for all items in the 107th JNLEP in GPT-4 was 72.5%, successfully meeting all the passing criteria. For the set of items without diagrams, the accuracy rate was 80.0%, which was significantly higher than that of the GPT-3.5 model (43.5%). The GPT-4 model demonstrated an accuracy rate of 36.1% for items that included diagrams. Advancements that allow GPT-4 to process images have made it possible for LLMs to answer all items in medical-related license examinations. This study’s findings confirm that ChatGPT (GPT-4) possesses sufficient knowledge to meet the passing criteria.

Performance of ChatGPT on Chinese national medical licensing examinations: a five-year examination evaluation study for physicians, pharmacists and nurses

BackgroundLarge language models like ChatGPT have revolutionized the field of natural language processing with their capability to comprehend and generate textual content, showing great potential to play a role in medical education. This study aimed to quantitatively evaluate and comprehensively analysis the performance of ChatGPT on three types of national medical examinations in China, including National Medical Licensing Examination (NMLE), National Pharmacist Licensing Examination (NPLE), and National Nurse Licensing Examination (NNLE).MethodsWe collected questions from Chinese NMLE, NPLE and NNLE from year 2017 to 2021. In NMLE and NPLE, each exam consists of 4 units, while in NNLE, each exam consists of 2 units. The questions with figures, tables or chemical structure were manually identified and excluded by clinician. We applied direct instruction strategy via multiple prompts to force ChatGPT to generate the clear answer with the capability to distinguish between single-choice and multiple-choice questions.ResultsChatGPT failed to pass the accuracy threshold of 0.6 in any of the three types of examinations over the five years. Specifically, in the NMLE, the highest recorded accuracy was 0.5467, which was attained in both 2018 and 2021. In the NPLE, the highest accuracy was 0.5599 in 2017. In the NNLE, the most impressive result was shown in 2017, with an accuracy of 0.5897, which is also the highest accuracy in our entire evaluation. ChatGPT’s performance showed no significant difference in different units, but significant difference in different question types. ChatGPT performed well in a range of subject areas, including clinical epidemiology, human parasitology, and dermatology, as well as in various medical topics such as molecules, health management and prevention, diagnosis and screening.ConclusionsThese results indicate ChatGPT failed the NMLE, NPLE and NNLE in China, spanning from year 2017 to 2021. but show great potential of large language models in medical education. In the future high-quality medical data will be required to improve the performance.

DEVELOPMENT OF TWO GERIATRIC CASES TO PREPARE STUDENTS FOR THE NEXT-GENERATION RN LICENSING EXAM

Abstract With the implementation of the Next Generation NCLEX-RN (NGN) national licensing examination in April of 2023, faculty in state of Maryland nursing schools were solicited for participation in a Maryland Nursing Workforce Center grant initiative to develop a repository of NGN case studies. A major change in the exam was the integration of a six-step clinical judgment model using a case-based format with client information presented in an electronic medical record using new question types designated for each of the steps presented sequentially. Twenty faculty “champions” from 13 Maryland schools attended several training sessions and were to develop two peer-reviewed cases for inclusion in the Qualtrics database. Once approved, these cases could then be accessed online via a secure link or QR code by Maryland-based nursing faculty and shared with students for instructional and practice purposes. Two gero-focused cases were developed. The first case focused on an older adult in a long-term care facility admitted to the hospital for a urinary tract infection with potential complication of urosepsis. Another featured a hospitalized older adult client with Alzheimer’s disease admitted from home with dehydration with potential for delirium superimposed on dementia. While a major objective of this innovative and proactive state-wide initiative is to optimize success on the modified NCLEX-RN, it is also hoped that these case examples, when appropriately integrated into the nursing curriculum, will enhance understanding of common geriatric scenarios and better prepare graduates for safe, effective nursing care of older adults.

GPT-4 can pass the Korean National Licensing Examination for Korean Medicine Doctors

Traditional Korean medicine (TKM) emphasizes individualized diagnosis and treatment. This uniqueness makes AI modeling difficult due to limited data and implicit processes. Large language models (LLMs) have demonstrated impressive medical inference, even without advanced training in medical texts. This study assessed the capabilities of GPT-4 in TKM, using the Korean National Licensing Examination for Korean Medicine Doctors (K-NLEKMD) as a benchmark. The K-NLEKMD, administered by a national organization, encompasses 12 major subjects in TKM. GPT-4 answered 340 questions from the 2022 K-NLEKMD. We optimized prompts with Chinese-term annotation, English translation for questions and instruction, exam-optimized instruction, and self-consistency. GPT-4 with optimized prompts achieved 66.18% accuracy, surpassing both the examination’s average pass mark of 60% and the 40% minimum for each subject. The gradual introduction of language-related prompts and prompting techniques enhanced the accuracy from 51.82% to its maximum accuracy. GPT-4 showed low accuracy in subjects including public health & medicine-related law, internal medicine (2), and acupuncture medicine which are highly localized in Korea and TKM. The model’s accuracy was lower for questions requiring TKM-specialized knowledge than those that did not. It exhibited higher accuracy in diagnosis-based and recall-based questions than in intervention-based questions. A significant positive correlation was observed between the consistency and accuracy of GPT-4’s responses. This study unveils both the potential and challenges of applying LLMs to TKM. These findings underline the potential of LLMs like GPT-4 in culturally adapted medicine, especially TKM, for tasks such as clinical assistance, medical education, and research. But they also point towards the necessity for the development of methods to mitigate cultural bias inherent in large language models and validate their efficacy in real-world clinical settings.

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.

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.

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.

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.

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.

Applying the 2022 Cardiovascular and Pulmonary Entry-Level Physical Therapist Competencies to Physical Therapist Education and Practice.

Competency-based education (CBE) is an emerging topic within physical therapy (PT). It has emerged to assure all stakeholders that physical therapist education program graduates are proficient in the requisite knowledge, skills, and behaviors (KSBs) essential for entry-level practice. Competencies have existed within cardiovascular and pulmonary (CVP) PT since 1980, updated in 2008, and most recently updated in 2022. This article discusses how individuals should apply the 2022 CVP competencies to clinical practice and education. The 2022 CVP competencies were developed using a modified mixed-method Delphi approach. These competencies set a level of proficiency for KSBs used within entry-level CVP PT practice following the patient-client management model. The position put forward in this article describes how and why multiple stakeholder groups should apply these entry-level competencies specifically for graduates of physical therapist education programs who are entering practice (entry level). The competencies provide a more detailed description of expected proficiency for entry-level CVP PT practice than currently available documents. These competencies may form the basis for developing entrustable professional activities (EPAs). The establishment of entry-level competencies is essential for use by multiple stakeholders to inform physical therapist curriculum, provide clinical instructors with a reference for expected levels of proficiency during final student clinical experiences, guide content on the Federation of State Boards of PT national licensure examination, and prepare employers to provide needed continued professional development, based on the clinical environment. These competencies lend themselves to the future development of EPAs in the PT profession for CVP PT.

Evaluation of Teacher Education Curricula and its relevance to licensure examination using Context, Input, Process and Product (CIPP) model

This study aimed to evaluate the relevance of the teacher education curricula of one state university in Samar Philippines to the national licensure examination for teachers. To this end, the CIPP (context, input, process, and product) evaluation model developed by Stufflebeam was employed. Documentary analysis of course catalog, interviews with the teachers and students as well as focus group discussion of graduates who took the exam were employed to gather data. Based on the experiences and viewpoint of the student-participants, there are areas for improvement of the curricula in terms of its relevance to the licensure examinations. The evaluation revealed mismatches and discrepancies of the curricula to the professional examination. It is recommended that an effective curricula should ensure that student graduates can depend on its content in order to hurdle licensure examination competencies. Hence to sustain its relevance, it entails constant upgrading of the curricula which involve both the faculty and the students.

THE IMPACT OF INDONESIAN MEDICAL DOCTORS NATIONAL COMPETENCY EXAMINATION (IMDNCE) TOWARDS LEARNING AND CLINICAL PRACTICES: A QUALITATIVE STUDY ON THE INTERNSHIP DOCTORS’ PERSPECTIVES

Background: The implementation of the national licensing examination for medical doctors is expected to have a broad impact on doctors and society. Indonesian Medical Doctor National Competency Examination (IMDNCE; Indonesian: Uji Kompetensi Mahasiswa Program Profesi Dokter or UKMPPD) as an ‘exit exam’ in the medical education process may significantly impact learning and clinical practices. The study’s objective was to explore the impact of IMDNCE on both the learning and clinical practices of doctors.Methods: The study subjects were internship doctors who had passed the IMDNCE. Participants were recruited by purposive sampling based on the ownership status of the institution (state/private) and the accreditation of respective medical schools and participants’ gender. The study participants consisted of 41 internship doctors working in 6 regions from 33 different medical schools out of 75 medical faculties in Indonesia.Results: IMDNCE has a positive influence on learning and clinical practice. The IMDNCE process emphasizes standard competencies that must be mastered and patient management process with current evidence that is not always achieved during clinical education, increasing clinical knowledge and skills, and increasing awareness of professional development. IMDNCE also has very well affected in the development of self-confidence and a sense of responsibility which are essential in clinical practice. In addition to psychological influences, IMDNCE improves competence in clinical skills and promotes good medical practice.

Quality of multiple-choice questions in medical internship qualification examination determined by item response theory at Debre Tabor University, Ethiopia

BackgroundAssessment of cognitive competence is a major element of the internship qualification exam in undergraduate medical education in Ethiopia. Assessing the quality of exam items can help to improve the validity of assessments and assure stakeholders about the accuracy of the go/no decision to the internship. However, we know little about the quality of exam items utilized to ascertain fitness to join the medical internship. Therefore, this study aimed to analyze the quality of multiple-choice questions (MCQs) of the qualification exam administered to final-year medical students at Debre Tabor University (DTU), Ethiopia.MethodsA psychometric study was conducted to assess the qualities of 120 randomly selected MCQs and 407 distractors. Item characteristics were estimated using the item response theory (IRT) model. T-test, one-way ANOVA, and chi-square tests were run to analyze the univariate association between factors. Pearson’s correlation test was done to determine the predictive validity of the qualification examination.ResultOverall, 16, 51, and 33% of the items had high, moderate, and low distractor efficiency, respectively. About two-thirds (65.8%) of the items had two or more functioning distractors and 42.5% exhibited a desirable difficulty index. However, 77.8% of items administered in the qualification examination had a negative or poor discrimination index. Four and five option items didn’t show significant differences in psychometric qualities. The qualification exam showed a positive predictive value of success in the national licensing examination (Pearson’s correlation coefficient = 0.5).ConclusionsThe psychometric properties of the medical qualification exam were inadequate for making valid decisions. Five option MCQs were not better than four options in terms of psychometric qualities. The qualification examination had a positive predictive validity of future performance. High-stakes examination items must be properly created and reviewed before being administered.