THE NATIONAL LICENSING EXAMINATION: A COMPARISON WITH OTHER MAJOR MEDICAL LICENSING EXAMINATIONS AND PRACTICAL SUGGESTIONS FOR WIDER ACCEPTANCE

Heads: A medical student completes their Bachelor of Medicine and Surgery (MBBS) degree after five years mentally exhausting back-breaking toil. They then go on to complete one demanding year internship in a hospital. Now they want start clinical practice. The regulatory body physicians has some other ideas though. It wants them give yet another exam, covering the same subjects have cleared during MBBS. When think right be practicing independently, study hard undertake an exam again. Tails: country knows quality teaching is not uniform. standard training also varies greatly. Yet, attaining MBBS completing internship, every doctor deemed qualified enough manage patients without any supervision. body, therefore, introduces uniform licensing that needs pass before starting independent believes only those who had attained minimum acceptable level competence will eventually capable thus treat people. Medical examinations are considered tool gauge doctor’s for unsupervised National Licensing Examination (NLE) was announced 24th September 2020 Section 20 Pakistan Commission (PMC) Act 2020.1 idea inspired by similar exams many countries.2 Fast forward more than year, this still faces stiff resistance from students Association (PMA).3,4 Broadly, there two main objections: nature itself, its applicability. deem it unfair asked appear obtaining degree. Another point contention including all current students. argued should began education PMC 2020. petition filed Lahore High Court effect dismissed adjudicating judge, making mandatory future NLE.5 Is really so flawed abandoned altogether? justified taking exam? Are concerns protesting valid? middle ground conflict? Let us analyze format NLE compare with most coveted world. designed as two-step examination. first step multiple-choice questions (MCQ) based theory component containing 70% MCQs sciences 30% basic sciences. order qualify second Clinical Skills (CSE). CSE aims evaluate essential skills required general practitioner through structured can acquiring qualification. Both steps need passed attain permanent license PMC.6 United States Exam (USMLE) well-known three-step comprising Step 1, 2 Knowledge (CK), 3. MCQ attempted local at end 2nd education. test examinee’s aptitude apply integral science concepts scenarios. CK assesses grasp knowledge understanding patient care under Local 4th education; passing receive graduation. 3 again candidate’s caliber practice medicine. This graduation necessary independently US. After decision abandon (CS) examination February 2021, currently no USMLE. International Graduates (IMGs) clear 1 (not necessarily fixed time) become eligible 3.7 Professional Linguistic Assessments Board (PLAB) two-part taken General Council (GMC) Kingdom (UK).PLAB tests ability acquired answer clinical-scenario questions. PLAB communication standardized patients.8 Currently, IMGs medicine UK. set change 2024; GMC Assessment (MLA) both UK locals 2024 onwards registration.9 above discussion bodies countries US addition college system 2024. Therefore, concept sound one, international practices. problem may lie timing exam. curriculum broadly divided into categories: Basic sciences, name suggests, contain core understand basics human body. These include like anatomy, physiology, biochemistry, pharmacology etc. typically focused three deal practical medicine, surgery, paediatrics, gynaecology given emphasis final key deadlock NLE. theoretical exam.6 means studying again, portions which studied ago. separate a) b) c) take when actually examined subjects, rather together end. Table demonstrates proposed TABLE I: PROPOSED FORMAT AND TIMING OF THE NATIONAL LICENSING EXAMINATION Subjects/Skills Format Minimum Qualification Sciences Year Communication Structured 5th NLE=National Examination; MCQ=Multiple-choice questions; MBBS=Bachelor Splitting advantageous concerned, i.e. PMC, students, public. achieve desired objective assessing physician’s offering registration. Students appearing accordance current/recent curriculum. reduce burden make agreeable them. public healthcare doctors would proved competence. Heads or tails? We win ways!