The need for national licensing examinations.

It is interesting to see how some developments in assessment in the USA and UK seem to have gone in opposite directions. The USA has a longstanding tradition of highquality national licensing examinations, whereas, in the UK, each medical school has traditionally been responsible for its own examination programmes. Although UK medical schools use external examiners, the country has no national licensing examinations. Strikingly, in the USA, methods to ensure the quality of medical students and graduates other than those of standardised testing are developed. By contrast, the idea of introducing a national licensing system is currently under investigation in the UK. Apparently it is feared that differences between medical schools in assessment in general and in pass ⁄ fail scores in particular may produce graduates of different levels of quality. A recent paper by Kathy Boursicot et al. demonstrates that such differences do exist and discusses its results in terms of the support they lend to the introduction of a national licensing examination.