The medical licensing examination debate

Abstract

National licensing examinations are typically large-scale examinations taken early in a career or near the point of graduation, and, importantly, success is required to subsequently be able to practice. They are becoming increasingly popular as a method of quality assurance in the medical workforce, but debate about their contribution to patient safety and the improvement of healthcare outcomes continues. A systematic review of the national licensing examination literature demonstrates that there is disagreement between assessment experts about the strengths and challenges of licensing examinations. This is characterized by a trans-Atlantic divide between the dominance of psychometric reliability assurance in North America and the wider interpretations of validity, to include consequences, in Europe. We conclude that the debate might benefit from refocusing to what a national licensing examination should assess: to achieve a balance between assessing a breadth of skills and the capacity for such skills in practice, and focusing less on reproducibility.

Sex differences in medico-legal action against doctors: a systematic review and meta-analysis

“…The burden of investigating complaints about doctors’ fitness to practise not only places an enormous level of stress on the doctor being investigated, as highlighted by a recent report on the impact on the mental well-being of doctors undergoing investigation [ 3 ], but also places a resource strain on regulators [ 4 ]. The increase in the number of investigations may also lead to patient concerns about the quality of care they receive.…”

Reforming regulatory relationships: The impact of medical revalidation on doctors, employers, and the General Medical Council in the United Kingdom

“…The reduction in medical autonomy attributed to these changes has been argued as necessary and timely (Chamberlain 2014;Saks 2014), although some would argue that it represents an unwarranted expansion of regulatory control (Williams et al 2014). As a component of regulation, revalidation is an important innovation when contrasted both with systems of medical regulation internationally and with the regulation of other health professions in the UK (Spendlove 2013;Archer et al 2017). Instead of doctors interacting directly (and relatively rarely) with the professional regulator, revalidation requires that appraisal and other information about performance instead be collected and considered at the organizational level, under the auspices of the RO.…”

“…Research specifically considering the regulation of medical work is less common. Such research has focused on how changes to regulation have been responded to by the medical profession, and what this means for the profession's relationship with the regulator, government, and wider society (Trubek et al 2008;Waring et al 2010;Chamberlain 2014;Archer et al 2017).…”

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

“…In large part this has been in response to the increasing demands of accountability and assurance of public trust, and as regulation has increased so has the demand for large scale examinations and assessments as a means of assuring minimum standards. 2 Much of the debate, including recent contributions to Academic Medicine, 3 - 5 has focused on the efficacy of national licensing and whether current examination systems are appropriately preparing physicians for independent practice. This paper reports a typology, arising from a systematic review, which broadens this debate by considering the wider context which has shaped the policies and debates concerning national licensing, namely: The internationalization of medical training, increased medical workforce mobility and, relatedly, workforce planning.…”