유럽면허시험 - 유일한 나아갈 길 (Med Teach, 2009)

European licensing examinations – The only way forward

JULIAN C. ARCHER

Peninsula College of Medicine & Dentistry, UK





 

의학교육은 global endeavor이다.

Medical education is a global endeavour leading to initiatives such as the World Federation for Medical Education(http://www.ifmsa.org/scome/wiki/index.php?title¼World_Federation_for_Medical_Education_(WFME)) and a virtualglobal medical school IVIMEDS (http://www.ivimeds.org/).Regionally including in Europe, medical specialties are work-ing closer together to support common goals including in areas of assessment (European Respiratory Society 2008). Despite this there is a growing debate about the introduction of national, not regional or international, licensing examinations(Tooke 2007; General Medical Council 2008) Europe should look to develop a regional approach.


의과대학의 퍼포먼스를 표준화하려는 external peer review process가 있다. 그러나 영국에서의 졸업시험에 관한 최근 연구결과를 보면 대학마다 qualifying exam에 대한 서로 다른 접근법을 갖고 있음을 보여준다. 이것의 영향력은 졸업 후에까지 이어져서 서로 다른 의과대학을 졸업한 학생은 이후 postgraduate exam에서도 유의미하게 다른 수행능력 차이를 보여준다. 최근에 졸업한 의사들은 국가 수준에서 공정하게fairly 비교되지 못하고 있다. 따라서 national postgraduate training program에서 유럽 내 여러 국가간 졸업생을 비교하려는 어떤 시도도 더 confounded될 수 밖에 없다.

There are external peer review processes that attempt to standardize medical school performance including assessment processes. However, it is known from recent studies of final examinations in the UK that medical towards schools often have several different approaches their qualifying exa-minations (McCrorie et al. 2008) including standard setting processes differences (Boursicot et al. 2007). The impact of these may permeate throughout a professional’s life to as graduates from different medical schools appear perform significantly different  in subsequent postgraduate examinations (Wakeford et al. 1993; McManus et al. 2008).Newly qualified doctors are not compared fairly at a national level (Ricketts & Archer 2008). Therefore any attempt to compare graduates from across Europe when recruiting to a national postgraduate training programme is additionally confounded. 


유럽면허시험은 여러 유의미한 장점이 있다. 공정한 평가는 높은 신뢰도를 필요로 하며, 높은 신뢰도를 얻기 위해서는 표준화와 구조화가 필요하다.

A European licensing examination would provide a number of significant benefits. Fair assessment requires good reliability and this in turn requires standardization and structure (van der Vleuten 1996).


또 다른 장점은 자원을 pool하는 능력이다. NBME나 ABIM이 대표적인 사례일 것이다. 이들은 평가방법론의 중대한 발전을 이끌어왔다.

 A further major benefit would be the ability to pool resources. In the US, the National Board of Medical Examiners and the American Board of Internal Medicine have led the way in large scale assessment design and implementation(Melnick 2009). This has led to significant advances in assessment methodology helping to inform the wider literature (Schuwirth 2007). 


Coordinated approach는 기준을 설정하고 질을 보장하는 robust, defensible한 방법이다.

A coordinated approach would lead to a robust,defensible way to define; implement, standard set and quality assure assessment. 


공통의 평가를 사용하는 전략은 공통의 의과대학 교육과정을 support하며, 모든 이해관계자들에게 이러한 정보가 제공될 수 있다. 공통의 교육과정과 면허시험은 증가하는 사립 의과대학에 대한 quality assurance를 가능하게 해줄 것이다.

A common assessment strategy would help to support a common medical curriculum for Europe and an opportunity for this to be informed by all stakeholders including patients and employers (Wass 2005). A common curriculum and licensing examination would also allow the quality assurance of the increasing number of private medical schools. 



IMG의사들이 종종 문화적 차이에 잘 통합되지 못하는 것이 이후 평가에서 수행능력이 떨어지는 이유로 언급되고는 한다. psycho-social skill의 평가가 포함된 잘 설계된 면허시험은 전 유럽에 걸쳐 의사에게 기대되는 것이 무엇인지를 모든 지원자들에게 guide해줄 수 있을 것이다.

IMG doctors are often poorly integrated into cultural differences perhaps explaining poorer performances in subsequent assessments such as Multi-source Feedback (Archer 2007). A well designed licensing examination that includes the assessment of psycho-social skills could help guide all candidates in what is expected of doctors working across Europe. 


가장 중요한 것은 patient care를 향상시킨다는 초기단계 근거이다.

Most importantly of all there is some initial evidence that licensing examinations improve patient care.


언어는 장애가 되어서는 안된다. 캐나다 면허시험은 영어와 불어로 동시에 제공된다.

Language should not be seen as a barrier. The Canadian licensing examination is implemented simultaneously in both English and French.


 

의과대학간 다양성이 사라지고 이것이 혁신을 저해할 것이라는 우려가 있다. 그러나 미국에서는 그러하지 않았다. 비록 일부 replacement strategy가 있을 수는 있겠지만, 면허시험은 local assessment를 대체하는 것이 아니고 더 강화시키는 것이다.

Concerns might be expressed about a reduction in diversity across medical school teaching methodology and that this in turn would stifle innovation. This has not been the experience in the US. The licensing examination should be seen as augmenting and not replacing local assessment, although it is likely that some replacement strategy would be adopted by most institutions.


면허시험이 one-off 지식검사로서 feasibility와 비용절감에만 신경쓸 것이라는 우려도 있다. 지식에 대한 검사는 평가에서 중요한 부분이긴 하지만, progress testing과 같은 방법으로 가장 잘 달성될 수 있다.

Concerns might be raised that a licensing examination would most likely consist of a one off knowledge test to achieve feasibility and minimize costs. Testing of knowledge would no doubt be an important part to any assessment approach but this might be best achieved over a number of occasions using methods such as progress testing (McHarg et al. 2005).


현재의 psychometric의 한계에 대한 논의에 더해서 평가에 따른 결정은 평가'프로그램'에 의해서 이뤄져야지 평가'방법method'에 의해서 이뤄져서는 안된다는 것이 인정되고 있다. 평가의 다른 영역에 대한 관심이 높아지면서, 유럽은 complementary한 평가방법을 찾고 다듬을 수 있을 것이다.

In addition there is discussion in the literature about the limitations of current psychometric Vleuten approaches (Schuwirth & van der 2006) and an be acknowledgement that assessment decisions should informed by assessment programmes not methods (van der Vleuten & Schuwirth 2005). With an increasing interest in other dimensions of assessment (Govaerts et al. 2007) Europe would be well placed to explore and refine complementary assess- ment methodologies and methods.




 2009 Mar;31(3):215-6.

European licensing examinations--the only way forward.

Author information

  • 1Peninsula College of Medicine & Dentistry, University of Plymouth Campus, Drake Circus, Plymouth PL4 8AA, UK. julian.archer@pms.ac.uk
PMID:
 
19811118
[PubMed - indexed for MEDLINE]


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