사우디 아라비아에서의 NLE (BMC Med Educ, 2008)

사우디 아라비아에서의 NLE (BMC Med Educ, 2008)

The need for national medical licensing examination in Saudi Arabia

Sohail Bajammal*1,14, Rania Zaini1, Wesam Abuznadah2, Mohammad Al-Rukban3, Syed Moyn Aly4, Abdulaziz Boker5, Abdulmohsen Al-Zalabani3, Mohammad Al-Omran6, Amro Al-Habib6, Mona Al-Sheikh7, Mohammad Al-Sultan8, Nadia Fida5, Khalid Alzahrani9, Bashir Hamad8, Mohammad Al Shehri10, Khalid Bin Abdulrahman11, Saleh Al-Damegh12, Mansour M Al-Nozha13 and Tyrone Donnon14

배경

Background

의학교육의 세 가지 상호연결된 영역

The three main interconnected domains of medical edu- cation are: curriculum design, instructional methods and assessment measures.

Figure 1 Dynamic Domains of Medical Education.

 

고찰

Discussion

사우디 아라비아 의학교육의 현재

The current status of medical education in Saudi Arabia

의과대학 설립

The first medical school in Saudi Arabia was established in 1967 at King Saud University. This was followed by the establishment of four medical schools over the span of thirty years (1967 to 1996). Since the beginning of the new millennium, 20 medical schools have been estab- lished (14) or planned for opening (6) in the coming few years. This will bring the total number of medical schools in Saudi Arabia to 25 (Table 1). The expansion in the number of medical schools is intended to meet the short- age of Saudi-national physicians, estimated to be less than 17% of the total physicians in 2000 [16] and to serve its population of around 28 million people and millions of tourists and pilgrims who visit Saudi Arabia annually.

 

의과대학 학제

Twenty of the 25 medical schools are government-funded with no tuition fee for Saudi students. The five private medical schools are open to students of all nationalities; however, the average annual tuition fee is around $15,000 US. Mirroring the British system, all of the medical schools admit students with a high school diploma to enroll in a six year program. Some schools (e.g. King Saud bin Abdulaziz University for Health Sciences, established in 2005) offer an additional graduate students-stream of a four-year program with a requirement of a pre-medical Bachelor degree, mirroring the North American system.

 

의과대학 선발

Acceptance into medical schools is based on students' high school grade point average, and performance on the General Aptitude Exam and National Achievement Test for Health Colleges. The latter two examinations, intro- duced four years ago, are national standardized tests con- ducted by the National Center for Assessment in Higher Education [17]. In addition, most schools include per- sonal interviews in the selection process.

Table 1: List of Medical Schools in Saudi Arabia

 

의과대학 교육과정: 각 의과대학은 각자의 교육과정/교육목표/교육방법을 결정함. 스펙트럼이 매우 다양함. 표준화 환자의 활용은 매우 적음

Each medical school in Saudi Arabia decides internally, by virtue of its curriculum committee, on the details of the curriculum and the educational objectives. Similarly, each medical school independently determines the instruc- tional methods to be used to deliver the curriculum. The spectrum of educational strategies ranges from a lecture- based/teacher-centered to problem-based/student-cen- tered approach to teaching and learning [18,19]. Finally, each medical school in Saudi Arabia develops and admin- isters its own formative and summative assessment meas- ures. Consequently, the methods of assessing students' knowledge, skills and attitudes in these medical schools are quite variable from one school to another. The use of stand- ardized patients in Saudi medical schools is minimal.

(학생)인턴십과 레지던트 수련을 위한 시험

A mandatory rotating internship year is required of all students before the medical diploma (either an MBBS or an MBChB) is awarded by a medical school. The medical diploma qualifies the graduate as a competent physician with the ability to practice medicine as a general practitioner anywhere in Saudi Arabia. If the graduate chooses to apply for a residency program in Saudi Arabia, he or she must sit for the "Acceptance Test", also known as Saudi Licensing Exam, regulated by the Saudi Commission for Health Specialties (SCHS) [20]. The "Acceptance Test" consists of 100 MCQs and lasts for 2.5 hours. In addition, some residency programs require specialty-specific exams, regulated by the SCHS, to screen candidates for entry into their programs.

 

SCHS의 역할

Established by a Royal decree in 1993, the SCHS is a scientific body with a corporate entity that has multiple roles focused mainly at the level of the postgraduate training programs and practicing healthcare professionals. These include the provision, supervision and accreditation of residency programs in the country in addition to the annual assessments and final certification examinations of residents in all healthcare specialties.

그러나 SCHS는 학부의학교육에 대한 관리에는 역할이 적다.

Yet, SCHS has a limited role in supervising undergraduate medical education.

새로운 의과대학 설립 외에도 정부에서는 여러 의과대학생들이 해외에서 학교를 다닐 수 있도록 지원해준다.

In addition to the establishment of new medical schools, the government has facilitated the sponsorship of many medical students to study abroad to face the increasing need for medical professionals.

이상의 특성을 여섯 가지로 요약 가능하다.

To summarize, we can identify six phenomena in the Saudi medical education movement:

• 1) 단기간에 다수 의과대학 신설
  the increase in the number of new medical schools over a relatively short period of time;

• 2) 교육 철학/방법/평가의 넓은 스펙트럼
  the wide spectrum of educational phi- losophies, instructional methods and assessment tech- niques;

• 3) 의과대학 졸업생에 대한 국가적으로 합의된 출판된 기준의 부재
  the absence of published national agreement on the competency of medical graduates or standards for medical school graduation outcomes;

• 4) 사우디 내에서 진료중인 의사 중 높은 해외의과대학 졸업생 비율
  the large propor- tion of foreign medical graduates practicing medicine in Saudi Arabia;

• 5) 해외에서 의학을 수학하고 온 사우디 학생의 규모
  the large number of Saudi medical stu- dents sent on scholarship to a wide spectrum of medical education systems around the world (from China in the Far East, to Slovakia in Eastern Europe, to Austria in West- ern Europe, to Canada in North America); and

• 6) 의과대학 지원자의 급격한 증가
  the exponential increase (150% to 200%) in the enrollment of medical students in the established medical schools with no proportional increase in resources.

추가적으로, 사우디의 의료시스템이 처한 도전과제에 대한 대중의 인식 수준이 높아지고 있다 (의사의 책무성, 환자안전, 잦은 의료과오 등)

In addition, there has been a heightened public awareness of the chal- lenges facing the Saudi medical system as presented in the local media. These include the need for physician accountability, assurance of patients' safety and frequent reports on medical errors.

 

 

사우디 의사면허시험의 비전

Vision of the Saudi medical licensing examination

사우디에는 의학교육을 위한 국가 수준의 합의된 (졸업)역량이 없다.

Currently, there is no published consensus on the national competencies for medical education in Saudi Arabia. On the contrary, other countries have con- sensus of lists of competencies that a graduating medical student is expected to master in order to practice medi-cine, thus it would be easier to design national licensing examinations to address these different competencies. Table 2 summarizes examples of national and interna- tional competencies of physicians.

 

Table 2: Examples of National Competencies of Physicians

 

 

고부담 시험 도입을 위한 준비

Preparation of high-stakes examinations

Roberts 등에 따르면 네 단계가 필요하다.

As explained concisely by Roberts and colleagues [22], the four steps involved in preparing high-stakes assessment exams are:

1) 교육목표의 블루프린팅 blueprinting the educational objectives,

2) 적절한 시험 형식의 선정 selection of appropriate test formats,

3) 적정 수준의 신뢰도 달성을 위한 평가 전략 적용 applying assess- ment strategies to achieve adequate levels of reliability, and

4) 적절한 스탠다드 세팅과 최종 합/불합 결정 implementing appropriate standard setting and decision-making procedures.

1) 교육목표의 블루프린팅: 교육목표, 학습목표에 맞는 시험의 내용의 배치를 보여주는 grid 작성

Blueprinting or creating a table of specifications provides a grid which maps the content of the examination against the educational goals and learning objectives of the planned curriculum. Blueprinting ensures that the con- tent and face validity of the test are established.

2) 적절한 시험 형식의 선정: 임상역량의 모든 부분에 적합한 단일한 평가형식은 없다. 어떤 수준에서 평가할 것인지가 중요하다.

The second step in the preparation of a high-stakes exam- ination is the selection of test formats best suited to the educational objectives to be assessed. Initially, it is impor- tant to acknowledge that there is no one single test format that is able to assess all aspects of clinical competence [24]. From one perspective, it is important to decide on the level of assessment we intend to evaluate when assess- ing the clinical competencies as presented in the frame- work proposed by George Miller [25] (Figure 2).

평가하고자 하는 것의 위계 뿐만 아니라, 세 영역 중 어떤 것을 평가하고자 하는지도 중요하다.

In addition to the hierarchy of the assessment process, it is important to consider the three domains of learning competencies being measured: knowledge (cognitive), skills (psychomotor) and attitudes (affective). Within each domain, there is taxonomy of levels of assessment, starting from simple basic tasks to advanced complex functions (Table 3).

3) 세 번째 단계는 적정 수준의 신뢰도 달성을 위한 평가 전략을 활용하는 것

The third step in preparing high-stakes examination is applying strategies to achieve acceptable reliability of the test.

 

측정오차에 기여할 수 있는 것들은 다양하다. 이 모든 것이 variation의 잠재적 근원이며, 신뢰도에 영향을 준다. 이것을 줄이븐 방법은, 블루프린트에 대한 피어리뷰, 출제자들을 위한 워크숍 등이 있다.

There are a number of fac- tors that can contribute to errors of measurement: All of these potential sources of var- iation, which add noise or confounding factors that influ- ence students' scores in testing, are detrimental to the overall reliability of the examination. The detrimental effects of these potential sources of variation can be reme- died by using peer-reviewed blueprints (or rubric) of the exams and conducting educational workshops and meet- ings for the examiners to assure that the best practices of developing MCQs and OSCEs are followed.

4) 네 번째 단계는 스탠다드 세팅이다. criterion-referenced 방법이 더 적절하다.

The fourth step in preparing high-stakes examination is standard setting. Asmost summative and licensure examinations are consid- ered to be high-stakes testing, the criterion-referenced standard setting method is preferred

 

Figure 2 Miller's Framework of Clinical Assessment (© Miller GE: The assessment of clinical skills/competence/performance. Acad Med 1990, 65: S63–S67. Figure 1 [25]. Reproduced with the permission of the copyright holder.): with the corresponding appropriate methods of assessment.

Table 3: Taxonomy of Educational Objectives: Knowledge (Cognitive), Skills (Psychomotor) and Attitude (Affective) Domains

 

의사국가시험의 형태 제안

The proposed examination

 

두 부분으로 나눠져 있다. 첫 번째 파트는 기초과학과 임상지식, 두 번째 파트는 임상술기와 태도

We are proposing an examination that consists of two parts (Figure 3). The first part tests the basic science and clinical knowledge and the second part tests the clinical skills and attitudes.

면허시험은 (SCHS와 같은) 독립된 judicial body에 의해서 수행되어야 한다. 그러한 단체는, 특히 프로젝트의 초반 단계에서는 경험이 많은 기관으로부터 조언을 얻을 필요가 있다. 또한, psychometrics와 testing에 전문가를 모집하여 시험을 개발하고 시행하는데 도움을 받아야 한다.

The licensing examination should be conducted and maintained by an independent judicial body (for exam- ple, SCHS) with representation from the medical schools. Such an organization, especially at the initial stages of such a project, would likely benefit from consulting expe- rienced organizations in conducting such examinations (e.g., the Medical Council of Canada and the National Board of Medical Examiners). Additionally, we suggest recruiting medical education experts in psychometrics and testing to assist in the development and administra- tion of these examinations seeking higher test standards.

우리는 관심있는 독자들을 초대하여 NBME에서 발간한 자료에 대한 컨설트를 받았다. 우리는 미래에 CAT를 도입하기 위해서 문제은행을 유지관리하는데 IRT를 사용할 것을 고려했다. CAT의 한 가지 장점은 더 적은 문항으로 신뢰도를 떨어뜨리지 않으면서, 동시에 문제은행이 지나치게 빨리 고갈될 우려를 덜면서 시험을 시행할 수 있다는 것이다.

We invite interested readers to consult a very helpful resource published by the National Board of Med- ical Examiners for constructing effective MCQs [29]. We suggest considering the use of Item Response Theory in maintaining a Questions Bank to enable computer adap- tive testing in the future. One of the advantages of compu- ter adaptive testing is the potential to use fewer numbers of questions without endangering the overall reliability of the test and, simultaneously, avoiding the risk of deplet- ing the items held within the Questions Bank too quickly.

우리는 SP와 표준화된 체크리스트를 활용한 OSCE스타일의 시험 형식을 활용할 것을 제안하였다. 비록 OSCE가 16개 스테이션까지 늘릴 경우 신뢰도, 타당도가 높지만 들어가는 비용 역시 크다. 적절한 시설과 인력을 갖춰야 하는 것은 물론이고, SP를 고용하고 교육시키는 비용도 있으며, 이런 것들이 신뢰도, 타당도를 높이는데 결정적이다.

We propose the use of an OSCE- style examination format that utilizes trained standard- ized patients and standardized checklists. Although the OSCE format has been found to have good reliability and validity when upwards of 16 stations are used, the expenses to develop and administer this type of examina- tion process can be significant. In addition to having the appropriate facilities and personnel to maintain such a testing centre, there are costs related to the hiring and training of the standardized patients and examiners (raters) that are crucial to ensure the high reliability and validity of the results.

Figure 3 Summary of Proposal.

 

의사국가시험 도입의 원동력

Driving forces for the national examination

 

1. 늘어나는 의과대학의 숫자

1. The increased number of medical schools

단기간에 의과대학이 빠르게 증가하였다. 기존 의과대학은 경험이 많은 의학교육자들을 새로운 의과대학에 빼앗기는 불이익을 당했고, 새로운 의과대학은 신생의과대학이라는 이유로 불이익을 당했다.

The exponential increase in the number of medical schools in Saudi Arabia in a short period of time necessi- tates a mechanism to ensure high-quality of graduating medical students both from the established and new med- ical schools. The established medical schools are at a dis- advantage due to relocation of some of their experienced medical educators to the new schools, while the new med- ical schools are often disadvantaged due to being new"

2. 평가방식의 일관성 부족

2. Lack of consistency in assessment methods

personal communication에 따르면 그러하다. 

Although we could not find published reports of the assessment methods used in Saudi medical schools, our personal communications and the fact that the authors of this report represent medical educators from many medical schools across the country confirm our position.

3. 사우디 내 해외 의과대학 졸업생의 높은 비율

3. Large proportion of foreign medical graduates in Saudi Arabia

SCHS에서 시행하는 시험이 있지만, 전공과목-기반의 시험이며, 의료전문직의 최소역량을 평가하는 시험이 아니다. 미국이나 캐나다는 해외 의과대학 졸업생이 반드시 시험을 통과해야 한다.

Although there are examinations conducted by the Saudi Commission of Health Specialties for the purpose of "Professional Classification", these examinations are specialty-based and are not necessarily tailored to address the minimal competencies of a medical professional. On the contrary, in the US or Canada, any foreign medical graduate must pass licensing examinations in order to be eligible to practice in the country, then he or

면허시험이 없는 나라에서조차 해외의과대학 졸업생은 의사면허시험을 통과해야 독립적 진료를 할 수 있다. 영국의 PLAB이나 호주의 AMC시험 등이 그 예이다.

Even in some coun- tries where there is no medical licensing examination for national graduates, foreign medical graduates have to pass a licensing examination before they are able to practice medicine in these countries. Examples include the Profes- sional and Linguistic Assessments Board (PLAB) Test in UK and the Australian Medical Council examination in Australia.

 

4. 다양한 학부(해외 의과대학) 졸업생

4. Scholarships for undergraduate medical students

해외에서 의과대학을 졸업한 학생이 늘어나면서 학생들이 이수한 학부의학교육의 퀄리티가 다양해질 것이며, 다양한 문화적 배경에서 의과대학을 졸업한 학생들이 사우디로 들어올 것이다

The expansion of international scholarship of undergrad- uate medical studies will bring many Saudi physicians with variable qualities of undergraduate medical educa- tion and from different cultural backgrounds into the country.

5. 계획된/전달된/평가된/잠재적 교육과정

5. Planned, delivered, assessed and hidden curricula

Richard Hays는 다음과 같이 묘사했다.

Richard Hays had nicely illustrated the dif- ferences and relationship between potential, planned, delivered, assessed and hidden curricula [35].

우리는 국가시험이 국가적으로 계획된 교육과정을 명시적으로 제시하고, 그 교육과정을 마찬가지로 명시적으로 제시된 방법으로 평가하여 잠재교육과정을 최소화시켜줄 것으로 기대한다.

We believe that a national examination will minimize this hidden curriculum because the national planned curricu-lum will be explicitly stated and the assessed curriculum will be similarly explicitly stated ensuring that most of the planned curriculum is assessed.

6. 표준화 절차의 완료

6. Completing the standardization process

입학과 레지던트 선발은 표준화 시험을 이미 실시중이다.

Interestingly, the decisions to admit students into medical schools are based on the national standardized tests con- ducted by the National Center for Assessment in Higher Education. Similarly, residents are assessed for fitness to practice based on national standardized tests conducted by the Saudi Commission for Health Specialties.

 

의사면허시험 도입의 장애요인

Hindering factors against the national examination

 

1. 유지를 위한 노력과 비용

1. Efforts and costs to maintain the process

계획/문항작성/수정/채점/분석 등

The planning, writing, revis- ing, scoring and analyzing of these examinations are very complex and tedious processes that require the allocation of quite a significant amount of time, money and person- nel. We believe that this is the strongest barrier against implementing such system.

 

2. 반대 주장

2. Opposing arguments

행정가들과 학생으로부터 저항은 자연스러운 것이다. 그러나 Khan and Sear가 GMC의 평가시스템 개혁에 대해 설문했을 때는 찬성이 많았다.

The natural resistance to change is expected from both the medical schools' administrators and students. Interest- ingly, this was not the case in Khan and Sear's national online survey of 401 final year medical students' opinion of the General Medical Council's proposed reform of the undergraduate medical assessment system [36].

현재의 SCHS의 Acceptance Test가 충분하다는 의견도 있지만 우리는 다르게 생각한다.

There is an argument that the current SCHS' "Acceptance Test", also known as Saudi Licensing Exam, is enough and might perceive this proposal as redundant. Our rebuttal to this argument is three folds.

• 첫째 이 시험은 전공의 수련을 받으려는 사람만 보게 된다.
  First, we want to establish a mandatory test for every physician to practice medicine in Saudi Arabia, regardless of his school of graduation and regardless of whether he or she is interested to join a residency program or not. The licensing exam will ensure that minimal competencies are achieved by every practicing physician in Saudi Arabia. This is not the case in the current "Acceptance Test". It is utilized mainly as a screening tool for entry into residency programs in Saudi Arabia.

• 둘째 지필고사만 치른다.
  Second, the proposed licensing exam will consist of a written part and OSCE part to ensure that competencies such as history taking, physical examination, and communication and counseling skills are achieved by practicing physicians with acceptable standards. This is not the case in the 100-MCQ "Acceptance Test" conducted by the SCHS. 

• 셋째 의과대학들의 benchmark로서의 기능을 하지 못한다.
  Third, the proposed mandatory licensing exam will function as a benchmark for medical schools to gauge their curriculum and instructional strategies. The SCHS' "Acceptance Test" is not suitable to provide this information for medical schools because only students who want to enroll in a Saudi residency program sit for this test.

 

 

3. 의과대학 교육 시스템의 잠재적 약점을 드러냄

3. Exposing potential weakness in medical schools education system

의과대학은 자신의 약점이 공개적으로 드러나는 것을 두려워할 수 있다.

Medical schools might resist this call for change fearing that they will be exposing the weaknesses of their medical schools publicly.

그러나 그러한 잠재적 부끄러움은 첫 5년간 결과를 비공개로 함으로써 하위권 의과대학이 문제를 해결할 시간을 줄 수 있다. 면허시험은 의과대학이 자신들의 교육시스템의 문제를 빠르게 파악할 수 있게 도와줄 것이며, 신생 의과대학에서 중요한 문제이다.

However, the potential embarrassment can be avoided by keeping the results of the medical schools per-formance confidential for the first 5 years of implement-ing the system. This will give the poor performing medical schools time to rectify their problems. The licensing exam has the potential for helping medical schools identify the potential weaknesses in their education system early,which is of crucial importance for new medical schools. 

 

4. 의과대학 교육과정의 유연성 저해

4. The fear of impeding flexibility within medical school's curriculum

의과대학이 국가커리큘럼을 만족시키기만 한다면, 나머지는 자율적으로 해도 된다. 

Therefore, as long as the medical school has ful- filled the national curriculum, each is free to complement their respective curriculum with additional materials and resources.

5. 비-아랍어 의사에 대한 언어 장벽

5. Language barrier for non-Arabic speaking physicians

모든 사우디 의과대학에서 영어로 교육하고 있다. 의무적 OSCE를 포함시키는 것은 환자와의 의사소통을 포함할 것이며, 환자는 대부분 아랍어를 활용하고, 아마 이 부분이 비-아랍어 의사에게 중요한 문제가 될 것이다.

English is the language of instruction and examination in all medical schools in Saudi Arabia. Implementing a man- datory OSCE part which entails communicating with patients, who are mostly Arabic-speaking, might be a major issue for non-Arabic speaking physicians.

의학교육의 강점

Strengths of the national medical licensing examination

의학교육의 약점

Weaknesses of the national medical licensing examination

 

 

Table 4: Summary of Driving and Hindering Forces along with strengths and weaknesses of a national medical licensing examination in Saudi Arabia

Driving Forces 

1. Increase in number of medical schools over short period 

2. Inconsistency and variable expertise in using valid and reliable assessment methods 

3. Large number of foreign medical graduates 

4. Saudi medical students on scholarships to various countries 

5. What is taught is not necessarily what is learnt. Issues of planned, delivered, assessed and hidden curriculum 

6. Standardized testing for admission to medical schools and exit from residency calls for standardization of exit from medical school

Hindering Forces

1. Cost and time 

2. Natural resistance to change 

3. Fear of discovering medical schools' weaknesses 

4. Restriction of medical schools freedom and flexibility on the choice of curriculum and assessment methods 

5. Difficulty on agreement on a set of educational objectives 

6. Language barrier for non-Arabic speaking physicians in the OSCE part of the licensing exam

Strengths

1. Standardization of medical education leads to graduating medical students with the minimal required competences 

2. Strengthens public trust and maintains the reputation of Saudi trained physicians 

3. Fair assessment of medical students and selection of candidates into residency program and jobs pool 

4. Provides quality assurance and feedback on curriculum implementation and instructional methods across all medical schools 

5. Frees medical teachers to teach and do research and leaves the complexity of conducting examinations to the national organization 

6. Saudi Arabia may act as a regional center for high quality medical licensing examination

Weaknesses

1. Standardization of medical education leads to loss of creativity and innovation required of a critical thinker physician 

2. League tables might be potentially detrimental to the morale of staff and students of "weak" medical schools

3. The risk that students might be exam-oriented

4. One time assessment is not as comprehensive as ongoing assessments of medical schools

5. Burdens the students with additional financial commitment

 

 

 

대안은?

Alternatives to national medical licensing examination

 

 

인증기관 설립

Development of a body of accreditation

 

Although there is no formal undergraduate medical accreditation organization in Saudi Arabia, the recent establishment of the National Commission for Academic Accrediation and Assessment [39] is promising. The com- mission has recently developed an accreditation system of medical schools in Saudi Arabia; the report is yet to be published. In order for any accreditation body to main- tain the highest standards of medical education, its poli- cies and decisions should be transparent and public and it should have enough administrative power to enforce needed changes in any medical school. Furthermore, accreditation is not an alternative to a national licensing exam. Both are complementary and help in competency assessment of our medical graduates.

 

외부 평가자

External examiners

Medical schools in most countries, including Saudi Ara- bia, use external examiners (from outside the medical school) to ensure that national and international stand- ards are met. Forbes discussed, in an overview, the requirements and duties of external examiners [40]. Exter- nal examining is not just the mere visit of another medical school during the final examination period. Karuhije and Ruff [41] identified six steps in the external examining experience:

1) appointment,

2) contract,

3) review of cur- riculum and examination materials,

4) on-site visit,

5) consolidating internal and external assessment, and

6) preliminary and final reports.

 

Sheehan [42] identified 15 facets for the role of external examiner:

• subject expert,

• experienced,

• impartial judge,

• custodian of standards,

• interpreter of regulations,

• rapid reader,

• board member,

• decision maker,

• conflict coper,

• interviewer,

• power source,

• signatory,

• migrant,

• reporter and

• outsider.

 

단점

Apart from the difficulty of finding persons with the aforementioned characteristics, the process of external examining is expen- sive, including the remuneration, travel, accommodation and hospitality costs. Considering there are 25 medical schools, the cost of multiple external examiners for each medical school can be substantial, yet the outcomes of external examining are not as objective as a national licensing examination.

의학역량 평가를 위한 국가센터 설립

Establishment of a national center for the assessment of medical competencies

As explained earlier, the process of designing, refining, running and scoring methodologically-sound high-stakes examinations is complex and time consuming. Hence, an alternative to a national medical licensing examination is the establishment of a national center for assessing medi- cal competencies. The function of such a center will be to provide training, advice and technical support in the plan- ning, conduct and analysis of different methods of medi- cal education assessment conducted by local medical schools. Additionally, the center may host a shared bank of assessment methods that can be used by any medical school in the region. Yet, security of the shared bank of assessment methods is an issue that needs to be addressed.

 

22. Roberts C, Newble D, Jolly B, Reed M, Hampton K: Assuring the quality of high-stakes undergraduate assessments of clinical competence. Med Teach 2006, 28:535-543.

29. National Board of Medical Examiners. Constructing Written Test Questions For the Basic and Clinical Sciences [http:// www.nbme.org/PDF/ItemWriting_2003/2003IWGwhole.pdf]

 

 

 

 

 

 

 

 

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BMC Med Educ. 2008 Nov 25;8:53. doi: 10.1186/1472-6920-8-53.

The need for national medical licensing examination in Saudi Arabia.

Bajammal S1, Zaini R, Abuznadah W, Al-Rukban M, Aly SM, Boker A, Al-Zalabani A, Al-Omran M, Al-Habib A, Al-Sheikh M, Al-Sultan M, Fida N, Alzahrani K,Hamad B, Al Shehri M, Abdulrahman KB, Al-Damegh S, Al-Nozha MM, Donnon T.

Author information

• 1Medical Education Unit, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia. sohail@bajammal.com

Abstract

BACKGROUND:

Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medicalgraduate.

DISCUSSION:

We are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia.

CONCLUSION:

The driving and hindering forces as well as the strengths and weaknesses of implementing the licensing examination are discussed in details in this debate.

PMID:

 

19032779

 

PMCID:

 

PMC2631006

 

DOI:

 

10.1186/1472-6920-8-53

[PubMed - indexed for MEDLINE] 

Free PMC Article