동남아시아의 면허시험: 교육정책의 변화에서 찾아낸 교훈( Asia Pacific Sch, 2019)

동남아시아의 면허시험: 교육정책의 변화에서 찾아낸 교훈( Asia Pacific Sch, 2019)
Licensing examinations in Southeast Asia: Lesson learnt from exploring changes in education policy
Rachmadya Nur Hidayah1, Richard Fuller2 & Trudie E. Roberts3

 

I. 배경
I. BACKGROUND

동남아시아의 의료 서비스는 급속한 지역 개발과 함께 세계에서 가장 인구가 많은 지역 중 하나에 고품질의 안전한 의료 서비스를 제공해야 하는 중대한 과제에 직면해 있습니다. 질병 부담의 추세가 비전염성 질병으로 이동하고 있으며, 세계화로 인해 환자와 의료 전문가의 이동이 증가하고 있습니다. 저소득 및 중간 소득 국가 또는 개발도상국에서 선진국으로 이동하는 것이 그 반대보다 더 흔한 것으로 알려져 있습니다(Tangcharoensathien 외., 2018). 의료 인력의 이동은 의학교육의 국제적 이동(예: 해외 의과대학)으로 이어져 의학교육의 글로벌-지역적 긴장을 야기했습니다. 의료의 질과 환자 안전을 보장하기 위해 WHO는 보건 인력의 국제 채용에 관한 글로벌 실천 강령을 통해 규제 기관이 의무적으로 국가 면허 시험(NLE)을 시행할 것을 권고했으며, 이는 동남아시아 국가에서 면허 시험 시행이 증가하는 추세에 따라 이러한 높은 수준의 교육 정책을 지원하는 것으로 간주되었습니다(Tangcharoensathien 외., 2018). 
Healthcare in Southeast Asia faces a major challenge–that of delivering high quality, safe care to one of the most populated areas in the world, alongside rapid regional development. The trend in disease burden is shifting to non-communicable diseases, along with the challenge of globalisation which contributes to the migration of patients and health care professionals. It is known that the migration from low- and middle- income countries, or from developing to developed countries, is more common than the opposite (Tangcharoensathien et al., 2018). The migration of health care workforce has been followed by the international movement in medical education (e.g. offshore medical schools), which have created global-local tensions in medical education. In the interest of ensuring the quality of care and patient safety, the WHO through its Global Code of Practice on the International Recruitment of Health Personnel, recommended the implementation of mandatory national licensing examinations (NLEs) by regulatory bodies have been viewed as supporting this high-stakes education policy, which was in line with the increasing practice of licensing examinations in Southeast Asia countries (Tangcharoensathien et al., 2018).

II. 국가 면허 시험: 북미와 유럽에서 얻은 교훈
II. NATIONAL LICENSING EXAMINATIONS: LESSONS FROM NORTH AMERICA AND EUROPE

면허시험을 졸업생의 자질 보증(그리고 더 나은 의료 서비스 결과 지원)에 활용하는 정책은 다른 지역에서도 사용되어 왔습니다. 미국 의사 면허 시험(USMLE)과 캐나다 의사 위원회 자격 시험(MCCQE)이 가장 대표적인 예입니다. 처음에는 의사들 간의 편차를 줄이기 위한 노력의 일환으로 설립되었지만, USMLE는 미국이나 캐나다에서 면허를 취득하고자 하는 국내 졸업생뿐만 아니라 해외 의대 졸업생들을 위한 평가 시스템으로 발전해 왔습니다. USMLE와 MCCQE는 지난 20년 동안 에세이 및 구두 시험에서 보다 체계적인 MCQ 및 임상 술기 평가로 변경되는 등 시행 방식에 변화를 겪었습니다. 면허의 초점은 교육 성과, 지속적인 의학 교육 및 재검증에 대한 예측, 기술 및 심리 측정의 사용으로 옮겨졌습니다. 북아메리카의 NLE는 자국 의료 졸업생과 이주하는 의료 전문가 모두의 자질을 보장하기 위한 노력으로 간주됩니다.
The policy of using licensing examinations for quality assurance of graduates (and arguably supporting better health care outcomes) has been used in other parts of the world. The United States Medical Licensing Examination (USMLE) and the Medical Council of Canada Qualifying Examination (MCCQE) are the most notable examples. Although firstly established as an effort to reduce variation among practitioners, the USMLE has been developed to an assessment system for international medical graduates as well as home graduates who wish to be licensed in the US or Canada. Both the USMLE and MCCQE went through changes in the administration; from essay and oral examination into a more systematic MCQ and clinical skills assessment in the last two decades. Licensure’s focus shifted into educational outcomes, projecting of continuing medical education and revalidation, the use of technology and psychometrics. NLEs in the Northern America are viewed as effort on ensuring the quality of both home medical graduates and migrating health care professionals.

두 나라에서 NLE의 영향은 이 분야의 연구 주제였습니다. 특히 임상 술기 평가 시행 후 의과대학 커리큘럼의 변화가 보고되었습니다. NLE의 더 나은 성과는 일차 진료에서 더 나은 예방 및 관리, 환자 불만 감소, 국제 졸업생의 더 나은 환자 치료, 졸업 후 평가에서의 더 나은 성과와 관련이 있습니다. 그러나 NLE가 환자에게 직접적인 영향을 미친다는 증거는 없었기 때문에 NLE가 환자 안전을 보장하는지 여부에 대한 논란이 제기되고 있습니다. 이러한 논란에도 불구하고 두 나라의 NLE는 의과대학의 인증 시스템과 지속적인 전문성 개발에 의존하는 교육 품질 보증 시스템의 초석이 되었습니다. 
The impact of NLEs in both countries have been a topic for research in this area. Changes in medical schools’ curricula, especially after the implementation of clinical skills assessment, were reported. Better performance in NLEs have been associated with better preventive and management in primary care; fewer patient complaints; better patient care for international graduates and better performance in postgraduate assessment. However, there were no evidence showing direct impact of NLEs to patients, which raises debate on whether the NLEs ensure patient safety. Despite the debate, the NLEs in both countries have become cornerstones of educational quality assurance system, which also relies on the accreditation system of medical schools and continuing professional development.

유럽 국가들은 의료 전문가의 이동과 품질 보증 문제에 대해 서로 다른 접근 방식을 취하고 있습니다. 유럽연합(EU) 회원국은 다른 EU 국가에서 졸업한 의료 전문가의 자격을 인정하기 때문에, 특히 의사의 경우 EU 내에서 일할 수 있는 기회가 동등하게 주어집니다. 외국 졸업생을 위한 시험이 있기는 하지만 의학 지식과 기술보다는 언어 능력에 중점을 두고 있습니다. EU 국가 간 커리큘럼의 다양성에 대한 우려가 있지만, 많은 전문가들은 인증accreditation 시스템이 졸업생의 자질을 보장하기에 충분하다고 믿었습니다(Archer et al, 2017). 그럼에도 불구하고 스위스, 폴란드, 독일과 같은 국가에서는 자국 졸업생과 비유럽경제지역(EEA) 국가 졸업생에 대한 의료 면허 시험을 마련했습니다. 2015년에 영국의 일반 의학 협의회는 이 단계를 밟아 2023년에 시행할 의료 면허 평가(MLA)를 시작할 계획입니다(Archer et al., 2017). MLA는 의과대학 평가에 포함되도록 설계되었기 때문에 향후 교육에 영향을 미칠 것으로 예상할 수 있습니다. 
European countries have different approaches to the issue of health care professionals’ migration and quality assurance. As European Union (EU) member countries recognise the qualification of health care professionals graduating from other EU countries, there are equal opportunities for them to work within the EU, particularly for medical doctors. Although there are examinations for foreign graduates, the focus is more on language competency rather than medical knowledge and skills. Whilst there are concerns about the diversity of curricula among EU countries, many experts believed that the accreditation systems were sufficient to assure the quality of their graduates (Archer et. al, 2017). Despite this, countries such as Switzerland, Poland, and Germany, have established medical licensing examinations for their home graduates and non-European Economic Area (EEA) countries’ graduates. In 2015, the General Medical Council in the United Kingdom followed this step and plans to start their medical licensing assessment (MLA) (Archer et al., 2017) which the GMC will put into action in 2023. The MLA is designed to be embedded in medical schools’ assessment, which means that there will be consequences in education that could be anticipated in the future.

두 지역의 교육 및 의료 시스템이 어떻게 운영되는지에 따라 졸업생과 의료 행위의 질을 보장하는 접근 방식이 다를 수 있습니다. 그러나 이 정책은 인증 시스템과 함께 교육 관행과 의료 시스템을 변화시킬 수 있다는 점에 주목할 필요가 있습니다. 
The two regions might have different approach in quality assuring the graduates and medical practice depending on how the education and healthcare system work in the regions. However, it is worth to notice that the policy, along with accreditation systems, could change the practice of education and possibly the health care system.

III. 아세안 국가 시험: 더 나은 치료를 위한 지역적 접근의 가능성?
III. NATIONAL EXAMINATIONS IN ASEAN: THE POSSIBILITY OF REGIONAL APPROACH FOR BETTER CARE?

EU 국가와 아세안 국가가 취하는 접근 방식은 유사하지만, 두 환경의 환자 관리 정책의 맥락과 교육 시스템이 다르다는 점에 주목할 필요가 있습니다. 아세안 국가들은 '역동적 개발 파트너십에 관한 아세안 비전 2020'을 추진하면서 보건의료 전문가들의 자유로운 서비스 제공을 위한 여러 가지 프레임워크에 합의했습니다. 아세안 국가의 간호사, 의사, 치과의사를 위한 상호 인정 협정(MRA)은 2006~2009년에 이 파트너십에 따라 만들어졌습니다. 이 협정에 따라 각국은 의료 전문가 이주에 대한 규정을 마련해야 했습니다. 이 규정은 면허 시험의 형태로 이루어졌으며, 이후 여러 회원국의 의료 전문직 교육 정책을 형성했습니다.
Although the approaches taken by the EU countries and ASEAN countries are similar, it is worth noting that the context of patient management policies in both settings are different, as well as their education systems. As they work towards the ASEAN Vision 2020 on Partnership in Dynamic Development, ASEAN countries agreed a number of frameworks to enable the free flow of services for professionals in health care. The mutual recognition arrangements (MRA) for nurses, medical and dental practitioners in ASEAN countries were created in 2006-2009 in response to the partnership. This arrangement required countries to establish regulations for migration of health care professionals. The regulations came in the form of a licensing examination, which have subsequently shaped health care professions education policies in a number of member states.

이들 국가에서 국가 면허시험을 도입한 것은 단순히 외국인 의료 전문가를 규제하기 위해서만이 아니라, 졸업생의 자질을 향상시키기 위한 목적도 있었습니다. 아세안 회원국 대부분은 개발도상국으로 의사 수 부족, 의료 전문가의 불균등한 분포, 교육 및 의료 시스템 개발 등 비슷한 문제를 겪고 있습니다(Kittrakulrat, Jongjatuporn, Jurjai, Jarupanich, & Pongpirul, 2014; Sonoda 외, 2017; Tangcharoensathien 외, 2018). 인도네시아의 경우처럼 엄격한 품질 보증 시스템 없이 더 많은 의사를 배출하기 위해 의과대학 수가 증가하면서 졸업생의 자질 저하가 우려되는 문제도 종종 발생합니다. 이들 국가는 기존의 면허 및 재면허 정책을 통해 의료 전문가에 대한 규제가 부족했기 때문에 전 세계적으로 더 나은 의료 서비스를 달성하기 위해 교육과 평가를 활용하는 방법으로 NLE를 도입하기 시작했습니다.

For these countries, introducing national licensing examinations was not solely about the need to regulate foreign health care professionals, but also to improve the quality of graduates. Most of ASEAN member states are developing countries sharing similar challenges: inadequate numbers of physicians, uneven distribution of health care professionals, and a developing education and health care system (Kittrakulrat, Jongjatuporn, Jurjai, Jarupanich, & Pongpirul, 2014; Sonoda et al., 2017; Tangcharoensathien et al., 2018). The challenges are often followed by the increasing number of medical schools to produce more doctors –as in Indonesia’s case, without a rigid quality assurance system, raising concern of lower quality of graduates. As these countries lacked regulation of health care professionals through existing licensing and re-licensing policies, they started to introduce the NLE as a way of using education and assessment to achieve better health care globally.

현재까지 아세안 회원국 10개국 중 태국, 필리핀, 인도네시아, 말레이시아 등 4개국이 NLE를 시행하고 있습니다. 각 국가마다 정책을 도입한 이유는 다릅니다. 

• 태국과 인도네시아는 유능한 의사를 확보하고 의과대학의 질을 향상시키기 위해 2006~2007년에 자국 및 해외 졸업생을 대상으로 NLE를 도입했습니다. 
• 인도네시아에서는 지난 10년간 의과대학 수가 증가하면서 의대별로 교육의 질적 차이가 발생하여 보건 전문직 교육의 질을 개선하려는 정부 정책에 영향을 미칠 수 있다는 우려가 제기되었습니다. 
• 필리핀과 말레이시아는 외국인 졸업생만을 대상으로 하는 NLE를 운영하고 있으며, 최근 몇 년 동안 그 수가 증가하고 있습니다. 

Four out of ten ASEAN member countries have implemented NLEs to date: Thailand, Philippines, Indonesia, and Malaysia. Each country has different reasons for introducing the policy.

• Thailand and Indonesia introduced the NLE for home and international graduates in 2006-2007, to ensure the quality of competent doctors and to improve the quality of their medical schools. 
• In Indonesia, there has been an increasing number of medical schools in the last decade, leading to concerns of differential quality of education delivered which impact on the Government’s policy to improve the quality of health professions education.
• Philippines and Malaysia, both had NLEs for international graduates only, whose number has been increasing in the recent years.

동남아시아 지역의 다른 국가들에는 현재 NLE가 없지만 정책 입안자들 사이에서 이 주제가 논의되고 있습니다(Kittrakulrat 외., 2014; Sonoda 외., 2017). 베트남과 라오스는 NLE를 개발 중이며, 인도는 국제 졸업생들이 자국 의료 시스템에서 일할 준비를 갖추도록 보장하는 정책의 일환으로 NLE를 고려하고 있습니다. 의료 전문직의 이동이 증가하는 추세(Tangcharoensathien 외., 2018)는 NLE가 아세안 경제 공동체(AEC)의 이념에 부합하는 문제이며, 의료 전문직이 이 지역 내 다른 국가에서 의술을 펼칠 수 있는 자격을 갖출 수 있음을 의미합니다(Kittrakulrat 외., 2014). 비교를 위해 대만과 한국 등 아시아의 다른 국가에서는 의료/보건 전문가 면허시험을 시행하고 있으며, 이는 의학교육에 영향을 미치고 있는 것으로 나타났습니다.
Even though the other countries in the South East Asia region currently do not have NLEs, the topic is being discussed amongst policy makers (Kittrakulrat et al., 2014; Sonoda et al., 2017). Vietnam and Lao are in the process of developing NLEs, and India is considering the NLE as part of their policy in ensuring international graduates are prepared to work in its healthcare system. The increasing trend of health care professions’ migration (Tangcharoensathien et al., 2018) means that the NLE is a relevant issue aligned with the idea of ASEAN Economic Community (AEC), where medical professions can be qualified to practice medicine in another country in this region (Kittrakulrat et al., 2014). For a comparison, other countries in Asia such as Taiwan and South Korea have been establishing medical/ health care professionals licensing examinations, which showed impact on medical education.

아세안 국가들은 해외 졸업생 유입에 대응하기 위해 NLE를 시행하고 있지만, 시험이 대부분 현지 언어로 진행되기 때문에 AEC 시대에 면허 시험에 대한 지역적 접근이 복잡해졌습니다. 마찬가지로 문화, 경제, 교육 및 의료 시스템의 차이도 AEC에서 의료 전문가의 자유로운 이동에 또 다른 도전 과제가 되고 있습니다. NLE를 시행하는 국가마다 면허 시험의 방법과 유형은 다양하지만, 지식과 임상 기술을 평가하는 것이 가장 일반적인 결과입니다(Price et al., 2018). 그럼에도 불구하고 현재 시행되고 있는 NLE는 아세안에서 환자 치료와 의학교육에 대한 공통적이고 동등한 기준을 찾을 수 있는 기회를 열어줄 수 있습니다.
Although ASEAN countries have been implementing NLEs to address the influx of international graduates, the fact that the examinations are mostly delivered in local languange makes it complicated for a regional approach of licensing examinations in the era of AEC. Similarly, the difference in culture, economy, education and health care system, also poses another challenge for the free-flow of health care professionals in AEC. Variation of methods and types of licensing examinations exist in countries implementing NLEs; although the knowledge and clinical skills are the most common outcome to be assessed (Price et al., 2018). Even so, the current practice of NLEs might open opportunities for finding common and equal standard for patient care and medical education in ASEAN.

IV. 아세안의 의료 면허 시험에서 얻은 교훈: 의료 전문가 교육에 대한 투자
IV. LESSON LEARNT FROM MEDICAL LICENSING EXAMINATIONS IN ASEAN: INVESTING IN HEALTH CARE PROFESSIONALS’ EDUCATION

아세안 회원국과 같은 개발도상국에서 의사면허시험의 발전은 의료, 더 나아가 보건의료 전문가 교육 시스템을 개선할 수 있는 경로를 제공합니다. 이들 국가에서는 해외에서 자격을 갖춘 의사 수가 국내 졸업생에 비해 많지 않더라도 유능한 의료 전문가를 배출하기 위한 중요한 단계로 간주됩니다. 정책을 바꾸고, 교육 시스템을 개선하고, 더 나은 의료인을 배출하기 위해 한 국가가 어떻게 나아가는지에 대한 이야기입니다.
The development of the NLE in developing countries such as ASEAN members offers a pathway for improving medical and to further extent, health care professionals’ education systems. For these countries, even though the number of overseas qualified doctors may not be significant compared to domestic graduates, the policy was considered an important step towards producing competent health care professionals. It is about how a country moves forward by changing policies, improving education system, and aiming to produce better health care providers.

보건 전문가 자질 향상 정책은 보건 분야 인적 자원의 교육과 훈련을 혁신하는 데 투자하는 WHO 전략과 일치합니다. WHO가 강조하는 혁신 전략은 교육 표준과 자금 확보를 위한 국가 정책 수립을 통해 고등 교육과 보건 부문 간의 협력에 의존합니다. 따라서 NLE를 시행하는 아세안 국가들에게 NLE는 보건 교육 개선을 위한 투자이자 향후 보건의료 시스템을 지원할 수 있는 수단입니다. 
The policy to improve the quality of health professionals is in line with WHO strategy to invest in transforming the education and training of human resources in health. The transformational strategy emphasised by WHO relies on collaborative work between higher education and the health sectors through establishing national policies to secure the education standard and funding. Therefore, for ASEAN countries implementing the NLE, it represents an investment for health education improvement, and a means to support their health care systems in the future.

라오스의 NLE 개발 경험은 라오스가 어떻게 정책을 바꾸고 교육 시스템을 강화했는지 보여줍니다(Sonoda et al., 2017). 라오스는 NLE를 수립하는 과정에서 정책과 이해관계자들과의 협력을 통해 교육 시스템을 강화해야 했습니다. 라오스의 경우 이러한 노력은 더 나은 의료 서비스를 향한 중요한 움직임으로 간주되었습니다. 라오스 정부는 유능한 의료 전문가를 배출하기 위해서는 교육 시스템을 개선해야 한다는 점에 주목하여 교육 커리큘럼과 평가 관행을 수정했습니다.

• 라오스의 경험 사례는 NLE 도입이 유능한 전문가를 배출하는 데 필요한 보건의료 전문직 교육의 개선을 이끌었음을 보여줍니다(Sonoda et al., 2017).
• 태국에서는 면허 시험이 학부 교육(예: 위험에 처한 학생 인식)과 졸업후 교육의 변화를 이끌었습니다.
• 싱가포르에서는 졸업후 과정에 국가시험을 도입하여 교육의 질을 보장하고 있습니다(Ruth et al., 2018). 

Lao’s experience in developing the NLE showed how the country changed its policy and strengthened their education system (Sonoda et al., 2017). In the process of establishing the NLE, Lao needed to strengthen their education system through policies and working with their stakeholders. In Lao’s case, these efforts were considered as significant moves toward better healthcare. The government took note that to produce competent health care professionals, they needed to improve the education system which made them revise educational curricula and assessment practices.

• The example from Lao’s experience showed that the introduction of NLE drives improvement in health care professions education which is necessary to produce competent professionals (Sonoda et al., 2017).
• In Thailand, the licensing examination drove changes in undergraduate education (e.g. recognising at-risk students) and postgraduate education.
• While in Singapore, the national examinations have been introduced in postgraduate studies for ensuring quality assurance (Ruth et al., 2018).

아세안 국가들의 의료 서비스 개선에 있어 NLE의 역할은 아직 더 커질 가능성이 있습니다. 아세안에서 인구가 가장 많은 인도네시아의 경우, 의대 졸업생을 대상으로 한 NLE는 보건 인적 자원을 강화하고 의료 전문가의 자질을 향상시키기 위한 정부 전략의 일환이었습니다. 2013년 의사 역량 시험 공동위원회에서 보고한 바와 같이, 이 시험은 장기적으로 의과대학을 포함한 의학교육의 질을 높이기 위해 고안되었습니다. 인도네시아의 최근 연구(Hidayah, 2018)에 따르면 NLE는 교육 관행 개선, 학습 자원 및 시설 개선, 교육 기관과 의료 서비스 제공자 간의 협력 등 의학교육에 여러 가지 긍정적인 결과를 가져왔다고 강조합니다. 2007년 시행 이후 치의학, 간호학, 조산학 등 다른 보건의료 전문직도 인증제 강화와 함께 발전하고 있습니다. 이해관계자 간의 협력과 인도네시아의 문화는 교육을 확대하는 데 공동의 노력을 이끌어냈습니다. 히다야의 연구(2018)에 따르면 의과대학은 유능한 졸업생을 배출하기 위해 교육의 질을 업그레이드하고 있습니다. 이러한 노력은 커리큘럼 및 평가 개발을 위한 협력 강화, 임상 배치 확대, 교수진 개발을 위한 협력 등의 형태로 이루어졌습니다. 예를 들어, 인도네시아 국가위원회에서 보고한 것처럼 의과대학 간 평가 실습을 위한 지역별 협력이 있었습니다. 특히 신생 의과대학과 사립 의과대학의 경우 이러한 협력은 교육 실습을 활용하는 데 도움이 됩니다. 연구에 따르면 인도네시아와 같은 의학교육 개발의 맥락에서 NLE는 규제기관(예: 정부)과 주요 이해관계자(예: 의과대학협회)의 중요한 역할을 연결하여 개선을 촉진하는 촉매제 역할을 한다고 강조합니다(Hidayah, 2018). 장기적으로 이러한 교육의 질 개선은 의학교육과 의대 졸업생의 질을 보장함으로써 보건의료의 향상을 가져올 것으로 기대됩니다.
The extent of the NLEs’ roles in bringing health care improvement in ASEAN countries is potentially greater still. In Indonesia, which has the largest population in ASEAN, the NLE for medical graduates was part of government strategies to empower human resources for health and improve the quality of health care professionals. As reported by the Joint Committee on Medical Doctor Competence examination in 2013, the examination was designed to lever the quality of medical education, including medical schools, in the long run. Emergent work from Indonesia (Hidayah, 2018) highlights that the NLEs led to a number of positive consequences for medical education:  improvement in educational practices, improvement of learning resources and facilities, and collaboration between education institutions and health care providers. Since its implementation in 2007, other health care professionals such as dentistry, nursing, and midwifery have been developing, along with the strengthening of accreditation system. The collaboration between stake holders and the culture of Indonesia led to the collective work in scaling up the education. Hidayah’s work (2018) revealed that medical schools have been upgrading their education quality to produce competent graduates. The effort came in the form of increasing collaboration for curriculum and assessment development, expanding clinical placements, and collaboration for faculty development. For example, there have been regional collaboration for assessment practice between medical schools as reported by the National Committee in Indonesia. Especially for new and private schools, this collaboration helps them in leveraging their educational practice. Research highlights that in the context of developing medical education such as Indonesia, the NLE acts as a catalyst to drive improvement, linking the vital role of the regulator (i.e. the government) and major stakeholders (e.g. association of medical schools) (Hidayah, 2018). In the long term, this improvement in the quality of education is expected to bring improvement in health care by ensuring the quality of medical education and medical graduates.

광범위한 보건 전문직 교육 분야에서 국가 면허 시험은 여전히 뜨거운 논쟁의 대상이 되고 있는 정책입니다(Archer et al., 2017). 그러나 아세안 국가들의 국가면허시험 시행 경험은 보건의료의 질을 향상시키기 위해 보건의료 전문가의 질 보증 시스템에서 이 높은 수준의 평가가 더 큰 역할을 할 수 있는 기회를 보여줍니다. 앞으로 교육 정책이 개발도상국의 의료 서비스 질 향상을 지원하는 방법에서 얻은 교훈은 전 세계 의료 문제에 대한 접근 방식을 개선할 수 있는 잠재력을 가지고 있습니다.

In the broader field of health professions education, national licensing examinations remain a hotly debated policy (Archer et al., 2017). However, the experience of ASEAN countries in implementing NLEs reveals opportunities for a bigger role for this high-stakes assessment in the quality assurance system of health care professionals in order to enhance the quality of health care. In the future, lessons learnt from how an education policy can support developing countries in improving their health care quality, has the potential to enhance the approach to health care problems globally.

 

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Abstract

Southeast Asian region has been experiencing significant challenges to their health care systems, driving some countries establishing policies to ensure the quality of the medical workforce through the introduction of national licensing examinations. This paper examines the experiences of Southeast Asian countries in implementing licensing examinations, highlighting the changes and development of the education policy and its impact on medical education. The lesson learnt from the high-stakes assessment policy offers a new perspective on how medical licensing examinations could represent a potential regional approach for a better health care.