Medical licensing examination in developed countries involves a lot of procedures. It may vary from country to country. This article highlights the different procedures for applying to medical licensing examination abroad.
1. United States Medical Licensing Examination (USMLE)
The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). The Composite Committee of the USMLE initiated a process to undertake a comprehensive review of the USMLE program in 2004. The Composite Committee establishes policy for the USMLE and is composed of representatives of the Federation of State Medical Boards (FSMB), National Board of Medical Examiners (NBME) and the Educational Commission for Foreign Medical Graduates (ECFMG), and the American public. The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. Each of the three Steps of the USMLE complements the others; no Step can stand alone in the assessment of readiness for medical licensure.
• National Board of Medical Examiners (NBME): For students/graduates of medical schools in the US or Canada taking or planning to take Step 1, Step 2 CK, or Step 2 CS
• Educational Commission for Foreign Medical Graduates (ECFMG): For students/graduates of medical schools outside the US and Canada taking or planning to take Step 1, Step 2 CK, or Step 2 CS
• Federation of State Medical Boards (FSMB): For any student / graduate taking or planning to take Step 3. Also for students / graduates looking for information about medical licensure.
Examinations for ECFMG Certification
The USMLE is a three-step examination for medical licensure in the United States. The USMLE provides a common system to evaluate applicants for medical licensure. The USMLE is sponsored by the Federation of State Medical Boards of the United States, Inc. (FSMB) and the National Board of Medical Examiners (NBME). The USMLE is governed by a committee consisting of representatives of FSMB, NBME, ECFMG, and the American public.
• Before you can apply for a medical license, you must pass a three-step test called the United States Medical Licensing Examination (USMLE), also known as the board exam.
This test is unusual for two reasons. First, you take each part at a different stage of your medical education. Second, unlike many standardized tests, the USMLE actually assesses your mastery of the material, not how well you take a test. While there are some test–taking strategies that will improve your performance, you won't pass without comprehensive and detailed knowledge of the sciences, as well as an ability to apply that knowledge in a clinical setting.
The USMLE is divided into three steps:
• Step 1 is a one–day test, usually taken at the end of the second year of med school. It emphasizes knowledge of basic sciences, including anatomy, biochemistry, behavioral sciences, microbiology, immunology, pathology, pharmacology and physiology. Topics such as nutrition, genetics and aging are also covered. All questions are multiple–choice.
• Step 2 is a two–day test, usually taken in the fourth year of med school. It has two components. The first (called Clinical Knowledge, or CK), requires you to answer multiple–choice questions on clinical sciences like surgery, internal medicine, pediatrics and obstetrics and gynecology. The second (called Clinical Skills or CS) requires you to examine and diagnose actors posing as patients. For the Step 2 CS, students must travel to one of five testing centers around the country.
• Step 3 is a two-day test, usually taken after the first year of residency. This is the final assessment of whether or not you're prepared to practice general medicine in an unsupervised setting. Like Step 2, Step 3 focuses on the diagnosis and treatment of patients. It includes both multiple choice questions and computer simulations of patient care.
The Step 2 CS has no numerical score. You earn a pass or a fail based on your ability to gather data, communicate with the patient and write an effective report. On all other parts of the test, the number of correct answers you earn is converted into two numerical scores, one on a three–digit scale and the other on a two–digit scale. These are simply two ways of reporting the same result to schools. You must earn a 75 on the two–digit scale to pass.
Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning.
Step 1 is constructed according to an integrated content outline that organizes basic procedures for applying
Log in to this website to:
• Apply for USMLE Step 1, Step 2 CK and/or Step 2 CS
• Print Scheduling Permit for Step 1, Step 2 CK and/or Step 2 CS
• Print Score Report for Step 1, Step 2 CK and/or Step 2 CS
• Request score documents, certificates and/or confirmation letters.
• Check the status of your registration and document request history.
• Schedule an appointment for Step 2 CS.
• Check and update your personal information (e.g., name, address).
• Print Step 1 and Step 2 CK Eligibility Period Extension Form.
• Print Score Recheck Form.
2. PLAB FOR UK
The PLAB is basically a registration examination that allows you to practice medicine in the UK. In that sense it is similar to the USMLE Steps of the US system. However, there are three important differences between the PLAB and USMLE exams:
• The PLAB exam is considered to be far easier, and less costly than the USMLE exams.
• There are only 2 parts to the PLAB exam, not 3 like in the USMLE Steps (or 4 if you count USMLE Step 3).
• The PLAB is a pass/fail exam. It makes absolutely no difference to your credentials if you pass the PLAB by an extremely wide margin or just manage to get through by a single mark. This is in contrast to the USMLE Step 1 and Step 2 CK exams, in which a candidate’s scores affect the strength of his CV.
The IELTS is a test of the candidate’s English skills. It stands for International English Language Testing System. People are required to take this exam to prove they have the minimum acceptable level of proficiency in the English language needed to engage in their academic or work pursuits in the UK, so its not just for doctors. This exam can be taken in many countries, including Pakistan. Currently, it costs around 80 Pounds Sterling and is held twice a month every month throughout the year.
The exam has four sections: Speaking, Listening, Writing and Reading. The result of the test is given as a number on a scale (called band) from 1 to 9. Each band or scale represents a certain level of competency in English. A score of 1 means that the candidate has only a rudimentary grasp of the language. A score of 9 means the candidate is as proficient as a native English speaker.
Each of the four sections are scored separately on the band of 1 to 9. The individual band scores in the different sections are then added up to give an average. For example, if a candidate gets 8 in Speaking, 8 in Listening, 7 in Writing and 7 in Reading it will give him an overall band score of 7.5.
In order to be eligible to take the PLAB exam, the candidate must have an overall score of at least 7. However, an imposition is made on the individual scores as well. The candidate must have at least 7 in the Speaking section and at least 6 in the other sections. So if a candidate gets 6.5 in speaking, he will not be eligible to take the PLAB exam - even if his overall score is 7 or above.
The IELTS can be taken even while the candidate is still a medical student, although it should be keep in mind that the IELTS result is valid for two years. The candidate must go on to take his PLAB exam within this two year validity period.
PLAB Part I
The first part of the PLAB exam, the Part 1 is administered in a number of countries, including Pakistan where it is held three times a year: in March, July, and November. Currently, the exam cost 145 Pounds Sterling.
In order to be eligible to take the exam, the candidate must be a medical graduate (he cannot give it before graduation) from a WHO-recognized medical college and also have the minimum required IELTS score in hand during the time of application.
The exam consists of a 3 hour paper containing 200 questions. The questions are called “Extended Matching Questions” or EMQs - which simply means they are multiple choice questions with a variable number of possible answers to the questions posed of which the best one is selected. The exam concentrates on the clinical subjects, not on basic sciences. There are also a few questions regarding medical ethics, evidence based medicine, epidemiology, and public health.
PLAB Part II
This part can only be taken in the UK. Recently, the capacity of the PLAB 2 center in London has been expanded enormously, and now the exam will be held several times a month every month, throughout the year. Currently, the exam costs 430 Pounds Sterling.
The Part 2 is a examination of clinical skills - not a paper-based EMQ exam. The system devised for testing the candidate’s clinical skills is called the Objective Structured Clinical Examination, or OSCE.
When you start the examination, you will go to your first “station” in which you will be given some instructions. It could be taking history from a patient there, performing an clinical examination, or a number of other things. You will have 5 minutes to accomplish your task and 1 minute of pause to think before each station. There are 14 stations in all, with two “rest” stations – so the exam lasts a total of 96 minutes. The primarily skills tested for are:
• History taking and diagnosis based on history alone.
• Proficiency at physical examination.
• Communication skills with patients.
• Management of emergency cases.
3. PRES: Licensing Exam for Doctors in Ireland
Ireland has a relatively easy exam called Pre Registration Examination System (PRES) formerly called TRAS. If a doctor wants to work in Ireland he must have a degree recognized by Medical Council of Ireland otherwise he has to pass Pres to get registered with the council and then he can practice.
There are three divisions Trainee specialist (training posts) and General division (non-training posts) and super division. Decide in which to opt prior to applying for pres. PRES is divided into 3 Levels commonly said as Pres 1, Pres 2, Pres 3.
Pres 1 is the assessment and verification of documents by the Medical council of Ireland. The requirements are MBBS, MD or equivalent degree in medicine and surgery, Internship in recognized hospital with the respective medical council, IELTS certificate with a combined score of 7.
Pres 2 is an online written MCQ exam. This can be taken in any of the examination centers in Ireland, Egypt, India, Pakistan. After clearing pres 1, medical council sends admission card and details about the procedure of applying for level 2. The syllabus includes all the final year subjects’ i-e surgery, gynae obs, paeds, psychiatry, general practice. It is negatively marked. Total time is 2 1/2 hours and total questions are 60.
Pres 3 is a clinical exam (OSCE) in which communication, interpretation and practical skills are examined. Level 3 exam is only taken in Ireland i-e Dublin, Cork or Galway. After passing level 3, applicant can register in training specialist or general division, and apply for respective jobs.
4. Medical Council of Canada Evaluating Examination
The Medical Council of Canada Evaluating Examination (MCCEE) is a four-hour, computer-based examination offered in both English and French at more than 500 centers in 80 countries worldwide. International medical students or U.S. osteopathic students in the final 20 months of their program and international medical school graduates or U.S. osteopathic graduates must take the MCCEE as a prerequisite for eligibility to the Medical Council of Canada Qualifying Examinations.
The MCCEE is a general assessment of the candidate’s basic medical knowledge in the principal disciplines of medicine. It is also designed to assess the skills and knowledge required at the level of a new medical graduate who is about to enter the first year of supervised postgraduate training.
The computer-based MCCEE consists of 180 multiple-choice questions, each listing five possible answers of which only one is the correct or best answer. The MCCEE questions cover the following domains: Child Health, Maternal Health, Adult Health, Mental Health, and Population Health and Ethics. A number of questions in the examination also have a focus on general practice.
Generally Mondays through Fridays; some sites may run on Saturdays and/or Sundays
• Application to the MCCEE is ongoing. While there are no deadlines for applying to the MCCEE, there are deadlines for scheduling an examination date and time once your MCCEE application is accepted.
• View the list of countries where the MCCEE is offered. The centres (i.e. test sites) are operated by Prometric, the service provider that the MCC has contracted for scheduling and administering the computer-based MCCEE.
5. EU/EEA area
All doctors working in Finland must be able to speak either Finnish or Swedish. Finland is officially a bilingual country and some 5% of the population speaks Swedish as their first language.
As a non-EU/EEA national, you need to provide official proof of your language proficiency in Finnish or Swedish before you can sit the three-part professional examination. Please note that the only proof we accept is a copy of your National Certificate of Language Proficiency at Skill Level 3 or Civil Service Language Proficiency Certificate at “Satisfactory”. If you are an EU/EEA national, Valvira does not require an official language certificate.
Practical medical training (medical internship)
Having completed your medical qualification in a non-EU/EEA country, you are required to complete a minimum of six months of supervised practice in Finland.
Professional competence examination
Applicants are required to demonstrate their professional competence through an examination. Passing the examination means that your professional skills and competence are equivalent to those who graduate in Finland.
You can sit the examination after you have completed the six months of supervised practice and have gained the official language certificate.
Limited authorisation to practice
After you have completed the examination Part 1, you can apply for a limited authorisation. The limited authorisation allows you to work at a Finnish state, local authority or joint authority-run hospital under lead and supervision of another doctor licensed to practice medicine.
The authorisation is granted for practice in a named specialty field and for a named hospital/ health centre for a maximum of six months at a time. You can apply for a continuation to the limited authorisation and the authorisation can be granted for a maximum of two years in total.
After you have completed the examination Part 2, you can apply for a limited authorisation at a state, local authority or joint authority-run hospital or health centre.
Please note that you are not allowed to work through a locum/ supply/ employment agency while the limited authorisation is in place. You need to sign an employment contract directly with your employer.
How to apply for limited authorization
Note: most applicants will already have sent copies of all the relevant documents when they applied for approval of qualifications or for Part 1 of the examination. Just make sure you have sent earlier the documents below; if not, then include them in your Application for Licensing.
• A copy of your passport or equivalent so that we can verify your nationality.
• A copy of your degree certificate or diploma and all relevant appendices such as degree transcript and grades awarded.
• A document confirming that you have completed your period of supervised practice.
• A document confirming that you have completed the three-part examination.
• Proof of your language proficiency.
6. China
Candidate should attend NMLE (National Medical Licensing Examination) which is conducted by the provincial health department. To practice medicine in Mainland China. NMLE website: www.nmec.org.cn
7. Australia
The Australian Medical Council (AMC) is responsible for processing all initial inquiries regarding assessment of international medical graduates and overseas trained specialists.
Common Assessment Requirements
Each of the pathways includes some (or all) of the following steps:
• Assessment of English language proficiency at a nationally agreed level;
• Primary source verification of qualifications;
• Assessment against a position description with the level of assessment according to level of risk (for Area of Need positions);
• Orientation within three months of starting employment and evidence of satisfactory completion of this submitted to the relevant medical board with the supervisor's three-month report
• AMC has approved four examination authorities in the United Kingdom (PLAB examination), the United States of America (the USMLE examination), Canada (the MCC Licensing Examination) and New Zealand (the NZREX examination). The AMC has also approved medical school accreditation programs in the United Kingdom and the Republic of Ireland as Competent Authorities.
Doctors eligible for the Competent Authority pathway are granted advanced standing toward the AMC Certificate and undergo up to 12 months workplace-based assessment to ensure satisfactory adjustment to the Australian health care system before they are eligible to receive the AMC Certificate and apply for general registration.
