Clinical skills examination as part of the Taiwan National Medical Licensing Examination

Dear Sir

Boursicot et al. (2011) stated “The current situation in relation to performance assessment and national regulatory standards are that Canada, China and Japan have established national licensing examinations and the USA has national assessment for entry into postgraduate training. Several other countries are exploring the use of national licensing examinations e.g. Korea, Indonesia and Switzerland.” Although Taiwan was not mentioned in their article, passing the Clinical Skills Test (CST) will be a prerequisite for taking the Step II Test of the Taiwan National Medical Licensing Examination (NMLE) starting in 2013.

Since 1968, Taiwanese medical graduates have been required to pass the NMLE in order to obtain a license for independent medical practice. The NMLE assesses extent of knowledge in a written format, leaving, however, the need to assess graduates’ clinical competencies unmet. As OSCEs were adopted by every medical school in Taiwan for several years (Huang et al. 2007), a national CST was then judged ready to be proposed. In 2009, the Taiwan Ministry of Examination announced that passing a performance-based national CST before graduation would be one of the requirements for taking the NMLE Step II Test from 2013.

In 2011 and 2012, a national trial for the CST, conducted by the OSCE Committee of the Taiwan Association of Medical Education, was successfully completed in four (2011) and six (2012) days over two consecutive weekends. On both occasions, the CST was composed of eight stations of clinical encounters with standardized patients and four stations of procedural skills. The borderline regression method was adopted for standard setting. The pass rates in 2011 and 2012 were 97.31% and 95.63%, respectively. Feedback from raters, standardized patients and students was collected for quality improvement. We look forward to the successful implementation of this requirement for all Taiwanese medical graduates next year.