歷屆臺灣國家醫師執照考試之分析

The purpose of the medical licensee examination (MLE) is to determine whether a medical graduate possesses the knowledge and ability to practice medicine. The MLE has been administered to all medical graduates in Taiwan for more than thirty years and a two-step examination has been adopted since 1994. In spite of various criticisms of the examination process, content and format the re are still no published studies of the MLE in Taiwan. The recent advocation of medical education reform highlights the need for timely analysis of the MLE in order to make sound recommendations to improve it. Two or three teachers from each of the various fields of basic and clinical science were invited to participate in this study. The characteristics of MLE examination questions of the period from 1994 to1998 were analyzed and the degree of correlation between basic and clinical science, degree of difficulty, distribution of topics in various clinical fields, frequency of clinical problems, and the relation of questions to the ten most common causes of death in Taiwan were studied. The result show that there were several shortcomings in the MLE questions. First, the integration of basic and clinical science on the tests was poor. Second, most of the questions emphasized knowledge recall rather than thinking processes, and as a consequence the questions were superficial and fragmented. Third, many of the questions were not of sufficient difficulty or were irrelevant to clinical practice. Fourth, the variation of distribution of questions among clinical fields was significant in these years. Fifth, there was a lack of case study questions to test ability in data gathering, analysis of laboratory test results, image analysis, hypothesis formation and solving clinical problems. Furthermore, locally important medical issues only occupied a small percentage of the MLE. In order to amend these deficiencies in the MLE, if will be necessary to redesign thee test with an emphasis on the integration of clinical and basic science and to include case study questions to test the abilities of medical school graduates to apply their knowledge in the solution of clinical problems.