In June 1998, the People’s Republic of China law on Medical Practitioners was promulgated to legalize the NMLE. Furthermore, NHC was held responsible for the implementation of the NMLE system . The current NMLE consists of two components, the clinical skill examination and the comprehensive medical knowledge examination. The clinical skill examination adopts a 3-station procedure to assess the ability of clinical reasoning, physical examination, and basic clinical operation. The comprehensive medical knowledge examination consists of 600 multiple-choice questions (MCQs), assessing knowledge on basic sciences, clinical medicine, medical humanism, and preventive medicine.
The first ever clinical skill examination of NMLE was held in September 1999. In November of the same year, the first comprehensive medical knowledge examination was held simultaneously at nearly 400 examination centers in 31 examination locations. Since 2001, the clinical skill examination has been administered in July each year, and comprehensive medical knowledge examination has been held nationwide in September each year. The number of candidates appearing for NMLE is large and has increased each year. Since the implementation of this system, more than 13 million individuals have participated in the NMLE and more than 4 million have been licensed as physicians . In 2020, there were a total of 600 examination sites for the comprehensive medical knowledge examination. The passing rates for the clinical skill examination and comprehensive medical knowledge examination among medical students who appeared for NMLE for the first time in 2020 were 88.98 and 72.5%, respectively.
At the same time, the quality of the physicians’ team has undergone tremendous improvement. NMLE can ensure better quality of admission of physicians and promote reforms in Chinese medical education. There are some experiences of continuous improvement and development of Chinese NMLE, which may have implications for the international community. The first is that Chinese NMLE has effective organizational mechanisms. More specifically, the leadership and organizational structure of NMLE are relatively strong and complete. The director of NHC is the committee director of NMLE. Besides, the directors of provincial and civic health commissions act as group leaders and chief examiners of NMLE. There are some relatively impeccable laws and regulations, such as Law of the People’s Republic of China on Medical Practitioner, Interim Measures of NMLE, Implementation Plan of NMLE, Measures of Handling the Irregularities in NMLE, and Contingency Plan of NMLE, which have been systematically implemented to guarantee the effectiveness of NMLE. In terms of organizational structure, examination districts and testing centers take the grading and administrative responsibility for the organization and implementation of the examination. Moreover, a series of working teams including item development team, examiner team, test management team, information technology team, and research team have been established, providing a strong workforce for NMLE.
In addition, evidence-based reforms and innovations have constantly been made in NMLE. NMEC has gathered a national medical education assessment expert team and funded research projects continuously to improve NMLE. Research on physician’s competence, phased examination, and examination syllabus design based on their competence, test prediction and equation, test validity and reliability, as well as examination fairness have all been conducted [10, 11]. According to the national admission guidelines on physicians, the examination syllabus was defined and the qualification criteria were confirmed. Besides, it also perfected and fine-tuned the best format of medical examinations, embodied humane guidance, and highlighted the orientation of competence . Furthermore, information technology has been applied in NMLE in the past few years. The NMLE has been conducted via computerized modes and a sound information sharing platform has been established. Besides that, the information system of examination management, item bank system, computer test system, and computer-based case simulations system of NMLE have been developed and successfully implemented.