Abstract
Background: National licensing examinations (NLEs) are large-scale examinations usually taken by medical doctors
close to the point of graduation from medical school. Where NLEs are used, success is usually required to obtain a license
for full practice. Approaches to national licensing, and the evidence that supports their use, varies significantly across
the globe. This paper aims to develop a typology of NLEs, based on candidacy, to explore the implications of different
examination types for workforce planning.
Methods: A systematic review of the published literature and medical licensing body websites, an electronic survey of all
medical licensing bodies in highly developed nations, and a survey of medical regulators.
Results: The evidence gleaned through this systematic review highlights four approaches to NLEs: where graduating
medical students wishing to practice in their national jurisdiction must pass a national licensing exam before they are
granted a license to practice; where all prospective doctors, whether from the national jurisdiction or international
medical graduates, are required to pass a national licensing exam in order to practice within that jurisdiction; where
international medical graduates are required to pass a licensing exam if their qualifications are not acknowledged to be
comparable with those students from the national jurisdiction; and where there are no NLEs in operation. This typology
facilitates comparison across systems and highlights the implications of different licensing systems for workforce
planning.
Conclusion: The issue of national licensing cannot be viewed in isolation from workforce planning; future research on
the efficacy of national licensing systems to drive up standards should be integrated with research on the implications of
such systems for the mobility of doctors to cross borders.