Analysing NLE in Pakistan context

For months now, there has been a hue and cry over the National Licensing Examination (NLE) in the medical community, which is why there’s a need to take a step back and objectively analyze the reasons behind this initiative. To give a brief background, the NLE was promulgated under the PMC Act in September 2020 by the national assembly instructing the Pakistan Medical Commission (PMC) to take the examination.
According to Section 10 of the PMC Act 2020, all medical and dental graduates who graduated after the promulgation of the PMC Act 2020 on 23rd September 2020 would now be required to pass the National Licensing Examination (NLE) to attain their full licenses as the PMC Act governed all future matters pertaining to obtaining a full license by any medical or dental practitioner in Pakistan.
The Pakistan Medical Commission replaced the now-defunct Pakistan Medical & Dental Council (PMDC) in September 2020. Back in 2019, an ordinance was passed by the National Assembly instructing the PMDC to conduct the NLE but it never saw the light of the day.
Another pertinent aspect is that the World Federation of Medical Education (WFME) had shared a set of standards in 2013 that required compliance by 2023; failure to enforce these standards will result in Pakistani graduates not being recognised internationally. A ten-year period was given to Pakistan to implement a standardised exam for licensing whereby a healthcare practitioner complies to minimum standards of competence before issuance of a license to practice. This examination was to ascertain that the doctor is a safe and competent practitioner, whose medical and dental education is at par with international standards.
This exam is to ensure they have the basic knowledge to treat patients while safeguarding their health. The philosophy behind NLE is to produce reliable doctors through a standardized, merit-based exit examination, who will go on to serve the best healthcare interests of the citizens of Pakistan safely and competently.
Fromsome graduates’ perspective, the NLE is a redundant exercise; they wonder why they must take yet another exam after five consecutive years of taking exams which already tested their knowledge, competence and clinical skills. In their opinion, the NLE is an additional, unfair burden on graduates who have to clear multiple examinations and a house job before being given a license to practice.
To provide clarity on these suppositions, one must first understand that in the ecosystem of medical and dental education in Pakistan, there has been an exponential growth of new private medical colleges taking root in the past 2 decades that resulted in a deterioration of the overall standards of medical and dental education. These colleges were allowed to run even though they did not meet the criteria set by the now-defunct PMDC.
Currently, there are a total of 176 colleges teaching MBBS and BDS in Pakistan, out of which 114 are private medical & dental colleges while 62 are public medical & dental colleges. Due to a lack of proper regulatory oversight, this has resulted in various colleges relaying different sets of instruction, syllabi and modes of teaching creating a substantial pool of doctors with skills that can’t be judged on a standard parameter.
On the same note is the influx of foreign medical and dental graduates from countries like Afghanistan, Kyrgyzstan and China who have not been trained according to the standards set by our country for purposes of obtaining a license to practice as a medical or dental practitioner. In fact, there have been recorded instances of foreign graduates not being able to perform the very basic clinical skills required to practice, causing bodily harm to patients.
There will be no exemption in the NLE and every graduate, whether from a local or international college, will need to take the exam before being issued a license. The only exemption is for foreign postgraduates who have trained in a PMC-recognised institution. These individuals will be registered as specialists in the PMC’s Specialist Register.
From the perspective of PMC’s regulatory functions, probably the most imperative advantage of the NLE would be the use of its computer-based testing methodology to gauge where institutes are failing their students due to subpar educational standards. This examination technique will allow PMC’s data scientists to collect a wide range of data points to not only ascertain graduates’ strengths and weaknesses but to also highlight where improvements can be made by medical and dental teaching colleges and hospitals in imparting both theoretical and practical knowledge. Monitoring multiple variables through a uniform toolkit such as the NLE is of the utmost importance, which is why the examination has been standardised across Pakistan and beyond.
In essence, the profession of providing healthcare to the public is a noble and sacred one. As the regulatory body of medical and dental education and licensing for Pakistan, the burden falls squarely upon PMC’s shoulders to make sure that the citizens of Pakistan receive nothing but the best healthcare practices the world has to offer.

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