Discrepancy between national medical licencing examination content and disease conditions encountered in postgraduate clinical training in Japan

Medical knowledge is an essential unit of the spectrum of entrustable professional activity for physicians, and knowledge assessment for the certification of medical licencing exists in many countries. To be registered as physicians, Japanese medical students must succeed in the National Medical Practitioners Qualifying Examination (NMPQE), which consists of multiple-choice questions that evaluate competence in basic clinical knowledge needed during the mandatory 2-year residency training. Such training comprises super rotations of internal medicine, emergency medicine, surgery, obstetrics and gynaecology, paediatrics and psychiatry. It is important that qualifying examinations in medicine be validated based on experience acquired in actual clinical practice; for example, the content of the maintenance of certification examination administered by the American Board of Internal Medicine is based on conditions encountered in clinical practice.1 However, the validity of the Japanese NMPQE has not yet been evaluated; thus, to specifically identify conditions not covered by the NMPQE, we compared the contents of the NMPQE for the fiscal year 2016 with clinical conditions frequently encountered by physicians during junior residency, that is, clinical training in postgraduate years 1 and 2. We collected data on conditions encountered by doctors during junior residency in the Urasoe General Hospital and other affiliated hospitals. Thirteen resident physicians had passed the NMPQE for the fiscal year 2016 and had completed the mandatory 2-year junior residency training programme at the Urasoe General Hospital. We identified …