Targeting Dreams of Becoming A Successful Doctor With The Right Nudge

“I have a dream….” 

The historic words of Martin Luther King Jr can easily be called one of the most common phrases the dreamers have ever used. Though the predicate of the sentence is dynamic and individual, the spirit behind it remains the same. 

For the medical students and graduates, this dream generally includes working at a reputed hospital in their desired country where they wish to build up a successful career. However, the most common challenge the majority of students face is qualifying the medical licensing exam.

Now, one might wonder, what is a medical licensing exam?

As the name suggests, it is the licensing exam to practice medicine. Every country has their own criteria to assess the learning and skills of the young medical graduate. For example, to practice in the USA, the student needs to qualify USMLE, for Britain it is PLAB, for CARICOM its CAMCE, for Canada it is MCCQE, etc. 

Below is the detailed and comprehensive guide that the students can refer to get the complete information about the above licensing exams. 

1. United States Medical Licensing Examination (USMLE)

Country	The United States of America
Total Steps/Parts	3
Conducted	Year Around
Annual Number of Candidates	100,000 (Avg)
Application Fee	USD 975 (for Step1 & 2)
Eligibility	For students who are studying outside USA: a medical student officially enrolled in, or a graduate of, a medical school that is outside the US and Canada, listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and that meets other eligibility criteria of the ECFMG
Who It is For:	To apply for United States (U.S.) medical residency programs, and eventually become licensed in the U.S. to practice medicine
No of Attempts	4 times with the maximum of three attempts in a 12-month period

The USMLE is often considered different because of two reasons. The first is that the steps of the exam are not continuous, there is a break usually of months. The other is that unlike the various standardized tests, USMLE focuses on the assessment of expertise and skills, instead of how well the student performs on the day of the exam. 

While taking the exam, some quick hacks may improve your overall performance, but it is less likely that the student will qualify the exam without the comprehensive knowledge of topics as well as possess the ability to apply the gained knowledge in a clinical setting. 

The exam is divided into three steps.

Step 1:

It is a one-day, multiple choice test, usually taken at the end of the second year of medical school. This step assesses the knowledge of basic sciences, including anatomy, biochemistry, behavioral sciences, microbiology, immunology, pathology, pharmacology and physiology along with the basic concepts of nutrition, genetics and aging, among the students.

Step 2:

The second step of USMLE is usually taken in the fourth year of medical school. It is a 2-day test, further divided into 2 parts: Clinical Knowledge (CK) and Clinical Skills (CS). In 2021, the composite committee of USMLE announced the discontinuation of Step-2 CS in order to provide a more transparent evaluation of the candidates.

Step-2 CK

In Step-2 CK, the number of questions for each block will vary but will not exceed 40 and the total number of items on the overall examination will not exceed 318.
The questions are usually MCQ type on clinical sciences like surgery, internal medicine, pediatrics and obstetrics and gynecology. 

ECFMG Pathway:

Once after qualifying the Step 2 CK, the candidate becomes eligible to qualify for the ECFMG certification. 

Pathway 1: Already Licensed to Practice Medicine in Another Country

Pathway 2: Already Passed an Objective Structured Clinical Examination (OSCE) for Medical Licensure Administered by an Acceptable Medical School

Pathway 3: Medical School Accredited by Agency Recognized by World Federation for Medical Education (WFME)

Pathway 4: Medical School Accredited by Agency that Has Received a Determination of Comparability by National Committee on Foreign Medical Education and Accreditation (NCFMEA)

Pathway 5: Medical School Issues Degrees Jointly with the U.S. Medical School Accredited by Liaison Committee on Medical Education (LCME)

Pathways 3, 4, and 5 are for applicants who do not meet the eligibility requirements for Pathway 1 and are students or recent graduates of a medical school that meets eligibility requirements established by ECFMG for Pathway 3, 4, or 5.

Pathway 6: Evaluation of Clinical Patient Encounters by Licensed Physicians

Step-3:

Step 3 is also a two-day test, generally taken after the first year of residency. This is the final assessment of students’ competency to practice in an unsupervised setting. It includes both multiple choice questions and computer simulations of patient care.

2. United Kingdom Medical Licensing Assessment (UKMLA)/  General Medical Council (GMC) -Professional and Linguistic Assessments Board (PLAB)

Country	Great Britain
Total Steps/Parts	2
Conducted (currently)	Outside the Country:  Twice A Year (March & November) In UK:  Four Times a Year (March, June, September & November)
Annual Number of Candidates	15,000 (Avg)
Application Fee	GBP 247 (for Part 1) (1 GBP= 1.23 USD)
Eligibility	For students who are studying outside UK, EEA & Switzerland: The candidates’ primary qualification must be accepted for limited registration by an institution listed in the World Health  Organisation Directory of Medical Schools. The candidates should have appeared for and secured a minimum score of 7 overall and a minimum of 7.0 for all of the four language modules. Additionally, the candidates should complete a minimum of 12 months of postgraduate clinical experience at a teaching hospital
Who It is For:	Those seeking medical residency programs or postgrad in the UK to eventually be licensed for independent practice.
No of Attempts:	PLAB-1: 4 PLAB-2: 2 years from the date of passing PLAB-1

The PLAB Exam aims to assess the application skills of the gained knowledge particularly in patient care. The exam is fairly practical and does not evaluate knowledge on the basis of memorization. The exam usually consists of the questions concerning current best practices and equipment frequently used in the hospitals of the UK. 

One of the key parameters of eligibility is Primary Medical Qualification (PMQ). That means, the student is required to have qualified the final term exam to appear for the exam. A provisional degree would also do. The student is then required to proceed with the GMC Registrations after the completion of the inhouse/ internship as required. 

The GMC PLAB is divided into 2 parts namely PLAB Part-1 & PLAB Part-2.

PLAB Part- 1
 
This exam is conducted in MCQ format consisting of 180 questions that have to be solved in 3 hours. Each starts with a short scenario followed by a question. 

The Part-1 of GMC PLAB is conducted in various countries such as India, Egypt, Bulgaria, Dubai, Nigeria and Pakistan.

The exam includes the evaluation of various management skills to monitor & interpret various long-term conditions observed in primary care as well as the common, important, or acute conditions (those common in emergency departments). 

PLAB Part-2

PLAB Part- 2 is an objective structured clinical exam (OSCE). It's made up of 16 scenarios, each lasting eight minutes and aims to reflect real life settings including a mock consultation or an acute ward. It tests your ability to apply knowledge to the care of patients, not how well you can remember and recite facts. The student is assessed on the maximum score of 216.

3. Caribbean Association of Medical Councils (CAMC)- Registration Exams

Country	CARICOM Countries
Total Steps/Parts	2
Conducted	Twice a Year  (April/May and October/November)
Annual Number of Candidates	9,000 (Avg)
Application Fee	USD 800
Eligibility	For students who are studying in CARICOM nations: a medical student officially enrolled in, or a graduate of, a medical school that is, listed in the World Directory of Medical Schools as meeting eligibility requirements, and that meets other eligibility criteria of the National Accreditation Council.
Who It is For:	For the students seeking to pursue medical career in the Caribbean region, and eventually practice independently
No of Attempts	Part-1: unlimited Part-2: 3

The Caribbean Association of Medical Councils (CAMC) the medical licensing examination for trained medical practitioners who wish to practice within the contributory CARICOM Member States (Antigua and Barbuda, Belize, Dominica, Grenada, Haiti, Montserrat, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, The Bahamas, Barbados, Guyana, Jamaica, Suriname, Trinidad and Tobago). The standard of the examination is defined as the level of attainment of medical knowledge, clinical skills and attitudes required of newly qualified graduates of accredited medical schools. 

The CAMC examinations consist of two components: 

Part-1: MCQ/ Written Test

The multiple choice examination is a test of the principles and practice of medicine in the disciplines of internal medicine, pediatrics, surgery, obstetrics, gynecology, community health, and psychiatry. The MCQ is in two parts (morning and afternoon sessions) each of three (3) hours duration.

Each part contains 100 questions. The MCQ examination is held over one day, simultaneously at approved centers in the Caribbean.

Part-2: Clinical Examinations

The Clinical Examinations aims to evaluate the clinical competence in terms of medical knowledge, clinical skill and professional attitudes for the safe and effective clinical practice of medicine in the Caribbean region among the students.

The exam generally consists of a multi-station structured clinical assessment of clinical skills. Disciplines covered include Medicine and surgery, obstetrics and gynecology, pediatrics, community health, and psychiatry. 

The students can proceed to the Clinical Examination only after qualifying the Written Test. After more than 3 failed attempts at the part-1 would require the student to restart from Part-1. 

4. Licentiate of the Medical Council of Canada (LMCC)

Country	Canada
Total Steps/Parts	3
Conducted	MCCQE Part-1: 4 times a year MCCQE Part-2: Twice a year
Annual Number of Candidates	11,000 (Avg)
Application Fee	USD 1375
Eligibility	For students who are studying outside Canada: A medical school accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS); or A medical school listed in the WDOMS  and identified by a Canada Sponsor Note indicating it is an acceptable medical school in Canada; or A United States School of Osteopathic Medicine accredited by the American Osteopathic Association.
Who It is For:	For the students seeking to residency or higher studies in Canada
No of Attempts	4

The Medical Council of Canada (MCC) grants a qualification in medicine known as the Licentiate of the Medical Council of Canada (LMCC) to physicians who have met its requirements. The LMCC is a part of the Canadian Standard, the set of requirements physicians need to meet to apply for a full license to practice medicine in Canada.  To attain the complete licensure, the student has to qualify 3 exams.

NAC Examination

The NAC Examination is a one-day exam that assesses the readiness of the student for the Canadian residency program. It is a national, standardized examination that tests the knowledge, skills, and attitudes essential for entrance into postgraduate training in Canada. It is a mandatory examination to proceed to the next level. 

The NAC Examination is an Objective Structured Clinical Examination (OSCE). For a given administration, all students are required to rotate through the same series of stations each being 11 minutes long. The score is measured on the scale of 1500. 

MCCQE Part I

The Medical Council of Canada Qualifying Examination (MCCQE) Part I assesses the critical medical knowledge and clinical decision-making ability of a candidate at a level expected of a medical student who is completing their medical degree in Canada. You must pass the MCCQE Part I and meet other eligibility criteria to obtain the Licentiate of the Medical Council of Canada (LMCC). 

The MCCQE Part I is a summative examination that assesses the critical medical knowledge and clinical decision-making ability of a candidate at a level expected of a medical student who is completing their medical degree in Canada. 

MCCQE Part II

The MCCQE Part II is an objective structured clinical examination that is one of the last steps in your journey to becoming a licensed and independent physician in Canada. The exam consists of a series of clinical stations. These stations assess the ability of the students in regards to applying medical knowledge, demonstrate clinical skills, develop investigational and therapeutic clinical plans, as well as demonstrate professional behaviors and attitudes at a level expected of Canadian physicians. 

Conclusion:

One of the key challenges that medical students face in their later years of medical school is to define their career goals. In the present world, having a degree is not enough, what is important is to know how to make the most out of it. 

For the dreamers of medicine and would-be doctors, it becomes important to have the right guidance and complete information before making any decision. The journey to become a doctor only starts after joining the medical school and the real struggle comes after it. Therefore, it is always advisable for medical students to start early. 

Now, let us hear another fun fact!

Did you know on average every fourth school graduate aspires to become a doctor, however only 2 out of those 10 get the opportunity to join the medical school and complete their medical degree. The above data clearly shows the missing link and the significant need for doctors in global healthcare. 

One of the most common hindrances faced by the students after their graduation is the lack of information about the medical licensing exam. These are just some of the many medical licensing exams which have been more popular among the students. 

Victoria University of Barbados has been leading in providing the right guidance to  the students towards their dream role. The curriculum university not only features in inculcating the best practices of US based curriculum but also provides the on campus coaching for the other licensing exam as per the need, preference and goal of the students. 

If you wish to know more about these exams, preparation tips & important dates regarding them, stay tuned because we will soon be back with more latest updates.